Objectives: To improve unintended pregnancy outcomes for mothers and neonates by studing of psychological, hormonal and biochemical adaptation of pregnant woman, status of fetus and neonate and working out of scientific-based system of prophylactic-treatment measures for those carring out an unintended pregnancy. Methods: Epidemology of unintended pregnancy was studied by survey among 397 parturients. Impact of unintended pregnancy in perinatal mortality structure was studied applying the Nordic-Baltic perinatal death classification to all cases in the Donetsk region in 1997-1998 (n=1126) and in Denmark (n=540). 781 case records were analyzed to work out neonatal weight and fundus-symphys measurement normogrammes as well as models of population, standardtized and individual fetal weight prognosis. Clinical, psychological, hormonal, biochemical peculiarities were studied in 569 pregnant women (60 with intended and 509 - with unintended pregnancy (among them: 50 with the threatened first trimester abortion, 115 with planned Cesarean Section, 246 - with traditional care and 98 - with proposed perinatal care (Case). Proposed perinatal care included: family centered maternal care during pregnancy, delivery and postpartum; psychological support and rational psychotherapy as well as consultation of Specialist in Psychology where appropriate under pshyhological tests control; pregnancy complications prognosis; biochemical disadaptation correction; oral misoprosol use for labour induction in preeclampsia; autologous blood and plasma transfusion, as well as Misgav Ladach Cesarean Section if planned operative delivery; partograph and auscultograph use during delivery; fetal pulse oxymetry in intrapartum hypoxia risk group. Mother's satisfaction with care provided was studied by self-questionnaires 24-48 hours and 6 months after delivery. Results: 79,6% of babies were delivered from unintended pregnancies. No contraception was used by 87% of their mothers to avoid the pregnancy. Women with unintended pregnancy had reported negative feelings regarding pregnancy ten-times more often than those with intended pregnancy. Antenatal deaths of growth-retarded fetuses, intrapartum and neonatal deaths associated with asphyxia are more common in Ukraine than in Denmark. Around one-third of these cases is unbooked in Ukraine, that can reflect the unintended pregnancy contribution in perinatal mortality. Multiple threatened abortions (22,4% vs. 6,7%), premature delivery (13,8% vs. 3,3%), fetal growth retardation (5,3% vs. 0), decreased Fisher score, smaller neonatal weigh, lower Apgar score, increased perinatal mortality were more often in unintended pregnancy. Unintended pregnancy was associated with social disadaptation, increased stressor score, higher discomfort estimation and level of anxiety, frequent depression signs development. Correlation was found between fetal status and ACTH, fetal status and ?-endorphin level. Conceptual model of perinatal complications in unintended pregnancy was proposed. Dicriminant functions were worked out to prognose threatened abortion, premature delivery, complicated delivery, intrapartum asphyxia, perinatal loss. Fundus-symphys nomograme developed has shown 87,8% specificity. The essential role of hemoglobin and trombocyte levels was revealed to prognose postoperative anemia in different types of autodonation use. Misgav Ladach Cesarean Section was associated with shorter of surgery duration and lower blood lost. Thus, autologous blood/plasma transfusion as well as Misgav Ladach Cesarean Section increases safety of operative delivery. Proposed perinatal care implementation led to decrease in: prematurity from 13,8% to 2,04%, pathological delivery from 61,4% to 26%, disturbance of of placenta delivery 4,3 times, manual uterus revision 4,6 times, frequency of neonatal asphyxia from 18,4% to 6,3% and increase in neonates weight (p<0,05). Better psychological adaptation with increase in estimation of general state, activity and mood as well as an anxity decrease by Teilor test was revealed. There was two-times decrease in fear of childbirth estimated by W-DEQ as well as postpartum depression estimated by Edinburg Depression Scale (score 13 versus 14). Proposed perinatal care model reduced delivery complications and improved womens' satisfaction with care provided. Those with proposed perinatal care reported "everything was nice at the Delivery Ward" 1,5 times more often and "not enough care was provided" 6,7 times less often than those with traditional care. Friendly attitude by the staff at the department was more often reported by the women in the Case Group (85,3% vs. 71,9%). Delivery duration less than 6 h (40,0% vs. 64,9%) and Oxytocin augmentation (8,5% vs. 19,8%) were less common among the Cases. Women in the traditional care group were more often dissatisfied with pain relief (11,3% vs. 1,6%, p<0,05) and staff support (11,3% vs. 1,6%, p<0,05). Quality of intrapartum care in multiple regression analyses was depended on friendly attitude of the staff (OR=12,34; 95%CI 3,15; 63,18), woman's estimation of Doctors' Care (OR=11,06; 95%CI 1,90;73,62), womens' estimatiom of Midwives' Care (OR=8,76; 95%CI 1,73; 49,05) as well as Oxitocin augmentation (OR=11,32; 95%CI 2,17; 71,78), p<0,0001. Conclusion: Unintended pregnancy is very frequent in Ukraine. Unintendenness is associated with high risk of unfourable pregnancy outcome. Implementation of proposed model of perianatal care improves unintended pregnancy outcomes as a result of psychological status improvement, homeostasis and fetal-placental system normalization.
