Pol'ova S. Pregnancy, delivery and the function of the phetoplacental complex in women with pulmonary tuberculosis: prophylaxis, diagnosis and treatment of complications.

The dissertation research deals with a solution of an urgent scientific problem which has a medical and social implication of a clinicopathogenetic substantiation of the course of pregnacy with underlying pulmonary tuberculosis by means of elaborating new scientifically substantiated methods of prognostication, diagnostics and treatment. On the basis of a retro- and a prospective clinico-statistical analysis the specific characteristics of the progress of pregnancy and labor, the state of the fetoplacental complex, immune and hormonal homeostasis and the risk factors of adaptation disturbances of the fetal intrawterine state have been evaluated. A study of immune homeostasis in gravidas, suffering from pulmonary tuberculosis, has demonstrated a deviation after the neutrophilic-monocytic type that is characteristic of the tuberculous process. It has been found out that tuberculosis is a weighty factor of a risk of vaginal infections that are caused by pathogenic and opportunistic microorganisms. The causes, favouring disturbances of the microecology of the vagina in women afflicted with tuberculosis are also asocial reproductive behavior, a low level of education and culture and species indenfication of the M.B.T. strain. It has been ascertained histologically that in the placentas of the basic group of women there occur both specific signs for tuberculosis (the presence of acid-fast bacteria, areas of caseous necrosis surrounded by epithelioid cells, lymphocytes and Langhans' cells) and nonspecific ones - an inhibition of the development of the chorial tree, an enhanced deposition of intervillous and peribasal fibrinoid, marked sclerosis of the stem villi. Other polymorphosis variants of this gene are observed in isolated cases. The proposed method of a complex examination and treatment of gravidas afflicted with tuberculosis has made it posible to raise the efficacy of treating obstetric complications at the stages of predravidic preparation and inpatient treatment.