The conducted retrospective clinical and statistical analysis of women's births in the conditions of a typical city maternity hospital for the previous 10 years allowed determining that the number of births increased every year, with the increase of the percentage of caesarean section. We have determined that one of the main indications to caesarean section during ten-year period were presence of the uterine scar, primary weakness of labor activity and the use of assisted reproductive technologies. The evaluation of postoperative complications showed, that the most common were uterus sub involution, postoperative scar infiltration and bleeding.
We have conducted detailed analysis of pregnancy, labor, state of the fetus and newborn among examined pregnant women with obstetric pathology and burdened reproductive history, which were divided into three groups: women with uterine scar, women after the use of assisted reproductive technologies and women with labor activity anomalies. Pregnancy in women with uterine scar progressed with complications: gestosis of the second half of pregnancy, placental insufficiency and anemia. Almost all women with uterine scar were delivered by caesarean section. A significant number of newborns, according to Apgar scale, were in impaired condition.
Almost all women after the use of assisted reproductive technologies were born by caesarean section. A significant number of newborns were born in the impaired state (mild and moderate hypoxia). Pregnancy in women with labor activity anomalies proceeded with the threat of termination of pregnancy in the first and second trimesters. In these pregnancies, high and low amount of amniotic fluid, pathologic preliminary period and premature membrane rupture were frequently encountered. Also, women with labor activity anomalies often have had insufficiently mature and immature cervix. As a manifestation of hypoxic conditions of the fetus before and during childbirth, women of this group the meconial coloration of amniotic fluid were often seen. In the structure of indications for operative delivery were the primary weakness of labor activity and a slightly smaller indicator of the secondary weakness of labor activity. A significant number of newborns were born in moderate to severe asphyxia.
In pregnant women with obstetric pathology and with a burdened reproductive history there is a feto-placental insufficiency, which is manifested by the suppression of the hormonal function of the feto-placental complex (reduction of the placental lactogen, estriol, estradiol and progesterone levels) due to impaired uterine-placental-fetal bloodflow and shows increased resistance in the umbilical arteries, fetal aorta, mid-cerebral artery of the fetus and uterine arteries.
We have found changes in mental health status in pregnant women that participated in the study, which were manifested by psycho-emotional instability and were accompanied by an increase in situational and personal anxiety. The personality of such pregnant women is characterized by psychopathological disorders. The most pronounced changes in the psycho-emotional state of pregnant women are manifested in the form of moderate depression and mid-level depression in pregnant women with uterine scar and in pregnant women after the use of assisted reproductive technologies and in pregnant women with labor activity anomalies.
Clinical and morphological studies have determined the diagnostic criteria for the status of the postoperative uterine scar on the uterus and the clinical, ultrasound, doppler and pathologic markers of failure of the postoperative scar on the uterus. Pathomorphological examination of placental tissue from the examined women allowed us to find out the pathogenetic mechanisms of changes in the uterine-placental complex, which leads to the development of placental insufficiency.
