Vorobey L. Fetal distress: mechanisms of development in women with complicated obstetric history and disorders of autonomic regulation

The dissertation presents a new solution for the modern obstetrical scientific problem – reducing the incidence of fetal distress in pregnant women with perinatal losses and autonomic regulation, which consist in a theoretical generalization of the study results of mechanisms and factors contributing to fetal distress in this category, in pathogenetic substantiation, development and implementation of treatment and prevention complex, differentiated in relation to the identified disorders. It is shown that pregnant women with a history of perinatal losses and fetal distress are characterized by severe autonomic dysfunction syndrome, significant sleep disturbances, anxiety and aggression, depression of varying degrees, hypersympathotonia according to the heart rate variability valuation. It was found that the violation of hormonal adaptation (increased cortisol, stress, and then depletion of the sympatho-adrenal system, which indicates an increase and then a decrease in adrenaline, norepinephrine and dopamine, progestogens insufficiency) in terms of hypomelatoninemia and vitamin D deficiency is the background for placental dysfunction development, which is confirmed by morphological and immunohistochemical changes in placenta (increased expression of vimentin, CD31 and VEGF). It is proved that the results of fetal cardiointervalography after 32 weeks, along with Doppler and cardiotocographic data may be early preclinical diagnostic markers of fetal distress. A new pathogenetically substantiated set of measures with medical support, mandatory psychological support, psychocorrection, additional diagnostic and prognostic tests with focus on prevention at the preconception stage and in the first trimester has been developed, which has reduced the incidence of fetal distress by more than 2 times (7 % vs. 26.7 %, p<0.05) and other obstetric and perinatal complications.