Shchurevska O. The course of the pregnancy and childbirth in conditions of social stress: diagnostics and correction

The dissertation is devoted to reducing the frequency of complications of mother, fetus and newborn under the influence of social stress, by the improvement of medical care and the development of individual treatment and prevention measures, based on a comprehensive clinical and psychological examination. The paper analyzes the frequency and a structure of complications of pregnancy and childbirth in women - IDPs (internally displaced persons). Psychological and clinical- laboratory screening of pregnant women was carried out in order to study the mechanisms of adaptation / maladaptation to the action of stressors depending on their individual personality and characterological types of response. There were found new data on the role of social stressors in the mechanisms of formation of the main obstetric pathology: miscarriage, preeclampsia, labor dystocia, lactation disorders. For the first time in Ukraine epigenetic markers of stress (hypoxic miRNAs), their role in programming of a fetal and a newborn?s pathology were investigated. The available data on stress-effector immune mechanisms of pathogenesis under social stress were supplemented. The degree of organic lesions on the CNS(central nervous system) of pregnant women that face social stress by neuroantibodies were studied. The algorithm of the management of pregnant women and parturients living in conditions of social stress was scientifically substantiated and introduced into outpatient and inpatient obstetric practice. The proposed psychoprophylactic correction helped to reduce the high level of both personal and reactive anxiety (in 1.7 times), increase the level of moderate and middle anxiety, helped to stabilize the emotional background and readiness for active action during childbirth. The predominance of moderate and low anxiety (1.5 times) indicated the stabilization of the experiences of this group of women before childbirth and concentration on preparation for this event. The predominance of successful subtypes in 3.5 times and the decrease in subtypes of the risk group in 6.5 times was also determined, which testified to their psychological readiness for childbirth and the formation of the maternal sphere. Normalization of the psychoemotional status of pregnant IDPs, their motivational and cognitive-behavioral components under the influence of the proposed measures reduced the incidence of complicated pregnancy: reduction by 1/3 in the incidence of anemia in pregnant women, preeclampsia, and by almost 2 times for colpitis, asympto- matic bacteriuria. An indicator of the effectiveness of this group was also an increase in the frequency of physiological childbirth - up to 81.25%, a decrease in caesarean section to 17.5% (with a predominance in their structure of planned operations) (51.9%), a decrease in the frequency of birth defects (in 2 times for the labor weakness and 6 times - uncoordinated labor), the number of drug interventions in childbirth (EDA was used only in 9.3% of cases against 42.5%), a decrease of 1.7 times for the number of hypotrophic and 1.5 times for macrosomal infants, reduction of perinatal morbidity from 18% to 8.75%, and prevention of birth injuries.