Kolomiiets O. Pregnancy and childbirth in women with various types of infertility in history (obstetrical tactics, prediction of complications, algorithm of treatment and prevention measures).

The dissertation is devoted to the reduction of maternal and perinatal morbidity in women with a history of infertility of various genesis, by creating a system of pre-gravid preparation and pregnancy management, forecasting obstetric complications based on the study of the hemostasis system, hormonal, bacteriological, and immunological indicators. In accordance with the set goal and objectives, the research was conducted in three stages: stage I – retrospective clinical and statistical analysis of the course of pregnancy and childbirth in 360 women with various types of infertility in history; II stage – clinical and laboratory examination of 160 pregnant women who had various types of infertility in the past and prediction of gestational complications in them; Stage III – evaluation of the clinical effectiveness of pre-pregnancy training and the medical-organizational algorithm for pregnancy management in 102 women with a history of combined infertility. An analysis of the characteristics of the course of pregnancy, childbirth and the condition of newborns, indicators of the hormonal function of the fetoplacental complex, sex and thyroid hormones, features of immune status; assessment of indicators of quality of life and psychoemotional state, the state of vaginal microbiocenosis and sexual infections, high-risk congenital thrombophilias and genetic disorders of the folate cycle, vitamin D saturation during pregnancy in women who had various types of infertility in the anamnesis, showed that this group of pregnant women risk group for the development of a high frequency of obstetric and perinatal complications. It has been proven that the anterior cervical angle is a new ultrasound marker of premature birth in pregnant women with a history of endocrine and combined infertility. At the current level, morphological and immunohistochemical studies of the placenta have been carried out in women in labor who had various types of infertility in their anamnesis. Based on the obtained research results, a method for predicting the main gestational complications in these pregnant women is proposed. The complex of pre-pregnancy training and medical and preventive measures during pregnancy, aimed at preventing obstetric and perinatal complications, has been improved. A developed algorithm for pre-gravid preparation, pregnancy management and a set of medical and preventive measures aimed at reducing the frequency of obstetric and perinatal complications in pregnant women with various types of infertility in the anamnesis is proposed for practical health care.