Кrotyk H. Reproductive health of women against the background of sexually transmitted infections. Qualifying scientific work on manuscript rights

The dissertation is devoted to the restoration of reproductive function in women with a history of sexually transmitted infections by optimizing, developing and implementing a scientifically based medical and organizational algorithm for diagnosis and treatment in the pre-gravid period before programs of assisted reproductive technologies and during pregnancy to reduce the frequency of obstetric and perinatal complications. At the І stage, an analysis of the structure and dynamics of the incidence of STIs in the entire population was carried out in the period from 2014 to 2019, according to the data of the statistical department of the Ministry of Health of Ukraine. At the II stage, a clinical and statistical analysis of outpatient charts and medical histories of 371 women who suffered from inflammatory diseases of the reproductive system was carried out; a retrospective analysis of 150 histories of pregnancy and childbirth was carried out: the main group (OG) included 100 pregnant women with a history of sexually transmitted infections (STI) and episodes of manifestations during this pregnancy and 50 pregnant women in the control group (CG) without this pathology. At the III stage, 91 pregnant women who became pregnant for the first time were laboratory examined and PCRdiagnosed for the following infections: Chlamydia trachomatis, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis and Gardnerella vaginalis; the frequency of combinations of the studied infections in female patients was determined and a morphological study of placental disorders in STI from 80 women of reproductive age was conducted. At the IV stage of the study, 247 women with infertility who had a history of STI and planned to participate in 8 the АRT program were examined: 115 women underwent the pre-gravid training offered by us, 56 of whom, in the АRT program, ended in pregnancy. Those women entered the 1st group and received our proposed medical and preventive measures; 132 women underwent standard pre-gravid training, 51 of whom completed the АRT program with pregnancy. They were included in the II group and received generally accepted medical and preventive measures. The control group (CG) consisted of 30 women who did not have a history of STI and signs of these diseases, without significant somatic pathology, who also became pregnant with the help of АRT. At the final stage, a proper clinical and laboratory examination was conducted in women of groups I and II, and the clinical effectiveness of the developed and implemented pregravid preparation algorithm before АRT cycles and pregnancy management in women with a history of STI was proven. In order to achieve the goal, the following tasks were set: to investigate and analyze the epidemiology, etiological structure and features of the clinical course of sexually transmitted infections in women of reproductive age with inflammatory diseases of the pelvic organs in the regions of Ukraine; to conduct a clinical and statistical analysis of the anamnesis of women of reproductive age who suffered from inflammatory diseases of the reproductive system; to study the peculiarities of the microbiocenosis of the vagina, the flora of the cervical canal and the uterine cavity in these women; to study the results of assisted reproductive technologies in infertility in married couples with a history of STІ; to determine the peculiarities of the course of pregnancy, childbirth and the condition of their newborns; to find out the features of the functional state of the fetoplacental complex in these pregnant women; to study the peculiarities of systemic and local immunity and nalyze the dynamics of laboratory indicators of the functioning of the immune and hemocoagulation systems in pregnant women with a history of STI after pre-gravid preparation before АRT cycles; to analyze the morphofunctional and morphometric changes in the placenta during a complicated course of pregnancy against the background of STІ in the anamnesis; to develop, scientifically substantiate and 9 implement an algorithm of pre-gravid preparation, pregnancy management and practical recommendations, to reduce the frequency of obstetric and perinatal complications in women with a history of STI and evaluate its effectiveness.