The dissertation is a fragment of research work of the Department of Perinatology, Obstetrics and Gynecology of Kharkov Medical Academy of Postgraduate Education on "System of forecasting, diagnosis and prevention of acquired and inherited factors of obstetric and gynecological complications taking into account the features of connective tissue, neuroendocrine disorders hemostasis”(state registration number 0116U002865, 2016-2021) The dissertation work was performed during 2017 - 2021 on the clinical basis of KNP“ City Perinatal Center ”. Chief physician - Korovay S. M.
The analysis of the results of complex clinical and laboratory examinations of 110 pregnant women aged 20–45 years, who formed groups with favorable (first group) and unfavorable (second group) pregnancy results, was carried out.
Criteria for selecting patients for the study were: pregnant women with physiological gestational age and preterm birth, pregnant women at risk of preterm birth, preterm birth and antenatal fetal death. Exclusion criteria were: severe extragenital pathology (diabetes, chronic kidney and liver disease with insufficiency), disorders of fat metabolism, skin diseases, autoimmune diseases, the presence of abnormalities in the development of the genitals, multiple pregnancies, pregnancies that occurred with the use of assisted reproductive technologies, as well as pregnancy that occurred after ovulation stimulation.
The first group consisted of pregnant women with physiological gestational age and preterm birth (TP) - 41 women, the second group included pregnant women at risk of preterm birth, preterm birth (PP) and antenatal fetal death - 42 women. Data on patients with preterm birth and antenatal fetal death (second group) were obtained by retrospective analysis of case histories. Indicators of pregnant women of both study groups were used to develop models for the prognosis and outcome of pregnancy. A group of 17 pregnant women (10 with a favorable pregnancy outcome, 7 with a premature birth) was formed to test the prognosis models. To clinically test the prognosis models, a group of 10 pregnant women with signs of threatened preterm birth was formed.
Based on the analysis of anamnesis results, general clinical and instrumental research methods, as well as the study of social and domestic condition, extragenital morbidity, gynecological and obstetric anamnesis, pregnancy and childbirth, the condition of newborns were determined indicators that were compared in pregnant women with favorable (urgent) adverse (PP) outcome of pregnancy. In accordance with the Order of the Ministry of Health of Ukraine 417 of 15.07.2011 "On the organization of outpatient obstetric and gynecological care in Ukraine" clinical and biochemical blood tests, determination of biochemical markers (human chorionic gonadotropin (HCG), plasma protein-A, with pregnancy (PAPP - A), alpha-fetoprotein (AFP), estriol level) to detect genetic pathology of the fetus, Doppler.
It was found that there are no significant differences in family and social status, as well as infectious diseases between groups of women with different pregnancy outcomes. There are also no significant differences in the incidence of most somatic diseases in both groups of pregnant women.
It was found that the onset of menstruation at 11-12 years was observed in 51% of pregnant women in the first group and only in 31 % of pregnant women in the second group. A significant (χ2 = 12.19; p <0.05) majority of pregnant women in the second group had later onset of menarche, which may be a sign of delayed sexual development due to functional immaturity of the hypothalamic-pituitary system and transient decline in the production of gonadotropic and sex hormones.
Background precancerous diseases of the cervix were in 56 % of women in the first group and 50 % - the second, ie the group on this basis did not differ significantly. There were also no significant differences in the incidence of a history of sexually transmitted infections between pregnant women in the first and second groups. Other gynecological pathology was observed in a small number of women in both groups. No significant differences between the study groups in the presence of certain gynecological pathology were found.
There were also no significant differences between the study groups in reproductive history. Thus, among women in the first group there were 41 % of first-borns, in the second – 52 %. In addition, women with first and second pregnancies accounted for a significant (χ2 = 8.24; p <0.05) majority in both study groups.
