The dissertation is devoted to the problem of reducing perinatal mortality and neonatal morbidity. The main attention of the study is paid to substantiating the clinical necessity, prognostic and diagnostic significance of functional tests based on changes in fetal cerebral hemodynamics in response to acoustic stimulus and respiratory retention, as an integral part of a comprehensive assessment of the adaptive and compensatory capabilities of the fetus.
The design of the dissertation research includes two stages – retrospective and prospective, which were performed in parallel and independently of each other.
A retrospective clinical and statistical analysis was carried out with a depth of 10 years (2010-2019), with a parallel expert assessment of cases of perinatal mortality (70 cases) and neonatal morbidity, from the point of view of clinical lapel. Сonditionally prevented were 52.7% of cases of stillbirths − antenatal and intranatal fetal death.
For the first time in Ukraine, the dissertation shows an increase in the total population perinatal risk over the last decade of the XXI century. This conclusion is justified by the negative dynamics of perinatal mortality and neonatal morbidity. Thus, over a 10-year period, there was a 1.4 – fold increase in the percentage of births of sick children, changes in the ratio of stillbirths to early neonatal death-with an advantage of 4−5 times in 2010, 7 times in 2014, and 6 times in 2019. It is noted that such dynamics are projected on negative changes in the medical and social portrait of the reproductive generation of women, the imperfection of the existing system for predicting perinatal outcomes, the lack of reliable criteria for assessing the compensatory resources of the main fetal life support systems − nervous and cardiovascular. It is emphasized that in such conditions it is necessary to make efforts to improve the system of monitoring the condition of the fetus, in particular, through the introduction of technologies for assessing adaptive and compensatory reserves in the conditions of an inevitable stress test at the end of pregnancy (due to "physiological aging of the placenta" and during childbirth (on the background of hypoxic episodes that are inevitable during uterine contractions).
SComparison of the results of functional tests and cardiotocography allowed us to establish that their complex use does not increase the "load" on the pregnant woman and on the fetus, but at the same time, it gives certain advantages regarding the adequacy of fetal assessment by deepening the prognosis criteria. It is noted that, from the point of view of cost, reproducibility, accessibility for practical obstetrics, clinical information content, the strategy for using functional tests in the complex of antenatal monitoring of pregnancy of low and high risk is adequate in relation to the task of predicting the condition of the newborn and deserves to ensure the integration of these technologies into the system of care for pregnant women.
Summarizing the results of the study, it is emphasized that functional tests aimed at studying changes in fetal cerebral blood flow in non-invasive samples are an effective diagnostic and prognostic platform in modern obstetrics. This opens up new opportunities to improve the quality of predicting the condition of the fetus during pregnancy with a normal course and with perinatal risk.
