The dissertation is devoted to improving reproductive health and reducing the incidence of miscarriages in women with endometrial pathology through the introduction of a scientifically sound range of treatment and rehabilitation measures and optimization of preconception period. 90 patients with endometrial pathology were examined: 24 women with chronic endometritis – group 1, 32 patients with intrauterine synechiae – group 2, and 34 patients with endometrial hyperplasia – group 3. The control group included 30 women with a normal menstrual cycle. Risk factors for endometrial pathology and reproductive failures in this category of patients were identified; they included age, high frequency of instrumental interventions, prolonged pelvic inflammatory disease, primary infertility, metabolic disorders and endocrinopathy, combination of endometrial pathology with uterine fibroids, endometriosis and polycystic ovary syndrome. There was a high proportion of pelvic pain syndrome, menstrual disorders, secretory dysfunction, anovulation, algodysmenorrhea, hypomenstrual and premenstrual syndrome. The course of pregnancy and childbirth was assessed and the leading criteria for the formation of risk groups for reproductive failure were identified. It was established that pregnancy in women with endometrial pathology was accompanied by a higher percentage of early reproductive losses, miscarriage and premature birth, preeclampsia, placental dysfunction, fetal distress and low birth weight in newborns. The following metabolic homeostasis disorders were noted: hyperprolactinemia, hyperestrogenemia, hypoprogesteroneemia, decreased sex steroid-binding globulin levels, vitamin D deficiency, abnormal lipid profile and markers of insulin resistance. The assessment of structural and functional changes of the endometrium and ovaries was presented, which allowed to indicate a significant proportion of dyschronosis, an increase in the proportion of sonographic signs of chronic endometritis, chronic venous blood filling and venous stasis, and an increase in ovarian tissue volume with decrease in ovarian reserve. The imbalance of neoangiogenesis at the preconception stage and during the first trimester of pregnancy was proved, the concentration of antiangiogenic growth factors sFlt-1 was increased, and the level of proangiogenic vascular-endothelial growth factor was decreased, especially in patients with chronic endometritis and deficiency of proangiogenic markers in the dynamics of pregnancy. An increase in the expression level of the plasma cell marker CD 138+ and CD 56+ was confirmed in 73.3% of cases according to the immunohistochemical study. The presence of adequate blood flow was found in a half of women with endometrial hyperplasia, and in a third of cases – in patients with chronic endometritis and synechiae. The evaluation of the effectiveness of the proposed treatment and rehabilitation measures was carried out in two groups – the main group and the comparison group. Patients in the comparison group showed incomplete recovery of endometrial echotexture (50% of cases), recurrence of endometrial pathology (in one third of observations), increase in the proportion of ovarian retention and their long-term verification, as well as preservation of symptoms of chronic pelvic pain and menstrual disorders (in two-thirds of observations). A high proportion of benign tumours and retention ovarian cysts in 24.4% of patients of group 3 was revealed. A rehabilitation program and personalized therapeutic options for preconception period were developed and proposed, in cases of single polyps of the endocervix and endometrium, micropolyposis, as well as intrauterine synechiae of type I-II; surgical correction, minimally invasive techniques and use of laser were recommended. The rehabilitation program was supplemented with anti-inflammatory, immunomodulatory, enzyme therapy, drugs that improve microcirculation, as well as hormonal correction, as a necessary component of the rehabilitation program. Its effectiveness in prolonging pregnancy, reducing the proportion of gestational complications and reproductive losses was evaluated. The use of the proposed program during the preconception petiod and hormonal support was accompanied by restoration of reproductive function, reducing the proportion of miscarriage by 1.8 times, premature birth – by 1.9 times, missed miscarriage – by 2.6 times, as well as prolongation of pregnancy and birth of healthy children – by 1.5 times. Key words: endometrial hyperplasia, intrauterine synechiae, chronic endometritis, infertility, rehabilitation therapy, preconception care. Branch – medicine.
