Perkhulyn O. Prevention of pregnancy loss in women with cervical insufficiency and anovulatory infertility in a history

The dissertation is devoted to reducing of the frequency of obstetric and perinatal complications in the women with risk of pregnancy loss who have CI and anovulatory infertility in a history, based on the study of hormonal background, genital microbiocenosis, functional state of the cervix and fetoplacental complex, and improvement of the diagnostic, preventive and treatment measures. The risk factors for the development of CI in the women with anovulatory infertility were determined: controlled ovarian stimulation for cycles with and without the use of assisted reproductive technologies, in vitro fertilization (IVF), polycystic ovary syndrome (PCOS). Further study of the state of hormonal features in the second and third trimesters of pregnancy was performed, which indicates a reduced concentration of progesterone and elevated levels of prolactin and cortisol, especially in women who became pregnant after IVF. The study of cervical tissue elasticity in pregnant women with CI and anovulatory infertility was supplemented with the data about an increase in the cervical elastography index and a decrease in the coefficient of cervical deformation in the internal os of the cervix and in cervical canal. The introduction of treatment measures to prevent the development of pregnancy loss in women with CI and anovulatory infertility in the history and the formation of indications for the preventive correction of pregnancy loss in pregnant women with anovulatory infertility in history and a high risk of pregnancy loss are substantiated. The identified risk factors for the development of CI in women after treatment of anovulatory infertility led to the development of an examination algorithm and the formation of a risk group. At 11-13 weeks + 6 days of pregnancy, the need for additional methods of examination of the cervix (elastography) in persons at risk has been proven. The results of a complex examination allowed to justify the use of an optimized approach to pregnancy management in women with CI and anovulatory infertility in order to prevent the obstetric and perinatal complications. Key words: miscarriage, isthmic-cervical insufficiency, anovulatory infertility, ovaries, uterus. Branch – medicine.