The dissertation provides a theoretical generalization and a new solution to the scientific task of modern obstetrics, which consists in reducing the frequency of obstetric and perinatal complications in women with a risk and threat of premature birth and placental dysfunction by developing diagnostic and therapeutic measures based on a comprehensive study of the risk factors of premature birth, clinical echographic, hormonal, microbiological, morphological features of the fetoplacental complex.
To achieve the goal, the tasks were set to conduct a retrospective analysis of the management of pregnant women with the risk and threat of premature birth in the conditions of real clinical practice; to study the state of vaginal microbiota, ultrasonographic, biochemical, hormonal features of the fetoplacental complex in pregnant women at risk and threat of premature birth; to investigate morphological features and the state of the receptor apparatus of the placenta in women with premature birth; justify, develop, implement and evaluate the effectiveness of differentiated preventive and therapeutic measures in women with risk factors for premature birth. According to the design of the study, the work was carried out in three stages to achieve the goal and solve the tasks. The first stage involved a retrospective analysis of medical records of 300 women with premature births at gestational ages of 22-27; 28-33 and 34-36 weeks. At the second stage, a prospective study was conducted involving 180 pregnant women (main cohort): control – 30 conditionally healthy pregnant women; Group I – 73 pregnant women at risk of premature birth; Group II – 77 pregnant women with risk factors for premature birth. At the third stage, justification, improvement, implementation and evaluation of the effectiveness of differentiated diagnostic and preventive and therapeutic measures in women at risk of premature birth and placental insufficiency were carried out. The management of pregnant women of the studied cohort was carried out in accordance with the order of the Ministry of Health of Ukraine No. 417 of 07.15.2011 "On the organization of outpatient obstetric and gynecological care in Ukraine". Pregnant women of the first group received generally accepted medical measures (tocolytic therapy, prevention of RDS of the fetus, symptomatic therapy).It has been proven that the early preclinical signs of placental insufficiency are changes in the hormone-producing function of the placenta - an early decrease in the level of β-hCG, a plateau in the increase in the level of placental lactogen, and a decrease in the serum level of progesterone and estriol. The data obtained in the dissertation work deepens and expands current ideas about the relationship between a difficult obstetric and gynecological history, complications of the first half of pregnancy, inflammatory and dysbiotic processes of the vagina, vitamin D deficiency with the development of placental dysfunction and the risk of premature birth in women of risk groups. Based on the results of the study, a complex of diagnostic and treatment-prophylactic measures to prevent premature births and reduce obstetric and perinatal complications was proposed, which was implemented in the work of health care institutions in the cities of Lviv and Lutsk. The effectiveness of differentiated pre-gravid preparation of patients with risk factors for premature birth has been proven. The evaluation of the proposed measures according to the efficiency criteria showed a decrease in the frequency of the threat of early miscarriage by 5.2 times, asymptomatic bacteriuria by 2.7 times, the threat of late miscarriage by 3.1 times, premature rupture of the membranes by 5.4 times; decrease in the frequency of premature births by 6.5 times in the absence of such at 22-33+6 weeks; reducing the frequency of fetal growth retardation syndrome by 3.1 times and fetal distress by 4.0 times, which, accordingly, reduced the frequency of cesarean delivery by 2.1 times and perinatal complications.
