Dyakunchak Y. "Risk assessment and prevention of early and late reproductive health disorders in women after emergency gynecological interventions"

Based on the results of the scientific research, the author established new aspects of the pathogenesis of reproductive function disorders in patients who underwent surgical interventions for acute gynecological pathology. She showed that rehabilitation therapy in the conditions of real clinical practice is carried out for a limited number of patients who have undergone emergency gynecological operations. The doctoral student proved for the first time that a significant frequency of inflammatory and dyshormonal pathology, reproductive losses, artificial termination of pregnancy before urgent surgical intervention, relapses of urgent gynecological pathology cause a low level of realization of reproductive function in patients of the studied cohort. According to the results of the study, it was established that recurrences of functional ovarian cysts, menstrual cycle disorders, constitute an increased risk of urgent surgical interventions in the absence of appropriate treatment, and the risk of ectopic pregnancy is high in the presence of transferred inflammatory processes of the lower genital tract. For the first time, it was proved that regardless of the type of urgent pathology that led to the surgical intervention, in the postoperative period there is an increase in the level of expression of both pro- and anti-inflammatory cytokines. The imbalance of pro- and anti-inflammatory cytokines depends on the duration of the preoperative course of acute gynecological pathology and the type of surgical intervention (laparotomy & laparoscopy) and is associated with severe calcidiol deficiency. It was established that the features of the hormonal balance of women who underwent urgent operations for acute gynecological pathology are long-term stress-induced hyperprolactinemia (15.0%), normgonadotropic dysfunction of the ovaries with anovulation and luteal phase insufficiency, a decrease in the level of AMH in 61.1% of patients with the effect of surgical energies on the affected ovary up to the 12th month after the operation. As a result, thanks to the obtained data of the scientific research, the need to improve measures for the prevention and treatment of reproductive disorders in women with urgent gynecological pathology based on the study of clinical and paraclinical features of the early and late postoperative periods and adequate medical correction of the detected disorders was scientifically substantiated. The practical significance of the dissertation work Dyakunchak Yu.R. consists in the fact that the use of an improved diagnostic and differentiated treatment-prophylactic complex of measures for patients who underwent urgent gynecological surgical interventions is proposed for health care institutions. The obtained results of the study make it possible to reduce the duration of postoperative pain, the intensity of pain from the second day after surgery by 2.9 times; reduce the frequency of inflammatory and non-inflammatory postoperative complications by 8.9 times; achieve clinical and laboratory normalization of the vaginal microbiota; ensure the establishment of an ovulatory MC with a full-fledged luteal phase and normal ovarian reserve; achieve the desired pregnancy naturally in the conditions of real clinical practice. I believe that the elements of scientific novelty are formulated correctly, their number and qualifying features meet the regulatory requirements. The novelty of the research results and their practical significance are confirmed by their implementation in the clinical practice of the Lviv Regional Center for Reproductive Health, the Lutsk Clinical Maternity Hospital, and the Volyn Regional Clinical Hospital. The theoretical provisions of the dissertation work are used in the educational process at the Department of Obstetrics, Gynecology and Perinatology of the Danylo Halytsky Lviv National Medical University.