The dissertation focuses on the prevention of premature birth by obtaining new data on pathogenetic variants of premature labor on the background of placental disorders. The study was carried out on the basis of the Kyiv Perinatal Center, which is the clinical base of the Department of Obstetrics and Gynecology №1 of the Bogomolets National Medical University in 2019 -2023.
The goal was to reduce perinatal morbidity and mortality by improving the effectiveness of diagnosing the causes of premature labor (PreL) against the background of placental disorders (PlaD). To achieve the established goal, the following tasks were set: to study t he peculiarities of the obstetric-gynecological and somatic anamnesis of women with premature birth on the background of placental disorders; to assess the state of vaginal biocenosis in these women and it`s connection with the development of premature birth activity; to determine the activity of the p65-subunit of the nuclear κB transcription factor (NF-κB) in the placenta of women with premature birth with the background of placental disorders; to study the ratio of T-helpers of types I and II in a blood sample followed by establishing the dependence of changes in the indicator on the activity of the p65 subunit of NF-κB; to assess the levels of interleukin-6 and interleukin-1ß in blood serum with the establishment of the dependence of their concentration on the activity of p65 NF-κB; to study the activity of caspase-3 in the placenta, as well as the concentration of caspase-3 in the blood serum of women with premature birth and placental disorders; to determine the role of the vascular endothelial growth factor gene polymorphism (936C/T) in the development of placental disorders and premature birth. In the course of the work, 147 pregnant women were examined, who were divided into III groups: main (MG), comparative (CmG) and control (CnG). The main group included 107 women with premature birth at 28-33+6 weeks of gestation due to placental disorders. The presence of PlaD was determined by the presence of at least 2 biochemical criteria, which were determined by analyzing the data of placental and fetal hormones (beta subunit of human chorionic gonadotropin, unconjugated estriol, alpha-fetoprotein, pregnancy-associated protein A < 0.5 MoM) at the first and second prenatal screenings and 1 ultrasound criterion (indices of blood flow resistance in the umbilical cord arteries above the 90th percentile). Depending on the presence of inflammation and dysbiosis of the genital tract (which wasdetermined by the combined analysis of vaginal smear microscopy data and real-time polymerase chain reaction of genital tract secretions), pregnant women of the main group were divided into group I (I and II degrees of vaginal cleanliness, absent according to polymerase chain reaction chain reaction (PCR) dysbiosis of the vaginal tract) and II (III and IV degrees of vaginal cleanliness, the presence of dysbiosis of the vaginal tract according to PCR), and depending on the clinical course of premature birth - into subgroups A (with the presence of preter premature rupture of membranes (PPROM) before the start of labor) and B (without PPROM). The control group included 20 pregnant women with a physiological course of pregnancy (including in the period of 28-33+6 weeks of gestation) and normal delivery at full term. In addition, a comparison group was formed: 20 pregnant women with premature birth without signs of placental disorders.
The results of the study of the anamnestic data revealed that in all studied groups the age of the patients ranged from 20 to 45 years, with an average of 30.2±5.9 years in group I-A; 30.4±7.0 years in group I-B; 26.6+6.3 years in group II-A;27±6.1 years in the II-B group, 29±5.4 years in the comparison group and 31.9±6.5 years in the control group. The age distribution of pregnant women did not have significant differences (p>0.05) between subgroups, as well as when comparing with comparison and control groups, but when analyzing the presence of a difference in the age of patients between groups I and II without dividing into subgroups, a significant difference was found (p =0.007), i.e. the fact that the group with detected infection and inflammation of the genital tract is characterized by a younger age of pregnant women, which can be explained by the development of specific and non-specific inflammatory processes due to the peculiarities of sexual behavior.
