The dissertation is devoted to the solution of an urgent problem of modern
obstetrics – improvement of obstetric and perinatal results in a group of advanced
maternal age patients with a pregnancy resulted from ART.
The advanced maternal age at first pregnancy and delivery has become a
widely acknowledged global demographic trend. Between 1980 and 2015 years,
the number of pregnancies among women aged 30 years and older increased more
than twofold (from 19.8% to 43.8%), and for women aged 35 years and older the
number increased threefold (from 4.6% to 16.3%). Considering the increased
genetic and obstetric risks, the international medical community has established
the term "advanced maternal age", defined as the age of a woman 35 years old and
over.
There are a number of medical aspects that complicate pregnancy and
childbirth at advanced maternal age (AMA), including the state of women`s health,
conception and reproductive problems, specific features of pregnancy and delivery.
According to the literature, women of advanced maternal age are more frequently
suffering from maternal and reproductive complications, those lead to an increased
number of surgical interventions, obstetric and perinatal morbidity and mortality.
These complications include preeclampsia, fetal growth retardation syndrome,
preterm delivery, postponed pregnancy, abnormal uterine activity and postpartum
hemorrhages.
Women of advanced maternal age are much more likely to experience
fertility problems and require the use of assisted reproductive technology (ART)
for conception. Annual reports of ART clinics from Australia, Europe, China, the
United States, and Canada confirm an increase in both the number and average age
of women who have used ART.
It has been proven that pregnancies after ART have a significantly higher
risk of adverse perinatal outcomes. Thus, ART pregnancies compared to
spontaneous pregnancies are more often complicated by gestational diabetes,
gestational hypertension, preeclampsia, intrahepatic cholestasis, placenta previa,
placenta accreta spectrum disorders, and obstetric hemorrhage. There was also a
statistically significant increase in the incidence of preterm birth, low birth weight,
and small for gestational age fetuses in patients with singleton pregnancies after
ART compared to the cohort of spontaneous pregnancies.
According to the data of several authors, the combination of age factor and
the use of ART has potentiated and increased obstetric and perinatal risks, but the
results of these studies are variable and have no specific clinical recommendations.
Considering the upward trend in the frequency of ART pregnancies in AMA
women, the high incidence of obstetric and perinatal complications, and the
absence of a unified approach to pregnancy and delivery management in this group
of patients, the formation of an effective clinical and diagnostic complex of
curative and preventive measures aimed to reduce the incidence of obstetric and
perinatal complications among women of advanced maternal age with pregnancy
resulting from ART seems to be an important issue.
Aim of the study: to reduce the incidence of obstetric and perinatal
complications in women of advanced maternal age after ART by improving the
management of pregnancy, delivery, and postpartum period.
Objectives of the study:
1. To determine the features of reproductive anamnesis, frequency and
structure of somatic and gynecological morbidity in women of
advanced maternal age after ART.
2. To investigate the features of pregnancy, delivery and postpartum, and
perinatal outcomes of this contingent of women.
3. To determine the structure of obstetric and perinatal complications in
women of advanced maternal age after ART and to evaluate their
clinical significance.
4. To develop a complex of treatment and preventive measures aimed to
reduce the incidence of obstetric and perinatal complications in women
of advanced maternal age after ART.
5. To evaluate clinical efficacy of the established complex of treatment
and preventive measures in the study groups.
