Soloviova N. Optimizаtion of diagnostics and prediction of obstetric and perinatal complications in pregnant women with a history of reproductive loss

The dissertation is devoted to the study of methods for optimizing diagnostics and prediction of obstetric and perinatal consequences of gestation and childbirth in pregnant women with a history of reproductive loss. The study was conducted in 4 stages. At the first stage, the results of a retrospective study of the course of pregnancy and childbirth of 130 pregnant women with a history of reproductive loss for the period 2017-2019 were analyzed, and the obstetric and perinatal consequences of childbirth in this contingent of women were assessed. In the second stage, a prospective study was conducted involving 105 pregnant women. The main group was 38 pregnant women with a history of reproductive loss, who were registered with the antenatal clinic regarding pregnancy and began their participation in the study after the start of full-scale military aggression against Ukraine. The comparison group was 37 women with a history of reproductive loss, who were registered regarding pregnancy and began their participation in the study before the start of the full-scale invasion, and the control group was 30 pregnant women without a history of reproductive loss. At the third stage, a comprehensive clinical examination of pregnant women included in the study was conducted, pregnancy management according to the current regulatory documents of the Ministry of Health of Ukraine, determination of biomarkers of nitrosating and oxidative stress (nitrotyrosine, 8-OHdG), psychological examination (Spielberger's scale of personal and reactive anxiety, Taylor's anxiety level measurement method, Perceived Stress Scale) At the fourth stage of the study, an assessment of the course of pregnancy and childbirth was conducted in women of all groups and an algorithm for predicting obstetric and perinatal consequences of childbirth in women with a history of reproductive loss was developed. Scientific novelty of the results obtained For the first time in Ukraine, a comprehensive clinical, psychological and biochemical study was conducted in women with a history of reproductive loss in conditions of martial law. The results obtained supplemented the understanding of the structure and frequency of extragenital pathology, obstetric complications of gestation and childbirth in pregnant women with one reproductive loss in history. The understanding of the features of the psychoemotional state in women with a history of reproductive loss, including in conditions of war in Ukraine, was expanded. This contingent of women was found to have a high level of stress, a high level of anxiety and their relationship with the features of the course of gestation. The understanding of the frequency of obstetric and perinatal consequences of childbirth in women with a history of reproductive loss was deepened. The relationship of the features of the psychoemotional state with biochemical disorders, namely, manifestations of oxidative and nitrosative stress, was proven. New data have been obtained on the manifestations of nitrosating stress in women with a history of reproductive loss, whose gestation was complicated by the clinical picture of miscarriage, which is one of the important links in the pathogenesis of gestational complications in this group of women. Practical result of the obtained results In order to optimize the management of pregnancy and childbirth in women with a history of reproductive loss, it is recommended to include an assessment of the psycho-emotional state in the complex of examinations upon registration, in particular, determining the level of stress and anxiety for timely consultation with a psychologist and appropriate psychological support. An algorithm for predicting the risk of premature birth in women with a history of reproductive loss using a clinical scale is proposed, which includes an assessment of the level of stress and anxiety, obstetric-gynecological and somatic history, as well as features of the course of gestation.