Тhe clinical lecture presents modern views on the problem of cervical insufficiency and its role in the miscarriage. Etiological agents of the cervical insufficiency development, its classification, diagnostic and differential diagnosis with short cervix have been reviewed. Particular attention has been drawn to the role of progesterone, microelements and connective tissue for development and progress of the mentioned pathology. The historical aspect was applied both for methods of possible treatments and prophylaxis of the cervical insufficiency and for advanced surgical and conservative correction. The algorithm of the obstetric actions for the cervical insufficiency is proposed.
associated hormones, hormones of the fetoplacental complex, pregnant womendisplaced persons Ключові слова: вагітність, стрес-асоційовані гормони, гормони фетоплацентарного комплексу, вагітніпереміщені особи Ключевые слова: беременность, стресс-ассоциированные гормоны, гормоны фетоплацентарного комплекса, беременные женщины-перемещенные лица Abstract. Features of hormonal function in pregnant women-displaced persons. Zhabchenko I.A., Korniets N.G., Tertychna-Telyuk S.V. Harmonious and stable psycho-emotional state of pregnant women is an important condition of successful pregnancy course, fetal development and physiological childbirth. People are facing various problems related to mental health that vary from psycho-emotional stress to the mental disorders. Important factors that determine the physiology of pregnancy are the psycho-emotional state of the pregnant and fetoplacental complex. Among the consequences of severe stress during pregnancy is dizziness, tachycardia, trembling of limbs, elevated arterial pressure, unmotivated increase in nervousness and anxiety, sleep disorder, depression that lead to worsening of general condition of a future mother. The purpose of the study was to determine changes in the production of placental hormones and stress-associated hormones in pregnant women-displaced persons. To carry out the study, a randomised dynamic prospective clinical-paraclinical examination of 96 pregnant women (the main group)displaced persons and 39 pregnant women (control group), who lived permanently in the territory of Ukraine under control, with gestation period after 22 weeks was used. Concentration of stress-associated (cortisol and prolactin) and placental (estradiol, progesterone, placental lactogen) hormones in serum was determined by solid-phase immunoassay. Increased estradiol concentrations and relative reductions in progesterone and placental lactogen, displacement of estrogen-progesterone equilibrium toward relative hyperestrogeny, increase in the concentration of stress-associated hormones were observed. The revealed hormonal and metabolic disorders in pregnant women, internally displaced persons, are biochemical markers of placental dysfunction, which testifies to the expediency of a comprehensive preconceptional preparation with the involvement of a psychologist and inclusion of preventive measures in the form of long-term progesterone support during pregnancy in the program of antenatal observation of such women. Реферат. Особенности гормональной функции у беременных-перемещенных лиц. Жабченко И.А., Корниец Н.Г., Тертычная-Телюк С.В. Гармоничное и стабильное психоэмоциональное состояние беременных женщин является важным условием успешного течения беременности, развития плода и физиологических родов. Люди сталкиваются с различными проблемами, связанными с психическим здоровьем,
One of the most important options of a favorable course of pregnancy, fetal development and physiological delivery is a balanced and preserving psycho-emotional condition of a woman during pregnancy. In order to study peculiarities of psycho-emotional condition of pregnant women-displaced people, dynamic prospective examination of 96 pregnant women in term of gestation more than 22 weeks (the main group) and 34 pregnant women from the local area (the control group) was conducted. According to STAI data, the mean score of the state anxiety in the main group was 1,6 times higher, personal anxiety — 1,4 times. According to results of the testing by I.V. Dobrjakov, the optimal PCGD type was characterized for 36 (37,5%) pregnant women-displaced people, 24 (25,0%) — hypogestognostic, 9 (9, 4%) — an euphoric, 18 (18,7%) — an anxious, 9 (9,4%) — a depressive. However, every second pregnant woman from the control group had optimal PCGD type – 20 (58,8%; p<0, 05), 12 (35,3%) — a hypogestognostic, 2 (5,9%) — an euphoric. The results of the testing by L. M. Rabovaluk confirmed, that almost all pregnant women of the control group had shown a low anxiety rate, at the same time, choosing the statements of the test, every fifth pregnant women of the main group (21–21,9%) obtained high diagnostic points, which give evidence of high anxious, depression presence. The study of indicators of anxiety, depression and violations of the attitude to pregnancy among pregnant women-displaced person will allow to individualize the approaches to antenatal observation, improve the quality indicators of a mother’s and newborn’s health.
The article presents an overview of domestic and foreign publications on pregravid preparation and early pregnancy in women with a history of habitual miscarriage (HM). Modern terminology is presented, questions about the causes of this pathology are considered and ways of its overcoming are determined. The views of specialists from leading institutions and obstetric and gynecological communities of the world on the issues of pregraved preparation and management of pregnancy in women with HM are presented. Among the main issues considered are the following: optimal timing for the next pregnancy; key recommendations on the management of women with HM (genetic examination, routine administration of progesterone preparations, correction of the «male factor», psychoemotional disorders, anatomical defects of female reproductive organs); the management of women with reproductive losses in the history on the background of antiphospholipid syndrome and congenital thrombophilia. It was noted the need to correct the infectious component of miscarriage. The role of vitamin and micronutrient supplementation in women with HM and their required quantity at the stage of pregravid preparation (folates, iron, iodine, vitamins D, B12) is defined. The evidence base on the use of sublingual and vaginal forms of micronized progesterone (luteina) for correction of the II phase of MC and early pregnancy in women with HM is presented. The emphasis is also on what should be avoided: unreasonable and unjustified prescriptions without special indications (additional examinations, medications, etc.). Key words: habitual miscarriage, pregravid preparation, key recommendations, micronutrient supplementation, micronized progesterone, gestalider, luteina.
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