Авраменко н.в. 1 КУ «Запорізький обласний медичний центр репродукції людини» ЗОР семененко і.в. 2 , сєрих к.в. 3 Факультет післядипломної освіти Запорізького державного медичного університету ОсОбЛивОсті пісЛядипЛОМнОї Освіти сіМейних ЛікАрів З питАнь пЛАнУвАння сіМ'ї тА беЗпЛіднОгО ШЛюбУ Анотація. В статті подано особливості викладання циклу тематичного удосконалення за темою «Безплідний шлюб. Планування сім'ї» для сімейних лікарів. Мета циклу -вдосконалення теоретичних знань щодо безпліддя та забезпечення лікарів загальної практики сучасними знаннями з лікування даної патології та планування сім'ї для підвищення їх професійного рівня надання медичної допомоги. Співробітники кафедри розробили цикл тематичного удосконалення «Безплідний шлюб. Планування сім'ї» для популяризації теоретичних знань з методів діагностики та лікування в практиці сімейного лікаря, підвищення якості лікувально-діагностичної допомоги гінекологічним хворим, покращення професійних навичок і умінь лікарів сімейної медицини. Проведення циклу тематичного удосконалення «Безплідний шлюб. Планування сім'ї» дає змогу доповнити, удосконалити та забезпечити високий рівень підготовки лікарів з питань планування сім'ї та покращення репродуктивного здоров'я населення. ключові слова: післядипломна освіта, акушерство, гінекологія, безпліддя, планування сім'ї, сімейна медицина.
Prenatal stress is quite a common occurrence in a modern society and in return affects the development of violations of women’s` reproductive health. It is an obvious need to give an appropriate attention to the woman in the process of a diagnosis of an obstetric and gynecological pathology and also a use of anti-stress therapy and the correction of systemic stress-induced disorders in treatment regimes. The purpose of research was to analyze the literary tributes, dedicated to the problem of prenatal stress and this infusion on the reproductive health of women. Material and methods. We analyzed publication of national and foreign authors on the research topic. Methods of research: statistical and method of expert evaluations. Results and discussion. Psychological unavailability to motherhood of infertile women creates a situation of a prolonged emotional stress, which leads to the prenatal stress and provokes an activation of the modified adaptive response, launches a pathological range of reproductive disorders. We studied the problem of prenatal stress and the general mechanisms of its effects on the body of women in the reproductive period. We described the long-term effects of prenatal stress on emotional suffering, mental and physical health of women. The experienced prenatal stress is a predictor of disorders of the reproductive system in the future, associated with emotional states, the elimination of which restores reproductive function. Psychological unpreparedness for motherhood among women with infertility creates a situation of prolonged emotional stress, which leads to prenatal stress and provokes the activation of their inherent altered adaptive response. The mentioned factors are the triggers for pathological range of reproductive disorders. Prenatal stress is a common phenomenon in modern society, which effects on the development of disorders of women reproductive function. Conclusion. There is a necessity to pay appropriate attention to the patient within the diagnosis of obstetric and gynecological pathology, as well as the necessity for adequate therapy and correction of system stress-induced disorders in treatment regimens. There is a necessity for in-depth study of infertility associated with prenatal stress, development of a comprehensive differential approach to diagnosis and treatment, taking into account the patients' psycho-emotional state with further improvement of pre-pregnancy training and tactics for treatment of such women
The purpose of the study was to go thoroughly into a question about the clinical features of the history and reproductive status in women with psychoemotional disorders associated with prenatal stress in comparison with the clinical features of the history and reproductive status of somatically healthy women with tubo-peritoneal factor infertility. Materials and methods. The study involved 120 patients, 80 of whom experienced prenatal stress: the main group, which was divided respectively into group 1 – women who underwent in vitro fertilization and group 2 – women who did not undergo in vitro fertilization. For comparison, a control group of 40 women without prenatal stress was formed. The age of the patients ranged from 22 to 45 years. Complaints, medical and life history, gynecological history, educational level were studied in all patients, and the causes of infertility were assessed. Results and discussion. Among the causes of primary infertility, hypothalamic-pituitary-ovarian insufficiency and associated ovulatory changes, which are manifested by menstrual irregularities, are dominant. Persistent anovulation, lack of correction of menstrual irregularities lead to the development of endocrine-dependent gynecological diseases, one of the manifestations of which is primary infertility. The frequency of infertility with a regular menstrual cycle is 30-70%. In these patients, combined forms of infertility are more common. The study found that in terms of place of residence, social status, the presence of bad habits, gynecological history data, infertile patients in vitro fertilization programs do not differ from healthy women with tubo-peritoneal factor of infertility. A significant difference was revealed between the indicators of the nature of the menstrual cycle in the comparison groups. It was found that a menstrual cycle lasting less than 23 days is a predictor of decreased functional activity of the hypothalamic-pituitary-ovarian axis in women. Analysis of the hormonal regulation of the reproductive function of the examined groups of women established the prevalence of follicle-stimulating hormone indices in the main group over the control group (9.6 ± 0.2 versus 6.2 ± 0.1 mMod / ml, respectively, p <0.05), and the thyroid-stimulating hormone level had no differences between comparison groups. We proposed to distinguish 3 states of ovarian reserve – normal, low and extremely low for women with infertility and a history of prenatal stress. Conclusion. Timely comprehensive assessment of the state of the endocrine system, the state of the ovaries in relation to the state of the regulatory mechanisms of psychoemotional adaptation of women with infertility associated with prenatal stress, which we studied, requires a partial revision of approaches to this group of patients and the timely use of in vitro fertilization to improve the effectiveness of infertility treatment
Persistent anovulation, menstrual disorders lead to the development of endocrine-dependent gynecological diseases, one of the manifestations of which is primary infertility. The aim of the study: to assess the clinical features of history and reproductive status in women with psycho-emotional disorders associated with prenatal stress. The study involved 120 patients, 80 of whom suffered prenatal stress: 1 – the main group, which is divided into 1A subgroup – women who underwent in vitro fertilization, and 1B subgroup – women who did not undergo in vitro fertilization. For comparison, a 2 – control group of 40 women without prenatal stress with exclusively tubal factor of infertility, in which the parameters of the functional state of the reproductive system corresponded to the normal ovarian reserve. The age of patients ranged from 22 to 45 years. Complaints, anamnesis of disease and life, gynecological anamnesis, level of education were studied in all patients, the causes of infertility were assessed. The results of the study were processed using the statistical package of the licensed program “STATISTICA® for Windows 13.0”. The normality of the distribution of indicators was established by the Shapiro-Wilk criterion. Descriptive statistics are presented as the arithmetic mean and standard deviation of M±SD or the median and quartile interval Me (Q1-Q2) depending on the distribution of the trait. It was found that in place of residence, social status, the presence of bad habits, gynecological history of infertile patients in in vitro fertilization programs do not differ from healthy women with tubal-peritoneal factor infertility. There was a significant difference between the indicators of the nature of the menstrual cycle in the comparison groups. It has been found that a menstrual cycle of less than 23 days is a predictor of reduced functional activity of the hypothalamic-pituitary-ovarian axis in women. Analysis of hormonal regulation of reproductive function of the examined groups of women found the prevalence of FSH in the main group over the control (9,611±0,212 vs. 6,221±0,113 mMod/ml, respectively, (p<0.05), and the level of TSH was not differences between comparison groups. We proposed to identify 3 states of ovarian reserve - normal, low and extremely low for women with a history of infertility and prenatal stress. Conclusion: timely comprehensive assessment of the endocrine system, ovarian status in relation to the state of regulatory mechanisms of psychoemotional adaptation of women with infertility associated with prenatal stress, which we studied, requires a partial revision of approaches to this group of patients and timely use of in vitro extracorporeal the effectiveness of infertility treatment.
Treatment of non-motor disorders in patients with infertility and prenatal stress (PS) is an important component of comprehensive treatment of the disease. This study examined the clinical effectiveness of a non-drug method of bioadaptive management - training based on biological feedback (BFB) in the correction of psychoemotional disorders in patients with infertility and prenatal stress. Object and methods of research. The study involved 41 patients with infertility and PS aged 22 to 45 years. Group I consisted of 21 women who underwent infertility treatment using in vitro fertilization and biological feedback, group II - 20 women who underwent treatment using in vitro fertilization without biological feedback. All patients were assessed for psychoemotional status on the Beck Depression Scale (BDI-II), tests for Spielberger-Khanin reactive anxiety, assessment of personal anxiety on the 1st day of observation, at the end of the course of BFB - training in group I and after 10±2 days in the comparison group. Results. There was a significant overall improvement in the psycho-emotional state of patients who underwent a full course of BFB - training at the end of therapy (p<0,05). There was a statistically significant difference between the level of certain psychoemotional disorders (in particular, anxiety, reduced stress resistance) of the studied groups (p<0,05). However, in contrast to group I patients who underwent BOS training, no statistically significant improvement in the psychoemotional status of group II patients during the observation period was found. Conclusions. BFB training can be considered as an appropriate component in the comprehensive treatment of psychoemotional disorders in patients with infertility and prenatal stress.
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