Особливості гормонального гомеостазу у жінок з порушеним дозріванням шийки матки

Abstract

The problem of untimely maturation of the cervix (belated in pregnancy or premature in the case of obstructive function of the cervix) in modern obstetrics is considered as a biological process closely related to such factors as chronological duration of pregnancy, mechanisms of start and duration of labor, the state of the fetoplacental complex and neck uterus. The objective: the determination of the features of hormonal homeostasis in women with cervix maturation. Materials and methods. In the dynamics of pregnancy, 28 pregnant women who were on treatment and birth in the department of the Pathology of Pregnancy and Childbirth were examined by the MI «IPOG them. Acad. O.M. Lukyanova NAMS of Ukraine». The distribution of women with cervix ripening is as follows: group 1 – pre-pregnant women at risk of post-term pregnancy – 13, 2-group – 15 pre-term women with ischemic-cervical insufficiency. Results. On the eve of labor in 39–40 weeks, the concentration of estradiol in the blood serum of women in group 1 reached the maximum values and amounted to 68.2±1.3 nmol/l. In women with isthmic-cervical insufficiency, the concentration of estradiol in the blood serum was within the limits of gestational norm. As the study shows, the concentration of progesterone in serum in group 1 – 759.9±23.2 nmol/l, the coefficient P/E2 – 10.9±0.78. It should be noted that in the 2nd study group, there is a shift in the estrogen / progesterone balance towards the estrogen, indicating an increase in the activity of α2-adrenergic receptors and a decrease in the representation and activity of β-adrenergic receptors. In the overwhelming number of women under study, 2 groups according to colpocytology had an estrogen type of smear (68.4%), corresponding to their hormonal changes in the concentration of estradiol and progesterone in serum. An increase in the concentration of cortisol in the blood of pregnant women in group 1 indicates a high level of psychoemotional stress and strain of neuroendocrine mechanisms of adaptation, which may be one of the causes of pregnancy. At the same time, the secretion of prolactin was significantly reduced in pregnant women in groups 2 with respect to women in group 1. Conclusions. The given data testify to the specific progesterone deficiency characteristic for pregnant women with functional impairment of obstructive function of cervix, which manifests itself by displacement of estrogen-progesterone ratio and is a sign of instability of hormonal production function of the placenta and one of the main pathogenetic parts of its dysfunction and failure of the cervix during pregnancy. The course of pregnancy in women at risk of post-term pregnancy is accompanied by a violation of the function of the fetoplacental complex represented by absolute and relative hypoestrogeny in the presence of unchanged relative to the norm of concentration of progesterone in serum. Key words: pregnancy, post-term pregnancy, fetoplacental complex, cortisol, thyroid hormones, colpocytology, isthmic-cervical insufficiency.