Perinatal Losses Research Articles

Role of lipid peroxidation and antioxidant defense destabilization in the pathogenesis of hypoxia in premature infants

The presented literature review describes current views on the problem of preventive diagnosis of hypoxic states in premature infants. To date it is one of the most actual directions in neonatology as according to World Health Organization data, the number of premature births in the world grows annually, and children born earlier than 37 weeks of gestation are at the highest risk for perinatal losses and disability. Special role among disturbing factors is given to conditions related to oxygenation violation in different tissues and organs of a premature infant. Thus, the article deals with lipid peroxidation and antioxidant defense destabilization and degree of their influence on the course of hypoxia. Special attention is paid to cytokine regulation of metabolic processes in a pregnant woman and an infant’s organism. Their role in the course of hypoxic states is emphasized, characteristic changes of some cytokine concentration in this pathology is described and also current views on the possibility of recombinant cytokines use as correction factors are presented. Literature analysis showed that despite significant success in the field of research of cytokine control of hemostasis of the human organism, the issue of pro- and anti-inflammatory interleukins’ role in oxidative stress in premature infants is still open. The authors consider that joint study of lipid peroxidation and cytokine profile may form extended viewpoint on hypoxia pathogenesis that will allow to prognose its severe and complicated course and to develop relevant correction methods.

Grief reactions of couples to perinatal loss: A one-year prospective follow-up.

To explore couples' perceptions of the effects of perinatal loss on their marital relationship, social support and grief 1year postloss, and analyse what factors changed the severity of their grief. Perinatal losses are traumatic events in the lives of families and can have serious long-term consequences for the psychological health of parents and any subsequent children. A prospective follow-up study. We recruited, at a teaching hospital in southern Taiwan, a convenience sample of 30 couples whose babies either miscarried or were stillborn. At 1month (T1), 3months (T2), 6months (T3) and 1year (T4) after the pregnancy loss, all participants completed four questionnaires. To analyse the changing status of their grief and its related factors, we used a generalised estimating equation(GEE) to account for correlations between repeated observations. Postbereavement grief levels fell over the four time-points. Mothers reported feeling more grief than did the fathers. Couples with a history of infertility, no religious beliefs or no living children before the loss felt more grief from a perinatal miscarriage or stillbirth. Furthermore, couples reported more grief if their marital satisfaction level was low, if their socioemotional support from husband's parents was low or if they had never participated in a ritual for their deceased baby. Six months postloss is the crucial period for bereaved parents after a perinatal loss. Being a mother, having no previous living children and low-level socioemotional support from the husband's parents are significant high-risk factors for a high level of grief 1year after perinatal death. We recommend that health professionals increase their ability to identify the factors that psychologically affect postloss grief. Active postloss follow-up programmes should focus on these factors to offer specific support and counselling.

Structure and factors of the risk of premature birth

Objective. To study the structure and risk factors of premature birth. Methods. Prospective open-label non-randomized clinical trial. The study included 11 861 births, including 1806 - premature (15.2%) in the CF “UMS of the National Research Center for Maternity and Childhood.” The odds ratio (OR), the confdence interval (CI) of risk factors for the development of preterm birth have been calculated. Results. When studying the social portrait of prematurely giving birth to women: the level of education (OR - 2.7, SE - 0.29, CI (95%) 1.5-4.8;) employment (OR-2.4, SE-0, 29; CI (95%) 1.3-4.1;) and the woman’s place of residence (OR 1.5, SE 0.29, CI 95% 0.9-2.7) are statistically signifcant risk factors for premature birth. The study of obstetrical anamnesis of pregnant women revealed the following: 14.2% - primitive, 85.8% - repeat pregnancy, 26.3% - with a syndrome of previous perinatal losses (2 or more spontaneous abortions), 32.2% - previous premature births, 2, 4% - with cervical insufciency. Conclusion. The main risk factors for premature birth are cervical insuffciency, repeated pregnancies with a parity of more than 4 (OS-1.19, SE-0.3, CI (95%) 0.7-2.2;), the presence of premature birth and fetal loss in the history (OR-2.66, SE-0.35, CI (95%), 1.3-5.3;), birth of small children (OR-2.38; SE-0.37; CI (95%) 1.2-5.1;). The social portrait of women with preterm birth appears as follows: age 20 to 34 years, predominantly in rural areas, housewives with low and medium education, with habitual loss of pregnancy or previous premature birth, cervical insufciency. Family planning, pre-birth training for a prospective mother and conducting preventive measures in pregnant high-risk groups for premature birth can be a condition for reducing the frequency of preterm labor

ANALYSIS OF WORK OF PERINATAL CENTERS IN NURSING OF PRETERM INFANTS IN UKRAINE

The Perinatal Center is a modern medical institution which unites all stages in performing high quality care for mothers and newborns. The development of a system of regional perinatal centers is recognized worldwide in reducing perinatal losses, frequency of chronic diseases and disability formation in Ukraine. The article reviews and analyzes the experience of perinatal centers in the period from 2014 to 2016, the main chellenges and proposals in increasing the effectiveness of rendering medical care to newborns in perinatal centers in Ukraine.

Diagnostic value of perinatal autopsies: analysis of 486 cases.

Autopsy is a beneficial procedure to determine the cause of death and the frequency of anomalies in perinatal losses. Even in the event of an autopsy not providing any additional information, completion of the procedure confirming the clinical diagnoses gives reassurance to both clinicians and parents. Here we present a 15-year archival study based on findings of perinatal autopsies. Four hundred and eighty-six cases from our archive were reviewed and according to the findings they were divided into three subcategories; (1) miscarriages (MCF); (2) fetuses terminated (FTA) for vital anomalies detected by prenatal ultrasonography; (3) premature or term newborns died within first month of life (neonates: NN). Autopsies were documented and classified according to week/age of cases, anomalies and causes of abortion or death. Two hundred and twenty-six of 486 cases (46.5%) were in MCF group while 227 (46.7%) and 33 (6.8%) were of them in FTA and NN groups, respectively. In FTA group, the most frequent anomaly detected was neural tube defects. In NN group, prematurity related complications were the most common cause of death. The autopsy process was found valuable in 39.7% of all cases. We suggest that autopsy procedure is diagnostically valuable even in situations when there is USG findings that are confirming FTAs or there is no important major fetal or placental anomaly detected in MCFs.

ОСОБЛИВОСТІ ПЕРЕБІГУ ГЕСТАЦІЇ У ЖІНОК ІЗ ГІПЕРТЕНЗИВНИМИ РОЗЛАДАМИ (РЕТРОСПЕКТИВНИЙ АНАЛІЗ)

Недостатня ефективність існуючих методів лікування гіпертензивних станів під час вагітності обґрунтовує доцільність пошуку нових антигіпертензивних засобів та методик їх застосування у вагітних, що дозволить попередити розвиток прееклампсії та еклампсії у значної кількості випадків, і, таким чином, знизити частоту розвитку ускладнень вагітності та перинатальних втрат.Мета дослідження – виявити фактори, що впливають на розвиток прееклампсії у вагітних з різними видами гіпертензивних розладів.Матеріали і методи. Проведено ретроспективний аналіз і багатопланову розробку 564 карт спостереження за вагітними та жінками з гіпертензивними розладами.Результати досліджень та їх обговорення. Хронічну артеріальну гіпертензію під час вагітності слід розглядати як один із факторів ризику виникнення прееклампсії та поєднаного гестозу, а низьку ефективність антигіпертензивної терапії або відсутність комплаєнсу можна вважати передвісником розвитку цих ускладнень. Наявність нелікованої хронічної артеріальної гіпертензії провокує маніфестацію прееклампсії та поєднаного гестозу у вагітних на 2–3 тижні раніше, ніж у жінок без артеріальної гіпертензії або при її адекватній терапії.Висновки. Наявність некорегованої хронічної артеріальної гіпертензії у вагітних суттєво підвищує частоту розвитку в них пізніх гестозів і значно погіршує прогноз виношування вагітності. Застосування адекватної антигіпертензивної терапії вазодилатуючими бета-адреноблокаторами сприяє достовірному зниженню частоти розвитку прееклампсії та тяжкості її перебігу.

Особливості моніторингу стану плода у вагітних з обтяженим акушерським анамнезом

The objective: to establish the features of fetus functional state definition in pregnant women with perinatal losses in history. Patients and methods. 89 pregnant women with perinatal losses in history were screened. The fetus functional status evaluation was based on cardiotocography and definition of fetal heart rate variability by cardiointervalography. Results. Received data showed the decrease of SDNN, RMSSD and pNN50 in pregnant women with perinatal losses in history, indicating the prevalence of parasympathetic effects on the fetal myocardium (p<0.05). Studies of mathematical time characteristics of fetal heart rate revealed a significant overweight of the metabolic-humoral regulatory circuit in women with normal pregnancy (p<0.05). Dynamic stress index evaluation indicates the centralization of heart rate regulation and significant intensity of the fetal compensatory mechanisms in pregnant women with perinatal losses in history. The cardiotocography revealed no difference between the fetal status in women of comparative groups (p>0.05). Conclusions. In pregnant women with perinatal losses in history owing to autonomic nervous system disregulation a significant intensity of fetal regulatory systems and the centralization of fetal cardiac rhythm control were observed. The cardiotocography and cardiointervalography data with revealed signs of excessive sympathetic activation can serve as preclinical signs of gestational pathology. Key words: perinatal losses, fetal functional state evaluation, cardiotocography, cardiointervalography, autonomic nervous system.

Gestational diabetes mellitus with its maternal and foetal outcome: a clinical study

Background: Prevalence of the diabetes among pregnant women is increasing, attributable to advance maternal age, multi foetal gestation, increased body mass index, strong family history, sedentary life style, change in the diet, continued immigration. Gestational diabetes has few symptoms, commonly diagnosed by screening during pregnancy.Methods: The present study was conducted at Department of Medicine and Department of Obstetrics and Gynaecology, Dr. S.N. Medical College, Jodhpur. Rajasthan, India.Results: Out of 476 patients attending the antenatal outdoor at the Umaid Hospital, Jodhpur, Rajasthan, India. The prevalence of gestational diabetes in present study was 7.98%, Incidence of GDM found to increase with increasing age with maximum prevalence (10.71%) in more than 30 years age group, with increasing parity, low socioeconomic strata and in urban population. With maximum prevalence amongst higher parities (12.5%) in >G5 and higher). The incidence was higher with history of PIH (36.36%), family H/O DM (33.3%), GDM (12.12%), perinatal losses (15.15%), anomalous baby (9.09%), high BMI (67%). GDM complicate the normal course of pregnancy with increased incidence of PIH (36.4), Polyhydramnios (27.2%), infections like vaginal candidiasis (24.2%) and UTI (39.3%). The infant of diabetic mother had 12 (32.29%), 9 (26.47%), 11 (32.35%), 8 (23.53%) 5 (14.70%) and 3 (8.82%) of hypoglycemia, respiratory distress, macrosomia, congenital anomalies, birth injuries, polycythaemia, and hypocalcaemia respectively in diabetic mothers with suboptimal glycaemic control during pregnancy.Conclusions: GDM continues to be an important obstetrical condition with significant feto-maternal morbidity. Complications in infant of diabetic mother are more common with those mothers who had poor glycaemic control.

Аналіз випадків абдомінального розродження за гострої гіпоксії плода

The objective: was to study the level of abdominal delivery, its structure according to indications from the fetus, the effect of cesarean sections on perinatal losses in acute fetal hypoxia. Patients and methods. The study was conducted on the basis of the Kyiv City Maternity Hospital №1 for the period from 2001 to 2011. The frequency of cesarean sections was studied and analyzed, the percentage of urgent and planned operations was established, the structure of cesarean sections according to the indications from the fetus was determined, the frequency of cesarean sections in acute hypoxia Fetus, perinatal losses were studied, an analysis of the dependence of perinatal losses on the frequency of cesarean sections during fetal distress was carried out. The analysis used the history of delivery of women giving birth, which culminated in cesarean section. Results. In analyzing the structure of cesarean sections, the fetal indications are as follows: fetal hypoxia, confirmed by objective methods, in the absence of conditions for urgent delivery per vias naturales; Pelvic presentation of the fetus at a mass of more than 3700 g; in vitro fertilization; incorrect position of the fetus after the outflow of amniotic fluid. The conclusion. An increase in the frequency of cesarean sections was noted. Attention is drawn to the positive trend of decreasing the frequency of urgent surgical interventions. The expected decrease in the number of perinatal losses with an increase in the level of caesarean sections due to fetal distress has not been confirmed. Key words: cesarean section, acute fetal hypoxia, cardiotocographic monitoring.

Профілактика невиношування вагітності у ІІ триместрі у жінок, які багато народжують

The objective: depression of frequency of not incubation of pregnancy in the ІІth trimester and perinatal pathology at multiborn women on the basis of studying clinical-ekhografical, dopplerometrical, endocrinological, biochemical and microbiological features, and also by development and deployment of advanced algorithm of treatment-and-prophylactic actions. Patients and methods. І a stage (retrospective research) – is carried out clinic - the statistical analysis of 146 stories of labors at multiborn women. ІІ a stage (prospective research) – 110 patients, among which 60 multiborn women who were divided into two groups are surveyed. Results. Еfficiency of the algorithm improved by us consists in essential depression at multiborn women of frequency of gestational anemia (by 2.5 times), threats of premature births (by 4.6 times), placental dysfunction (by 2.3 times), disturbances of microbiocenosis of sexual ways (by 2.2 times), premature births (twice), premature rupture of born covers (by 2.7 times), fetus arrests of development (by 2.0 times), a fetus distress (by 3.1 times), an abdominal delivery (by 2.8 times) and realization of an intraamnialny becoming infected (by 2.5 times). The cooperative case rate of newborns in the early neonatal period decreased by 2.5 times, and perinatal losses were absent. Conclusion. Use of advanced algorithm needs to be applied at multiborn women in medical institutions of all levels. Key words: not incubation, multiborn women, prophylaxis.

Asymptomatic placental abruption in the third trimester of pregnancy

The article presents 3 clinical cases of asymptomatic placental abruption, diagnosed occasionally during routine ultrasound. There were analyzed risk factors of placental abruption: thrombophlia, diabetes, perinatal losses. All cases demonstrated complete coincidence of ultrasonic and morphological data in placental abruption. The patients had been delivered successfully due to correct diagnostics and severe maternal and fetal complications were not realized.

Ретроспективный анализ гестационных осложнений и перинатальных исходов у женщин с дисфункцией щитовидной железы

The objective: A study of features of the course of pregnancy and perinatal outcomes in women with thyroid dysfunction. Analysis of the risk prediction of gestational and perinatal complications, depending on the level of antibodies to thyroid peroxidase (AB-TPO). Patients and methods. A retrospective study of 526 histories and stories birth of generations of women-carriers of antibodies to thyroid peroxidase and 489 of their newborns The group of comparison was formed of 40 stories birth somatically healthy women without the elevated levels of AB-TPO and 40 stories of their newborns. The analysis of the course of pregnancy and perinatal outcomes, evaluation of risk prediction of gestational and perinatal complications, depending on the level of AB-TPO. Results. Established that women carriers of AB-TPO age has the older category; among extragenital diseases most often identified diseases of otolaryngology and neurocirculatory dystonia. Obstetric anamnesis burdened by the pregnancy miscarriage and perinatal losses. In the structure of gestational and perinatal complications, the principal place is the threatened miscarriage, preeclampsia, fetal distress, asphyxia of newborns. Discovered the effect of the starting threshold level of AB-TPO on the risk of occurrence impendence interruption of pregnancy (AB-TPO=315 IU/ml); the risk of miscarriage (AB-TPO=339.8 IU/ml); the risk of fetal distress (AB-TPO = of 247.5 IU/ml); the risk of neonatal asphyxia (AB-TPO=234.8 IU/ml). Didn’t discovere influence of starting threshold level of AB-TPO on the risk of preeclampsia and pathological birht. Conclusion. Women carriers of the AB-TPO constitute a group of high risk of obstetric and perinatal pathology. Discovered the influence of the starting threshold level of AB-TPO on the risk of gestational complications. Key words: pregnancy, level of antibodies to thyroid peroxidase, miscarriage, gestational and perinatal complications.

Пути снижения перинатальных потерь у беременных с острым панкреатитом

Пути снижения перинатальных потерь у беременных с острым панкреатитом

Оптимізація тактики ведення вагітних з перинатальними втратами в анамнезі

The objective: to improve the effectiveness of gestational complications prevention in women with a previous perinatal losses (PL) by diagnostic methods optimization. Patients and methods. 85 pregnant women with previous perinatal losses were examined. Group II (control group) included 89 pregnant women without PL. The relationship between neurovegetative violations and pregnancy complications in women with adverse obstetric history were found using the heart rate variability method and determination of mother–placenta–fetus system status. Results. The overbalance of the sympathetic effects, mostly in the third trimester, was observed in pregnant women with previous perinatal losses, unlike the control group (p<0,05). This may be explained due to depletion of compensatory reserves of autonomic nervous system. In the second trimester increased sympathetic tone was established after stress tests in women of the main group, probably, because of the compensatory-adaptive reactions of all parts of the autonomic nervous system realization. Conclusion. Vegetative homeostasis violations with increased sympathetic tone cause placental dysfunction with metabolic changes, fetal growth retardation and other gestational complications. The dominance of sympathetic tone in pregnant women with previous perinatal losses and hormonal function of mother–placenta–fetus system indicate an imbalance of neurohumoral regulation and can be the diagnostic and prognostic sign of pregnancy complications. Key words: neurovegetative regulation, perinatal losses, placental dysfunction, cardiointervalography.

Діагностика, профілактика та прогнозування перинатальної патології при аномаліях плацентації (ретрохоріальні гематоми та аномалії розташування плаценти)

The objective: depression of frequency of perinatal pathology at various pathology of placentation (retrochorial hematomas and anomalies of locating of placenta) on the basis of improvement and introduction of algorithm of diagnostic, treatment-and-prophylactic and prognostic actions. Patients and methods. Researches were conducted in two stages - on 1 us at first the retrospective analysis of clinical course of pregnancy and labors at 100 women (retrospective group) with a retrochorial hematoma is carried out, and then 150 pregnant women who were divided into three subgroups prospective are surveyed. At the 2 stage 250 women entered research – 2 group, from which 200 – with misplaced of placenta and 50 – with normal. Results. Use of the algorithm of maintaining women improved by us with retrochorial hematomas allows to reduce the frequency of early genesial losses (from 25.0% to 10.0%), to improve perinatal results (lack of cases of perinatal losses in the prospective researches and 40,0‰ in retrospective, to reduce perinatal case rate (from 30.0% to 15.6%), and also promotes pregnancy prolongation. At women with misplaced of placenta allows to reduce the frequency of placental dysfunction from 42.0% to 28.0%; fetus arrests of development – from 30.0% to 18,0%; premature births – from 18.0% to 8.0%; perinatal mortality – from 30.0‰ to 10.0‰ and a post-natal case rate – from 28.0% to 16.0%. Conclusion. Results of the conducted researches testify that prophylaxis of perinatal pathology at women with various options of pathology of placentation to which we referred existence of retrochorial hematomas and placenta misplaced, has to have complex stage-by-stage character taking into account results of clinical and additional methods of researches, and also on the basis of introduction improved by us to algorithm. Key words: retrochorial hematoma, placenta misplaced, perinatal pathology, prophylaxis.

ПРОФІЛАКТИКА НЕВИНОШУВАННЯ БАГАТОПЛІДНОЇ ВАГІТНОСТІ З ВИКОРИСТАННЯМ РОЗВАНТАЖУВАЛЬНОГО АКУШЕРСЬКОГО ПЕСАРІЯ

Мета дослідження – оцінити ефективність застосування розвантажувальних акушерських песаріїв у жінок з багатоплідною вагітністю з високим ризиком невиношування.Матеріали та методи. Проаналізовано 40 випадків застосування розвантажувальних акушерських песаріїв у вагітних з двійнятами з ознаками невиношування у термінах 18–28 тижнів вагітності, котрі склали першу групу обстежуваних. Друга група – 12 вагітних з двійнятами, котрим був накладений шов на шийку матки з приводу істміко-цервікальної недостатності. Контрольна група – 18 вагітних з двійнею, яким призначалась консервативна терапія. Проведений аналіз перебігу вагітності, пологів, післяпологового періоду та стану неонатальної адаптації в обстежуваних групах.Результати дослідження та їх обговорення. Динаміка вкорочення шийки матки була значно повільнішою у пацієнток І групи, яким було встановлено розвантажувальний акушерський песарій, це є ефективним методом профілактики та лікування невиношування у жінок з багатоплідною вагітністю, зниження частоти пізнього аборту та передчасних пологів, перинатальних втрат. Пацієнтки І групи мали меншу кількість випадків передчасного розриву плодових оболонок у 7 (17,5 %) пацієнток І групи порівняно з 3 (25,0 %) жінками ІІ групи та у 5 (27,7 %) вагітних контрольної групи. В І групі обстежуваних термінові пологи відбулися у 34 (85 %) випадках, у ІІ групі – у 9 (75,0 %) випадках, у контрольній – 12 (66,6 %) випадках. В контрольній групі перинатальні втрати склали 2,7 %. В І групі перинатальних втрат не було. При оцінці стану неонатальної адаптації новонароджених обстежуваних груп прослідковується зниження росто-вагових показників у дітей ІІ та контрольної груп, також спостерігається зниження показників оцінки стану новонароджених за шкалою Апгар у ІІ та контрольній групах.Висновки. Методика застосування розвантажувального акушерського пессарія є патогенетично обґрунтованою у вагітних з багатопліддям і дозволяє пролонгувати вагітність до доношеного терміну у 85 % жінок досліджуваної групи, знизити медикаментозне навантаження на вагітну та плід.

Comparative Assessment of Women's Reproductive Health in the Areas Bordering With the Aral Sea Region.

AIM:We examined 435 women of Aktobe region and 328 women of South Kazakhstan region, living in areas bordering the Aral Sea region during the study and comparative assessment of the impact of climatic and anthropogenic factors of Aral region on the reproductive health of the female population.MATERIAL AND METHODS:The survey based on the comprehensive clinical-functional and laboratory studies accounting the regional and environmental ecological factors. Survey subject was the area of 2 settlements of Aktobe region and 1 settlement of South Kazakhstan region.RESULTS:In all three areas it was revealed that the examined women had the later menarche. There is a trend towards younger age for menopause. The women of South Kazakhstan region often suffer from the pelvic inflammatory disease.CONCLUSION:Perinatal losses, the case of spontaneous interruption and stagnant pregnancy in history, which can be repeated, one in three women has in the zone of ecological disaster.

MULTIPLE PREGNANCY, ANTENATAL CARE PROBLEMS AND THEIR SOLUTIONS RESULTS

Aim of the work. The aim of our study is to summarize the course of pregnancy and delivery in multiple pregnancies in modern conditions. Materials and methods. The analysis of the pregnancy course, labor and perinatal outcomes was carried out in 182 women with diochorionic and 86 patients with monochorionic twins and 40 women with a singleton pregnancy. Multiple pregnancies were proved to be a monochorionic (MH) and diochorionic (DH) that is a high risk factor for perinatal complications. The research included clinical and laboratory examination metods, study of hormonal function of fetoplacental complex (FPC), transvaginal ultrasound examination. Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1. Results and discussion. In the analysis of pregnancy the abortion threat was detected in 51 (59.3%) women with monochorionic and 34 (62%) women with diochorionic twins. Preeclampsia during pregnancy complicated in 26 (30.2%) and 43 (23.6%) patients, with monochorionic and diochorionic placentation type, respectively. A frequent complication of both the MH and DH twins was anemia, which was found in more than half of the surveyed (56.9 and 51%, respectively). Delivery in the case of multiple pregnancies is also much more complicated and is terminated surgically three times more often than in singleton births. The most frequent indications for operative delivery were first breech fetus, fetal distress during pregnancy and childbirth, FGR, severe preeclampsia, premature detachment of normally situated placenta, anomalies of labor activity. These perinatal losses were equally observed both after cesarean section and after spontaneous labor and amounted to 4% at monochorionic and 1.7% at diochorionic twins. The frequency dependence of identified lesions at pregnancy with twins was established by chorionic. Careful observation of the patients with multiple pregnancies in the antenatal period, the prevention of the most frequent complications, ultrasound monitoring of early pregnancy allows a differentiated approach to the management of pregnancy and childbirth, helping to reduce perinatal morbidity and mortality. Conclusions. Multiple pregnancies occur with a large number of complications compared with singletons. Thus, the increase of frequency of multiple pregnancy influences the obstetric and perinatal indicators, pushing this issue in a number of the most pressing issues of modern obstetrics and perinatology.

Clinical and anamnestic features of pregnant women that have subchorionic hematomas

Objective: researching of the clinical and anamnestic features of pregnant women have a 1-trimester abortion threat with the formation of a subchorionic hematoma (SCH), living in the Rostov region, and fi nd clinical and anamnestic risk factors of subchorionic hematoma. Materials and methods: in a study performed in State budgetary institution of the Rostov region Perinatal Center in years 2013-2016, 270 pregnant women with subchorionic hematoma in the period of 6-12 weeks of pregnancy and 79 pregnant women without subchorionic hematoma (relatively healthy) were included. Results: according to the study, the clinical and anamnestic features of the subchorionic hematoma in the Rostov region are lower body weight and body mass index, and the presence of uterine fi broids. Th e risk of subchorionic hematoma increases 19 times if woman has non-developing pregnancy history, 8.5 times — reccurent miscarriage, 7.5 times — perinatal losses. Conclusion: history of early pregnancy losses, both single (one spontaneous abortion or one non-developing pregnancy) and two or more early reproductive losses, history of perinatal loss increase the risk of subchorionic hematoma in a case of pregnancy.

ПРОФІЛАКТИКА ПЕРИНАТАЛЬНИХ ВТРАТ ПРИ СИФІЛІСІ.

Методи профілактики перинатальних втрат при сифілісі визначені на основі вивчення клініко-епідеміологічних особливостей і структури репродуктивних та перинатальних втрат серед 712 випадків сифілісу у вагітних в ЛОКПЦ, ЛОКЛ та ЛКОШВД № 1 в 2011–2015 роках. Профілактика перинатальних втрат складається з організаційних заходів Ж/К щодо раннього звернення вагітних у межах І триместру з приводу доношування вагітності й охоплення реакцією Вассерманна всіх вагітних при 1-му зверненні в Ж/К, поліпшення санітарно-просвітницької роботи акушерів-гінекологів і сімейних лікарів серед населення та молоді навчальних закладів, особливо підлітків, з метою роз’яснення здорового способу життя, попередження інфікування населення сифілісом та іншими збудниками сексуально- трансмісивних інфекцій, особливо підлітків, соціальної адаптації підлітків і їх статевого виховання.