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24Практика показывает, что пациентам необходимо какое -то время, чтобы полностью адаптироваться к полным съемным протезам.
В день сдачи полных съемных протезов проблемы с речью наблюдались у 58% пациентов, у 48% через 1 сутки, у 38% через 1-5 дней и у 12% через 5-30 дней (рис. 1).
Вдень сдачи полных съемных протезов проблемы с актом жевания наблюдались у 88% пациентов, через сутки у 78%, через1-5 дней у 72% и через 5-30дней у 42%(рис1). Механизм пережевывания пищи состоит из совокупности взаимосвязанных процессов. Зубы — лишь значительная часть этого процесса. В этот процесс входят язык, губы, щеки и слюнные железы.
При сдачи полных съемных протезы на верхнюю челюсть отмечалось раздражение слизистой протезного ложа у 37% пациентов и 63% на нижней челюсти, по истечении суток жалобы стали 32% в/ч и 58% н/ч, через-5 дней 18% в/ч и 21% н/ч, через 5-30суток 6% в/ч и 9%н/ч.(Рис2) В целом важно, чтобы зубные протезы не вызывали травматических повреждений, т.е. не раздражали слизистую оболочку полости рта. В некоторых случаях пациент с травматическим повреждением или дискомфортом может быть не в состоянии есть, глотать или даже говорить. Ортопеду стоматологу необходимо устранить все эти жалобы, чтобы пациент комфортно пользовался изготовленными протезами. Наше исследование показало, что для возвра-
щения к полноценному функциональному состоянию необходимо от 1 -до 30 дней. Все это сугубо индивидуально, кому-то достаточно 1 дня кому-то значительно больше.
Литература
1. Вагнер В.Д*., Булычева Е.А. Качество стоматологической помощи: характеристики и критерии //Стоматология.-2017.-№1.-23-24 с.
2. Bayramov Y.i., Bayramova N.Y., Tam protezlarin tutuculugunda anatomik faktorlar va onlarin maruz qaldigi tazyiqa göra xarakteristikasi. Saglamliq-2010. №8.-184-185 s.
3. Senih Qalikkocaoglu. Tam protezler.Cilt II.4 Baski.Ankara 2004.576-577.
4. Садыков, М.И. Оптимизация протезирования больных полными съемными пластиночными протезами на нижней челюсти [Текст] / М.И. Сады-ков, С.В. Винник // Стоматолог-практик. - 2014. -№4. - С. 24-25.
5. Садыков, М.И. Характер изменения площади протезного ложа нижней челюсти в зависимости от типа атрофии [Текст] / М.И. Садыков, С.В. Винник // Сборник статей Международной научно-практической конференции «Достижения и перспективы медицины» Уфа. - 2014. - С. 24-27.
6. М.И. Садыков, А.М. Нестеров, С.В. Вин-ник, А.Р. Эртесян. Усовершенствованный метод изготовления полного съемного пластиночного протеза на нижней челюсти. Современные проблемы науки и образования. - 2016. - №3
PRETERM LABOR IN MODERN OBSTETRICS
Shevchenko A.,
Candidate of Medical Sciences Department of Obstetrics and Gynecology Zaporizhzhia State Medical University Syusyuka V., Doctor of Medical Sciences Department of Obstetrics and Gynecology Zaporizhzhia State Medical University
Kruf Y.,
Doctor of Medical Sciences Department of Obstetrics and Gynecology Zaporizhzhia State Medical University Kyryliuk A., Candidate of Medical Sciences Department of Obstetrics and Gynecology Zaporizhzhia State Medical University Deynichenko O., Doctor of Philosophy Department of Obstetrics and Gynecology Zaporizhzhia State Medical University Onopchenko S. Candidate of Medical Sciences Department of Obstetrics and Gynecology Zaporizhzhia State Medical University
ABSTRACT
Data from national and worldwide literature on the study of premature birth problem are presented in the article. The accent is placed on risk factors, modern pathogenetic mechanisms of development, diagnosis and
tactics in premature birth. The frequency of preterm births didn't tend to decrease over the past decade despite all the efforts of scientific and practical obstetricians. The relevance of studying this problem is due not only to medical consequences, as evidenced by the proportion of premature infants in perinatal morbidity and mortality structure, as well as social significance.
Keywords: miscarriage, premature birth, etiopathogenesis, diagnosis, obstetric and perinatal complications.
Labor are considered to be preterm (partuspraema-turus) when they happen during period from 22 to 37 full weeks of gestation and lead to the birth of premature babies with unfinished period of normal intrauterine developement [1]. The term «premature babies» was adopted in 1929 and it is recognized worldwide. According to the recommendation of the Ministry of Health, since 1961 all infants whose weight is less than 2,500 grams are defined as newborns with «low birth weight». Since 1974 children, born with a body weight of more than 500 grams with gestational age from 22 full weeks are considered viable. To date, preterm labor (PL) are births that occurred between 22 full to 36 weeks and 6 days from the first day of the last menstrual period.
The urgency of PL takes an important place in modern obstetrics due to the high proportion of premature newborns (PN) in the structure of perinatal morbidity and mortality. On January 1, 2007, Ukraine connected to new standards of the Ministry of Health to define the term of the PN. As a result, perinatal morbidity and mortality rates have increased. In scientific works of B. M. Ventskivsky, V. V. Kaminsky, V. I. Gryshchenko and others (2009) authors emphasized the problem of premature infants, which account for 75% in the structure of neonatal mortality. At 23 weeks of gestation, among those, who were born, only 20% survive (every 5th newborn) at 26 weeks - 60%, at 27-28 weeks - about 80% of PN. Among those, who were born in 32 weeks of gestation and later, almost 100% survival was noted. Approximately 15 million children worldwide are born prematurely each year. From these, 1 million die before the age of 5 (that is 18% of all deaths of children of this age). 35% of cases of early and late neonatal death of newborns (under 28 days of age) are associated with premature birth [2]. Despite all the efforts of scientific and practical obstetrics, the incidence of PL over the past decade has not tended to decrease and varies from 6 to 15% depending on the geographical and demographic situation of the studied population. In recent decades, the number of pregnant women with risk of PL increased, including patients with scar on the uterus, premature rupture of amniotic membranes, extragenital pathology, multiple pregnancies, pregnancies with a help of reproductive technologies (IVF, ICSI, stimulation) [3-6].
The literature presents various statistics on the frequency of spontaneous abortions - from 12-13% to 2535% of the total number of pregnancies [3, 5]. In low-income countries, the average incidence of preterm birth is about 12% compared to 9.4% and 9.3% in middle-income and high-income countries, respectively [7]. The lowest rate was recorded in the Netherlands (3.5%) and the highest in India (34%). In the United States, about 7.5% of births are premature. In France -5%. According to the data of the Department of Health of Ukraine, frequency of premature births in Ukraine in
2019 was 3.4%. The WHO Committee of Experts provides data according to which the frequency of PL and miscarriage tends to increase.
The main factors of PL are: biological (age, anthropometric data, ethnic characteristics of parents, genetic and chromosomal abnormalities); ecological (unfavorable ecological environment increases the frequency of miscarriage by 1.7-2.2 times); infection (acute, chronic, systemic, ascending; bacterial and / or viral); mechanical factors (multiple births, polyhydramnios, abnormalities of uterine development, infantilism, isthmic-cervical insufficiency, intrauterine syn-echiae); endocrine; genetic; thrombosis and placental abruption occur because of thrombophilic disorders; maternal and fetal stress, which leads to hormonal changes [8].
According to the literature, one of the leading factors among miscarriages is the inflammatory disease of the ovum, placenta and its membranes, as well as internal genitals [9, 10]. Thus, the frequency of the detected inflammatory process in the placenta after a long period of intrauterine miscarriage is 76.5%, and without signs of threat - 20.2% [11-13]. Chronic infection also plays a specific role, namely: brucellosis, toxoplasmosis, rickettsiosis, as well as mumps viruses, herpes and cy-tomegalovirus [14, 15]. There are disorders in the reproductive system that cause chronic endometritis, followed by abortion thanks to the long-term persistence of infectious agents in the endometrium. Thus, in pregnant women with anamnesis of inflammatory miscarriage, the incidence of asymptomatic persistence of opportunistic pathogens in the endometrium is 68.3%, while in patients with a stillborn pregnancy in anamnesis of mixed infection with two or more pathogens in 26.7%. The main risk factors for obstetric and perinatal complications in women with a history of sexually transmitted infections (STIs) are: presence of a high infectious index in anamnesis (76.0% and 72.0%), chronic and acute inflammatory processes of the urinary tract (48.0% and 40.0%), STIs before pregnancy (32.0% and 28.0%), as well as reproductive losses of infectious origin (21.0% and 28.0%): miscarriages, fetal growth retardation and history of placental dysfunction, ante- and intranatal fetal death [16-19].
It was found that the risk of abortion is 5 times more common in women with abortion in anamnesis than in primiparous women, and its frequency is about 20% [20, 21]. An unfavorable prognostic factor is the presence of a history of medical abortions, which contribute to the growth of PL during the next pregnancy in 22.3-69.4% of cases [22]. In turn, inflammatory diseases of the uterine appendages, which often occur after an abortion, in 80% are the cause of spontaneous abortion. This fact is confirmed by studies of AV Kuz-netsova and co-authors (2002). Concomitant endo-crinopathies and autoimmune disorders, even acting indirectly on the pregnant woman, lead to fetal
developmental disorders and abortion. These indicators, according to various authors, range from 21.3% to 44.7% of cases [23-25].
Today, sexually transmitted diseases are also relevant and lead to the termination of a desired pregnancy and PL. According to the literature the increase in the incidence of AIDS in pregnant women, chlamydial infection (12-42%), herpes virus type II and cytomegalovirus (8-30%), bacterial vaginosis (20-65%) are the reasons of PL in 34-65% of cases [26-31]. In 80% of cases, the infection is mixed viral-bacterial or viral-viral, often in combination with candidiasis. As a result in a pregnant woman's body develops secondary immunodeficiency, which is clinically manifested by symptoms of abortion [32-36].
There are many reasons that can lead to the development of PL. However, it is advisable to focus on more detailed disorders of the functional state of the feto-placental complex (FPC), that leads to a high incidence of prenatal mortality [37], as well as the problem of vitamin D deficiency, which can not only cause dysregulation of phosphorus-calcium metabolism during pregnancy (impaired mineralization of the fetal bone system), but also increases the risk of preeclampsia, gestational diabetes, neonatal hypocalcemia, type 1 diabetes, metabolic syndrome, cardiovascular disease, etc. [38, 39].
According to MM Chernyak and OO Korchynska, PL remain the most common complication of pregnancy, which significantly increases the level of perinatal morbidity and mortality. However, it is undeniable that the prediction and prevention of PL is one of the main areas of prevention of perinatal losses [40].
PL in 64-74% of cases is caused by hormonal disorders. First of all, hormonal insufficiency of the ovaries and placenta on the background of infantilism of the reproductive system (70-75%). The state of hormone-producing function in PL is quite fully described in the works of R. L. Goldenberg, O. J. Rouse (2012). In miscarriage, the formation of the placenta occurs against the background of disruption of the synthesis of sex steroids, which is a significant imbalance of all metabolic changes in 75%. An important factor that determines the level of hormones in blood is the intensity of uteroplacental circulation, which determines the rate of estrogen precursors to the placenta and the rate of estriol produced in the placenta into a maternal circulation [41]. Persistent estrogen deficiency and placental progesterone are caused by activation of the androgenic spectrum of steroid hormones. During first months of pregnancy, despite the relative activity of some hormones, such as estradiol, the level of total estrogen and progesterone decreases progressively [42, 43]. Steroid imbalance in miscarriage leads to persistent changes in hormonal balance in the hypothalamic-pituitary system, impaired synthesis and secretion of gonadotropins, which are manifested in acyclic peaks of luteinizing and follicle-stimulating hormones with low total gon-adotropic activity in urine [44-46]. Decreased estriol production on the background of high blood levels of 17-B estradiol may be one of the diagnostic criteria, which, according to FF Burmunolova (1998), helps to increase the contractile activity of the uterine muscles.
According to R. L. Goldenberg (1998), the processes of biosynthesis of sex steroids during the formation of placenta are not fully normalized even under the influence of therapy, which can have negative consequences during pregnancy.
Pathogenetic relationship of morphological structure, features of feto-placental barrier and ovarian hypofunction was proved [47-51]. This leads to the premature occurrence of persistent placental insufficiency. The state of ovarian hypofunction and genital infantilism is prognostically unfavorable, which, according to EK Ailamazyan (2004), leads to involuntary premature termination of pregnancy in 32-34% of cases. Risk factors of PL include endocrine forms of infertility. According to V. M. Sidelnikova and co-authors (2010), the high-risk group of miscarriage and PL includes women whose pregnancies occurred after induced ovulation. The evaluation of functional diagnostic tests plays a leading role [52-54]. PL can be caused by disorders not only of ovarian function and fetopla-cental complex, but also by an adrenal cortex. However, I. S. Sidorova and I. O. Makarov (2000) proved that in a mechanism of miscarriage or premature birth, the change in glucocorticoid function of the adrenal cortex is not so significant. At the same time, one of the reasons for abortion, especially after the 20th week of pregnancy, may be hyperandrogenic adrenal gene-sis.30-40% of women with a threat of preterm labor (TPL) have functional insufficiency of the thyroid gland and a predisposition to hypothyroidism, while clinical manifestations are absent or have an erased character. It was proved that a decrease in production of thyroid hormones leads to conformational changes in protein composition of molecules, followed by a decrease in a number of sulfhydryl groups in blood serum of pregnant women [55-57]. Violation of hormonal homeostasis can be caused by a number of other immediate factors. The leading role among them belongs to neuroendocrine pathology, in particular diabetes melli-tus [58-60].
An important place among the causes of PP belongs to isthmic-cervical insufficiency (ICF), as well as malformations of the uterus. ICF may be functional, depending on endocrine disorders, including ovarian hypofunction. However, the most common cause of ICF is internal os injuries during instrumental abortion (up to 42%), less often - in large fetuses, rapid births, surgical manipulations (obstetric forceps, vacuum extraction of the fetus), unrecovered cervical ruptures [61-69].
Today the dominant is opinion that there is a natural selection at a high initial level of creation of chromosomal-abnormal embryos which is aimed on eliminating of chromosomal mutations carriers [70, 71]. Therefore, couples with more than two miscarriages in anamnesis need a thorough medical and genetic counseling, which includes genealogical research with analysis of the couple's family, including not only anamnestic data about miscarriages, but also all cases of premature births, stillbirths, fetal growth retardation (FGR), congenital anomalies, mental retardation and infertility [72-74].
A number of Ukrainian scientists, such as V. A. Potapov, T. V. Demchenko, M. V. Medvedev (2004), proved the role of preeclampsia in pregnant women as one of the causes, which can provoke PL (10,9-24%), polyhydramnios (16.6%), abnomal location and premature detachment of placenta (22.8%), as well as extragenital diseases (15.7-26.2%) [75-77]. The share of these diseases and complications of gestation in the structure of PL is about 40% [78-80].
Pregnant women with even one involuntary termination of pregnancy in anamnesis belong to the risk group for miscarriages and PL at different termines of pregnancy. A. Bocking and co-authors (1999) indicate that if there is at least one preterm birth in anamnesis, the risk of developing them during the next pregnancy is 37%, and in case of two or more births - more than 70%.
Literature data indicate the teratogenic effects of smoking and alcohol on the pregnant woman as a possible cause of complications during pregnancy and its premature termination [81-83].
Among researchers, the question of the influence of age on the likelihood of TPL remains controversial. According to Yu. P. Vdovichenko, A. V. Tkachenko (2002), TPL are more common (up to 67.3%) at the age of 21-30 years, ie during the heyday of a woman's reproductive function. At the same time, O. V. Salamin (2001) emphasizes that miscarriages and PL are more common in women under 18 and over 35 (50.4%).
It should be noted that there is a category of women in whom, despite all the studies, the cause of preterm termination of pregnancy can not be determined and the frequency of idiopathic PL is from 27.5 to 63.7% [84-86]. In a number of cases it has been stated that empirical drug therapy may be ineffective, while the use of psychocorrection methods gives a positive result [87, 88].
The variety of causes of PL dictates the need to know mechanisms of childbirth, which will individualize therapy for the threat of premature birth and save the lives of women and unborn children. The general level of health decreases, the fertile function of women worsens. Considering polyetiological nature of premature birth, the quality of outpatient and inpatient care of this cohort of women is of great importance. Since causes of abortion occur long before pregnancy, it is obvious that patients with this pathology in anamnesis should be examined and treated before pregnancy or from the moment of registration.
References
1. Prospects for treatment of threat of premature birth with the use of sublingual form of micronized progesterone / G. I. Reznichenko, N. Yu. Reznichenko, V. Yu. Potebnya, I. L. Antonyuk. Women's health. 2016. № 7. P. 28-33.
2. Walani S. R. Global burden of preterm birth. Int J Gynecol Obstet. 2020. № 150. P. 31-33.
3. Premature birth as the mo st important problem of modern obstetrics / G. M. Savelieva, R. I. Shalina, M. A. Kurzer, etc. Obstetrics and gynecology. 2012. № 8-2. P. 4-10.
4. Comparative characteristics of different methods of laboratory diagnosis of premature birth / S. I. Zhuk, I. V. Us, O. G. Vykova, N. V. Pekhno. Women's health. 2015. № 5. P. 38-40.
5. Premature birth - pathogenesis, prognosis and prevention (guidelines) / I. B. Ventskivska, V. V. Po-dolsky., V. V. Bila, O. S. Zagorodil. Kyiv, 2014. 22p.
6. Modern aspects of the study of predictors of premature birth in terms of evidence-based medicine / D. G. Konkov, A. V. Chernov, I. L. Corn, N. G. Burtyak. Bulletin of morphology. 2012. № 1. P. 193197.
7. Mosendz O. V. Causes and clinic of very early preterm birth. Reproductive Health of Women. 2021. №6. P. 44-49.
8. Preterm labor / G. T. Suchih, V. N. Serov, L. V. Adamyan etc. Problems of Reproduction. 2017. Vol. 23, № S6. P. 56-79.
9. Pathogenetic substantiation of use of natural progesterone in obstetric practice / V. O. Bitsadze, S. V. Akinshina, D. H. Khizroeva, etc. Obstetrics, Gyne-cology and Reproduction. 2014. Vol. 8, № 2. P. 79-88.
10. Savelieva G. M., Panina O. B., Bugerenko E. Yu. Estimation of blood flow in the mother-placenta-fetus system in early stages of pregnancy and intrauterine circulation in pre-pregnancy period. Journal of Obstetrics and Gynecology. 2012. Vol. 61. P. 73-78.
11. Konkov D. G., Halych S. R. Estimation of efficiency of prevention of premature childbirth in world practice: the purpose - the analysis of randomized controlled researches. Health of Ukraine. 2013. № 4. P. 3233.
12. The problem of the XXI century: premature birth / O. G. Pekarev, N. V. Onoprienko, P. Yu. Shtuk-kina, etc. Medicine and education in Siberia. 2013. № 4. P. 39.
13. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications / H. Blencowe, S. Cousens, M. Z. Oestergaard et al. Lancet. 2012. Vol. 379, № 9832. P. 2162-2172.
14. Kurtash N. Ya., Perkhulin O. M. Evaluation of disorders of a hormonal state of fetoplacental complex in pregnant women with HBV infection. Obstetrics. Gynecology. Genetics. 2016. Vol. 2, № 3. P. 19-22.
15. Nagornaya V. F. Hyperandrogenism as a cause of miscarriage. Obstetrics. Gynecology. Genetics. 2015. № 2. P. 12-17.
16. Korsak V. V., Patskan I. I. The effect of vaginal microbiotomy on pregnancy and childbirth. The 7th International scientific and practical conference «World science: problems, prospects and innovations» (March 24-26, 2021) Perfect Publishing, Toronto, Canada. 2021. 903 p.
17. Angiogenic factors and cytokines in women with physiological and complicated pregnancies depending on the sex of a fetus / T. L. Botasheva, V. A. Linde, N. V. Ermolova, etc. Taurian medical and biological journal. 2016. Vol. 19, № 2. P. 22-27.
18. Krotik O. Clinical analysis of somatic and reproductive history in pregnant women with a history of
sexually transmitted infections. Perinatology and repro-ductology: from research to practice. 2021. №1.4. P. 24-34.
19. Semenyak A. V. et al. "Intrauterine infection of the fetus-relay of diagnosis and treatment." Neonatology, Surgery and Perinatal Medicine. 2021. №11.2 (40). P. 27-32.
20. The short-term prediction of preterm birth: a systematic review and diagnostic metaanalysis / A. B. Boots, L. Sanchez-Ramos, D. M. Bowers et al. American journal of obstetrics and gynecology. 2014. Vol. 210, Iss. 1. P. 54.e1-54.e10.
21. Clinical Management and Outcome of Pregnancies Complicated by Previous Abruption / M. Sa-kikawa, T. Adachi, Y. Nakabayashi et al. Hypertension in pregnancy. 2011. Vol. 30, Iss. 4. P. 457-464.
22. Podolsky V. V. Abortion and its consequences for the reproductive health of women of childbearing age. Women's health. 2013. № 10. P. 32-34.
23. Modern ideas about the influence of regulatory autoantibodies on the development of the gestational process / R. S. Zamaleeva, V. K. Lazareva, I. A. Cherepanova, etc. Practical medicine. 2013. № 7. P. 6366.
24. Kornatska A. G., Vovk I. B., Chubey G. V. Reproductive health of women with uterine leiomyoma on the background of inflammatory diseases of the pelvic organs. Collection of scientific works of the Association of Obstetricians and Gynecologists of Ukraine.
2016. Vol. 2. P. 234-240.
25. Microbiological aspects of dysbiosis in infertility and miscarriage and their correction / N. K. Silina, G. M. Koval, T. M. Silina and others. Women's health.
2017. 10. P. 50-53.
26. Pyrohova V., Schuruk N. Vagine biotope in women with habitual abortion Giornale italiano di os-tetricia e ginecologia. 2013. Vol. 135, N 1. P. 312-313.
27. Boyko V. I., Bolotna M. A. Diagnosis and prevention of placental dysfunction in young women giving birth for the first time. Women's health. 2015. №. 8. P. 110-111.
28. Golovachuk O. K., Kalinovskaya I. V. Tactics of pregnancy management in women with identified genital infection. Modern science: current problems and ways to solve them. 2014. Vol. 8. P. 15-18.
29. Polymorphism of hemostasis and folate metabolism genes in the formation of placenta previa / N. I. Fadeeva, G. V. Serdyuk, M. G. Nikolaeva, etc. The attending physician. 2016. №. 3. P. 48.
30. STRIDER (Sildenafil TheRapy in dismal prognosis early onset fetal growth restriction): an international consortium of randomised placebo-controlled trials / A. Pels, L. C. Kenny, Z. Alfirevic et al. BMC pregnancy and childbirth. 2017. Vol. 17. № 1. P. 440.
31. Isolated oligohydramnios at term as an indication for labor induction: a systematic review and metaanalysis / G. Shrem, S. S. Nagawkar, M. Hallak, A. Walfisch. Fetal diagnosis and therapy. 2016. Vol. 40. № 3. P. 161-173.
32. Sandlin A. T., Chauhan S. P., Magann E. F. Clinical relevance of sonographically estimated amniotic fluid volume: polyhydramnios. Journal of ultrasound in medicine. 2013. Vol. 32, Iss. 5. P. 851-863.
33. Association of isolated polyhydramnios at or beyond 34 weeks of gestation and pregnancy outcome /A. Aviram, L. Salzer, L. Hiersch et al. Obstetrics and gynecology. 2015. Vol. 125, Iss. 4. P. 825-832.
34. A critical assessment of the «sterile womb» and «in utero colonization» hypotheses: implications for research on the pioneer infant microbiome / Perez-M. E. Muñoz, M. C. Arrieta, A. E. Ramer-Tait, J. Walter. Microbiome. 2017. Vol. 5, Iss. 1. P. 48.
35. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery / U. S. Sangkomkamhang, P. Lumbiganon, W. Prasertcharoensuk, M. Laopaiboon. The Cochrane database of systematic reviews. 2015. Iss. 2. P. CD006178.
36. Associations between low-and high-dose oral fluconazole and pregnancy outcomes: 3 nested case-control studies / A. Bérard, O. Sheehy, J. P. Zhao et al. CMAJ: Canadian Medical Association journal. 2019. Vol. 191, Iss. 7. P. E179-E187.
37. Romanenko T. G., Tkachenko A. V. Immuno-logical aspects of prevention, prognosis and treatment of miscarriage. Pediatrics, obstetrics and gynecology. 2010. № (6). P. 117-119.
38. Volosovsky P. R. Features of functional state of fetoplacental complex in women with a history of ectopic pregnancy. Women's health. 2016. № (7). P. 91-93.
39. Pirogova V. I., Shurpyak V. I., Zhemela N. I., Golota L. I. On the prevention of complicated pregnancy with a lack of vitamin D and its deficiency. Women's health. 2016. № (6). P. 19-27.
40. Chernyak M. M., Korchynska O. O. The current state of the problem of placental dysfunction in women with a burdensome obstetric history. Problems of clinical pediatrics. 2015. № 4 (30). P. 42-48.
41. Lisova, K., I. Kalinovska, Tokar P. "Changes in hormonal status of pregnant women with miscarriage in early gestation." Neonatology, Surgery and Perinatal Medicine. 2020. № 10.4 (38). P. 35-40.
42. Some aspects of the etiopathogenesis of premature birth / S. P. Pisareva, I. I. Vorobyova, A. A. Zhyvetskaya-Denisova and others. Taurian Medical and Biological Bulletin. 2012. Vol. 15, № 2. ch. 1. P. 242-245.
43. Mechanisms of adaptation of pregnant women with miscarriage in the dynamics of conservative therapy / V. A. Potapov, V. G. Syusyuka, V. A. Zharkikh, A. V. Plotnik. Women's health. 2016. № 5. P. 77-83.
44. Kalinovskaya I. V., Kondrya D. O. Changes in trophoblast hormones in pregnant women with miscarriage at early gestation. South Ukrainian Medical Journal. 2013. №. 6. P. 54-56.
45. Kondrya D. O., Podolsky V. V. Changes in trophoblast hormones in pregnant women with miscarriage in early gestation. Bukovynian Medical Bulletin. 2015. Vol. 19, № 2. P. 103-105.
46. Pecheryaga S. V. Prevention and treatment of primary placental dysfunction with abnormal placement of the fertilized egg in the uterus: dis... Cand. honey. Sciences: 14.01.01 / VDNZ of Ukraine «Buko-vyn. State Med. University». Chernivtsi, 2016. 180 p.
47. Ecological-hygienic and genetic risk factors for reproductive health of the female population of the Belgorod region / I. N. Verzilina, M. I. Churnosov, S. P. Pakhomov, etc. Moscow: Publishing House of the Russian Academy of Medical Sciences, 2014. 375 p.
48. Thrombophilia and pregnancy / M. V. Galaiko, O. V. Rybina, M. S. Litvinenko, etc. Clinical oncohematology. Basic research and clinical practice. 2017. № 3. P. 409-422.
49. Kamilova M. Ya., Rakhmatulloeva D. M., Arabova S. U. Changes in placental hormones and markers of apoptosis in women with risk of abortion and aggravated miscarriage. Sciences of Europe. 2017. № 14-1. P. 45-48.
50. Fetal sex in the expression of angiogenic factors and maintenance of cytokine balance in the maternal body during physiological pregnancy and placental insufficiency / T. L. Botasheva, V. E. Radzinsky, A. V. Khloponina, etc. Medical Bulletin of the North Caucasus. 2019. V. 14, №. 2. P. 325-329.
51. Second trimester serum biomarker screen for fetal aneuploidies as a predictor of preterm delivery: A population-based study / S. Nunthapiwat, R. Sekar-arithi, C. Wanapirak et al. Gynecologic and obstetric investigation. 2019. Vol. 84, Iss. 4. P. 326-333.
52. No evidence of obstetrical adverse events after hyperimmune globulin application for primary cytomegalovirus infection in pregnancy: experience from a single centre / L. D. Chiaie, P. Neuberger, M. Vochem et al. Archives of gynecology and obstetrics. 2018. Vol. 297, Iss. 6. P. 1389-1395.
53. Kolokot N. G. Improving the diagnosis of fetal growth retardation in pregnant women through the use of biochemical markers that characterize stress adaptation disorders. Zaporozhye medical journal. 2018. V. 20, № 2. P. 231-235.
54. Susyuka V. G., Abramov A. V., Belenichev I. F. The state of oxidative-antioxidant homeostasis of pregnant women with a history of miscarriage at the stage of sanatorium recovery. Medical hydrology and rehabilitation. 2015. V. 13, № 1-3. P. 42-47.
55. Melikova T. A. Optimization of methods of diagnosis and treatment of miscarriage in autoimmune diseases of the thyroid gland: author's ref. dis... Cand. Med. Sciences: 14.01.01 / Kharkiv. nat. med. un-t. -Kharkiv, 2017. 24 p.
56. Raghupathy R., Szekeres-Bartho J. Dydroges-terone and the immunology of pregnancy. Hormone molecular biology and clinical investigation. 2016. Vol. 27, Iss. 2. P. 63-71.
57. Maternal and neonatal outcomes of the pregnant women with idiopathic thrombocytopenic purpura / R. Melekoglu, S. Eraslan, A. G. Ba§temur et al. Perinatal Journal. 2017. Vol. 25, Iss. 4. P. 108-115.
58. Modern view of major obstetric syndromes (Review of foreign literature) / T. G. Romanenko, R. M. Mitsoda, Yu. Yu. Bobyk, N. Yu. Lemish. Women's health. 2019. № 2. P. 96-103.
59. Posokhova S., Kucherenko O. Risk factors for hypoxic-ischemic encephalopathy of premature infants. Science Review. 2020. № 3. P. 7-10.
60. Dnistryanska A. P., Musienko O. S., Yarem-chuk L. V. Comparative characteristics of the fetoplacental complex in women with type 1 diabetes and in pregnant women with gestational diabetes. Reports of Vinnytsia National Medical University. 2019. №. 4. P. 652-658.
61. Short cervix - predictor of preterm birth / L. M. Malanchuk, I. N. Malanchin, S. L. Malanchuk, Z. N. Kuchma. Women's health. 2016. № 1. P. 67-69.
62. Kusa O. M., Pakharenko L. V., Basyuga I. O. Miscarriage: the main etiopathogenetic aspects of isth-mic-cervical pathology. X International Scientific and Practical Conference «Topical issues, achievements and innovations of fundamental and applied sciences». 2021. P. 171-173.
63. Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: US Preventive Services Task Force Recommendation Statement / D. K. Owens, K. W. Davidson, A. H. Krist et al. JAMA. 2020. Vol. 323, Iss. 13. P. 1286-1292.
64. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases / C. Chen, X. Song, W. Wei et al. Nature communications. 2017. Vol. 8, Iss. 1. P. 875.
65. Colpocytological study data in women with habitual miscarriage depending on the ecological status of the environment / L. S. Tselkovich, RB Balter, ES Makarova, etc. Postgraduate Journal of the Volga Region. 2017. № 1-2. Pp. 39-42.
66. Vaginal progesterone reduces the rate of pre-term birth in women with a sonographic short cervix: a multicenter, randomized double-blind, placebo-controlled trial/ S. S. Hassan, R. Romero, D. Vidyadhari et al. Ultrasound in obstetrics and gynecology. 2011. Vol. 38, Iss. 1. P. 18-31.
67. Nosenko O. M., Kamel B. Influence of detection of risk factors and timely diagnosis and correction of isthmic-cervical insufficiency on the results of childbirth. Collection of scientific works of the Association of Obstetricians and Gynecologists of Ukraine. 2019. № 2. P. 91-96.
68. Syusyuka V., Solovyova N., Khvoyko V. Estimation of risk factors for isthmic-cervical insufficiency. Proceedings of ICNS conferences. 2020. P. 4243.
69. Ibadova T. V., Malyar V. V., Malyar V. A. Undifferentiated connective tissue dysplasia is a factor of high risk of ICI in case of miscarriage and premature pregnancy. Problems of clinical pediatrics. 2019. № 3. P. 10-13.
70. Role of natural killer cells in reproductive failure / A. O. Agnaeva, O. N. Bespalova, D. I. Sokolov et al. Journal of obstetrics and women's diseases. 2017. Vol. 66, Iss. 3. P. 143-156.
71. Methods for diagnosing the threat of abortion in the first trimester / E. V. Enkova, I. A. Tyurkin, O. V. Hoperskaya, O. V. Gaiskaya. Systems analysis and management in biomedical systems. 2017. T. 16. № 1. P. 44-48.
72. Ginzburg B. G. Physical development of children born in families with repeated miscarriages. Russian Journal of Perinatology and Pediatrics. 2017. Vol. 62, № 4. P. 59-64.
73. The role of systemic inflammatory response syndrome in the development of premature births / M. K. Medzhidova, VL Tyutyunnik, NE Kahn, etc. Problems of reproduction. 2016. Vol. 22. № 2. P. 116-120.
74. Ways to reduce frequency of pregnancy complications with the help of vitamin-mineral complex / S. M. Geryak, N. V. Petrenko, V. Yu. Dobryanska and others. Women's Health: Implementation of Modern Protocols in Clinical Practice: Coll. Science. Ukr. interdisciplinary scientific-practical conf. March 1-2 Ter-nopil: Textbook. and manual., 2018. P. 37.
75. Suleymanova V. S., Ablekovskaya O. N. Estimation of the most common complications of pregnancy in women in modern radioecological conditions. Sakharov Readings 2019: Environmental Problems of the XXI Century: Proceedings of the 19th International Scientific Conference, May 23-24, 2019, Minsk, Republic of Belarus. Minsk: IVC Minfina, 2019. Ch. 2. P. 23-26.
76. Peculiarity of vaginal microbiota in women with bronchial asthma depending on the course of pregnancy / E. A. Boitsova, T. V. Kosenkova, N. M. Bog-danova, etc. Medicine: theory and practice. 2019. Vol. 4. № 3. P. 148-156.
77. Peculiarities of functional endothelial activity in pregnant women with hypertensive disorders and their newborns / G. N. Chistyakova, I. I. Remizova, S. V. Bychkova, etc. Problems of reproduction. 2020. Vol. 26. № 1. P. 95-103.
78. The role of preimplantation genetic screening in the effectiveness of assisted reproductive technologies in patients with habitual miscarriage (literature review) / O. E. Korotchenko, N. V. Dolgushina, A. G. Syrkasheva, E. V. Kulakova. Reproduction problems. 2017. V. 23. № 2. P. 50-55.
79. Comparing serum levels of Th17 and treg cytokines in women with unexplained recurrent spontane-
ous abortion and fertile women / N. Roomandeh, A. Saremi, J. Arasteh et al. Iranian Journal of Immunology. 2018. Vol. 15, Iss. 1. P. 59-67.
80. Th1/Th2 Dichotomy in Obese Women with Gestational Diabetes and Their Macrosomic Babies / A. Seck, A. Hichami, S. Doucoure et al. Journal of diabetes research. 2018. Vol. 2018. Article ID 8474617
81. Bulavenko O. V., Muntyan O. A. Clinical and anamnestic features of pregnancy loss in women from primary non-vintage. Medical forum. 2017. № 12. P. 48-50.
82. Anokhova L. I., Belokrinitskaya T. E., Smol-yakov Yu. N. Prediction of placental insufficiency in premature birth. Transbaikalian Medical Bulletin. 2016. № 2. P. 66-70.
83. Bondarenko N. P. Factor of activation of systemic inflammatory response as a predictor of negative consequences of parvovirus infection in different trimesters of pregnancy. Women's health. 2018. № 3. P. 95-98.
84. Sadygov Yu. M. Prediction and prevention of late pregnancy in late pregnancy in women with viral infections. Women's health. 2016. № 7. P. 94-96.
85. Markin L. B., Kuninets G. Ya. Effectiveness of preventive measures with the use of vitamins and minerals in persons with idiopathic habitual miscarriage. Lviv Clinical Bulletin. 2014. № 1-2. P. 39-41.
86. New model for predicting preterm delivery during the second trimester of pregnancy / Y. Z. Zhu, G. Q. Peng, G. X. Tian et al. Scientific reports. 2017. Vol. 7, Iss. 1. 7: 11294.
87. Boychuk O. G. Influence of psychological factors on the psycho-emotional status of women with infertility. Theoretical and applied problems of psychology. 2018. № 1. P. 334-344.
88. Sirakovska OB Psychological aspects of women's reproductive health. Psychological journal. 2018. №. 4. pp. 185-205.
