Introduction. In recent years, there have been significant changes in the understanding of the hormone melatonin (MT). It has been confirmed that the processes of conception, pregnancy, and childbirth directly depend on the rhythm and level of MT secretion, but there is no general concept that could describe in detail the mechanisms of influence on ontogenesis.The aim of the study. To assess MT in the blood of pregnant with retrochorial hematoma (RCH) up to 12 weeks of pregnancy.Material and methods. Two groups were formed: 1st comprized 40 pregnant women with RCH, 2nd, control consisted of 44 healthy pregnant. Obstetric research, enzyme immunoassay to determine MT, and ultrasound were performed.The approval of the scientific work was obtained from the Bioethical Commission of the Bukovinian State Medical University (Ukraine).Statistical analysis was performed according to generally accepted methods of variational statistics.The work is a fragment of the research work “Prevention, diagnosis and treatment of disorders of the perinatal period and the reproductive system of women and adolescent girls” (No. 201110Н, state registration number 0111U006499).Results. A significant decrease of MT in the 1st group and the dependence of its level on the size of the RCH was revealed: in the case of hematomas up to 1 cm MT (59.31±10.32 pg/ml) (р ˂ 0.001), which is not observed in hematomas more than 1 cm, which are dangerous for pregnancy (93.98±14.52 pg/ml), which may indicate a compensatory increase in MT; and the term of pregnancy (in 10-12 weeks 79.03±9.61 pg/ml (р ˂ 0.05), in 5-6 weeks 93.78±17.44 pg/ml).Conclusions. In cases of RCH up to 1 cm the content of MT decreases with the development of pregnancy, which can be used as a prognostic marker for the diagnosis of pregnancy complications. The increase in the level of MT with RCH more than 1 cm can be considered as a compensatory increase for the preservation of pregnancy and a regulatory influence on the further course of pregnancy.

Іntroduction. Intrauterine infection of the fetus is oneof the most important problems in obstetrics. The absenceof adequate treatment leads to a number of complicationsthat develop during pregnancy, childbirth, and postpartumperiod. There are often situations when the consequences ofthe invasion of microorganisms are more important than thepresence of an infectious agent itself.The aim is to analyze the indicators of microcytosis ofthe vagina, cervical canal, the peculiarities of pregnancywith infection of the fetus, and the effectiveness of varioustreatment regimens.Material and methods. 20 healthy women withphysiological course of pregnancy (the control group) and62 pregnant women with signs of fetal infection (the maingroup) were examined using clinical, microbiological,bacteriological, serological methods, statistical analysis,and fetal ultrasound.Results. Depending on the trimester, pregnant womenof the main group were divided into two subgroups: thefirst subgroup - at 18-24 weeks (50 pregnant women), thesecond - at 28-34 weeks (12 pregnant women).The statistical analysis of changes in vaginalmicrocynosis was conducted depending on the term. Thesignificant difference regarding the effect of gram negativediplococci, morphologically similar to gonococcus,Streptococcus agalactiae in the third trimester was found outalong with Ureaplasma urealyticum, Chlamidia trahomatisin the second trimester and Trichomonas vaginalis andMycoplasma hominis regardless of trimester.Ultrasound in the first subgroup revealed a syndromeof fetal growth retardation in 20 % of women, an abnormalamount of amniotic fluid in 24 %, changes in the structureof the placenta in 14 %, enlargement of the pelvic system ofthe kidneys in 52 %, intestinal hyperechogenicity in 60 %,and hepatomegaly in 4 % of cases. In the second subgroup,the abnormal amount of amniotic fluid was found in 16.7 %of pregnant women, changes in the structure of the placentain 83,3 %, and progressive shortening of the cervix in 33.3% of cases.Pregnant women of the main group were offered acourse of specific antibacterial therapy.In case of positive dynamics within three days (reductionof pathological secretions, polyhydramnios and otherultrasound signs of fetal infection), treatment is continued.In case of negative dynamics or no effect within three daysantibacterial agent must be changed. If symptoms reoccur,a repeat course with a new antibacterial agent is prescribed.Conclusions. Disorders of vaginal microcynosis andcervical canal were found in 80.6% of pregnant women,the rest of them were diagnosed with the ultrasound signsof infection of the fetus without changes in vagina andcervical canal.The proposed regimens of antibacterial therapy areeffective in the second trimester of pregnancy, indicatingthe necessity of examination and treatment during thisperiod, and in case of structural changes in the cervix causedby gram-negative diplococci, morphologically similarto gonococcus and Trichomonas vaginalis. Antibacterialtherapy is not effective enough in case of the developmentof placental dysfunction, and the threat of premature birthin the third trimester.

Іntroduction. Today, a quarter of the population of economically developed countries has a body weight that is 15% larger than the norm. According to various authors, the timely onset of menarche in women with various forms of obesity and reproductive dysfunction is observed in 31% of cases only. Obesity results in insulin resistance, which in its turn results in hyperinsulinemia. The main reason of the connection of insulin resistance with reproductive function disorders consists in the specific influence of insulin on ovaries. Insulin suppresses apoptosis, binding to receptors of various growth factors that promotes long existence of atresizing follicles. In the pathogenesis of the metabolic syndrome, along with the development of hyperinsulinemia and insulin resistance, a significant role belongs to the imbalance of adipocytokines, one of which is adiponectin. The aim is to analyze metabolic processes in the formation of menstrual dysfunction in adolescent girls with obesity to improve diagnostic methods of menstrual disorders. Material and methods. Clinical and laboratory examination of adolescent girls aged 12-18 years was held, among which 79 had obesity and complaints about menstrual dysfunction (the main group); 31 with normal body weight and regular menstrual cycle (the control group). Research methods: general clinical, biochemical (indicators of lipid and carbohydrate metabolism were determined), instrumental (ultrasound), statistical. Results. It was found that 53.3% of the girls from the main group had the beginning of the first menstruation after 14 years, delayed menstruation from 42 days to 6 days, duration 2.1 ± 0.05 days, which was significantly shorter, the volume of 10.2 ± 0.05; 0.4 points (average 1-2 pads per day) was significantly lower (p <0.05). Ultrasound showed uterine hypoplasia in almost every second girl in the main group - 36 (45.46%). Hyperleptinemia and leptin resistance was found in obesity of the first degree 34.8 ± 1.75, in obesity of the second degree 37.15 ± 2.12, in obesity of the third degree 40.64 ± 2.0. It was 14.35 ng / ml in the control group, p<0,01. Hyperleptinemia in the main group was accompanied by hyperinsulinemia in 26% of cases and insulin resistance. The relationship between low values of adiponectin and elevated body mass index in patients of the main group was established, which was confirmed by the results of correlation analysis (adiponectin & body mass index: ρ = -0.74). Analysis of the results revealed a decrease of A/L level in the main group by 4.3 times. Based on our own results, the A/L and HOMA-AD models can be considered more accurate for determining insulin resistance. Conclusions. 1. Changes of the menstrual cycle in overweight girls were found. The association of adipokines secretion disorders is characterized by hyperleptinemia, leptin resistance, decreased Adiponectin / Leptin index and hypoadiponectinemia, which, in combination with insulin resistance, indicates the participation of adipokines in the genesis of oligomenorrhea. The algorithm of adolescents’ treatment with menstrual dysfunction on the background of obesity must include the calculation of Adiponectin/Leptin and HOMA-AD, which will make it possible to avoid overdiagnosis of insulin resistance.

The authors have carried out an examination and treatment of 25 pregnant women with pyelonephritis, which arose during different terms of pregnancy, using a "stepwise" antibiotic therapy with a transition to suppressive therapy until the end of pregnancy. A comparison group was made up of 20 pregnant women with pyelonephritis, who were not preseribed suppressive therapy. The absence of recurrences in 95 % of the gravidas of the basic group has been established, regardless of the drug used for suppressive therapy. In the comparison group of women who were not prescribed suppressive therapy until the end of pregnancy, the absence of the relapse was observed in 11 % of pregnant women, which was significantly different.