To determine the role and effectiveness of the proposed the­rapeutic and preventive complex in the correction of psychoemotional state in the dynamics of pregnancy in pregnant women after assisted reproductive technologies (ART) application in order to improve the tactics of antenatal obser­vation and prevention of obstetric and perinatal complications. 299 pregnant women were comprehensively examined and a set of therapeutic and preventive measures was carried out: the main group included 249 women whose pregnancy occurred as a result of ART application. The control group consisted of 50 pregnant women with spon­taneous pregnancy. The complex of measures for pregnant women after ART application included: micronized pro­gesterone, magnesium oxide, folic acid, L-arginine aspartate, Omega-3 polyunsaturated fatty acids and long-term psychological correction – before ART program, at 8-10 weeks of pregnancy, at 16-18 weeks of pregnancy and at 28-30 weeks of pregnancy. Introduction of the proposed complex of psychoemotional correction contributed to the formation of reactive anxiety and personal anxiety levels at a moderate level in women of subgroups IA-44 (89.8%) and 43 (87.6%), IIA – 43 (89.6%) and 44 (91.7%) and IIIA – 30 (83.3%) and 26 (72.2%), which is considered to be an adaptive, physiological type during pregnancy. The positive effect of the proposed complex of psychoemotional correction demonstrates the improvement of processes of formation of type of component gestational dominant, its return to the optimal type in women of subgroup IA – 41 (83.6%), IIA – 39 (81.3%) and IIIA – 26 (72.2%) that is close to the physiological course of pregnancy and contributes to the reduction of perinatal and obstetric complications among pregnant women of these subgroups.

Research objective: to determine the role and effectiveness of the proposed therapeutic and prophylactic complex in the correction of vaginal biocenosis disorders in the dynamics of pregnancy in pregnant women after assisted reproductive technologies (ART) to improve the tactics of antenatal observation and prevention of obstetric and perinatal complications.Materials and methods. 299 pregnant women were examined: the main group included 249 women with pregnancy after ART, the control group consisted of 50 pregnant women with spontaneous pregnancy.Therapeutic and prophylactic measures for pregnant women after ART included: micronized progesterone, magnesium oxide, folic acid, L-arginine aspartate, ω-3-polyunsaturated fatty acids, long-term psychological correction (on the eve of the ART program, at 8–10 weeks, 16–18 weeks and 28–30 weeks of pregnancy). The drug for antibiotic therapy for local sanitation of the genital tract was chosen taking into account the sensitivity to antibiotics of certain microbial associates and was prescribed for 7–10 days.At the second stage of sanitation of the genital tract probiotics were prescribed under the control of pH-metry to maintain the acidic environment of the vaginal contents, colonize the vagina and the vaginal part of the cervix with lactobacilli.Results. There was a significant decrease in the proportion of women with a large number of epithelial cells in the main groups, which are a sign of alterative inflammation, and this is coincides with a similar indicator in the control group. Women with moderate leukocyte count and mixed Gram-negative microflora prevailed in IB, IIB and IIIB subgroup, who received conventional therapy. There was no significant difference in IIIA and IIIB subgroups.In the vaginal biocenosis significantly increased the Lactobacillus spp. content against the background of probiotics with local and general action in ІА, ІІА and ІІІА subgroups. The average Lactobacillus spp. concentration was significantly different from the average indicators of subgroups receiving conventional therapy for vaginal sanitation, with a significant decrease in the biocenosis of aerobic and anaerobic microorganisms and Candida albicans, which indicates the effectiveness of the proposed two-stage treatment.Conclusions. The proposed improved two-stage sanitation of the genital tract with a selective probiotic against the background of long-term progesterone and magnesium support ensures the stabilization of the vaginal pH at the physiological level corresponding to the normocenosis, and contributes to a significant increase in Lactobacillus spp. within the physiological norm with a significant decrease of Candida albicans concentration in the biotope, as well as opportunistic pathogens of aerobic and anaerobic origin. This is provides conditions for the prolongation of pregnancy in women after ART treatment cycles.

Doppler study is one of the main methods for assessing the condition of placental blood circulation and fetal hemodynamics. Doppler blood flow in the uterine arteries demonstrates the broad capabilities of the method for predicting pregnancy complications such as gestosis, fetal development delay, preterm birth, as well as for diagnosing adverse perinatal consequences. However, there is still no clear opinion about the feasibility of using Doppler as a screening test, as well as about the optimal pregnancy period for this type of study. The objective: is to study the hemodynamic features in pregnant women after assisted reproductive technologies (ART) application in the dynamics of the first part of pregnancy. Materials and methods. 299 pregnant women were examined – the main group included 249 women whose pregnancy occurred as a result of ART application. The control group consisted of 50 pregnant women with spontaneous pregnancy and its physiological course. I group – 94 women with tubal-peritoneal factor of infertility, II group – 87 women with endocrine factor of infertility, III group - 68 women whose infertility was caused by the male factor. Doppler ultrasound examination of the uterine arteries, arteries of the umbilical cord and middle cerebral arteries of the fetus were conducted. Results. It was found that the highest intensity of hemodynamics in the uterine artery basin at 11–12 weeks of gestation was recorded in a group of patients with a physiological course of pregnancy. The systolic-diastolic ratio in the right and left uterine arteries in these patients was 1.9 (1.8–2.7) and 2.1 (1.9–2.6), respectively. In contrast to women in the control group, pregnant women after ART application analyzed indicators were higher (1.6–1.9 times; p<0.0001). The systolic-diastolic ratio in the right uterine artery in III group was 3.0 (2.4–3.5), I group – 3.3 (3.1–3.4). Similar data were obtained analyzing the curves of blood flow rates in the left uterine artery – 2.9 (2.1–3.5) and 3.0 (2.7–3.6), respectively. The highest peripheral resistance, both in the right (3.6 (3.4–3.7) and left (3.5 (3.2–3.8) uterine arteries, was naturally registered in pregnant women of II group. In 36 (72%) patients with uncomplicated course and successful gestation at 11–12 weeks of pregnancy, blood flow was not recorded in the intervellon space. In the vast majority – 50 (73.5%) pregnant women of I group, two types of blood flow were registered in the intervellar space: pulsating arterial and continuous venous. Only in 18 (26.5%) patients of this group the blood flow in intervellon space was not determined. As a result of the obtained data analysis, it was found that at 16-17 weeks of gestation, the highest intensity of blood flow in the uterine artery pool was recorded in the control group. Thus, the systolic-diastolic ratio of the right and left uterine arteries in these subjects was 1.6 (1.5–1.8) and 1.8 (1.6–2.0). In pregnant women of the main group, the indicators were significantly higher (1.2-2.0 times; p<0.0001). The systolic-diastolic ratio in the uterine arteries in group III was 2,1 (1,9–2,6); 2,2 (1,9–2,5), in the II group – 3,1 (2,5–3,3); 2,2 (1,9–2,5), in the I group – 2,6 (2,5–3,2); 2,7 (2,5–2,9). In contrast to the control group, in which the systolic-diastolic ratio in the fetal umbilical artery was 3.4 (3.3–3.5), in III group patients, there was a significantly higher intensity of umbilical blood flow (S/D – 3.3 (3.5–3.6), p=0.03). At the same time, feto-placental hemodynamics in II and I groups patients was characterized by a significant increase in the numerical values of blood flow in the umbilical arteries (S/D – 4.5 (4.4–4.7), p=0.0001 and 3.5 (3.5–3.6), p=0.03, respectively). In patients of the control group, the systolic-diastolic ratio of the middle cerebral artery of the fetus at 16–17 weeks of gestation was 3.4 (3.4–3.5), almost completely coinciding with the same indicator in the umbilical artery (S/D – 3.4 (3.3–3.5). Patients of group III had a higher blood flow intensity, as evidenced by significantly lower (S/D 3.2 (3.1–3.3), compared with the control group (S/D 3.4 (3.4–3.5) absolute values of the systolic-diastolic ratio. An increase in the intensity of blood flow in the fetal medial artery (against the background of increased vascular resistance in the umbilical artery) was also recorded in the group of subjects of group II (S/D – 2.8 (2.7–2.9). High absolute values of systolic-diastolic ratio in the indicated vessel (4.4 (4.3–4.5) were found in the fetuses of the examined group and group, which characterize a significant decrease in the intensity of cerebral blood flow, compared with all the analyzed groups. Conclusions. Thus, the results of the study allow us to attribute Doppler ultrasound to highly informative research methods that make it possible to predict hemodynamic changes in the mother-placenta-fetus system, depending on the type of infertility, take preventive measures and start correction in time. Keywords: pregnancy, assisted reproductive technologies, Doppler ultrasound, uterine arteries, systolic-diastolic ratio.

Study objective: to determine the role and effectiveness of the proposed therapeutic and preventive complex and psychoemotional correction of hormonal disorders in the pregnancy dynamics after assisted reproductive technologies (ART) to improve the antenatal observation and prevention of obstetric and perinatal complications.Materials and methods. The study included 299 pregnant women: the main group included 249 women whose pregnancy occurred as an ART result; the control group included 50 pregnant women with spontaneous pregnancy. Therapeutic and prophylactic complex for pregnant women after ART included: micronized progesterone, magnesium oxide, folic acid, L-arginine aspartate, ω3-polyunsaturated fatty acids and long-term psychological correction on the eve of the ART program, at 8–10, 16–18 and 28–30 weeks of pregnancy. Results. There was a significant increase in the β-chorionic gonadotropin (β-hCG) level in women of the study groups in the first trimester of pregnancy against the background of the proposed treatment. Mean β-HCG value at 7–8 weeks of gestation in the subgroup IA exceeded the subgroup IB by 37% (p <0.05), in subgroup IIA it exceeded the subgroup IIB by 33% (p <0.05). The mean β-hCG value in subgroups IIIA and IIIB did not have a significant difference in the dynamics of the first trimester compared with the control group and among themselves (p >0.05).Mean progesterone value at 7–8 weeks of gestation in subgroup IA increased by 38% in comparison with pregnant women who received the conventional treatment complex (p <0.05), in subgroup IIA it was 73% higher than in subgroup IIB (p <0.05). There was no significant difference in the progesterone level in subgroups IIIA and IIIB in the dynamics of the first trimester.The average cortisol value at 23–24 weeks of pregnancy in subgroup IA decreased by 42% (p <0.05), in pregnant women with endocrine infertility against the background of the proposed treatment complex it was 62% less than in subgroup IIB (p <0.05). The average cortisol level in women with a male factor of infertility was 63% lower than in subgroup IIIB against the background of the proposed complex (p <0.05).Conclusion. Advanced therapy with micronized progesterone in combination with magnesium saturation, L-arginine aspartate, folic acid, ω-3 polyunsaturated fatty acids, as well as long-term psychoemotional correction is appropriate and effective compared to conventional therapy for pregnant women.

1 2 ABSTRACT The aim: To obtain the first estimates of the current prevalence rate of episiotomy infections in the puerperium and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population consisted of all women who had a vaginal delivery in 7 Regional Women’s Hospitals of Ukraine. Definitions of episiotomy infections were used from the Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN). Results: Total 35.6% women after vaginal delivery had episiotomy done. The prevalence rate of episiotomy infections was 17.7%. The predominant pathogens were: Escherichia coli (49.2%), Enterobacter spp. (11.1%), Streptococcus spp. (9.1%), Enterococcus faecalis (6.5%), Klebsiella spp. (8.1%), followed by Pseudomonas aeruginosa (4.7%), Staphylococcus aureus (4.2%), Proteus spp.(2.9%) and Staphylococcus epidermidis (2.8%). The overall proportion of methicillin-resistance was observed in 17.3% of Staphylococcus aureus (MRSA). Vancomycin resistance was observed in 6.8% of isolated enterococci. Carbapenem resistance was identified in 8% of P.aeruginosa isolates. Resistance to third-generation cephalosporins was observed in 15.2% Klebsiella spp. and E.coli 16.4% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 26.4%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (31.4%, vs 12.5%). Conclusions: Episiotomy infections in the puerperium are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. Optimizing the management and empirical antimicrobial therapy may reduce the burden of episiotomy infections, but prevention is the key element.