The objective: to establish probable clinical and paraclinical risk factors for the development of gestational hypertensive disorders (GHD) in pregnant women after the use of assisted reproductive technologies (ART).Materials and methods. A clinical and statistical analysis of the birth histories of 362 women who became pregnant after the use of ART was carried out. Among them, 103 patients with had pre-gestational arterial hypertension (AH) and were included in the 1st group, 51 patients with increased blood pressure for the first time after 20 weeks of pregnancy – GHD, were included in the 2nd group, and 208 women without hypertensive disorders (HD) neither before nor after pregnancy were included in the 3rd group (control one). To determine the prognostic value of probable clinical and paraclinical risk factors for the GHD development in patients after ART, the following factors were analyzed: place of residence, age during pregnancy, obstetric, gynecological and reproductive history, marriage status, body mass index. The assess of commonly known factors was also evaluated for the risk of development for GHD. The influence of method of artificial insemination is also considered.Statistical processing of the results was carried out using standard Microsoft Excel 7.0 and “Statistica 6.0” programs. Results. The research demonstrated that HD is a common complication in pregnant women after the use of ART and accounts for 42.5 %. The frequency of women ≥40 years old was significantly higher in the 1st (42.8 %) and 2nd (25.5 %) groups than in the 3d one (15.5 %), as well as the prevalence of secondary infertility among the examined female patients – 23.3 %, 37.2 % and 6.3 %, respectively. Diabetes was found in women of the 1st (7.8 %) and 2nd (5.9 %) groups statistically more often compared to the control group (1.9 %), multiple pregnancy – in 45.6 %, 52.9 % and 27.0 % cases, respectively; 11.8% of patients in the 2nd group were diagnosed with autoimmune diseases.In patients with pregestational AH and GHD there was the high frequency of secondary infertility which is significantly more compared to the control group (p<0.05). Therefore, it can be assumed that this factor may influence the development of GHD in the future.The use of donor eggs was significantly more frequent in women of the 2nd group (21.5 %) compared to patients of the 1st (4.9 %) and control (5.3 %) groups (p<0.05). Transfer of cryopreserved embryos was used in 54.3 % of pregnant women of the 1st group and in 45.1 % of pregnant women in the 2nd group, which is reliable compared to the indicators of the control group (17.7 %; p<0.05). This makes possible to state that the use of donor eggs and the transfer of cryopreserved embryos can lead to an increase in the risk of GHD development in the future.In the group of pregnant women with pregestational AH, there were significantly more patients with an intergenetic interval of 10 years or more. This suggests that a large intergenetic interval may have an adverse effect on the progression of hypertension during pregnancy. Conclusions. The clinical and paraclinical risk factors for the development of gestational hypertensive disorders in women who became pregnant after the use of ART were determined – pre-gestational arterial hypertension, diabetes, autoimmune diseases, multiple pregnancy after the use of ART, as well as moderate risk factors: the first pregnancy from “this partner” and the patient’s age ≥40 years. Additional risk factors for the development of gestational hypertensive disorders were established – pathological childbirth during previous pregnancies, secondary infertility, use of donor eggs, transfer of cryopreserved embryos, intergenetic interval of 10 years or more.

The article is devoted to a review of the literature, which highlights the issues of maternal and perinatal complications and management of pregnant women who are renal transplant recipients.The risks of the development of hypertensive complications, preeclampsia, infectious complications, gestational diabetes and the risk of the fetus during pregnancy in these women are discussed in details. Pregnancy does not cause graft rejection, but pregestational hypertension, increased plasma creatinine and significant pregestational proteinuria are the risk factors for this complication. Pregnant women with a kidney transplant have a significantly higher risk of fetal growth retardation and premature birth.The article provides recommendations for the optimal period for pregnancy after transplantation which are recommended by various professional medical societies, although there is still no agreement on this issue: the American Society of Transplantation claims that the ideal period is 12-24 months after transplantation, while European best practice guidelines recommends to plan pregnancy no earlier than 2 years after surgery.The observation of pregnant women who are renal transplant recipients should be performed by an obstetrician-gynecologist with experience in high-risk pregnancy together with a transplantologist and perinatologist or neonatologist. All pregnant women who are kidney transplant recipients should be monitored for blood pressure, and aggressive antihypertensive therapy should be prescribed if it increases. It is also necessary to monitor the function of the graft, on suspicion of rejection it is possible to perform ultrasound-controlled kidney biopsy.The principles of immunosuppressive therapy during pregnancy, which includes prednisolone, methylprednisolone, tacrolimus, cyclosporine and azathioprine, and the description the side effects for the mother, the impact on the fetus and breastfeeding of each of the drugs are presented in the article. In the absence of obstetric complications, the optimal method of delivery is spontaneous delivery through the natural birth canal in the term of 38-40 weeks of pregnancy. Breastfeeding is recommended despite immunosuppressive therapy. Breast-feeding should be avoided when such medications as mycophenolate mofetil, sirolimus, everolimus and belatacept are used.Despite the high risk of pregnancy and childbirth, kidney transplant recipients have a good chance of pregnancy outcomes and giving birth to a living child while maintaining their own health. Therefore, motherhood should be encouraged among such women, supported and provided with highly qualified medical care.

The number of pregnant women with kidney transplant is growing and will continue to increase in Ukraine and all over the world, taking into account the development of transplantology. Such patients belong to the high-risk group, however, a clear understanding and adequate evaluation of the prognostic factors which are described in the literature will allow to transfer from prohibition and intimidation to the stage of supporting motherhood and providing highly qualified medical care to women with kidney transplants.This article presents two clinical cases of pregnancy and childbirth in women with kidney transplants, which occurred in the Department of Internal Pathology of Pregnant Women of the State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O. M. Lukyanova National Academy of Sciences of Ukraine”. Both patients with kidney transplants that functioned for 4 and 5 years, respectively, visited the doctor in early pregnancy.The anamnesis of the first pregnant woman was without peculiarities, while the second patient already had an episode of acute transplant rejection in the anamnesis and organ retransplantation from her mother. In addition, she had viral hepatitis B and C, as well as an insufficient level of immunosuppression. The function of the transplants in both women was satisfactory, each of the persons suffered from secondary nephrogenic anemia. Correction of immunosuppression in both patients was difficult, especially at 28 weeks, which is associated with hemodilution of pregnant women. Both women experienced an episode of urinary tract infection, which is experienced by about 40 % of pregnant kidney recipients.The first pregnant woman was practically healthy at full term pregnancy and had no indications for abdominal operation delivery, however, due to a clinically narrow pelvis she had cesarean section, which is a technically difficult surgery in such cases. In the second patient, the last weeks of pregnancy were complicated by hypertension of non-placental origin and transplant function disorders, which became an indication for cesarean section at 38 weeks. In the postpartum period kidney function began to recover. The condition of both newborns was satisfactory.Therefore, despite the reliable pregnancy outcomes in kidney transplant patients, an increased risk of obstetric complications and adverse perinatal outcomes remains. Interdisciplinary monitoring with timely correction of kidney transplant function disorders, monitoring of immunosuppressive therapy, prevention of premature births, careful control of blood pressure and adequate fetal monitoring allows to hope for favorable obstetric and perinatal outcomes in this group of patients.

Immune thrombocytopenia (ITP) is an autoimmune disease which is characterized by antibody-mediated destruction of platelets by the reticuloendothelial system. The rate of ITP is 3.3 per 100,000 adults per year with a prevalence of 9.5 per 100,000 adults. Pregnancy does not increase the frequency or severity of ITP, but ITP can significantly affect pregnancy and cause bleeding in women.Pregnancy requires regular control of the number of platelets: monthly in the I and II trimesters, every 2 weeks – in the III trimester, and weekly control near the delivery date. Indications for treatment are determined by the pregnant woman condition, not the fetus, since it has not been proven that the treatment reduces the risks of thrombocytopenia in newborns with the development of cerebral hemorrhage.The drug of the first line of treatment of such pathology is prednisolone at a dose of 1 mg/kg orally once a day. An increase in the number of platelets is usually observed within 3-7 days, the maximum response is determined after 2-3 weeks. If necessary, the dose can be increased. When the required level of platelets is reached, the dose can be gradually reduced by 10-20 % to the minimum dose necessary to maintain the number of platelets at an acceptable level.Thrombocytopathy can be the cause of primary hemostasis disorders, even if the number of platelets in the blood is normal. For diagnosis, tests are carried out to detect the aggregation ability of platelets. In addition, flow cytometry can be used, which makes it possible to detect the defects of surface membrane receptors, as well as defects of the end point of secretion.ITP is a common cause of thrombocytopenia after viral infections. The onset of this pathology is more often detected in the second and third weeks after the onset of COVID-19. The treatment aim is to prevent the significant bleeding in patients with COVID-19.The article presents a clinical case of a pregnant woman with ITP and thrombocytopathy, whose pregnancy was complicated by COVID-19. The patient complained on bleeding gums, the appearance of hematomas on the skin. Medical treatment of the main disease included prednisolone, eltrombopag, intravenous human immunoglobulin, transfusion of platelet concentrate. At 34–35 weeks of pregnancy alive boy was born with a body weight of 2800 g, length of 49 cm, 7–8 points on the Apgar scale.