The aim: The aim of the study was to improve the results of treatment of patients with endometriosis by using a combination method of therapy. Materials and methods: For two years, 136 women of reproductive age who underwent laparoscopic surgeries for ovarian endometriosis were monitored: Group I (n = 24) did not receive any hormonal treatment in the perioperative period; Group II (n = 32) – received gonadotropin-releasing hormone agonists within 3 months after surgery; Group III (n = 80) prior to laparoscopic removal of the ovarian cyst used gonadotropin-releasing hormone agonists – Triptorelin 3.75 mg intramuscularly for 2 months, as well as three months after surgery. The control group consisted of 30 healthy women of reproductive age with regular menstrual periods. All patients underwent transvaginal ultrasound, counting the number of antral follicles before and after treatment. Serum hormone levels (FSH, prolactin, thyrotropic hormone, anti-Mullerian hormone, inhibin B) were determined by enzyme-linked immunosorbent assay on Cobas e-411 analyzer (Roche Diagnostics, Switzerland) on day 2-3 of the menstrual cycle and on day 2–3 of the first menstrual period after the end of treatment. Laparoscopic removal of the cyst was performed with exfoliation of the cyst, hemostasis on the wound surface of the bed of the cyst was performed with a bipolar electrocoagulator. Bipolar coagulation and resection of the ovarian tissue with no potential was used during surgical treatment of the ovaries, which made it possible to preserve the intact portion of the ovary as much as possible. Results: Analysis of ovarian reserve indices, namely number of antral foliculs, number of antral follicles, AMG, and inhibin B levels in all examined patients with ovarian endometriomas were significantly lower than those of the control group before the start of treatment: in the ovarian endometrial group group 1.26 times (p <0.01), inhibin B – 1.5 times (p <0.01), the number of antral follicles – 1.2 times (p <0.01), due to the development dystrophic changes of the follicular apparatus due to prolonged compression, hypoxia, fibrosis in the ovaries. Patients who planned pregnancy were advised to have an active sexual life before menstruation was restored. In 23 (46.9%) of 49 patients who had reproductive plans, pregnancy occurred without first menstruation after a course of gonadotropin-releasing hormone agonists, 12 (24.5%) women became pregnant during the first three menstrual cycles. Extracorporeal fertilization was recommended for women who did not have pregnancy within 6 months of surgery. For two years in women who did not plan pregnancy, recurrence of endometriosis was not observed. Conclusions: The combination of laparoscopic treatment with gonadotropin-releasing hormone agonists in patients with endometriosis with infertility allowed to restore reproductive function in 71.4% of women, which indicates the effectiveness of the treatment method used. In addition, it helps to achieve lasting remission and addresses the socio-social problems of women’s health and maternity.

The aim: to study the content of trace elements (Fe, Cu, Zn, Co, Cr, Ni, Pb) in the placenta of pregnant healthy women and with signs of intrauterine infection of the fetus, features of transplacental transmission of infectious process from mother to fetus and to investigate the role of the placenta in trace element supply of the fetus. Materials and methods. 43 pregnant women between the aged 16 to 40 years were monitored, including 12 with physiological pregnancy (group 1) and 31 with signs of STI (group 2). All pregnant women underwent standard comprehensive examination, evaluation of fetal cardiac output and non-stress testing using cardio-toсography (CTG) in the third trimester. The group of pregnant women with signs of fetal ulcers included women whose pregnancy was complicated by chronic fetoplacental dysfunction (FPD), infectious lesions of the fetoplacental complex, which were diagnosed on the basis of ultrasound signs of placenta, syndrome of infectious and surrounding infections. Results: The content of essential trace elements in the placenta of the main group was significantly lower than in the placenta of the control group. There was a decrease in the concentration of iron by 32%, zinc – by 46%, nickel – by 44%, copper more than tripled, chromium – 4 times. Deficiency of essential trace elements (iron, zinc, copper, chromium, nickel) and elevated lead content in the placenta leads to the formation of conditions for the development of placental dysfunction, the progression of which leads to fetal distress, developmental delay syndrome and antenatal fetal death. Conclusions: 1. One of the links in the pathogenesis of intrauterine infection in the fetus is the imbalance of essential trace elements in the system «mother – placenta – fetus». 2. Pregnant women with signs of intrauterine infection are characterized by a deficiency of serum Fe, Cu, Zn, Ni and an increased content of Pb, Cr and Co compared with pregnant women with physiological pregnancy. 3. Umbilical cord blood of women with evidence of fetal fetal infection also has a reduced content of iron, copper, zinc and high levels of lead, cobalt and chromium. 4. Disruption of placental function in intrauterine infection of the fetus is caused by reduced content of iron, zinc, copper, nickel and lead accumulation.

The aim: To study and analyze the dynamics of women’s reproductive health in Ukraine as a factor in population reproduction and to study the features of menstrual disorders in Ukraine in 2010-2019. In women of reproductive age with hyperproliferative pathology of the endometrium without atypia. Materials and methods: A descriptive epidemiological study was conducted using data from the departmental statistical reporting of the Ministry of Health of Ukraine on the number of cases of gynecological pathology for 2010–2019. The peculiarities of menstrual function in patients of reproductive age with atypical hyperproliferative pathology of the endometrium were studied. We examined 84 patients of the gynecological department of the Sumy Regional Clinical Perinatal Center with a diagnosis of hyperproliferative pathology of the endometrium without atypia, who sought medical help during 2017-2020 for hyperplastic processes of the endometrium in reproductive age (18 to 49 years). All patients were divided into three groups, up to group I women with endometrial hyperplasia without atypia (HGE) (n = 30); Group II – patients diagnosed with endometrial polyps (n = 30); group III included patients with combined hyperproliferative pathology (uterine body polyps and endometrial hyperplasia without atypia) (n = 24). Results: As a result of the conducted systematic analysis it was established: the higher the prevalence of PMC, the higher the frequency of diseases of the genitourinary system and some gynecological diseases. This is confirmed by the calculated coefficients of correlation of the prevalence of PMC with the frequency of diseases of the genitourinary system (r = 0.75, p<0.001), salpingitis (r = 0.63, p<0.001) and endometriosis (r = 0.42, p<0, 05). The assessment of the relative risk of gynecological diseases has shown that the greatest attention needs to be paid to improving the diagnosis of infertility and endometriosis, as well as the prevention and treatment of salpingitis and uterine cancer. When women with menstrual disorders go to the gynecologist, it is necessary to pay attention to the presence of hyperproliferative pathology, and if women have other chronic diseases, offer rehabilitation of these foci, which can further have a positive effect on reproductive health. Conclusions: The highest rates of menstrual irregularities were found in women with endometrial hyperplasia without atypia and a combination diffuse hyperplasia with endometrial polyps in contrast to patients with only endometrial polyps. Menstrual irregularities can be considered as a marker and indicator of dysfunction of the genitourinary system and the presence of a hyperproliferative process at the prehospital stage.

The aim: The purpose of the study is a comparative evaluating the effectiveness of using the different methods of treatment of miscarriage in multiple pregnancies taking into account the condition of the cervix. Materials and methods: 86 pregnant women with diarrheal twins were monitored. On the basis of studying the premorbid background, somatic and reproductive history, features of the gestational period, leading antenatal risk factors for the development of complications in multiple pregnancies were identified. With the help of transvaginal cervicometry the prognostic ultrasound criteria of the condition of the cervix and its obstructive capacity in case of premature birth are investigated. Results: In the event of uncomplicated pregnancy multiple birth is characterized by a gradual shortening of the cervix in dynamics from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm by 20 weeks, from 37.7 ± 4.1 mm to 30.2 ± 3.9 mm to 30 weeks, to 21.1 ± 3.1 mm to 37 weeks. In the period of 25–27 weeks, the appearance of a V-shaped opening of the uterine cervix in half of the women was observed, which remained until the end of gestation. Shortening of the cervix was the most significant in patients with the risk of abortion who received only tocolytic therapy. In the 2nd trimester revealed a V- or U-shaped opening of the cervical canal. In pregnant women at risk who had an obstetric pessary, a decrease in the length of the cervix was found, which was similar to the rate of its shortening in uncomplicated multiple pregnancies. The condition of the cervix in the presence of a pessary before delivery probably did not differ from the condition of the cervix with the normal course of multiple pregnancies. Conclusions: Pregnant women with uncomplicated multiple pregnancies revealed a decrease in the length of the cervix with an increase in gestation. At the end of pregnancy, the internal jaws acquired a predominantly Y-shape. In pregnant women with the risk of pregnancy termination who received tocolytic therapy, the cervix was the shortest. In late gestation, V- and U-shaped internal jaws were observed. Changes in the cervix after the placement of obstetric pessaries are similar to changes in uncomplicated pregnancy.

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.