Главная Коллекция "Revolution" Медицина Непланована вагітність (особливості перебігу вагітності та пологів, удосконалення надання допомоги в перинатальному періоді)

Непланована вагітність (особливості перебігу вагітності та пологів, удосконалення надання допомоги в перинатальному періоді)

Дослідження особливостей клінічного перебігу вагітності, пологів, стану плода та новонародженого при непланованій вагітності. Розробка та наукове обґрунтування системи лікувально-профілактичних заходів для жінок, що виношують неплановану дитину.

Рубрика Медицина
Вид автореферат
Язык украинский
Дата добавления 28.07.2014
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Results: 79,6% of babies were delivered from unintended pregnancies. No contraception was used by 87% of their mothers to avoid the pregnancy. Women with unintended pregnancy had reported negative feelings regarding pregnancy ten-times more often than those with intended pregnancy. Antenatal deaths of growth-retarded fetuses, intrapartum and neonatal deaths associated with asphyxia are more common in Ukraine than in Denmark. Around one-third of these cases is unbooked in Ukraine, that can reflect the unintended pregnancy contribution in perinatal mortality.

Multiple threatened abortions (22,4% vs. 6,7%), premature delivery (13,8% vs. 3,3%), fetal growth retardation (5,3% vs. 0), decreased Fisher score, smaller neonatal weigh, lower Apgar score, increased perinatal mortality were more often in unintended pregnancy. Unintended pregnancy was associated with social disadaptation, increased stressor score, higher discomfort estimation and level of anxiety, frequent depression signs development. Correlation was found between fetal status and ACTH, fetal status and в-endorphin level. Conceptual model of perinatal complications in unintended pregnancy was proposed. Dicriminant functions were worked out to prognose threatened abortion, premature delivery, complicated delivery, intrapartum asphyxia, perinatal loss. Fundus-symphys nomograme developed has shown 87,8% specificity.

The essential role of hemoglobin and trombocyte levels was revealed to prognose postoperative anemia in different types of autodonation use. Misgav Ladach Cesarean Section was associated with shorter of surgery duration and lower blood lost. Thus, autologous blood/plasma transfusion as well as Misgav Ladach Cesarean Section increases safety of operative delivery.

Proposed perinatal care implementation led to decrease in: prematurity from 13,8% to 2,04%, pathological delivery from 61,4% to 26%, disturbance of of placenta delivery 4,3 times, manual uterus revision 4,6 times, frequency of neonatal asphyxia from 18,4% to 6,3% and increase in neonates weight (p<0,05). Better psychological adaptation with increase in estimation of general state, activity and mood as well as an anxity decrease by Teilor test was revealed. There was two-times decrease in fear of childbirth estimated by W-DEQ as well as postpartum depression estimated by Edinburg Depression Scale (score 13 versus 14). Proposed perinatal care model reduced delivery complications and improved womens' satisfaction with care provided. Those with proposed perinatal care reported "everything was nice at the Delivery Ward" 1,5 times more often and "not enough care was provided" 6,7 times less often than those with traditional care. Friendly attitude by the staff at the department was more often reported by the women in the Case Group (85,3% vs. 71,9%). Delivery duration less than 6 h (40,0% vs. 64,9%) and Oxytocin augmentation (8,5% vs. 19,8%) were less common among the Cases. Women in the traditional care group were more often dissatisfied with pain relief (11,3% vs. 1,6%, p<0,05) and staff support (11,3% vs. 1,6%, p<0,05). Quality of intrapartum care in multiple regression analyses was depended on friendly attitude of the staff (OR=12,34; 95%CI 3,15; 63,18), woman's estimation of Doctors' Care (OR=11,06; 95%CI 1,90;73,62), womens' estimatiom of Midwives' Care (OR=8,76; 95%CI 1,73; 49,05) as well as Oxitocin augmentation (OR=11,32; 95%CI 2,17; 71,78), p<0,0001.

Conclusion: Unintended pregnancy is very frequent in Ukraine. Unintendenness is associated with high risk of unfourable pregnancy outcome. Implementation of proposed model of perianatal care improves unintended pregnancy outcomes as a result of psychological status improvement, homeostasis and fetal-placental system normalization.

Key words: unintended pregnancy, epidemiology, perinatal period, clinical-psyhological peculiarities, hormonal and biochemical homeostasis, complications prognosis, technology of care.

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