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Urinary tract infections (UTIs) are an extremely common pathology among pregnant women and women in labor, the manifestation of which occurs during pregnancy. Physiological changes in a woman’s organism form an optimal background for infection or activation of the aggression of one’s own microbial environments – the microflora that colonizes the periurethral area and mostly belongs to the family of enterobacteria and staphylococci. Clinical manifestations of UTIs during pregnancy are extremely variable and do not always correspond to the usual course of the disease, which necessitates the search for modern approaches to diagnosis and treatment. Also, UTI is one of the leading factors that provoke severe pregnancy complications and can lead to adverse obstetric outcomes. The objective: to evaluate the effectiveness of the modern etiopathogenetic approach to the treatment of UTIs during pregnancy. Materials and methods. In the study, which began in 2022 and is ongoing, 1615 pregnant women at gestational ages 6-37 weeks with clinical manifestations of urinary tract infections (UTIs). This work presents the survey results of 615 pregnant women with UTIs at gestational ages from 20 to 28 weeks, both before and one month after treatment initiation. These women were monitored during their pregnancies in prenatal care clinics of municipal non-commercial enterprises across all regions of Ukraine. At the stage of prescribing treatment the examined women are divided into two groups. The main group included 374 pregnant women with established diagnoses of acute urethritis, acute cystitis, gestational pyelonephritis (GP) and asymptomatic bacteriuria (ABU), who have received antibacterial and uroseptic agents for treatment in accordance with current clinical guidelines in combination with a herbal uroantiseptic containing 120 mg of cranberry berry extract and 36 mg each of extracts of goldenseal, lovage root, rosemary, as well as auxiliary substances. The comparison group included 241 pregnant women with established diagnoses of acute urethritis, acute cystitis, GP and ABU, who were treated exclusively with antibacterial and uroseptic agents for UTIs manifestations. The effectiveness of treatment methods was evaluated on the basis of a developed questionnaire with information on the main symptoms characteristic of diseases of the urinary system, before and one month after the prescribed treatment. Results. On the background of addition to the main antibacterial and uroseptic therapy the herbal uroantiseptic, containing 120 mg of cranberry berry extract and 36 mg each of extracts of yarrow, lovage root, rosemary, as well as auxiliary substances already a month after the start of treatment, the absence of complaints was found in the majority of pregnant women in the main group, related: with frequent urination – 354 (94.6%) (comparison group – 208 (86.3%); p<0.05), the need for urgent urination – 374 (99.1%) (comparison group – 232 (96.3%); p<0.05), the feeling of incomplete emptying of the bladder – 348 (93.3%) (comparison group – 202 (83.9%); p<0.05), with pain: during urination – 369 (98.7%) (comparison group – 231 (95.9%); p<0.05), in the lower abdomen, not associated with urination – 366 (97.9%) (comparison group – 230 (95.9%); p<0.05), in the lower back – 369 (98.7%) (comparison group – 229 (95.1%); p<0.05), with discharge from the urethra not related to urination – 374 (100.0%) (comparison group – 233 (96.7%); p<0.05). Conclusions. On the background of the prescribing of a herbal uroantiseptic containing 120 mg of cranberry extract and 36 mg of extracts of yarrow, lovage root, and rosemary, as well as auxiliary substances, additionally to the main antibacterial and uroseptic therapy in pregnant women of the main group, in a significantly greater number of cases the absence of complaints, which are associated with manifestations of urinary tract infections, was determined. The use of the herbal uroantiseptic, containing 120 mg of cranberry berry extract and 36 mg of extracts of yarrow, lovage root, and rosemary, is safe and creates favorable conditions for the course of pregnancy and further childbirth due to the potentiation of the effects of antibacterial and uroseptic therapy and the effective prevention of recurrences of urinary tract infections. [ABSTRACT FROM AUTHOR]

Pregnancy with bacterial vaginosis (BV) is accompanied by a high risk of various obstetric and perinatal complications, including miscarriage, preterm birth, placental dysfunction, premature rupture of membranes, chorionamnionitis, polyhydramnios, etc. Screening for BV is carried out in the first half of pregnancy during the registration of a woman, however, taking into account the gestational age, many drugs with antimicrobial and antiseptic effects are categorically contraindicated, as they have an embryo- and fetotoxic effect. Timely detection and correction of microbiocenosis disorders of the birth canal is an extremely important element to prevent a number of obstetric and perinatal complications. A balanced approach in the treatment of vaginal dysbiosis consists in the use of modern combined antiseptic preparations for local treatment, which do not contain antibacterial components and are safe for use during pregnancy. The objective: to determine the effectiveness of the treatment of BV in primigravida women in the first half of pregnancy. Materials and methods. 126 primigravida women aged 18–35 years in the first half of pregnancy were examined during pregnancy registration. The participants were selected randomly. The main group included 36 primigravida women with a gestation period of up to 20 weeks with a diagnosis of BV according to the Amsel and Hay–Ison criteria, who were treated with a combined antiseptic drug (chlorhexidine and chlorophyllipt) – suppository vaginally twice a day, the course of treatment – 5 days. The control group included 30 primigravida women with a gestational age of up to 20 weeks with vaginal normocenosis. For all women the pH of vaginal secretions was determined, followed by microscopy of a native smear, stained according to Gram, and a cultural study was performed. Adherence to the Amsel criteria was also determined, followed by evaluation by the Hay– Ison criteria. The clinical effect was evaluated according to clinical examination data before and on the 6th day of treatment with a combined antiseptic drug (chlorhexidine and chlorophyllipt) using bacterioscopic and bacteriological methods. Results. A normal pH was observed only in every fifth part of examined pregnant woman (28 women – 22.2%), while in the rest patients the acidity of the vaginal environment was not normal. Normocenosis was observed only among 1/3 of primigravida women (37 women – 29.4%). A third of the patients were diagnosed with BV (36 women - 28.6%), every fifth pregnant woman – vulvovaginal candidiasis (28 women - 22.2%). In healthy pregnant women (control group, n=30), the main component of the microbiocenosis was Lactobacillus spp. with a small content of facultatively anaerobic microorganisms. In the main group Atopobium vaginae (38.9%), Gardnerella vaginalis (33.3%), Prevotella bivia (27.8%), Candida spp. (22.2%), as well as Lactobacillus spp. in low titers were dominated. Before the treatment all 36 pregnant women of the main group corresponded to the 3rd type according to the Hay–Ison criteria with the dominance of Gardnerella vaginalis and/or Mobiluncus morphotypes and a small number or complete absence of lactobacilli, which served as the basis for establishing the diagnosis of BV. After treatment type 1 (94.4%) was found in 34 pregnant women, and type 2 (5.6%) – in 2 pregnant women. The results of the microbiological study indicate the normalization of the content of the biotope with the predominance of Lactobacillus spp. in women of the main group, in whom the indicators were similar to the control group. Conclusions. Since pregnancy with BV is accompanied by a high risk of obstetric and perinatal complications, the premorbid background of which is laid already in the first half of pregnancy, there is an urgent need to carry out the birth canal sanitation. The drugs of choice for the BV in the first half of pregnancy are local combined agents of a wide spectrum of action. A universal antiseptic with an anti-inflammatory effect, which includes two components – chlorhexidine and chlorophyllipt, fully meets the recommendations for efficiency and safety and can be used for the BV in the first half of pregnancy. [ABSTRACT FROM AUTHOR]

The course of pregnancy that occurs as a result of the application of assisted reproductive technologies is accompanied by numerous complications that affect the indicators of perinatal morbidity and mortality. Nowadays in Ukraine, there is no unified approach to the management of women whose pregnancy occurred as a result of ART application, which determined the direction of this work. The objective: to assess perinatal consequences against the background of the introduction of the proposed treatment complex in women whose pregnancy occurred as a result of the application of assisted reproductive technologies. Materials and methods. 249 pregnant women were examined, which were divided into: group I – 94 women with tubo-peritoneal, group II – 87 women with endocrine and group III – 68 women with male types of infertility. Depending on the prescribed therapy, women of groups I, II and III are divided into: subgroup IA – 49 pregnant women with tubo-peritoneal, subgroup IIA – 48 pregnant women with endocrine, subgroup IIIA – 36 pregnant women with male factor of infertility who received the proposed therapeutic and preventive complex; subgroup IB – 45 pregnant women with tubo-peritoneal, subgroup IIB – 39 pregnant women with endocrine, subgroup IIIB – 32 pregnant women with male factor of infertility, which were observed in accordance with generally accepted standards of obstetric care. Results. Against the background of prescribing the proposed complex, there was a significant decrease in the frequency of threatened miscarriage in women of Group I by 41.6%, in women of Group II by 37.1% (p<0.05). In the second and third trimesters, there was a significant decrease in the number of cases of threatening late spontaneous miscarriages, threatening premature birth, placental dysfunction, preeclampsia, and fetal growth retardation syndrome (p<0.05). A significant indicator of the effectiveness of the proposed treatment complex is a significant increase in the proportion of urgent labor in women of subgroups IA and IIA. Thus, 46 (93.8%) women of subgroup IA and 46 (95.8%) women of subgroup IIA had urgent labor. Assessing the pathological conditions of newborns, it should be noted that in children from women in labor of subgroups who received the proposed complex, respiratory disorders syndrome (p<0.05), intraventricular hemorrhages (p<0.05), hypoxic-ischemic encephalopathy (p<0.05), and cases of antenatal infection (p<0.05) were determined in a significantly smaller number of cases. Conclusions. The effectiveness of the proposed treatment complex and the complex of psychoemotional correction in pregnant women after the use of assisted reproductive technologies is confirmed by a reliably better course of the first, second and third trimesters of pregnancy, a reliably better course of Labor, which was reflected in an increase in cases of urgent labor and a decrease in cases of complications in childbirth, which was reflected in a significant decrease in the number of cesarean sections. Improvement of perinatal consequences against the background of the use of the proposed treatment complex and the complex of psychoemotional correction in newborns from women in labor after the use of assisted reproductive technologies is confirmed by a significantly larger mass of newborns, a significantly smaller number of newborns with low gestational weight, a significantly higher Apgar score, a significantly smaller number of cases of pathological and transient conditions, and a significantly shorter duration of stay of women in labor and newborns in an obstetric hospital, as well as the absence of cases of early neonatal and perinatal mortality among newborns. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence and atrophic colpitis are among the most common pathologies in women in late reproductive and premenopausal age, which occur against the background of the progression of estrogen deficiency in late reproductive age. In recent years, laser energy has been actively used in clinical practice to correct the manifestations of genitourinary syndrome. A special feature of laser technology is the use of a package (sequence) of laser pulses with a low energy density, the duration and frequency of which are programmed in such a way that, providing a deep thermal effect, tissue ablation is not allowed. The objective: to evaluate the effectiveness of an integrated approach in the treatment of atrophic colpitis and stress urinary incontinence in women of late reproductive and premenopausal age. Materials and methods. 69 women aged 45-55 years with manifestations of GUS were examined. In all women, the intensity of vaginal symptoms, the effect of urinary incontinence on quality of life, urinary incontinence symptoms, female sexuality, vaginal pH were examined, and light-microscopic and morphometric studies of vaginal biopsies were performed. For the purpose of treatment, women were offered 3 sessions of therapy, of a CO2-laser and the appointment of vaginal suppositories, which include natural substances with expressed regenerative, antiseptic, anti-inflammatory and immunostimulating properties. The total duration of treatment was 8 months. Results. The average pH value of vaginal contents in patients with Hus was 4.9±0.3. Complaints of burning and tingling, dryness and itching in the vagina and external genitalia prevailed among vaginal smptomas. On the D.Barlow scale 6 (8.7%) and 12 (17.4%) respondents rated their symptoms at 1 and 2 points. According to the results of the UDI-6 questionnaire, a significant majority of women complained of loss of urine associated with coughing, sneezing or laughing, loss of urine associated with the need for urgent urination, and loss of a small amount of urine not associated with physical activity. Light-microscopic and morphometric analysis of biopsies revealed the presence of significant thinning of the vaginal epithelium with a decrease in the cells of the intermediate line, a decrease in the content of glycogen in the cytoplasm and smoothness of the basal relief. Conclusions. The effectiveness of the proposed treatment complex is confirmed by a significant decrease in the number of vaginal symptoms, an increase in the number of women who evaluated the intensity of existing symptoms on a D Barlow scale scores of 1 and 2 points, a decrease in the number of women with urinary incontinence symptoms in the UDI-6 questionnaire, and an increase in the number of women with mild to mild urinary incontinence in the ICIQ-SF questionnaire. The positive effect of the proposed combined complex on the condition of the vaginal mucosa was confirmed by activation of remodeling processes, which was reflected in an increase in the proliferative activity of multilayer flat non-keratinized epithelium in response to photothermal laser exposure. [ABSTRACT FROM AUTHOR]

The improvement of the providing medical services quality to pregnant women remains an urgent issue in modern obstetrics. Women with perinatal losses deserve special attention, especially in the second half of pregnancy. Changes in the hemostasis system are an integral part of the development of pregnancy. The tendency to hypercoagulation has significant pathogenetic significance and can be the cause of a number of complications – miscarriage in the I trimester of pregnancy and preeclampsia, premature birth, antenatal fetal death (AFD) – in the II and III trimesters of pregnancy. Also, pregnancy is a background process for the activation of a number of diseases, in particular hereditary thrombophilia. The objective: to evaluate the changes in the hemostasis system in women with antenatal fetal death and the effectiveness of the use of low molecular weight heparins for the correction of disorders in the hemostasis system in this category of patients during childbirth and in the postpartum period. Materials and methods. 72 women were examined, including 42 pregnant women with AFD (main group) and 30 pregnant women with a physiological course of pregnancy, childbirth and the postpartum period (control group). The state of the hemostasis system was studied using a standard coagulogram. D-dimer was determined by immunoturbometric analysis. To assess the state of the hemostasis system, the following biochemical tests were used: procoagulant link – fibrinogen content and indicators: prothrombin index, activated partial thrombin time (APTT), thrombin time (TP), ancistrone time (AT), soluble fibrinogen-monomer complex (SFMC), factor X (FX); to evaluate the antithrombin system, the content of antithrombin-III (AT-III), protein C were determined; to characterize the state of the fibrinolytic system – the amount of plasminogen, α2 -antiplasmin, fibrinogen degradation products (FDC). Thrombophilia markers and antiphospholipid antibodies were also determined. The preference was given to vaginal childbirth. During childbirth, mechanical compression of the lower limbs was applied using special compression stockings (compression level 2). In 12 hours after delivery thromboprophylaxis with low molecular weight heparins was started, the drug of choice being enoxaparin sodium. After 48 hours of the postpartum period, a comparative analysis of coagulogram indicators was performed to further determine the timing of thromboprophylaxis. Results. Analysis of family thrombotic anamnesis revealed risk factors in 12 (28.6%) patients of the main group. In close relatives of the first line, the presence of peripheral vein thrombosis was found – 5 (41.7%) cases, myocardial infarction under the age of 45 – 3 (25.0%) cases, pulmonary embolism – 1 (8.3%) case, transient ischemic attack of the brain – 3 (25.0%). In the control group only 2 (6.6%) patients had a family history of venous thromboembolism in first-line relatives. The analysis of the coagulation system shows significantly higher fibrinogen values (the main group – 5.3±0.2 g/l, the control group – 4.3±0.1 g/l; p<0.05), functional FX activity (the main group – 149.3±3.1%, control group – 107.3±2.7%; p<0.05), SFMC (main group – 15.9±1.2 μg/ml, control group – 7.8±0.9 μg/ml; p<0.05) and D-dimer (main group – 4.4±0.25 μg/ml, control group – 0.7±0.2 μg/ml; p< 0.05) in pregnant women of the main group. An increase in these indicators is a predictor of thrombus formation, activation of blood coagulation by the internal pathway with a decrease in the antithrombin reserve due to FX. During the correlation analysis, a strong direct relationship (r=0.8633) was established between the indicators of SFMC and FX in the blood serum of pregnant women of the main group, the combination of which determines the tendency to clot formation. Determination of markers for the most common types of thrombophilia shows the dominance of hereditary forms (prothrombin, Leiden mutation, MTHFR) in 43% of pregnant women of the main group. The implementation of the proposed treatment approach contributed to a significant decrease in the average concentration of fibrinogen 48 hours after delivery in postpartum women of the main group (main group: before delivery – 5.3±0.2 g/l, after 48 hours after delivery – 3.9±0.3 g/l; control group: 48 hours after delivery – 3.2±0.2 g/l; p<0.05) in combination with a synergistic decrease in the average indicators of SFMC (main group: before delivery – 15.9±1.2 μg/ml, 48 hours after delivery – 6.2±0.2 μg/ml; control group: 48 hours after delivery – 5.4±0.3 μg/ml; p<0.05) and FX (main group: before delivery – 149.3±3.1%, after 48 hours after delivery – 103.1±3.6%; control group: after 48 hours after delivery – 117.1±4.1%; p<0.05). Conclusions. Increased coagulation function was confirmed in pregnant women with antenatal fetal death (AFD). Thanks to the proposed method of correcting disorders in the hemostasis system, a decrease in the frequency of postpartum thromboembolism in women with AFD is achieved, as well as an improvement in the main indicators of the hemostasis system. This prevents the emergence of a chronic form of the syndrome of disseminated intravascular blood coagulation which is developed in the cases of AFD. [ABSTRACT FROM AUTHOR]