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Ефективне формування та підтримка здоров’я матерів і дітей, що визначають фундаментальну основу формування здоров’я майбутнього суспільства і людства, обороноздатність, трудовий резерв та інтелектуальний потенціал країни, можливе лише за наявності ефективних систем охорони здоров’я. Мета - проаналізувати інтегральну ефективність медичної допомоги матерям і дітям на підставі визначення переліку та вагового внеску окремих показників структурної ефективності в інтегральний коефіцієнт. Матеріали та методи. На основі даних загальної і медичної статистики України здійснено структуризовану за окремими компонентами оцінку інтегральної ефективності медичної допомоги матерям і дітям. Використано методи системного підходу, структурно-логічного, епідеміологічного аналізу, математичний, моделювання. Результати. Дані проведеного аналізу діяльності служби охорони здоров’я матері і дитини України у 2021 році свідчать про достатній, вищий за середній, рівень досягнення запланованих результатів - коефіцієнт комплексної оцінки (ККО) становить 0,79 із коливанням у розрізі компонентів від високого рівня (0,89 за результатами структури) до вищого за середній (0,76 за показниками процесу та 0,78 за показниками результативності). За даними геопросторового аналізу, лідерами інтегральної ефективності діяльності служби охорони здоров’я матері і дитини з високим рівнем ККО (≥0,80), що свідчить про достатню ефективність медичної допомоги матерям і дітям, стали Тернопільська, Чернівецька, Львівська, Івано-Франківська, Сумська області і м. Київ. Аутсайдерами інтегральної ефективності медичної допомоги матерям і дітям із середнім рівнем ККО (0,61-0,69), що потребують прийняття управлінських рішень із питань ефективнішої їхньої діяльності, стали Донецька та Херсонська області. Найбільш проблемними індикативними показниками діяльності служби охорони здоров’я матері і дитини ККО є рівень материнської смертності (коефіцієнт досягнення нормативного значення - КДНЗ) = 0,00), частота кесаревого розтину (КДНЗ=0,37), частота мало вагових новонароджених (КДНЗ=0,50), індекс неонатального трансферу (КДНЗ=0,60). Висновки. Розроблений інструментарій інтегральної оцінки ефективності медичної допомоги матерям і дітям дає змогу забезпечити на уніфікованій основі об’єктивне оцінювання і моніторинг її в цілому, у розрізі регіонів і за окремими компонентами з розробленням заходів впливу на виявлені проблеми та їхню імплементацію в діяльність служби охорони здоров’я матері і дитини. Автори заявляють про відсутність конфлікту інтересів.

This article presents current data about the perinatal effects of prolonged stress on pregnant women during the COVID-19 pandemic. The peculiarities of the postcovid syndrome in general and in the female population in particular are determined. Peculiarities of pregnancy and perinatal consequences after coronavirus infection, as well as manifestations of postcovid syndrome in this group of women are considered. There is an increase in the frequency of anxiety and depressive disorders in pregnant women and women in labor during the pandemic and their impact on the fetal brain and its subsequent mental state. The specific effects of long-term stress have been identified: it has become known that pregnant women during the pandemic are exposed to prolonged stress, which affects the course of gestation. Among the most common conditions under the stressors impact (illness of the woman or her close environment, loss of relatives and acquaintances, existence in limited physical and communication space, deterioration of financial condition, etc.) should be noted the increasing risk of abortion up to 17–28%; exacerbation during pregnancy of chronic somatic diseases (hypertension, diabetes, metabolic syndrome, chronic pancreatitis, neurological and mental illness, etc.); increase in body mass index on the eve of pregnancy and pathological weight gain; strengthening of nutritional deficiencies (folate, iron, magnesium, vitamin D, iodine, etc.). The timely detection and possible ways to correct these conditions are considered, given the transition to remote methods of monitoring pregnant women in quarantine. Organizational , treatment and prevention measures with inclusion of micronized progesterone, magnesium citrate, folate (metafolin) and vitamin D, as well as methods of psychoprophylaxis and psychotherapy are also proposed. Magnesium is of particular importance in pregnant women, it has neuroprotective and metabolic properties, in particular when used as a citrate in soluble form. The main directions of rehabilitation measures for pregnant women and women in labor after COVID-19 have been formulated.

Pinopodia of the receptive endometrium is one of the prerequisites for successful embryo implantation. Study objective: to analyze the morphological changes of the endometrium in infertile women, in particular to investigate the apical surface of epithelial cells and pinopodia formation. Materials and methods. 12 patients with a history of previous implantation failure were examined. Patients underwent hysteroscopy with biopsy under intravenous anesthesia on 20–24th day of the menstrual cycle. Morphological structure of pinopodia on the surface of the endometrial epithelium was evaluated by scanning electron microscopy. Results. Apical surface of epitheliocytes was damaged in 16.7% studied biopsies. Morphological picture and maturity of the endometrial glands did not correspond to the actual day of the menstrual cycle in 41.7% biopsies. Degree of glands maturity in these patients was low, so there was a delay in the menstrual cycle. Ultrastructural examination showed clear changes in the structure of secretory and ciliary cells in 33.3%. On the apical surface of the secretory cells there was no or small number of microvilli; cilia of eyelashes were shortened or sometimes fused together. Pinopodia as a one of the most important components of implantation was detected in only 50% of patients. Only in 33.3% of participants visualized fully developed, mature pinopodia. Conclusions. Analysis of own data showed that in the endometrium of women with previous unsuccessful implantation there are certain morphological changes, which are physiologically manifested by a delay in the luteinizing phase of the menstrual cycle and, possibly, as a result mismatch of endometrial structure and embryo maturity. Time of pinopodia onset in participants varied from 20 to 24 days of the menstrual cycle. It is necessary to improve the design and conduct further research to study the association between the expression of receptivity markers and ultrastructural structure.

Diabetic patients are in the spotlight from the early stages of a pandemic, as growing epidemiological data show they are at higher risk for severe clinical outcomes from COVID-19. As the global COVID-19 pandemic continues to evolve, it is also becoming increasingly apparent that the interactions between COVID-19 and diabetes mellitus (DM) are complex pathophysiological mechanisms. The outcome of COVID-19 is more severe in people with DM, which has the potential to accelerate the onset of acute metabolic complications of DM such as diabetic ketoacidosis and hyperglycemia. These mechanisms underlying these associations remain unclear, but they likely include the angiotensin converting enzyme receptor 2, a binding site for SARS-CoV-2, which is expressed in key metabolic organs such as in the pancreas, in particular in β-cells. The potential β-cell tropism of SARS-CoV-2 can damage cells and impair insulin secretion, causing hyperglycemia and ketoacidosis. Understanding the bidirectional interaction between DM and COVID-19 will be critical to protecting and treating people with DM. Current epidemiological data on COVID-19 do not support the hypothesis that diabetic patients are at increased risk of infection compared to the general population. To date, it has been established that decompensated DM is an independent factor that aggravates the course of coronavirus infection and significantly increases the risk of a fatal outcome of the disease. The review provides a brief summary of the evolution of pathogenetic and clinical aspects for understanding the mechanisms of this pathological tandem, as well as therapeutic strategies for treating patients with COVID-19 and DM. As the incidence of DM continues to rise globally, more than ever, diabetes prevention and control must be a priority for health systems around the world.

Purpose of the study: to determine the regional characteristics of the health indicators of pregnant women on the basis of integral assessment of extragenital pathology, complications and adverse consequences of pregnancy. Materials and methods. A comprehensive retrospective analysis of regional characteristics and dynamics of the main indicators of pregnant women’s health in Ukraine for the period 2010–2019 was carried out. According to the Center for Medical Statistics of Ukraine integral assessment (IA) of pregnant women’s health was carried out according to the generally accepted calculation method using integral indicators of the extragenital pathology frequency, pregnancy complications and its adverse consequences. Results. Health of pregnant women remains unsatisfactory with multidirectional trends in the frequency of individual pathologies in recent years. Simultaneously with a downward trend against the background of a high level of anemia and genitourinary system diseases (24.73 and 14.38 per 100 pregnant women in 2019, the rate of decline was 6.29% and 1.74%), gestosis, preeclampsia and eclampsia (6.57, 2.11 and 1.2%, 9.48%), not carrying a pregnancy, delivering a dead fetus (5.84, 0.43 and 15.92%, 9.3%), the incidence of circulatory system diseases and thyroid gland dysfunctions (7.61, 9.88, growth rate 18.7%, 2.33%) is increasing. Incidence of diabetes in pregnant women in Ukraine rapid increases in 10.4 times (0.17 per 100 pregnant women in 2010 and 0.77 in 2019). High regional differences in the frequency of different pathologies of pregnant women were revealed. The difference between the highest and lowest rates of circulatory system diseases in 2019 was 23.9 times, diabetes mellitus – 12.6 times, thyroid diseases – 5.4 times, genitourinary system diseases – 4.3 times, anemia in pregnant women – 3.4 times, and complications and adverse effects of pregnancy – 2.4–4.7 times. The analysis of the IA of the health status of pregnant women according in 2019 revealed that the level of health was higher than the average in Ukraine in Ivano-Frankivsk (65.5%), Zaporizhzhya (72.82%), Odesa (75.5%), Zakarpattia (76.5%), Lviv (81.1%), Sumy (81.3%), Luhansk (84.3%) and Ternopil (84.4%) regions, and low than the average level in Dnipropetrovsk (132.35%), Poltava (123.1%), Chernivtsi (118.0%), Chernihiv (111.7%) regions and Kyiv (117.1%). Conclusions. Developed toolkit for the IA of pregnant women’s health makes it possible to provide an objective assessment of pregnant women’s health in general and for individual components in the context of regions as a means of timely identification of problems that require intervention and effective management decisions to minimize risk factors that cause impaired health in pregnant women.