DIFFERENTIATED APPROACHES TO THE MANAGEMENT OF PREGNANCY AND CHILDBIRTH WITH PREMATURE DISCHARGE OF AMNIOTIC FLUID

Today, preterm birth remains one of the most significant medical and social challenges in maternal and child healthcare. According to the World Health Organization (WHO), "...70% of early neonatal deaths and 65-75% of infant deaths are due to premature babies..." The global preterm birth rate ranges from 5% to 15% of all pregnancies, with this indicator showing consistent annual increase. The purpose of the study: improvement of the differential approach to pregnancy and delivery management based on hormonal, microbiological, immunological and ultrasonographic changes in cases of preterm premature rupture of membranes (PPROM). The object of the study was 177 pregnant women observed at the Bukhara Regional Perinatal Center. The investigation was conducted in two phases. Phase I (2020-2021) involved retrospective analysis of medical records from 157 pregnant women with PPROM at the city maternity complex. Phase II (2022) prospectively examined 177 pregnant women: Group 1 comprised 107 women with PPROM and subsequent delivery; Group 2 included 30 women with PPROM and pregnancy continuation; the control group consisted of 40 healthy pregnant women. The principles of bioethics, approved by the Scientific Council of Bukhara State Medical Institute, are preserved and upheld in full compliance. The statistical software package Statgraphics (Stadia version) and the Statsoft Inc. 99, USA computer statistical program were used in the work. To compare the significance of differences in the results in the studied groups, Student's t-test and paired t-test were used. Differences were considered significant at a 5% significance level according to the Student's table (p<0.05, i.e., 95% probability of the event). The study was conducted in accordance with the research plan of the Bukhara State Medical Institute within the framework of the topic "Early detection and diagnosis of pathological factors affecting the health of the population of the Bukhara region in the post-COVID-19 period, as well as the development of new methods of treatment and prevention (2022-2026)". Result. The age range of participants was 19 to 39 years, with mean age 27.5 ± 5.45 years. Analysis of residence distribution revealed 46.4% urban and 53.6% rural dwellers. By social status, 56.69% were homemakers, 35.67% were employed, and 7.64% were students. Primigravida accounted for 43.4% of cases, secundigravida for 28.7%, and multigravida (third or more pregnancy) for 28%. Delivery occurred at 36-37 weeks in 54.14% of cases, at 34-35 weeks in 40.76%, and before 34 weeks in 5.10%, with mean gestational age at delivery of 34.96 ± 0.2 weeks. Conclusion. Ultrasonographic assessment demonstrated cervical shortening by factors of 1.3 and 1.2 in the main and comparison groups respectively versus controls (p<0.05). The amniotic fluid index measured 56.9 ± 4.03 mm in the delivery group, 79.3 ± 6.73 mm in the pregnancy continuation group, and 151.1 ± 12.64 mm in controls. The single vertical pocket measurements were 17.5 ± 0.89 mm (delivery group) and 38.9 ± 0.69 mm (pregnancy continuation group), representing 2.3-fold and 1.5-fold reductions versus controls (60.3 ± 1.73 mm; p<0.05).