PLACENTAL DYSFUNCTION, FETAL AND NEWBORN CONDITION WITH COVID-19 IN PREGNANCY

Abstract

Purpose. To determine signs of placental dysfunction, to assess the condition of the fetus and newborn in case of Covid-19, transferred to a woman during any.
 Materials and methods. 50 pregnant women with a severe course of Covid-19 (group 1) and 150 pregnant women with moderate severity of the disease (group 2) were examined. The control group consisted of 50 pregnant women who did not suffer from Covid-19. The state of uterine-placental-fetal blood flow was determined by the Doppler method. To assess the condition of the fetus, a cardiotocogram was recorded, cardiotocogram analysis was performed according to the Dawes/Redman criteria, and the biophysical profile of the fetus was established. Pathomorphological examination of the placenta was conducted.
 Results. Established placental insufficiency in most cases (72.0%) of patients with a severe course of Covid-19, supports the growth of the fetus and its distress in 32.0% and 48.0% of women. The results of dopplerometry at 32-34 weeks revealed significant violations of maternal-placental-fetal blood flow. A decrease in the pulsatility index in the middle cerebral artery of the fetus and cerebro-placental ratio indicates the centralization of fetal blood flow in response to hypoxia. When the status of the fetus is reduced, a reduced assessment of the biophysical profile of the fetus is indicated (6.69±0.30). According to the Dawes/Redman criteria, fetal protein acidemia occurred in 48.0% of patients, critical condition - in 8.0% of pregnant women. Pathomorphological examination of the placenta reveals violations of various structures in the form of degenerative and alterative-degenerative changes, dysmucoidosis, circulatory disorders, damage to the endothelium and thrombus formation, ischemia, infarction, and vasculitis. Signs of chorioamnionitis are found in 18.0% of placentas. 44.0% of children are born asphyxiated, 36.0% have respiratory failure, and 16.0% have bilateral pneumonia. High frequency of neurological disorders (56.0%), gastrointestinal (50.0%), hypoglycemic (34.0%) and hemorrhagic (32.0%) syndromes. 22.0% of children needed care in the intensive care unit. Perinatal mortality was 0.4 ‰.
 Conclusion. Сhildren born to women whose pregnancy complicated their SARS-CoV-2 infection belong to the high-risk group and require final follow-up to monitor the status of developed clear care algorithms depending on the condition.