THE ROLE OF MORPHOLOGICAL STUDIES OF PLACENTA IN DIAGNOSIS OF INTRAUTERINE INFECTIONSOF NEWBORNS

Abstract

Introduction. Infectious disorders of the afterbirth (or placenta) are now of frequent occurrence, and have specific morphologic manifestations, which significantly affects the course of pregnancy, childbirth, intrauterine growth and development and postnatal health of the infant.The purpose of the study was to optimize the diagnosis and prognosis of the severity of intrauterine infection in neonates based on an assessment of risk factors, perinatal history and the results of morphological studies of afterbirth of those mothers, who had children with intrauterine infection.Materials and methods. Clinical and laboratory examination of 834 mothers and their diseased newborns suspected to have intrauterine infection the first 3 days of life was performed. The subject of in-depth study was a group of 224 patients with newborns with congenital infections. The control group consisted of 30 apparently healthy newborns. Confirmation of intrauterine infection was conducted based on history, physical exam data, and standard tests and using morphological studies of the born placenta.Results of the study. Among the total number of examined newborns, intrauterine infection was verified in 708 (84.9%) patients. The subject of the in-depth study was a group of 224 (31.6%) diseased newborns with congenital viral infections. Among them were term infants - 132 (58.9%) and premature babies - 92 (41.1%). Among 224 children, 77 (34.4%) mixed viral infections, 62 (27.7%) viral and bacterial infections, 53 (23.6%) mixed viral TORCH infections with monoviral infections - in 32 (14.3%). Among the risk factors, acute respiratory viral infections predominate in pregnant women (45.5%), threatening miscarriage (43.7%), anemia of pregnancy (25.0%), preterm delivery (41.1%), placental dysfunction 23.2%), preeclampsia (17.4%), asphyxia of newborns (40.6%). Analyzing the results of a histological study of 224 placentas in women who gave birth to children with congenital viral infections we revealed that in addition to specific morphologic changes caused by respiratory viruses, 54 (24%) also manifested non-specific inflammation(deciduitis, villusitis) and diverse variants of altered placental circulation. It confirms that in addition to the direct harmful effect of the virus, the secondary hypoxia and fetal supply disturbance can occur. The absence of specific signs and symptoms of viral infections in pregnant women does not exclude the need to investigate the afterbirth of children at risk to have intrauterine infection.Conclusions. The results of the histological examination of the placentas substantiate both the etiology of congenital viral infections based on specific morphological features, as well as the effect of nonspecific inflammatory changes (basal deciduitis, vylusitis) and variations of transplacental circulation disturbances on prediction the severity of congenital viral infections in newborns.