Complicated Course Of Pregnancy Research Articles

Maternal and newborn outcomes in patients with endometriosis-associated infertility

Aim. To identify the characteristics of pregnancy and childbirth in women with endometriosis-associated infertility (EAI).Materials and Methods. Here we performed retrospective case-control study which included 115 women with histologically verified endometriosis and 250 women without this condition. Statistical analysis was conducted using the IMB SPSS Statistics 20 software package. The data distribution was assessed using the Kolmogorov-Smirnov test. Quantitative data are presented as median (Me) and interquartile range (Q1 – Q3) using the Mann-Whitney test. The level of statistical significance for testing the null hypothesis was set at p < 0.05.Results. Pregnancy in patients with EAI was statistically significantly more often complicated by placenta previa compared to the control group: 6 (5.2%) versus 3 (1.2%) (p = 0.031). Patients with EAI were delivered via cesarean section in 49.6% of cases, compared to 13.2% in those without EAI (p < 0.001). Labor in women with EAI was statistically significantly more often complicated by uterine inertia (hypotonic labor, 7.0% versus 2.4% in those without EAI, p = 0.043), retained placenta (4.3% vs 0.4%, p = 0.013); and hypotonic bleeding (3.5% vs 0.4%, p = 0.036). Maternal and neonatal outcomes including birth weight, Apgar scores at 1 and 5 minutes, and the duration of hospital stay did not differ significantly between the groups.Conclusions. Patients with EAI are characterized by a complicated course of pregnancy and childbirth with a higher incidence of placenta previa, abnormal labor, hypotonic bleeding, retained placenta, and cesarean delivery. Hence, the development of respective therapeutic and preventive measures is required to prevent these complications.

CHARACTERISTICS OF RISK FACTORS FOR THE DEVELOPMENT OF PRIMARY PLACENTAL DYSFUNCTION IN WOMEN WITH A THREAT OF ABORTION IN THE FIRST TRIMESTER OF PREGNANCY

The aim of the study – to optimize the prediction of primary placental dysfunctiondevelopment by determining the risk factors for its development in women with a threatof miscarriage in the early stages of pregnancy.Materials and methods. A prospective analysis of the somatic, reproductive and obstetricanamnesis of 40 pregnant women with threatened abortion in the 1st trimester ofpregnancy and clinical manifestations of placental dysfunction (PD) was carried out –the main group, 60 pregnant women with threatened abortion without PD (comparisongroup). The control group consisted of 50 women with the physiological course of the firsttrimester of pregnancy. Results. Among those with symptoms of threat of termination of pregnancy in the earlystages of pregnancy and PD, the number of women of borderline reproductive age (≤18years and ≥40 years), with obesity (BMI > 30) and a combination of several co-morbidextragenital pathologies was significantly higher than in the comparison group and inthe control group. In the anamnesis of pregnant women of the main group, gynecologicaldiseases, early pregnancy losses (spontaneous miscarriages and non-developingpregnancies) were significantly more often detected. In the first trimester of pregnancyvaginal bleeding, chorionic detachment, retrochorionic hematoma, and low chorionicposition were diagnosed significantly more often in women of the main group. In 7.5 % ofcases, in the first trimester of pregnancy, pregnant women with a threat of abortion andPD had an acute respiratory viral infection.The relationship between the development of primary PD and the frequency of gestationalcomplications associated with the placenta (PE (20.0 %), Abruptio placentae (17.5 %),fetal growth retardation syndrome (10.0 %) and fetal distress (27.5 %)) was established.Every third pregnancy ended in premature birth (32.5 %). The percentage of deliveries byCS in the main group was 62.5 %. Complications of pregnancy and childbirth, associatedwith impaired placental function, led to a high frequency of births of babies in a state ofmoderate and severe asphyxia (15.0 % and 5.0 %, respectively) and stillbirths.Conclusions. The conducted studies confirmed that the development of placentaldysfunction from the early stages of pregnancy in women with a threat of abortion isthe cause of the complicated course of pregnancy and childbirth, which lead to adverseperinatal consequences. Risk factors for the development of placental dysfunctionin pregnant women with threatened abortion are the borderline reproductive age ofthe mother, obesity, a combination of several co-morbid extragenital pathologies,gynecological diseases and early reproductive losses in the anamnesis. Also, the riskfactors for impaired placental formation are detachment of the chorion, retrochorialhematoma, and acute respiratory viral infections in the early stages of pregnancy.

RISK FACTORS FOR THE DEVELOPMENT OF PLACENTAL DYSFUNCTION ON THE BACKGROUND OF PREGNANT WOMEN GENITAL INFECTIONS

The progress of perinatology revealed new problems related to the gestational process and antenatal protection of the fetus. Among indicators of perinatal morbidity in modern conditions, one of the leading places occupied by placental dysfunction, the frequency of which, according to the data of domestic and foreign scientists ranges from 36% to 60%. It is known that among the many factors that affect the complicated course of pregnancy and perinatal morbidity, infectious factors in modern conditions occupy one of the leading places. Despite certain achievements in elucidating the etiological factors and pathogenesis of the development of placental dysfunction (PD), the issues of diagnosis and treatment of this pathology in pregnant women need further improvement. Thus, the study of links in the pathogenesis of manifestations of placental dysfunction, which develops during pregnancy in the early stages of gestation against the background of genital infections, is relevant and promising.The purpose. To assess the risk factors for the development of placental dysfunction in pregnant women with genital infections.Material and methods. The retrospective comparative study included 55 women who gave birth after involuntary childbirth according to the regional perinatal center of Chernivtsi, who had signs of placental dysfunction and genital infections during pregnancy during the period 2021-2022.Research results. One of the most important factors affecting the fetoplacental system, which leads to the development of chronic PD (CPD), are infections of the TORCH group. Infections during pregnancy, depending on the gestational period, lead to miscarriage, abortion, stillbirth, malformations of the child, cerebral defects, as well as to acute and chronic neonatal diseases. We conducted a retrospective analysis of risk factors, the frequency and structure of obstetric complications based on the data of 55 birth stories of the regional perinatal center in Chernivtsi for 2021-2022. Manifestations of placental dysfunction against the background of genital infections were studied at different gestational periods. Placental dysfunction occurs at different gestational periods in women of different ages. However, in young people (up to 18 years old) it occurs less often at all stages of gestation, compared to other age categories. A significant number of pregnant women with manifestations of placental dysfunction suffered from infectious diseases in childhood (measles, chicken pox, acute respiratory and viral infections, angina, various disorders of menstrual function (hyperpolymenorrhea, hypomenstrual syndrome, algodysmenorrhea) were quite often observed in pregnant women with manifestations of placental insufficiency. More often, placental dysfunction develops during first births than during repeated births. Cases of stillbirth, spontaneous miscarriages, artificial abortions and ectopic pregnancies often occur in the anamnesis. A number of authors [41] indicate that pregnant women with manifestations of placental insufficiency often experience various complications of the current pregnancy. Modern scientific studies show that almost 80% of pregnant women with genital infections show significant changes in the immune, endocrine and coagulation systems, which lead to a violation of the formation of the fetoplacental complex and a violation of adaptation mechanisms in the mother-placenta-fetus system.Conclusion. Clinical and statistical analysis shows the negative impact of manifestations of genital infections in different gestational periods on the course of pregnancy and the state of the fetus and newborn. The conducted studies on this issue give reason to talk about the need to review the system of obstetric tactics for these pregnant women, and further improvement of medical measures for antenatal protection of the fetus with this complication of pregnancy.

#860 The role of immunocorrection in the treatment of patients chronic pyelonephritis

Abstract Background and Aims Chronic pyelonephritis in the structure of extragenital pathology in pregnant women occupies a leading place due to the high prevalence, complicated course of pregnancy and childbirth. Chronic pyelonephritis (CP) triggers a cascade of reactions, primarily immune, at the systemic and local levels. With HP the role of the immune system in pregnant women is not only a pathological process occurring in the kidneys, but also takes into account a number of changes in the restructuring of the immune system of a pregnant woman. In relation with the above, the study of the role of the immune system of pregnant women with chronic pyelonephritis is of great interest. To study the effectiveness of immunocorrective therapy in the complex treatment of patients with chronic pyelonephritis. Method 43 pregnant women with CP were examined, the average age was 28.3 ± 0.2 years. The study included clinical research methods (survey, questionnaire, objective examination). Of the laboratory methods a general analysis of blood, urine, urine analysis according to Nechiporenko, tank. urine culture, biochemical blood tests and instrumental (ultrasound) research methods. Cellular immunity was studied by monoclonal antibodies, humoral immunity was studied by Mancini immunodiffusion. Among the surveyed women, the first group of upp was pregnant women (n = 14) receiving traditional therapy. The second group of 13 pregnant women with CP on the background of traditional therapy received ozone therapy (basic treatment + 400 ml of saline solution ozonated to a concentration of ozone in a liquid of 4 mg/l, intravenously, drip). The third group of 15 pregnant women with CP - with traditional therapy received ozone therapy and immune-regulating therapy with polyoxidonium. Results The characterization of clinical and laboratory data on the background of therapy showed significant shifts, as lower back pain decreased by 85.71%, 92.31% and 93.33%, respectively, in both the first and second and third groups. Indicators such as dysuria decreased by 92.85%, 92% and 93% (respectively in the first, second and third groups). Leukocyturia decreased significantly on the fifth day by 71.43%, 84.62%, 86.67% (in the first, second and third groups, respectively). Results indicators of eradication of pathogens after treatment in combination with traditional therapy with ozone and immune-correcting therapy, they were significantly better than in the ozone therapy group against the background of traditional therapy and in the traditional treatment group (86.6%, 84.6% and 64.28%, respectively). As a result of the study, significant decreases in cellular immunity indicators, in particular CD3, CD4, were revealed before the treatment of patients and CD8 and revealed a significant increase in IgA, IgM. After the treatment in the treatment group in combination significant increases in the number of CD3, CD4 and CD8 were revealed by traditional therapy with ozone- and immune-regulating therapy (by 76.1%, 64.68% and 58.3%, respectively), compared with the group of women who received only ozone therapy against the background of traditional therapy and in the group of traditional treatment (66.23%, 59.54%, 54.2% and 61.12%, 54.68%, 51.4%, respectively), and normalization of immunoglobulins A was noted and M. Conclusion Along with the improvement of clinical and laboratory data in CP normalization of cellular and humoral immunity indicators was noted in pregnant women. Additional assignment to traditional therapy for chronic pyelonephritis of pregnant women, ozone therapy and therapy for correction of the immune system is a more effective treatment method.

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Features of pregnancy and childbirth in mothers and girls suffering from abnormal uterine bleeding during puberty.

Aim: To determine the peculiarities of the course of pregnancy and childbirth in mothers whose children suf f er from abnormal uterine bleeding during puberty. Materials and Methods: The study involved examination of 95 girls aged 10 to 18, who were divided into clinical groups: clinical group I (main (MG)) - 65 girls with abnormal uterine bleeding during puberty, clinical group II (control (CG)) - 30 somatically healthy girls, who came to clinic for a medical checkup. Results: Assessment of histories on the condition of mothers during pregnancy and childbirth in the MG showed existing gestational disorders. Thus, in MG, mothers were 17 times more likely to suf f er from extragenital disorders, 15-20 times more likely to suf f er from colds, 10 times more likely to suf f er from toxicosis in the fi rst half of pregnancy and preeclampsia, and 8 times more often to have placental dysfunction. Childbirths of mothers of MG girls were characterized by a pathological course: premature discharge of amniotic fl uid, weakness of labor, preeclampsia during childbirth, fetal distress. In MG, operative deliveries were resorted to 13 times more often. In addition, birth trauma occurred in 15.38% of newborns, asphyxia at birth in 41.53%, and hypoxic-ischemic brain damage in 23.07%. Conclusions: During the analysis of history data, peculiarities of the course of pregnancy and childbirth in mothers whose children suf f er from abnormal uterine bleeding during puberty were revealed. The mothers of these girls have a complicated course of pregnancy and childbirth. Pathological effects on the fetus in the ante- and intranatal periods create the basis for the development of pathological puberty, which can manifest itself in the form of abnormal uterine bleeding.

ФАКТОРЫ РИСКА ОЖИРЕНИЯ И МЕТАБОЛИЧЕСКОГО СИНДРОМА У ПОДРОСТКОВ

Obesity is one of the urgent problems of the healthcare system. Despite a large number of studies, the issue of risk factors for this condition, as well as the associated metabolic syndrome, remains relevant to date. Also interesting is the question of analyzing risk factors in patients with obesity and metabolic syndrome, and without them. The purpose of the study was to study risk factors in adolescents with obesity and metabolic syndrome. The study examines the role of perinatal factors, heredity, peculiarities of eating behavior, the role of psychological status and microsocia. It was shown that perinatal factors (complicated course of pregnancy and childbirth), problems of early breast-feeding (previously artificial feeding, perinatal damage of the central nervous system, anemia, rickets), as well as burdened heredity for cardiovascular and endocrine pathology (obesity, diabetes mellitus 1 type) had all obese adolescents, regardless of the presence of metabolic syndrome; the peculiarities of the nutritional status (food with a lot of carbohydrates and refined fats, protein deficiency) in combination with physical inactivity and the formation of an unhealthy lifestyle were noted in all examined adolescents. Psychological problems, such as a high level of anxiety, low self-esteem, social phobia, violation of personal perception and motivation, as well as pathology of the microsocial environment, that is, family problems prevailed in adolescents with obesity and components of metabolic syndrome. The identified features should be taken into account when developing prevention and rehabilitation programs for overweight and obese patients.

Vascular growth factors of the placenta, apoptosis of blood neutrophils in pregnant women with post-COVID syndrome

Research objectives: to determine the activity of vascular placental growth factors, apoptosis and necrosis of neutrophils in the blood of pregnant women with post-COVID syndrome.Methods and materials. 30 pregnant women (the main group) with SARS-CoV-2, positive Ig A, M or G to SARS-CoV-2 at 30–34 weeks of pregnancy took part in the study. The control group consisted of 30 women with physiological pregnancy.Blood neutrophils were studied by flow cytofluorometry. The proportion of neutrophils that were at the stage of apoptosis and necrosis was determined. The correlation of these indicators with the uncomplicated course of the gestational process during the physiological course of pregnancy and with the development of gestational complications against the background of post-COVID syndrome was determined.In the third trimester of pregnancy, we collected blood samples to determine the effect of SARS-CoV-2 infection on placental angiogenesis. We evaluated a panel of biomarkers: vascular endothelial growth factor (VEGF), placental growth factor PlGF, and interleukin-32α (IL-32α).Results. In pregnant women of the main group with a complicated course of pregnancy accompanied by post-COVID syndrome, apoptosis was at the level of 24.30 ± 0.50% of neutrophil cells, which was significantly different from the control group (4.45 ± 0.25%) (р < 0.001). The level of late apoptosis, necrosis of neutrophils increased 4 times – from 4.20 ± 0.65 to 16.80 ± 0.54% (р < 0.001). The concentration of IL-32α in pregnant women of the control group was 67.27 ± 5.63 pg/ml. Post-COVID syndrome caused an increase in this indicator in the main group by 2.8 times compared to the control group (188.36 ± 25.22 pg/ml) (p < 0.001). In the III trimester, the concentration of VEGF reached maximum values in the main group and was 192.20 ± 10.02 pg/ml, which is 2 times higher than in the control group at the same time (95.30 ± 5.65 pg/ml), (p < 0.001). In the control group the level of PIGF at full-term pregnancy was 144.53 ± 15.55 pg/ml. In women with postpartum syndrome, PIGF significantly decreased and was 43.92 ± 4.81 pg/ml, which was only 30% of the PIGF value in women with an uncomplicated pregnancy (p < 0.001).Conclusions. The development of metabolic disorders and apoptotic changes in the placental tissue are confirmed at the morphological level in the form of destructive and necrotic changes in the microcirculatory channel of the placenta. An increase in the level of annexin-positive neutrophils and activation of the degree of neutrophil necrosis is accompanied by fetoplacental dysfunction, by violation of the balance of placental growth factors and is an important marker for predicting of fetal growth retardation in pregnant women with post-COVID syndrome.

Predictors of late spontaneous miscarriages depending on the phenotype of abortion

The aim. Assessment of risk factors for late miscarriages depending on the clinical phenotype of abortion.Materials and methods. The study included 156 women. The main group consisted of 66 patients with late spontaneous abortion at a gestational age of 12,0–21,6 weeks, 47 of them with miscarriage on the background of isthmic-cervical insufficiency or premature rupture of amniotic fluid, 19 with late miscarriage against the background of blood discharge. Control group – 90 patients whose pregnancy ended in term delivery.Results. Analysis of the prevalence of extragenital pathology revealed a high incidence of anemia (31,8 %; p = 0,000), obesity (12,12 %, p = 0,013), and gastrointestinal diseases (12,12 %; p = 0,004) in women with late miscarriage. When analyzing gynecological pathology, it was revealed that surgical treatment of the cervix was 9,6 times more common in patients of the main group compared to the control group (10,6 and 1,1 %; p = 0,008; OR = 10,68 CI 1,28–89,04), the frequency of abnormalities in the development of the uterus – 7,5 times more often in the group with bleeding compared to the group of patients with isthmic-cervical insufficiency (15,8 and 2.1 %; p = 0,035; OR = 8,63 CI 0,84–88,97). Significant risk factors for late miscarriages are preterm birth (18,2 %, p = 0,000), non-developing pregnancy (18,2 %; p = 0,026), medical abortions (42,6 %; p = 0,003). When analyzing the course of pregnancy, prognostically unfavorable markers of miscarriage were identified: the threat of termination of a real pregnancy (53,0 %; p = 0,000), isthmic-cervical insufficiency (19,1 %: p = 0,000) and violations of the vaginal biocenosis (71,2 %, p = 0,000).Conclusion. Thus, the presence of extragenital pathology, aggravated obstetric anamnesis and complicated course of pregnancy is typical for patients with late spontaneous abortions, which requires monitoring of this category of patients at the stage of preconception preparation, treatment of extragenital pathology, as well as timely prevention, diagnosis and treatment of complications at different stages of pregnancy.

FUNCTIONAL STATE OF THE PINEAL GLAND IN WOMEN WITH THREATENED ABORTION IN THE FIRST TRIMESTER – FURTHER PROSPECTS OF PREGNANCY

Melatonin is an important hormone for normal pregnancy development, but the infl uence of serotonin remains poorlyunderstood. Low melatonin production can lead to spontaneous abortion by stimulating progesterone secretion and inhibiting prostaglandin synthesis. Melatonin has an eff ect on the induction and blocking of apoptosis of the villous cytotrophoblast and promotes the development of the syncytiotrophoblast. Analysis of the frequency of positive pregnancy showed a signifi cant impact on the course of pregnancy and childbirth, compliance with sleep and rest also contribute to a positive eff ect, but there is no general concept, which makes the subject relevant.The aim of the study. To evaluate the functional state of the pineal gland, in particular, the amount of melatonin and serotonin in the blood of pregnant women at 10-12 weeks of gestation with a threat of abortion, which was manifested by bloody discharge or formation of retrochorionic hematoma, and the consequences of pregnancy.Materials and methods. Two groups were formed: I main group – 40 pregnant women with a threat of abortion and formation of retrochorionic hematoma, II control group – 44 healthy pregnant women. Obstetric examination, enzyme- linked immunosorbent assay for determination of melatonin, serotonin, chorionic gonadotropin, and ultrasound were performed. Informed consent of pregnant women was obtained with adequate explanation of the purpose, objectives, methods and scope of laboratory and instrumental research methods. The study protocol was approved by the Commission on Biomedical Ethics of the Bukovinian State Medical University, 2015 (minutes of the Commission meeting No 2 from the 19.10.2023 year). The study was conducted in accordance with the basic provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Scientifi c Medical Research Involving Human Subjects (1964-2008), the Order of the Ministry of Health of Ukraine 690 of September 23, 2009 (as amended by the Order of the Ministry of Health of Ukraine 523 of July 12, 2012). Statistical analysis was performed using generally accepted methods of variance statistics. Reliability was assessed by Student’s t-test. Diff erences were considered signifi cant if the signifi cance level was p≤0.05. We also performed correlation analysis in Microsoft Excel, using the method of squares (Pearson’s method) to determine the correlation coeffi cient. The work is a fragment of the research work of the Department of Obstetrics and Gynecology, UDC 618.1-053.34 + 618.1-0536 /.8]. –07-084-08 «Prevention, diagnosis and treatment of disorders of the perinatal period and reproductive system of women and adolescent girls» (No. 201110Н, state registration number 0111U006499. The term of implementation is 02.2011-12.2015).Results of the study. According to the obtained results, retrochorionic hematoma up to 1 cm is detected three times more often than over 1 cm, while the level of melatonin is not signifi cantly lower, but with retrochorionic hematoma over 1 cm a signifi cant decrease is observed in cases of further normal pregnancy and childbirth. With further complications of pregnancy in retrochoroidal hematoma up to 1 cm, there is a signifi cant signifi cant decrease in melatonin (p ˂ 0.001), in contrast to retrochoroidal hematoma over 1 cm, where no signifi cant diff erence was found in the complicated course of pregnancy (p > 0.05). Serotonin levels were elevated in all subgroups regardless of hematoma size and subsequent pregnancy outcome. Conclusions. In case of threatened abortion in the fi rst trimester with formation of retrochorionic hematoma, the risk ofcomplicated pregnancy remains in 60.87 % of cases. Determination of pineal hormones revealed a signifi cant increase inserotonin with a simultaneous signifi cant decrease in melatonin, while maintaining a positive relationship between the hormones, indicating a disruption of melatonin synthesis in the central nervous system. This is confi rmed by the normal level of chorionic gonadotropin and the preservation of embryonic viability. Since the disruption of hormone formation in the pineal gland has been established, adherence to the recommendations for adequate rest may positively aff ect the further outcome of pregnancy and childbirth.

ANALYSIS OF THE RISK FACTORS OF PERINATAL PATHOLOGY IN WOMEN WHO HAD COVID-19 DURING PREGNANCY

The aim of this study is to look at the impact of COVID-19 on the occurrence of perinatal complications in women who contracted COVID-19 during pregnancy, among the population of the Lviv region. Data on the results of medical and social characteristics, somatic and reproductive anamnesis, and the course of pregnancy of women who contracted COVID-19 during pregnancy (the main group) were analyzed. 20.0% of women who contracted COVID-19 during pregnancy were aged 36 years or older, while there were no women of this age in the control group (p< 0.05). The majority of pregnant women who contracted COVID-19 during pregnancy, namely 68.0% lived in the city, and the majority of healthy pregnant women in the control group lived in rural areas, namely 70.0% (p <0.05). According to social status, a significant part of the women of the main group, namely 30.0% were employed, compared to the women of the control group, where only 16.7% or (p<0.05) were employed. 24.0% of women in the main group had certain peculiarities in their reproductive anamnesis and 52.0% of them had somatic diseases. None of the women in the control group had reproductive or somatic history of complications. All women in the main group had a complicated course of pregnancy, in particular, 30.0% of women had preeclampsia, 28.0% had anemia of various degrees, 52.0% of pregnant women had combined complications, and 16.0% of women had an exacerbation of somatic pathology. In the control group, 90.0% of women did not have a complicated course of pregnancy. The majority of pregnant women (96.0%) fell ill with COVID-19 in the 3rd trimester of pregnancy, and only 4.0% of people – in the 2nd trimester. About half of the women (54.0%) had a mild course of COVID-19, 38.0% of pregnant women had a moderate course of the disease, and 8.0% had a severe course of the disease. Therefore, women over 36 years, living in an urbanized area with somatic pathology and complicated course of pregnancy can be considered as risk factors for perinatal complications for pregnant women with COVID-19.

Expression profile of plasma microRNAs and target genes in patients with complicated pregnancy

Aim: comparative analysis of the expression profile of plasma microRNAs and target genes in patients with complicated pregnancy.Materials and Methods. A prospective observational comparative study in parallel groups was carried out. The study included 73 women divided into three groups: the main group – 42 patients with preeclampsia (PE), the comparison group – 12 pregnant women with fetal growth retardation (FGR), the control group – 19 clinically healthy women with uncomplicated pregnancy. An examination was performed, which included the analysis of clinical characteristics and the study of microRNA expression in blood plasma using the real-time polymerase chain reaction.Results. MicroRNA hsa-miR-210-5p and hsa-miR-1972 were not identified in any plasma sample. Analyzing plasma microRNAs in group of women with PE showed significant changes in the expression levels of hsa-miR-517a-3p (p = 0.025), hsa-miR-517c-3p (p = 0.036), hsa-miR-574-5p (p = 0.015), hsa-miR-517a-3p (p < 0.001) and an increase in miR-20a-5p (p = 0.046) compared to control group. No significant differences were found in the miRNA expression profile in group of women with FGR compared to control group. Assessing an influence of the studied microRNAs on regulatory signaling pathways allowed to establish that hsa-miR-miR-146a-5p, -181a-5p, -210-3p, -517a-3p, -517c-3p, -574-3p, -574-5p, -1304-5p are potential regulators of the reaction cascades involved in the PE pathogenesis.Conclusion. The changes revealed in the circulating blood plasma miRNA level indicate the presence of specific transcriptomic alterations during complicated course of pregnancy.

Effective preconception preparation for women with iron deficiency

Introduction. Latent iron deficiency, which has a high prevalence among women of childbearing age, most often, in the absence of therapy, progresses in pregnant women into manifest iron deficiency, manifested by clinical symptoms of anemia and associated with a complicated course of pregnancy, childbirth, the postpartum period, unfavorable outcomes of newborns. The above justifies the need for correction of iron deficiency at the preconception period.Aim. To evaluate the effectiveness of therapy latent iron deficiency at the stage of preconception period.Materials and methods. The study included 32 women at the stage of pregnancy planning with latent iron deficiency. All women taking the drug Ferretab 1 pill per day for 1 month. The level of blood parameters was assessed at 3 months before the intended conception, in the I, II and III trimesters of pregnancy, in the 3rd day after delivery. In newborns, the indicators of a clinical blood test were evaluated on the 2nd day after birth. We evaluated such indicators as the level of hemoglobin, erythrocytes, hematocrit, the average content of hemoglobin in erythrocytes, serum ferritin, serum iron, transferrin.Results. Evaluation of laboratory data in the course of the study confirmed the effectiveness of the use the complex drug Ferretab. Patients already at the first visit to the doctor during pregnancy had a positive trend and a significant increase in the level of hematological parameters.Conclusions. Oral administration of the complex drug Ferretab showed high efficiency in the treatment of latent iron deficiency at the stage of preconception period, significantly increasing the levels of hematological parameters, good tolerance and a small number of side effects, contribute to the high adherence of patients to therapy, which allows achieving significant clinical results.

Risk factors for the formation of congenital hyperplasia of blood vessels (infantile hemangioma)

The aim the study. To identify correlations between the development of blood vessel hyperplasia (GCS) and risk factors in pregnant women. To identify correlations between the development of blood vessel hyperplasia (GCS) and risk factors in pregnant women. A selective retrospective analysis of 173 case histories and outpatient records of patients of the Clinic of Pediatric Maxillofacial Surgery and Dentistry of the Central Research Institute of Dentistry and Maxillofacial Surgery for 2011-2021 was carried out. The obstetric history of the mother, chronic diseases of mothers during pregnancy and bad habits were studied. The interrelation of the influencing unfavorable factor on the isolation, prevalence and vastness of foci of infantile hemangioma was determined. There was no statistically significant relationship between the harmful habits of the mother and the number of lesions, as well as the isolation of the lesion of the mandibular-facial region (CHLO) and the prevalence of the process in the child. It was found that the prevalence of the process, the isolation of the lesion and the number of foci of CHLO did not have a reliable relationship with the complicated course of pregnancy in the mother. A reliable relationship was revealed between the number of lesions in the CHLO and chronic hypoxia, between the number of defects of the cardiovascular system and the prevalence of the process. But there was no reliable relationship between the number of CCC lesions and the number of lesions. 24 patients out of 173 were premature. In these patients, a statistical severity to the occurrence of GCS was revealed. There was no reliable relationship between the genetic predisposition on the line of both parents and the prevalence of the process, with the isolation of the lesion of CHLO and with the number of foci of CHLO lesions. Prematurity, chronic hypoxia, multiple malformations of the fetal cardiovascular system are risk factors for the development of vascular hyperplasia in children.

Role of innate errors of immunity in the group of children with fatal outcomes during the first year of life

In the modern world, inborn errors of immunity (IEIs), or primary immunodeficiencies (PIDs), are among of the main causes of childhood disability and mortality, determining the demographic state of mankind not only at present, but also in the future. In the Sverdlovsk Region over the past 5 years, there were about 30% of children who died from severe combined primary immunodeficiency. This retrospective study is devoted to the study of the nosological profile of mortality in the children with immune-dependent disorders in the Sverdlovsk Region, as well as to assess information significance of extrachromosomal circular DNA molecules (TREC and KREC) analysis. Some anamnestic data on the course of prenatal period in the current and previous pregnancies were considered the signs of suggested diagnosis of primary immunodeficiencies, i.e., threats of pregnancy loss at the early terms, documented cases of early childhood death, persistent viral and bacterial infections in the mother, complicated course of pregnancy in the mother, as well as some clinical manifestations, including fungal-bacterial sepsis, generalized viral infection, repair disorders, reduced physiological tolerance accompanied by autoimmune organ damage and uncontrolled systemic inflammation. The study demonstrated a wide range of nosological entities of innate errors of immunity in the structure of early childhood mortality, including both classical forms of primary immunodeficiencies and the disorders not directly related to innate errors of immunity, but those showing phenotypically pronounced immunodeficiency and their immediate role in statistical deviations. Among the main criteria that may presume possible presence of an immune-dependent pathology in the early neonatal period we considered the molecular markers of naive T and B cells (TREC and KREC, respectively) revealed in 70% of the cases studied, with, at least, one of these indexes found to be reduced. It is important to understand that primary immunodeficiencies are not as rare as previously thought. Therefore, it is necessary to carry out timely and high-quality diagnostics, in order to avoid unavoidable deaths.

PECULIARITIES OF PREGNANCY AND DELIVERY IN WOMEN WITH HISTORY OF INFERTILITY

Institute of Hereditary Pathology of the National Academy of Medical Sciences of Ukraine, Lviv. Ukraine. Objective: to analyze data on somatic, reproductive, gynaecological history, pregnancy course and outcomes in women with a history of infertility residing in the Lviv region. Material and methods. The data and results of medical genetic counselling of 170 women aged 18-42 with a history of infertility (main group) were analyzed. The comparison was carried out with similar parameters of 80 healthy women aged 18-42 years in the control group. The data of somatic, reproductive, gynecological anamnesis, the pregnancy course and outcomes were studied. Statistical processing of the findings obtained was carried out by the Statistica 7.0 software package using the standard Excel 2013 statistical analysis package. Differences were considered statistically significant at p <0.05. Results. The analysis of the data of the results of medical genetic counselling of 170 women with a history of infertility for 2019-2021 was carried out. The patients with a history of infertility were significantly more likely to be over 36 years of age compared to the same indicators in the control group. They had a complicated somatic anamnesis, 80.0% versus 20.0% in the control group, with a significant predominance of cardiovascular pathology (21.8% and 11.2%), and they also more often had reproductive history complications, 51 (30.0%) versus 11 (13.7%), mainly due to spontaneous miscarriages and missed pregnancies: 46 (27.0%) and 11 (13.7%), respectively. The gynaecological history in all these patients was complicated by infertility, and only infertility was in 113 (66.5%); infertility in combination with ovarian apoplexy was found in 17 (10.0%) and with ectopic pregnancy in 15 (8.8%) that was significantly higher in relation to respective data in the control group of women: 2 (2.6%) and 1 (1.3%), respectively. In women with a history of infertility, a high incidence of pregnancy complications was noted: 146 (85.9%) versus 39 (48.75%) in the control group: they more often gave birth for the first time: 110 (64.7%), and 35 (43.7%) in the control group. Analysis of the data obtained showed the presence of a large number of maternal risk factors for obstetric complications in this group of women. Conclusion. The study has demonstrated the risk factors for the occurrence of obstetric pathology in women with a history of infertility include presumably older age (over 36 years) (13.5%), a complicated reproductive history (30.0%) mainly due to spontaneous miscarriages and missed pregnancies (27.0%); complicated somatic history (80.0%) with a significant predominance of the pathology of the cardiovascular system (21.8%). A gynaecological history aggravated by infertility was found in all 170 (100.0%) women of the main group, and a significant increase in the combination of infertility with ovarian apoplexy was detected in 17 (10.0%) and with ectopic pregnancy in 15 (8.8%) women compared with the control group: 2 (2.6%) and 1 (1.3%), respectively. The complicated course of pregnancy was found in 85.9% of women with a history of infertility and in 48.75% of women in the control group; they more often gave birth for the first time: 110 (64.7%) versus 35 (43.7%) patients in the control group (p<0.05). Women with a history of infertility are at risk for obstetric complications.

Issues of safe correction of gastroduodenal symptoms during pregnancy

Extragenital diseases make a great effect on the complicated course of pregnancy and childbirth. The lack of pregravidar preparation and somatic diagnostics lead to miscarriage, preeclampsia, and placental disorders. Therefore, the development of various algorithms for the management of pregnant women suffering from diseases of the gastrointestinal tract and the safe correction of various gastroduodenal symptoms, which is sometimes characteristic of the gestation period, are relevant. The purpose of the study: evaluation and critical analysis of modern data in the field of diagnosis and safe correction of various gastroduodenal symptoms during pregnancy. Materials and methods. Collection of modern Russian and foreign literature sources on the correction of gastroduodenal pathology during pregnancy, generalization and critical analysis of this problem. Results. Heartburn, constipation, flatulence are the most common complaints during pregnancy. The causes of their occurrence are physiological features during gestation, aimed at the most favorable gestation of the fetus. The first-line preparations are alginates created on the basis of alginic acid of brown alga. Antacids have a number of disadvantages. Proton pump inhibitors are prescribed extremely rarely and cautiously during pregnancy. In case of constipation in pregnant women, it is recommended to prescribe lactulose preparations together with defoamers. Prebiotics perfectly regulate the work of the intestine. The etiology, mechanisms of occurrence, clinical symptoms, differential diagnosis and treatment of intrahepatic cholestasis of pregnant women were analyzed. Its possible prognoses and risks for the mother and fetus, the possibilities of diagnosis and correction are determined. Diseases of the gastrointestinal tract in pregnant women cause difficulties in diagnosis and treatment. For the most optimal course of pregnancy, there are sufficiently effective gastroenterological drugs recommended so that the effect of treatment is maximized and the side effect is minimized.

Experience in the use of cognitive psychocorrection of the emotional state of women with complicated pregnancy in the third trimester

In the article the data of experimentalpsychological investigation of pregnant women with complicated course of gestation are drawn to determine the peculiarities of their psychological status. One hundred pregnant women in the third trimesterwere examined, 64 of them demonstrated symptoms of late gestosis. The investigation revealed high level of both reactive and personal anxiety in women with complicated course of pregnancy. All the women of this group were subjected to supporting psychotherapy, which was directed to the decreasing psychological troubles. The basic aim of cognitive psychocorrection was to overcome different systemic presuppositions, to help the pregnant women to elaborate an alternative behavioral pattern and to change their attitude to themselves, to form the sense of self-confidence. The results received testify to the expediency of including psychotherapy (supporting and cognitive psychocorrection) into the complex of treatment.

The role of monoamines in the development of complicated pregnancy in chronic arterial hypertension

In the Russian Federation, the frequency of hypertensive disorders during gestation is 7-29%, while 80% of cases are chronic arterial hypertension. The mechanism of the complicated course of pregnancy in hypertensive disorders is not clear and is debatable. The article presents the features of the monoamine status in pre-pregnant women with chronic arterial hypertension.

Взаимосвязь гормонального профиля и тревожных расстройств у женщин — внутренне перемещенных лиц с угрожающим прерыванием беременности

Актуальность. Беременность — очень важный, критический этап в жизни каждой женщины. Хронический стресс может влиять на течение беременности, приводя к увеличению числа осложнений. Перемещенные лица обычно имеют более высокие показатели депрессивных и посттравматических симптомов, чем население регионов, в которые они переселяются. В антенатальном периоде повышена склонность к психоэмоциональным расстройствам, около 54 % женщин испытывают тревогу в течение всей беременности. Угроза прерывания беременности (УПБ) — самое распространенное осложнение беременности, возникающее в 15–20 % случаев продолжающейся беременности и связанное с осложненным течением беременности и родов. Гормональный гомеостаз играет важную роль в поддержании и развитии беременности. Цель работы: изучить особенности взаимосвязи гормонального профиля и тревожных расстройств у женщин — внутренне перемещенных лиц (ВПЛ) с угрожающим прерыванием беременности, проживающих в Луганской области, для усовершенствования лечебно-профилактических мероприятий и профилактики акушерских и перинатальных осложнений у таких женщин. Материалы и методы. Обследовали 24 беременных со статусом ВПЛ, находившихся на стационарном лечении по поводу УПБ в учреждениях здравоохранения Луганской области (I группа). Контрольную группу (II группа) составили 25 беременных с неосложненным анамнезом с физиологическим течением беременности аналогичного гестационного срока. Определяли концентрацию эстрадиола, прогестерона, пролактина, кортизола. Для оценки уровня тревожности применялся тест Спилбергера. Результаты. У пациенток группы I выявлен статистически значимый относительный прогестероновый дефицит, достоверное превышение уровней стресс-ассоциированных гормонов пролактина и кортизола. Показатели реактивной и личностной тревожности достоверно выше в группе I. Установлена положительная корреляционная связь между показателем реактивной тревожности и концентрацией кортизола. Предикторами развития тревожных расстройств, по данным множественного регрессионного анализа, выступают уровень личностной тревожности и концентрации кортизола и прогестерона. Выводы. Антенатальное изучение показателей тревожности, уровня стресс-ассоциированных гормонов, прогестерона у беременных — ВПЛ с симптомами УПБ позволит индивидуализировать подход к ведению и своевременно разработать в случае необходимости корректирующие и реабилитационные мероприятия, которые будут способствовать благополучному завершению беременности и влиять на здоровье матери и ее потомства.