Complicated Course Of Pregnancy Research Articles

Fetal fraction of free-DNA: clinical-diagnostic parallels

Introduction. Since 2011, a technology such as a non-invasive prenatal test (NIPT) has been used in the world i order o identify pregnant women at a high risk of giving birth to a child with chromosomal aneuploidy (CA). An important indicator of the test's effectiveness is the fetal fraction (FF), since its low level does not allow to give a reliable result to a patient.Aims: to determine the factors that can affect the level of FF during NIPT.Materials and methods. A retrospective comparative covenant study was carried out. The study included 288 patients who underwent NIPT in 2015-2018 after the standard complex of prenatal diagnosis (t 12-18 weeks of pregnancy). We assessed the correlation of the FF level with various clinical and anamnestic parameters and with indicators of biochemical screening for the first trimester (PAPP-A and β-ХГЧ). A comparison was made in terms of the FF level during pregnancy with a favorable and unfavorable outcome.Results. The average FF level in patient where CA was detected in the fetus was 9.01 (5.4-11)%, in the absence of CA — 9.7 (6.5-11.95)%, the difference are not statistically significant (p = 0.37). In patients with a physiological course of pregnancy, this indicator was 10.07 (6.6-12.57)%, and in patients with a complicated course of pregnancy, it was significantly lower — 8.11 (5.35-11.29)% (p = 0.02). We also analyzed the presence of a correlation between the level of FF and fetal weight at term, but no statistically significant correlation was found (r=0.13). There is a statistically significant inverse relationship between the FF level d the age of the pregnant woman, the patient's weight and body mass index, the number of pregnancies in the anamnesis, as well as a direct relationship between the FF and the β-hCG level (in MoM).Conclusions. FF is an important parameter of NIPT. A sufficient level of FF not only indicates a high reliability of the result obtained during NIPT, but also increases the chances of a favorable pregnancy outcome. The level of FF can be influenced by a number of clinical and anamnestic characteristics of the patient (weight body mass index, age, obstetric history). Studies aimed at determining the level of FF in various physiological and pathological conditions during pregnancy seem promising and thanks to them, it is possible that new models for predicting pregnancy complications will subsequently be proposed.

The Content Of Vitamin D Metabolites In Rachit In Children Of Early Age Who Received Specific Prevention

52 patients with rickets and 10 healthy children were examined. Among patients with rickets, 35 children were born in women with a complicated course of pregnancy (threat of termination, toxicosis of the first and second half). In 12 children, mothers had chronic liver and kidney diseases before giving birth. The level of 25(OH) vitamin D (25-oxycalciferol) and 24.25 (OH)2 vitamin D (24.25-dioxycalciferol) was determined. The content of calcium-regulating hormones in the blood serum was determined by radioimmunological analysis. To assess the severity of the rickets process, the activity of alkaline phosphatase in the blood serum was determined using a standard kit. The aim of our study was to determine the effect of specific prevention on the metabolism and course of the clinical form of rickets in young children.

Clinical and Paraclinical Aspects of Uterine Fibroids Complicated by Infertility

The relevance of preventing the development of uterine leiomyoma is important in connection with an increase in the frequency and decrease in the onset disease age, as well as a social tendency to postpone the implementation of reproductive function to a later age. On the one hand, the uterine fibroids presence can lead to a reproductive dysfunction, in particular infertility. On the other hand, there is a complicated course of pregnancy, a high risk of reproductive losses, anomalies of labor and postpartum complications.The objective: to determine the relationship between uterine leiomyoma and infertility in reproductive age women based on the course of the disease and data from instrumental research methods.Materials and methods. An analysis of complaints, medical history, clinical data and results of an ultrasound study of 336 reproductive age patients with uterine leiomyoma was carried out. The clinical features, the frequency of concomitant pathology, the dependence of infertility and miscarriage on the localization and size of nodes, the onset disease age and anamnesis were studied.Results. It was found that among patients with uterine leiomyoma, infertility occurred in 34 % of cases. These patients were significantly younger compared with other groups and their disease developed much earlier, on average, at 29 years old. Among the concomitant pathologies, the combination of uterine fibroids and infertility is characterized by a high frequency of concomitant inflammatory diseases of the genital organs (73 %) and genital adhesions (39.1 %). Women with miscarriage are characterized by the presence of multiple uterine fibroids (66.7 %) with large nodes (62.5 %) that distort the uterine cavity (41.7 %). In patients who realized reproductive function, uterine leiomyoma developed 5 years later than in the group with infertility.Conclusions. The etiology of infertility in uterine leiomyoma is multifactorial. The concomitant inflammatory process of the genitals is one of the factors in the early manifestation of uterine leiomyoma, which should be taken into account when examining patients and determining measures for preventing the development of the disease and rapid growth of nodes. For miscarriage, the presence of multiple nodes, distorting the uterine cavity, larger than 30 mm, is critical.

COVID-19, septic shock and syndrome of disseminated intravascular coagulation syndrome. Part 2

The article discusses the issues of hemostatic system disorders in patients with COVID-19. Strengthening the coagulopathy characteristic of DIC-syndrome, is a key sign of deterioration and an unfavorable prognosis in COVID-19 patients. Data obtained by Chinese colleagues demonstrates that a significantly increased level of D-dimer is one of the predictors of death. The article also highlights the preliminary recommendations of the International society of Thrombosis and Hemostasis (ISTH, 2020) to identify markers such as D-dimer, prothrombin time and platelet count as significant predictive markers in severe COVID-19 patients. The necessity of anticoagulant therapy in hospitalized patients is justified.
 The article discusses the features of sepsis in pregnant women. Data from a meta-analysis of 19 studies evaluating pregnancy complications and outcomes in patients with various coronavirus infections are presented. Despite the complicated course of pregnancy, there were no cases of vertical transmission of viral infection.
 In the pathogenesis of severe COVID-19 complications with the formation of severe acute respiratory distress syndrome, multi-organ dysfunction, super inflammation and cytokine storm play a leading role. In connection with viral sepsis, the article discusses the role of hemophagocytic lymphohistiocytosis as a hyperinflammatory syndrome characterized by fulminant and fatal hypercytokinemia with multiple organ failure, the role of hyperferritinemia in predicting the outcomes of severe sepsis. Groups of patients at high risk of death are discussed, as well as the need for anticoagulant and anti-cytokine therapy in patients with COVID-19.

Акушерські та перинатальні наслідки у жінок із загрозою переривання вагітності, які проживають у зоні збройного конфлікту

The objective: was to evaluate the course of pregnancy, childbirth and perinatal outcomes of delivery of women with threatened interruption of pregnancy (TIP), living in the Lugansk region, to improve treatment and preventive measures and prevent obstetric and perinatal complications in such women. Materials and methods. A prospective clinical and statistical analysis of the course of pregnancy and childbirth of 86 pregnant women in first and second trimesters of pregnancy were hospitalized regarding TIP in the hospitals located in the Luhansk region was performed (group I). The control group consisted of 64 pregnant women with non-complicated obstetric anamnesis and physiological course of pregnancy with similar gestational period of pregnancy and place of residence (group II). Results. In women of group I, a history of female genital inflammatory diseases was significantly more frequent, and a complicated course of pregnancy and childbirth was registered. The number of cases of acute respiratory viral infection (ARVI) was in 4, isthmic-cervical insufficiency (ICI) was in 3 times more often than in healthy pregnant women, asymptomatic bacteriuria, recurring TIP, gestational pyelonephritis and ureaplasma infection were found only in pregnant women of group I, the number of cases of anemia there was no significant difference. 13 (15.12%) of women of group I and 3 (4.69%) of group II (p=0.041) had spontaneous preterm birth at 33–37 weeks of gestation; operative delivery was registered in 23 (26.74%) and 8 (12.50%) cases, respectively (p=0.033). It was established that recurrent TIP, ARVI during this pregnancy, ICI, gestational pyelonephritis are statistically significant risk factors for preterm delivery and operative delivery. Premature rupture of the membranes was found in 1.58, weakness of labor – in 2.2, premature detachment of a normally located placenta – in 6, fetal distress – in 1.9 times more often in women of group I, central placenta previa was noted only in group I. Conclusions. The complicated course of the first and second trimesters of pregnancy, in particular, recurrent TIP, ARVI during this pregnancy, ICI, gestational pyelonephritis, had a direct effect on frequency increase of premature termination of pregnancy and operative delivery in patients of the main group compared with women of the control group. The presence of a history of chronic female genital inflammatory diseases, sexually transmitted infections, ARVI during this pregnancy, TIP in the first and second trimesters, allows pregnant women to be at high risk of developing gestational complications in order to conduct timely treatment. Key words: pregnancy, the threat of abortion, childbirth, the condition of newborns.

ТЕЧЕНИЕ БЕРЕМЕННОСТИ И ИСХОДЫ РОДОВ У ЖЕНЩИН С ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ

Background. The problem of genital endometriosis is relevant both in medical and in social aspects.Aim of the research. To analyze the course of pregnancy, childbirth and their outcomes in genital endometriosis to justify the critical terms of the complicated course of pregnancy and determine approaches for the development of therapeutic and preventive measures.Material and methods. The main group – 160 pregnant women, previously treated for genital endometriosis. The control group was 50 healthy women with a normal pregnancy. The generally accepted clinical laboratory and instrumental methods of the research were used. Statistical analysis of the data was carried out using the software package Statistica 10.0. Results. Gestational periods of 6-12 weeks, 18-22 weeks, 30-34 weeks of pregnancy are critical for women of the main group. The course of pregnancy is complicated by the threat of an early miscarriage (50%), placental disorders (65%), chronic hypoxia (35%) and fetal growth retardation (20%), anomalies of labor (60%).Conclusions. The complicated course of pregnancy in patients with genital endometriosis justifies the need to develop a comprehensive program for the prevention of gestational and perinatal complications.

Treatment of the newborn with a floating thrombus in the right atrium: case report

Venous thrombosis in newborns in pediatric surgery is rare. Aim of the article: description of the case of treatment of a newborn with a floating thrombus of the right atrium. This article reports the case of a 26-day-old child with a floating right atrium thrombus with a background of late neonatal sepsis, septicemia, osteomyelitis of the proximal humerus, severe anemia and bacterial endocarditis. Primary cause of the right atrial thrombus was a complicated course of pregnancy with anemia, inflammatory disease and colpitis of the mother in the obstetric history. Features of presented case: surgical removal of thrombus with cardiopulmonary bypass. Conclusion ― Thrombosis of the heart cavities in newborns is a rare and dangerous condition, requiring urgent treatment. The presence of a floating thrombus in the heart cavity, is an indication for the surgical removal of a thrombus.

Болезни пародонта и осложненное течение беременности

Болезни пародонта и осложненное течение беременности

ФОЛАТНЫЙ ЦИКЛ: ПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ ОСЛОЖНЕНИЙ БЕРЕМЕННОСТИ (ЛИТЕРАТУРНЫЙ ОБЗОР)

The problem of prevention of complicated course of pregnancy and childbirth takes a leading place in modern obstetrics and perinatology. The authors conducted a profound analysis of numerous clinical studies in the area of folate metabolism in general, its role in the reproductive health of women, gestational complications, and the formation of fetal pathology. The significance of folic acid deficiency which is related to diet peculiarities, to insufficient enzymes intake, as well as to defects in folate exchange genes, which determine the reduced enzyme activity, is evaluated. In recent years, there has been much evidence that mutant homozygous (TT) and heterozygous (CT) genotypes are much more common among women with complicated pregnancies. Genetic deficiency of the key enzyme of the folate cycle – methylene-tetra-hydro-folate-reductase (MTHFR) is one of the reasons of hyperhomocysteinemia that has a pronounced toxic effect, damages the endothelial lining of the blood vessels and triggers a disorder of the processes of coagulation. Hyperhomocysteinemia has a big influence on the development of pregnancy complications, which depend on microcirculation, starting with spontaneous miscarriage in the first trimester of pregnancy and ending with preeclampsia, premature placental abruption and intrauterine fetal death. The consequences of the folate cycle problems at different stages can be congenital malformations of the fetus, especially defects of the neural tube. The importance of folic acid in the pathogenetic mechanisms of anemia is described. An interesting question is the role of low-functional alleles of folate genes in reproductive function disorders: under condition of infertility and miscarriage. The presented literature review is a reasonable conclusion for the need of further study of folate metabolism, taking into account genetic predisposition and other components.

Specific Characteristics of Bioelectric Activity of the Brain in Women with Placental Dysfunction Considering the Type of Psychological Component of Gestation Dominant

The study of the influence of the autonomic nervous system on the course of pregnancy, childbirth and fetal state remains relevant. Changes in the parameters of electroencephalography may be detected long before the onset of clinical symptoms in the complicated course of pregnancy. 
 The objective of the research was to evaluate electroencephalography in women with placental dysfunction and gestational complications taking into account the type of psychological component of gestation dominant. 
 Materials and methods. Electroencephalography was performed in 60 pregnant women at the age of 19 to 45 years with gestational hypertension and fetal distress during pregnancy. The main group included 40 patients, who were stratified according to the type of psychological component of gestation dominant: 10 patients with euphoric type, 20 pregnant women with anxious and depressive type, 10 patients with hypogestognostic type. The comparison group comprised 20 patients with optimal type of psychological component of gestation dominant and normal course of the first half of pregnancy. The assessment of psychological component of gestation dominant was carried out according to the method proposed by Dobriakov I.V. - "Pregnant woman attitude test". Registrations, spectral and coherent analysis of electroencephalography were performed using BrainTest-24 hardware and software complex. \textbf{Results and discussion. }Electroencephalography of the patients of the comparison group was in line with current concepts regarding the physiological norm. In the main group, there were the following changes in electroencephalography: non-sinusoidal forms of alpha-oscillations (77.5%), high index of fast rhythms, flashes of spike waves under load, disturbances of the frontal occipital gradient with the focus on the anterior sections of the hemispheres. 
 Conclusions. The use of electroencephalography in women with different types of psychological component of gestation dominant in case of progressive placental dysfunction and preeclampsia on its background allows identifying characteristic changes, modifying the program of therapeutic measures, differentiating obstetric tactics and terms of delivery.

Особливості психоемоційного стану та біопродукування стрес-асоційованих гормонів у вагітних після застосування допоміжних репродуктивних технологій

The article represents the results of a prospective clinical and paraclinical examination of women with a history of infertility, pregnancy in which occurred as a result of the assisted reproductive technologies application. The objective: was to study the dynamics of pregnancy features of the psycho - emotional state and the concentration of stress-associated hormones in the serum of pregnant women after the application of assisted reproductive technologies in order to improve the tactics of antenatal care and prevention of obstetric and perinatal complications. Materials and methods. The main group consisted of 80 pregnant women with endocrine infertility, in which pregnancy occurred as a result of therapeutic cycles of ART, control – 50 first-pregnant women with spontaneous fertilization, taken in an arbitrary order of clinical, statistical and laboratory and instrumental studies. In pregnant women of the study groups, in order to determine the psycho emotional state in the screening mode, a clinical interview was conducted by filling out questionnaires that contained the Spilberger test questions in modification of Y.L. Hanina and «Test of relationof pregnant» by the method of I.V. Dobryakova. In the dynamics of pregnancy, the concentration of prolactin (PRL) and cortisol (K) was determined by the enzyme immunoassay on the Reader-MSR-1000 apparatus using test systems manufactured by Hema-Medicament (Russia). Results. Pregnant women with infertility in past history were characterized by a state of chronic stress. According to the results of the Spielberger test in modification Y .L. Hanina every second pregnant of main group had a high level of reactive and every fourth personal anxiety. Almost 90.0% of pregnant women after art are characterized by the presence of pathological PKGD, among which an alarming and depressive type was registered in every sixth and twelfth pregnant woman, respectively. The obtained data are confirmed by the results of the study of the level of K and PRL. For women with a history of infertility and pregnancy, which is the result of therapeutic cycles of ART, inherent in increasing concentrations of stress-associated hormones – cortisol and prolactin, which is one of the reasons for the complicated course of pregnancy and requires reasonable pathogenetic correction. Conclusion. For women who are pregnant as a result of the use of therapeutic cycles of art characterized by a high level of personal and reactive anxiety and PKGD, which confirm the presence of neuropsychiatric and afferent disorders. Increasing the concentration of stress-associated hormones is one of the causes of complicated pregnancy and requires a reasonable pathogenetic correction. Key words: pregnancy, infertility, assisted reproductive technologies, psychological status, cortisol, prolactin.

ASSESSMENT OF RISK FACTORS OF SEPTIC COMPLICATIONS OF THE PUERPERIUM

Postpartum purulent-septic complications (PPSC) and their problems are most urgent for modern obstetrics due to their significant frequency. Maternal sepsis is one of the leading causes of maternal mortality around the world, accounting for about one-tenth of the global number of maternal deaths. Understanding the risk factors for the development of septic complications of puerperium is important for preventive strategies. Aim. To study the possibility of forming high-risk groups on the basis of analysis of anamnestic data and the course of puerperium in women with PPSC as part of the preventive measures for the development of such complications. Materials and methods. The first stage of the study involves a retrospective analysis for the allocation of risk factors for the development of PPSC in women, who underwent inpatient treatment for this pathology - main group (n=108); сontrol group (n=35) – parous with uncomplicated flow of the postpartum period. Prospective research enrolled 65 pregnant women with extragenital pathology and/or complicated pregnancy (group 1); 30 pregnant women without severe concomitant somatic pathology with physiological course of pregnancy (group 2). The following were taken into account: age, obstetrical and gynecological history, extragenital pathology, laboratory diagnostic data. Differences in mean values were considered significant with a probability level of at least 95 % (p<0.05). Results. To the risk factors for the development of PPSC, we classified as follows: gynecological diseases in history: menstrual dysfunction, chronic inflammatory diseases of the genital organs, bacterial vaginosis; complications of pregnancy and labor: preeclampsia, preterm labor, premature rupture of membranes, long anhydrous span, chorioamnionitis, weakness of labor, genital tract ruptures, placental attachment pathology, operative vaginal birth, bleeding; concomitant extragenital pathology: diabetes, obesity, diseases of the urinary system, diseases of the cardiovascular system, respiratory diseases, varicose disease, anemia. Conclusions. The connection between the presence of concomitant somatic pathology, the complicated course of pregnancy and labor and the subsequent development of septic complications in the postpartum period have been established. Prediction of the risk of their occurrence at the stage of pregraviditic preparation, with various complications of pregnancy and childbirth, especially in women with extragenital pathology, differential prevention will reduce the frequency of PPSC.

Modern aspects of tactics in the genital herpes viral infection (literature review)

Genital herpes affects all population groups. 98% of the adult population worldwide have antibodies to the herpes simplex virus (HSV-1 or 2). This viral infection is a significant medical and social problem. HSV can lead to a complicated course of pregnancy, causing miscarriages, premature birth, intrauterine fetal death, systemic viral disease in newborns. There is evidence that HSV has a connection with malignant tumors of the prostate and cervix, contributing to their development. This literature review contains modern aspects of epidemiology, etiology, pathogenesis, clinic, diagnosis, treatment of genital herpes, including its recurring forms with valacyclovir (Valvir). Indications for hospitalization of patients with genital herpes were noted and the prognosis of this pathology was determined. The tactics of managing pregnant women with this pathology is presented.

Порівняльний аналіз вмісту токсичних (кадмію, свинцю) та есенціальних (цинку,міді) мікроелементів у крові жінок І триместру неускладненої та ускладненої гестації

Introduction. Modern ecological situation considering global environmental pollution by heavymetals and imbalance of trace elements create preconditions for increasing the frequency of gestationalcomplications and adverse effect on children’s health throughout all periods of growthand development, including the intrauterine stage.The aim of this study was to evaluate the content of toxic (cadmium, lead) and trace (zinc, copper)elements in women’s blood during I trimester of uncomplicated and complicated pregnancyand to assess the signifi cance of their infl uence on the gestational process.Materials and methods. Investigation of cadmium, lead, zinc and copper content in the bloodof 42 women with uncomplicated pregnancy and 50 women with gestation complicated by anemia(44.0 %) and threatened abortion (56.0 %) was carried out. Determination of metals wasevaluated by inversion voltammetry method.Results. The elevated levels of toxic elements were found in all groups of women with complicatedcourse of pregnancy. The average level of cadmium in the fi rst trimester of gestation was significantly (p 0.05), lead (r=0.12; p>0.05) and zinc (r=-0.22; p>0.05), however, it is signifi cantly(p<0.05) combined with low concentrations of copper (r=-0.31).Conclusions. The average levels of toxic metals in the blood of women with complicated gestationwere signifi cantly higher compared to the physiological course of pregnancy, while the contentof trace elements were signifi cantly lower. In the fi rst trimester of gestation, the developmentof threatened abortion was combined with high levels of lead and cadmium and low levelsof zinc and copper, and the risk of anemia was correlated with a low concentration of copper inthe blood of pregnant women.

АКУШЕРСЬКІ ТА ПЕРИНАТАЛЬНІ НАСЛІДКИ ВАГІТНОСТІ У ЖІНОК З ОЖИРІННЯМ

Мета дослідження оцінити характер і частоту акушерських та перинатальних ускладнень у жінок з ожирінням.Матеріали та методи. На базі пологового будинку № 6 м. Києва був проведений ретроспективний аналіз історій пологів у вагітних з ожирінням за 2015–2016 роки. Було проаналізовано перебіг вагітності, пологів, післяпологового періоду, стан плода і новонародженого у 100 жінок з ожирінням (ІМТ&gt;30 кг/м²), які були розподілені на три підгрупи залежно від ступеня ожиріння: 1-а – 48 жінок з ожирінням І ступеня, 1-б – 32 жінки з ожирінням ІІ ступеня та 1-в – 20 жінок з ожирінням ІІІ ступеня. Групу порівняння склали 100 жінок без ожиріння.Результати дослідження та їх обговорення. Аналіз перебігу вагітності у жінок з ожирінням в І триместрі виявив високу частоту загрози переривання вагітності – 25 % проти 10 % в групі вагітних з нормальною масою тіла. Найчастішими ускладненнями у другому триместрі вагітності були: гіпертензія вагітних, яка зустрічалась у 22 % жінок з ожирінням; прееклампсія, яка спостерігалась у жінок з ІМТ&gt;30 у 4 рази частіше, ніж з ІМТ&lt;25. У вагітних з ожирінням дисфункція плаценти відмічалась в 2 рази частіше, ніж у вагітних з нормальною масою тіла. В ІІІ триместрі вагітності відсоток жінок з прееклампсією подвоювався з кожними 5–7 кг/м² ІМТ. Гестаційна гіпертензія зустрічалась у 5 разів частіше у вагітних з ожирінням. При ІМТ&gt;30 дисфункція плаценти відмічалась в 3 рази частіше в порівнянні з жінками, які мали нормальну масу тіла. Встановлена відсоткова залежність передчасних та запізнілих пологів від ІМТ, які зустрічались в 2 рази частіше у жінок з ожирінням. Ризик індукованих пологів був у три рази вищий у вагітних з ІМТ&gt;30. Відсоток кесарського розтину підвищувався із збільшенням ІМТ і ,відповідно, становив 22 % у жінок з ожирінням проти 8 % – без нього. Найчастіше показання до кесарського розтину були: первинна (5 %) та вторинна (7 %) слабкість пологової діяльності, дистрес плода (7 %), прееклампсія важкого ступеня (7 %) у порівнянні з показниками в групі вагітних без ожиріння (відповідно, 2 %, 2 %, 3 %, 0 %).Висновок. Проведене дослідження підтвердило, що ожиріння незалежно від його ступеня є преморбідним фоном для ускладненого перебігу вагітності та пологів, який сприяє розвитку несприятливих перинатальних наслідків. Подальше вивчення метаболічних особливостей при ожирінні і визначення патогенетичних механізмів формування ускладнень вагітності та пологів забезпечать розробку ефективної тактики ведення жінок з ожирінням як на етапі прегравідарної підготовки, так і на гестаційному етапі спостереження, що забезпечить зниження частоти акушерських і перинатальних ускладнень.

НЕКОТОРЫЕ ПОКАЗАТЕЛИ МОРФОФУНКЦИОНАЛЬНОЙ АКТИВНОСТИ ЛИМФОЦИТОВ ПЕРИФЕРИЧЕСКОЙ КРОВИ У ЖЕНЩИН С ОСЛОЖНЕННЫМ ТЕЧЕНИЕМ БЕРЕМЕННОСТИ

The aim of the research was to study some indices of morphofunctional state of lymphocytes in the peripheral blood under a complicated course of pregnancy in women of Khabarovsk. 96 women were examined in different trimesters of gestation. Two main groups depending on the type of complications were formed: the first group consisted of pregnant women with vaginitis, the second group had women whose pregnancy was complicated with clinical manifestations in the form of edemas, proteinuria and hypertensive disorders. The group of comparison included the women without complications. In the peripheral blood of the women under study with the method of high tech automated digital system of blood smear test VISION HEMA there was done a morphometric assessment of lymphocytes and with histochemical methods there was found a level of fermentation activity of succinate dehydrogenase (SDH), α-glycerophosphate dehydrogenase (α-GPDH) and lactate dehydrogenase (LDH). By morphometric studies of lymphocytes of the peripheral blood in pregnant women of the first group in the III trimester of gestation the indices of the square of the cell, of cytoplasm, cytoplasm brightness, the square of the nucleus and the brightness of the nucleus were 102.33±9.83 mсm², 36.84±4.88 mсm², 181.39±6.94 units of optical density, 65.69±6.87 mсm², 97.44±6.88 units of optical density, respectively (in the group of the comparison these data were 121.31±4.44 mсm²; 46.14±2.52 mсm²; 167.74±3.44 units of optical density; 75.33±2.66 mkm², 88.00±3.36 units of optical density, respectively). In the second group of women the same data in the same period of pregnancy corresponded to the following values: 128.44±4.89 mсm², 57.15±3.87 mсm², 173.53±4.65 units of optical density, 70.95±3.39 mсm² and 91.13±4.93 units of optical density (in the group of comparison there were the following data: 109.92±3.57 mсm², 39.63±1.53 mсm², 158.96±2.63 units of optical density, 75.37±3.23 mсm², 82.16±2.58 units of optical density, respectively). By the results of histochemical studies the level of activity of enzymes SDH, α-GPDH, LDH in the first group of pregnancy was 15.38±2.10, 10.72±0.58 and 20.53±2.36 pellet/cell, respectively. And just the other way round in pregnant women of the second group there was revealed a statistically reliable suppression of fermentation activity of these enzymes: 9.11±0.75 (p&amp;#60;0.05); 9.61±1.06 (p&amp;#62;0.05); 8.31±1.20 (p&amp;#60;0.05) pellet/cell in regard to the data in the group of comparison (12.84±1.21; 12.18±1.13 and 13.09±0.78 pellet/cell, respectively). Thus the changes of morphometric indices characterizing parameters of the cell, the nucleus and lymphocytes cytoplasm in a complex study with their fermentation activity can be extra diagnostic criteria of the formation of different complications during pregnancy. The obtained data allow to justify in-time application of medications for the correction of metabolic disorders of immune competent cells with the aim to decrease unfavorable perinatal outcomes.

The new directions in the physiotherapeutic applications of the natural potassium salts of the Western Ural

The subjects of investigations were the modern sylvinite constructions of different types. The study included a total of 195 patients who were randomly divided into two groups. The main group consisted of 50 patients presenting with allergic respiratory diseases, 20 ones with atopic dermatitis, and 21 with vulgar psoriasis. 31 patients had undergone aortocoronary bypass surgery in the preceding period. 49 pregnant women presented with a complicated course of pregnancy. 24 patients suffered from chronic generalized catarrhal gingivitis. The control group was comprised of 188 persons presenting with the same diseases (46, 30, 18, 20, 49, 25 patients in each of the above groups respectively) who received only the traditional pharmacotherapeutic treatment. All the patients underwent evaluation of the respiratory and cardiovascular functions. The clinical manifestations and the skin damage areas were estimated in the patients with atopic dermatitis and vulgar psoriasis. Blood circulation in placenta, the state of the periodontal tissues, and local immunity in the oral cavity mucosa, as well as the subjective psychological status were evaluated. The physical and chemical characteristics of the internal environment of the salt constructions (microclimatic factors, radiation, air ionization, salt aerosol content) were estimated. The data obtained provided a basis for the development and patenting of the methods for the treatment of atopic dermatitis, vulgar psoriasis, placental insufficiency, and chronic generalized catarrhal gingivitis based on the halotherapeutic modalities. The results of the long-term hygienic, physical and clinical investigations made it possible to identify the complex of curative factors inherent in the natural mineral sylvinite constructions. These factors are believed to create the optimal conditions for the efficient management of the patients presenting with dermatological, cardiological, obstetrical, and stomatological problems.

THE STRUCTURE OF THE GENETIC POLYMORPHISMS IN PATIENTS WITH METABOLIC SYNDROME AND A COMPLICATED PREGNANCY IN HISTORY

Objective. To analyze the structure of the gene polymorphisms of hemostasis, platelet receptors and enzymes of the folate cycle in patients with metabolic syndrome (MS) and a complicated pregnancy in history. Materials and Methods. The study included 115 patients with MS. Of these, group 1 (64 patients) had a complicated course of pregnancy in anamnesis and group 2 (51 patient) with no pregnancies in anamnesis. The control group consisted of 50 somatically healthy mothers. All the patients were carried out molecular analysis of gene polymorphisms of the hemostatic polymorphisms of platelet receptor genes, polymorphisms of genes of folate cycle enzymes by polymerase chain reaction. Results. In all patients with MS was identified pathology of genes of hemostasis, platelet recept ors or enzymes of the folate cycle, and in all cases attended a multigenic (more than two defect genes) form of pathology. In the study, the patients with MS was significantly higher frequency of polymorphism in the gene for inhibitor of tissue plasminogen activator, in the gene of tissue plasminogen activator, fibrinogen gene, in the gene for angiotensin-converting enzyme gene of the receptor of angiotensin II 1 type. Gene polymorphisms of platelet receptors were also found significantly more often in patients with MS. Results of the study of folate cycle enzymes genes showed the prevalence of pathological polymorphisms in this group of genes in the genotype of patients with MS. In patients with MS and a complicated pregnancy in history was revealed not only a large frequency of occurrence of a pathological gene polymorphisms, but also the predominance in the structure the homozygous forms of these polymorphisms. Conclusion. Thus, it becomes obvious pathogenetic role of latent thrombophilic states in the development of various obstetric complications in patients with MS and the reason underlying this condition is a multigenic structure of the gene polymorphisms of hemostasis, platelet receptors and enzymes of the folate cycle in all MS patients.

The histone proteins of blood leukocytes under miscarriage.

To analyze fractions of histones in lymphocytes of peripheral blood of women under physiological and complicated course of pregnancy. Three groups of female patients were examined (85 persons in all). The main group (I) included 30 women with physiological course of pregnancy; the main group (II) included women with threat of miscarriage (35 persons); control group (III) consisted of 20 healthy and without pregnancy women. The study established significant increasing of content of histone proteins under physiological development of pregnancy, especially fractions (H2A, H3, H4) and H2B as compared with control. In female patients from group II content of total histone fraction (H2A, H3, H4) remained at the level of women without pregnancy and reliably differed from similar indices of group I. The established alterations possibly are necessary for decreasing of activity of lymphocytes and development of tolerance to tissues of fetus.

DIAGNOSTIC SIGNIFICANCE OF DETERMINING OXYGEN SATURATION VALUE IN FULL-TERM NEWBORN INFANTS

Aim. To determine the standard values of oxygen saturation and the causes of its fall in full-term newborn infants for improvement of diagnostic possibilities of pulse oximetry in neonatological practice. Materials and methods. 543 full-term newborn infants underwent pulse oximetry, 226 - echocardiographic examination. Results. Oxygen saturation standards in newborn infants were developed. It was shown that presence of fetal communications as well as small muscular defect of interventricular septum is not accompanied by decrease in its value and increase in gradient of indices between the upper and the lower extremities. The following factors lowering oxygen saturation in full-term newborn infants without organic cardiovascular diseases were detected: complicated course of pregnancy and labor, polycythemia, declined contractile ability of myocardium. Growth of gradient of indices between the upper and lower extremity was observed in case of mild cerebral ischemia and in infants with high weight and body length indices at birth.