Complicated Obstetric History Research Articles

Obstetric and gynecological management in a patient with abnormal invasion of the placenta (placenta percreta)

Pathological placental invasion is a dangerous anomaly during pregnancy, which causes increased maternal morbidity and mortality. Patients with abnormal placental invasion may experience life-threatening uterine bleeding during delivery, particularly in cases of placenta percreta. This often requires surgical intervention, specifically a hysterectomy, which some researchers refer to as the “gold standard” treatment for pathological placental invasion, with rates ranging from 47% to 77.8%. Conversely, other researchers recommend a conservative approach, involving the complete removal of the placenta percreta, excision of damaged areas on the uterine walls and bladder, and metroplasty and restoration of the integrity of the. This article presents a clinical case of a 40-year-old patient with a complicated obstetric history, including abnormal placental invasion (placenta percreta) involving the anterior wall of the uterus and the bladder. Delayed diagnosis of such pathology leads to inappropriate treatment and, consequently, acute massive bleeding, posing a risk to the patient’s health and life. The applied comprehensive diagnostic and therapeutic measures facilitated the preservation of the pelvic organs and restoration of the patient’s reproductive function.

Pregnancy and psychoemotional state of women after in vitro fertilization

Aim. To study the psycho-emotional state of pregnant women after IVF and to identify the factors influencing it.Materials and methods. A total of 104 pregnant women were included in a comparative study. They were divided into two groups: one group consisted of women whose pregnancy occurred after IVF (main group), and the other group consisted of women whose pregnancy occurred naturally (comparison group). Psychodiagnostic questionnaires were used to assess the psycho-emotional state of the pregnant women. Statistical processing was performed using the STATISTICA 10.0 program, and differences were considered significant at a significance level of p=0.05.Results and discussion. The results of the analysis showed that the mean age of pregnant women after IVF was 30.8±1.3 years, which was significantly higher than that of women with natural pregnancy (mean age 22.38±4.6 years). In the group of women who became pregnant after IVF, there were more women with a complicated obstetric and gynaecological history and with extragenital pathology. The results of psychodiagnostic studies showed that women in the IVF group had a high level of anxiety. Factors such as the age of the pregnant woman, history of infertility, longterm and unsuccessful infertility treatment, and the presence of somatic pathology negatively affect the mental health of pregnant women.Conclusion. Thus, a high level of anxiety, fear about the course of the pregnancy and the health of the unborn child is characteristic of women whose pregnancy occurred after IVF. Psycho-emotional reactions are associated with the nature of the pathology of the pregnancy, the duration of infertility treatment and a burdened obstetric and gynaecological history. It is important to create special consultation rooms for psychological support. The help of a perinatal psychologist is necessary. Collaboration between the psychologist and the attending physician can achieve the best results.

Intrauterine fetal hypoxia: risk factors for development and diagnosis

Fetal hypoxia is not an independent disease, but is a complication resulting from pathological processes, primarily in the mother’s body. There are many risk factors for the development of this pathological condition, which results in adverse changes in the fetal body. That is why early diagnosis is so important, the ―gold standard‖ of which is cardiotocographic examination, ultrasound diagnostics and assessment of minimal facial movements in the early stages. The purpose of the study is to study the risk factor for the development of acute and frequent fetal hypoxia, as well as the possibility of the occurrence of diseases during pregnancy and childbirth in order to determine preventive measures. For this purpose, an analysis of the necessary literature was carried out. As a result, in order to reduce the development of fetal hypoxia, it is necessary to improve the quality of health of the population in the preconception period; women with a complicated obstetric history are at high risk for this nature

Modern possibilities of correcting violations of the vaginal biotope in pregnant women at risk in wartime conditions

Research objective: to determine the effectiveness of a complex local preparation with antiseptic action based on octenidine and repair agent dexpanthenol (Prodexyn) in the syndrome of abnormal vaginal discharge (AVD) in pregnant women with obstetric pathology during the gestation and in the sanitation of the birth canal on the eve of childbirth.
 Materials and methods. 49 pregnant women were examined and divided into 2 groups: group I – 21 women (including 6 pregnant women with the status of internally displaced persons (IDPs)) with AVD in the period of 14–36 weeks of pregnancy; group II – 28 pregnant women (15 of them IDPs) on the eve of childbirth, who needed sanitation of the birth canal in the period of 37-41 weeks. The selection of patients was based on complaints, objective examination in mirrors and determination of vaginal pH. A bacterioscopic and bacteriological study was carried out if the pH deviates from the norm in order to identify pathogens and control the treatment effectiveness. Prodexyn was prescribed to all women in the vaginal suppositories at night for 10 days from the II trimester of pregnancy.
 Results. Most of women had a complicated obstetric and gynecological history, chronic inflammatory diseases of the pelvic organs, and viral infections. 87.7% of women had obstetric complications during current pregnancy.
 In the group I the primary average value of vaginal pH was 4.94 ± 0.02, and was the highest in IDPs (5.0-5.3). In the group II the pH before delivery at the initial screening was 5.1 ± 0.03, and in IDPs it was 5.7. Bacterioscopic examination in both groups showed a large number of leukocytes, cocci and fungal flora. Bacteriological examination in both groups showed a total of 11 pathogenic and opportunistic pathogens in various 2–3 component microbial and microbial-fungal associations against the background of a significant decrease in the number of lactobacilli. Single cases of Staphylococcus aureus and Streptococcus agalactiae (in group I) and Streptococcus viridans (in group II) were found.
 After sanitation the state of the vaginal biotope significantly improved in the majority of pregnant women of both groups. pH in group I was 4.51 ± 0.013, in group II was 4.55 ± 0.03. According to bacterioscopy, the number of leukocytes, coccal, bacillus and fungal flora significantly decreased in both groups. Bacteriological examination showed positive dynamics of the microflora concentration and the amount of its species spectrum. The lactobacilli concentration increased in both groups. Worse indicators of the vaginal biotope restoration were observed in IDPs, especially in the I group in the II–III trimesters, which required an extension of the treatment course for another 5–10 days.
 Conclusions. The complex local preparation with antiseptic action Prodexyn for AVD in pregnant women with obstetric pathology has shown its effectiveness and safety. As a result of the treatment, the number of pathogenic and conditionally pathogenic flora decreased significantly, with a simultaneous increase in the saprophytic flora and lacISSN 2309-4117tobacilli concentration.

Clinical and laboratory study of premature infants with hypoxic-ischemic encephalopathy

We conducted a comprehensive clinical and laboratory study of 102 preterm infants with hypoxic-ischemic encephalopathy (HIE) of varying gestational ages. All preterm infants were born to mothers with a complicated obstetric history. Clinical manifestation of CNS hypoxic-ischemic injury was observed in 100% of this cohort. Intracranial hemorrhages (ICH) of grades I-IV were registered in 38 (37.2%) cases, while periventricular leukomalacia (PVL) was present in 5 (4.9%) cases. Intrauterine growth restriction (IUGR) was observed in 36 (35.3%) cases, and respiratory distress syndrome (RDS) in 65 (63.7%) cases. Mild cerebral ischemia was diagnosed in 51 (50%) cases, moderate-severity cases in 32 (31.4%) cases, and severe CI in 19 (18.6%) preterm infants. The severity of clinical progression of HIE in preterm infants was shown to be dependent on gestational age, intrauterine hypoxia, and birth asphyxia. The health status of their mothers plays a crucial role in the development of CNS and other systemic injuries in preterm infants. Therefore, premature births remain a pertinent issue in modern society.

Features of pregnancy course in patients with thrombophilia and abnormal placenta location

Aim: to identify inherited and acquired thrombophilia as well as features of pregnancy course in women with abnormal placenta location.Materials and Methods. Within the framework of a prospective controlled cohort non-randomized, interventional study there was analyzed pregnancy course in 135 women with abnormal placenta location: group I – 42 patients with abnormal placenta location in history; group II – 61 women with placenta previa detected during ongoing pregnancy; group III – 32 patients with placenta previa detected both in ongoing and previous pregnancy. The control group consisted of 120 pregnant women with normal placenta location without a previous complicated obstetric history. All patients underwent clinical examination of pregnancy course assessing fetus intrauterine growth retardation (IUGR) and fetal biophysical profile; inherited and acquired thrombophilia were identified – analyzing circulating antiphospholipid antibodies (APAs) by ELISA, inherited thrombophilia by polymerase chain reaction to identify mutations in genes encoding 5,10methylenetetrahydrofolate reductase (MTHFR), G20210A mutations in prothrombin gene, V Leiden mutation, polymorphismin fibrinogen and plasminogen activator inhibitor 1 (PAI-1) genes.Results. Inherited thrombophilia was detected in 101 (74.81 %) pregnant woman with abnormal placenta location: group I – in 31 (73.8 %) patients, group II and group III – in 44 (72.1 %) and 26 (81.3 %) patients, respectively. Inherited forms of thrombophilia were detected in 29 (24.2 %) women from control group. Multigenic forms of thrombophilia peaked in group III (14/43.8 %), followed by group I (16/38.1 %) and group II (23/37.7 %). In the control group, multigenic thrombophilia was detected in 16 (13.3 %) women. Selective inherited thrombophilia and АРАs circulation were detected in 30 (22.22 %) women with abnormal placenta location: group I – in 8 (19.0 %) patients, group II – in 13 (21.3 %), and group III – in 9 (28.1 %) cases. In the control group, there were only 8 (6.7 %) such patients. Patients with IUGR signs were identified in all study groups: 4 (9.52 %) in group I, 6 (9.84 %) in group II, 6 (18.75 %) in group III as well as in control group in 6 (6.67 %) women.Conclusion. Pregnancy management in patients with thrombophilia and placental abnormalities should be accompanied by an proper fetal assessment (biophysical profile) and, in some cases, anticoagulant or antiplatelet therapy. However, insufficient number of cases requires to conduct further investigations to assess a relation between thrombophilia, placenta previa and a risk of obstetric complications particularly IUGR.

Факторы риска антенатальной гибели плода у беременных женщин с отягощенным акушерским анамнезом, перенесших COVID

Objective. To investigate the significance and prognostic value of risk factors for intrauterine fetal demise (IUFD) in women with complicated obstetric history (COH) who had COVID-19 in the second and third trimesters of pregnancy. Patients and methods. A retrospective study of 5027 medical records of pregnant women, postpartum women and neonates who received treatment in obstetric institutions in Almaty with positive PCR results for SARS-CoV-2 in the second and third trimesters of pregnancy was conducted. IUFD occurred in 46 (0.9%) pregnant women. Results. The risk of IUFD increased with prolongation of COVID-19 treatment during pregnancy (OR = 8.673, 95% CI: 4.252-17.692), in the absence of therapy with low-molecular-weight heparin (OR = 4.835, 95% CI: 2.471-9. 459) and was also characteristic of moderate and severe COVID-19 (OR = 4.2667, 95% CI: 1.0603-17.1689), with history of maternal anemia and acute respiratory viral infections (ARVI) (OR = 3.524, 95% CI: 1.643-7.559 and OR = 4.117, 95% CI: 1.881-9.010, respectively). Meanwhile, the absence of antibiotic and corticosteroid therapy was associated with a lower risk of IUFD (OR = 0.415, 95% CI: 0.184-0.937 and OR = 0.278, 95% CI: 0.142-0.547, respectively). Conclusion. The risk of IUFD in pregnant women with COH and COVID-19 during pregnancy increased significantly with the duration of COVID-19 treatment, with moderate and severe course, and with the deficiency of anticoagulant therapy. At the same time, the absence of glucocorticosteroids and antibacterial agents showed a negative association with IUFD. Key words: intrauterine fetal demise, antibiotic therapy, anticoagulants, pregnancy, glucocorticosteroid therapy, COVID-19

Analysis of the course of the new coronavirus infection COVID-19 in pregnant women under treatment in the Infection Department of Clinical Hospital no. 1 in Smolensk

BACKGROUND: The physiological features of the pregnant womans body include her in the risk group for a more severe course of the disease, therefore, the management and treatment of such patients requires the most careful monitoring, as well as the coordinated work of a gynecologist and an infectious disease specialist.
 AIM: To evaluate the variants of the course of the disease in pregnant women with confirmed coronavirus infection.
 MATERIALS AND METHODS: The medical records of patients who were treated in the infectious diseases department of the Clinical Hospital No. 1 in Smolensk from May 2020 to September 2021 were analyzed, the necessary data were included in the protocols of our study. Such indicators as the main diagnosis and severity of the course of the disease, complaints at admission, the presence and stage of fever, age, gestational age, the presence of concomitant pathology and a complicated obstetric and gynecological history were evaluated.
 RESULTS: Analysis of the course of the disease according to the medical history showed that a moderate form of a new coronavirus infection dominates pregnant women.
 CONCLUSIONS: A trend towards a moderate course of a new coronavirus infection COVID-19 has been established. The probability that this is due to the presence in most patients with a history of diseases of the cardiovascular system, kidneys, liver, as well as diabetes, obesity, anemia.

MO080: Pre-Eclampsia in Patients With Chronic Kidney Disease (CKD)

Abstract BACKGROUND AND AIMS CKD is a significant risk factor for preeclampsia (PE). However, the features of PE in this cohort of patients (pts) have not been previously studied in detail. In this regard, the analysis of PE in pts with CKD is of great clinical and social importance. The aim of the study is to analyze the incidence and characteristics of PE in pts with CKD METHOD A retrospective analysis of 60 case histories of pregnant women with CKD (1–4 stages) was carried out, 27 of which had CKD st. 3a-4, followed in the dedicated center from 2018 to 2021. About 10 (37%) women with CKD 3a-4 developed PE, then the course of their pregnancy was analyzed. Indicators of creatinine, proteinuria and blood pressure were assessed at the time of the first visit to the center and further at the time of PE. The physiological response of the kidneys to pregnancy was assessed in six women in whom the value of creatinine before pregnancy was known as a decrease in creatinine concentration by 10% from the initial (before pregnancy). In 6 out of 10 women, the baseline pre-gestational SCr was available, and the physiological kidney response to pregnancy, which was considered as a persistent decrease in SCr by at least 10% from the baseline level, was assessed. In four pts, there was no information about blood creatinine before pregnancy. RESULTS In the group of pts with PE and advanced CKD, the mean age was 32.3 (±4.8) years (from 28 to 42 years). The most common cause of CKD was GN—6 (60%) and one each—tubulointerstitial nephritis, diabetic nephropathy, aHUS, APS-associated nephropathy. CKD C3a: 4 (40%) pts, C3b: 3 (30%) and C4: 3 (30%) pts. Complicated obstetric history (PE, antenatal fetal death) had 3 (30%) of 10 pts. The mean term of gestation at the time of first visit to nephrologist was 15.6 weeks. At the first measurement during pregnancy, the mean Scr was 157 (±69) μmol/L; the physiological response of the kidneys to pregnancy was noted only in 1 out of 6 pts. The mean proteinuria was 1.2 (±0.8) g/L. Arterial hypertension had 3 (30%) pts and only 1 woman received antihypertensive therapy before pregnancy with the achievement of target BP values. The mean blood pressure at the first visit was: SBP 131 (±11.5)/DBP 84 (±7.3) mm. Hg. Aspirin for the prevention of PE was prescribed in a timely manner in six cases (60%); in 4 pts (40%) aspirin was either not prescribed or was added to therapy after 12 weeks of pregnancy. Anticoagulant therapy with LMWH was prescribed before 28 weeks of gestation for patients with PU >1 g/day (seven cases). Combined antiplatelet and anticoagulant therapy was performed in 4 (40%) cases. PE before 34 weeks of gestation (early PE), developed in 7 (70%) pts, and the mean term for the development of PE was 31.3 weeks [27; 36.5]. The mean blood pressure at the moment of PE was 142 (±17)/90 (±10.6) mm Hg. The majority of women showed an increase in proteinuria (Table 1). The development of AKI was noted in six cases (Table 1). Another sign of a severe course of PE was thrombocytopenia in two cases (less than 100 thousand in 1 μL), in one of them as the part of HELLP syndrome. The markers of PE (sFLT1, PLGF, sFLT1/PLGF) were analyzed in five (50%) cases. The mean value of the ratio at the moment of PE was: sFLT1/PLGF: 157.6 that for a given gestational term (31.3 weeks) corresponds to severe ischemic damage to the placenta. The mean delivery term was 32.4 weeks of gestation; all newborns were alive and viable with the mean weight 1514 g (978–2250 g). CONCLUSION According to our data, the main features of PE in pts with advanced CKD are its early onset (up to 34 weeks), severe course with AKI in 60% of cases, with relatively low BP values.

Фактори ризику гастроінтестинальної харчової алергії в дітей раннього віку

Purpose - to study risk factors of gastrointestinal food allergy (GIFA) in young children. Materials and methods. 68 young children with GIFA and 22 children of the same age with an unencumbered individual allergy history were examined. A study of children perinatal, family and individual allergy history was conducted, and a survey was conducted on the state of parents’ health. The vitamin D supply of children was determined by quantifying of serum 25-hydroxycalciferol (25(OH)D) concentration by using an immunochemical analyzer. Results. Anamnestic risk factors that showed a significant association with the development of GIFA in young children and reliably differed from the control group were: complicated obstetric history, medical treatment of mothers during pregnancy, early artificial feeding, burdensome family allergy history and gastrointestinal diseases presence in parents. Insufficient supply of vitamin D was in 79.4% of patients with GIFA compared with 13.6% of children in the control group. The average serum 25(OH)D value in children with GIFA was 34.18±1.7 ng/ml, which is significantly lower than in the control group (40.2±2.3 ng/ml; p<0,05), which may be an additional factor in the development and severity of the disease. Conclusions. Risk factors of gastrointestinal food allergy have been identified, which will improve the prevention, early diagnosis and treatment of gastrointestinal allergic disease. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author. Key words: gastrointestinal food allergy, risk factor, vitamin D, young children.

Threatened abortion in women with retrohorial hematomas in the first trimester

The objective: to study the features of the clinical course of the first trimester of pregnancy, complicated by the threat of abortion with the formation of retrochorial hematoma (RCH). Materials and methods. 100 pregnant women aged 18–44 years (average age 28.08±3.5 years) in 6–13 weeks of gestation were examined. The main group consisted of 70 patients and was divided into two subgroups: subgroup A (n=40) – 40 primigravida women with the threat of abortion and RCH; subgroup B (n=30) – 30 multigravida women with the threat of abortion and RCH and a complicated obstetric and gynecological history. Control group (n=30) – primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination, ultrasound examination of the uterus and fetus with Doppler, determination of the infectious profile (bacterioscopy).Results. The majority of the patients in all groups had a complicated somatic history, while in half of the cases there was a combination of two or more somatic diseases – in 45.7% of pregnant women in the main group and 33.3% – control group. 32.9% of women in the main group had a genetically determined form of thrombophilia. A complicated obstetrical and gynecological history was established in 22.5% of patients in subgroup A, 30% – subgroup B and 16.6% of pregnant women in the control group. Mostly, inflammatory diseases of the pelvic organs were detected in the main group – 15–21.4% (in both subgroups) and previous surgery on the pelvic organs (11.4% in total). A high incidence of spontaneous miscarriages was found in patients of subgroup B (13–43.3%). Every fourth pregnant woman in the main group had a 3–4 degree of purity of vaginal smears. For the first time, the hematoma was diagnosed before 6 weeks of gestation in 8% of pregnant women of subgroup A (2.5% of these patients had a spontaneous abortion at 9–10 weeks) and in 30% of women in subgroup B (23.3% of them had an interruption of pregnancy at 7–12 weeks). The corporal location of RCH was found in 28.6% of patients in the main group (15.7% and 12.9% in subgroups, respectively), supracervical – 71.4% (almost the same in both subgroups), while hematomas of more than 25 cm3 were detected in 8 patients of the main group (25% and 75% in subgroups, respectively), all of such RCH were located corporally. In 70% of supracervical RCH, a small and medium volume of hematoma was diagnosed, which was in 1.5 times more often detected in pregnant women of subgroup A. Hematomas of a larger size were found in 3 times more often in women of subgroup B. The main clinical symptoms of threatened abortion with the formation of RCH were bleeding from the genital tract (53–75.7%), pain syndrome (48–68.5%), uterine hypertonus or a combination of these symptoms (39–55.7%).Conclusions. The presence of chronic extragenital pathology, chronic urogenital infection, surgical interventions on the pelvic organs, a high frequency of artificial and spontaneous abortions, recurrent miscarriage, a history of missed pregnancy in combination with a large volume of RCH, the corporal location of PCH, the term of gestation in which a hematoma is found, as well as ultrasound signs of uterine hypertonus are unfavorable predictors of early miscarriage and reproductive losses.

Clinical-anamnestic characteristic of first-year children with CNS hipoxyc-ischemic injury

Diseases of the nervous system occupy the second place among the causes of childhood disability. Perinatal injuries of the nervous system constitute up to 65–75 % of all diseases of the nervous system in childhood and lead to disability in 15–30 % of full-term newborns, 40–60 % of born prematurely.Aim: to provide the clinical-anamnestic characteristics of newborns with hypoxic-ischemic CNS injury.Materials and methods. The study included 100 newborns. The main group – 31 patients with CNS hypoxic-ischemic injury complicated by an infectious process, the comparison group – 35 patients with CNS hypoxic-ischemic injury without the infectious process, the control group – 34 conditionally healthy children born without signs of CNS hypoxic-ischemic injury and inflammatory diseases.In the course of the work, the clinical-anamnestic method and the methods of mathematical statistics were used. Statistical processing of results was performed using license program package Statistica 13.0 (StatSoftInc, serial number JPZ8041382130ARCN10-J).Results. It was found that it is impossible to assess the condition of newborns without taking into account an obstetric history due to the fact that complications of the prenatal period lead to the action of harmful factors of different nature on an immature fetus and can cause severe damage including the development of hypoxic-ischemic brain injury.Conclusions. Prematurely born children with hypoxic-ischemic CNS injury complicated by the infectious process, unlike conditionally healthy prematurely born children, are characterized by low gestational age (29.55 ± 4.20 weeks and 36.0 ± 0.0 weeks, respectively), the prevalence of pathology in the second half of pregnancy and threatened miscarriage. The presence of a complicated obstetric history greatly increases the possibility of hypoxic-ischemic brain injury in newborns, and its infectious-inflammatory complication is more likely to develop in children with low body weight and low Apgar scores. The phenomena of hypoxia, both hypoxic and circulatory, are more common for patients who were born prematurely.

Title: Effect of multiple maternal red cell alloantibodies on the occurrence and severity of Hemolytic Disease of the Fetus and Newborn

IntroductionAntenatal antibody screening in India is focused on the detection of anti-D in RhD-negative mothers. HDFN outcome can also be affected by the presence of antibodies other than anti-D. We planned this study to find the impact of ‘anti-D in combination with additional antibodies’ on the development and severity of HDFN compared with ‘anti-D alone’. MethodsThis is a retrospective study performed at a referral center in northern India from October 2015 to March 2018. Antibody screening was performed on women with complicated obstetric history. Women with anti-D antibody were included in the study and categorized on the basis of presence of additional antibody (anti-D alone or in combination with other antibody). Various clinical, laboratory & interventional parameters were used to define HDFN and severe HDFN. Perinatal outcome was then compared between the two groups. ResultsA total of 176 women with anti-D antibody were included in the study. Of these, 136 cases (77.3%) had anti-D alone while at least one additional antibody was present in 40 (22.7 %) cases. Most common additional antibodies were anti-C, anti-E and anti-c. After excluding 46 women for various reasons, 130 women were left for final analysis. Approximately 57% and 78% of cases were affected by severe HDFN amongst women with anti-D alone and in combination, respectively. Relative risk of developing severe HDFN was 1.7 times higher in women with additional antibody. ConclusionsPatients with combination antibodies were found to have more severe HDFN compared to the ones with anti-D alone.

POSSIBILITIES OF CORRECTION OF PSYCHOVEGETATIVE DISORDERS IN PREVENTION OF FETAL DISTRESS WITH WEIGHTENED OBSTETRIC ANAMNESIS

The purpose – to evaluate the effectiveness of the correction of psychovegetative disorders in the prevention of fetal distress in pregnant women with complicated obstetric history (perinatal losses).Materials and methods. Pregnant women with complicated obstetric history were divided into 2 clinical groups: the main (group I) and the comparison group (group II). Patients of the main group (n = 60) were prescribed the proposed treatment complex, which includes a combination of psychotherapy and autonomic stabilizing drugs. The comparison group consisted of 60 pregnant women with a history of perinatal losses that did not differ in age, sex, body mass index and received only standard drug therapy. Cardiointervalography indicators were used to assess the dynamics of autonomic imbalance before and after treatment. The level of psycho-emotional state and psychosomatic disorders was determined by the Spielberg-Khanin scale.Results. Under the influence of the therapy, the severity of clinical manifestations of autonomic disorders was significantly reduced, and the frequency of sympathotonia was significantly reduced according to cardiointervalography. After treatment in the main group there was a significant increase in the percentage of pregnant women with normoadaptive state of regulatory systems from 48.3% to 86.7%, a marked decrease in anxiety and restoration of normal psycho-emotional state. The use of the proposed treatment complex helped to improve the course of pregnancy in patients with a history of perinatal losses, in particular, reduced the incidence of hemodynamic disorders from 34.1% to 10% and fetal distress - from 10.8% to 3.3%.Conclusions. The increase in the incidence of obstetric complications, in particular, fetal distress, in pregnant women with a history of perinatal losses is associated with the development of autonomic disorders, as evidenced by cardiointervalography. Analysis of heart rate variability can be used for early diagnosis of autonomic disorders and prevention of gestational complications. The proposed treatment complex, which included psychoemotional regulation and symptomatic therapy of autonomic dysfunction, helps to optimize the fetus perinatal protection, to prevent the hemodynamic disorders and fetal distress.

Features of the medical history and pregnancy outcomes in women with antiphospholipid syndrome depending on correction methods

Hypothesis/aims of study. The aim of this study was to evaluate the features of the medical history and pregnancy outcomes in women with miscarriage and antiphospholipid syndrome depending on the methods of its correction.
 Study design, materials and methods. A prospective cohort study was conducted, in which a total of 137 pregnant women with a history of abortion and antiphospholipid syndrome were examined. The women were divided into two groups according to the principle of the presence or absence of plasmapheresis procedures in the scheme of miscarriage therapy at the pregravid stage. Group I (main) consisted of individuals (n = 73), who were treated with the inclusion of plasmapheresis at the pregravid stage; group II (comparison) included women (n = 64), who were not given efferent therapy.
 Results. Antiphospholipid syndrome was more common in patients with a complicated obstetric and gynecological history. As a result of persistent infection, chronic endometritis and salpingo-ooparitis were more often observed in patients with TORCH infection. The titer of antiphospholipid antibodies, regardless of the presence or absence of TORCH infection, decreased after plasmapheresis, such positive dynamics being observed only in patients with a history of gestational losses of less than four.
 Conclusion. The level of reduction of antiphospholipid antibodies in relation to the initial values was 6095%, which indicates the optimal choice of the characteristics of plasmapheresis therapy and its duration.

Fetal inheritance of GP*Mur causing severe HDFN in an unrecognized case of maternal alloimmunization

The clinical and laboratory features of hemolytic disease of the newborn can be challenging to diagnose during pregnancy in the apparent absence of a blood group antibody. Low-frequency antibodies go undetected due to the lack of appropriate antigen-positive reagent red blood cells (RBCs). A pregnant woman of Southeast Asian descent was referred to a maternal-fetal medicine outpatient clinic due to a complicated obstetric history and a negative antibody screen. This initial visit at 29 weeks and 0 days' gestational age (GA) was unremarkable. A hydropic infant, born at 29 weeks and 5 days' GA, succumbed on the seventh day of life. Comprehensive laboratory testing was performed after birth. The hospital blood bank performed a maternal antibody identification. Direct antiglobulin test was performed on the cord blood. A reference laboratory confirmed an anti-Mia , performed paternal Mia phenotyping, and identified a hybrid glycophorin B-A-B GP*Mur allele. Maternal alloimmunization to low-frequency antigens remains a challenge. Southeast Asians make up a significant percentage in some US locations. Worldwide reports on the frequency of maternal alloimmunization of the MNS system can be used to guide the use of specific reagent RBCs for testing. Such strategies rely on the identification of blood donor units for reagent manufacture and use in perinatal antibody screens. The incidence of Mia and related antibodies is significant among Southeast Asians. In North America, prenatal antibody screening cells are not routinely chosen to match this population. The clinical and societal implications are discussed.

FETAL DISTRESS DIAGNOSTICS AND PREVENTION IN WOMEN WITH PERINATAL LOSSES IN HISTORY

Purpose of the study. To establish the features of diagnostics and prevention of fetal distress in pregnant women with complicated obstetric history.Material and methods. The study involved 104 women with a history of perinatal losses and 110 women with a physiological pregnancy. The cardiotocography, cardiointervalography and ultrasound with dopplerometry were performed to diagnose the fetal distress. A complex containing Acetylsalicylic acid, Magnesium, L-carnitine, Ginkgo biloba, Omela white and Hawthorn was proposed in order to prevent the occurrence of fetal distress in pregnant women with perinatal losses in history.Results and discussion. A study of heart rate variability showed a predominance of the sympathetic tone in women with complicated obstetric history, namely with a perinatal losses in history. Fetal distress was diagnosed significantly more often in pregnant women with a history of perinatal losses than in women of the control group. The disadaptation syndromes were significantly more often diagnosed in newborns from women with a history of perinatal losses.Conclusions. The proposed diagnostic and prophylaxis algorithm allowed to reduce the incidence of fetal distress in women with a history of perinatal losses by 2.2 times, to increase the percentage of timely physiological deliveries and to improve the newborn’s condition after birth.

Features of Diagnostics and Prophylaxis of Fetal Distress in Women with Autonomicdisorders

The objective: to establish relationships between prenatal stress changes, autonomic disorders and the fetal distress development in pregnant women with perinatal losses in history.Materials and methods. 214 pregnant women were examined. In the 104 pregnant women with perinatal a history of losses, the control group (group II) – 110 women without obstetric history. Study groups were identical in age, duration of pregnancy and parity of childbirth. To study the state of vegetative regulation was usedanalysis of cardiointervalography indicators. Assessment of adaptation reactions was carried out in terms of regulatory activity systems. To study the hemodynamic component of the system «mother–placenta–fetus» was performed by Doppler ultrasound.Results. In the majority of women in control group (82.7%), the normal reactivity of both departments of the autonomic nervous system was noted. Autonomic reactivity in the main group was manifested as sympathotonia in 48.1% of women and hypersympathotonia in 34.6% of patients. The norm-adaptive state was detected in 90% of pregnant women of II group. In 50% of patients with complicated obstetric history a hypoadaptive state of regulatory systems was established. Symptoms of placental dysfunction occurred in 46.2% of pregnant women in group I and in 29.1% of control group patients. Ultrasound signs of fetal distress were found in 10.6% in I group and 2.7% in II group. At the same time, in 7.7% of the main group, fetal distress occurred in preterm pregnancy. In the control group preterm caesarian section due to fetal distress was perform in 0.9% of women.Conclusions. In women with perinatal losses, an autonomic dysfunction, which is manifested by hypersympathotonia, and disorders of regulatory and adaptive mechanisms are installed, which lead to a functional reserves exhaustion. In pregnant women with perinatal losses a greater frequency of placental dysfunction with the hemodynamic disorders in the system of «mother–placenta–fetus» and fetal distress are observed due to established autonomic disorders.

Особливості перебігу вагітності та пологів у жінок після застосування допоміжних репродуктивних технологій на тлі ожиріння (За даними ретроспективного аналізу)

The objective: to study the structure and frequency of complications of pregnancy, deliveries and perinatal outcomes in three groups of women: women with infertility and obesity, treated by application of in vitro fertilization (hereinafter IVF), pregnant women after IVF application with normal body weight, and pregnant women on the background of obesity which did not have an infertility in past history. Materials and methods. A retrospective analysis of 221 case histories of pregnancies and labors in women who were treated and gave birth in the Pregnancy and delivery pathology Department of SI «Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O. M. Lukyanova of NAMS of Ukraine» for 2012 – 2016 years was carried out. Results. The overwhelming majority of pregnant women after IVF on the background of obesity are primaparas, who have a complicated obstetric history, hormonal changes in the form of progesterone deficiency predominantly and chronic inflammatory processes. Pregnancy with a combination of infertility, treated by the means of IVF application, and obesity, in most cases is accompanied by a long-term threat of termination of pregnancy (48.8%), threatening preterm deliveries (56%), placental dysfunction (41.5%), premature rupture of the amniotic membranes (41.5%), other problems during pregnancy, at the same time, every second woman (58.5%) had a combination of several complications, and required a long-term and repeated inpatient treatment (53.7%). The specific gravity of surgical delivery was 90%, and 16.2% of such deliveries were complicated by pathological blood loss. The number of preterm deliveries was 17.1%, with perinatal losses up to 11.3‰. Among full-term newborns 21.3% of newborns had malnutrition of the I degree and 17% of them had hypoxic-ischemic lesion of CNS. Conclusion. The course of pregnancy, delivery and the postpartum period in the studied contingent of women has a significant frequency of complications, mainly the coinciding ones, which affects on the consequences of perinatal outcomes and requires further study of this problem and the development of differentiated algorithms for antenatal observation. Key words: pregnancy, obesity, in vitro fertilization, complications, delivery, newborn.

THE RELATIONSHIP BETWEEN THE FREQUENCY OF CONGENITAL MALFORMATIONS IN NEWBORNS OF WOMEN RESIDING IN AN INDUSTRIAL REGION WITH THE POLYMORPHISM OF THE GENES OF THE BIOTRANSFORMATION SYSTEM

Introduction. There is a number of polymorphic genes, the products of which take part in the biotransformation process and possess of the different activity. As a result of an imbalance in the processes of xenobiotic biotransformation, there is occurred an accumulation of toxic electrophilic compounds, the rise in a mutagenic activity, that can be very important in the formation of congenital malformations. Therefore, the study of the association of gene polymorphisms of the first and second phases of biotransformation with various congenital malformations is topical. The aim of the study. To investigate the role of the polymorphism of genes of the xenobiotic biotransformation system (CYP1A2*1F, GSTT1, GSTM1) encoding the enzymes I and II detoxification phases in women with the complicated obstetric history, residing in an industrial region. Material and methods. A survey of 53 women of reproductive age living in the territory of Novokuznetsk was carried out. The comparison group (the control) consisted of 27 women. These women did not have spontaneous miscarriages, and they carried the fetus to term without congenital malformations. The study group included 26 women who gave birth to babies with congenital malformations. Genomic DNA was isolated by the phenol-chloroform extraction method followed by the ethanol precipitation. The molecular and genetic analysis of the gene polymorphism of cytochrome 1A2 (CYP1A2), glutathione S-transferase τ-1 (GSTT1) and glutathione S-transferase μ-1 (GSTM1) was carried out using Real-Time mode. Results. A high risk of congenital fetal malformations in women with the A/A CYP1A2*1F genotype and resistance to these pathologies in the presence of a heterozygous form of the gene C/A CYP1A2*1F was revealed. The relationship between the high risk of stillbirth due to the placental insufficiency in women with deletion polymorphism of the gene GSTM1 “-”, while the normal functioning gene GSTM1 “+” was associated with the resistance to antenatal fetal death.