Development Of Placental Dysfunction Research Articles

ENZYMES AND METABOLITES OF ENDOGENOUS CARBON MONOXIDE IN THE FETOPLACENTAL SYSTEM DURING PHYSIOLOGICAL GESTATION AND PLACENTAL DYSFUNCTION

Introduction. Prenatal ontogenesis largely depends on the functional and metabolic viability of the placenta and the entire fetoplacental complex. That is why the dysfunction of the placenta due to the changes in cellular regulation processes will lead to pregnancy complications and impaired fetal develop-ment. An important component of the system of intra- and intercellular regulators is the gas transmitter – carbon monoxide. Its role in cellular signaling and communication reactions, and at the same time, insufficient data of its metabolism, justifies the need to conduct research on this gas transmitter during complicated pregnancy. The aim of the work. To study the features of the metabolism of the active cellular mediator - the gas transmitter carbon monoxide in different objects of the fetoplacental system during physiological pregnancy and placental dysfunction. Material and methods. The research materials included placental tissue, amnion and amniotic fluid. The work uses spectrophotometric methods, enzyme immunoassay, and ion exchange chromatography. Results. Multidirectional changes in the activity of the studied enzymes (heme oxygenase and histidine decarboxylase), the content of the substrate of His-tidine reaction and the product of reaction of Histamine are established in case of placental disfunction. There is a certain correlation between the discov-ered studied components. Indicators of carbon monoxide metabolism can be markers for predicting postnatal damage – cerebral disorders in newborns. Conclusions. The identified injuries are obviously important links in the chain of disorders accompanied by the development of placental dysfunction.

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.

Modern approach to infusion therapy of pregnant women with gestational hypertension

To date, there are no effective treatment for placental dysfunction in pregnant women with gestational hypertension. Therefore, the purpose of our study was to investigate the clinical efficacy of proposed method of infusion therapy for pregnant women with gestational hypertension, which included a complex of drugs: pentoxifylline, arginine hydrochloride with levocarnitine and rheosorbilact. We observed 73 pregnant women with single fetation, starting from 28 weeks of gestation, who were observed before and during childbirth, and in the postpartum period by the time of discharge from the hospital. All examined women were divided into 3 groups. The first group included 30 pregnant women with gestational hypertension, who received (along with the basic therapy of methyldopa drugs) a complex of infusion solutions: pentoxifylline 0.05% – 100 ml; solution containing arginine hydrochloride 4.2% and levocarnitine 2.0% – 100 ml; reosorbilact preparation – 100 ml. The infusion was carried out once a day in the specified sequence for 10 days. The second group included 20 patients with gestational hypertension on basic therapy with methuldopa only. The control group included 23 women with physiological pregnancy. The data of our study show that in patients receiving the proposed infusion therapy there was a significant decrease in the development of placental dysfunction by 38.3%, the threat of premature birth – by 18.3% and fetal distress – by 30.0%, premature rupture of the membranes – by 35.0%, weakness of labor – by 28.3%, a decrease in the risk of perinatal central nervous system damage – by 33.3% and the frequency of cephalohematomas – by 30.0% compared with women who received only antihypertensive therapy.

Placental Dysfunction and Acute Toxoplasmosis: The Role of Melatonin in Relation to Inflammatory Cytokines Interleukin-10 and Interleukin-12.

The objective of this study was to elucidate the potential role of anti-inflammatory interleukin (IL)-10 and pro-inflammatory (IL-12) cytokines as well as melatonin (MEL) in the development of placental dysfunction in the pregnant women with acquired toxoplasmosis (TOX). This case-control study was carried out at the Department of Clinical Parasitology in teamwork with the Department of Gynecology and Obstetrics, Al-Yarmouk Teaching Hospital, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq, from September 2018 to February 2019. The recruited patients and healthy controls were allocated into two groups - Group A: pregnant women with acute TOX (n = 45) and Group B: healthy pregnant women (n = 25). Anti-Toxoplasma (Toxo) immunoglobulin M (IgM), serum and placental as well as serum-placental (SP) ratio of MEL, IL-10, and IL-12 were measured. SPSS version 20.00 was used for data analysis. Anti-Toxo IgM serum level and IL-12 serum levels were higher compared with controls (P = 0.001). Both MEL and IL-10 serum levels were lower in the pregnant women with acute TOX compared with controls (P = 0.002 and P = 0.002), respectively. Besides, Both MEL and IL-10 placental levels were lower in the pregnant women with acute TOX compared with controls (P = 0.001). As well, placental IL-12 level was higher in the pregnant women with acute TOX compared with controls (P = 0.001). SP ratio of MEL was higher in the pregnant women with acute TOX compared with controls (P = 0.001). MEL and anti-inflammatory IL-10 are reduced in the pregnant women with acute TOX, while IL-12 is increased. SP ratio of MEL but not of IL-10 or IL-12 is elevated in the pregnant women with acute TOX reflecting the risk of PD.

Assessment of placental complex function and miscarriage prevention in pregnant women with uterine fibroid

The objective: to reduce the frequency of the threat of pregnancy interruption and loss in women with uterine fibroid through treatment prediction and improvement.Materials and methods. A complex examination of 70 pregnant women with uterine fibroid at 15-16 weeks of pregnancy (main group) and 50 pregnant women without uterine fibroid at the same gestational term (control group) was carried out at 4 clinical bases of the Department of Obstetrics and Gynecology N1 of the Shupyk National Healthcare University of Ukraine in the time period of 2020-2022. Pregnant women in the main group were divided into 2 subgroups depending on the type of the nodes: Ia – 39 pregnant women with subserous type of fibroid nodes (type 5-6 according to FIGO) and Ib – 31 pregnant women with intramural fibroid (type 3-4 according to FIGO). The pregnant women in the main group received the complex of developed therapy for pregnancy interruption (micronized progesterone, magnesium preparations, vitamin B6, acetylsalicylic acid), in the control one – the common therapy (bed rest, abstinence from sexual life, micronized progesterone preparations, tranexamic acid).The concentrations of estradiol, progesterone, human chorionic gonadotropin (hCG) were determined in the blood plasma of all persons at 15–16 weeks and 24 weeks of pregnancy.Results. In the II trimester the concentration of estradiol in the blood of pregnant women with intramural uterine fibroid, especially with multiple forms, was significantly higher than in the control group (p<0.05). At the same time, in pregnant women with intramural fibroid node(s) the mean concentration of estradiol exceeded the similar indicator in the group with the subserosal type (p<0.05). These changes indicated the stress of the hormonal function of the placenta and were considered by us as one of the signs of the initial stage of placental dysfunction.With an increase in estradiol concentration, a significant decrease in progesterone amount was noted. Progesterone deficiency was significantly more common in the subgroup of pregnant women with multiple intramural uterine fibroid and nodes in contact with the uterine cavity, especially at the place of placenta attachment (type 3) – 165.24±14.71nmol/l compared to the control group – 219.96±16.63 nmol/l, and with pregnant women with subserosal node(s) – 210.61±18.57 nmol/l (р<0.01), which confirms the threat of abortion and indicates the development of placental dysfunction. In the II trimester of pregnancy the concentration of hCG in women with uterine fibroid was significantly lower than in women without uterine fibroid and especially lower in multiple uterine fibroid. In the women of the main group progesterone and hCG concentrations in the blood plasma normalized (p>0.05) after the treatment, but the level of estradiol in the group of pregnant women with multiple intramural uterine leiomyoma remained significantly higher (p<0.05).Conclusions. Pregnant women with uterine fibroid have an increased risk of placental dysfunction with a disbalance of the main placental hormones: an increase in estradiol concentration and a relative decrease in progesterone and human chorionic gonadotropin, a shift in the estrogen-progesterone balance towards relative hyperestrogenia.The use of medical measures with long-term support with progesterone, magnesium and low doses of acetylsalicylic acid for the prevention of miscarriage in persons with the clinical manifestations of the threat of gestation is quite effective.

Characteristics phetoplacental complex change in women with pulmonary tuberculosis, complicated by iron deficiency anemia

87 pregnant women have been examined, 57 of them had pulmonary form of TB, complicated by IDA (main group). The control group consisted of 30 conditionally somatic-healthy patients with physiological pregnancy. Changes in the parameters of erythron, increased metabolic acidosis, development of placental dysfunction (93%), violation of hemodynamics in the utero-placental-fetal basin, and low biophysical profile of the fetus were found. The main group patients received comprehensive anti-anemic, antihypoxic, detoxificative, antioxidant and membrane-stabilizing therapy. After the pathogenetic treatment, the general condition of mother and fetus improved, e. g. the total index of biophysical profile of fetus in the pregnant women of the main group increased from (6.87 ± 0.18) points to (8.73 ± 0.12) points Women with pulmonary tuberculosis and iron-deficiency anemia require complex pathogenetic therapy, which significantly improves the erythron signs, fetal, newborn and general mother’s condition.

The Pregnancy Zone Protein (PZP) is significantly downregulated in the placenta of preeclampsia and HELLP syndrome patients

Preeclampsia is characterized by maternal hypertension and multi-organ injury. Elongation factor Tu GTP binding domain containing 2 (EFTUD 2) and the Pregnancy Zone Protein (PZP) seem to be important immunomodulatory factors in early gestation. Little is known about the role of EFTUD2 and PZP in disorders of late pregnancy like preeclampsia, HELLP syndrome and intrauterine growth restriction (IUGR). PZP, EFTUD2 and hCG expression was investigated by immunohistochemistry in the placenta of healthy pregnancies (n = 13), preeclampsia (n = 11), HELLP syndrome (n = 12) and IUGR (n = 8). Correlation analysis of protein expression was performed via Spearman correlation coefficient. The characterization of EFTUD2 and PZP expressing cells was evaluated by double-immunofluorescence. After cultivation of the chorion carcinoma cell line BeWo with hCG the expression of PZP and EFTUD2 was investigated by immunocytochemistry. PZP expression was significantly downregulated in the syncytiotrophoblast (ST) and extravillous trophoblast (EVT) of preeclampsia (ST: p 0.001, EVT:p = 0.019) and HELLP syndrome (ST: p = 0.004, EVT: p = 0.035). The expression of EFTUD2 was significantly lower in preeclampsia (ST: p = 0.003, EVT: p 0.001), HELLP syndrome (ST: p = 0.021, EVT: = 0.001, EVT: p = 0.001). EVTs were identified as EFTUD2 and PZP expressing cells by double-immunofluorescence. Stimulation of BeWo chorion carcinoma cells with hCG 1000 IU/mL for 48 h resulted in a significant upregulation of PZP expression (p = 0.027). Our results indicate that PZP and EFTUD2 might be involved in the development of placental dysfunction in preeclampsia and HELLP syndrome.

Antiphospholipid antibodies and their role in the development of placental dysfunction

The objectives: to assess the spectrum and diagnostic value of antiphospholipid antibodies (APLA) by placental dysfunction. Materials and methods. A study of the APLA spectrum in 122 patients with placental dysfunction in the II and III trimesters of pregnancy was carried out. The control group included 64 practically healthy women in the II and III trimesters of pregnancy with a physiological course of gestation and without a complicated reproductive and somatic history. Results. The overall frequency of detection of critical APLA in the group of women with placental dysfunction was 46.7%, while in women with a physiological course of pregnancy there were no cases of a positive serological reaction to the content of APLA. The number of patients with high and medium titers of IgG and IgM (critical APLA) was low – 11.5%. Noncritical APLA (antiphosphatidylethanolamine and antiphosphatidylserine IgM and IgG antibodies) were more often determined in low and medium titers in patients with placental dysfunction without pronounced hemodynamic changes and were detected in 36.9% of cases.Most of the patients with circulating antibodies to cardiolipin and β2-glycoprotein-1 (21 (17.2%) people) had low (up to 20 U/ml) levels of APLA. The median APLA level in patients with placenta-associated complications which were associated with placental dysfunction (28.5 (18.1) was higher than in patients without these complications (18.6 (7.4); P<0.01).Conclusions. The circulation of APLA in the mother’s blood is of a great importance for predicting of the placental dysfunction development and its severity. An increase concentration of circulating APLA in the maternal blood serum correlates with the frequency of severe forms, the timing of the onset of placental dysfunction and the development of placenta-associated pregnancy complications. In placental dysfunction, the APLA spectrum includes lupus anticoagulant, antibodies to cardiolipin, phosphatidylserine and phosphatidylethanolamin. Their identification increases the efficiency of diagnostics of antiphospholipid syndrome.

Prevention of pregnancy complications and delivery at low placentation

Objective is to evaluate the effectiveness of the developed method of preventing pregnancy complications with low placentation from early gestation.Material and methods. We have examined 119 pregnant women with low placentation. This diagnosis was made at 6-7 weeks of gestation on the basis of echographic research. The main group consisted of 64 pregnant women with low chorionic location who underwent prevention from pregnancy complications in early gestation by the complex of medicines developed by us and a control group -55 women with low placentation who had not undergone complications prophylaxis from early gestational periods. The prophylactic complex included Luteina, ginkgo biloba extract, folio and biolectra. To assess the effectiveness of the therapy in the study groups, we analyzed the course of pregnancy in early and late gestation, as well as complications of pregnancy and delivery.Results. The frequency of pregnancy pathologies in the main group, where the prevention of pregnancy complications from early gestation with low placentation, was significantly lower than in the control group. According to the study, the risk of abortion with bleeding and without bleeding in the first and second trimesters significantly decreased in the main group of pregnant women (p<0.05). In the third trimester of gestation in the group where the prevention of pregnancy complications was significantly reduced, the incidence of preterm birth, premature detachment of the low-lying placenta, fetoplacental dysfunction, fetal developmental delay syndrome and fetal distress during pregnancy (p<0.05). Also, in the main group there was a lower percentage of premature births and births that ended by cesarean section.Conclusions. 1. The place of attachment of the placenta in the uterine cavity is closely related to its function, the development of placental dysfunction, pregnancy and delivery. 2. Studies have shown the effectiveness of our proposed comprehensive drug prevention of complications of pregnancy with low placentation, which in turn has led to improved pregnancy and delivery and has become an effective means of preventing placental dysfunction.

INTRAUTERINE FETAL INFECTION - THE REALITIES OF DIAGNOSIS AND TREATMENT

Іntroduction. Intrauterine infection of the fetus is oneof the most important problems in obstetrics. The absenceof adequate treatment leads to a number of complicationsthat develop during pregnancy, childbirth, and postpartumperiod. There are often situations when the consequences ofthe invasion of microorganisms are more important than thepresence of an infectious agent itself.The aim is to analyze the indicators of microcytosis ofthe vagina, cervical canal, the peculiarities of pregnancywith infection of the fetus, and the effectiveness of varioustreatment regimens.Material and methods. 20 healthy women withphysiological course of pregnancy (the control group) and62 pregnant women with signs of fetal infection (the maingroup) were examined using clinical, microbiological,bacteriological, serological methods, statistical analysis,and fetal ultrasound.Results. Depending on the trimester, pregnant womenof the main group were divided into two subgroups: thefirst subgroup - at 18-24 weeks (50 pregnant women), thesecond - at 28-34 weeks (12 pregnant women).The statistical analysis of changes in vaginalmicrocynosis was conducted depending on the term. Thesignificant difference regarding the effect of gram negativediplococci, morphologically similar to gonococcus,Streptococcus agalactiae in the third trimester was found outalong with Ureaplasma urealyticum, Chlamidia trahomatisin the second trimester and Trichomonas vaginalis andMycoplasma hominis regardless of trimester.Ultrasound in the first subgroup revealed a syndromeof fetal growth retardation in 20 % of women, an abnormalamount of amniotic fluid in 24 %, changes in the structureof the placenta in 14 %, enlargement of the pelvic system ofthe kidneys in 52 %, intestinal hyperechogenicity in 60 %,and hepatomegaly in 4 % of cases. In the second subgroup,the abnormal amount of amniotic fluid was found in 16.7 %of pregnant women, changes in the structure of the placentain 83,3 %, and progressive shortening of the cervix in 33.3% of cases.Pregnant women of the main group were offered acourse of specific antibacterial therapy.In case of positive dynamics within three days (reductionof pathological secretions, polyhydramnios and otherultrasound signs of fetal infection), treatment is continued.In case of negative dynamics or no effect within three daysantibacterial agent must be changed. If symptoms reoccur,a repeat course with a new antibacterial agent is prescribed.Conclusions. Disorders of vaginal microcynosis andcervical canal were found in 80.6% of pregnant women,the rest of them were diagnosed with the ultrasound signsof infection of the fetus without changes in vagina andcervical canal.The proposed regimens of antibacterial therapy areeffective in the second trimester of pregnancy, indicatingthe necessity of examination and treatment during thisperiod, and in case of structural changes in the cervix causedby gram-negative diplococci, morphologically similarto gonococcus and Trichomonas vaginalis. Antibacterialtherapy is not effective enough in case of the developmentof placental dysfunction, and the threat of premature birthin the third trimester.

CHANGES OF HORMONAL STATUS IN PREGNANT WOMEN WITH MISCARRIAGE IN EARLY GESTATION TERMS

Introduction. The article represents the results of the study of the placental hormone level during the early stages of gestation (5-20 weeks).
 The aim of the study. To analyze the level of hormones of the fetoplacental complex in pregnant women with miscarriage, along with the dynamics of changes in these indicators. To evaluate the features of the hormonal status of women during law-risk pregnancy and miscarriage in history and the impact of these features on the functional state of the fetoplacental complex and the subsequent course of pregnancy.
 Material and methods. We examined 30 somatically healthy women with a physiological course of pregnancy (the control group) and 30 pregnant women with a miscarriage in history (the main group).
 Research results. It was found that the content of estradiol, chorionic gonadotropin and placental lactogen in the blood plasma of pregnant women of the main group was significantly lower during the entire gestational period compared to the control group. Estradiol levels in pregnant women with miscarriage were 4.2 times lower than in healthy pregnant women. Placental lactogen levels in the main group of pregnant women were 6.1 times lower, and chorionic gonadotropin - 3.7 times lower compared with the control group. There was also a significant backlog in the growth of hormone levels as the pregnancy progressed. In its turn it indicates the development of placental dysfunction in women with a miscarriage in history in the early stages of gestation.
 Conclusions. As a result of the described changes there is a violation of the first wave of cytotrophoblast invasion and, as a consequence, incomplete gestational remodeling of segments of spiral arteries. The walls of blood vessels are not completely replaced by fibrinoid and the formed placental vessels do not provide a constant flow of arterial blood into the intervillous space. As a result, the uterine-placental area and the formed placenta are not ready to meet the needs of the developing fetus. In the future, this can lead to perinatal losses.

The potential role of the E SRRG pathway in placental dysfunction.

Normal placental development and function is of key importance to fetal growth. Conversely aberrations of placental structure and function are evident in pregnancy complications including fetal growth restriction (FGR) and preeclampsia. Although trophoblast turnover and function is altered in these conditions, their underlying aetiologies and pathophysiology remains unclear, which hampers development of therapeutic interventions. Here we review evidence that supports a role for estrogen related receptor-gamma (ESRRG) in the development of placental dysfunction in FGR and preeclampsia. This relationship deserves particular consideration because ESRRG is highly expressed in normal placenta, is reduced in FGR and preeclampsia and its expression is altered by hypoxia, which is thought to result from deficient placentation seen in FGR and preeclampsia. Several studies have also found microRNA (miRNA) or other potential upstream regulators of ESRRG negatively influence trophoblast function which could contribute to placental dysfunction seen in FGR and preeclampsia. Interestingly, miRNAs regulate ESRRG expression in human trophoblast. Thus, if ESRRG is pivotally associated with the abnormal trophoblast turnover and function it may be targeted by microRNAs or other possible upstream regulators in the placenta. This review explores altered expression of ESRRG and upstream regulation of ESRRG-mediated pathways resulting in the trophoblast turnover, placental vascularisation, and placental metabolism underlying placental dysfunctions. This demonstrates that the ESRRG pathway merits further investigation as a potential therapeutic target in FGR and preeclampsia.

Etiopathogenetic aspects of placental dysfunction in women with miscarriage (literature review)

Advances in perinatology have revealed new problems related to the gestational process and antenatal protection of the fetus. Among them, the leading place belongs to chronic placental insufficiency (CPI). One of the main causes of CPI is miscarriage. The aim of the work is to consider the main aspects of the etiology and pathogenesis of the development of placental insufficiency in women with miscarriage. The article covers the issues of etiology, as well as the main pathogenetic ways in the development of placental dysfunction in women with miscarriage. Risk factors, mechanisms of development of placental insufficiency (PI), and also its forms depending on etiological factors are allocated. The peculiarities of the morphological structure of the placenta in women with this pathology in early and late gestation terms, their impact on the subsequent course of pregnancy, development and condition of the fetus are considered in detail. The relationship between structural changes in the placenta and clinical manifestations of PI is shown. The influence of rheology and hemodynamic disorders on the condition of the fetus is highlighted.Conclusions. There are a large number of etiological factors that lead to the development of placental insufficiency. However, for a variety of reasons, this pathology has key pathogenetic ways, which are common for different forms. Knowledge of the causes of placental dysfunction during miscarriage, features of pathogenesis and morphological changes that develop even in early terms of gestation has a great clinical importance, because it will contribute to the development of methods of early prevention and pathogenetically conditioned correction of this pathology.

ФАКТОРИ РИЗИКУ ГІПОКСИЧНО-ІШЕМІЧНОЇ ЕНЦЕФАЛОПАТІЇ НЕДОНОШЕНИХ НОВОНАРОДЖЕНИХ


 
 
 
 The article presents the results of an assessment of risk factors for the development of hypoxic-ischemic encephalopathy in premature newborns. Perinatal risk factors for hypoxic-ischemic encephalopathy in premature newborns were the factories that lead to the development of placental dysfunction, fetal growth retardation, antenatal fetal distress and premature birth. The most important factor in the development of GIE is gestation (up to 32 weeks gestation), placenta previa with bleeding and premature placental abruption in the given time.
 
 
 

EUTHYROID GOITER AS RISK FACTOR OF PERINATAL COMPLICATIONS

The spread of thyroid diseases among women of fertile age are constantly increasing. The frequency of euthyroid goiter occupies one of the first places among the pregnant and constitutes from 30% to 40% according to the data of various authors. At the same time, it has an unfavorable influence on the health of a future mother and it is dangerous for the development of the fetus and newborn. In addition, pregnancy itself can affect the development of the given pathology. Interrelation of these processes is not completely studied. Clinical-statistical analysis of the course of pregnancy, labor and newborn state among 50 women with euthyroid goiter has been conducted. The obtained results confirm that euthyroid goiter changed the indices of maternal hemodynamic leading to disorders of the uterine-placental blood circulation and development of placental dysfunction. The results of investigation testify about complicated flow of pregnancy (80% of cases) and labor (88% cases). The examination found that the lower level of free thyroxin of mother correlated with the lower scale evaluation of the fetus. Results of histological examinations of placentas interpret thyroid pathology as the risk factor promoting the development of chronic placental dysfunction.

CORRECTION OF ELECTROLYTE DISTURBANCES IN PREGNANT WOMEN WITH MITRAL VALVE PROLAPSE

Idiopathic mitral valve prolapse in pregnant women has a more severe duration, associated with higher incidence of various cardiovascular and obstetric complications, accompanied by a number of phenotypic and visceral abnormalities that can be inherited to the child, that demonstrates a higher overall clinical significance of mitral valve prolapse precisely for pregnancy. The deficiency of vitamins, micro- and macroelements in these patients negatively predetermines the course of pregnancy and requires additional compensation for their deficiency.The purpose of the study was to investigate the importance of electrolyte disturbances as predictors of development of obstetric and perinatal complications in pregnant women with mitral valve prolapse and cardiac rhythm disturbances and to evaluate the effectiveness of their correction by using preventive use of a balanced vitamin and mineral complex Emfetal.Materials and methods. The study included 98 pregnant women with idiopathic (primary) cardiac arrhythmia in the form of supraventricular or ventricular extrasystoles. 78 patients received detailed nutrition and physical activity recommendations and used a balanced vitamin-mineral complex Emfetal by 1 pill 2 times a day in two courses for 28 days in the gestation period of 15-16 and 28-29 weeks. The comparison group included 20 pregnant women with mitral valve prolapse and arrhythmia who did not receive vitaminelectrolyte treatment. The control group consisted of 20 healthy pregnant women.Results. The analysis of pregnancy and childbirth in the main group of women has shown that women with cardiovascular risk factors (mitral valve prolapse, heart rhythm disturbance) during pregnancy have significantly more complications than in the general population. The gestational process was more often complicated by miscarriage, the development of placenta dysfunction, anemia, preeclampsia, fetal growth retardation syndrome. The development of the above-mentioned complications of pregnancy could be facilitated by the low concentration of ionized micronutrients and some vitamins in blood plasma level of these patients as it should be needed for normal fetal and physiological pregnancy development. At the same time, a decrease in blood plasma levels of vitamin C, important ionized macro- and microelements such as magnesium, iodine, selenium, iron were detected in these pregnant women during the laboratory biochemical study. In this case, the presence of mitral valve prolapse complicated by cardiac arrhythmias in pregnant women is associated with relative hypomagnesaemia. It is the disturbance of the normal balance between the Mg2+ and K+ ions can serve as a marker not only for cardiac rhythm disturbances but also as a predictor of the development of other obstetric and perinatal complications in pregnant women with mitral valve prolapse. Using the balanced vitamin-mineral complex Emfetal in pregnant women with mitral valve prolapse and extrasystoles is accompanied by a significant decrease of the patients with arrhythmia (by 55.1 %) and daily number of extrasystoles based on the results of the Holter heart rate analysis.Conclusions. Pregnancy in women with cardiovascular risk factors, such as mitral valve prolapse and cardiac arrhythmias is often complicated by the development of placental dysfunction (60.0%), early miscarriage (30.0%), anemia (75.0%), preeclampsia (30.0%), fetal growth retardation syndrome (10.0%). Decrease in magnesium level below 0.62 ± 0.04 mmol/l while decreasing the normal serum Mg2+ / Ca2+ and Mg2+ / K+ ratio is associated as with the development of cardiac arrhythmias in the form of extrasystolic arrhythmia, as a high rate of pregnancy complications. Using of the balanced vitamin-mineral complex (emphetal), therapeutic and prophylactic measures contributes to a significant decrease in the daily amount of extrasystoles and the frequency of development of severe pregnancy complications.

On the issue of pathogenesis of placental dysfunction in women with miscarriage

To determine the correlation of local non-progressive abruption of placenta and the development of placental dysfunction with undifferentiated connective tissue dysplasia (UCTD), we have conducted the case-consequence research with 100 patients. The research included two stages. At the first stage, all the predictors of this complication were divided into 4 groups: somatic anamnesis, obstetric, gynecological and infectious anamnesis, course of the given pregnancy and results of tests for Phase-II detoxification gene polymorphism. At the second stage, all the significant predictors were included in a multifaceted logistic regressive analysis. The most significant causes of local non-progressive abruption of placenta at placental dysfunction are the following: UCTD (OR-18.86; 6.58–54.02), its visceral markers such as scoliosis (OR 5.76; 2.08–15.97), heart diseases (mitral valve prolapse, hypertensive neurocirculatory dystonia, supplemental chord) (OR 8.61; 3.11–23.83), myopia (OR 6.25; 2.26–17.29), platypodia (OR 4.49; 1.61–12.55), renal diseases (OR 7.94; 2.87–21.98). The sheer presence of UCTD in this category of patients increases by 18 times the risk of disorder of trophoblast invasion and development of placental dysfunction. Key words: local placental abruption, undifferentiated connective tissue dysplasia, placental dysfunction, gene polymorphism.

MATRIX METALOPROTEINASE-2 AND PLACENTARY DYSFUNCTION DEVELOPMENT IN PREGNANCY WITH PERINATAL INFECTIONS

The search for a statistically significant link between sFasL and their potential regulators MMP-2 is necessary to optimize the tactics of managing and treating pregnant women with perinatal infections. To determine the level of MMP-2 in pregnant with perinatal infections and its role in the development of placental dysfunction. The study involved examination of 230 pregnant, who were divided into 3 groups (60 people each): Group I with viral (CMV, HSV-1,2,6 types), Group II with bacterial (chlamydia, ureaplasma, mycoplasma) and Group III with mixed infection. Group IV was the control one, and included 50 pregnant with a physiological course of pregnancy. The study implied determination of serum levels of MMP-2 and sFasL, the level of caspase-3 in the placenta, ultrasound was performed by the MINDRAY M7 (China) scanner. The data obtained were statistically processed using the STATISTICA software. Pregnant women with perinatal infection were found to have a significant increase in sFasL and caspase-3 levels in all the studied groups as compared to corresponding values in the control group (Kruskal-Wallis test, p <0.001). In all groups of pregnant women with perinatal infection the level of MMP-2 in serum was elevated with respect to control values approximately 3-4 times (Kruskal-Wallis test, p <0.05). According to ultrasound data, hypoplasia of placenta was observed in (46.6 ± 6.4)% of cases in Group І and in (30 ± 6.4)% in Group ІІІ. In Groups II and III, placental hyperplasia was detected in (20 ± 5.2)% and (26 ± 5.7)% of cases, respectively. The findings showed that secondary to the impact of perinatal infection among a number of indices in the peripheral blood of pregnant women, a significant role is played by an increase in levels of MMP-2 and sFasL. These indices reflect and determine the induction of apoptotic response from the placenta in this category of pregnant women. The revealed increase in caspase-3 level means that pregnant women with perinatal infections undergo caspase cascade of apoptosis in placental cells. Thus, the obtained results indicate that pregnant women with perinatal infections develop an increase in the level of MMP-2 and activation of the Fas-dependent signaling pathway of programmed cell death, which leads to the launch of a caspase cascade of apoptosis in placental cells. An increase in the loss of placental cells due to apoptosis may be one of the key factors triggering the development of placental dysfunction and, as a consequence, unfavorable conditions for fetal development.

Частота дефицита кальцитриола и полиморфизма гена рецепторов витамина D у беременных с плацентарной дисфункцией на фоне перинатального инфицирования

The pleiotropic extra-skeletal effects of calcitrioland its effect on the development of pregnancies various complications are now devoted to many researches. The objective: to evaluate the vitamin D status and frequency of polymorphism of the VD receptor’s (VDR) gene in pregnant women with placental dysfunction (PD) and verified perinatal infection (VPI). Materials and methods. There were 40 patients with a physiological pregnancy and 56 pregnant women with PD on the VPI background examined. The level of total VD in serum was determined by immunoassay; by polymerase chain reaction were assessed the frequency of the BsmI-polymorphism (A&gt; G, rs1544410) of the VDR gene. Results. In patients with PD, a vitamin D-deficiency status is diagnosed more frequently – 28.5% VS 15.30% (RR=1.42; 95%CI: 1.08–1.87; р≤0.05). The level of VD in serum of women with PD is lower than in women with a physiological pregnancy (31.40±8.6 ng/ml VS 43.54±11.20 ng/ml, p≤0.01). In women with PD (71.43%), the heterozygous combination of A / G-type alleles was identified more often than in healthy pregnant women (35%) (OR=3.61; 95%СІ: 2.01–6.47; χ2 19.24; р&lt;0.01): in carriers of this type of Bsml-polymorphism of the VDR gene, the risk of PD increases 3.6-fold. Conclusions. The formation of PD of the pleiotropic effects of vitamin D саn be explained particularly, but further research is necessary, including in the molecular genetic direction, which are likely to help in preventing the development of placental dysfunction in a some group of women. Key words: vitamin D, calcitriol, receptors, pregnancy, placental dysfunction, gene polymorphism.

Прогнозування плацентарної дисфункції у жінок із варикозною хворобою нижніх кінцівок

The objective: to develop technique of forecasting of placental dysfunction at women with varicose illness of the bottom extremities. Materials and methods. For determination of the prognostic importance of separate indicators are analysed case histories of 155 women. The main group was made by 110 patients for whom diagnosed placental dysfunction; group of comparison – 45 patients without obstetric pathology, with the normal course of pregnancy and lack of clinical picture of placental dysfunction. We studied indicators of possible individual risk factors of development of this pathology. Were estimated 36 indicators grouped in such directions: social characteristics, reproductive anamnesis, genital and extragenital pathology. Results. Proceeding from the importance of risk factors of development of placental dysfunction it is possible to draw a conclusion about their the burdened influence on a combination to varicose illness of the bottom extremities. It is also possible to claim that existence of varicose illness of the bottom extremities at women serves as the reliable burdening factor, capable to make a systemic adverse influence on condition of hemodynamic in system vessels a mother-placenta-fetus. Conclusion. Use of an offered technique of forecasting allows to change in due time tactics of treatment-and-prophylactic actions and to reduce the frequency of obstetric and perinatal complications. Key words: placental dysfunction, varicose illness of the bottom extremities, forecasting.