Early Terms Of Gestation Research Articles

Restoration Treatment for Female Patients with Non-Bearing Pregnancy at the Early Terms of Gestation

The article presents the research materials devoted to the peculiarities of carrying out the rehabilitation treatment and rehabilitation of patients, after the artificial termination of pregnancy in the early stages. Methods and means of non-drug restorative treatment are described, practical recommendations for its practical application at different stages of rehabilitation are given.

The features of the fetoplacental complex in women with retrochorial hematomas in the I trimester of pregnancy

The problem of placental dysfunction is one of the most important in modern obstetrics. Pregnant women with retrochorial hematomas (RCH) in the I trimester are at risk of placental pathology development, which leads to appearance of other negative obstetrical and perinatal pregnancy outcomes. The objective: to study the parameters of the fetoplacental complex in pregnant women with various forms of RCH based on the data of instrumental examinations. Materials and methods. The study included 140 pregnant women with RCH which appeared from 6 weeks of gestation till delivery: 60 women with recurrent RCH (1st group); 50 pregnant women, in whom RCH was diagnosed only in the early terms of gestation – 6–12 weeks included (2nd group), and 30 prospectively examined patients with uncomplicated pregnancy, without significant extragenital pathology and negative factors in the obstetrical and gynecological history (control group). Results. The frequency of placental dysfunction in recurrent RCH was 70.0%, in primary RCH – 30.0%; the level of early forms (up to 32 weeks) of fetal development retardation in the 1st group was 65.0%, with a significant prevalence of 2nd-3rd degree – 23.3%. Premature maturation of the placenta in recurrent RCH was found in 33.3% of cases, in primary form – in 16.0%. Echo-signs of mesenchymal dysplasia and heterogeneity of the placenta were found in 11.7% and 4.0% of women of the 1st and 2nd groups, respectively. With recurrent RCH, the frequency of oligohydramnios was 16.7% versus 4.0% – with primary RCH; blood flow disorders were diagnosed in 23.3% and 6.0% of cases. In 5.0% of patients of the 1st group, decompensated placental dysfunction with the development of acute fetal distress was diagnosed. Conclusions. In women with retrochorial hematomas in the I trimester of pregnancy, the course of pregnancy is characterized by disorders in the fetoplacental complex, which are more pronounced by recurrence of hematomas.

P–414 HLA-G expression as a new prognostic marker of successful implantation

Abstract Study question Is the low HLA-G expression a determinant of early reproductive loss? Summary answer Low expression of HLA-G is associated with pregnancy complications and can be one of the reasons of spontaneous abortion (such as RPL). What is known already The dysregulated maternal immune responses to invading embryos may play role in RIF, RPL, and second- and third-trimester obstetrical conditions. HLA-G is a molecule that was first known to confer protection to the fetus from destruction by the immune system of its mother, thus critically contributing to fetal–maternal tolerance due to inducing displacement of pro-inflammatory to Th1 cell-mediated response of Th2, has a positive influence on the process of implantation. HLA-G is mainly restricted to the fetal–maternal interface on the extravillous cytotrophoblast, to placenta, amnion. Study design, size, duration It was a prospective complex cohort study from 2016–2020 years with pathomorphological investigations. The purpose of this study is to investigate the HLA-G and KIR2DL4 expression in chorionic villous among 3 groups (study included 118 cases of abortion material): group 1 – 36 cases after missed abortion with normal karyotype, group 2 – 36 cases after missed abortion with polyploidy and group 3 – 46 cases after induced abortion group (normal pregnancy). Participants/materials, setting, methods Criteria of inclusion: abortive material from 3 groups of women with missed or after induced abortion; 6–12 weeks, singleton pregnancy, cytogenetic of chorionic villous was obligatorily - normal fetal karyotype and polyploidy of fetus. Pathomorophological investigation included H&E stain, IHC and confocal laser scanning microscopy. Immunohistochemical examination included quantitative and qualitative assessment of the expression of Anti-HLA-G (mouse monoclonal) in an extra villous trophoblast and Anti-KIR2DL1+KIR2DL3 + KIR2DL4 + KIR2DS4 (rabbit polyclonal) in chorionic villi. Main results and the role of chance The immunohistochemical study showed homogenous distribution HLA-G expression in extravillous trophoblast cells (EVT) and KIR2DL4 expression in chorion villous both in missed abortion groups and in induced abortion group. HLA-G expression average relative area in 1 and 2 groups was not statistically different (in 1 group with normal karyotype 33,9±3,5 and in 2 group 38,6±2,8). But the expression of HLA-G in 3 group was strictly higher (55,6 ±2,4). The average relative area of KIR2DL4 receptor wasn’t statistically different among 3 groups. However, the histological picture both missed abortion groups (for the genetic\immunological reasons for rejection) is the only one - this is a missed abortion of an early terms of gestation. In a histological study of missed abortion, as our study shows, the histological picture is similar in 1 and 2 groups. Thus, in 1 group with a normal karyotype of the fetus (before conducting the chorion cytogenetic study in the genetics laboratory) in 59.2% the histological examination determined a picture of an impaired early pregnancy with signs of trophoblast chromosomal pathology. Thus, without a cytogenetic study of the chorion, it is impossible to clearly determine whether the chromosomal pathology of the fetus is the cause of missed abortion. Limitations, reasons for caution There is no limitations, reasons for caution. Wider implications of the findings: Thus, HLA-G molecule has a leading role in the onset and successful prolongation of pregnancy, implantation, placentation and fetal development. Trial registration number 98–2019

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.

The influence of associated infection on the development of miscarriage

The article presents the results of a study of the vaginal microbiota in women with miscarriage in early term of gestation. It has been established that pregnant women with lower genital tract infections are at high risk for perinatal and postpartum complications. In most of them (76.0 %) there was a lack of Preconception Prevention with the study of the vaginal biotope. In pregnant women at risk of miscarriage on the background of lower genital tract infection, microbial and viral associations are more common than monoinfection. Taking into account the negative effects of lower genital tract infection on the further course of pregnancy and childbirth and the condition of newborns, at the stage of Preconception Prevention should be studied vaginal microbiota. During pregnancy, it is necessary to conduct a thorough examination of women with timely identification of risk factors for miscarriage, which include associated infections, and their adequate correction.

Prevention of disorders in fetoplacental complex during the early term of gestation with low placentation

Objective is to develop new methods to prevent primary placental dysfunction (PD) in early gestational age with low placentation.Material and methods. We have examined 119 pregnant women with low placentation. This diagnosis was made from 6-7 weeks of gestation on the basis of echographic research. The main group consisted of 64 pregnant women with low chorionic location, which was used to prevent PD from the early gestational age by the complex of medicines developed by us and a control group of 55 women with low placentation that had not undergone PD prophylaxis from early gestational periods. The treatment and prophylactic complex included: Luteina, ginkgo biloba extract, folio and biolectra. In the main and control groups of pregnant women with low placentation, the state of synthetic function was studied on blood levels of pregnancy proteins: trophoblastic β-glycoprotein (TBG), α-microglobulin fertility (AMGF) and hormonal functions of the fetoplacental complex: chorionic gonadotropin (HG), progesterone, placental lactogen (PL) and estradiol. The tests were conducted in 9-12 weeks of gestation. Results. According to the study conducted in pregnant women in the main group, a significant increase in hormonal parameters, in particular, НCG, progesterone and PL, was observed in comparison with the control group. Also, in pregnant women with the use of the prophylactic complex, the concentration of TBG increased by almost 2 times and the AMGF level was 29.2%. The frequency of complications of pregnancy in the first trimester in the main group where PD was prevented from early gestational periods was significantly lower than in the control group. Conclusions. 1. The proposed prophylactic of primary placental dysfunction in an abnormal placentation primarily promotes the elimination of hormonal and protein imbalance in the mother-placenta-fetus system, enhances utero-placental circulation and microcirculation, improves the metabolic function of the placenta. 2. The need for prevention of primary placental dysfunction with low placentation is confirmed by a decrease in the frequency of threats of abortion without bleeding and bleeding.

DIAGNOSTIC FEATURES OF PLACENTAL DYSFUNCTION IN PREGNANT WOMEN WITH BACTERIAL VAGINOSIS

The article presents doppler ultrasound test results of uterine arteries resistance in women with bacterial vaginosis in early term of gestation. When the systolicdiastolic relation in uterine arteries is more than 2,9, the resistance index is more than 0,46 and the pulsating index is more than 1,82, the formation of primary placental dysfunction is diagnosed. Early pathogenetically substantiated correction of revealed violations allowed to reduce the risk of placental dysfunction in this group of pregnant women in 3,9 times and fetal growth retardation (FGR) by 7,9 times compared to the average population data.

Особливості формування судинного компонента хоріона при невиношуванні вагітності у І триместрі гестації

In women with miscarriage in early pregnancy by ultrasound was studied the volume of the ovum, the volume of the cavity of the amnion and their relationship. Using special three-dimensional VOCAL program performed the calculation of the volume of the chorion, the evaluation of his vascular system based on the definition of the vascularization index (VI) and flow index (FI). The aim of the study: to study the stages of growth and vascularization of the chorion with the threat of miscarriage in the first trimester of gestation. Materials and methods. There were examined 50 pregnant women with threat of miscarriage at early terms of gestation: 30 - burdened obstetric history (BOH), receiving the drug micronized progesterone 50 mg 3-4 times per day (the main group) and 20 pregnant women, the history of which was not encumbered, who were on symptomatic therapy (control group). Results. Analysis of the frequency of occurrence of extragenital pathology in the study groups showed that in women with recurrent pregnancy loss and BOH somatic diseases were almost 2 times more often than in the control group (respectively 60% and 30%). The frequency of infectious complications in the first trimester of pregnancy in women with threatened abortion and BOH compared to the control group of patients, significantly more frequently noted violations of vaginal microbiocenosis, in the form of gardnerellosis (20% and 10%), Candida vaginitis (30% and 5.5%) and urogenital infections – chlamydia, ureaplasmosis, mycoplasmosis (15% and 0%). All pregnant women was carried out sanitation of the source of infection in the first trimester of gestation – local therapy, systemic treatment after completion of the processes of placentation. Conclusion. The study found that use of micronized progesterone in miscarriage in the first trimester of gestation contributes to the growth of the volume of the chorion, the intensity of the flow in the parenchyma and a complete restructuring of the spiral arteries resulting in inadequate formation of the placental-uterine blood flow, which certainly improves the prediction of the further course of pregnancy. Key words: miscarriage, the I trimester of gestation, the vessels of the chorion.

ОСОБЛИВОСТІ ГОРМОНАЛЬНОЇ ФУНКЦІЇ ФЕТОПЛАЦЕНТАРНОГО КОМПЛЕКСУ ПРИ БАГАТОПЛІДНІЙ ВАГІТНОСТІ.

<p><br />Доведено кореляційний зв’язок між динамікою рівня гормонів фетоплацентарного комплексу та перебігом багатоплідної<br />вагітності. Згідно з проведеними дослідженнями, у вагітних із багатопліддям при концентрації прогестерону до 80 % від<br />рівня, характерного для одноплідної вагітності, збільшується ризик розвитку передчасних пологів. При несприятливому на-<br />слідку вагітності концентрація прогестерону і плацентарного лактогену може відповідати нормі для показників одноплідної<br />вагітності чи перевищувати її на 10 %, що розцінюється як дисфункція плаценти. Ретельне спостереження за пацієнтками<br />з багатопліддям в антенатальному періоді, профілактика найбільш частих ускладнень вагітності (передчасні пологи, ане-<br />мія, гестози, затримка розвитку плода), моніторинг з ранніх термінів вагітності дозволяють диференційовано підходити до<br />ведення вагітності і пологів, сприяючи зниженню перинатальної захворюваності і смертності.<br /><br /></p>

A Method for Detection of Cholesterol Synthesis in the Placenta during Exacerbation of Cytomegalovirus Infection.

Histochemical analysis showed that exacerbation of cytomegalovirus infection even at early terms of gestation (weeks 5-6) suppresses synthesis of mevalonic acid, squalene, and 7α-dehydrocholesterol dehydrogenase in the placenta. Inhibition of cholesterol biosynthesis in the placenta at the early stages of gestation decreases production of sex hormones, reduces cholesterol concentration in the maternal peripheral blood, and impairs cholesterol supply to the fetus, which is associated with the risk of placental insufficiency.

Quantitative characteristic of different types of villous formations of chorion at its low location in early terms of gestation

We studied the morphological features of chorion at its lowest location by morphometric and immunohistochemical methods in early term of gestation. New results that indicate the reduction of percentage of trophoblastic, villous processes and proliferative index in trophoblast villous formations, especially in the period 9-12 weeks gestation have been obtained.

Changes of hormones of trofoblast in pregnant with noncarrying in early terms of gestation

Changes of hormones of trofoblast in pregnant with noncarrying in early terms of gestation

The hormonal and genetic parallels in women with threatening miscarriage of early term of gestation

The hormonal and genetic parallels in women with threatening miscarriage of early term of gestation

СУЧАСНІ АСПЕКТИ ВЕДЕННЯ БАГАТОПЛІДНОЇ ВАГІТНОСТІ.

В статті проведений ретельний аналіз перебігу вагітності,<br />пологів і перинатальних результатів у 182 пацієнток з багатоплідною вагітністю в залежності від типу плацентації. Доведено, що<br />багатоплідна вагітність - як монохоріальна, так і дихоріальна, - є чинником високого ризику перинатальних ускладнень.<br />Встановлена виражена залежність від хоріальності частоти виявлених патологічних змін при ультраросонографії. Ретельне<br />спостереження за пацієнтками з багатопліддям в антенатальном періоді, профілактика найбільш частих ускладнень вагітності<br />(передчасні пологи, анемія, гестози, затримка розвитку плода), ультразвуковий моніторинг з ранніхтермінів вагітності дозволяють<br />диференційовано підходити до ведення вагітності і пологів, сприяючи зниженню перинатальноїзахворюваності і смертності.

Echographic peculiarities of embryonal development in pregnant women of the group risk with genital infection

The article presents the echographic features of embryonal development in pregnant women with genital infections. The estimation of ultrasonic criteria of development of embryo was conducted in the early terms of gestation: estimation of structures of the embryo, cardiac performance indicators, presence of retrochorionic haematoma. It enabled to estimate the prognosis of pregnancy and possibility of development of placenta disfunction.

Interaction of decidual CD56+ NK with trophoblast cells during normal pregnancy and recurrent spontaneous abortion at early term of gestation.

The immunological paradox of pregnancy, when maternal immune system recognizes but does not reject the semiallogenic foetus, is not yet fully understood. The aim of this work was to detail the mechanisms of the interaction of decidual CD56+ NK, infiltrating the maternal part of placenta, and trophoblast cells of foetal origin. Samples of the endometrial tissue from 13 healthy non-pregnant women, 37 placentas, obtained after medical abortion of viable pregnancy at 7-10weeks of gestation, and 26 samples of placentas from first-trimester recurrent spontaneous abortion (RSA) were used as the material for investigation. Phenotype of NK was assessed by flow cytometry. The influence of trophoblast cells upon IFNγ and GrB mRNAs expression by dNK was investigated by RT-PCR. The influence of dNK upon trophoblast cells migration and invasion was studied using collagen and Matrigel systems. In RSA group comparing to the normal pregnancy, the decrease of dNK with inhibitory receptors (NKG2A) and elevation of activated dNK were seen. In normal pregnancy, but not in RSA, trophoblast cells increased the expression of IFNγ and GrB mRNAs by CD56+ dNK. Both in normal and RSA pregnancy, dNK inhibited the migration and invasion of trophoblast cells. Initially, low invasive and migration capacities of trophoblast cells were seen during RSA. Thus, unbalanced activation of dNK can lead to the impairment of dNK and trophoblast cells interaction during RSA.

Echographic characteristics of embrion development in normal pregnancy and placental insufficiency on the background of miscarriages

The article presents the results of ultrasound examination of healthy pregnant women and those with miscarriages in early terms of gestation. The changes which are typical for primary placental insufficiency onset have been detected.

Trophoblastic beta1-glycoprotein and hemostasis system in pregnant women with antiphospholipid syndrome.

Clinical and laboratory studies were carried out in 38 pregnant women with antiphospholipid syndrome. Increased functional activity of platelets and decreased protein-producing function of the placenta were observed starting from the early terms of gestation. These disorders were followed by the development of hypercoagulation in the plasma component of hemostasis, appearance of intravascular blood clotting markers, and inhibition of AT III and protein C. This led to the progress of disorders in the microcirculatory bed, fetoplacental insufficiency, decrease in trophoblastic beta1-glycoprotein level, chronic hypoxia, and fetal death. Infection accelerated this process. Measurements of trophoblastic beta1-glycoprotein every 2 weeks help to diagnose fetoplacental disorders, predict the course of pregnancy, and evaluate the efficiency of drug therapy.