Intrauterine Fetal Growth Retardation Research Articles

Pregnancy Associated Plasma Protein-A (PAPP-A) as a Marker to Distinguish Normotensive with Early 2nd Trimester and Late 3rd Trimester Onset of Preeclampsia

Introduction: Preeclampsia is a hypertensive condition that occurs after 20 weeks of gestation accompanied by target organ damage. Complications of preeclampsia can cause intrauterine fetal growth retardation, and placental hypoperfusion, even in the most serious situations, namely termination of pregnancy and death of the fetus and/or mother. Pregnancy-associated plasma protein-A (PAPP-A) is a high molecular weight glycoprotein that is produced in the placenta and secreted into the maternal bloodstream. However, based on several studies that have been conducted, there is uncertainty in the results of assessing PAPP-A levels obtained in pregnant women in the second and third trimesters. Aim: Proving differences in PAPP-A levels in the second and third trimesters in the incidence of early-onset preeclampsia and normotensive pregnancy. Methods: An analytic observational study with a cross-sectional approach was carried out in the delivery room of RSUP Dr. Kariadi Semarang, Halmahera Health Center, Ngesrep Health Center, Bulu Health Center, and private midwife practice in Semarang City. The subjects of the study were six 2nd-trimester preeclampsia patients, fourteen 3rd-trimester preeclampsia patients, and twenty normotensive pregnancy patients who met the inclusion and exclusion criteria. Data were analyzed using Mann Whitney with a significance of p<0.05 Results: There was a significant difference in PAPP-A levels (p<0.001) between the preeclampsia and normotensive pregnancy groups, whereas PAPP-A levels were higher in the preeclampsia group. There were significant differences in PAPP-A levels (p<0.001) between the 2nd-trimester preeclampsia, 3rd-trimester preeclampsia, and normotensive pregnancies, where the highest PAPP-A levels were found in the 2nd-trimester preeclampsia group. Conclusion: There was a significant difference in PAPP-A levels between the second and third trimesters of early-onset preeclampsia compared to normotensive pregnancies, where PAPP-A levels were higher in the second and third trimesters of early-onset preeclampsia. Elevated PAPP-A levels in the second and third trimesters are associated with an increased risk of early-onset preeclampsia.

Study of various groups of regulatory molecules during pregnancy against the background of chronic pyelonephritis

The presence of infectious inflammatory process in a pregnant woman can lead to a disorder in the “mother – placenta – fetus” system.Aim of the study was to investigate the level of regulatory and pro-inflammatory molecules in pregnancy occurring against the background of chronic pyelonephritis without exacerbation.Material and methods. The concentration of IL-17A, monocytic chemotactic protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and IgG autoantibodies to double-stranded DNA (AAT to nDNA) was determined in the blood serum of pregnant women with a gestation period of 36–40 weeks using ELISA.Results. It has been shown that in the third trimester of pregnancy occurring against the background of chronic pyelonephritis without exacerbation, compared with a normal pregnancy, the level of MHP-1 and IL-17A increases, the content of VEGF decreases, and the concentration of AAT to nDNA does not change significantly. An increase in the proinflammatory cytokine IL17A and a decrease in VEGF level can lead to intrauterine fetal growth retardation due to inhibition of amino acid transporters in the placenta.Conclusions. In pregnancy occurring against the background of chronic pyelonephritis without exacerbation, a change in the level of IL17A, MСP-1, VEGF can have a significant impact on the course of pregnancy.

Implications for miR-339-5p regulation of trophoblast proliferation and migration in placentas associated with porcine intrauterine growth retardation using integrated transcriptome sequencing analysis

Placental dysfunction is considered as one of the main etiologies of fetal intrauterine growth retardation (IUGR). MicroRNAs (miRNAs) have been demonstrated to be a vital epigenetic modification involved in regulating the placental function and pregnancy outcomes in mammals. However, the mechanisms underlying placenta-specific miRNAs involved in the occurrence and development of pig IUGR remain unclear. In this work, we compared the placental morphologies of piglets with IUGR and normal birth weight (NBW) by using histomorphological analysis and performed a miRNA–mRNA integrative analysis of the gene expression profiles of IUGR and NBW placentas through RNA sequencing. We also investigated the role of differentially expressed ssc-miR-339-5p/GRIK3 through an in vitro experiment on porcine trophoblast cells (PTr2). IUGR piglets had significantly lower birth weight, placental weight, placental efficiency, and placental villus and capillary densities compared with the NBW piglets (P < 0.05). A total of 81 differentially expressed miRNAs and 726 differentially expressed genes in the placentas were screened out between the IUGR and NBW groups. The miRNA–mRNA interaction networks revealed the key core miRNA (ssc-miR-339-5p) and its corresponding target genes. Subsequently, we found that upregulation of ssc-miR-339-5p significantly inhibited the migration and proliferation of PTr2 cells (P < 0.05). The dual-luciferase reporter system showed that GRIK3 was the target gene of ssc-miR-339-5p, and the transcription level of GRIK3 may be negatively regulated by ssc-miR-339-5p. Additionally, overexpression of ssc-miR-339-5p significantly increased (P < 0.05) the mRNA expression levels of genes involved in the cytokine–cytokine receptor interaction pathway. These results indicate that ssc-miR-339-5p may affect the migration and proliferation of trophoblast cells by regulating the expression of GRIK3 and altering the placental inflammatory response, resulting in a suboptimal morphology and function of the placenta and the development of pig IUGR.

A Study of the Literature on Intrauterine Treatment Options for Chronic Placental Insufficiency with Intrauterine Growth Restriction Using Intrauterine Intravascular Amino Acid Supplementation.

Intrauterine growth retardation (IUGR) is a very serious prenatal condition with 3-5% incidence of all pregnancies. It results from numerous factors, including chronic placental insufficiency. IUGR is associated with an increased risk of mortality and morbidity and is considered a major cause of fetal mortality. Currently, treatment options are significantly limited and often result in preterm delivery. Postpartum, IUGR infants also have higher risks of disease and neurological abnormalities. The PubMed database was searched using the keywords "IUGR", "fetal growth restriction", "treatment", "management" and "placental insufficiency" for the period between 1975 and 2023. These terms were also combined together. There were 4160 papers, reviews and articles dealing with the topic of IUGR. In total, only 15 papers directly dealt with a prepartum therapy of IUGR; 10 of these were based on an animal model. Overall, the main focus was on maternal intravenous therapy with amino acids or intraamniotic infusion. Treatment methods have been tested since the 1970s to supplement the fetuses with nutrients lacking due to chronic placental insufficiency in various ways. In some studies, pregnant women were implanted with a subcutaneous intravascular perinatal port system, thus infusing the fetuses with a continuous amino acid solution. Prolongation of pregnancy was achieved, as well as improvement in fetal growth. However, insufficient benefit was observed in infusion with commercial amino acid solution in fetuses below 28 weeks' gestation. The authors attribute this primarily to the enormous variation in amino acid concentrations of the commercially available solutions compared with those observed in the plasma of preterm infants. These different concentrations are particularly important because differences in the fetal brain caused by metabolic changes have been demonstrated in the rabbit model. Several brain metabolites and amino acids were significantly decreased in IUGR brain tissue samples, resulting in abnormal neurodevelopment with decreased brain volume. There are currently only a few studies and case reports with correspondingly low case numbers. Most of the studies refer to prenatal treatment by supplementation of amino acids and nutrients to prolong pregnancy and support fetal growth. However, there is no infusion solution that matches the amino acid concentrations found in fetal plasma. The commercially available solutions have mismatched amino acid concentrations and have not shown sufficient benefit in fetuses below 28 weeks' gestation. More treatment avenues need to be explored and existing ones improved to better treat multifactorial IUGR fetuses.

Intrauterine fetal death and associated maternal conditions

Background: Intrauterine fetal death (IUFD) is a cataclysmic event for the parents. It is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with IUFD. Methods: This was a retrospective study carried out in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, from November 2019 to October 2020 . The details of history, examination findings, investigation reports , mode of delivery and fetal outcome were obtained from records. Results: A total number of 57 intrauterine fetal death were reported amongst 1534 deliveries conducted during the study period. The occurrence of intrauterine fetal death was 37.1/1,000 live births ; Among all these intrauterine fetal death cases, 87.7% deliveries were preterm and 89.4% deliveries were singleton delivery. The other associated maternal conditions were uncontrolled blood glucose in 64.9% cases, hypertensive disorders in 36.8% cases, other medical causes in 10.5% cases. Associated fetal conditions included intrauterine growth retardation of fetus in 28.0% cases, oligohydramnios in 21.0% cases, congenital malformation in 14.0 % cases. Placental condition included antepartum hemorrhage in 3.5% cases. Conclusions: In this study, the occurrence of intrauterine fetal death was associated with high incidence of uncontrolled blood glucose, oligohydramnios and congenital malformations . This emphases the importance of proper antenatal care and identification of risk factors and its proper treatment. BIRDEM Med J 2023; 13(2): 88-91

A CASE REPORT : PREGNANCY IN AN UNICORNUATE UTERUS WITH NON COMMUNICATING NON CAVITATED HORN

Müllerian duct anomalies (MDA) are an uncommon but can be a treatable form of infertility [ ]. Patients with MDA are known 1 to have higher incidences of infertility, repeated first trimester spontaneous abortions, fetal intra-uterine growth retardation, fetal malposition, pre-term labour and retained placenta [

КЛИНИКО-ЛАБОРАТОРНЫЕ ПОКАЗАТЕЛИ БЕРЕМЕННЫХ КОРОВ, ПРЕДРАСПОЛОЖЕННЫХ К РАЗВИТИЮ ГЕСТОЗА

The article presents materials on studying clinical and laboratory indicators of pregnant cows at 60 days of gestation, prone to the development of gestosis. In cows with the uterine fetal growth retardation syndrome at 2 months of pregnancy, subsequently complicated by gestosis, the established morphobiochemical changes indicate failures in the protein metabolism, functioning of the liver, kidneys, and the circulatory system. The changes also show an intensive accumulation of lipid peroxidation products, with a decrease in the activity of the enzymatic and non-enzymatic link of the AOD. The development of the fetal intrauterine growth retardation syndrome occurs against the background of a trophism disorders in the developing embryo. This at early stages of pregnancy is clinically manifested by a decrease in the size of the uterine horn cavity by 22.2-34.2%, the length of the fetus – by 41.5-48.9%, the body diameter – by 19.9-28.9%, the size of the corpus luteum of the ovary – by 15.7-24.1%.

Histomorphological evaluation of placenta in SARS-CoV-2 patients: A cross-sectional study.

SARS-CoV-2 has emerged as a major pandemic of the century and little is known about the impact of maternal infection on placental histopathology. Histopathologic examination of placental tissue can contribute to significant information regarding the pathophysiology of the disease and how it affects the fetal outcome. This was a cross-sectional study conducted at the Department of Pathology, Government Doon Medical College and Hospital, Dehradun, on the placenta of 50 coronavirus disease 2019 (COVID-19)-positive pregnant females confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) from August 2020 to October 2020. Fifty term historical placentas were taken as control. Placenta sections were fixed in formalin, processed into paraffin blocks, stained with hematoxylin and eosin (H and E) stain, and visualized for any abnormality. The most prominent histological finding in the placenta of pregnant women affected by COVID-19 was chorangiosis, which is a feature of fetal vascular malperfusion seen in 28 (56%) cases. Other features included maternal vascular malperfusions (MVM) such as villous crowding and agglutination in 12 (24%) cases. Tenney-Parker change was seen in 13 (26%) patients. Intervillous fibrinoid deposition and intervillous hemorrhage were seen in 37 (74%) patients and 7 (14%) patients showed significant calcification. Other findings observed were less common. Infection with SARS-CoV-2 may be associated with a significant impact on fetal and maternal circulation causing features of fetal and maternal malperfusion such as chorangiosis, villous crowding, and agglutination. Indicating that the infection could cause a potential rise in the risk of adverse perinatal outcomes such as intrauterine fetal growth retardation, preterm birth, or stillbirth.

Effects of maternal HF diet and absence of TRPC1 gene on mouse placental growth and fetal intrauterine growth retardation (IUGR)

Placental tissue intracellular calcium (Ca2+) regulates placental development and growth. Maternal high-fat diet (HFD) results in placental lipid accumulation, increased inflammation, reduced nutrient transport expression, and intrauterine growth restriction (IUGR). Currently, whether maternal HFD differentially affects placental and fetal growth and development under reduced Ca2+ influx is not yet known. We hypothesized that maternal HFD feeding decreases placental growth and development resulting in IUGR and that reduction of Ca2+ influx in the placenta worsens maternal HFD-induced placental dysfunction and IUGR. Three-week-old female B6129SF2/J wild type (WT) and transient receptor potential canonical 1 (TRPC1) protein deficient (KO) mice were fed normal fat (NF, 16 kcal % fat) and high fat (HF, 45 kcal % fat) diets for 12 weeks prior to mating with NF diet fed male mice. Fetuses and placentae were examined at mid- (D12) and late- (D18) gestation. At D12, maternal HFD had no effects on placental or fetal weight changes in WT and TRPC1 KO mice while absence of TRPC1 resulted in decreased placental and fetal weights. At D18, maternal HFD increased placental weights in both TRPC1 KO and WT mice, in part, by moderately increasing placental tissue triacylglyceride (TAG, P=.0632). At D12, mRNA expression of key placental growth factors including IGF1, PLGF, and VEGF were increased in WT compared to TRPC1 KO mice while IGF2 and VEGF mRNA expression were increased at D18. Results presented in our study demonstrated that maternal HFD increased placental weight, in part, due to increased lipid concentration resulting in IUGR and via an additive adverse effect of genotype and maternal HFD. Future studies are needed to determine the signaling mechanism underlying Ca2+ influx reduction-induced placental dysfunction and IUGR.

Association between Prenatal Maternal Tobacco Use and Intrauterine Growth Restriction: A Case-Control Study

Introduction: Intrauterine growth restriction (IUGR) refers to the poor growth of a baby while in the mother’s womb during pregnancy. More than 9% of women smoke tobacco and one-third of women consume smokeless tobacco in developing countries. The intent of the study was to examine the effect on fetal intrauterine growth retardation using maternal tobacco. Methods: This convenient case-control study was conducted with 75 cases and 150 suitably matched controls enrolled in the Department of Pediatrics at Sylhet MAG Osmani Medical College Hospital for about 12 months. Ethical considerations were undertaken before the enrollment of patients. Data were analyzed using SPSS software. Result: ST user mothers of IUGR infants used jarda or gul as smokeless tobacco about 5 times a day and smoker mothers smoked about 5 sticks a day. Maternal tobacco use had a higher (6.9 times) risk of having IUGR babies compared to the non-tobacco user. Conclusion: This study observed that maternal total tobacco use showed a risk of having IUGR infants more than 6.9 times in contrast to non-tobacco user.

Fetal growth retardation as a complication of post-COVID endotheliitis: causes, consequences, ways of prevention

The risk of fetal intrauterine growth retardation (IUGR) is increased in women who have experienced acute infections, as well as in pregnant women with gynecological pathology and endocrine diseases. A woman’s lack of nutrition also makes a negative contribution to the development of IUGR. The frequency of IUGR in the population is very variable and depends on a number of reasons. In practically healthy pregnant women, IUGR is registered in 3–5% of cases, in case of complicated obstetric and gynecological diagnosis and complicated pregnancy – in 10–25%. Morphofunctional disorders in the chorion/placenta in pregnant women with COVID-19 on the background of post-covid endotheliitis are the main pathogenetic factor in the development of preeclampsia, ectopic pregnancy, antenatal fetal death, and impaired condition of the fetus and newborns. Sufficient saturation of the pregnant woman’s body with the nitric oxide donor L-arginine and L-carnitine (main cofactor of fatty acid metabolism in cells) with the improvement of microcirculation and the correction of hypovolemic disorders in the fetoplacental complex can be considered one of the real ways to prevent IUGR in women in the post-covid period.A review of the scientific literature on pathogenesis, diagnosis, impact on the life and health of a newborn with IUGR in women after COVID-19, as well as the possibilities of medical correction of placental dysfunction during pregnancy was performed.This analysis and our own clinical experience allow us to state the fact that after a coronavirus infection during pregnancy, one of the frequent and threatening for the further development of the child is the formation of placental dysfunction and IUGR. One of the ways to prevent these conditions is to saturate the woman’s body with the nitric oxide donor L-arginine from the stage of pre-gravid preparation, which will provide the opportunity for adequate angiogenesis and development of the embryo/fetus. In the case of additional risk factors, such as coronavirus disease, complex therapy blood (Rheosorbilact), in combination with a nitric oxide donor and L-carnitine as an endothelium-protective agent (Tivor-L).

Association of HIF-1A (rs11549465) gene polymorphism with congenital malformations and intrauterine growth retardation of the fetus

Introduction. Congenital malformations have long received the status of a marker of environmental distress. Six per cent of the newborns in the world are diagnosed with congenital malformations of various etiologies, 30 million develop intrauterine growth retardation, often associated with hypoxia, while the number of these pathologies is significantly higher in environmentally unfavourable regions. The degree of resistance to hypoxia is determined by the transcription factor induced by hypoxic conditions - HIF. There is revealed polymorphism of the HIF gene, which determines the differences in the activity of the transcription factor encoded by this gene, and therefore, the differences in the level of resistance to hypoxia. Recently, HIF has also been detected in response to the activation of free radical processes. Materials and methods. The study examined fifty five women living in the South of Kuzbass, most of them in the city of Novokuznetsk. 18 women were included in the control group because they carried a healthy child, the study group consisted of 11 women who gave birth to children with intrauterine growth retardation, and 26 women who gave birth to children with congenital malformations. Genomic DNA was isolated from peripheral blood leukocytes using the phenol-chloroform extraction method. Gene typing was carried out by the Real Time method. Results. Among the studied groups, in women who gave birth to children with congenital malformations, there were no reliable differences in the occurrence of polymorphisms of mutant and wild types. In the group of women who gave birth to children with intrauterine growth retardation, a reliable association of C/T polymorphism in the mother with intrauterine fetal growth retardation was shown (χ2 = 4.54; OR = 9.71), while the ancestral form of C/C was associated with resistance to this pathology. Limitations. Since the identification of the association of the HIF-1A (rs11549465) gene polymorphism with intrauterine growth retardation was of a pilot nature, it is advisable to increase the sample. Conclusion. The results obtained may indicate the leading role of the HIF-α subunit in the body’s adaptation to hypoxia and the secondary importance of this protein in the regulation of pro- and antioxidant balance.

Abnormal growth and morphogenesis of placenta at term is linked to adverse fetal development after perigestational alcohol consumption up to early gestation in mouse.

Gestation alcohol consumption produces fetal growth restriction and malformations by affecting the embryo-fetal development. Recently a relationship between abnormal placentation and fetal malformation and intrauterine growth retardation has been suggested. However, the effects of perigestational alcohol ingestion up to early pregnancy on the placenta at term and its association with fetal abnormalities are little known. In female mice, ethanol 10% in water was administered for 15 days previous and up to days 4 (D4), 8 (D8), or 10 (D10) of gestation (TF), and gestation continues without ethanol exposure. Control females (CF) received ethanol-free water. At day 18, feto-placental units and implantation sites were studied. TF had increased resorptions and only fetuses from D8-TF and D10-TF had significantly increased weights versus CF. D4 and D10-TF-placentas had significantly reduced weights. All TF had increased junctional zone (JZ) and reduced labyrinth (Lab) areas (PAS-histology and morphometry) compared with CF. Fetuses with mainly with craniofacial abnormalities and skeletal defects (Alizarin red staining), significantly increase; while the fetal bone density (alizarin color intensity, ImageJ) was reduced in D4, D8 and D10-TF versus CF. Although all TF-placentas were histo-structural affected, TF-abnormal fetuses had the most severe placental anomalies, with junctional abundant glycogenic cells into the labyrinth, disorganized labyrinthine vascularization with signs of leukocyte infiltrates and feto-maternal blood mix. Perigestational alcohol consumption up to early gestation induces at term fetal growth alterations, dysmorphology and defective skeleton, linked to deficient growth and abnormal morphogenesis of placenta, highlighting insight into the prenatal etiology of FASD.

Prenatal diagnosis and molecular cytogenetic characterization of inherited chromosome 2q11.1q11.2 microduplication with fetal intrauterine growth retardation

Prenatal diagnosis and molecular cytogenetic characterization of inherited chromosome 2q11.1q11.2 microduplication with fetal intrauterine growth retardation

Характеристика стану новонароджених від жінок із прееклампсією, фізіологічною масою тіла та ожирінням

The purpose of the study was to characterize the condition of newborns on the Apgar scale and to compare the body weight of newborns from obese women, who used a treatment and prevention complex aimed at preventing preeclampsia, and to compare with the condition of newborns from obese women, who received conventional prevention of preeclampsia and with physiological body weight. Materials and methods. We conducted a clinical and statistical analysis of 255 medical records of newborns, which were divided into 6 groups according to the growth and weight of their mothers, taking into account the presence of preeclampsia and the use of treatment and prevention complex: Group I (control) consisted of newborns (n=33) from women with physiological body weight (body mass index = 18.5-24.9 kg/m2); Group II – newborns from women with physiological body weight and preeclampsia (n=13); Group III – newborns from obese women of I-III degrees (n=90); Group IV – newborns from obese women of I-III degrees, who used treatment and prevention complex (n=65); Group V – newborns from obese women of I-III degrees, and preeclampsia (n=41); Group VI – newborns from obese women of I-III degrees, and preeclampsia who manifested against the background of the use of treatment and prevention complex (n=13). Pregnancy of obese women was carried out according to the order of the Ministry of Health of Ukraine No. 151 dated 24.01.2022, which provides for the appointment of pregnant women at risk (including obesity): acetylsalicylic acid 100 mg/day from 12 weeks to 36 weeks of pregnancy and calcium supplements 1.5 g/day from the 16th week of pregnancy. In addition to the prescribed drugs, obese pregnant women who agreed to take our proposed set of preventive measures aimed at the prevention of preeclampsia, used a combination of drugs L-arginine and semi-synthetic diosmin according to the scheme: from 12 to 16, from 22 to 26, and from 32 to 36 weeks of pregnancy. The dose of diosmin, the release form of which is tableted, was 600 mg per day, the method of oral administration. L-arginine, used as a syrup for oral administration, 5.0 ml 3 times a day. The quantitative indicators obtained in the course of the survey were processed by the methods of mathematical statistics with the help of calculations of the ratio of the chances of the disease in the examined newborns. Results and discussion. The analysis of the state of newborns in the groups we studied shows that the number of premature babies and children who suffered in utero was significantly higher among children born to mothers whose pregnancies were complicated by preeclampsia and mothers who are obese, and as a result further increase in the incidence among these children. We found that the highest percentage of newborns weighing less than 2,500 grams is concentrated in groups with preeclampsia and concomitant obesity, which is due to premature birth and cases of intrauterine fetal growth retardation. Сases of fetal asphyxia were also more common in neonates from women with preeclampsia and concomitant obesity. Cases of fetal macrosomia were significantly more common in infants born to obese women. Conclusion. The use of our proposed treatment and prevention complex for pregnant women with concomitant obesity, having a positive effect on the functioning of the fetoplacental complex, helps to improve the condition of newborns on the Apgar scale and body weight of newborns compared to newborns from obese women who received conventional prophylaxis of preeclampsia

Obstetric and perinatal pathology in pregnant women who had complications from the group of the Great Obstetrical Syndromes

The objective: to analyze the obstetric and perinatal outcomes of childbirth in pregnant women who had complications from the group of the great obstetrical syndromes.Materials and methods. A retrospective statistical analysis of obstetric and perinatal outcomes of childbirth of 239 pregnant women (the Ist group – main one) who had complications from the group of the great obstetrical syndromes (GOS). They were divided into three subgroups: Ia subgroup included 103 pregnant women with severe preeclampsia (PE), Ib subgroup – 67 pregnant women with placental insufficiency, with clinical manifestation of fetal intrauterine growth retardation (IUGR), Ic subgroup – 69 pregnant women with spontaneous preterm birth in the gestational age 22-36 weeks. The control group (CG) included 56 practically healthy pregnant women with a normal reproductive history and uncomplicated course of this pregnancy.Statistical processing of the study results was performed using standard programs Microsoft Excel 5.0 and Statistica 6.0.Results. The incidence of gestational diabetes mellitus in patients of the I group (28 (11.7 %) women) was higher than in CG (2 (3.6 %) persons). Cervical insufficiency was diagnosed in every fifth patient of Ic subgroup (12 (17.3 %) patients; χ2=15.56, p&lt;0.01; OR=9.25; CI 95%: 2.55–33.54 relative to CG), gestational anemia – in 179 (74.8 %) pregnant women in the I group and 18 (32.1 %) women in CG (p&lt;0.01).A significantly high rate of mild congenital malformations was present in subgroup Ib (7 (10.4 %) of pregnant women; χ2=12.67, p&lt;0.01; OR=7.93; CI 95%: 2.14-29.26). 21 patients in the I group had with antenatal fetal death, 6 (5.8 %) – severe PE, 11 (16.4 %) – IUGR. Five cases of early neonatal mortality was diagnosed in the I group. The rate of perinatal mortality in the I group was high and amounted to 108.7 ‰.The operative delivery in the I group was performed in 127 (53.1 %) patients which is significantly more than in CG (χ2=42.93, p&lt;0.01; OR=4.93; CI 95%: 2.99– 8.13). In 24 (18.9 %) pregnant women in the I group the indication for operative delivery was acute distress, which is significantly more than in CG (2 (3.6 %) women; χ2=7.36, p&lt;0.01; OR=5.17; CI 95%: 1.2–22.28). The mean score on the Apgar scale in newborns in CG was significantly higher compared with the I group (p&lt;0.01).Conclusions. The course of pregnancy and childbirth in women who had complications from the group of the great obstetrical syndromes was accompanied by the development of gestational diabetes, gestational anemia and cervical insufficiency. Complications such as fetal distress, severe preeclampsia, fetal growth retardation with decompensated hemodynamic disorders of the uterine and placental blood circulation, led to a high frequency of cesarean section in these patients.

Disturbance of utero-placental-fetus blood flow in pregnant women with community-acquired pneumonia of bacterial and viral (COVID-19) etiology

Introduction. Placental insufficiency is one of the most frequently developing complications in pregnant women with acute respiratory failure, which is a consequence of community-acquired pneumonia (CAP), including viral etiology. The impact of COVID-19 infection on the course of pregnancy, the condition of the fetus and newborns has not been studied enough. Aim. To study the state of uteroplacental-fetal circulation, placenta and fetus in women with bacterial and COVID-19-associated CAP in the second and third trimesters of pregnancy. Materials and methods. The history of childbirth and the results of examinations of 120 women in the second and third trimesters of pregnancy were analyzed, including 37 women with moderate CAP of bacterial etiology, 48 women with COVID-19 infection. The comparison group consisted of 35 women with uncomplicated pregnancy. The state of the placenta and fetus was assessed according to the data of ultrasound and utero-placental-fetal blood flow – Doppler study. Pulsation indices (PI) and cerebro-placental ratio (CPR) were analyzed. Results. According to our data, the risk of developing chronic placental insufficiency in pregnant women with COVID-19-associated CAP of moderate severity was higher than in groups of women with CAP of bacterial etiology and in the comparison group. In groups with CAP, significant differences were found in the indices of CPR, PI of the uterine arteries, umbilical cord arteries and middle cerebral artery, corresponding to I (A, B) or II degree of disturbance of the uteroplacental and/or placental-fetal blood flow. Chronic intrauterine fetal hypoxia and fetal growth retardation were more frequently detected in the group with COVID-19-associated CAP. Newborns born to mothers with COVID-19 infection have an increased risk of neonatal damage to the central nervous system (CNS). Conclusion. COVID-19-associated CAP, compared with CAP of bacterial etiology, increases the risk of chronic placental insufficiency, intrauterine fetal hypoxia and fetal growth retardation, and the development of neonatal CNS damage.

PEMPHIGOID GESTATIONIS : REPORT CASE AND LITERATURE REVIEW

Pemphigoid gestationis is a gravidic dermatosis usually appearing between the 28th and 32nd week of amenorrhea. The rash is pruritic, bullous or vesiculopapular and of periumbilical topography. In addition to clinical findings, Thediagnosis is confirmed by direct immunofluorescence. If local treatment fails, systemic corticosteroid therapy should be administered. Oral corticosteroids are the therapeutic mainstay in pregnancy and postpartum.. Consequences may be maternal (threat of premature delivery), fetal (intrauterine growth retardation), and neonatal (skin rash). Through this observation and a review of theliterature the authors will try to focus on the physiopathology, clinicalprofile, immunological diagnosis, treatment and evolution of PG.

Pathogenetic associations of indicators of prenatal screening of the firsr trimester of pregnancy with fetal growth retardation

Objective. To determine the relationship between the indicators of prenatal screening of the 1st trimester and the intrauterine growth retardation (IUGR).&#x0D; Materials and methods. A prospective cohort study was carried out. Group 1 included 75 patients with fetal intrauterine growth retardation, group 2 414 women who gave birth to a live, full-term healthy baby with normal weight and height parameters. In all patients, the anamnestic parameters, indicators of PAPP-A, b-hCG, PlGF, thickness of the collar space and the pulsation index of the uterine arteries (PI UA) were compared.&#x0D; Results. A number of significant differences in the anamnestic parameters were found between the groups. In group 1, multiparous women were met more often (16 % compared with 2.9% in group 2, p0.001), women after сesarean section (13.3% and 5.6%, respectively, p=0.013), women with a history of spontaneous and artificial abortions (46.7% and 34.1 %, p=0.036). In addition, in group 1, patients were more likely to have uterine myoma in 9.3 % versus 3.4% in group 2 (p=0.019). In group 1, during the first trimester screening, PAPP-A values ​​were lower 1.238 (0.682.05) IU/ml versus 2.25 (1.283.9) IU/ml in group 2 (p0.001), and PlGF 13.73 (10.2219.09) IU/ml versus 17.19 (12.125.38) in group 2 (p=0.002). There were no significant differences in the level of b-hCG. The average pulsation index of the uterine arteries, on the contrary, in group 1 in the first trimester was higher than in group 2 1.73 (1.422.11) and 1.55 (1.321.85), respectively (p=0.024).&#x0D; Conclusions. Thus, a number of anamnestic data and screening indicators for the first trimester have a statistically significant relationship with the presence of IUGR of the fetus; therefore, these indicators can be used to assess the risk of this pregnancy complication.

Utility of sonographic transcerebellar diameter in the assessment of gestational age in normal and intrauterine growth-retarded fetuses.

The fetal cerebellum has been shown to be least affected by external pressures and molding during pregnancy and therefore might provide more accurate estimation of GA. To study the utility of transcerebellar diameter (TCD) measured by ultrasound for the detection of GA in normal and intrauterine growth-retarded (IUGR) fetuses. This cross-sectional study comprised 500 antenatal patients with a GA between 14 and 39 weeks and who were certain of their last menstrual periods. The TCD was measured ultrasonographically and the corresponding GA was determined. The GA was also determined with other customarily used sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) and compared with TCD. Data of normal pregnancy patients was used to formulate nomograms by taking the 5th, 50th, and 95th percentile measurements. TCD to AC ratio was also calculated in both normal (n = 424) and IUGR pregnancies (n = 76). TCD showed significant correlation with gestational age (GA) measured by last menstrual period (LMP) as well as with GA calculated with other biometric fetal parameters. TCD also showed significant correlation with GA in normal (R2 = 0.979) as well as with IUGR pregnancies (R2 = 0.942). TCD to AC ratio remained fairly constant in normal pregnancies while it was increased in IUGR pregnancies. TCD and TCD/AC ratio can be employed as an objective parameter to establish the GA in normal as well as IUGR pregnancy cases.