Fetoplacental Complex Research Articles

Possibilities of antenatal pathology diagnostics in women after assisted reproductive technologies

PURPOSE: improving the efficiency of diagnosis of placental insufficiency using modern diagnostic methods.
 MATERIALS AND METHODS: The analysis of individual cards, analysis of the gynecological history and somatic morbidity of 426 pregnant women who did not have somatic pathologies and underwent screenings in accordance with the current regulations were performed. The main group of them consisted of 290 women, who showed signs of chronic placental insufficiency at different stages of pregnancy. The control group consisted of 136 women who had no signs of placental insufficiency throughout their pregnancy.
 RESULTS: It was revealed that the main reasons for the development of chronic placental insufficiency of the main group are preeclampsia (68.4%), the threat of termination of pregnancy (34.7%), burdened obstetric and gynecological history (32.5%), isoserological incompatibility (25.6%), pyelonephritis during pregnancy (14.2%) and anemia of pregnant women (13.2%). It was revealed that visualization of the fetoplacental complex and measurement of peripheral resistance in the umbilical artery during the second trimester of pregnancy are not very informative. To reduce the negative impact of fetoplacental insufficiency and its timely diagnosis, it is necessary to use radiation methods for examining the motherplacentafetus system.
 CONCLUSIONS: For timely diagnosis of fetoplacental insufficiency and reduction of its negative impact, it is necessary to use radiation methods of studying the mother-placenta-fetus system.

Clinical and anamnestical aspects of very early preterm birth

The objective: determine risk factors, causes and clinical features of patients with very early preterm birth. Materials and methods. The study analyzed the data of anamnesis, the course of pregnancy, childbirth and perinatal outcomes of 166 women of reproductive age with very early preterm birth at 22–27 weeks of gestation. The fact of childbirth at these stages of pregnancy is the main criterion of inclusion. The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early preterm (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. During the management of pregnancy of patients of these groups, special attention was paid to the assessment of risk factors for the development of very early preterm labor, among which the main ones were urogenital infections (83,7% and 78,9% in groups 1 and 2, respectively), which caused perinatal mortality in both groups (p˂0,05). A combination of pathogens was found in almost half of the subjects (43% in group 1,44% in group 2). Patients of both groups had a serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. The main complications of gestation of pregnant women of both groups in the second trimester were the miscarriage risk (43% and 30%, respectively) and dysfunction of the fetoplacental complex (FPC) (22,7% and 21,8%, respectively), which caused the syndrome of delayed fetal development in both groups of subjects - in 66% and 63% of children, respectively. Conclusion. Analysis of general and obstetric history, the presence of infectious factor in combination with extragenital pathology confirm the polyetiology of the causes that leads to very early preterm birth. Considering the main risk factors of preterm birth, a thorough examination for urogenital infections in women at the stage of pre-pregnancy and during pregnancy, followed by treatment and restoration of normal vaginal biocenosis, as well as study of fetoplacental system function from early pregnancy. Preventive measures and timely treatment of fetoplacental disorders should promote prolonging pregnancy to longer gestations, which is the best way to improve perinatal outcomes.

Features of lipid peroxidation processes and antioxidant protection system in pregnant women with type I diabetes mellitus and their newborns

The objective: to determine the characteristics of lipid peroxidation processes and the antioxidant defense system in pregnant women with type I diabetes mellitus and their newborns. Materials and methods. 160 patients at 12–41 weeks of gestation were examined. The main group included 110 pregnant women with type I diabetes mellitus, the control group – 50 healthy pregnant patients. Evaluation of lipid peroxidation activity was determined by the content of diene conjugates, lipid hydroperoxide, malondialdehyde in blood serum and erythrocytes, superoxideanion O2 in blood plasma. Results. Analysis of the results in patients with diabetes mellitus showed a significant activation of lipid peroxidation processes. In the first half of pregnancy, the content of lipid hydroperoxide, malondialdehyde of plasma and erythrocytes, as well as superoxide anion in patients with diabetes mellitus was higher than in healthy pregnant women. In the second half, all lipid peroxidation indicators in patients with diabetes mellitus exceeded the corresponding indicators in healthy pregnant women. The dynamics of antioxidant defense system indices in diabetes mellitus indicates a compensatory tension of its main links with a subsequent decrease in their activity, in contrast to healthy pregnant women, where the antioxidant defense system activity increases adequately to the growth of lipid peroxidation activity. Conclusion. Disorders in the lipid peroxidation system in pregnant women with diabetes mellitus should be regarded as such that negatively affect the development and functioning of the fetoplacental complex. The results indicate the need to include the pregnant women with diabetes mellitus in the risk group of the placental dysfunction development, with the aim of its timely prevention, thereby reducing perninatal morbidity and mortality.

Immunohistochemical features of the fallopian tubes’ structure in case of fetuses with a gestational term of 21-28 weeks from mothers with a chronic infection of the lower genital tracts

In the following article we are disclosing immunohistochemical features of the fallopian tubes’ structure in case of fetuses with a gestational term of 21-28 weeks. We have studied the structure of organs of 15 fetuses from mothers with a chronic infection of the lower genital tracts (HILGT) (the group of comparison) relatively to one in case of 15 fetuses from mothers with a physiological pregnancy (the main group). All fetuses had a gestational term of 21-28 weeks and had died intranatally as a result of an acute disorder of uterine-placental circulation. Methods of reearch: organometric, histological, immunohistochemical and statistical. The complex research allowed to reveal a probable decrease of the organometric data as well as indicators of thickness of the main structural components of the organs’ wall in case of fetuses from mothers of the group of comparison relatively to ones in case of fetuses from the main group. By applying histological method we had reveled a disorder in the strucuture of mucous and muscular membranes in the structure of organs of fetuses from mothers with a pathology of pregnancy, which is manifested by decreasing of number of folds, uneven thickness of the mucous membrane as well as disorder in formation of the muscular membrane’ layers. Immunohistochemical method has revealed an increase of apoptotically changed mucosal cells in the fallopian tubes of fetuses from mothers with HILGT. By applying MCAT to endotheline-1 we have revealed an increased glow of endithelial cells in vessels both of arterial and venous types in the strucuture of the organs’ wall in case of fetuses from the group of comparison. During the study on the endocrine activity of organs of fetuses from mothers with complicated pregnancy we have postulated a probable decrease of the cells’ glow’ intensity towards MCAT of progesterone. At the same time, there is also an inflammatory infiltration in the mucous membrane of the fallopian tubes’ wall. The aforementioned changes in the strucuture as well as in the functional activity of fetuses’ organs from mothers’ with HILGT are formed under the influence of chronic hypoxia and endocrine insufficiency of the feto-placental complex, which is taking place in case of this pathology. Histological and immunohistochemical features of the fallopian tubes’ structure in case of fetuses from mothers with complicated pregnancy are indicating a disorder in formation and maturing of the organ as well as they could lead to development of ectopic pregnancy and tubal infertility in the subsequent ontogenesis.

Pregnancy planning in women with diabetes mellitus type 2

BACKGROUND: The increase in the incidence of type 2 diabetes mellitus worldwide and the improvement in the quality of diabetic and obstetric care lead to an increase in the number of pregnant women with type 2 diabetes mellitus. The incidence of obstetric and perinatal adverse outcomes in women with type 2 diabetes mellitus is often higher than in women with type 1 diabetes. In the world literature, there are few works on the effect of pregnancy planning on the course and outcome of pregnancy in women with type 2 diabetes mellitus.
 AIM: The aim of this study was to evaluate the role of pregnancy planning in patients with type 2 diabetes mellitus in improvement of pregnancy and birth outcomes.
 MATERIALS AND METHODS: We retro- and prospectively analyzed the course and outcome of pregnancy in 124 women with type 2 diabetes mellitus, who were observed in the Diabetes Mellitus and Pregnancy Center of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott for the period from 2010 to 2019. The study included 34 women with type 2 diabetes mellitus at the stage of pregnancy planning and 90 women during pregnancy. All patients underwent a general clinical examination, carbohydrate metabolism correction, training at the School of Diabetes Mellitus in the principles of rational nutrition, self-control of glycemia and insulin therapy. Diabetes compensation was assessed by the level of glycated hemoglobin, determined using a method certified in accordance with the National Glycogemoglobin Standartization Program and standardized in accordance with the reference values adopted in the Diabetes Control and Complications Trial, as well as by the level of glycemia (self-control at least four times a day). We also assessed the severity of vascular complications of type 2 diabetes mellitus before and during pregnancy, and identified and treated comorbidities. To assess the degree of obesity, the criteria of the World Health Organization and the pregravid body mass index calculated by the Quetelet formula were used. The severity of preeclampsia was assessed in accordance with federal clinical guidelines. Ultrasound examination of the fetus with Doppler blood flow in the vessels of the fetoplacental complex was performed using a Voluson E6 ultrasound system (GE Healthcare, USA). For the timely diagnosis of diabetic fetopathy and fetal cardiomyopathy, dynamic fetometry and echocardiography were conducted. In addition, cardiotocography was performed for antenatal assessment of the fetus from the 30th week of pregnancy. After delivery, a neonatologist assessed the condition of the newborn using the Apgar scale at the first and fifth minutes of life, and then the assessment was carried out in the early neonatal period.
 RESULTS: In the group of women who received pregravid training, the course and outcomes of pregnancy were significantly better: the frequency of preeclampsia was lower (14.7%) compared to the group of women with an unplanned pregnancy (40.0%); there was no severe preeclampsia compared to the same women (13.3%). The number of preterm births was significantly lower (14.7%) in the group of women with planned pregnancy compared to the group of women without pregravid preparation (37.8%). In addition, in the group of women planning pregnancy, there were no fetal congenital malformations, neonatal hypoglycemic conditions, hypertrophic cardiomyopathy; in the group of women with an unplanned pregnancy, these parameters being found to amount to 6.7%, 24.4% and 6.7%, respectively. There was no perinatal mortality in the group of women with a planned pregnancy; however, this parameter was shown to be 3.3% in the group of women with an unplanned pregnancy.
 CONCLUSIONS: Pregnancy planning in patients with type 2 diabetes mellitus can significantly improve the course of pregnancy and childbirth outcomes.

STUDY OF THE INFLUENCE OF HORMONAL FUNCTION IMPAIREMENT OF THE PLACENTA ON THE STATE OF FETUS AND NEWBORN IN WOMEN WITH NODULAR GOITER

The thyroid gland pathology is one of the most common in the world and is on the samelevel with diabetes mellitus and diseases of the cardiovascular system in its importance.Extragenital pathology, in particular, nodular goiter in pregnant women acts as anadditional stress factor that can negatively affect hormonal relationships in the motherplacenta-fetus system and contribute to an increase in the frequency of complications ofpregnancy, childbirth, and impairment of the fetus and newborn condition.The aim of this work – to study the disturbance effect in the hormonal function of theplacenta on the condition of the fetus and newborn from women with nodular goiter.Material and methods. The analysis of the state of the fetus and newborn of 20 apparentlyhealthy women (control group) and 54 women with nodular goiter (main group). Of these,30 newborns from women with grade I nodular goiter were included into group I, and24 newborns from women with grade II nodular goiter were included into group II. Theintrauterine fetus state was judged about according to the data of cardiotocography, fetalbiophysical profile (FBP), ultrasound examination, and Doppler results. The functionalstate of the fetoplacental complex was assessed by determining the serum concentrationof estradiol (Е2), estriol Е3), progesterone, placental lactogen, as well as the results ofhistological examination of the placentas.Results. The study of the placenta hormonal function, the results of ultrasound diagnosticsand histological examination of the placentas indicate the presence of placentaldysfunction in pregnant women with nodular goiter, that affected the condition of thefetus and newborn. Thus, the cardiotocographic index in fetuses from pregnant women,suffering from nodular goiter, is significantly less than in healthy pregnant women(p<0.05). The average PPI score in women with nodular goiter is also significantly lowerthan in the control group (p<0.05). Doppler data indicate a change in the parameters of the maternal hemodynamics, that led to a violation of the uteroplacental blood flow, thedevelopment of fetal hypoxia.Conclusions. The presence of nodular goiter in the mother is a risk factor for placentaldysfunction. Starting from the second trimester of pregnancy, there are significant changesin the content of placental hormones in the blood. A decrease in the concentration ofprogesterone in the blood serum in pregnant women with nodular goiter, in the latestages of pregnancy, can serve as a marker of the threat of termination of pregnancyand premature birth. A decrease in the content of estradiol and placental lactogen inthe maternal blood serum can be used as a marker of fetal distress in pregnant womenwith nodular goiter. The condition of the fetus and newborn is in direct proportion to thedegree of manifestation of the nodular goiter and the functional state of the placenta.

Causes and clinical picture of very early preterm birth

The objective: the determination of the risk factors, causes and clinical features of very early preterm birth.Materials and methods. The data of anamnesis, the course of pregnancy, childbirth and perinatal outcomes in 166 women of reproductive age with very early preterm birth at 22–27 weeks of gestation were analyzed. The fact of childbirth at these terms of pregnancy is the main criterion of inclusion. The patients were divided into two groups depending on the criteria of live birth: 1 group — 79 women, whose labor was regarded as late miscarriage (retrospective study); 2 group — 87 women with very early preterm (prospective study). Exclusion criteria: congenital malformations of the fetus. Results. The main risk factors for the development of very early preterm labor are urogenital infections (83.7 % and 78.9 % in 1 and 2 groups, respectively). A combination of pathogens was found in almost half of the subjects (43 % in 1 group, 44 % in 2 group). The patients in both groups had a complicated general and obstetric anamnesis, in particular, a significant frequency of inflammatory processes of the genital organs (50.0 % – in 1 group and 59.2 % – in 2 group), surgical interventions (50.0 % and 59.2 %, respectively), as well as hormonal disorders and related diseases (ovarian dysfunction – 27.8 % and 27.6 %, uterine fibroids – 16.4 % and 17. 2%, ovarian cysts – 11.4 % in both groups). 35.4 % of patients in 1 group and 28.7 % of patients in 2 group had a history of chronic foci of infections, pathology of the urinary system – 30.3 % and 28.7 %, respectively, of the digestive tract – 24 % and 22.98 %, hypertension – 32.9 % and 31 %. The main complications of gestation in pregnant women in both groups in the II trimester were the threat of abortion (43 % and 30 %, respectively) and dysfunction of the fetoplacental complex (22.7 % and 21.8 %). This caused fetal growth retardation in both groups – 66 % and 63 % of newborns, respectively.Conclusions. Analysis of the general and obstetric history, the presence of infectious factor in combination with extragenital pathology confirm the polyetiology of the causes that leads to very early preterm birth. Considering the main risk factors of preterm birth, a complete examination for urogenital infections in women before and during pregnancy, followed by treatment and restoration of normal vaginal biocenosis, as well as the study of fetoplacental system function from early pregnancy is neseccary.Preventive measures and timely treatment of fetoplacental disorders should prolong pregnancy for the terms in which there is the best way to improve perinatal outcomes.

Features of the functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections

The objective: a study of the features for the formation and functioning of the fetoplacental complex in pregnant women with a history of sexually transmitted infections.Materials and methods. We examined 50 pregnant women with a history of sexually transmitted infections (I group – the main group). The control group consisted of 30 pregnant women without somatic and gynecological pathology, who had vaginal delivery. All pregnant women underwent a comprehensive clinical examination, taking into account complaints, medical history, objective and additional methods of examination. The levels of estriol, cortisol, placental lactogen and progesterone in the blood serum of pregnant women and the state of fetoplacental complex in terms of 18–20th, 28–30th and 38–40th weeks were determined.Results. In the pregnant women in I group, starting from the 18th weeks there was a significant decrease in the secretion of progesterone (160,8±15,9 nmol/L versus 202,4±5,5 nmol/L, respectively; p<0,05), placental lactogen (77,5±13,2 nmol/L versus 91,3±23,8 nmol/L)/ This means that already in these stages of pregnancy there are signs of placental dysfunction in pregnant women with a history of sexually transmitted infections. The changes in the functional state of the fetoplacental complex at the 28–30th weeks are more pronounced, as evidenced by an increase in the frequency of early intrauterine growth restriction (12.0 %), disorders of fetal breathing (11.0 %) and fetal movements (18.0 %) (according to the biophysical profile score assessment); premature of the placenta, increased hormonal insufficiency of the fetoplacental complex and the first signs of hemodynamic disorders (an increased blood flow in the umbilical artery and uterine arteries and a slight decrease in blood circulation in the middle cerebral artery of the fetus). At the final assessment of the condition of the fetoplacental complex at the 38–40th weeks in pregnant women with a history of sexually transmitted infections, a satisfactory condition was observed in 24 % of cases, compensated ultrasound changes occurred in 46.0 % of cases; subcompensated – in 20.0 % and decompensated – in 10.0 % of cases, respectively, which causes a high frequency of obstetric and perinatal complications in this group of pregnant women.Conclusions. The formation and functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections, from early pregnancy is characterized by a significant level of functional disorders of the fetus, placenta and the amount of amniotic fluid on the background of pronounced hemodynamic and endocrinological disorders, which requires prevention in the pre-pregnancy period.

Gene expression of the congenital immunity in tissues of the placenta and fetal membranes in full-term pregnancy

AIM: To assess the level of expression of TLR2, TLR4, TLR7 genes in the placenta and fetal membranes during full-term physiological pregnancy, without signs of onset of labor.
 MATERIALS AND METHODS: The study was carried out at the premises of City Clinical Hospital No. 1 named after N.I. Pirogov (Samara), and included 15 pregnant women at 37-41 weeks of gestation without somatic pathology, exacerbation of chronic and acute inflammatory diseases, obstetric complications (placental insufficiency, preeclampsia). All patients were delivered by elective caesarean section due to fetal malposition. The level of expression of TLR2, TLR4, TLR7 genes was determined by reverse transcription and real-time PCR (RT-PCR) on the basis of the laboratory of NPO DNA-Technology using a set of reagents Proba NK.
 RESULTS: The data on the features of TLR2, TLR4, TLR7 expression in the placenta and membranes during full-term pregnancy were obtained. Direct correlations were found between the production of TLR2, TLR4, TLR7 of the fetal membranes and TLR2 of the placenta. The expression of placental TLR4 and TLR7 was not associated with the production of the TLRs. Significant differences were revealed in pregnant women with inflammatory and involutive-dystrophic changes in the placenta and the level of TLR4 expression.
 CONCLUSIONS: The expression of the Toll-like receptors (TLRs) in the tissues of the fetoplacental complex occurs uniformly during physiological pregnancy. There are positive correlations between the expression of TLR2, TLR4, TLR7 of the fetal membranes and TLR2 of the placenta, as well as its mass. The most significant indicator of the inflammatory process is the placental expression of TLR4.

Prevention of the fetoplacental complex disorders in women at risk and the risk of preterm birth (Literature review)

The obstetrician-gynaecologist practitioners consider a woman’s health from her reproductive potential support standpoint, and the problem of miscarriage is considered as one of the most important health problems in the world. The difficulty in solving the premature birth problem is the presence of many factors and preconditions that determine the risks of miscarriage. The article provides an overview of current international guidelines for assessing the root causes and preconditions for preterm birth. The problem of preterm birth risks is discussed, taking into account both the socio-economic living conditions of pregnant women and the factors that accompany the formation of the pathogenesis of preterm birth (placental dysfunction). There were examination and evaluation of the clinical significance of the factors that can lead to dysfunction of the fetoplacental complex (partial placental abruption, low placentation, placental dysfunction, premature placental maturation, placental malnutrition/hypertrophy, polyhydramnios/dehydration, placental abruption syndrome and growth retardation syndrome, fetal-placental blood flow, acute/chronic fetal distress). It was noted that hemodynamic disorders in the placenta depend on both the nature and duration of adverse factors. Those factors are pregnancy in unfavourable terms for the birth of children (up to 18 and after 40 years), high frequency of extragenital pathology, complicated reproductive history, genital infectious diseases (chlamydial infections, trichomoniasis, urogenital mycoplasmosis), smoking during pregnancy, the impact of environmental and economical character.Attention is paid to the hemodynamic disorders assessment (vascularization of the lower uterus) in pregnant women and determination of their role in the fetoplacental dysfunction development. The role of the hemodynamic disorders in the placenta is considered as the morphological and biochemical adaptive reactions abnormality.

Effect of Rheology of Blood and Haemostasis of the Cows on the Viability of the Offspring and Reproduction

The Results of the studies indicate that in 45.44% of cows-the initial duration of the third period of genera was more than 9 hours, and in cows of the second - third lactation only in 27.28% of animals. Morphometry indicators of a body mass of newborns calves and placenta show the conditions of growth and development of fetal, which are connected with functional activity of the feto-placental complex and on average, the body weight of the calves of the first subgroups (animals derived from cows with the duration of the third period of genera up to six hours) proved by20.80%-21.20% more than the calves of the fourth subgroups. Below the mass proved and placenta of calves, fourth subgroups (in 1.25 by Times – 1.18 by Times, (P < 0.05), compared to this indicator of the first subgroups of calves. Increased activity of the factors of hemostasis and rheology of blood is set in animals in which the duration of time of the third period of genera was up to 12 and more hours. Under these conditions, the viscosity of animal blood in 1.39-1.40 by Times, (P < 0.05) and 1.30-1.40 by times (P < 0.05), the content of Fibrinogen in 2,47-2,04 by Times<0.01). The given data indirectly indicate the increase of blood viscosity, reduction of its blood flow, especially in the capillary system vessels. In our opinion, this is the cause of the birth of animals with low viability as evidenced by the coefficients of the catabolism factor, oxygenic homeostasis, samples of Mack Klur Aldrich, "immature" surfactant system. Recovery of the reproductive function of cows after calving and duration service period in animals of the first subgroups was in 1.17 – 1.14 by times shorter than in cows of the fourth subgroups

Using pentoxifylline, arginine hydrochloride, levocarnitine and rheosorbilact solutions for correction of fetoplacental dysfunction in pregnant women with preeclampsia

Annotation. As of today, there is no effective method for treating the fetoplacental dysfunction (FPD) in pregnant women with preeclampsia. The aim of research was the study of the method proposed by the authors for restoring the functional activity of the fetoplacental complex in pregnant women with FPD on the background of treatment of preeclampsia. А randomized controlled study of the effect proposed treatment (intravenous solution of pentoxifylline; solution containing arginine hydrochloride and levocarnitine; rheosorbilact) of 37 pregnant women at 35-40 weeks of gestation with FPD on the background of moderate preeclampsia, was performed. Such ultrasound doppler measurements have been studied: systolic-diastolic ratio, resistance index, pulsation index in the umbilical arteries, right and left uterine arteries, fetal middle cerebral artery, fetal internal carotid artery and fetal aorta before and after the performed treatment. Statistics were processed using LibreOffice Calc (Mozilla Public License v 2.0), adapted for medical and biological research. We used nonparametric Wilcoxon criteria, Mann-Whitney criteria at a significance level of p <0.05. After the performed treatment, stabilization of the fetoplacental blood circulation in women of the main group was observed, which manifested by decrease in S/D in umbilical artery in 1.3 times, in the left uterine artery in 1.4 times and in the fetal aorta in 1,1 times, and decrease in RI indices in the umbilical artery in 1.1 times, in the right uterine artery in 1.3 times, and increase in the middle cerebral artery in 1.4 times. So, in the course of the proposed treatment, the restoration of the blood flow velocity and the stabilization of vascular resistance in uterine arteries and the umbilical artery were observed in the women of the main group. The research of the possibility of using the above methodology in earlier gestational age and in the risk group for the prevention of preeclampsia is prospective and requires further attention.

Early prediction of placental insufficiency in obese women

Obesity is one of the most important problems in modern health care. The high prevalence of this pathology also affects women of reproductive age, which leads to an increase in the prevalence of obesity in pregnant women.
 Purpose of the work ‒ analysis of the effect of adipokine indicators on predicting the development of placental insufficiency in obese women.
 Materials and methods. 225 women were examined who were subdivided by such a parameter as obesity into 4 groups: 3 main and 1 control. The control group consisted of 55 pregnant women with an initially normal BMI value (18.5‒24.9 kg/m2). Group 1st included 109 pregnant women with grade I obesity (BMI 31.88 1.4 kg/m2), group 2nd ‒ 34 pregnant women with grade II obesity (BMI 36.6 1.1 kg/m2), group 3rd ‒ 31 pregnant women with grade III obesity (BMI 42.2 1.9 kg/m2).
 We studied the data of the anamnesis of pregnant women (somatic and obstetric-gynecological), indicators of adiponectin and omentin, peculiarities of the course of pregnancy and childbirth (data of cardiotocography (CTG), ultrasound markers of disturbances in the formation and functioning of the fetoplacental complex), indicators of labor activity, parameters of newborns (mass-growth, state on the Apgar scale, ponderal index, fetal-placental ratio) and the course of the postpartum period.
 When conducting statistical analysis in the case of comparing two dependent (paired) samples of parameters, the paired Students t-test was used.
 The results were considered statistically significant if the р was less than 0.05. With this indicator, the value of the probability of difference between the compared categories was more than 95%.
 Results. The possibility of predicting the development of placental insufficiency depending on the concentrations of omentin and adiponectin was confirmed. The development of placental insufficiency is most likely with omentin values in the range of 177.6‒191.2 g/ml and adiponectin in the range of 16.0‒22.5 g/ml.
 Conclusion. Determination of adipokine levels at 8‒9 weeks gestation may be practically significant in predicting the development of placental insufficiency in obese women.

Oxidative stress and its significance in the pregnancy pathogenesis in dairy cows

The lipid peroxidation and the antioxidant defence system indices in red-and-white dairy cows with the pregnancy pathology development - gestosis and with its physiological course - were investigated. The study objects were the Druzhba breeding plant (Voronezh region) animals with average annual milk production of 6,5 – 6,7 thousand kg. For the experiment, two groups were formed, the first (n=18) consisted of animals with gestosis clinical manifestations, the second (n-12) - animals with a pregnancy physiological course. The animals’ clinical condition was assessed using conventional methods. An increase in the malondialdehyde content in the animals’ blood with pathology, an increase in the catalase and glutathione peroxidase activity were found. The antioxidant defence non-enzymatic link components content - vitamin E and vitamin C - was reduced. With clinical gestosis, a decrease in the content of progesterone, testosterone, estradiol-17 β and cortisol in the blood plasma was noted, which indicates a fetoplacental complex functional insufficiency. Thus, oxidative stress arising against the imbalance background in the system “lipid peroxidation - antioxidant protection” is one of the factors determining the gestosis pathogenesis. The study results enhance the processes understanding occurring during the pregnancy pathological conditions development and will be useful in choosing prevention and therapy effective methods.

Condition of the mother–placenta–fetal system in pregnant women with a general gynecological anamnesis

The objective: based on the results of cardiotocographic (CTG) and ultrasound methods to determine the features of the fetoplacental complex (FPC) in pregnant women with a burdensome gynecological anamnesis.Materials and methods. 150 patients at 37–41 weeks of gestation were examined. The main group includes 100 pregnant women with chronic salpingo-ophoritis, the control group – 50 healthy pregnant women of the physiological obstetrics department. CTG monitoring of the fetus, ultrasound feto- and placentography, Doppler uterine-placental-fetal blood circulation were used to assess the state of FPC in pregnant women.Results. Analysis of fetal CTG and hemodynamic parameters in the uterine artery and umbilical vessels in pregnant women with chronic salpingo-ophoritis suggests that the course of pregnancy on the background of chronic salpingo-ophoritis in the mother is a factor that adversely affects the fetus and requires active pregnancy. Carrying out treatment-and-prophylactic measures for the purpose of improvement of perinatal results. The combination of unfavorable results of the examination by these methods, as well as adverse results after the usual comprehensive treatment in pregnancy 37–42 weeks is, in our opinion, an indication for emergency delivery according to the indications of the fetus.Conclusion. Identified disorders of uteroplacental and placental-fetal circulation should be regarded as those that correspond to the first degree of severity (disorders of uteroplacental with preservation of placental-fetal circulation). The results indicate the need to include women with chronic salpingo-ophoritis in the group of increased risk of placental dysfunction (PD) in order to prevent it in a timely manner, thereby reducing perinatal morbidity and mortality.

Justification of the choice of diosmin vasoprotective as a preventive agent of pre-eclampsia

In this study, the effectiveness of vasoprotective Diosmin for the prevention of pre-eclampsia in pregnant women of high-risk group with severe forms of placental insufficiency was evaluated. The choice of prophylactic agent in the clinical group is justified by close pathogenetic relationship between placental insufficiency and pre-eclampsia on the one hand, and proved fetoprotective action of Diosmin in case of placental insufficiency on the other hand. It is shown that a normalizing effect on the uterine-placental- fetal blood flow, the functional state of the endothelium of blood vessels, the production of growth factors, the induction of apoptosis of immunocompetent cells by trophoblasts, metabolism and angiogenesis in the placenta, contributes to clinically significant reduction in the frequency of implementation of fetoplacental complex pathology and pre-eclampsia.

Changes in the level of fetoplacental complex hormones in pregnant women with miscarriage.

The purpose of the study was TO analyze the fetoplacental complex hormone levels and changes in their dynamics in pregnant women with miscarriage and the impact of these features on the subsequent course of pregnancy. Hormone levels were determined at different stages of gestation in 50 healthy women with a physiological course of pregnancy (control group) and 50 pregnant women with a history of miscarriage (main group). The women of the main group had a significantly slower rate of increase in hormones and a lag in quantitative indicators than the control group. The estradiol level indicators were 4.1 times (76.0%) and 2.89 times (65.5%) lower in women with miscarriage in the embryonic and late fetal period, respectively, compared to healthy women. Indicators of the level of placental lactogen and chorionic gonadotropin in the embryonic period in women with miscarriage were lower by 39.1% and 50.9%, respectively, compared to healthy women. In the late fetal period, the level of these hormones was lower by 72.9% and 35.4%, respectively. In the embryonic and late fetal periods, progesterone levels were lower by 67.4% and 68.4%, respectively, compared to the control group. The data obtained are evidence of a pronounced hormonal abnormality of the placenta, and hence a marker of fetoplacental dysfunction, which on the background of miscarriage develops at the early stages and continues to progress with the course of pregnancy.

HYPODYNAMIA AS A FACTOR MODIFYING FUNCTIONAL MORPHOLOGY OF HUMAN PLACENTA

The aim: Study of the functional morphology of placenta in a sedentary lifestyle of a woman during pregnancy. Materials and methods: Object of the study: placentas obtained as a result of deliveries at term from women, urban residents, aged 20-40 years old, leading a sedentary lifestyle, and patients with a sufficiently high level of physical activity, the criteria of which corresponded to WHO recommendations. Immunohistochemical and morphometric studies of the placentas were carried out, followed by statistical analysis. Results: Prerequisites for reducing the efficacy of the functioning of fetoplacental complex with a sedentary lifestyle were sclerosis, the formation of intervillous fibrinoid and fibrinoid substitution of terminal villi. The inclusion of compensatory mechanisms in the form of placental hypertrophy, angiomatosis, sinusoidal transformation of the capillaries of terminal villi, thinning of the syncytiocapillary membrane associated with an increase in the content of von Willebrand factor in the villus syncytiotrophoblast, in aggregate, normalizes the exchange between maternal and fetal blood and creates certain prerequisites for the successful completion of pregnancy. However, thinning of the syncytiocapillary membrane increases the risk of rupture and direct contact of the internal media of the mother and the fetus. Conclusions: Sedentary lifestyle of a pregnant woman leads to structural and functional changes in the placenta, which can be a serious prerequisite for the development ofpathological abnormalities in the function of the "mother-placenta-fetus" system. To a certain extent, these changes are leveled due to compensatory processes in the placenta, the margin of efficacy of which needs further investigation.

Some issues of conducting and treatment of pregnant women with chronic tonsillitis

The was an analysis carried out for examination of complications among females during a gestation period and during the act of delivery with pathology of the upper respiratory air-ways. Chronic Tonsillitis is one of the most frequently encountered malfunctions among gravida. Chronic pathological process which gets localized primarily on the palatine tonsils become the focus of permanent pathological impulsing. The evaluation of general condition offunctionality of a fetoplacental complex among these groups ofpatients is the most topical issue at present.

Fetoplacental complex parameters’ changes during repeated increase of the blood volume in female rabbits

One of the mandatory stages of introducing new drugs into obstetric practice is preclinical trials, the purpose of which is to study the effect of drugs on the development of fetuses and placentas. When conducting experimental studies, the main group of animals receiving the drug is compared with the control group of animals that do not receive drugs. At the same time, the volume of the test drug itself can significantly change the blood volume (BV) of an experimental animal, especially a small one, and such administration repeated repeatedly over several days can accumulate this effect, having an adverse effect on the functional state of the fetus. A model of chronic placental insufficiency created on the 18th day of pregnancy in female rabbits by ligating 1/3 of the preplacental vessels in one uterine horn was used to study the effect on the development of the brain and placenta of normally developed and retarded fetuses of multiple daily (1928 days of pregnancy) infusions of saline solution to females in a volume of 6% of the animals BV and comparable to the volume of medications used in the treatment of placental insufficiency in clinical practice (main group of rabbits). It was found that repeated daily administration of saline solution to a female rabbit in the second half of pregnancy, which is about 6% of the BV, causes a violation of the functional state of her normally developed and, to an even greater extent, retarded fetuses. This is manifested by a 1.4-fold reduced survival rate of fetuses in the intact horn of the uterus and a more pronounced violation of brain metabolism in fetuses of the intact and experimental horns compared to those of the control group of females.