Further Course Of Pregnancy Research Articles

THE RISK OF PERINATAL LOSSES DUE TO PARVOVIRUS INFECTION DURING PREGNANCY AND WAYS TO PREVENT THEM

THE RISK OF PERINATAL LOSSES DUE TO PARVOVIRUS INFECTION DURING PREGNANCY AND WAYS TO PREVENT THEM

Glucose level in amniotic fluid as a preclinical marker of chorioamnionitis

The article presents the results of a study amniotic glucose concentration as a potential early indicator of the inflammatory process in the fetal membranes. The main focus was on the analysis of the features of pregnancy and labor in women with premature rupture of membranes (PROM) during full-term and preterm labor according to amniotic fluid glucose levels. Currently, the expectant approach in cases of PROM is widely practiced throughout the world. The objective: to estimate the glucose level in the amniotic fluid as a preclinical marker of chorioamnionitis. Materials and methods. Depending on the glucose concentration in the amniotic fluid at the time of rupture of membranes and the term of rupture of membranes, 97 pregnant women were divided into 4 groups. I and II groups consisted of women with PROM between 24 and 36 weeks and 6 days. In the I group there were 34 pregnant women with a glucose concentration in the amniotic fluid of more than 0.5 mmol/l, and in the II group – 15 pregnant women with the indicator of less than 0.5 mmol/l. III and IV groups included pregnant women with PROM at full-term pregnancy (after 37 weeks). In the III group there were 34 patients with an amniotic glucose concentration of more than 0.5 mmol/l, and in the IV – 14 pregnant women with the indicator of less than 0.5 mmol/l. In all groups, the further course of pregnancy, the time period from the rupture of membranes to the beginning of labor, the need for induction of labor, hyperthermia before the beginning of labor, deviations from the normal course of labor were analyzed (hyperthermia, fetal distress in labor, uterine weakness) and the frequency of operative delivery. Results. The study determined that women with an amniotic glucose concentration below 0.5 mmol/l at the time of hospitalization were more likely to have hyperthermia before and during childbirth. Hyperthermia was most often observed during the first 12 hours after membrane rupture. In addition, these women were more prone to serious birth complications, such as fetal distress, weak labor, and a greater likelihood of needing an operative delivery. Conclusions. 1. A decreased amniotic glucose level less than 0.5 mmol/l is associated with more frequent clinical manifestations of amniotic infection (20% in preterm pregnancies and 14.8% – in full-term pregnancies) than in groups with a glucose content of more than 0.5 mmol/l (8.8% in preterm pregnancies and 5.9% – in full-term pregnancies, p≤0.05). 2. Among patients with a glucose content in amniotic fluid less than 0.5 mmol/l, laboratory manifestations of intra-amniotic infection were detected more often (40% in preterm pregnancies and 42.5% in full-term pregnancies) than among pregnant women with a glucose content of more than 0.5 mmol/l (20% in both full-term and preterm pregnancies, p≤0.05). 3. Determination of the glucose level in amniotic fluid can be considered as an available method of preclinical diagnosis of chorioamnionitis for the individual choice of management tactics in case of premature rupture of the amniotic membranes, which is especially important in premature pregnancy.

THE ROLE OF MELATONIN IN COMPLICATED PREGNANCY

Introduction. In recent years, there have been significant changes in the understanding of the hormone melatonin (MT). It has been confirmed that the processes of conception, pregnancy, and childbirth directly depend on the rhythm and level of MT secretion, but there is no general concept that could describe in detail the mechanisms of influence on ontogenesis.The aim of the study. To assess MT in the blood of pregnant with retrochorial hematoma (RCH) up to 12 weeks of pregnancy.Material and methods. Two groups were formed: 1st comprized 40 pregnant women with RCH, 2nd, control consisted of 44 healthy pregnant. Obstetric research, enzyme immunoassay to determine MT, and ultrasound were performed.The approval of the scientific work was obtained from the Bioethical Commission of the Bukovinian State Medical University (Ukraine).Statistical analysis was performed according to generally accepted methods of variational statistics.The work is a fragment of the research work “Prevention, diagnosis and treatment of disorders of the perinatal period and the reproductive system of women and adolescent girls” (No. 201110Н, state registration number 0111U006499).Results. A significant decrease of MT in the 1st group and the dependence of its level on the size of the RCH was revealed: in the case of hematomas up to 1 cm MT (59.31±10.32 pg/ml) (р ˂ 0.001), which is not observed in hematomas more than 1 cm, which are dangerous for pregnancy (93.98±14.52 pg/ml), which may indicate a compensatory increase in MT; and the term of pregnancy (in 10-12 weeks 79.03±9.61 pg/ml (р ˂ 0.05), in 5-6 weeks 93.78±17.44 pg/ml).Conclusions. In cases of RCH up to 1 cm the content of MT decreases with the development of pregnancy, which can be used as a prognostic marker for the diagnosis of pregnancy complications. The increase in the level of MT with RCH more than 1 cm can be considered as a compensatory increase for the preservation of pregnancy and a regulatory influence on the further course of pregnancy.

A focus on pregnancy course and outcomes of women with zero-fluoroscopy catheter ablation during gestation: a 2-year follow-up study

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmias in pregnant are common clinical problem. Catheter ablation may be required in cases of drug refractory and hemodynamically unstable arrhythmias. Data on further course of pregnancy, perinatal outcomes and results of zero-fluoroscopy catheter ablation in pregnant patients is limited. Purpose we aimed to determine efficacy and safety of zero-fluoroscopy catheter ablation during gestation. Methods 54 pregnant indicated for catheter ablation (Mean age of women was 26.2±3.2 years, mean gestation age 23.3 ±2.4 weeks) due to drug refractory. Further course of pregnancy, perinatal outcomes, complications and arrhythmia recurrence checked during 2-year follow-up. Results Atrioventricular nodal reentrant tachycardia was the most common arrhythmia (n=21; 38.9%). This was followed by Wolff–Parkinson–White syndrome (n=18; 33.3%). In five pregnant was combination of accessory pathways with slow conduction ways (9.3%). Cases of zero-fluoroscopy catheter ablation of ventricular tachycardia (n=2; 3.7%) and premature ventricular contraction (n=8; 14.8%) during gestation were rare. Zero-fluoroscopy catheter ablation successfully performed in all cases (median procedural time was 73±13 minutes). Procedural complication was in one cases (ileofemoral thrombosis). There was no termination of pregnancy after ablation. In five women were increased uterine contractility and uterine blood flow violation (n=5; 9.3%). Preterm delivery was in two cases (3.7%) at 35 and 36 weeks of gestation. Type of delivery was vaginal in the majority (n=42; 77.7%). There were three cases of placental abruption and preeclampsia (5.6%). There were 55 live births (in one case were twins). Fetal birth weight was 3238.7±559.2 grams, 5 minute Apgar was 8.5±1.1. There were no maternal and fetal mortality. At 2-year follow-up there were no arrhythmia recurrence. Conclusions Zero-fluoroscopy catheter ablation during gestation may be safe and effective. It is associated with benign pregnancy course, perinatal and neonatal outcomes.

Angiogenic imbalance as a starting point for the development of placental dysfunction and pregnancy complications in patients with pathology of the fetal environment

In recent years, scientific views on perinatal protection of fetus have shifted to earlier periods of pregnancy – to the I trimester, because from this stage the formation of the fetoplacental complex and laying of organs and tissues take place, which in most cases determines the further course of pregnancy. The objective: to clarify the role of the imbalance of angiogenic growth factors as one of the pathogenetic mechanisms in the development of placental dysfunction, and to conduct a postnatal macromorphometric study of placenta and umbilical cord in women with pathology of the fetal environment. Materials and methods. The object of the study were 80 pregnant women (the main group) with a singleton pregnancy, selected from the cohort of patients from the risk group for the development of preeclampsia and miscarriage. Among them, at 30–32 weeks of gestation oligohydramnios was diagnosed in 40 patients (the first group) and polyhydramnios – in 40 women (the second group). The control group included 30 somatically healthy pregnant women with a normal volume of amniotic fluid and a physiological course of pregnancy.The concentrations of placental growth factor (PlGF), vascular endothelial growth factor-1 (VEGF-1), and an anti-angiogenic marker of neovasculogenesis, soluble fms-like tyrosine kinase (sFlt-1), were performed at 12–16 and 28–32 weeks of pregnancy by enzyme immunoassay method. The study of the structural and functional features of the placenta and umbilical cord included sonographic and organometric methods. The variational statistical method of analysis of the obtained results was carried out using the «STATISTICA for Windows®-6.0» package.Results. In the women of the main group in the I trimester the ultrasound signs of pathology of the embryo and extraembryonic structures were significantly more often observed: low placement of the fertilized egg (33.8 %), its deformation (27.5 %), and partial detachment of the chorion (28.5 %). At 12–16 weeks of pregnancy, a pronounced vascular imbalance was established with a 2.5-fold decrease in the concentration of PlGF in the case of oligohydramnios compared to control data, a 1.8-fold decrease in the level of free VEGF-1 (in the case of oligohydramnios), and an increased level of antiangiogenic growth factors (sFlt-1).The postnatal examination of the placenta and umbilical cord showed that in the pregnant women of the main group a predominance of abnormal forms of placenta (16.3 %), a predominance of eccentric and marginal types of attachment of the umbilical cord (53.8 %), main and intermediate types of vascular branching (63.7 %), changes in the diameter of the umbilical cord (17.5 %), a combination of these features in a third of cases (31.3 %) were found. In the women of the main group, there was a decrease of the placental-fetal coefficient compared to the individuals of the control group, which was especially pronounced in pregnant women with oligohydramnios (up to 0.11±0.01 units compared to control data - 0.16±0.01 units).Conclusions. In the period of 12–16 weeks of pregnancy a vascular imbalance was established at the stage of placentation in patients who were diagnosed pathology of the perinatal environment at 30–32 weeks. In particular, by oligohydramnios there is a 2.5-fold decrease in the concentration of PlGF compared to the control data, a 1.8-fold decrease in the level of VEGF-1, and an increased antiangiogenic growth factor (sFlt-1), which became a prerequisite for the development of placental dysfunction.The results of the postnatal examination of the placenta and umbilical cord became an indirect reflection of placentation conditions. They demonstrated the predominance of abnormal forms, the predominance of the eccentric and marginal type of attachment of the umbilical cord, the main and intermediate type of vascular branching, an increased rate of umbilical cord pathology (Warton’s jelly deficiency, anomalies of the umbilical cord vessels) and a decreased placental-fetal ratio in women with amniotic fluid pathology, which was it is especially pronounced with oligohydramnios.

THE ROLE OF MELATONIN IN COMPLICATED PREGNANCY

In recent years, there have been signifi cant changes in the understanding of the hormone melatonin (MT). It has been confi rmed that the processes of conception, pregnancy, and childbirth directly depend on the rhythm and level of MT secretion, but there is no general concept that could describe in detail the mechanisms of infl uence on ontogenesis. The aim of the study. To assess MT in the blood of pregnant with retrochorial hematoma (RCH) up to 12 weeks of pregnancy.Material and methods. Two groups were formed: 1st – 40 pregnant women with RCH, 2nd control– 44 healthy pregnant. Obstetric research, enzyme immunoassay to determine MT, and ultrasound were performed. Statistical analysis according to generally accepted methods of variational statistics.The approval of the scientifi c work was obtained from the Bioethical Commission of the Bukovinian State Medical University (Ukraine).Research results. A signifi cant decrease of MT in the 1st group and the dependence of its level on the size of the RCH was revealed: in the case of hematomas up to 1 cm MT (59.31±10.32 pg/ml) (р ˂ 0.001), which is not observed in hematomas more than 1 cm, which are dangerous for pregnancy (93.98±14.52 pg/ml), which may indicate a compensatory increase in MT; and the term of pregnancy (in 10-12 weeks 79.03±9.61 pg/ml (р ˂ 0.05), in 5-6 weeks 93.78±17.44 pg/ml).Conclusions. In cases of RCH up to 1 cm the number of MT decreases with the development of pregnancy, which can be used as a prognostic marker for the diagnosis of pregnancy complications. The increase in the level of MT with RCH more than 1 cm can be considered as a compensatory increase for the preservation of pregnancy and a regulatory infl uence on the further course of pregnancy.

CHARACTERISTICS OF THE COURSE OF THE GESTATION PERIOD, CHILDBIRTH AND NEWBORN CONDITION IN PATIENTS AT THREAT OF PREGNANCY TERMINATION IN EARLY TERMS

Despite the successes of modern obstetrics and perinatology, stillbirth occupies one of the leading places inthe structure of perinatal morbidity and mortality. Today, every 5-6 women lose a pregnancy, and the majority of spontaneous miscarriages occur in the 1st trimester of pregnancy.The aim of the study is to examine the peculiarities of the course of the gestation period, childbirth and the condition of newborns in patients with a threat of early termination of pregnancy.Materials and methods. We carried out a retrospective analysis of 100 individual charts of pregnant and parturient women with a threat of abortion in the 1st trimester of pregnancy (the main group). In 40 patients (subgroup I), the threat of termination of pregnancy was accompanied by bleeding, in 60 – the threat of termination without bleeding was diagnosed (subgroup II).The control group consisted of 50 pregnant women with the physiological course of the first trimester of pregnancy. Statisticalanalysis was performed according to generally accepted methods of variational statistics. Reliability was assessed by Student's t-test.Differences were considered significant at a significance level of p≤0.05.The conduct of research was approved by the Ethics Committee of the BSMU, which is confirmed by the protocol of the Commission on Biomedical Ethics regarding the observance of moral and legal rules for conducting medical scientific research.Processing of personal data was carried out after receiving the patient's informed consent.Results and their discussion. The research groups were representative in terms of residence, social status, and education. Menstrual and reproductive anamnesis data in the main and control groups also did not differ significantly. The rate of spontaneous abortions and terminations of pregnancy according to medical indications was significantly higher in women with threatened termination of pregnancy both with and without bleeding compared to controls. Patients of the main group had a significantly higher history of both gynecological diseases and extragenital pathology.Pregnant women with retrochorial hematoma and bleeding accounted for 70%, in 30% of women in the 1st trimester of pregnancy, in the presence of bloody secretions, retrochorial hematoma was not diagnosed. The percentage of asymptomatic retrochorial hematomas was 15%. Anomalous location of the chorion in the 1st trimester of pregnancy was diagnosed much more often in the 1st and 2nd subgroups.The analysis of the further course of pregnancy in women with episodes of miscarriage in the early stages of gestation showed that in the main group the level of perinatal complications, such as the threat of premature birth (30%), placental dysfunction (38%), preeclampsia (11%), fetal distress (20%), SZRP (19%) was significantly higher. Accordingly, the rates of premature birth (13%), fetal distress (25%), and labor anomalies (10%) were higher in childbirth.When analyzing the condition of children at birth, the level of moderate asphyxia in the main group was higher than in the control group (8±2.7% and 0%, respectively). The average weight of full-term newborns in the study group was significantly lower (3020.0±21.4) than that of children in the control group (3685.0±28.1 g) (p<0.05).Conclusions.Pregnant women with a threat of miscarriage in the first trimester of pregnancy are a high-risk group for the occurrence of perinatal complications.The level of complications in the II and III trimesters of pregnancy is significantly higher if the threat of early termination of pregnancy was accompanied by bleeding.In pregnant women with bleeding earlier (up to 8 weeks), compared to patients with bleeding at 9-13 weeks, the frequency of threatened miscarriage in the II trimester of pregnancy, premature birth, placental dysfunction, preeclampsia, and SZRP was significantly higher.

Clinical and psychological ground of principles of prognostication of premature delivery risk

The objective: to assess the diagnostic significance of anamnestic and clinical-psychological factors and develop the prediction criteria for the threat of premature birth (PB). Materials and methods. An analysis of the data of pregnant women who were tested in the II and early III trimesters (screening is the I stage of the study) was carried out. The pregnant women were conditionally divided into two groups. The main group included 30 women whose further course of pregnancy was complicated by the threat of PB. The comparison group included 222 women without clinical manifestations of threat of PB during the current pregnancy. During the II stage of the study, the systematization of existing anamnestic and clinical-psychological factors among the examined women was performed. At the III stage, a comparative analysis of the frequency of the symptoms identified at the I stage was carried out in pregnant women in groups with the calculation of diagnostic coefficients (DC) of measures of informativeness (MI) according to formulas. Diagnostic (prognostic) tables were created for each factor, DC and MI were calculated based on the ratio of frequencies. According to the methodology for calculating the accuracy of the diagnostic decision to achieve a probability level of 95 % (p=0.05), the limit ∑DC is a constant = ±13, to achieve a probability of 99 % = ±20, to achieve a probability of 99.9% = ±30. If there is a factor in the column of the scale that is not included in the spectrum of exclusions, put a check mark in the “yes” column of the corresponding row. In the absence of such a check mark is placed in the “no” column of the corresponding row. Regarding the filling of each row, the sum of DC is calculated by adding up the indicated DCs, in the case of reaching the value of ∑DC, a preliminary diagnostic conclusion is made about the probability for threat of PB (at ∑DC = -13), which has a confidence level of 95 % (p=0.05). If the value of ∑DK = -20 is reached, a final diagnostic conclusion is made about the probability of 99 % for threat of PB (p=0.01). If the limit of the range is -13 < ∑DC < +13, the conclusion is significant because in such case its “p” is > 0.05.Results. Based on the values ​​of DC and MI of Kullbak (valid signs), a clinical scale to predict threat of PB with a confidence level of 95 % (p=0.05) or 99 % (p=0.01) was developed. Among the informative signs (factors) for predicting of threat of PB the following factors were established: spontaneous miscarriage in the anamnesis, high personal and situational anxiety (45 points and above), IV and more pregnancies and artificial abortion in the anamnesis, as well as the level of neuroticism (16 points and above). Conclusions. It has been established that anamnestic and clinical-psychological factors, namely, miscarriage in the anamnesis, artificial abortion in the anamnesis, IV and more pregnancies, high levels of personal and situational anxiety and neuroticism, are important and effective criteria for predicting the threat of premature birth.

Pregnancy outcomes and newborn characteristics in women with follicular fluid thyroid autoantibodies undergoing assisted reproduction.

Higher levels of thyroid autoantibodies in follicular fluid (FF) of thyroid autoimmunity (TAI) positive women are strongly correlated with serum levels and may have effect on the post-implantation embryo development. Literature highlights that levothyroxine (LT4) treatment may attenuate the risk of adverse pregnancy outcomes. The aim of the study was to estimate the pregnancy and newborn outcomes in women with FF thyroid autoantibodies undergoing assisted reproductive technology (ART). The study population included 24 women with confirmed clinical pregnancy, 8 TAI positive and 16 TAI negative women. LT4 supplementation was applied in 20.8% patients, TAI positive. Pregnancy outcomes were: twin pregnancy rate 41.7%, early miscarriage rate 8.3%, late miscarriage rate 4.2%, preterm birth rate 16.7%, term birth rate 70.8%, live birth rate 96.0%. There was significant difference in serum and in FF TgAbs (p< 0.001)between the groups according to TAI, while serum fT3 was lower in the group with TAI (p = 0.047). Serum P4 was higher in LT4 treated group (p = 0.005), with TAI, and newborns in this group had higher birth weight (p = 0.001) and height (p = 0.008). Maternal complications occurred in 23.8% of patients. No congenital malformations in newborns were noted. Thyroid autoantibodies present in FF may have an effect on the post-implantation embryo development, but have no effect on further course of pregnancy. The special benefit of LT4 treatment for successful ART outcome was demonstrated for newborn anthropometric parameters.

Influence of Eearly Necrectomy in Pregnant Rats with Deep Thermal Skin Burns on Maternal Oxygen-Dependent Processes and Further Course of Pregnancy

Influence of Eearly Necrectomy in Pregnant Rats with Deep Thermal Skin Burns on Maternal Oxygen-Dependent Processes and Further Course of Pregnancy

ELECTRON-MICROSCOPIC FEATURES OF THE LOWER UTERINE SEGMENT MYOMETRY IN WOMEN WITH PLACENTAL PRESENTATION

The article presents modern phenomena about electron microscopic features of the studied placentas. Placenta previa is an urgent problem of modern obstetrics, as it is the main cause of obstetric bleeding in the third trimester of pregnancy. The aim of the study was to study the electron microscopic features of the myometrium of the lower uterine segment in women with placenta previa. Materials and methods. In accordance with the aim of the research, 122 pregnant women with atypical location of the placenta were examined, who were hospitalized and delivered in the Perinatal Center of Kyiv during 20140–2020 at 36 + 6 days and 38–39 weeks of gestation. In 10 pregnant women with placenta previa performed electron microscopy of the myometrium of the lower uterine segment during placenta previa, which formed the main group. The control group included 6 pregnant women within 38 weeks with a normal location of the placenta. In all pregnant women of the main group, myometrial biopsies were taken in the placenta previa of the lower uterine segment. Results and their conclusions. The study found that the most significant electron microscopic changes were found in the myometrium, which is primarily related to the contractile function of smooth myocytes. Obviously, this is due to lack of energy supply, resulting in a decrease in both the number of mitochondria and their functional state. This process is also complicated by other energy sources – trophic inclusions. The condition of blood vessels at presentation of a placenta also changes, both a hypoxic condition of vessels, and surrounding fabrics develops. The detected electron microscopic changes of the placenta give an understanding of the further course of pregnancy and fetal development, because it is the placenta that ensures the interaction of the mother and fetus.

The feasibility of ultrasound screening of the urinary system in order to detect urological diseases in pregnant women when registering in an antenatal clinic

The frequency of urinary tract infection in pregnant women is 5–12%. Pregnant women with kidney abnormalities are at high risk for developing pregnancy complications. Moreover, the state of the kidneys and upper urinary tract in the vast majority of patients before pregnancy and in the first trimester of pregnancy remains unclear due to the existing observation algorithm. Due to the lack of previous information about the state of the organs of the urinary system, urologists often find themselves in a difficult diagnostic collision. Objective: to determine the role of ultrasound screening of the organs of the urinary system of pregnant women when registering in an antenatal clinic in the first trimester of pregnancy. Materials and methods. Ultrasound screening was performed for 370 pregnant women using Logiq-400 MD and HONDA HS-2000 ultrasound machines. A comprehensive ultrasound of the urinary system, including dopplerography and dopplerometry of the renal vessels and ureteric jets, was performed in 32 pregnant women. Results. Ultrasound screening revealed urolithiasis in 12 pregnant women, stage I hydronephrosis in 21, stage II hydronephrosis in 43 (20 with secondary pyelonephritis), pyelonephritis in 16, cystitis in 5, kidney doubling in 8, solitary cyst kidneys – in 3, a single kidney – in 1 pregnant. In the presence of hydronephrosis, positional therapy was recommended for all pregnant women, they were allocated to the risk group with impaired urodynamics and with the possible development of pyelonephritis. In two pregnant women, the data of complex ultrasound and lack of relief of pyelonephritis within 3–4 days, despite the positional and antibiotic therapy, served as the basis for the drainage of the upper urinary tract using the ureteric stent. Stenting made it possible to quickly stop gestational pyelonephritis, and the further course of pregnancy proceeded without complications. Conclusions. Ultrasound screening of the organs of the urinary system of pregnant women when registering in the antenatal clinic revealed urological pathology in 29.5% of pregnant women. Of these, in particular, hydronephrosis was detected in 11.9%, hydronephrosis complicated by pyelonephritis in 5.4%, pyelonephritis in 4.3%, urolithiasis in 3.2%, renal development abnormalities in 2.2%. When conducting ultrasound screening in the first trimester of pregnancy, in case of complications of pregnancy from the urinary organs in the second or third trimesters, repeated ultrasound is a dynamic study. This contributes to a more objective assessment of the clinical situation and facilitates the development of tactics of conducting a pregnant by urologist. Ultrasound screening makes it possible to judge the nature of the occurring urodynamic disorders during pregnancy, timely conduct adequate correction of urodynamic disorders, minimize negative consequences in the event of gestational pyelonephritis, and also prevent the transition of the serous form of pyelonephritis to purulent. These measures help maintain maternal and fetal pregnancy and health. In the future, we consider it appropriate to conduct a comprehensive examination of future parents before the planned pregnancy, including the mandatory ultrasound of the urinary system in women.

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.

Do lifestyle factors influence the rate of complications after amniocentesis?

The impact of lifestyle factors including health-promoting physical activity on complication rate following amniocentesis is unclear. To examine the further course of pregnancy in patients undergoing amniocentesis in relation to selected risk factors including the level of health-promoting activity and occupational work on the complication rate after genetic amniocentesis. Medical records from 317 diagnostic amniocenteses were analyzed and 230 procedures carried out on 219 pregnant women were included in the study. The mean maternal age was 34.50 ±5 years (range: 22-47 years). In the patients studied, amniocentesis was performed at 12-24 gestational weeks with a median at 16 gestational weeks (mean: 16.13 ±2.02 weeks). Overall, 174 amniocenteses (75.6%) did not reveal any genetic disorder while 56 (24.4%) confirmed a genetic disorder. One hundred procedures (43.5%) were followed by at least 1 complication, while 130 procedures (56.5%) were uneventful. The following complications were observed: general pain - 37 (16%), fever - 5 (2.2%), dizziness - 7 (3%), amniotic fluid leakage - 5 (2.2%), vaginal bleeding - 3 (1.3%), and fetal death - 11 (4.8%). The following lifestyle factors were reported: use of stimulants - 12 (5.2%), occupational work - 158 (68.7%), commuting - 137 (59.6%), and physical activity - 62 (27%). Abdominal pain/uterine contractions were significantly more frequent with generalized pain, fever, vaginal bleeding, and physical activity. The presence of dizziness correlated with generalized pain in women who were working and commuting. Working occupationally when pregnant correlated positively with practicing sport. Better newborn condition was significantly correlated with older gestational age and longer sick leave. Physical activity performed by pregnant women after amniocentesis increases the risk of post-procedural complications such as abdominal pain, uterine contractions, dizziness, and syncope. Reducing physical effort 2 weeks after the procedure is recommended. Further studies are warranted.

Safety of amniocentesis in normal pregnancies and pregnancies considered high-risk due to fetal genetic anomalies - an observational study

Purpose: To evaluate the effect of clinical and demographic factors on the further course of pregnancy and post-procedure complications in healthy and high-risk pregnancies. Materials and Methods: Data of 230 amniocenteses with normal (n=174) and abnormal genetic findings (n=56) were collected retrospectively. Details of birth, neonatal condition, patient characteristics, and post-procedure complications were analysed. Results: The mean maternal age at amniocentesis was 34.50 ± 5 years-old. One hundred (43.48%) were followed by at least one complication. Fetal death occurred after 11 (4.78%) procedures including seven with genetic disorders. There was no significant difference in complication rates between study groups, except for fetal death, which was significantly more common in high-risk pregnancies (p = 0.0017). Abdominal pain correlated with pyrexia and vaginal bleeding. Conclusion: The most severe complications were associated with fetal genetic disorders. The authors conclude that amniocentesis is a safe procedure; however, significant correlations between the incidence of certain complications may be relevant in planning antenatal care.

Improving the Predictive Accuracy for Pre-eclampsia by Combining Demographic and Socio-economic Risk Factors with Biochemical Indicators

Objective: Since prevention of pre-eclampsia is not possible, the target should be to estimate the severity of the disease that will provide intensive supervision during the further course of pregnancy. So, the aim of this study is to improve the predictive accuracy for pre-aclampsia by defining the demographic and socio-economic characteristics of pregnant women with pre-eclampsia in Macedonia combined with certain biochemical indicators. Methods and materials: The data used in this study are collected from a case control study which was conductedat the University Clinic of Gynecology and Obstetrics, University "Ss. Cyril and Methodius" in Skopje, Macedonia. The study included 50 pregnant women with singleton pregnancies between 28 and 40 gestational weeks hospitalized with symptoms of pre-eclampsia, determined by standard clinical laboratory analysis. The control group consisted of 50 normotensive pregnant women of the same gestational age. After obtaining consent for participation in the examination of every pregnant woman, a detailed history was taken, cardiotocography and ultrasound biometry were preformed. Also a blood sample was drawn to determine serum concentrations of appropriate markers and clinical laboratory testing to assess the severity of pre-eclampsia (moderate or severe). Inflammatory cytokines IL-10 was analyzed from peripheral blood 1-1,5ml by enzymatic amplification chemiluminescence on the device Immulite 1000, Siemens Healthcare Diagnostics, USA. The data were digitized and all statistical tests were performed using SPSS version 13.0. Logistic regression analysis (Binary Logistic Regression) was used to determine the predictive value of the different parameters for the occurrence of severe preeclampsia. Rates of probability - odds ratios (OR) and 95% Confidence Intervals (CI) were calculated in order to quantify independent associations. Results: Analysis applied in this study for several of the demographic and clinical risk factors for pre-eclapsia showed that elevated systolic blood pressure of 160 mmHg or higher, diastolic blood pressure of 100 mmHg or higher, pregnancy at older age than 35 years as is nulliparity are associated with highly significant risk for developing severe form of pre-eclampsia. Other risk factors examined in this survey such as duration of gestation, BMI, number of pregnancies, previous pregnancy with pre-eclampsia, diabetes and smoking status according to the results of this study, are risk factors that insignificantly increase the risk for severe form of pre-eclapmsia. As for the biochemical indicators, reduced serum concentrations of IL10 are statistically significantly associated with the development of severe form of preeclampsia in pregnant women. IL10 was also found to be negatively correlated with proteinuria, and positively correlated with blood platelets. Significantly higher concentration of IL10 was confirmed in patients with higher number of platelets in the blood, and vice versa. On the other hand, the serum concentration of IL10 was significantly lower in patients with higher amount of proteins in the urine, and vice versa. Conclusions: Examination of clinical risk factors combined with biochemical markers can improve the predictive success of pre-eclampsia and has important clinical values in improving the prognosis of pregnant women and fetuses.

Pregnancy-associated breast cancer: maternal breast cancer survival over 10years and obstetrical outcome at a university centre of women's health.

Pregnancy-associated breast cancer (PABC) is considered the second most common malignancy affecting pregnancy. The limited knowledge as to long-term survival is nonuniform. This retrospective study aims to contribute by a follow-up of pregnancies of breast cancer patients treated at a single university centre with focus on maternal long-term survival in relation to time point of diagnosis (before, during, and after pregnancy). Data of 25 patients were reviewed for the period between 2000 and 2009 in relation to their neonatal and maternal outcome parameters as well as their maternal breast cancer outcomes by assessing maternal mortality at annual intervals up to a maximum of 10years follow-up. Median age at diagnosis was 33years. Maternal survival rate of the total collective came to 76% after 5years and to 68% after 10years. The newborns were healthy, 22% of them presented with a 1'Apgar score 5-7. Preterm delivery occurred in 53%. PABC significantly affected maternal survival compared to the national breast cancer cohort at 5years and barely significantly at 10years, with highly significant (p < 0.003) to significant (p < 0.01) effects at 5 and 10years, respectively, for PABC diagnosed during and after pregnancy. The present findings on survival rates suggest that maternal medical assessment at the beginning of and during further course of pregnancy should include a scrutinized thorough breast examination. Conveying/delivering special competences to monitor these high-risk pregnancies at the interface of oncological care should be considered an obligatory part of academic medical education, obstetrical training and interprofessional midwifery education.

Комплексний підхід до лікування раннього токсикозу у вагітних після застосування допоміжних репродуктивних технологій

Obstetricians-gynecologists do not always pay sufficient attention to nausea and vomiting of pregnancy (NVP), sometimes its severity is underestimated and adequate treatment is not prescribed. The objective: to investigate the efficacy and safety of the complex therapy of NVP in pregnant women after ART, including a preparation of ginger extract with pyridoxine and psychotherapy. Materials and methods. Sixty pregnant women were examined after applying VRT, with mild manifestations of NVP. The main group consisted of 30 women, with Emegest (ginger and pyridoxine extract) and psychotherapy used in NVP therapy, and a comparison group of 30 women who only adhered to recommendations on changes in diet and life. The presence of the syndrome of autonomic dysfunction was established using the A.M.Veyn questionnaire. For self-assessment of the level of reactive and personal anxiety, testing was carried out according to the method of Ch.D. Spilberger, Yu.L. Khanin. The quality of life was assessed using the SF-36 questionnaire. Results. The use of recommended NVP therapy in pregnant women after ART makes it possible to improve the condition of women already for 2–3 days, and in 2 weeks of treatment it is essential to reduce or even eliminate the symptoms of NVP. Complex therapy reduces the severity of the syndrome of autonomic dysfunction and the level of personal and situational anxiety, which, against the background of improving the overall condition, positively affects the quality of life. The applied therapy had no side effects or complications, positively influenced the further course of pregnancy and the condition of the fetus and the newborn, in particular, the frequency of preeclampsia is decreased by half and the birth asphyxia by 1.5. Conclusion. The safety and efficacy of Emegest in the complex therapy of nausea and vomiting of pregnancy allows us to recommend its use in pregnant women after ART. Key words: nausea and vomiting of pregnancy, Emegest, auxiliary reproductive technologies, psychotherapy.

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.

Circulating regulatory T-cells as a pregnancy marker of immunological testing for predicting adverse pregnancy outcomes: A preliminary study

Results: In the group c was higher the percentage of ACLAG, IL-6 (p=0.002), 18 (p=0.016) and 23 (p=0.002) and ACLA-G (p<0.001). In other pathologies was higher only percentage of ACLA-M (p<0.001). ROC analysis shows, that ACLA-G were positive in 25% of preeclampsia and in no other pathologies (sensitivity 25%, specificity 98.6%, PPV 80%, NPV 85.5%). ACLA-M were positive in no preeclampsia but it were positive in 14.9% of other pathologies (sensitivity 14.9%, specificity 100%, PPV 100%, NPV 28.6%). IL-15 was positive only in the patients who developed severe preeclampsia. IL-16was elevated only in the group a. Other parameters did not differ significantly. Conclusions: This study has shown that, in general, the evaluation of selected immunological markers can help to contribute to the prediagnostics of patients with preeclampsia in the third trimester. The occurrence of ACLA-G in the first trimestermay indicate the risk of preeclampsia in the further course of pregnancy, while first-trimester ACLA-M are connected rather with the other pathologies. Acknowledgement: This research was supported by PRVOUKP25/LF1/2 and MZCR-RVO-VFN 64165.