Gestation In Women Research Articles

Impact of Viral Myocarditis on the Course of Pregnancy and Delivery

Background: COVID-19 is mainly a respiratory infection; however, in some cases, it can result in cardiac complications in pregnant women leading to the development of myocarditis.Material and methods: In 2021-2022 we studied the impact of COVID-19-associated myocarditis on the course of pregnancy in the Republican Perinatal Center (Tashkent, Republic of Uzbekistan). We examined a total of 147 pregnant women with myocarditis (of them, 95 women had COVID-19 while pregnant and 52 women had chronic focal myocarditis). The patients underwent electrocardiography, echocardiography, ultrasonography, and laboratory studies (troponin T1).Results: COVID-19 in pregnant women can lead to COVID-19-associated myocarditis with signs of circulatory failure (68%), in contrast to chronic focal myocarditis with impaired circulation and chronic heart failure (84.7%). Metabolic changes on echocardiography were more typical of COVID-19-associated myocarditis (group 1) than indolent focal myocarditis (group 2); however, pathological changes were more common in group 2, indicating more pronounced changes in the myocardium of pregnant women with chronic focal myocarditis.Conclusions: The course of gestation in women with COVID-19-associated myocarditis was characterized by the hypertensive syndrome, increased risk of miscarriage, intrauterine growth restriction, and nonreassuring fetal status, but these complications were less common compared with group 2 with chronic focal myocarditis, in which case operative vaginal delivery is indicated.

Clinical Implications of Premature Rupture of Membranes in Gestational Women in a Tertiary Care Hospital: A Prospective Observational Study

Clinical Implications of Premature Rupture of Membranes in Gestational Women in a Tertiary Care Hospital: A Prospective Observational Study

Prediction of pre-eclampsia using maternal hemodynamic parameters at 12 + 0 to 15 + 6 weeks.

To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor. This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days. Two-dimensional transthoracic echocardiography was performed at 12 + 0 to 15 + 6 weeks to evaluate maternal hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR)). Maternal hemodynamic parameters were expressed as multiples of the median (MoM) values, determined by linear regression models to adjust for gestational age (GA) and MF. The distribution of log10 MoM values of maternal hemodynamic parameters in cases of PE and unaffected pregnancies, and the association between these hemodynamic parameters and GA at delivery, were assessed. The risks of preterm PE (delivery before 37 weeks) and any-onset PE (delivery at any time) were reassessed using Bayes' theorem after maternal hemodynamic parameters were added to the FMF triple test. The screening performance for preterm PE and any-onset PE was determined by the area under the receiver-operating-characteristics curve (AUC) and detection rate at a 10% fixed false-positive rate (FPR). Differences in AUC (ΔAUC) were assessed using DeLong's test. A total of 743 cases were analyzed, of whom 39 (5.2%) subsequently developed PE, including 29 (3.9%) cases of preterm PE and 10 (1.3%) cases of term PE. Mean log10 SVR MoM was significantly higher in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 SV MoM and log10 CO MoM were significantly lower in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 HR MoM was not significantly different between the study groups. Mean log10 CO MoM and log10 SVR MoM were not significantly correlated with GA at delivery in preterm PE and any-onset PE. For the prediction of preterm PE and any-onset PE, adding CO or SVR or replacing MAP with CO and SVR in the FMF triple test achieved an identical or greater AUC compared with the FMF triple test, but ΔAUC was not significantly different. In addition, adding CO or SVR or replacing MAP by CO and SVR in the FMF triple test did not improve the detection rate for preterm PE and any-onset PE at a fixed FPR of 10%. Women with preterm PE or any-onset PE exhibited increased SVR and decreased CO before the clinical manifestations of PE became apparent. These changes may serve as early indicators of cardiovascular maladaptation. However, assessment of maternal hemodynamics at 12 + 0 to 15 + 6 weeks does not enhance the screening performance for preterm PE and any-onset PE of these parameters. The FMF triple test remains superior to other biomarker combinations for predicting PE. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Mechanistic target of rapamycin signaling activity in the human placenta across gestation and in maternal obesity†.

The mechanistic target of rapamycin system is vital to placental development, formation, and function. Alterations in this system in the placenta have been associated with altered fetal growth. However, changes in placental mechanistic target of rapamycin signaling across gestation are poorly understood. We collected 81 human placental samples from 4 to 40weeks gestation to test the hypothesis that placental mechanistic target of rapamycin signaling activity increases over gestation and is activated in maternal obesity in early gestation. Proteins involved in upstream mechanistic target of rapamycin regulation and mTORC1/2 downstream signaling were quantified using immunoblotting in placentas of male or female fetuses. Readouts of mTORC1 activation, phospho-rpS6, and phospho-4EBP1 were highest in first trimester and decreased across gestation. Phosphorylation of AKT (308 and 473) increased over gestation. Interestingly, abundance of cytochrome c oxidase I and mitochondrial ATP synthase, key subunits of mitochondrial complexes III/IV and V, respectively, were elevated in first trimester obese placentas compared to control, but only in placenta from female fetuses. We suggest that the high placental mechanistic target of rapamycin signaling activity in early pregnancy may be related to the high anabolism and active trophoblast proliferation and invasion in the second half of the first trimester. In addition, we conclude that maternal obesity has only limited impact on this key placental signaling pathway across gestation in women.

Prediction of late-onset preeclampsia using plasma proteomics: a longitudinal multi-cohort study

Preeclampsia is a pregnancy disorder with substantial perinatal and maternal morbidity and mortality. Pregnant women at risk of preeclampsia would benefit from early detection for follow-up, timely interventions and delivery. Several attempts have been made to identify protein biomarkers of preeclampsia, but findings vary with demographics, clinical characteristics, and time of sampling. In the current study, we combined three independent longitudinal pregnancy cohorts (Detroit, Stanford and Oslo) resulting in 124 late-onset preeclampsia (LOPE) cases and 178 gestational age matched controls, and analyzed > 1000 proteins in maternal plasma sampled between 12 and 34 weeks of gestation. Differential abundance analysis of combined protein data revealed increased deviation in protein abundance trajectories throughout gestation in women destined to develop LOPE compared to controls. There were no differentially abundant proteins at time interval T1 (12–19 weeks), yet 31 differentially abundant proteins were found at time interval T2 (19–27 weeks), and 48 proteins at time interval T3 (27- 34 weeks). Multi-protein random forest models assessed via cross-validation predicted LOPE with an area under the ROC curve of 0.72 (0.65–0.78), 0.76 (0.71–0.81) and 0.80 (0.75–0.85) at time interval T1, T2 and T3, respectively. The results at T3 were confirmed using a leave-one-cohort-out analysis suggesting cross-cohort consistency, and at T1 and T2 when the largest two cohorts were used as training sets.

Role of routine uterine artery Doppler at 18-22 and 24-28 weeks' gestation following routine first-trimester screening for pre-eclampsia.

To assess the performance of mean uterine artery pulsatility index (UtA-PI) at 18-22 and 24-28 weeks of gestation in the prediction of pre-eclampsia (PE) and small-for-gestational age (SGA), and its role in reassessing the risk of PE and SGA in pregnancies screened for PE in the first trimester. This was a retrospective observational cohort study of 4464 women with singleton pregnancy screened routinely for PE in the first trimester, using the Gaussian algorithm, from March 2019 to May 2021, and who underwent UtA-PI assessment at 18-22 gestational weeks. Women were categorized as low risk or high risk based on the risk index obtained after first-trimester screening for PE. In high-risk patients, UtA-PI was also assessed at 24-28 weeks of gestation. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio and area under the receiver-operating-characteristics curve were calculated to assess the performance of UtA-PI at 18-22 and 24-28 weeks in predicting PE and SGA in the high-risk group. In all participants, different UtA-PI percentiles at 18-22 or 24-28 weeks, or their combination, were analyzed to explore their role in reassessing the risk of PE and SGA following first-trimester PE screening. The performance of UtA-PI at 18-22 and 24-28 weeks in the high-risk group was good for predicting preterm PE and preterm SGA, and excellent for predicting early-onset PE and early-onset SGA, with an NPV of > 97% for all outcomes. In the low-risk group, UtA-PI ≥ 95th percentile at 18-22 weeks' gestation identified a subgroup of pregnancies with a significantly higher risk of preterm SGA compared to the low-risk group. In the high-risk group, UtA-PI < 60th percentile at 18-22 weeks' gestation, UtA-PI < 85th percentile at 24-28 weeks' gestation, and UtA-PI < 85th percentile at 24-28 weeks' gestation in women with UtA-PI ≥ 60th percentile at 18-22 weeks, identified subgroups of pregnancies with a risk of PE and SGA comparable to that of the low-risk group. The performance of UtA-PI at 18-22 and 24-28 gestational weeks in high-risk pregnancies identified during first-trimester screening for PE is similar to that in the general population. The risk of PE and SGA in a high-risk cohort can be reassessed by measuring UtA-PI at 18-22 weeks, 24-28 weeks or both, allowing adjustment of follow-up, particularly de-escalation of care. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Effect of Listening to Murotal Al-Quran on Anxiety of Pregnant Women with Preeclampsi

Preeclampsia is a special condition of pregnancy characterized by hypertension and proteinuria after 20 weeks of gestation in women who had normal blood pressure before pregnancy. Pregnancy with preeclampsia can cause anxiety due to fear and worry felt by pregnant women towards themselves and their babies. This study aims to analyze the effect of listening to murottal Al-Quran on the anxiety of pregnant women with preeclampsia. The research method used was pre-experiment with one group pre-post design to determine the effect of listening to Murottal Al-Quran on the anxiety of pregnant women with preeclampsia. The population in this study were pregnant women in the third trimester who experienced mild and severe preeclampsia at the Muhammadiyah Hospital in Palembang. The sample in this study was pregnant women in the third trimester who experienced mild preeclampsia at the Muhammadiyah Hospital in Palembang as many as 11 people. The instruments used in this study were questionnaires to measure anxiety Stai-Y1 and Stai-Y2, observation sheets and murottal Al-Quran. Results of the study. Conclusion: listening to murottal Al-Quran can reduce the anxiety of pregnant women with mild and severe preeclampsia.

Peculiarities of the course of gestation in women with a history of reproductive loss

Aim. Тo assess the frequency of extragenital pathology, features of obstetric and gynecological history and the course of pregnancy in women with a history of reproductive loss. Materials and methods. The study was conducted on the basis of the Municipal non-profit enterprise “Maternity house No. 9” of the Zaporizhzhia City Council with the involvement of 75 pregnant women with one reproductive loss in history. The control group consisted of 30 women without a history of reproductive loss. Women who had reproductive losses were divided into 2 groups. Group I (main group) includes 38 pregnant women who registered for pregnancy and began their participation in this study after the start of a full-scale war on the territory of Ukraine. II (comparison) group included 37 women who were registered for pregnancy before the start of the full-scale war. It should be noted that 17 pregnant women (44.7 %) had the status of an internally displaced person. The average age of women in group I was 30.10 ± 5.86 years, in group II – 28.80 ± 6.07 years, and 26.50 ± 4.95 years in the control group. The anamnesis data and features of the course of gestation were studied in all patients. Management of pregnancy and childbirth of women was carried out in accordance with the current Orders of the Ministry of Health of Ukraine. Variational and statistical processing of the results was carried out using the Statistica 13 program. Results. According to the results of the study, it was established that the frequency of extragenital pathology in women with one reproductive loss was higher, compared to women who had no such experience. Diseases of the cardiovascular and urinary systems occupy a leading place in this category of women. According to obstetric and gynecological anamnesis, a significant predominance among women of I and II groups of diseases of the reproductive system, compared to women of the control group, was established. Also, in the corresponding groups, a high frequency of miscarriage was established both in the period up to 12 weeks (28.95 % in the I group, 43.2 % in the II group against 6.67 % in the control group), and in the period of 12–22 weeks (34.20 % in the I group, 29.73 % in the II group vs. 13.33 % in the control group). Conclusions. Based on the conducted analysis, a high frequency of pregnancy complications was established for pregnant women who had a history of one reproductive loss. This contingent of women also has a high frequency of extragenital and gynecological concomitant pathology. Such results make it possible to assume a connection between the presence of one reproductive loss in women in the anamnesis and gestational complications of the next pregnancy.

Effect of aspirin on biomarker profile in women at high-risk for preeclampsia

Effect of aspirin on biomarker profile in women at high-risk for preeclampsia

Care of late intrauterine fetal death and stillbirth: Green-top Guideline No. 55.

Care of late intrauterine fetal death and stillbirth: Green-top Guideline No. 55.

Cesarean hysterectomy in pregnancies complicated with placenta previa accreta: a retrospective hospital-based study

BackgroundPlacenta previa accreta (PPA) is a severe obstetric condition that can cause massive postpartum hemorrhage and transfusion. Cesarean hysterectomy is necessary in some severe cases of PPA to stop the life-threatening bleeding, but cesarean hysterectomy can be associated with significant surgical blood loss and major complications. The current study is conducted to investigate the potential risk factors of excessive blood loss during cesarean hysterectomy in women with PPA.MethodsThis is a retrospective study including singleton pregnancies after 28 weeks of gestation in women with placenta previa and pathologically confirmed placenta accreta spectrum who received hysterectomy during cesarean sections. A total of 199 women from January 2012 to August 2023 were included in this study and were divided into Group 1 (estimated surgical blood loss (EBL) ≤ 3500 mL, n = 103) and Group 2 (EBL > 3500 mL, n = 96). The primary outcome was defined as an EBL over 3500 mL. Baseline characteristics and surgical outcomes were compared between the two groups. A multivariate logistic regression model was applied to find potential risk factors of the primary outcome.ResultsMassive surgical blood loss was prevalent in our study group, with a median EBL of 3500 mL. The multivariate logistic analysis showed that emergency surgery (OR 2.18, 95% CI 1.08–4.41, p = 0.029), cervical invasion of the placenta (OR 2.70, 95% CI 1.43–5.10, p = 0.002), and intraoperative bladder injury (OR 5.18, 95% CI 2.02–13.28, p = 0.001) were all associated with the primary outcome. Bilateral internal iliac arteries balloon occlusion (OR 0.57, 95% CI 0.34–0.97) and abdominal aortic balloon occlusion (OR 0.33, 95% CI 0.19–0.56) were negatively associated with the primary outcome.ConclusionsEmergency surgery, cervical invasion of the placenta, and intraoperative bladder injury were potential risk factors for additional EBL during cesarean hysterectomy in women with PPA. Future prospective studies are needed to confirm the effect of intra-arterial balloon occlusion in cesarean hysterectomy of PPA.

Laminiria Tents versus Vaginal Prostaglandin in Cervical Ripening in Term Induction of Labor with Unfavorable Cervix: A Randomized Controlled Trial

Abstract Background Mechanical methods used for induction of labor received a great attention nowadays due to the serious side effects of the pharmacological methods. Hygroscopic dilators are considered important subtype of these mechanical methods. One of them is Laminaria which is a synthetic type of sea algae that induces cervical dilation by absorbing water from the cervix and gradually increasing in thickness. Objective To compare the effectiveness and safety of Laminiria tents to intravaginal prostaglandins for cervical ripening in induction of labor at term gestation in women with unfavorable cervix. Methods A total of 90 pregnant women at term gestation with unfavorable cervix admitted to the labor ward for induction of labor at Ain Shams University Maternity Hospital, in the period from March 2022 to March 2023, were enrolled in the study and underwent assessment using Bishop score with monitoring differences between two groups in mode of delivery, time to enter active phase, time to delivery, changes in bishop score and noted complications. This study was registered on clinicaltrials.gov with number (NCT06151925) Results In the present study we demonstrated that in laminaria group, there was 66.7% had NVD and 33.3% had CS while in prostaglandin group, there was 71.1% had NVD and 28.9% had CS in which there was no statistically significant difference between laminaria and prostaglandin groups regarding routes of delivery. In this study we demonstrated that Time needed to enter active phase (hours) in laminaria group was 16 (10 – 19) while in prostaglandin group was12 (8 – 16) in which there was a statistically significant difference between laminaria and prostaglandin groups regarding Time needed to enter active phase (hours) (p = 0.022). In this study we demonstrated that regarding induction delivery time (hours) in laminaria group was 20 (13 – 25) while in prostaglandin group was 16 (11 – 20) in which there was a statistically significant difference between laminaria and prostaglandin groups regarding induction delivery time (hours) (P = 0.036). Conclusion Vaginal prostaglandin is more effective than laminaria tent for ripening of cervix before induction and can decrease labor duration and time to delivery. However, for better results further studies with a larger sample size are recommended.

Evidence that systemic vascular resistance is increased before the development of gestational diabetes mellitus

Evidence that systemic vascular resistance is increased before the development of gestational diabetes mellitus

Can short- and long-term maternal and infant risks linked to hypertension and diabetes during pregnancy be reduced by therapy?

Hypertensive disorders of pregnancy (HDP), especially preeclampsia, and diabetes during pregnancy pose significant risks for both maternal and infant health, extending to long-term outcomes such as early-onset cardiovascular disease and metabolic disorders. Current strategies for managing HDP focus on screening, prevention, surveillance, and timely intervention. No disease-modifying therapies exist so far for established preeclampsia; delivery remains the definitive resolution. Preventive measures-including early pregnancy screening, exercise, and low-dose aspirin-show promise. Antihypertensive treatments reduce severe hypertension risks, whereas magnesium sulfate remains the standard for preventing eclampsia. Planned delivery from gestational week 37 can balance maternal benefits and neonatal risks in women with established preeclampsia. Delivery between 34 and 37 weeks gestation in women with preeclampsia has to balance risks for mother and infant. Lifestyle interventions-particularly diet and physical activity-are pivotal in managing gestational diabetes mellitus and type 2 diabetes. The oral antidiabetic metformin has shown benefits in glycaemic control and reducing maternal weight gain, although its long-term effects on offspring remain uncertain. The safety of other peroral antidiabetics in pregnancy is less studied. Advancements in glucose monitoring and insulin administration present encouraging prospects for enhancing outcomes in women with diabetes types 1 and 2. Both HDP and diabetes during pregnancy necessitate vigilant management through a combination of lifestyle modifications, pharmacological interventions, and timely obstetric care. Although certain treatments such as low-dose aspirin and metformin show efficacy in risk reduction, further research is ongoing to ensure safety for both mothers and their offspring to reduce short- and long-term adverse effects.

Uterine Artery Doppler in the Second Trimester as a Predictor of Preeclampsia in High Risk Pregnancy

Abstract Background Preeclampsia is a multisystem disorder of pregnancy which is a major cause of maternal and fetal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive. Aim of the Work The aim of the work was to evaluate the role of uterine artery Doppler in the second trimester as a predictor of preeclampsia in high risk pregnancy. Patients and Methods We included 80 pregnant females in the second trimester at high risk pregnancy in our study, uterine artery Doppler ultrasound was done in the second trimester and the patients were followed up in the third trimester for blood pressure measurement and diagnosis of PE. Results Our results revealed correlation between high indices of uterine arteries and development of PE. Conclusion Our study revealed that we can use uterine artery Doppler as a reliable method to predict preeclampsia.

COVID-19 vaccination before or during pregnancy results in high, sustained maternal neutralizing activity to SARS-CoV-2 wild-type and Delta/Omicron variants of concern, particularly following a booster dose or infection

COVID-19 vaccination before or during pregnancy results in high, sustained maternal neutralizing activity to SARS-CoV-2 wild-type and Delta/Omicron variants of concern, particularly following a booster dose or infection

The use of late preterm antenatal corticosteroids in women with gestational diabetes : a puzzle worth solving

BackgroundTo investigate the association between late preterm antenatal corticosteroid treatment and outcome in late preterm neonates born to mothers with gestational diabetes mellitus,MethodsAll patients with gestational diabetes mellitus who had a late preterm delivery at Etlik Lady Zübeyde Hospital between 2017 and 2021 were included. Women who met the inclusion criteria and were not given antenatal corticosteroid treatment during current pregnancy before 34 0/7 weeks of gestation were divided into two groups according to whether or not they received late preterm antenatal corticosteroid treatment. The two groups were compared in terms of adverse neonatal complications. The main outcomes were composite respiratory outcome and composite neonatal outcome. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome.ResultsThis retrospective cohort study included a total of 400 participants with gestational diabetes mellitus who had a late preterm delivery within the study period. Of these women, 196 (49%) received late preterm antenatal corticosteroid treatment. Main outcomes showed no difference. Decreasing gestational age at birth was identified as an independent risk factor predicting both composite respiratory outcome and composite neonatal outcome in multivariate logistic regression analysis.ConclusionsAntenatal corticosteroid treatment at or after 34 0/7 weeks of gestation in women with gestational diabetes mellitus who had a late preterm delivery was not associated with improvement in adverse neonatal outcomes. Decreasing gestational age at birth was the only independent risk factor predicting composite neonatal and composite respiratory outcomes.

Association of ACE*(Insertion/Deletion) Variant with the Elevated Risk of Preeclampsia Among Gestational Women.

The renin-angiotensin-aldosterone system has an indispensable function in the uteroplacental circulation, placental growth, and blood pressure optimization. The angiotensin I converting enzyme (ACE) gene is a critical integrator for electrolyte balance, and water retention, along with inhibiting preeclampsia. The main goal of this pertaining study is to assess the contribution of ACE*(Ins/Del) variant with the susceptibility for preeclampsia with focus on the severity of the disease among gestational hypertensive women. This retrospective study included 225 participants [125 PE gestational women, and 100 normotensive healthy controls] matching with age, and geographical region. PE women classified into 82 early-onset PE women, accompanied with 43 late-onset PE women. Additionally, PE women categorized into 59 mild PE women, together with 66 severe PE women. The genotyping and characterization of ACE*(Ins/Del) variant were applied using the PCR technique. Our findings indicated higher frequency of the ACE*(Del/Del) genotype and ACE*(D allele) with elevated risk of preeclampsia compared to normotensive controls under recessive (OR = 2.09, and p-value = 0.007), and allelic (OR = 1.75, and p-value = 0.012) models. In addition, testing logistic regression revealed that the levels of endothelin-1 and malondialdehyde exposed significant difference for the ACE*(Del/Del) genotype among early-onset and late-onset PE women (p-value = 0.024, and 0.23, respectively). Furthermore, carriers of the ACE*(Del/Del) genotype observed statistically significant with lower sodium concentrations among severe PE women (p-value = 0.034). The ACE*(Del/Del) genotype and ACE*(D allele) were associated with increased risk preeclampsia among gestational women. Furthermore, early-onset PE and late-onset PE were correlated with endothelin-1 and malondialdehyde concentrations among Egyptian women.

Динамическое исследование маркеров преэклампсии во второй половине гестации у пациенток из групп высокого риска

Objective. To determine the blood levels and correlation of pre-eclampsia (PE) markers (sFlt-1, PlGF) at 20–22 and 30–32 weeks’ gestation in women who are at high risk for developing adverse obstetrical outcomes and to study the patterns between them and clinical characteristics of pregnancy. Patients and methods. This longitudinal prospective cohort study included 113 pregnant women who were examined and gave birth between 2020 and 2022. All patients were divided into several groups: group I (n = 34) – pre-gestational diabetes mellitus (DM); group II (n = 21) – chronic arterial hypertension (CAH); group III (n = 25) – obesity; group IV (n = 8) – women aged ≥40 years after the use of assisted reproductive technologies (ART); group V (n = 25) – control group. The levels of sFlt‑1, PlGF and their ratio at 20–22 and 30–32 weeks’ gestation were determined, considering the presence of PE and/or fetal growth restriction (IUGR). The correlation between their levels and the development of PE and IUGR, as well as the risk of PE, was evaluated according to the combined first-trimester screening. Results. The sFlt-1/PlGF ratio was higher in groups I, II and IV at 20–22 and 30–32 weeks’ gestation. The highest value of sFlt‑1/PlGF ratio was observed in patients with gestational arterial hypertension (GAH) and PE, especially with its severe form. In all patients who had moderate PE, the sFlt-1/PlGF ratio was above 38, and in severe PE it was above 85. There was a direct correlation between the sFlt-1/PlGF ratio and the risk of developing PE (0.585; 0.526), an inverse correlation with the PE risk quartile (-0.606; -0.579) and time to PE manifestation in the groups of patients with DM (-0.277; -0.164) and CAH (-0.383; -0.581), and a direct correlation with uterine artery pulsatility index (UtA-PI) at the time of the study (0.459; 0.588). Conclusion. This study emphasizes the importance of dynamic monitoring of PE markers in the blood of high-risk pregnant women for timely initiation of necessary clinical interventions.

Factors Associated with Spontaneous Preterm Birth after Ultrasound-Indicated Cerclage.

Ultrasound-indicated cerclage (UIC) is recommended to prevent spontaneous preterm birth (sPTB) in women with a short cervix at mid-trimester and a history of PTB. We assessed the factors related to sPTB after UIC and determined the corresponding risks. This retrospective cohort study was conducted at a university hospital. UIC was performed between 15 and 26 weeks of gestation in women with a cervical length of <2.5 cm. Univariate and multivariate analyses were used to examine factors associated with sPTB after UIC. An earlier gestational age and shorter cervical length at UIC were associated with sPTB after UIC. While PTB history was not associated with an increased risk of sPTB, it did increase the risk of repeat cerclage after UIC. Higher levels of preoperative serum inflammatory markers and obesity significantly increased the risk of sPTB after UIC. These findings provide helpful guidance for patient counseling and management in predicting the delivery timing after UIC in women with a short cervix in the mid-trimester.