Gestational Arterial Hypertension Research Articles

Obesity Increases Maternal Complications in Pregnant Women of Sinop: A Retrospective Cohort Study

Obesity is a chronic metabolic disease that can promote serious comorbidities as maternal complications. Thus, the objective of this study was to analyze the prevalence of overweight and obesity, and the incidence of maternal complications in pregnant women of Sinop, Mato Grosso, Brazil. It was a retrospective cohort study with clinical and epidemiological data collected from the medical records of pregnant women diagnosed in 2020. Pregnant women were subdivided into three groups: eutrophic, overweight, and obese. Data from 700 pregnant women were evaluated, 251 in the eutrophic group, in the 220 overweight group and 229 in the obese group. The percentage of pregnant women with diabetes mellitus and arterial hypertension was significantly higher in the overweight and obesity groups when compared with the eutrophic group. The incidence of gestational diabetes mellitus was significantly higher in the overweight and obese groups when compared with the eutrophic group (p < 0.0001). The incidence of gestational arterial hypertension was also significantly higher in the overweight (6.8%) and obese (12.7%) groups when compared with the eutrophic group (1.2%) (p < 0.0001). The incidence of pre-eclampsia was also higher and statistically different in the overweight and obese groups. In conclusion, it was observed that most of the pregnant women presented with overweight/obesity and that this excess body weight contributed significantly to the incidence of several maternal complications.

Concentrations of heat shock protein 70 (hsp70) in pregnant women with gestational arterial hypertension

Concentrations of heat shock protein 70 (hsp70) in pregnant women with gestational arterial hypertension

ПРЕДИКТОРЫ НЕБЛАГОПРИЯТНЫХ СОБЫТИЙ У БЕРЕМЕННЫХ С ДЕФИЦИТОМ МАССЫ ТЕЛА

It is known that underweight is associated with an increased risk of pregnancy complications on the part of the mother. The purpose of the study is to identify predictors of adverse events during pregnancy in underweight women. Material and methods. 82 pregnant women with body weight deficiency were examined. The control group consisted of 35 pregnant women with normal body weight. All patients included in the study underwent conventional clinical, instrumental and laboratory examinations, including the collection of anamnestic data, physical examinations, a set of laboratory studies, transthoracic echocardiography, Holter monitoring of the electrocardiogram. Results. Maternal risk predictors of pregnancy complications and their threshold values were identified: BMI >18.135 kg/m2, triglycerides >1.765 mmol/l, LDL >2.79 mmol/l, leptin <8.8 ng/ml, potassium <4.15 mmol/l, rhythm disturbances (extrasystole) >400 per day. Conclusions. Pregnancy against the background of underweight is characterized by such complications as threatened miscarriage, toxicosis, HFPN, abnormal amount of amniotic fluid (polyhydramnios, oligohydramnios), preeclampsia, gestational arterial hypertension, placental abruption, placental hypertrophy. A prognostic model has been developed to assess the risk of maternal complications during pregnancy in underweight pregnant women.

THE INFLUENCE OF EXCESSIVE WEIGHT GAIN ON DISTURBANCE OF THE UTERINE-PLACENTAL BLOOD FLOW IN PREGNANT WOMAN WITH ARTERIAL HYPERTENSION

Objective: To evaluate the development of violations of uterine-placental blood flow depending on weight gain during pregnancy in women with arterial hypertension. Design and method: A prospective cohort examination of 110 pregnant women with arterial hypertension (including chronic and gestational arterial hypertension) and 80 women of the control group (practically healthy women without increasing blood pressure) was conducted. The study was conducted on the basis of perinatal centers of Astana (Kazakhstan) in 2018-2019. The weight gain for the period of pregnancy in women with hypertension and control groups was studied. The body mass index (BMI) was calculated and weight gain for the period of pregnancy in the studied groups. Results: One of the main causes of the development of complications during pregnancy by the fetus is a violation of uterine-placental blood circulation (UPC), which depends not only on blood pressure levels. Disorders of the UPC were detected in pregnant women with hypertension and control groups of 20% and 2.5%, respectively (p = 0.0003). In pregnant women with hypertension, the odds ratio of chances of the development of UPC disorders increased by 4.4 times compared to the pregnant woman of the control group. Excessive increase in body weight during pregnancy in pregnant women with hypertension was detected in 16% and in the control group 5% (p = 0.018). The relative probability of developing a violation of the UPC with an excessive increase in the weight of a pregnant woman with hypertension soared by 50%. In the control group of pregnant women with a normal pressure level, excess weight gain was detected in 6.3% and there were no violations of the UPC. Conclusions: According to the results of the study, in pregnant women with hypertension, violations of the UPC were significantly more common compared to the control group. The odds ratio of the chances of developing uterine-placental blood flow surges by 4.4 times in pregnant women with hypertension compared to pregnant women with a normal level of pressure. Excessive weight gain in pregnant women with hypertension increases the development of impaired UPC.

Complications and outcomes of pregnancy in patients with antiphospholipid antibodies during various treatment methods

Introduction. Antiphospholipid antibodies (APAs) exert multifaceted effects on the course of pregnancy by disrupting microcirculation, affecting the hemostasis, as well as damaging the endothelial membranes, leading to early reproductive loss and development of placenta-associated complications depending on the affected gestation stage. Planning and management of pregnancy in women in the absence of criteria for complete antiphospholipid syndrome (APS) currently remains unresolved issue. The absence of generally accepted treatment standards for this category of patients and inability to substantiate the diagnosis according to the APS classification criteria complicate selection of therapeutic tactics.Aim: to conduct a comparative analysis of therapy-based complications and outcomes of pregnancy in APA carriers.Materials and Methods. During the period 2019–2021 a prospective study of 150 patients who entered pregnancy with aggravated obstetric and gynecological history, serum APA level was examined. Considering the risks of developing obstetric and thrombotic complications, all patients were prescribed prophylactic doses of low molecular weight heparins (LMWHs) and low doses of acetylsalicylic acid (ASA). The patients were divided into 3 groups using a random number generator. Group 1 (n = 50), in addition to the prescribed LMWH (enoxaparin sodium 40 mg 1 time per day) and ASA (150 mg 1 time per day), also underwent plasmapheresis (PF) 4 sessions per 1 course in 6–8, 12–14 and 22–24 weeks of pregnancy; group 2 (n = 50) received courses of intravenous immunoglobulins (IVIG) at a course dose of 300 ml (15 g) simultaneously; group 3 (n = 50) received no additional therapies. Rate of pregnancy complications was comparatively assessed – development of fetal growth retardation (FGR), low birth weight fetus, gestational arterial hypertension (AH), moderate and severe preeclampsia (PE), anemia and delivery outcomes.Results. It was found that in group 3 there was a higher incidence of gestational hypertension (p2,3 < 0.0001), moderate PE (p 1,3 =0.071; p 2,3 = 0.0019), low weight fetus for gestational age (p2,3 = 0.0002) and FGR (p2,3 = 0.003). In group 1, compared with group 2, there were more often observed small weight for gestational age fetus (p1,2 = 0.018) and FGR (p1,2 = 0.024), gestational hypertension (p1,2 = 0.0008), anemia (p1,2 < 0.0001) and latent iron deficiency (p1,2 < 0.0001). Also, groups 2 and 3 vs. group 1 were more likely to have intrahepatic cholestasis during pregnancy (p1,2 = 0.013; p1,3 = 0.003).Conclusion. In the group of patients receiving complex therapy consisting of LMWHs prophylactic doses, low ASA doses and IVIG courses, the risks of developing placenta-associated complications and iron deficiency were reduced compared to other groups indicating about a higher efficiency of this therapy regimen. However, the development of intrahepatic cholestasis during pregnancy was less common in the group of patients receiving PF courses, in contrast to using IVIG courses, which can be accounted for by additional effect of efferent therapeutic methods and should be taken into account in a differentiated approach for management of patients with liver and gallbladder pathology.

Определение риска осложнений беременности и родов у женщин с исходно нормальной массой тела в зависимости от прибавки массы в процессе гестационного периода

Aim. To study the results of the course and outcomes of pregnancy in women depending on weight gain and to determine the risk of complications of the gestational period. Using the continuous sampling method, we conducted a retrospective study of the outcomes of pregnancy and childbirth in 1080 women with initially normal body weight. The initial body mass index in pregnant women of the survey group was in the parameters of 18.5–24.9. Depending on the recommended (11.5–16.0 kg) weight gain, pregnant women were divided by us into 3 subgroups: MG; GS1; GS2. The MG (363 people) included pregnant women whose total body weight gain during the entire pregnancy corresponded to the recommended weight gain parameters (11.5–16.0 kg). GS1 (543 people) included pregnant women whose total body weight gain was below the reference values (11.5 kg). GS2 (174 people) included women whose weight gain during pregnancy exceeded the reference values (16.0 kg).was carried out using the polymerase chain reaction method (Kvant-21 test). Results. With an excess of the recommended weight gain in women, parameters in which the relative risk index was more than 2 were found to be 3.5 times more than in women with a deficiency in body weight gain. These include iron deficiency anemia (8.57); gestational arterial hypertension (2.59); pregnancy-induced edema (3.2); pathology of the urinary system of inflammatory origin (3.4); ZRP (2.63); the birth of infants with a body weight of 2000 to 2499 g (2.76) and a body weight of 4500–4999g (2.77). Conclusion. Our results suggest that excess weight gain during pregnancy, even against the background of normal initial body weight, is a risk factor that has a negative impact on the condition of women and infants, to a greater extent than lack of weight gain. However, it should be noted that at present there is a certain trend towards an increase in the number of pregnant women with a lack of weight gain, which also carries certain risks for their health, although to a lesser extent than excess weight gain.

Ранняя и поздняя формы задержки роста плода. Факторы риска и осложнения раннего неонатального периода

Objective. To study clinical and anamnestic risk factors for the development of complications during the early neonatal period in early- and late-onset fetal growth restriction (FGR). Patients and methods. This study included 92 patients: 40 with early-onset FGR and 52 with late-onset FGR. The age aspect, medical records, pregnancy and delivery characteristics, complications in the early neonatal period were examined in all patients. Results. Most patients with FGR had complicated somatic and obstetric/gynecological histories. Patients with early-onset FGR were more likely to have chronic arterial hypertension, spontaneous abortion, missed miscarriage, and uterine surgeries. In the first and second trimesters of pregnancy, only patients with early-onset FGR had elevated blood pressure. In the third trimester, patients with early-onset FGR were significantly more likely to develop pre-eclampsia and its complications than patients with late-onset FGR. Patients with early-onset FGR delivered earlier than patients with late-onset FGR, which affected the early neonatal period. Conclusion. The presence of hypertensive complications starting early in pregnancy and the results of biochemical screening tests should be considered as part of the prediction of FGR. Timely diagnosis, treatment and prevention of gestational complications will improve maternal and perinatal outcomes. Key words: gestational arterial hypertension, fetal growth restriction, late-onset fetal growth restriction, pre-eclampsia, earlyonset fetal growth restriction, chronic arterial hypertension

The effect of gestataional hypertension on the ultrastructural structure of the placenta

The objective: to study pathological changes and compensatory-adaptive reactions in the structural and ultrastructural components of the placental barrier in pregnant women with gestational arterial hypertension, who received magnesium preparations. Materials and methods. 100 patients with gestational hypertension were examined. The presence of magnesium deficiency in these women was determined by the results of our questionnaires.Pathomorphological and electronic microscopic examination of 32 placentas of patients with gestational hypertension was carried out. 12 placentas of them were from pregnant women who received the proposed management of pregnancy, which included magnesium drugs (I group), and 11 placentas – from patients with risk of preeclampsia, who were observed with the use of standard approaches of pregnancy for women with the risk of preeclampsia (II group). Control group included the results of pathomorphological and electronic microscopic study of 9 placentas from healthy women.Results. Placental of women with gestational hypertension have structural features, which is manifested by the mosaic change of placental barrier in the form of uneven circulatory disorders with hemorrhages and stasis (at the ultrastructural level) in the fetal microvessels of the villi, reducing the placental functional area (rapprochement of the villi), presence of stromal sclerosis villi, foci of pathological immaturity, increase in calcium salts (mineral dystrophy) on the background of compensatory reactions. Electronic microscopic study of the placentas in the I group revealed an increase in the compensatory-adaptive reactions of the placenta – thinning of the placental barrier, activation of cytotrophoblast cells in the placental barrier, increase the number of syncytiocapillary membranes in terminal villi with syncytiotrophoblast organic activation, increase in the number of ribosomes, the appearance of orthodox configuration of mitochondria, increasing the number of capillary membranes and thinning of syncytia, reducing the number of sludge phenomena in microvessels, which leads to an increase in the possibility of nutrient transfer from mother to fetus, etc.Conclusions. The use of the proposed therapy, which involves magnesium, diosmin and others substances, leads to a significant decrease in the frequency of detection of pathological changes in structural and ultrastructural components of the placental barrier and increased compensatory-adaptive reactions which can be considered the result of the positive impact of the proposed therapy on the placental ultrastructural elements in women with risk of preeclampsia.

Сосудистая ретинальная патология: влияние гестационной артериальной гипертензии и преэклампсии на ее формирование

Purpose. To assess the effect of gestational arterial hypertension (AH) and preeclampsia on the possible development of vascular retinal pathology in the separated postpartum period. Material and methods. 231 women with different types of pregnancy. 1st main group – pregnant women with gestational hypertension. 2nd main group – pregnant women with preeclampsia. 1st comparison group: pregnancy with chronic hypertension without proteinuria. 2nd comparison group: edema and / or proteinuria during pregnancy, but without hypertension. Control group – physiological pregnancy. The term of an ophthalmological examination after pregnancy is 6–12 years. Results. Over the past time period after childbirth, 67 women in the total population were found to have systemic vascular pathology (29 %). The formation of vascular retinal pathology for the period after childbirth occurred in 50 women in the general population (21.6 %). Conclusion. The incidence of vascular retinal pathology in the late postpartum period (up to 12 years) was statistically significantly higher in the groups with preeclampsia (48 %) and gestational hypertension (40 %) in comparison with the physiological course of pregnancy, as well as in pregnancy accompanied by edema without AH and with the presence of AH before pregnancy (4, 6 and 8 %, respectively, p < 0.01). Keywords: systemic vascular pathology, retinal vascular pathology, hypertensive disorders during pregnancy, endothelial dysfunction.

Pheochromocytoma and pregnancy

A clinical case of a pregnant patient with gestational arterial hypertension resulting from pheochromocytoma is presented. Th e article presents an algorithm for diff erential search for the cause of gestational arterial hypertension, clinical and laboratory data and therapeutic measures provided to the patient, on the basis of which endocrinologists together with obstetricians and gynecologists can determine the tactics of pregnancy and delivery of women with hormone-active adrenal tumors.

Technology for early differential diagnosis of hypertensive disorders during pregnancy

BACKGROUND: To date, no test provides sufficient sensitivity and specificity for the early diagnosis of severe preeclampsia. Meanwhile, severe preeclampsia is a condition that threatens the life of not only the mother, but also the fetus, and requires a solution to the issue of delivery. Therefore, the search for markers of severe preeclampsia is still relevant today.
 AIM: The aim of this study was to create a technology that allows for early differential diagnosis of hypertensive disorders during pregnancy based on a comprehensive analysis of echocardiographic data.
 MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 112 cases of labor was carried out. The total sample was divided into five study groups: 30 relatively healthy women (group 1); 25 patients with chronic arterial hypertension (group 2); 21 patients with gestational arterial hypertension (group 3); 13 patients with moderate preeclampsia (group 4); and 23 patients with severe preeclampsia (group 5). The groups were formed in accordance with current clinical guidelines. Echocardiographic examination in all cases was carried out upon admission to the hospital. Statistical processing of the results was performed using the IBM SPSS Statistics Version 25.0 program.
 RESULTS: The technology for early differential diagnosis of hypertensive disorders during pregnancy is implemented based on a multilayer perceptron, the percentage of incorrect predictions being 20.5 %. The structure of the trained neural network included six input neurons: gestational age, left atrium size in the parasternal position, right ventricular size, interventricular septal thickness, systolic blood flow velocity, and pressure gradient in the pulmonary artery.
 CONCLUSIONS: Comprehensive analysis of echocardiographic data allows for early differential diagnosis of hypertensive disorders during pregnancy, while considering the result of neural network analysis as an additional criterion for severe preeclampsia. In the future, the use of this technology in clinical practice will not only optimize the tactics of managing patients with hypertensive disorders at admission to the hospital, but also reduce the incidence of adverse obstetric and perinatal outcomes.

Cerebral neurotrophic factor as a predictor of the severity of hypertensive complications in pregnancy

Introduction. We studied the quantitative content of brain-derived neurotrophic factor (BDNF) in the serum of pregnant women with hypertensive disorders at 22 to 42 weeks' gestation. A correlation was found between brain plasma neurotrophic factor and the severity of preeclampsia and its complications, such as HELLP syndrome, placental detachment. The increase in BDNF reflects an increase in compensatory restorative functions of the nervous system. Increased brain neurotrophin reserve in severe complications of hypertensive disorders requires further study of the pathogenesis from the standpoint of neuroplasticity, which in turn will improve timely diagnosis and prevention. Purpose of the study — determination of quantitative serum brain-derived neurotrophic factor as a possible predictor of the severity of preeclampsia and its complications. Materials and methods. The study was conducted on the basis of the M.A. Tver'e Maternity Hospital, Perm. Eighty-eight pregnant women at 22 to 42 weeks' gestation were examined, 77 of them with hypertensive disorders as chronic arterial hypertension, gestational arterial hypertension, preeclampsia, and HELLP syndrome. The comparison group consisted of 11 healthy pregnant women. The control group included 11 non-pregnant healthy women. Results. The presence of hypertensive complications in pregnancy and their correlation with the quantitative content of serum BDNF was studied. Discussion. Brain-derived neurotrophic factor determined in peripheral blood serum is one of the laboratory indicators that allow to predict the likely manifestations of preeclampsia and HELLP syndrome and reliably determine the severity of these complications. Conclusion. In severe complications of hypertensive disorders a reliable increase of BDNF in blood serum was revealed, which in turn is a diagnostic marker of these conditions.

The hemostatic parameters in pregnant women with different types of diabetes mellitus

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough.AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age.MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed.RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications.CONCLUSIONS: Diabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

Periodontal Condition in High-Risk Pregnant Women

Introduction: Oral health is related to the systemic health of the pregnant woman and the fetus, highlighting the importance of the oral health approach as a gestational health problem. Objective: To verify the prevalence of periodontal pocket and to analyze the relationship of the condition with sociodemographic factors, medical history, and behavioral profile in high-risk pregnant women. Methods: This cross-sectional, observational and analytical study comprised 800 high-risk pregnant women. Interviews were performed using a structured questionnaire to obtain data on sociodemographic characteristics, medical history and behavioral factors and the periodontal examination was carried out using the Community Periodontal Index (CPI). Statistical analyzes were performed to estimate odds ratio (OR) and 95% confidence interval (CI) between periodontal pocket and variables age group, living area, skin color, housing, marital status, schooling, family income, gestational period, number of children, arterial hypertension, gestational arterial hypertension, diabetes mellitus, gestational diabetes mellitus, smoking habit and alcoholism. Results: Of the total of 800 pregnant women examined, it was observed that 216 (27%) showed periodontal pocket. The condition was associated with age group (35-45 years: OR=2.498; CI=1.297-4.813; p-value=0.006), schooling (≤7 years: OR=1.638; CI=1.017-2.638; p-value=0.042), family income (≤USD$ 400.00: OR=1.431; CI=1.004-2.041; p-value= 0.048), diabetes (OR= 2.508; CI=1.511-4.163; p-value=0.000) and smoking habit (OR=2.211; CI=1.460-3.348; p-value=0.000). Conclusions: The prevalence of periodontal pocket was high and the factors age, low schooling, low family income, diabetes and smoking habit are related to greater chances of occurrence in high-risk pregnant women.

DENTAL CARIES STATUS IN HIGH-RISK PREGNANT WOMEN: SYSTEMIC CONDITIONS AND SOCIODEMOGRAPHIC FACTORS

The aim of this research was to investigate the oral health condition of high-risk pregnant women. This was a cross-sectional study carried out in the specialised medical service for high-risk pregnant women from 2016 to 2018. Oral health data were collected in 1500 high-risk pregnant women using a methodology recommended by the World Health Organisation to perform the clinical examination. High-risk pregnant women scheduled for prenatal consultations were included in the present study. The exclusion criteria were refusal by the pregnant woman to participate in the study or inability to perform the oral examination due to excessive nausea or vomiting of the patient. The following variables were analysed: age, income, educational level, arterial hypertension, gestational arterial hypertension, diabetes mellitus, gestational diabetes mellitus, obesity and smoking. Association tests, chi-square, were made at significance level of 5%. After, univariate and multivariate logistic regression analyzes were performed to estimate odds ratio and confidence interval. The Decayed teeth was associated with following variables: income (p=0.00); educational level (p=0.00) arterial hypertension (p=0.01), smoking (p=0.00) and obesity (p=0.00). It was concluded that dental caries have a high prevalence in high-risk pregnant women and are associated with income, educational level, arterial hypertension, smoking and obesity.

Особенности состояния коагуляционного и сосудисто-тромбоцитарного звена гемостаза у беременных с различными типами сахарного диабета

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough. AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age. MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed. RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications. CONCLUSIONS: D iabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

The role of dyslipidemia in the pathogenesis of perinatal complications in pregnant women with diabetes mellitus

Hypothesis/Aims of study: The prevalence of diabetes mellitus in pregnant women is increasing. Physiological hyperlipidemia is usually developed during the last third of gestation, increases during pregnancies complicated by diabetes mellitus. Abnormal lipid profiles are associated with adverse perinatal outcomes. However, the associations between maternal dyslipidemia and pregnancy complications in women with different diabetes mellitus types remain unclear. The aim of this study was to assess the lipid profile in women with different types of diabetes mellitus (Type 1, Type 2, and gestational diabetes) based on the therapy in the third trimester of pregnancy, to investigate the associations between serum lipid profile and perinatal complications, and to determine possible prognostic value of lipids in the development of adverse pregnancy outcomes.
 Study design, materials and methods: The study included 277 women who were divided into several groups depending on the type of diabetes mellitus and its therapy method, a group of patients with preeclampsia, and the control group. We analyzed the clinical and laboratory data of outpatient and inpatient cards of pregnant women in the period between 2010 and 2017. Maternal blood samples were collected between 28 and 32 weeks of gestation. The samples were assayed for fasting triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol concentrations, as well as the atherogenic index of plasma. We also assessed the incidence of gestational arterial hypertension, preeclampsia, intrauterine growth restriction, and preterm birth.
 Results: Pregnant women with various types of diabetes mellitus were characterized by a significant rise in serum triglycerides and very-low-density lipoprotein cholesterol levels, an increase in the atherogenic index of plasma, and a significant decrease in antiatherogenic, high-density lipoprotein cholesterol levels. These changes were most pronounced in pregnant women with pregestational diabetes mellitus types and in groups receiving insulin therapy. Correlation analysis revealed weak positive correlations between serum triglycerides concentrations and macrosomia (r = 0.26) and between the atherogenic index of plasma and severe preeclampsia (r = 0.26). The analysis of the ROC curve showed that triglycerides, very-low-density lipoprotein cholesterol, and the atherogenic index of plasma are predictors of severe preeclampsia.
 Conclusion: Diabetic pregnancies are associated with increased dyslipidemia, which plays an essential role in the pathogenesis of perinatal complications. Evaluating lipid profile markers in the third trimester of diabetic pregnancy may be valid predictors of severe preeclampsia.

Kidney ultrasound biometric data dynamics in women with gestational hypertension

Introduction: The stable level of morbidity in the Russian Federation of pregnant women with gestational arterial hypertension (GAH) and as a consequence of the disability of women of working age and their offspring actualizes the search for early ultrasound markers of kidney damage as a target organ urgent. Objectives: Despite the variety of publications on ultrasound semiotics of the kidneys, there are no specific biometric parameters of the kidneys in pregnant women without somatic pathology, which actualizes this study. Patients and Methods: A comprehensive clinical examination of 183 outpatients and inpatients (mean age 27.9 ± 4.7 years) with gestational hypertension performed. Results: There is a significant increase in the volume of the right kidney, the left kidney shape index, the diameter of the renal calyces and pelvis, the coefficient of asymmetry, the ratio of the diameter of the renal calyces to the volume of the right kidney with an increase in the degree of gestational hypertension. Conclusion: Structural changes of kidneys are interconnected with hemodynamic parameters observed and can be expressed by mathematical model.

Uterus didelphys and successful pregnancy: case reports

Objective: To report a clinical cases of uterus didelphys and successful pregnancy. Case details: Case 1: patient with high-risk pregnancy due to Hypothyroidism, overweight and the presence of uterus didelphys. In the past history: anemia, the patient reported menstrual irregularity. The pregnancy went according to the proper procedures, however, a significant increase in weight was observed, as a consequence, gestational arterial hypertension was detected. Cesarean delivery occurred at 37 weeks and three days without complications. Case 2: patient diagnosed with uterus didelphy at 65, history of treatment for becoming pregnant, intense menstrual flow, cramps and two successful pregnancies. However, the patient was not aware of the uterine malformation and there was no information about this fact in the medical record. All patients included in this study provided informed consent. Final consideration: Despite pregnancy being considered the presence of the uterus didelphys, the pregnancies went according to the appropriate procedures considering the guidelines recommended by the Ministry of Health (MS). Therefore, the therapeutic approach applied to clinical cases was successful.

Features of the course of pregnancy in women with polycystic ovary syndrome

Polycystic ovary syndrome is one of the most common pathologies in the practice of an obstetrician-gynecologist. Overcoming infertility characteristic of this syndrome is an important problem of endocrinology, gynecology, and reproductive medicine. Innovative therapeutic and surgical methods of treatment can correct hormonal and metabolic disorders, induce ovulation and achieve a long-awaited pregnancy. Early gestation periods in patients with polycystic ovary syndrome often occur with miscarriage, and the risks of developing gestational diabetes mellitus, cervical insufficiency, gestational arterial hypertension, preeclampsia, and placental insufficiency increase. We have analyzed modern ideas about the effect of various pathogenetic links of polycystic ovary syndrome on the course of pregnancy.