Growth Retardation Syndrome Research Articles

COVID-19 AND PREGNANCY

Physiological changes that occur during pregnancy may alter the response to COVID-19 infection. Pregnancy is considered a risk factor for infectious diseases, but the increased risk of complications with COVID-19 is controversial. Since the beginning of the pandemic, the impact of the disease on the condition of the mother and fetus has been questioned. The aim of the study. To assess the impact of the SARS-CoV-2 virus on the course of pregnancy, fetal growth depending on the period of pregnancy, when the disease occurred in a pregnant woman in a mild and moderate form. Materials and methods. Two groups were formed: 1st main group 60 pregnant women suffering from COVID-19 in different stages of pregnancy, 2nd control group 20 healthy pregnant women without COVID-19 infection. A general clinical, bacterioscopic, bacteriological, immunoenzymatic, ultrasound examination was performed. Statistical analysis was performed according to generally accepted methods of variational statistics. Approval of the scientific work was obtained from the Bioethics Commission of the Bukovyna State Medical University (Ukraine). The work is a part of the research work "Prevention, diagnostics and treatment of disorders of perinatal period and reproductive system of women and adolescent girls" (No. 201110H, state registration No. 0111U006499). Research results. A significant decrease in free estriol was revealed by 3.82±0.29 (p<0.01) in the main group when infected in the first trimester of pregnancy with the subsequent development of fetal growth retardation syndrome in 14.29% in the first trimester and in 12.5% ​​in in the third trimester of pregnancy, intrauterine infection of the fetus in 25%. Infection with SARS-CoV-2 in the third trimester of pregnancy led to a decrease in fetal growth and the birth of children with a weight of 2962.55±56.73 (p<0.05). Conclusions. The most favorable period for infection with SARS-CoV-2 during pregnancy is the second trimester (50%), however, a decrease in the hormone-producing function of the placenta is observed during infection in the first trimester, which leads to the development of fetal growth retardation, however, the weight at birth does not differ from the control group , unlike infection in the third trimester, where there is a significant decrease in fetal growth, the study is important for timely prevention of complications.

CHARACTERISTICS OF RISK FACTORS FOR THE DEVELOPMENT OF PRIMARY PLACENTAL DYSFUNCTION IN WOMEN WITH A THREAT OF ABORTION IN THE FIRST TRIMESTER OF PREGNANCY

The aim of the study – to optimize the prediction of primary placental dysfunctiondevelopment by determining the risk factors for its development in women with a threatof miscarriage in the early stages of pregnancy.Materials and methods. A prospective analysis of the somatic, reproductive and obstetricanamnesis of 40 pregnant women with threatened abortion in the 1st trimester ofpregnancy and clinical manifestations of placental dysfunction (PD) was carried out –the main group, 60 pregnant women with threatened abortion without PD (comparisongroup). The control group consisted of 50 women with the physiological course of the firsttrimester of pregnancy. Results. Among those with symptoms of threat of termination of pregnancy in the earlystages of pregnancy and PD, the number of women of borderline reproductive age (≤18years and ≥40 years), with obesity (BMI > 30) and a combination of several co-morbidextragenital pathologies was significantly higher than in the comparison group and inthe control group. In the anamnesis of pregnant women of the main group, gynecologicaldiseases, early pregnancy losses (spontaneous miscarriages and non-developingpregnancies) were significantly more often detected. In the first trimester of pregnancyvaginal bleeding, chorionic detachment, retrochorionic hematoma, and low chorionicposition were diagnosed significantly more often in women of the main group. In 7.5 % ofcases, in the first trimester of pregnancy, pregnant women with a threat of abortion andPD had an acute respiratory viral infection.The relationship between the development of primary PD and the frequency of gestationalcomplications associated with the placenta (PE (20.0 %), Abruptio placentae (17.5 %),fetal growth retardation syndrome (10.0 %) and fetal distress (27.5 %)) was established.Every third pregnancy ended in premature birth (32.5 %). The percentage of deliveries byCS in the main group was 62.5 %. Complications of pregnancy and childbirth, associatedwith impaired placental function, led to a high frequency of births of babies in a state ofmoderate and severe asphyxia (15.0 % and 5.0 %, respectively) and stillbirths.Conclusions. The conducted studies confirmed that the development of placentaldysfunction from the early stages of pregnancy in women with a threat of abortion isthe cause of the complicated course of pregnancy and childbirth, which lead to adverseperinatal consequences. Risk factors for the development of placental dysfunctionin pregnant women with threatened abortion are the borderline reproductive age ofthe mother, obesity, a combination of several co-morbid extragenital pathologies,gynecological diseases and early reproductive losses in the anamnesis. Also, the riskfactors for impaired placental formation are detachment of the chorion, retrochorialhematoma, and acute respiratory viral infections in the early stages of pregnancy.

Clinical effectiveness of prevention of great obstetrical syndromes

The objective: development of a method of prevention of great obstetrical syndromes (GOS) from the standpoint of a single genesis determined by morphofunctional disorders in the fetoplacental system (FPS) and evaluation of its clinical effectiveness.Materials and methods. 155 women of the high-risk group for the development of GOS were examined. I group – 32 pregnant women who had GOS prophylaxis with low doses of acetylsalicylic acid (ASA) 100–150 mg per os once a day from the 12th to the 36th week of pregnancy; II group – 31 pregnant women who from the 6th to the 16th week had prophylactically progesterone according to the scheme: 200 mg once a day per vaginally every day; III group – 36 pregnant women who received prophylactic monotherapy, consisting of the use of magnesium with a complex with vitamin B6 for three courses of 6 weeks each; IV group – 56 pregnant women who refused any preventive measures.To assess the effectiveness of preventive therapy a dynamic examination of the pregnant women of the study groups, their fetuses and newborns was carried out. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs.Results. The analysis of obstetrical and perinatal outcomes in women of the high-risk group for the development of GOS showed that the development of placental insufficiency (PI) in the IV group was realized in 100% (56 cases), including severe forms in 51.8% (29 cases); the frequency of PI in I, II and III groups was 12.5% ​​(4 cases), 29.0% (9 cases) and 36.6% (11 cases), respectively, and was significantly lower (p<0.05); premature births were in 3 cases each in I and III groups, which amounted to 9.3% and 8.3%, respectively (р<0.05), in II group – 2 cases (6.5%); p<0.05.In general, the realization of GOS (preeclampsia, fetal growth retardation syndrome, premature birth) in I group was 25.0% (8 cases), including severe form – 3.1% (1 case); in the II group – 29.0% (9 cases), severe forms – 2 cases (6.3%); in the III group – 30.6% (11 cases), severe forms – 3 cases (8.3%) versus 100.0% (56 cases) realization of all clinical manifestations of GOS in the IV group of the study (р<0.05).Conclusions. A promising direction for the prevention of vasculitis in the high-risk group for their development is the consistent, early gestational appointment of low doses of ASA according to the developed method, which demonstrates the greatest effectiveness: a significant reduction in the frequency of preeclampsia, placental insufficiency with fetal growth retardation, premature birth, severe forms of preeclampsia according to optimized by the standards of evidence-based medicine: the number of pregnant women who need prophylaxis is 1.4; 95% confidence interval (CI): 1.1–1.7; odds ratio 5.3; 95% CI: 4.7–5.8.

INVESTIGATING INDICATORS OF ANXIETY, PSYCHOEMOTIONAL TENSION AND STRESS IN PREGNANT WOMEN DURING MARTIAL LAW

Introduction. Pregnancy is a vulnerable period marked by psychoemotional changes, ushering in a new stage with profound shifts in a woman's mental well-being. Elevated stress levels during pregnancy correlate with various adverse psychological and physiological outcomes for both the mother and child. In the current context, the ongoing war serves as an additional stressor for Ukrainian women. Pregnant women exposed to conflict face an increased risk of maternal mortality and a higher likelihood of delivering infants with health complications. Recognizing potential factors contributing to psychoemotional changes in pregnant women is a critical undertaking that should be initiated early in pregnancy.
 The purpose of this study is to assess indicators of anxiety, psychoemotional tension and stress in pregnant women during martial law
 Materials and methods. Psychometric testing of 50 pregnant women was performed by using three anxiety/stress scales: the Spielberger-Hanin Scale, the Psychological Stress Measure (PSM-25), and the Impact of Event Scale (IES-R). The participants were categorized into three groups: group 1 comprised pregnant women residing in areas directly impacted by the full-scale invasion, facing active hostilities or constant rocket fire without changing their residence (17 women, one experiencing occupation for < 1 month); group 2 included internally displaced women (13 individuals, two in settlements occupied for < 1 month); and group 3 encompassed 20 women residing in areas where active hostilities were not taking place.
 Results. According to the Spielberger-Hanin scale, the highest rate of reactive (46.2%, n=6) and personal anxiety (38.5%, n=5) was observed in the group of internally displaced women. The results of the IES-R were as follows, according to the invasion subscale: the highest level was observed in the group of women who were in settlements where there were no active hostilities (45%, n=9), avoidance was found in women who did not change their place of residence, where there was or continues to be active hostilities (58.8%, n=10), excitement – in internally displaced persons (46.2%, n=6). According to the PSM-25, no woman had a high level of stress, it was increased in women of the first group (23.5%, n=4). In the first studied group, complications were dominated by polyhydramnios (29.4%, n=5), fetal growth retardation syndrome (11.8%, n=2), umbilical cord localization pathology (5.9%, n=1), premature detachment a normally located placenta (11.8%, n=2) and one woman had surgery during pregnancy (5.9%, n=1). In the second group, there was a threat of abortion (30.8%, n=4). , preeclampsia in the first half of pregnancy (7.7%, n=1) and placenta localization pathology (7.7%, n=1). In the third group, there was a threat of premature birth (35%, n=7), preeclampsia (20% , n=4), oligohydramnios (25%, n=5), placental pathology (20%, n=4) and premature rupture of membranes (25%, n=5). Regarding the termination of pregnancies (table 4), the majority of pregnancies in all studied groups ended in term delivery, the highest percentage of premature deliveries (35%, n=7) was observed in the third group. In the group where there were women from the zone of active hostilities (group 1), one case of neonatal death was recorded, which was associated with significant fetal malformations.
 Conclusions. Stress is an adaptive process that induces changes in the body. This study revealed that each group experienced stress. It is noteworthy that stress during pregnancy is not solely attributed to war; factors such as the pregnancy itself, its parity, and the presence of somatic diseases also contribute. Consequently, there is a need to formulate measures for the psychoprophylaxis of women and to conduct further observations, assessing larger research cohorts.

Analysis of perinatal consequences against the background of the proposed treatment complex in pregnant women after the application of assisted reproductive technologies

The course of pregnancy that occurs as a result of the application of assisted reproductive technologies is accompanied by numerous complications that affect the indicators of perinatal morbidity and mortality. Nowadays in Ukraine, there is no unified approach to the management of women whose pregnancy occurred as a result of ART application, which determined the direction of this work.The objective: to assess perinatal consequences against the background of the introduction of the proposed treatment complex in women whose pregnancy occurred as a result of the application of assisted reproductive technologies.Materials and methods. 249 pregnant women were examined, which were divided into: group I – 94 women with tubo-peritoneal, group II – 87 women with endocrine and group III – 68 women with male types of infertility. Depending on the prescribed therapy, women of groups I, II and III are divided into: subgroup IA – 49 pregnant women with tubo-peritoneal, subgroup IIA – 48 pregnant women with endocrine, subgroup IIIA – 36 pregnant women with male factor of infertility who received the proposed therapeutic and preventive complex; subgroup IB – 45 pregnant women with tubo-peritoneal, subgroup IIB – 39 pregnant women with endocrine, subgroup IIIB – 32 pregnant women with male factor of infertility, which were observed in accordance with generally accepted standards of obstetric care.Results. Against the background of prescribing the proposed complex, there was a significant decrease in the frequency of threatened miscarriage in women of Group I by 41.6%, in women of Group II by 37.1% (p<0.05). In the second and third trimesters, there was a significant decrease in the number of cases of threatening late spontaneous miscarriages, threatening premature birth, placental dysfunction, preeclampsia, and fetal growth retardation syndrome (p<0.05). A significant indicator of the effectiveness of the proposed treatment complex is a significant increase in the proportion of urgent labor in women of subgroups IA and IIA. Thus, 46 (93.8%) women of subgroup IA and 46 (95.8%) women of subgroup IIA had urgent labor.Assessing the pathological conditions of newborns, it should be noted that in children from women in labor of subgroups who received the proposed complex, respiratory disorders syndrome (p<0.05), intraventricular hemorrhages (p<0.05), hypoxic-ischemic encephalopathy (p<0.05), and cases of antenatal infection (p<0.05) were determined in a significantly smaller number of cases.Conclusions. The effectiveness of the proposed treatment complex and the complex of psychoemotional correction in pregnant women after the use of assisted reproductive technologies is confirmed by a reliably better course of the first, second and third trimesters of pregnancy, a reliably better course of Labor, which was reflected in an increase in cases of urgent labor and a decrease in cases of complications in childbirth, which was reflected in a significant decrease in the number of cesarean sections.Improvement of perinatal consequences against the background of the use of the proposed treatment complex and the complex of psychoemotional correction in newborns from women in labor after the use of assisted reproductive technologies is confirmed by a significantly larger mass of newborns, a significantly smaller number of newborns with low gestational weight, a significantly higher Apgar score, a significantly smaller number of cases of pathological and transient conditions, and a significantly shorter duration of stay of women in labor and newborns in an obstetric hospital, as well as the absence of cases of early neonatal and perinatal mortality among newborns.

Risk factors for preeclampsia in pregnant women at risk

Despite the large number of studies conducted on the development of preeclampsia, today, this pathology of pregnancy tends to increase the manifestations of adverse consequences. It is essential to implement early diagnosis of the risk of preeclampsia in pregnant women for timely prevention. This pathology requires the cooperation of both obstetricians and gynecologists, family doctors, and cardiologists. A comprehensive approach to the diagnosis of preeclampsia in pregnant women will allow timely detection of the risk of the occurrence of the specified pathology and will provide an opportunity to carry out preventive measures promptly.Objective: to conduct a retrospective analysis of individual charts of pregnant women and birth histories of pregnant women with preeclampsia and to analyze risk factors that may cause the occurrence of this pathology.Material and methods. A retrospective analysis of 100 individual charts of pregnant women and histories of childbirth with preeclampsia at the obstetric hospital of the Chernivtsi Regional Perinatal Center for 2018-2021 was conducted in order to determine risk factors for the development of preeclampsia during pregnancy. We used standard methods of mathematical and correlational analysis.Results. Gestational anemia, placental dysfunction, in the form of fetal distress and fetal growth retardation syndrome were observed in pregnant women with preeclampsia. It is worth noting that in pregnant women with preeclampsia, childbirth can be complicated by premature rupture of the fetal membranes, premature birth, fetal distress, as well as abnormal labor activity, which leads to an increase in the frequency of cesarean section.Conclusions. It is important when registering pregnant women at risk of developing preeclampsia to conduct a detailed collection and analysis of the obstetric history, identification of the risk group of pregnant women and timely prophylactic treatment in order to prevent the occurrence of this pathology.

Clinical assessment of the placenta function in women at risk and threat of premature delivery

Premature birth, despite the significant achievements of perinatal medicine in recent decades, remains an urgent global and national medical and social problem, as it is the leading cause of perinatal morbidity and mortality. According to modern views, placental dysfunction can be one of the causes of premature birth, and its frequency, according to randomized studies, can be from 78 to 91%, depending on the gestational age. At the same time, the research conducted to date does not provide a clear understanding of the role of timely diagnosis and prevention of placental dysfunction in preventing premature birth.The objective: to perform clinical evaluation of the prevalence of placental dysfunction in women at risk of preterm birth and with threat of preterm birth.Materials and methods. 180 pregnant women were took part in the study. To achieve the research aim, three research groups were formed. I group – 73 pregnant women with threat of premature birth; II group – 77 pregnant women with risk factors for premature birth. Women with risk factors for premature birth were included in the study at the stage of pregnancy planning (IIA subgroup, 39 women) or from the moment of applying to a women’s outpatient clinic to monitor the course of pregnancy (IIB subgroup, 38 pregnant women). The control group included 30 pregnant women with an uncomplicated course of pregnancy.Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum were performed at 18–21+6 and 28–30 weeks of gestation.Results. Analysis of the prevalence of risk factors for placental dysfunction and preterm birth in patients of the studied cohort showed that in pregnant women with preterm birth (I group), the combination of risk factors was 5.2; in pregnant women who received pre-gravid training (IIA subgroup) – 3.2; in pregnant women who were included in the study in the I trimester of pregnancy (IIB subgroup) – 4.7, while in pregnant women of the control group – only 0.8 (p<0.05).The threat of early spontaneous miscarriage with the formation of a retrochorial hematoma as a clinical manifestation of primary placental dysfunction was determined in 43.8% of pregnant women whose premature delivery was carried out for medical reasons. Placenta abruption in these patients can be considered as decompensation of the primary dysfunction of the placenta with the transition to acute placental insufficiency.The formation of chronic placental dysfunction, clinically manifested by the syndrome of fetal growth retardation, was most often observed in patients whose pregnancy ended in spontaneous premature birth at 34–36+6 weeks in the presence of an untouched amnion, – 68.6% compared to births at 28–33+6 weeks of gestation – 25.9% and with childbirth at 22–37+6 weeks – 13.3%.Conclusions. Clinical manifestations of placental dysfunction were detected in 30.6% of patients with premature birth, with morphological signs in 60.4% of cases, which indicates the hidden course of placental insufficiency before the development of premature birth.Morphological signs of placental dysfunction were determined in 87.5% of cases of premature births for medical reasons and in 100.0% of cases of spontaneous births at 22–27+6 weeks of gestation (with a combination of risk factors from 2.1 to 3.0), in 66.7% – with premature births at 28–33+6 weeks of pregnancy, in 40.0% – with premature births at 34–36+6 weeks of pregnancy and only in one (5.6%) case – with term births.The frequency of fixation of morphological characteristics of placental dysfunction correlates with the frequency of early pregnancy complications, primarily with the formation of retrochorial hematomas in the first half of pregnancy.

PECULIARITIES OF THE COURSE OF PREGNANCY IN WOMEN OF DIFFERENT POPULATION GROUPS BURDENED WITH ANEMIA AND HELICOBACTERIOSIS

Peculiarities of the course of pregnancy in women of different ethnic groups are burdened with anemia and helicobacteriosis in modern living conditions after the pandemic of coronavirus infection, the state of constant stress of the war in Ukraine. The purpose of the study was to determine the characteristics of the course of pregnancy in women of different population groups burdened with anemia and helicobacteriosis
 Materials and Methods. 30 pregnant women of reproductive age, burdened with anemia, residents of the city of Odesa (group I) and countries of Southeast Asia (group II) were under our observation. All women were registered at the women’s clinic. The monitoring algorithm included clinical and laboratory studies of Helicobacter pylori infection (total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens).
 Results. The presence of infectious processes in the body of women is one of the etiological factors of gestational complications, including the progression of the severity of anemia in pregnant women. The clinical severity of anemia in pregnant women was consistent with a high coefficient of positivity of total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens and a low level of hemoglobin, the level of ferritin, folic acid, cyanocobalamin, the vital trace element iron. Indicators of the clinical course of pregnancy in group I and group II had a significant difference (p<0.05), respectively: early toxicosis (mild, moderate, severe) – 20.0 %, 0 %, 0 % and 26.7 %, 20.0 %, 0 %; syndrome of the threat of early miscarriage - 13.3 % and 33.3 %; late miscarriage threat syndrome – 6.7 % and 20.0 %; secondary placental dysfunction – 0 % and 20.0 %; fetal growth retardation syndrome (FGRS) – 0 % and 6.7 %; intranatal fetal distress – 0 % and 6.7 %. The postpartum period in 13.3 % of women in the 2nd group had a lochiometer.
 Conclusions. Peculiarities of the course of pregnancy in women of different population groups burdened with anemia and helicobacteriosis consisted in the progression of the severity of the clinical and laboratory course of anemia and gestational complications during the trimesters. The clinical severity of anemia in pregnant women was consistent with a high ratio of total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens and a low level of hemoglobin, the level of ferritin, folic acid, cyanocobalamin, the vital trace element iron. It is recommended to determine the ratio of total antibodies (IgG, IgM, IgA) to Helicobacter pylori antigens in the blood of pregnant women with anemia and at the stage of pregnancy planning. Positive results are an indication for examination of all family members.

Акушерська та перинатальна патологія в жінок з великими акушерськими синдромами в анамнезі

Purpose - to determine the features of obstetric and perinatal pathology in women who had complications from the group of major obstetric syndromes (MOS) in the anamnesis during previous pregnancies. Materials and methods. A prospective analysis of the course of pregnancy, childbirth and the condition of newborns was conducted in 120 pregnant women who had complications from the group of MOS in the anamnesis during previous pregnancies and received generally accepted diagnostic and treatment-prophylactic measures during this pregnancy (during 2019-2022). Statistical processing of research results was performed using the standard programs Microsoft Excel 5.0 and Statistica 6.0. Results. Peculiarities of the course of pregnancy and childbirth in women with a history of MOS are characterized by a high frequency of the threat of premature birth - 32.5% of cases, which determines the high frequency of perinatal pathology. In addition, it is possible to note the high frequency of premature births - 10.8% of cases. Attention is drawn to the stable high rates of the following complications of the III trimester of pregnancy: gestational anemia in 29.2% of cases; preeclampsia 13.3% of cases; placental insufficiency with growth retardation syndrome in 14.2% of cases; and violation of microbiocinosis of the genital tract in 24.2% of cases; without a tendency to decrease the frequency of these complications over the years. The consequence of these complications is an increase in the frequency of cesarean sections to 30.1% of cases. Conclusions. The identified features of obstetric and perinatal pathology in pregnant women who had complications from the MOS group during previous pregnancies can serve as markers for predicting the risk of developing complications from the mother and the fetus in these pregnant women. In our opinion, further analysis of functional, instrumental and laboratory indicators in these women can provide an opportunity to identify the most informative prognostic criteria regarding the development of MOS, and will allow the development of an effective method of predicting obstetric and perinatal complications in these women. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Women's informed consent was obtained for the study. No conflict of interests was declared by the author.

The course of pregnancy and childbirth in women with fetal growth retardation syndrome

The course of pregnancy and childbirth in women with fetal growth retardation syndrome

NOVEL ULTRASOUND TECHNOLOGIES IN ASSESSING THE STATE OF THE MOTHER–PLACENTA–FETUS SYSTEM

The leading process in early pregnancy is forming the mother–placenta–fetus system. The central link of the mother–placenta–fetus system is the placenta. The structural features of the placenta reflect complex relationship between the mother's body and the fetus. Disorder in forming and functioning of the placenta underlies the development of complications such as early termination of pregnancy, placental insufficiency, fetal growth retardation syndrome, preeclampsia, premature birth. In this regard, an integrated approach in studying the hemodynamic system of mother–placenta–fetus is of particular importance. Ultrasound examination remains one of the most promising diagnostic methods. The aim of the study is to increase the effectiveness of diagnosis and prediction of gestational complications associated with violation of hemodynamic parameters in the mother–placenta–fetus system. Materials and methods. The study included 40 patients between the 30th and 32nd weeks of pregnancy with a singleton spontaneous pregnancy: 20 patients with normal course of pregnancy and 20 patients with a diagnosis of placental insufficiency. Ultrasound examination included standard echography in B-mode, color Doppler mapping and the use of modern techniques – three-dimensional imaging technology and innovative techniques of high-precision microvascular imaging SMI (Superb Micro-Vascular Imaging). Results and discussion. In patients with normal pregnancy, a variant of a three-dimensional model of the vascular network with a complex massive vascular network prevailed, whereas in the group with placental insufficiency, a three-dimensional vascular model looked simple: several intertwined vessels. Visual assessment of the placental vascular tree using SMI technology revealed the absence of a clear vascular pattern in the area of interest in patients with placental insufficiency, whereas active placental blood flow was determined in patients with normal pregnancy. Conclusions. The use of modern ultrasound technologies enables to obtain information about the state of placental blood flow, which gives the opportunity to diagnose the development of placental insufficiency in a timely manner.

Особливості перебігу вагітності в жінок із передчасними пологами

Purpose - to determine the peculiarities of the course of pregnancy and childbirth in women who had complications from the group of major obstetric syndromes, clinically manifested by premature birth (PB). Materials and methods. A retrospective clinical-statistical analysis of the course of pregnancy and childbirth of n=69 pregnant women with spontaneous PB at a gestation period of 24-36 weeks and 6 days was carried out. Depending on the period of pregnancy, they were divided into groups: the Group I - 9 pregnant women 24-26 weeks 6 days, the Group II - 28 women 28-31 weeks 6 days, the Group III - pregnant women 32-36 weeks 6 days. The Control group (CG) consisted of 56 practically healthy pregnant women with a healthy reproductive history and an uncomplicated course of this pregnancy. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. Were received significant differences between the Group I and the CG (p=0.007), in the presence of signs of the threat of termination of pregnancy during the second “wave” of cytotrophoblast invasion, so the chance of giving birth in the early term is 4.2 times higher than at term. In the presence of isthmic-cervical insufficiency (ICN), the reliability of differences between the Groups I and II (p=0.0021), Groups I and III (p=0.012) is observed between the Group I and CG (p=0.00083) and the risk of very early PB is 2.6 times higher than the risk of premature, late premature - 2.2 times. Disturbances in uteroplacental blood circulation have the presence of significant differences between Groups I and II (р=0.0051). There is a direct relationship between the level of blood pressure and blood circulation in the uterine arteries. Therefore, the observed difference is not accidental: in the Group II, preeclampsia was observed significantly more often. Violation of feto-placental hemodynamics when comparing groups demonstrated the existence of statistically significant differences between the Groups I and II (p=0.048), as well as between the Group I and CG (p=0.02). In the presence of clinical signs of fetal growth retardation syndrome (GRS), there is a significant difference between the Groups I and II (р=0.033). Conclusions.The features of the course of pregnancy with premature birth include the threat of termination during the second “wave” of cytotrophoblast invasion; isthmic-cervical insufficiency, which can lead to very early premature birth; vaginal infectious-inflammatory and dysbiotic diseases. Severe forms of placental insufficiency and preeclampsia are more often an indication for termination of pregnancy at 28-33 weeks 6 days. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. A informed sonsennt was collected in order to carry out the research. No conflict of interests was declared by the author.

Функціональний стан фетоплацентарного комплексу у вагітних із HCV-інфекцією

Purpose - to study the functional state of the fetoplacental complex (FPC) during pregnancy in women with hepatitis C virus (HCV infection). Materials and methods. A prospective clinical and statistical analysis of the functional state of the FP during pregnancy in 40 women (main group, MG) with HCV infection was conducted on the basis of the Kyiv City Center of Reproductive and Perinatal Medicine for the period 2020-2021. The control group (CG) consisted of 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The hormonal status of FPK in MG of pregnant women, starting from the 18th week, was characterised by a significant decrease in the secretion of progesterone (PG) (159.314.6 nmol/l in MG versus 205.44.8 nmol/l in CG; p<0.05) and human chorionic gonadotropin (39.24.6 mIU/mL versus 52.85.3 mIU/mL, respectively). Estradiol (E2) levels in MG of pregnant women from the 18th week of pregnancy were significantly lower (26.32.7 nmol/l) than in CG of pregnant women (33.71.4 nmol/l, p<0.05). A synchronous decrease in the level of PG and E2 was observed in the case of threatened abortion against the background of bloody discharge, which indicated clinical manifestations of placental dysfunction (PD). In MG of pregnant women, the level of placental lactogen (PL) at week 18 was almost the same (80.913.2 nmol/l) compared to CG of pregnant women (79.57.1 nmol/l; p>0.05). From the 29th week, the level of E2 in MG of pregnant women is significantly different from CG (25.61.3 nmol/l in MG versus 51.20.7 nmol/l in CG; p<0.05). The most pronounced difference was the level of estriol (E3) and cortisol (Cr) in blood serum relative to CG in MG of pregnant women, which was manifested by a decrease in the level of E3 (up to 86.4±5.2 nmol/l in MG versus 98.42.6 nmol/l in CG; p<0.05) against the background of a simultaneous increase in Cr content (up to 751.118.6 nmol/l in MG versus 625.618.4 nmol/l in CG; p<0.05). Endocrinological disorders also changed before delivery (39-40 weeks): the E2 level decreased (to 45.41.9 nmol/l in MG versus 65.30.6 nmol/l in CG; p<0.05), E3 (up to 28.32.0 nmol/l versus 57.81.8 nmol/l, respectively; p<0.01), PG (up to 499.4±11.6 nmol/l versus 604,216.3 nmol/l, respectively; p<0.05) and PL (up to 201.4±12.4 nmol/l versus 63.418.8 nmol/l, respectively; p<0.05) and the Cr content increased (up to 812.4±16.7 nmol/l versus 651.614.6 nmol/l, respectively; p<0.01). Conclusions. The functional state of the FPC in pregnant women with HCV infection, on the eve of delivery, is characterized by a high level of premature maturation of the placenta, changes in the volume of amniotic fluid, due to which significant hemodynamic and endocrinological subcompensated disorders appear, but in some cases they are decompensated, which causes disorders from the functional state of the fetus and the high frequency of development of fetal growth retardation syndrome in this group of women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Особливості перебігу вагітності та пологів у жінок із ранньою та пізньою формами затримки росту плода

Purpose - to determine the features of the course of pregnancy and childbirth in women who had complications from the group of major obstetric syndromes (MОS), which were clinically manifested by early and late forms of fetal growth retardation syndrome (GRS). Materials and methods. A prospective analysis of the characteristics of the course of pregnancy and childbirth was conducted in 99 women who had complications from the group of MОS and were clinically manifested by fetal GRS, of which the Group I - 21 pregnant women with an early form of GRS, the Group II - 78 pregnant women with a late form of GRS. The diagnosis of GRS was established on the basis of ultrasound and Doppler examination data using percentile curves. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. The analysis of the course of the II trimester in the Group II of pregnant women showed that the threat of termination of pregnancy occurred in 22 (28.2%) cases, with the transition to isthmic-cervical insufficiency and was 5 (6.4%) cases. An increase in the frequency of arterial hypertension was noted up to 3 (14.3%) cases in the Group I of pregnant women, while acute respiratory diseases in 6 (7.7%) cases and gestational pyelonephritis in 4 (5.1%) cases occurred only in the Group II female patients. The diagnosis of placental insufficiency and GRS was made more often in the Group I and amounted to 6 (5.8%) cases. In the III trimester of pregnancy in the examined patients, it was found that the diagnosis of placental insufficiency was in 7 (33.3%) patients, preeclampsia in 6 (28.6%) pregnant women and arterial hypertension in 3 (14.3%) patients and met reliably more often in the Group I (p<0.05), and such complications as fetal distress in 4 (5.1%) cases, acute respiratory diseases in 6 (7.7%) cases occurred only in the Group II. It was established that in the group with the early form of GRS, the average delivery time was 31 weeks, and in the group with the late form of GRS - 39 weeks. The frequency of delivery by caesarean section in the Group I was significantly higher and amounted to 13 (61.9%) cases against 21 (26.9%) cases in the Group II (p<0.05). Conclusions. The course of pregnancy in women with various forms of the GRS syndrome has its own characteristics, namely: with the early form of the GRS, pregnancy is significantly more often complicated by the threat of termination, gestational anemia, bacterial vaginosis, early development of placental insufficiency, and preeclampsia, which in turn leads to a significant increase in the frequency of cesarean delivery autopsy in case of premature pregnancy. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. Women’s informed consent was obtained for the study. No conflict of interests was declared by the authors.

Correction of placental dysfunction in the first trimester of pregnancy as a method of preventing fetal growth retardation

Objective: to study the effectiveness of complex therapy of placental dysfunction (PD) as a method of prevention of fetal growth retardation syndrome in pregnant women with miscarriage in the 1st trimester of pregnancy.Materials and methods. 100 pregnant women with verified PD on the background of miscarriage in the first trimester of pregnancy took part in the study.Verification criteria for PD were: a decrease in the volume of the chorion and its vascularization index by more than 15%, an increase of the resistance index in the uterine and spiral arteries during dopplerometric examination at the end of the first trimester of pregnancy.The patients were divided into groups: group I (main) – 36 pregnant women with PD who received complex treatment, group II (comparative) – 32 pregnant women with PD who were prescribed only hormonal support, III group (control) – 32 patients with the physiological course of the first trimester of pregnancy. Complex therapy in the group I included hormonal agents, venotonic drug Normoven, the drug Magnicum, and the drug Artihol.Clinical data, ultrasound fetometry, dopplerometric study of utero-fetal blood flow were used to assess the effectiveness of treatment.Results. Already in the 22–24th week of gestation there was no significant difference in the resistance index in the spiral and uterine arteries between the main and control groups (p > 0.05). Ultrasound fetometry at 32–34 weeks of gestation showed that in the first group there were 8.3% (3) fetuses small for gestational age, 15.6% (5) in the second group and 3.1% (1) in the control. The average body weight of newborns in the main group and in the comparison group differed significantly and was 2810 ± 267 and 2610 ± 175 g respectively (р < 0.05) and 3295 ± 295 g in the control group.Conclusions. Complex, pathogenetically justified, long-term treatment of PD from the early stages of pregnancy makes it possible to avoid progression of compensated and development of subcompensated stages of placental disorders. Complex therapy of PD, which includes micronized progesterone, Normoven, Artichol and Magnicum, Complex PD therapy, which includes micronized progesterone, Normoven, Artihol and Magnicum, normalizes blood flow in the mother-placenta-fetus system, normal growth and fetus development and is an effective way of preventing fetal growth retardation.

Клінічний перебіг вагітності та пологів після допоміжних репродуктивних технологій на тлі інфекцій, що передаються статевим шляхом

Purpose - to reveal the features of the course of the disease, childbirth, and the postpartum period in patients after assisted reproductive technologies (ART) against the background of sexually transmitted infections in the anamnesis. Materials and methods. 132 women with infertility on the background of sexually transmitted infections (STIs) in the anamnesis standard preparation for the ART program was carried out, of which 55 women completed the ART program with pregnancy and were included in the main group. The control group is 30 pregnant women without a period of infertility who became pregnant on their own. Statistical processing of research results was carried out using standard programs Microsoft Excel 5.0 and Statistica 8. Results. Pregnancy and childbirth in women after ART with a history of STIs occurs with a significantly high frequency of the following complications: threat of termination of pregnancy - 9 (16.4%); reproductive losses in the first half of pregnancy - 10 (18.2%); carrier of chronic viral and bacterial infection in the first half of pregnancy - in all women; early development of preeclampsia - 6 (13.3%); placental dysfunction - 26 (57.8%); fetal growth retardation syndrome - 17 (37.8%); fetal distress - 10 (22.2%); premature birth - 12 (26.7%); and high frequency of caesarean section - 40 (88.9%). Conclusions. The obtained results indicate that the development, implementation and application of an improved algorithm of pre-gravid preparation in women with a history of STIs before the ART program is relevant, which, in our opinion, can have a positive effect on the obstetric consequences of the delivery of these women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Особливості функціонування імунологічної толерантності під час вагітності (огляд літератури)

Pregnancy is a special state in a woman’s life, which can definitely be considered an «immunological paradox», because the growth of a genetically «alien» fetus takes place in a woman’s body. Despite the direct contact between cells of fetal origin (syncytiotrophoblast) and cells of the maternal immune system, which are in excess in the decidual membrane of the uterus, rejection of the semi-allogeneic fetus does not occur. A state of permanent natural immunological tolerance, during which the body does not respond to certain antigens expressed by trophoblast cells, while maintaining the ability to respond immunologically to other immunogens is the opposite phenomenon of the immune response, it is acquired by the body during its development and is not genetically determined. Purpose - to analyze the phasing of immunological changes in the mother’s body, which are aimed at the development and preservation of pregnancy, to specify their role in the correct flow of placental waves, prevention of the development of placental dysfunction and obstetric complications associated with it. A review of modern medical literature on the processes of immunological changes during trophoblast invasion and placentation in early pregnancy is given. For a more detailed understanding, the influence of each link of the immune response in the process of developing immune tolerance was analyzed. It has been established that for the development of a normal pregnancy there is a genetically programmed immune mechanism that ensures a decrease in the local and systemic immune response to the semi-alien implanted blastocyst, embryo and fetus. This is achieved through the step-by-step course of three phases of immunological shifts: the unfolded immune conflict; suppression of the immune response and intense immune conflict. The physiological course of gestation and the development of the placenta, in which the balance between the processes of neoangiogenesis and apoptosis is maintained, is ensured by adequate expression of HLA-G locus molecules by trophoblast cells, inhibition of Th1-type cytotoxic reactions against placenta cells by the mother's body. Analyzed changes in the cytokine balance, which shifts towards immunosuppressive cytokines, which suppress cellular immune reactions and stimulate the production of blocking antibodies, the quantitative composition of which can be considered decisive when carrying a genetically foreign fetus. Consequently, a relative secondary cellular immunodeficiency is formed, which is mainly due to a deficiency of circulating T-helper/inducers, a decrease in the CD4/CD8 immunoregulatory index and suppression of the functional activity of the T-cell immune system. It has been proven that impaired immunological tolerance, trophoblast invasion and vascular remodelling processes controlled by the maternal immune system at the local and systemic levels lead to early reproductive losses, premature birth, placental dysfunction, and are associated with fetal growth retardation syndrome, pre-eclampsia and other complications. No conflict of interests was declared by the authors.

Перебіг вагітності та пологів у жінок із прееклампсією

Purpose - to determine the features of pregnancy and childbirth in women who had complications from the group of major obstetric syndromes (MOS), which were clinically manifested by pre-eclampsia. Materials and methods. A retrospective clinical and statistical analysis of the course of pregnancy and childbirth in 103 pregnant women with pre-eclampsia (main group - MG) was performed. The control group (CG) included 56 practically healthy pregnant women with a favorable reproductive history and uncomplicated pregnancy. Statistical processing of the study results was performed using standard software Microsoft Excel 5.0 and Statistica 6.0. Results. Moderate pre-eclampsia prevailed in pregnant women of MG - 71 (69.6%) cases versus 2 (3.5%) cases in CG (p<0.05). Severe pre-eclampsia was observed in almost every third pregnant woman of MG - 31 (30.4%) cases. One of the main complications of the third trimester of gestation, as well as in the first and second trimesters, was gestational anemia - 38 (37.2%) cases in MG versus 14 (25.0%) cases in CG (p<0.05). Placental insufficiency was significantly more common in pregnant women of MG - 33 (32.1%) cases versus 2 (3.5%) cases in CG (p<0.05); which led to the development of fetal growth retardation syndrome in 10 (9.7%) cases in MG. The threat of preterm birth was noted in 16 (15.6%) cases in MG versus 4 (7.1%) cases in CG (p<0.05), preterm birth was noted - in 12 (11.7%) cases, and the incidence of cesarean section was 32 (31.1%) cases versus 5 (8.9%) cases (p<0.05). Conclusions. The features of the course of pregnancy and childbirth in women with MOS, which is clinically manifested by the development of pre-eclampsia, are characterized by a significantly high frequency of threatened abortion, gestational anemia, bacterial vaginosis, placental insufficiency, fetal growth retardation syndrome, premature rupture of membranes, premature birth, premature detachment of a normally located placenta, fetal distress and, as a result of these complications, an increase in the incidence of caesarean section to 31.1%. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. Informed consent of women was obtained for the study. No conflict of interest was declared by the author.

Course of pregnancy and childbirth in women with primary hypothyroidism

Introduction. Primary hypothyroidism is observed in women of reproductive age in 2–3 % of cases. The most common thyroid pathology during pregnancy is subclinical hypothyroidism (SHT), which is caused by newly diagnosed autoimmune thyroiditis (AIT) or severe iodine deficiency. In some regions of the Russian Federation, the population has a mild iodine deficiency, the average concentration of iodine in the urine being found at 78 µg/L (the normal range is 100–200 µg/L). In women with primary hypothyroidism, complications of pregnancy and childbirth include: premature birth, weakness of labor, eclampsia, premature rupture of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), intrauterine growth retardation syndrome, fetal macrosomia, congenital hypothyroidism in the fetus, etc.Aim: to study the features of pregnancy and childbirth course in women with primary hypothyroidism.Materials and Methods. In a retrospective study, there were analyzed 62 birth histories, of which 37 were for patients with thyroid diseases. Two groups were formed: the main group – 25 patients with primary hypothyroidism, the comparison group – 25 patients without thyroid pathology. During the study, the next parameters were analyzed: age, number of pregnancies, number of births, term of delivery, body mass index, level of thyroid stimulating hormone (TSH), titer of thyroid peroxidase antibodies, newborn body weight, newborn assessment according to Apgar scale.Results. In the main group, the cause of primary hypothyroidism was as follows: newly diagnosed SHT – in 18 (48.6 %), AIT – in 7 (18.9 %) pregnant women. In the first trimester of pregnancy, TSH level in patients with hypothyroidism was 3.06 ± 0.36 mU/L. The following complications of pregnancy and childbirth course were identified: GDM (32.0 %), anemia of the first degree (12.0 %), large fetus (12.0 %), PROM (12.0 %), perineal rupture of the first degree (16.0 %), anomalies of labor activity with ineffective labor stimulation (8.0 %), pelvic-head disproportion (8.0 %).Conclusion. Timely diagnosis and compensation of hypothyroidism with hormone replacement therapy and iodine preparations, prediction of possible complications and correction of identified complications are the main ways to achieve a successful outcome of pregnancy and childbirth for mother and fetus.

Features management of very early preterm birth

The objective: to determine features of tactics of very early preterm birth depending on the gestational age with the assessment of perinatal consequences. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation (the main criterion of inclusion). The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early premature (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups had serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. All women have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. The main complications of gestation in pregnant women of both groups in the second trimester were the threat of abortion and insufficiency of the fetoplacental (IFP), which caused fetal growth retardation syndrome (FGRS) in both groups – 66% and 63% of children, respectively. IFP in VEPB was confirmed histologically in 68% and 72% of cases in each group of mothers. Vaginal delivery occurred with 55 patients of group 1 and 26 women of group 2 (69,6% and 29,9%), among them in the period of 22–24 weeks – 100% and 57,1%, 25 weeks – 83,3% and 26,7%, 26–27 weeks – 57,7% and 24,1%, respectively, in each group. Indications for cesarean section (CS) in group 1 were mainly from the mother (75%), in group 2 – 27,8% from the mother, from the fetus – 4,9% (IFP), according to the combined indications – 65,6% (deep prematurity). Expansion of indications for CS in VEPB by 41% led to a decrease in perinatal mortality by 1,5 times (p<0,05). In the postpartum period, patients in both groups showed a decrease in purulent-septic complications on the background of preventive treatment from 13,9% (group 1) to 4,6% (group 2) (p<0,05). In the analysis of perinatal mortality, the highest rates were observed at 22–24 weeks of gestation, while they are 1,5 times lower at 25 weeks and 3,5 times lower at 26–27 weeks. The study found that the method of delivery did not affect perinatal outcomes at 22–25 weeks, but at 26–27 weeks, the survival of children born by CS surgery is higher than in spontaneous births, by 10% (p<0,05). Expansion of indications for the prevention of respiratory distress syndrome (RDS) of the fetus from 22 weeks in group 2 (in group 1 was not performed) by 10,7% led to an increase in survival of children with extremely low body weight (ELBW) by 11% (p<0,05). Conclusions. Under threat of VEPB the choice of delivery tactics is determined by the gestation period, the state of health of the mother and fetus, the degree of readiness of the birth canal for delivery. Premature pregnancy is not an indication for CS, except the specific obstetric indications, but abdominal delivery is possible for children in early pregnancy (22–25 weeks). The questions concerning the usage of instrumental care at birth, determination of gestational dates for the beginning of RDS prophylaxis with glucocorticoids, the necessity of using tocolysis remains ambiguous. Proper definition of management of women who give birth prematurely will allow timely implementation of measures aimed at improving the results for mother and newborn, and can be prognostic.