Physiological Course Of Pregnancy Research Articles

Analysis of Ultrasound Parameters in Pregnant Women with Retrochorial Hematoma

The purpose of the study was to determine the parameters of ultrasound examination in patients with retrochorial hematoma in the early stages of pregnancy. Materials and methods. Ultrasound examination was performed in 210 women in the early stages of pregnancy to study the features of the echographic parameters of embryo development during the formation of retrochorial hematoma. The main group consisted of 100 pregnant women with signs of early termination and diagnosed retrochorial hematoma. The comparison group consisted of 80 pregnant women with the threat of early termination, but without retrochorial hematoma. The control group included 30 conditionally healthy women with a physiological course of pregnancy. All groups were comparable in age and parity. During ultrasound scanning in the first trimester, the localization of the fetal egg, its size, thickness and echogenicity of the chorion, the diameter of the yolk sac and the echogenicity of its walls were evaluated, attention was paid to the location, volume, and duration of hematoma manifestation. Results and discussion. Pregnant women with the threat of termination at the time of examination had clinical signs of threatening miscarriage. In the women of the main group with the formation of retrochorial hematoma in the first trimester, a certain clinical picture was observed: in 85.0% of cases – pain syndrome, in 71.0% – increased uterine tone and in 42.0% of cases – episodes of bloody discharge. In patients of the comparison group with the threat of termination of pregnancy, but without the formation of retrochorial hematoma, the incidence of pain syndrome was 86.3%, increased uterine tone – 77.5%, bleeding from the genital tract – 46.3%. Pregnant women with retrochorial hematoma have a higher incidence of pathology of extraembryonic formations (chorion, yolk sac). Prognostically unfavorable ultrasound signs are the formation of a retrochorial hematoma up to 6 weeks, a delay in coccygeal-parietal size of the embryo for more than 7 days, corporeal localization and a large volume of hematoma, a violation of uterine blood flow. Normal uterine blood flow was observed in all women of the control group. In patients of the comparison group, blood flow disorders were recorded in 29 (37.2%) women (p=0.000). In the main group of patients with retrochorial hematoma, uterine blood flow disorders were noted in 60 (60.0%) women (p=0.000). Conclusion. Pregnant women with retrochorial hematoma in the first trimester have a higher incidence of pathology of extraembryonic formations (chorion, yolk sac). Prognostically unfavorable ultrasound signs are the formation of a retrochorial hematoma up to 6 weeks, a delay in coccygeal-parietal size of the embryo for more than 7 days, corporeal localization and a large volume of hematoma, a violation of uterine blood flow

Комбінований пренатальний скринінг І триместру вагітності як прогностичний маркер розвитку «великих акушерських синдромів»

Purpose - to conduct an analysis of the combined prenatal screening of the trimester I of pregnancy in women who had complications from the group of great obstetric syndromes. Materials and methods. A retrospective statistical analysis of the combined prenatal screening of the trimester I was carried out. Of the 239 pregnant women (Group I - main) who had complications from the group of great obstetric syndromes, according to the data of the pregnancy monitoring exchange cards, combined prenatal screening of the trimester I was carried out in 65.3% of pregnant women, which amounted to 156 pregnant women who were divided into three subgroups: Ia (n=74) pregnant women with severe preeclampsia, Ib (n=40) pregnant women with placental insufficiency, clinically verified fetal growth retardation; Ic (n=42) of pregnant women with spontaneous premature birth in the gestation period of 22-36 weeks. The control group (CG) was 56 practically healthy pregnant women with a healthy reproductive history and an uncomplicated course of this pregnancy. Statistical processing of the research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. In the Group I, the average term of trimester I screening was 12 weeks 3±4 days, in the CG - 12 weeks 1±3 days, the difference in the gestational term of the trimester I combined screening was statistically insignificant. The lowest level of PAPP-A was determined in subgroups Ia and subgroup Ic. In the Group I, the level of PAPP-A was on average 2.16 (1.35-3.24) IU/l and 0.836 (0.571-1.14) MoM, and in CG - 2.62 (1.82-4, 12) MO/l and 1.16 (0.786-1.7) MoM. According to the relative number of patients with a level of PAPP-A <0.5 MoM, no significant differences were found between the Group I and CG, but in subgroup Ib the percent of such patients was the highest, which is significantly more than in CG. More significant differences were found at the level of PAPP-A <0.3 MoM: in Group I there were 11 (7.05%) patients with a level of PAPP-A <0.3 MoM, in CG - 1 (1.78%). The number of patients with a level of PAPP-A >1.5 MoM, on the contrary, turned out to be the largest in CG - 15 (26.8%) compared to 23 (14.7%) in the Group I and with subgroup Ia - 9 (12.2%). The level of β-hCG in the studied groups was not statistically significant. There was no statistically significant difference in the thickness of the nuchal translucency, but in the Group I this indicator was slightly higher. The largest nuchal translucency value was in subgroup 1b. There were no statistically significant differences in the frequency of the absence of imaging of the nasal bone during ultrasound screening. According to the frequency of detection of reverse blood flow in the ductus venosus, it was not possible to detect statistically significant differences. This sign occurred only in 3 (1.92%) patients of the Group 1 (1 patient in each subgroup) and in 1 (1.78%) patient of CG. Conclusions. In patients who later developed pregnancy complications belonging to the group of great obstetric syndromes, in the trimester I, a number of prenatal screening indicators differ from those in patients with a physiological course of pregnancy. When conducting a standard set of prenatal diagnostics, the most significant differences were found in the level of PAPP-A (MoM). The results obtained during the analysis of PAPP-A are promising from the point of view of using this parameter as an element of the prognostic model of great obstetric syndromes for the successful course of pregnancy and the birth of a child with a normal body weight. 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.

Сравнительный анализ качества сна здоровых девушек и женщин в период гестации

Background: Sleep disorders during pregnancy pose a real threat to the mother and fetus due to a violation of the physiological course of the gestation process, the release of melatonin (central and peripheral). The aim of the study:Comparative evaluation of sleep and chronotype indicators in healthy pregnant and healthy non-pregnant women. Materials and methods: There was conducted a voluntary survey of 210 relatively healthy non-pregnant girls (medical students), the average age was 20±3.5 years, and 69 women with physiological pregnancy (the average age was 29.69±5.03 years) according to the Russian version of the Munich Chronotype Questionnaire in the conditions of Vladikavkaz without a block of subjective self-assessment of the chronotype. 100 people were randomly selected from a group of healthy girls –group 1; pregnant women were divided by trimesters: group 2 (I trimester, 10 women), group 3 (II trimester, 20 women), group 4 – (III trimester, 39 women). Integral indicators were calculated on weekends and working days: the middle and duration of sleep, wake-up time, "jetlag" (desynchronosis), and the chronotype was estimated. Statistical processing was carried out by methods of variational statistics IBM SPSS 23 and Statistica 10.0. Results: Physiological pregnancy is characterized by a statistically significant improvement in sleep indicators, a shift in the middle of sleep to the period of maximum melatonin concentration, a decrease in sleep deficit on working days, and a reduction in jet lag. The increase in sleep duration noted in pregnant women prevents a number of physical and mental health disorders associated with the secretion of melatonin and the restructuring of the NEIM system. In all trimesters of pregnancy, an intermediate chronotype (ImCht) was determined – a "medium" chronotype, in non-pregnant women – a slightly late chronotype (SLCht) – a "slightly late" chronotype, which also speaks in favor of greater sleep stability during the physiological course of pregnancy. Conclusion: The use of the Munich Chronotype Questionnaire (MCTQ) in pregnant women allowed us to determine the trends of physiological changes in normal sleep indicators.

The role of coagulation hemostasis for development of early-onset preeclampsia in low-risk patients

Aim: to determine a role of specific parameters of coagulation hemostasis for development of severe early-onset preeclampsia (еPE) in low-risk patients.Materials and Methods. A single-center prospective study included 40 patients with a physiological course of pregnancy and term delivery (control group) as well as 41 pregnant women with developed severe еPE (study group). Patients at the gestational age of 19–21 and 27–28 weeks in the comparison groups were examined for serum tissue factor (TF) activity; tissue factor pathway inhibitor (TFPI) and potential to generate thrombin in calibrated thrombography test.Results. Patients with developed ePE vs. control group were found to have significantly increased TF activity at both time points: 49.1 pmol/ml vs. 5.3 pmol/ml (p < 0.0001) and 56.7 pmol/ml vs. 6.6 pmol/ml (p < 0.0001); respectively. At gestational age of 19–21 weeks; patients in the study vs. control group had serum TFPI level significantly lower (1.1 U/ml vs. 1.6 U/ml; p < 0.0001) that was significant elevated up to 2.1 U/ml by 82 % at 27–28 weeks of pregnancy. At both time points; a significantly increased thrombin generation was detected in women with developed ePE.Conclusion. The development of ePE is characterized by increased potential to generate thrombin. TF has been identified as a more sensitive marker of activated coagulation hemostasis; and its significantly increased activity was recorded at gestational age of 19–21 weeks that allows us to consider TF as a prognostic biomarker.

The health status of children born to mothers with preeclampsia

Purpose. Study of perinatal and neonatal outcomes in newborns born to mothers with preeclampsia.Characteristics of children and research methods. Perinatal outcomes were analyzed in 559 mother–newborn pairs divided into 2 groups: Group 1 included 200 children to mothers with preeclampsia (143 with moderate and 57 with severe preeclampsia). Group 2 was composed of 359 newborns to mothers with a physiological course of pregnancy. The medical history, features of the course of pregnancy, delivery, and the early neonatal period were analyzed. The condition of newborns was assessed on the Apgar scale at 1 and 5 minutes, the assessment of physical development — using centile tables for full-term and premature newborns (INTERGROWTH-21st), the assessment of neuromuscular and physical maturity on the Ballard scale.Results. The study showed that children born to mothers with preeclampsia are significantly more likely to have metabolic and hematological disorders, a higher risk of developing infectious and inflammatory diseases, and a direct correlation with the period of manifestation and severity of preeclampsia. The higher occurrence of these conditions and the structure of pathological changes in the neonatal period led to a longer stay of children of this group after birth at newborn intensive care units, and also required observation at the second stage of nursing.Conclusion. Preeclampsia is a risk factor for neonatal complications. The identified features of adaptation in newborns from patients with preeclampsia and the structure of pathological conditions in the early neonatal period should determine the management tactics and timeliness of treatment and diagnostic measures aimed at improving the provision of medical care to the pregnant woman and subsequently the newborn.

BLOOD MINERAL PROFILE IN NEWBORN CALVES WITH INTRAUTERINE GROWTH RETARDATION

Widespread intrauterine growth retardation of embryo and fetal (IUGR) in cattle and its negative effects on postnatal growth and offspring health threaten the economic sustainability of livestock production. IUGR calves often exhibit birth weight deficits, early death, metabolic abnormalities, low growth rate, and poor feed utilization. Effective correction of these disorders is impossible without a detailed study of the causes, mechanisms of development and consequences of IUGR. In the present work, a comparative analysis of the content of macrominerals and trace elements in the blood of newborn Simmental calves with IUGR (Group I, n = 20) and the physiological course of pregnancy in their mothers (Group II, n = 20) was carried out. Blood for studies in calves was obtained at 1 day of age, before the 4th feeding of colostrum. The content of sodium, potassium, calcium and magnesium in blood serum samples and the content of iron, copper, zinc, manganese, cobalt and selenium in whole blood samples were studied by atomic absorption spectrometry (AA6300, Shimadzu, Japan). Group I calves had increased serum potassium (by 6.7%, P = 0.022) and magnesium (by 6.3%, P = 0.004) and decreased sodium (by 4.3%, P = 0. 005), reduced whole blood selenium (by 41.0%, P = 0.0001), copper (by 23.6%, P = 0.0001), and manganese (by 23.4%, P = 0.005) compared with Group II animals. The blood content of the other minerals studied did not differ significantly between the groups. The possible causes and consequences of the identified disorders of the mineral blood profile in newborn calves with IUGR were analyzed.

Clinical and anthropometric parallels in the diagnostics of pyelonephritis in pregnant women

BACKGROUND: The most dangerous disease in the structure of urinary tract infections during pregnancy is pyelonephritis. Favorable ground for its occurrence is created by anatomical and physiological changes in the urinary system in pregnant women against the background of gestational restructuring of the body. It seems very relevant to study the constitutional features of pregnant women with pyelonephritis and reference points - markers associated with the risk of developing pyelonephritis, the individual characteristics of its course and the effectiveness of therapy using the fundamental basis of clinical anthropology.
 AIM: Evaluation and comparative analysis of anthropometric and bioelectrical impedance body parameters in pregnant women with pyelonephritis.
 MATERIALS AND METHODS: The study included 94 pregnant women with pyelonephritis hospitalized in the urological department of the Clinical Regional Hospital (Krasnoyarsk) from 2019 to 2021. In addition to traditional tests, anthropometric and bioelectrical impedance analysis was carried out to assess the constitutional features and criteria of normal and pathological variability boundaries of pregnant women with pyelonephritis. The control group included 39 women with physiological course of pregnancy without urological diseases.
 RESULTS: The constitutional identification in the group of women with pyelonephritis in pregnancy was dominated by the mesomorph body type, with a smaller proportion presenting the endomorph type and the rarely detected central and ectomorph types. Vector analysis of soma components in pregnant women with pyelonephritis are characterized by high mesomorph scores reflecting the degree of skeletal and muscular development compared to the control group, with the lowest ectomorph values. According to bioelectrical impedance analysis, most patients have significant differences in a number of body composition parameters. Morphometric features of the pelvicalyceal system on the affected side are most prominent in the representatives of endomorph and central body types. There are significant correlations between the degree of pelvicalyceal system dilatation on the affected side and anthropometric and bioimpedance parameters of body composition.
 CONCLUSION: The study revealed a number of clinical and anthropometric parallels and constitutional features of pregnant women with pyelonephritis with the characteristics of the component body composition. Relationships have been established between various indicators, which at first glance are not related to each other, but have a significant impact on the clinical manifestations of gestational pyelonephritis. The results of the pilot study and further development of the methodology will make it possible to determine the most significant constitutional predictors of the development of pyelonephritis in pregnancy and the possibility of conducting preventive therapy.

The interplay of hormonal and infectious factors in the pathogenesis of complicated pregnancy

Introduction. The causes for adverse pregnancy outcomes are usually complex and, in some cases, can worsen each other.Aim. To assess the role and establish the interplay of hormonal and infectious factors in the pathological course of pregnancy in women with threatened spontaneous miscarriage.Materials and methods. A total 120 pregnant women were enrolled for the observational prospective study, in which they were divided into 4 groups. Group 1 included 32 patients with threatened spontaneous miscarriage and hyperandrogenism (HA), who received glucocorticosteroids (GCS); group 2 included 28 patients with threatened spontaneous miscarriage and HA, who did not receive GCS; group 3 included 30 patients with threatened spontaneous miscarriage without HA; group 4 (control) included 30 women with a physiological course of pregnancy. The following examination methods were used: clinical assessment of the course of pregnancy; measurement of the serum levels of dehydroepiandrosterone sulfate (DHEA-S), 17-hydroxyprogesterone (17-OHP) and total testosterone at weeks 5 to 8, 9 to 12, 13 to 18, 19 to 24 and 25 to 32 of gestation; microbiological tests of vaginal discharge.Results. The evaluation of androgenic status showed that the levels of the tested hormonal parameters in women with HA significantly exceeded those of the control group, while the changes in 17-OHP and testosterone secretion was comparable to that in women without HA, and DHEA-S level decreased to control values by the third trimester. The use of corticosteroids was associated with significant changes in the values and secretion levels of 17-OHP and DHEA-S, but not testosterone; DHEA-S levels decreased to the values that were significantly lower as compared to all groups in the third trimester of pregnancy.Conclusions. Vaginal infections play an important role in the genesis of gestational failures. Hyperandrogenism exacerbates the problem of miscarriage, however, the use of corticosteroids does not result in improved hormonal characteristics and clinical pregnancy outcomes, deteriorating the vaginal biocenosis.

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.

Эндотелиальная дисфункция при окклюзиях ретинальных вен

Purpose. To conduct a comparative analysis of the level of markers of endothelial dysfunction (ED) in women with retinal vein occlusion (RVO) and preeclampsia. Material and methods. The main group included 16 non-pregnant women with RVO (16 eyes). Their age ranged from 34 to 45 years (average 38±3.4 years). The 1st comparison group was formed by 30 pregnant women with preeclampsia (60 eyes). Their age varied from 22 to 43 years (30±6.9 years). The 2nd comparison group was formed by 20 women with a physiological course of pregnancy of comparable age and duration of pregnancy. The control group included 20 somatically healthy nonpregnant women (40 eyes). ED markers were studied twice in the 1st and 2nd comparison groups (III trimester of pregnancy and 6–8 months after delivery). In the main and control groups – once. Results. The levels of von Willebrand factor and endothelin-1, which are the main markers for the development of ED, turned out to be high both in women of the main group (110.3±29.2% and 2.6±0.4 ng/ml, respectively) and in the 1st comparison groups (109.3±33.2% and 2.69±1.49 ng/ml, respectively). They differed statistically significantly from the control group and the 2nd comparison group (66.5±12.4%, 0.86±0.25 ng/ml and 64.3±7.3%, 0.96±0.28 ng/ml, respectively).

CHANGESINIMMUNOLOGY STATUS IN PREGNANT WOMEN WITH EARLY GESTOSES

One of the frequent complications of early terms of pregnancy is vomiting in pregnant women, which causes have not been studied sufficiently. The signs of early gestosis usually appear from the 4-9th week of pregnancy and decrease up to the 16th week. At the moment, there is no tendency for early gestoses to decrease their frequency. In the last years, huge significance for early gestosis lies in the disordered immune system in a pregnant woman. On the 4-5th week of pregnancy, the mother’s body gets antigens from the fetus that contributes to early gestosis.
 Aim of the research. Study features of immune-mediated inflammatory disorders during the early gestoses of different severity degrees.
 Materials and methods. We examined 120 females. The control group consisted of 30 women with the physiologic course of pregnancy. The main group had 90 pregnant females with present early gestoses of different severity degrees: the 1st one had 30 pregnant patients with present vomiting of a mild degree, the 2nd one – 30 females with early gestoses of moderate degree, the 3rd one – 30 women with early gestoses with the severe course. Inclusion criteria to the main group were considered the age of the patients from 18 to 40 years, present vomiting, present intrauterine singleton pregnancy, patient’s consent to the research, pregnancy term of 4-12 weeks. Exclusion criteria were gastrointestinal and hepatic diseases of different etiology in anamnesis, the patients younger than 18 years old and older than 40 years old, present oncologic diseases, ectopic pregnancy, patients with surgical intervention on the pelvic organs in anamnesis, pregnant women with IVF, present multiple pregnancy, present neuropsychiatric pathology, absent patient’s consent to the research, pregnancy term more than 12 weeks. In blood serum, the examinees had tested cytokine level, which regulated immune-mediated inflammatory response (IL-10, IL-6) on the STAT FAX 303/PLUS Microstrip Reader in the private certified laboratory PrimaMED (Ivano-Frankivsk).
 Results of the research. We tested levels of pro- and anti-inflammatory cytokines, vascular endothelial growth factors in blood serum in pregnant women with present early gestosis dependently on severity degree. Pregnant females with vomiting of several degrees have distorted humoral immune responses. This is seen provably by misbalanced pro- and anti-inflammatory cytokine levels in blood serum. The pro- and anti-inflammatory cytokine levels in pregnant patients with early gestoses depend on the severity of early gestoses. In the group of pregnant women with the mild course, we observed the lowest average values of IL-6 and the highest IL-10 level in blood serum. The females with moderate degree presented a probable decrease of IL-10 levels in 7.3 % and a significant increase of IL-6 levels in 5.5 % compared to the indices in females of the 1st group. The clearest misbalance in pro- and anti-inflammatory cytokines was registered in pregnant women of the 3rd group (severe degree). The women from this group presented a probable decrease of IL-10 level in 22.0% and a significant increase of IL-6 level in 14.8% compared to the indices in females from the 2nd group.
 Conclusions:
 
 The signs of early gestosis are associated with induction of inflammation.
 There are close direct correlations between severity degrees of early gestosis and IL-10 levels and inverse correlations with IL-6 levels. In females with signs of severe early gestosis in blood serum, we recorded a probable decrease of IL-10 levels and a probable increase of IL-6 levels compared to the values in females with mild and moderate early gestosis.

Optimization of early markers for the diagnosis of preeclampsia on the background of metabolic syndrome

Annotation. Preeclampsia remains a mysterious puzzle for clinicians and researchers who have been uncovering it for decades. The search for new modern diagnostic markers for the possibility of early prevention of this complication will facilitate the course of pregnancy and childbirth. Preeclampsia can affect 2-8% of all pregnancies. The study of angiogenic biomarkers to stratify the risk of disease is the aim of our study. Patients are divided into groups due to the severity of preeclampsia. Group I included 26 pregnant women with moderate preeclampsia, diastolic blood pressure was up to 90 m Hg, to group II – 20 pregnant women with moderate preeclampsia, the level of diastolic pressure was up to 99 m Hg. The third group included pregnant women in whom the physiological course of pregnancy without complications and concomitant extragenital pathology. Inhibin A levels were determined using a Beckmann Coulter analyzer and test system (Germany); ELISA Testkit, Access-Inhibin A Kit by Beckmann Coulter, the concentration of vitamin D in the serum of patients was determined using an analyzer and test system Immulite (Siemens AG, Germany). Statistical analysis of the obtained results was performed minus the mean value (M) and the standard error of the mean value (m). Qualitative indicators are presented in the form of %. Comparison of quantitative indicators with normal distribution was performed by Student’s t test (p<0.05), and with abnormal distribution in unrelated samples – using Mann-Whitney test (U test), comparison of relative values – using χ2 (chi) -square). A significant relationship (p=0.041) was found between inhibin A levels and the occurrence of preeclampsia. Vitamin D deficiency (24.5±1.01 ng/ml) was also found in women in the study groups. The level of placental growth factor in all women in the first trimester of pregnancy was 45.93±11.74 pg/ml, which corresponds to normal values. The mean level of insulin-like growth factor was reduced (120.87±4.12 ng/ml) compared with the control group (224.1±6.24 ng/ml). Thus, increased inhibin A, decreased IGF, and vitamin D deficiency may be a marker for a patient at risk for preeclampsia.

Морфологічні особливості плаценти від вагітних з плацентарною дисфункцією, обумовленою цукровим діабетом

The purpose of the study was to conduct a comparative analysis of morphological examination of the placenta depending on the type of diabetes in pregnant women with placental dysfunction. Materials and methods. To analyze the morphological changes of the placenta in pregnant women with various forms of diabetes, 50 placentas were studied. The age of patients ranged from 22 to 39 years. All placentas were divided into three groups according to the objectives of the study: group I – 20 placentas, after childbirth in women with pre-gestational diabetes; group II – 20 placentas, after childbirth in women with gestational diabetes; group III (control) – 10 placentas, after childbirth in women with physiological course of pregnancy. The presence of placental dysfunction in pregnant women was determined using ultrasound and Doppler examination of the fetoplacental complex, the data of hormonal and immunological studies. After delivery, the placentas were weighed, thickness and diameter were measured, an external evaluation was carried out, attention was paid to the presence of infarctions, the development of connective tissue, the number of cotyledons, and the features of umbilical cord attachment. In histological preparations, the diameter of villi, the number of capillaries, syncytial nodules, the number of capillaries in villi were calculated, focusing on the methods described for assessing the placentas in diabetes mellitus. Results and discussion. Macroscopic examination in the control group showed that 90% of placentas did not have pathological changes, cotyledons were clearly separated, umbilical cord discharge in 7 placentas was central; infarctions and thinning of some cotyledons were visualized in 1 (10%) placenta. Macroscopic examination of the placentas of women with pre-gestational diabetes showed increased weight compared to the control group (748.8±48.5 g versus 643.2±57.0 g, p <0.05) and diameter (25.5±2.3 cm versus 22.8±2.1, p> 0.05) of placentas, which is a characteristic manifestation of diabetic pathology. The average number of cotyledons also differed significantly from the indicators of the control group (12.8±3.2 and 9.3±1.2, respectively, p <0.05). The number of visible infarctions and thinning of individual cotyledons of the placentas did not exceed 20%. Macroscopic examination of the placentas after childbirth in women with gestational diabetes revealed changes similar to group I, but less pronounced: the weight of the placenta was significantly higher compared to the control group (720.2±20.5 and 643.2±57.0, respectively, p <0.05), the number of cotyledons exceeded the control indicators, but this difference was not significant, and the number of infarctions and thickenings did not differ from the control group. Conclusion. Morphological examination of the placentas revealed typical changes for diabetes, which are the result of hypoxia and prolonged dyscirculation: an increase in weight, placenta size, the number of cotyledons at the macroscopic level. Microscopic examination revealed an increase in villi, vessels in villi, thinning of the placental barrier, fibrinoid deposition. The changes were more pronounced in placentas obtained after childbirth in women with pre-gestational diabetes, which is a more severe pathology. Stimulation of childbirth led to minor dyscirculatory disorders in some placentas (vasodilation and plethora)

ОСОБЕННОСТИ СТОМАТОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЙ ПРИ НАРУШЕНИИ В АКУШЕРСКО-ГИНЕКОЛОГИЧЕСКОМ СТАТУСЕ У ЖЕНЩИН С ОТЕКАМИ, ВЫЗВАННЫМИ БЕРЕМЕННОСТЬЮ

Introduction. The course of dental diseases in pregnant women is significantly affected by extragenital pathology, recorded in 95% of pregnant women and 40% of non-pregnant women of reproductive age.
 Objectives: to identify the relationship between changes in obstetric and gynecological status in women with edema caused by pregnancy and the frequency of dental diseases.
 Materials and methods. The study groups included 127 pregnant women, including 79 women with edema caused by pregnancy, which made up the 1st group and 48 women with the physiological course of pregnancy, who were included in the 2nd group. The dental status (indices of the CPU, PMA, IZN, the structure of gingivitis), anthropometric data, somatic complications, the results of a general blood test, analysis of coagulogram indicators, analysis of biochemical parameters of the blood of pregnant women, and a general analysis of urine were studied.
 Conclusion. When studying the relationship between dental status and somatic obstetric and gynecological pathology in pregnant women with diagnosed edema caused by pregnancy, gingivitis is often recorded in the oral cavity, the prevalence of diseases of the urinary system, which were detected in 36.7%, was diagnosed in second place, chronic arterial hypertension 15.2%, in the third – iron deficiency anemia 13.9%. Our data indicate that the complication of the course of the third trimester of pregnancy with edema is accompanied by a deterioration in periodontal status, oral hygiene, and a 100% prevalence of gingivitis.

Clinical and Genetic Characteristics of Preeclampsia.

Preeclampsia (PE) is a severe complication of pregnancy accompanied by arterial hypertension, edema, or proteinuria with impaired functioning of various organs and systems. It is also an important medical and social problem, which has been one of the leading causes of maternal and perinatal mortality and morbidity worldwide. Despite the achievements of modern medicine, the etiology of this pathology is still unknown. Recently, many scientists have especially focused on the study of genetic factors underlying the etiopathogenesis of PE, namely, the contribution of individual polymorphic loci of various candidate genes. The current study aimed to investigate the clinical characteristics of PE and the contribution of the polymorphic loci rs1042838 of Progesterone Receptor (PGR) gene and rs8068318 of the T-Box Transcription Factor 2 (TBX2) gene to the development of PE. The study was conducted on 219 women with PE with the mean±SD age of 26.52±5.51 years and 329 women with the physiological course of pregnancy as the control group with the mean±SD age of 26.27±4.88 years. In total, 64.20%, 68.29%, 16.44%, 98.63%, and 35.48% of women with PE had increased systolic and normal diastolic blood pressure (SBP and DBP) values, proteinuria, edema, and overweight (BMI≥25), respectively. In the control group, 100%, 1.53%, 1.12%, and 35.48% of cases had normal SBP values with no proteinuria, DBP>90 mm Hg, edema, and overweight (BMI≥25), respectively. An association was observed between the CC genotype of the rs8068318 polymorphism of the TBX2 gene with the risk of developing PE in women with PE (OR=2.12, 95%CI: 1.14-3.92, P=0.02). In addition, there was an association between the rs8068318 TBX2 polymorphic locus with lower SBP (Me=140, Q25 - Q75 130 - 142.5, P=0.01) and PBP (Me=50, Q25 - Q75 40 - 55, P<0.01). According to the GeneCards database, the TBX2 gene, a member of a phylogenetically conserved gene family, is located on the long arm of chromosome 17 and encodes the TBX2 T-box transcription factor protein, which is a regulator of the transcriptional activity of various genes (i.e., it suppresses the expression of CDKN2A (p19/ARF), inhibits cyclin-dependent kinase p21 Cip1 (CDKN1A), and affects the expression of MYC, RAS, BRCA1, and BRCA2 genes).

The prediction of different phenotypes of preeclampsia in the first trimester of pregnancy (two-center retrospective study)

AIM: The aim of this study was to determine the effectiveness of predicting the development of placental or maternal preeclampsia (PE) by clinical and anamnestic risk factors and results of the combined screening in first trimester of pregnancy.&#x0D; MATERIALS AND METHODS: This two-center retrospective case-control study included the data analysis of somatic status, the obstetric and gynecologic anamnesis, and the results of the combined screening of 373 women in the first trimester of pregnancy. The control group consisted of 200 women with physiological course of pregnancy and labor. The main group comprised 173 patients whose pregnancy was complicated by early-onset (n = 44, 25%) or severe late-onset (n = 129, 75%) PE. We analyzed more than 100 clinical and anamnestic risk factors for PE implementation and evaluated the risk of developing PE at 11.0-13.6 weeks of gestation using the Fetal Medicine Foundation calculator.&#x0D; RESULTS: Maternal risk factors for PE development are identical for clinical phenotypes, except for the family anamnesis of arterial vascular accidents in first-line relatives under 45 years of age, which are significantly interfaced to risk of placental PE development (OR 6.38, 95% CI 2.002.28; p = 0.0017). A comprehensive assessment of clinical and anamnestic data at 11.0-13.6 weeks of gestation allows for predicting the implementation of maternal severe PE in 36.7% of cases and placental PE in 29.6% of cases with an identical false positive rate of 10.5%. Carrying out the combined screening in the first trimester allows for determining the risk of PE development up to 37 weeks without differentiation by clinical phenotypes, with a test sensitivity of 53.9% at a false positive rate of 34.7%.&#x0D; CONCLUSIONS: The prediction of placental or maternal PE development in the first trimester of pregnancy is possible only by maternal, clinical and anamnestic risk factors with a low predictive value of the test. Carrying out the combined screening with the inclusion of maternal risk factors, uterine artery pulsation index and pregnancy-associated plasma protein-A level increases the predictive value of the test for PE development up to 37 weeks from 37.6% to 53.6% at a high rate of false positive results. Validation of medical technologies for predicting clinical PE phenotypes in the population of women, taking into account a territorial origin and risk factors, will allow for defining the shortcomings of the model and improving its predictive value.

Antiphospholipid antibodies, genetic thrombophilia and fetal growth retardation

Aim: to study the role of antiphospholipid antibodies (AРA) and genetic thrombophilia as a potential cause of the development or a component in the pathogenesis of early and late fetal growth retardation (FGR).Materials and Methods. There was conducted a prospective randomized controlled trial with 118 women enrolled. The main group consisted of 83 patients, whose pregnancy was complicated by FGR degrees II and III, stratified into two groups: group 1 – 36 pregnant women with early FGR, group 2 – 47 pregnant women with late FGR. Women were subdivided into subgroups according to the FGR severity. The control group consisted of 35 pregnant women with a physiological course of pregnancy. АРА were determined according to the Sydney antiphospholipid syndrome criteria by enzyme immunoassay (ELISA): against cardiolipin, β2 -glycoprotein 1, annexin V, prothrombin, etc. (IgG/IgM isotypes); lupus anticoagulant – by the three-stage method with Russell's viper venom; antithrombin III and protein C levels – by chromogenic method; prothrombin gene polymorphisms G20210A and factor V Leiden – by polymerase chain reaction; homocysteine level – by ELISA.Results. AРA circulation (medium and high titers), genetic thrombophilic defects and/or hyperhomocysteinemia were detected in 40 (48.2 %) patients with FGR, which was significantly higher than that in the control group (p &lt; 0.05): in group 1 (41.7 % of women) AРA (30.6 %) and AРA with genetic thrombophilia or hyperhomocysteinemia (11.1 %) were revealed; in group 2 (51.1 % of women) AРA (21.3 %), AРA with hyperhomocysteinemia (4.3 %), genetic thrombophilia (25.5 %), and due to hyperhomocysteinemia (2.1 %) were found. No differences in prevalence of thrombophilia rate in patients were observed related to FGR severity, but a correlation between the FGR severity and AРA titers was found.Conclusion. Testing for the presence of AРA, genetic thrombophilia and hyperhomocysteinemia should be recommended for patients with FGR (including those with FGR in medical history), especially in the case of its early onset. It is recommended to determine the full AРA spectrum.

Soluble PD-L1 and B7-H4 serum levels during the course of physiological pregnancy.

The aim of this study was to evaluate the soluble programmed death-ligand (sPD-L1) and soluble B7-H4 (sB7-H4) serum concentration levels longitudinal throughout the three trimesters of uncomplicated pregnancies. METHOD OF THE STUDY: sPD-L1 and sB7-H4 levels were determined with enzyme-linked immunosorbent assay (ELISA). The patients (n=26) were divided into three groups according to the pregnancy trimester. Among 26 women involved in the study 14 had longitudinal sB7-H4 and sPD-L1 measurements in each trimester of pregnancy. During the course of pregnancy, the sB7-H4 blood serum levels were significant higher in second trimester than in first and third trimester, whereas sPD-L1 levels increased significantly over the course of pregnancy. The highest serum levels of sPD-L1 in the third trimester suggest increasing suppression of maternal immunity throughout pregnancy, whereas elevated sB7-H4 concentration levels in second trimester suggests different profile of T-cell regulation in physiological pregnancy.

Assessment of the vitamin d levels effect on the course of the first trimester of pregnancy

Introduction. The course of physiological pregnancy is provided by many complementary factors. Thus, a deficiency in one of the links of the metabolic network contributes to the development of an imbalance in the work of the whole organism, which ensures the growth and development of the embryo from the first days of gestation. It has been proven that vitamin D can act as an immune regulator during implantation, providing a protective effect in whole period of pregnancy.Aim. The aim of this study is assessed the features of the course of pregnancy in patients with different levels of vitamin D in the blood in the first trimester.Materials and methods. A prospective multicenter randomized study was conducted in the North-West region of the Russian Federation among 88 pregnant women in the first trimester of gestation (up to 13 weeks). All patients were divided into 3 groups depending on the initial level of vitamin D (group 1–14 women with a 25(OH)D &lt; 10 ng/ml, group 2–62 pregnant women from 10 to 30ng/ml, group 3–12 pregnant women with a vitamin D content &gt; 30 ng/ml).Results. In group 1.86% of patients with severe vitamin D deficiency were diagnosed with threatened miscarriage, which is significantly higher than in group 3 (85.7% and 33.3%, χ2 = 7.490, p = 0.007). At the same time, retrochorial hematoma in group 1 occurred 3.5 times more often than in group 3 (57.1% and 16.67%, respectively, χ2 = 4.473, p = 0.035). Subsequently, every 4th woman from the group with vitamin D deficiency gave birth earlier than expected, which was not observed among patients from group 3 (25%, 0%, χ2 = 1.231, p = 0.268).Conclusion. Prescribing cholecalciferol vitamin replacement therapy as part of complex preserving therapy for threatening miscarriage, followed by monitoring its blood level and deviating from normal parameters, contributing to a favorable course of pregnancy and improving perinatal outcomes.

Исследование взаимосвязи состава микровезикул крови беременных с последующими плацента-ассоциированными осложнениями

Study Objective: To find the relationship between the levels of mitochondrial signal protein sequences in blood microvesicles of pregnant women and subsequent development of foetal growth retardation syndrome (FGRS), low birth-weight baby, preeclampsia (PE) or foetuses and newborns with normal weight and height. Study Design: Prospective comparative study. Materials and Methods. The microvesicular blood plasma fraction of women with placenta-associated complications in the outcome of previous pregnancies was studied as a risk group for their recurrence (n = 96). The study group was divided into 4 sub-groups: sub-group IА included 32 patients with pregnancies complicated with FGRS; sub-group IB comprised 20 patients with FGRS and PE; sub-group IC included 24 pregnant women, whose newborns were small for gestation age; sub-group ID was 20 pregnant women with a history of placenta-associated complications and abnormal Doppler velocimetry results, whose postnatal weight and height did not differ from normal values. The control group consisted of 20 women with a physiological course of pregnancy. The microvesicular fraction of the peripheral blood of the patients was obtained by differential plasma ultracentrifugation. Protein of the outer membrane of mitochondria (VDAC1), mitochondrial DNA transcription and replication activator (TFAM), recombinant protein of the outer membrane of mitochondria (MFN2), and TAZ protein encoding cardiolipin modelling in oxidative damage were measured by western blot analysis using a monoclonal antibody panel. Study Results. Plasma microvesicles in patients with subsequent placenta-associated complications demonstrated decreased levels of a number of mitochondrial proteins (VDAC1, TFAM, MFN2, OPA1). Levels of these proteins determine successful intercellular signaling on the adequate functional activity of mitochondria, their integrity and normal biogenesis. Conclusion. The obtained results allow to make a conclusion about a pronounced violation of mitochondrial biogenesis in the body of women with intrauterine growth restriction, which probably makes a serious contribution to the development of pathology and its progression. Keywords: foetal growth retardation syndrome, microvesicles, habitual abortion, placental insufficiency, preeclampsia, mitochondria, pregnancy.