Premature Termination Of Pregnancy Research Articles

FEATURES FUNCTIONING OF THE DETOXIFICATION SYSTEM AT THE THREAT TERMINATION OF PREGNANCY AS A CONSEQUENCE OF ACCUMULATION OF 137CS

To date, there is no consensus on the pathogenesis of miscarriage. In modern life, human health is signifi cantly infl uenced by environmental factors. In this regard, 37 years after the accident at the Chornobyl nuclear power plant, the question of remote cytogenetic and hereditary eff ects in the off spring of parents aff ected by radiation remains relevant. Ecosystems contaminated with radioactive substances are a source of exposure for humans. Internal irradiation is the cause of reproductive losses. Radiation stress aff ects the course of redox processes in the body. Biochemical indicators are markers of the infl uence of environmental factors on a person. The study is dedicated to determining the state of peroxide hemostasis in the case of miscarriage. Aim: to determine the peculiarities of the functioning of the detoxification system in case of miscarriage due to the accumulation of 137Cs.Material and methods. The fi rst (research) group included women with reproductive losses in anamnesis and signs oftermination of the current pregnancy; the second (control) group included women with an uncomplicated history and course of pregnancy. Additionally, the fi rst group was divided into subgroups according to pregnancy outcomes: А – 38 women who gave birth at 37-40 weeks, despite the complicated course of the current pregnancy, В – 13 women who gave birth at 28-36 weeks + 6 days, С – 9 women who birth at 22-27 weeks + 6 days. The state of peroxide hemostasis in women was studied using biochemical studies. Accumulation of 137Cs with diff erent activity was detected in the placentas of the examined women of both groups using β-spectrometry. Morphological examination of placentas was performed according to the protocol. The severity of placental damage was studied by Olympus BX51 and Axioskop 40 microscopes. Analyzing the results revealed a relationship between biochemical indicators, the activity of 137Cs, and pregnancy scenarios. Statistical data analysis was performed using Microsoft Excel (2016) and Fisher angular transformation. The diff erence between comparative values was considered signifi cant at p < 0.05 (probability index greater than 95 %). Permission to conduct research was obtained from the Medical Ethics Committee of the SI «Institute of Pediatrics, Obstetrics, and Gynecology named academic Elena M. Lukyanova of the National Аcademy of Мedical Sciences of Ukraine» (protocol No 3 of 07.06.2017).Scientifi c research work is to «Develop the latest and improve existing technologies for diagnosis, prevention, and treatmentof premature termination of pregnancy in women with miscarriage taking into account the passport of the placenta» (2018-2020). Code VN.20.00.02.18, state registration number 0118U000039, KPKV 6561040.Results. It has been confi rmed that the state of the environment plays a decisive role in the pathogenesis of miscarriage. Ithas been proven that placental dysfunction caused by abnormal oxidative stress due to the action of incorporated 137Cs leads to pregnancy termination. As a result of the depletion of the antioxidant reserve, the compensatory capabilities of the placenta decrease. It was established that activity in the placenta up to 1.0 Bq/kg of 137Cs does not aff ect the course of gestation. The compensatory capacity of the placenta remains preserved even with the accumulation of 1.1 to 4.4 Bq/kg of 137Cs. At the same time, it is possible to prolong the pregnancy until the term of timely delivery. Internal irradiation with an activity of 4.5-10.4 Bq/kg of 137Cs causes damage to the stroma of the maternal surface of the placenta and premature birth at 28-36 weeks + 6 days. At the same time, newborns are viable due to the preservation of compensatory reactions in the placenta. Accumulation of more than 10.4 Bq/kg of 137Cs causes antenatal death of the fetus and early premature birth due to damage to maternal and fetal structures of the placenta. An increase in the content of malondialdehyde and a decrease in the activity of superoxide dismutase in the blood indicate the severity of radiation damage.Conclusions. Internal exposure to 137Cs disrupts the architecture and functional capacity of the placenta. Extreme eff ectsdepend on the activity of 137Cs, the compensatory capabilities of the placenta, and the pregnant woman’s body. Activation of lipid peroxidation acts as a biochemical amplifi er of radiation exposure. An increase in the blood of malondialdehyde, diene conjugates, and free SH groups is associated with the severity of radiation damage. An early marker of primary placental dysfunction, premature birth, and antenatal fetal loss is an increase in MDA content in the blood by 12.0 % and a decrease in SOD by 6.5 % relative to permissible values. An early marker of exhaustion of the compensatory reserve is an increase in the content of MDA in the blood by 23.3 % and a decrease in SOD by more than 18.2 % relative to the permissible values. Decompensation of adaptation mechanisms in the system «mother- placenta-fetus» leads to antenatal losses.

P.144 Awake craniotomy in pregnancy: a systematic review

Background: Awake Craniotomy during pregnancy is a rare but urgent procedure. Since pregnancy can both accelerate the progression of a tumor and mask other diagnoses, cases may lead to premature termination of pregnancy. From a neurosurgical, anesthetic, and obstetrical perspective, these operations may be challenging. Methods: In accordance with the PRISMA guidelines, MEDLINE, Scopus, and Web of Science databases were searched from inception to January 3rd, 2023. Studies were included if they included pregnant patients who underwent awake craniotomy. Results: Nine papers fit the criteria for the final analysis. All investigations were case studies. A total of nine patients were included. Mean age at surgery was 26.9 years, and mean gestational age at craniotomy was 20.9 weeks. Eight (88.9%) patients underwent craniotomy for tumor resection and the other had a pseudoaneurysm repair. Glioma was the most common tumor pathology (n=5), followed by meningioma (n=1), and glioblastoma (n=1). None of the patients experienced significant intraoperative or immediate postoperative complications. There were no obstetrical complications or significant changes in fetal status during or after surgery, and all reported deliveries were successful with healthy infants. Conclusions: Awake craniotomy during pregnancy can be a safe procedure with appropriate pre-operative patient selection and extensive multidisciplinary planning.

Genetic factors of early termination of pregnancy

Pregnancy loss and premature delivery are combined by the definition Premature Termination of Pregnancy, while these conditions affect up to 5% of women of reproductive age. In some cases, genetic components are both etiologic and pathogenetic factors of premature birth, however, This challenge is further complicated by the fact that extensive population-based genetic studies and subsequent validation of the data are required, especially in multi-ethnic populations.
 Genome-wide studies will demonstrate polymorphic variants of hundreds of genes that are candidates for being associated with termination of pregnancy, including those regulating embryo implantation, pregnancy support, and immune system response. The review provides information about the genes and genetic polymorphisms that are involved in the regulation of the female reproductive system and associated with premature birth. A special role in the genetic mechanisms of miscarriage and/or preterm birth belongs to steroid hormone receptors, enzymes of the arachidonic acid metabolism, pro- and anti-inflammatory cytokines. However, the infectious factor takes the first place as a leading one, forming cause-and-effect relationships in the chain of pathogenetic links or giving modality to other factors. Most often, it is genetic polymorphisms associated with an over-activity of the immune system that underlie premature termination of pregnancy.
 Subsequent Investigation of the human genome, epigenome, and transcriptome helps to identify molecular mechanisms linked with preterm delivery and premature newborn clinical appearance in early and late neonatal life and even predict developmental outcomes. These data could be used to develop targeted interventions aimed at selecting the most effective individual treatment and rehabilitation plan. The data obtained in future studies could be used to develop for preconception care, targeted therapy and the most effective individual treatment plan.
 Keywords: genetic polymorphism; miscarriage; over-active immune responses; premature birth; premature termination of pregnancy; transcriptome.

PREVENTION OF REPRODUCTIVE LOSSES ASSOCIATED WITH INTRAPLANTAR ACCUMULATION OF RADIONUCLIDES.

to determine the effectiveness of radioprotective therapy in preventing reproductive losses and perinatal consequences associated with the incorporation of radionuclides in the placenta. According to the research design, the first group consisted of 153 women with reproductive losses in anamnesis and signs of termination of the current pregnancy. The control consisted of 30 women with a physiological pregnancy and an uncomplicated history. Based on the fact that one of the causes of premature termination of pregnancy is the vulnerable effect of 137Cs incorporated in the placenta, «Apple Pectin Antioxidant» (the «APA») with a high sorption potential was included in preventive measures regarding reproductive losses and perinatal consequences. The effectiveness of therapy with the inclusion of «Apple Pectin Antioxidant» was evaluated based on indicators of the fetoplacental complex and pregnancy scenarios. The results were compared with the effectiveness of standard treatment for habitual miscarriage of pregnancy. It was established that the destructive effect of incorporated 137Cs leads to placental dysfunction and fetal distress. Therapy with the inclusion of «APA» more significantly than standard treatment increases the progesterone-synthesizing function of the placenta, microcirculation, adaptation potential, and antioxidant protection of cells with the efficiency of 7.5 %, 10.7 %, 17.7 %, and 43.4 %, respectively. «APA» has a positive effect on the scenarios of pregnancy. «APA» in the composition of therapy to preserve pregnancy contributed to a decrease in the frequency of premature births by 11.4 % and an extension of their term to 34 weeks of gestation. Extending the gestational age of preterm birth reduced the frequency of severe asphyxia by 18.7 %, hypoxic-ischemic central nervous system injury by 13.5 %, respiratory distress by 17.3 %, and intraventricular hemorrhage 2nd and 3rd degrees by 12.7 %.All children were born alive due to the preservation of the compensatory ability of the placenta. Termination of pregnancy is a universal reaction of the mother and the fetus to negative exogenous and endogenous influences. Placental dysfunction is the most frequent cause of reproductive losses. Incorporated 137Cs is one of the factors that disturb the architecture of the placenta. Extreme effects depend on the number of incorporated 137Cs and the compensatory capacity of the placenta. Today, the possibility of internal exposure to 137Cs is associated due to consumption of agricultural products. Unfortunately, the level of food contamination with radionuclides remains higher than permissible. Living in an area with a standard radiation background does not guarantee a person the radiation safety of agricultural products. The confirmation is the accumulation of 137Cs in the placentas of women from different regions of Ukraine. The high efficiency of therapy with «APA» is associated with the removal of radionuclides and the minimization of the effect of internal irradiation, which made it possible to reduce the frequency of termination of pregnancy by 28.0 % due to the reduction of cases of premature births (-11.4 %), spontaneous abortions (-11.0 %), termination of pregnancy (-5.5 %). The «APA» is advisable to prescribe from pregravid and during pregnancy to all women, regardless of the region of residence.

Reproductive health under global warming

Reproductive health problems are attracting the attention of biomedical scientists in connection with changes in the environment. Climate change in the direction of rising temperatures is an urgent threat to human health with negative long-term effects. Under conditions of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature newborns. The priority to reduce the negative health effects of climate change is to identify most sensitive risk groups to the negative impacts of climate change on health, which include pregnant women and newborns. The strategy to prevent and reduce changes in reproductive health is based on the recognition of global warming as a risk factor that contributes to the growth of premature birth and the associated adverse effects of pregnancy.

Study of the state of the vaginal microbiota in women with risk and threat of preterm birth

The objective: to compare the state of the vaginal microbiota in women with risk of preterm birth and threat of preterm birth.Materials and methods. The study involved 150 pregnant women. The inclusion criteria for the study were the presence of risk factors for preterm birth – I group (80 women) or the threat of preterm birth – II group (70 women). The control group consisted of 20 conditionally healthy pregnant women. Ultrasound (transvaginal) examination and assessment of the state of the vaginal microbiota were carried out at 17-21+6 weeks of gestation in pregnant women in the I group and during hospitalization with a confirmed threat of pregnancy interruption at 22-35+6 weeks in pregnant women in the II group. The exclusion criterion was premature rupture of membranes confirmed by the Actium Prom test. Observation of pregnant women of the studied cohort continued until the end of pregnancy.To assess the state of the vaginal microbiota, the determination of the pH of the vaginal content, molecular biological, and bacterioscopic methods were used.Results. Bacterial vaginosis and mixed vaginitis were diagnosed in patients with a threat of premature birth significantly more often than in healthy pregnant women and pregnant women in the I group, and, accordingly, there was a much smaller rate of pregnant women with the 1st degree of vaginal cleanliness among the patients with a threat of premature birth .The frequency of detection of anaerobic dysbiosis was the highest among pregnant women in the II group with the threat of premature birth (34.3 %) compared to the pregnant women in the I group (21.3 %). Aerobic dysbiosis (aerobic vaginitis) was diagnosed only in pregnant women with a threat of premature birth (11.4 %). In the presence of dysbiotic and inflammatory changes in the microbiota of the vagina, there is a high risk of premature birth – OR=2.962 (95% CI: 1.32–6.645), while for pregnant women in the risk group of premature birth it is OR=8.120 (95% CI: 2.149 –30.686), and for pregnant women with an existing threat of premature birth – OR=10.133 (95% CI: 3.149–32.604). Candida non.albicans was mainly found in the patients with recurrent episodes of vulvovaginal candidiasis before pregnancy.Conclusions. Anaerobic and mixed dysbiosis of the vaginal microbiota is one of the risk factors for spontaneous and threatening premature births, which requires the development of diagnostic and therapeutic measures to prevent premature termination of pregnancy.

Placental dysfunction in women at risk and threat of premature delivery

Premature birth remains one of the most urgent problems of modern obstetrics. It is not possible to reliably establish the cause in 70–80% of premature births, so the search for risk factors and markers of premature termination of pregnancy is justified. According to many authors, 25–30% of women at risk of premature birth have placental dysfunction.The objective: was to assess the prevalence of placental dysfunction in women at risk of preterm birth and with preterm birth.Materials and methods. 80 pregnant women were under observation. The criteria for inclusion in the study were the presence of risk factors for premature birth – Group I (30 women) or the threat of premature birth – Group II (30 women). The control group consisted of 20 conditionally healthy pregnant women. Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum was performed at 18–21+6 and 28–30 weeks of gestation.Results. The average age of the patients was 31.4±2.5 years, there was no significant difference in age, life history, social status, somatic pathology between the formed groups. Pregnant women of groups I and II probably had a history of pelvic inflammatory disease more often than in controls; colpitis; sexually transmitted infections; pathology of the cervix and operations on the uterus and appendages. The course of this pregnancy in most of the women of the studied cohort was complicated by the threat of termination of pregnancy, 36.7% of pregnant women of the I group and 46.7% of the II group had premature births. Signs of premature ripening of the placenta were detected in 13 (43.3%) pregnant women of the experimental cohort and in 1 (5.0%) of the control group (Р<0.0001), which was accompanied by changes in parameters during dopplerometry of utero-placental blood flow. Clinical manifestations of placental dysfunction occurred in 36.7% of patients in the risk group of premature birth and pregnant women with a threat of premature birth, and were manifested by a decrease in the level of progesterone, a plateau in the increase in the level of placental lactogen. Morphological signs of placental dysfunction were found in 43.3% of cases of premature birth, which correlates with the frequency of early complications of pregnancy, primarily with the formation of retrochorial hematoma.Conclusions. Clinical manifestations of placental dysfunction (fetal growth retardation, preeclampsia) occur in a third of patients of the risk group and pregnant women with a threat of premature birth, which correlates with changes in the hormone-producing function of the placenta.

МОРФОЛОГИЧЕСКИЕ АСПЕКТЫ НЕСОСТОЯТЕЛЬНОСТИ ПЛОДНЫХ ОБОЛОЧЕК ПРИ НЕДОНОШЕННОЙ БЕРЕМЕННОСТИ ПО ДАННЫМ СКАНИРУЮЩЕЙ ЭЛЕКТРОННОЙ МИКРОСКОПИИ

Abstract. Currently, one of the most significant pathologies in obstetric practice is rupture of amniotic fluid in preterm pregnancy, which in more than 50% of cases precedes premature termination of pregnancy. This study is devoted to the study of the morphological foundations of the formation of insolvency of the membranes in preterm pregnancy. Using a Hitachi S-4500 scanning electron microscope at a magnification of 130 and 900 times, the ultrastructure of two fetal membranes (smooth chorion and amnion) was studied during physiological gestation and during pregnancy complicated by premature rupture of the fetal membranes with an anhydrous interval of not more than 6 hours and the absence of clinical and laboratory signs of the inflammatory process. The material was taken during a caesarean section. Tissue samples with dimensions of 1-4 mm are stained according to the Kranovsky method. It has been established that during a physiologically proceeding pregnancy, the outer layer of the amnion is represented by a cubic epithelium, which has a brush border on the apical part of the stellate shape. Amnion cells are tightly adjacent to each other. The inner layer of the amnion is represented by mesenchymal epithelium. The study of the ultrastructure of the smooth chorion during physiological pregnancy showed that its outer surface, in contact with the decidua, consists of tightly contacting cells with stellate microvilli. The inner surface of the smooth chorion, adjacent to the amnion, is represented by spongy tissue. The study of the ultrastructure of the fetal membranes during preterm pregnancy, complicated by prenatal rupture of amniotic fluid, made it possible to establish that the morphological basis of the failure of the fetal membranes is damage to the brush border of the amniotic epithelium and an increase in intercellular gaps in the amniotic membrane, which indicates the inferiority of the fetal membranes already at the stage of their formation.

MODERN ASPECTS OF THE ETIOPATHOGENESIS OF ISTMIC-CERVICAL INSUFFICIENCY

Isthmic-cervical insufficiency (ICI), which results in the failure of the circular muscles of the internal os, isthmus and cervix of the uterus is important in the pathogenesis of preterm birth. The existing types are anatomical, functional and congenital ICI. ICI is a pathological condition of the cervix and the isthmus, in which they are unable to withstand the intrauterine pressure and keep a fertilized egg in the uterine cavity until birth. ICI is a serious complication of pregnancy. Genetic, hormonal, inflammatory-infectious, immunological, traumatic factors play a role in the occurrence of ICI. The aim of the study is to study the peculiarities of reproductive health and gestational process of pregnant women with ICI, according to the literature. For the study, we analyzed domestic and foreign publications on this topic in professional journals, as well as data from Internet resources. Results of the research show that ICI plays a special role among many causes that lead to preterm termination of pregnancy and premature birth in the II-III trimesters. The properties of the cervix depend on the ratio of connective and muscle tissue. Today, most authors distinguish between congenital, acquired, organic and functional isthmic-cervical insufficiency.Organic (post-traumatic, secondary) ICI occurs due to mechanical damage to the cervix. Functional ICI is the result of a violation of the relationship between the muscular and connective tissues of the cervix, as well as the result of changes in the response of its structural elements to neurohumoral stimuli. Functional ICI most often occurs as a consequence of a violation of the hormonal background of women (ovarian hypofunction, hyperandrogenism). Congenital ICI occurs in malformations of the uterus, genital infantilism. Histological examination of cervical tissue in women with ICI reveals an increase in muscle tissue up to 50%, which leads to early softening of the cervix of the uterus and development of its functional insufficiency. According to Kaufman KP (2021), the role of connective tissue in the development of ICI is confirmed by the fact, that this pathological condition of the cervix is found in women with Marfan syndrome and Ehlers-Danlos syndrome. The role of undifferentiated connective tissue dysplasia (UCTD) as a risk factor for complicated pregnancy, including ICI.Research of Huang J and co-authors (2021) found the presence of nutritional imbalance in patients with UCTD, which was manifested by changes in serum concentrations of magnesium, calcium, zinc, iron, copper, selenium, inorganic phosphorus. The relationship between changes in the microcirculation system, tissue perfusion and cervical condition is currently being actively discussed and confirmed in numerous studies.Fettweis JM (2019) believes that the mechanism of abortion at different stages of gestation is not the same in pregnant women with ICI. At the same time, all pregnant women with ICI at all stages of gestation have increased cytokine levels. However, an important factor in the premature termination of pregnancy in ICI is assigned to the infectious factor. The results of the study of the pathogenetic role of local immune responses in women with habitual miscarriage are often contradictory and dictate the need for further researches.Eventually, isthmic-cervical insufficiency is a multifactorial complication of pregnancy, in which genetic, hormonal, inflammatory-infectious, immunological or traumatic factors play a role.

Role of polymorphic loci <i>VDR</i> rs10735810, <i>MTHFR</i> rs1801131, <i>MTHFR</i> rs1801133, <i>MTR</i> rs1805087,<i> MTRR</i> rs1801394 AND <i>VEGFA</i> rs3025039 in missed abortion: A prospective cohort study

Background. Premature termination of pregnancy, including miscarriage, remains among the critical problems in modern obstetrics and gynaecology practices. In the context of early gestational failure and the notion that 80% of early miscarriages are triggered by genetic reset — some natural filter — an analysis of current knowledge of the genetic aspects of missed abortion (MA) appears relevant.Objectives. A study of the haplotype frequencies for VDR rs10735810, MTHFR rs1801131, MTHFR rs1801133, MTR rs1805087, MTRR rs1801394 and VEGFA rs3025039 polymorphic loci and their association with vitamin D deficiency in women with missed abortion.Methods. A total of 178 women aged 18 to 41 years were examined. The main cohort consisted of MA patients (n = 101) who were divided between cohort I (n = 58; patients with primary MA) and cohort II (n = 43; patients with recurrent MA). The control cohort (n = 77) consisted of women with a successful pregnancy (Z34.0) entailing a term and live birth. Genotyping of polymorphic loci VDR rs10735810, MTHFR rs1801131, MTHFR rs1801133, MTR rs1805087, MTRR rs1801394 and VEGFA rs3025039 was performed in 177 patients. Total serum 25(OH) D (n = 99) was determined by mass spectrometry. Statistical analysis was carried out using the Statistica v. 10 data analysis software (StatSoft, Russia; TIBCO, USA). Results. No differences were revealed for the frequencies of studied haplotypes between MA women and those who gave birth to healthy full-term newborns (p >0.1). No association was found between first-trimester MA and the presence of polymorphic loci variants (p >0.1). The GG haplotype of gene VDR is even less frequent in recurrent MA patients than in control (14.0% vs. 23.7%; OR = 2.29; 95% CI: 0.738–7.075). The GG haplotype of gene MTR has a 2-fold higher frequency in primary MA patients compared to control, albeit at no statistical significance (8.6 vs. 4.0%). Haplotype TT of the gene VEGF polymorphism occurs even less frequently in primary MA patients than in control (3.5 vs. 7.9%, respectively). Patients with first-trimester MA exhibited an association between vitamin D deficiency and the frequency of polymorphic variants VDR rs10735810 (p = 0.0304) and MTHFR rs1801133 (p = 0.0180). The other studied genes did not reveal such an association.Conclusion. The study demonstrates a pathogenetic association of polymorphic variants VDR rs10735810 and MTHFR rs1801133 with missed abortion and vitamin D deficiency.

The effectiveness of correction methods for isthmic-cervical insufficiency: cohort study results

AIM: To assess the pregnancy outcomes in patients with isthmic-cervical insufficiency (ICN) and the effectiveness of modern methods of correction, namely cervical cerclage, obstetric discharge pessary, and progesterone preparations.
 MATERIALS AND METHODS: The retrospective analysis included 184 females with ICN, who were divided into three groups based on ICN correction methods: 1st group consisted of 82 (44.6%) females who were corrected by cervical cerclage; 2nd group with 67 (36.4%) females by obstetric pessary; and 3rd group with 35 (19.0%) females by progesterone therapy with ICN sign appearance.
 RESULTS: According to the obtained data, every second patient (53.3%) in our study had risk factors for ICN development due to the mechanical expansion of the cervical canal in cervical anamnesis. In most cases, ICN was diagnosed in 20 weeks and more, and the median period of correction was 21 [2022] weeks in 1st group, 24 [2226] weeks in 2nd group, and 22 [2022] weeks in 3rd group (p 0.001). The overall incidence of preterm birth (PTB) in 1st group was 48.8%, whereas 40.3% in 2nd group and 60% in 3rd group. The share of timely births accounted for 41.5% in 1st group, whereas 53.7% in 2nd group and 11.4% in 3rd group.
 CONCLUSION: Correction of ICN with cervical cerclage and obstetric pessary showed similar effectiveness and allowed prolonged pregnancy to more favorable terms. The correction group with only progesterone preparations noted a high frequency of premature pregnancy termination since this group initially included females with a higher risk of PTB and adverse factors for further prolonged pregnancy.

MORPHOLOGICAL AND IMMUNOHISTOCHEMICAL FEATURES OF PLACENTAL DAMAGE DUE TO THE INCORPORATION OF 137Cs.

to investigate the morphological and immunohistochemical features of placental damage due to theincorporation of 137Cs depending on the scenario of pregnancy completion. The study material consisted of placentas from 60 women with reproductive losses inanamnesis and signs of termination of the current pregnancy (first group) and placental samples from 30 women with an uncomplicated gestation and an unencumbered anamnesis (control group). The detailed study required the distribution of placental samples from the first group into subgroups. Subgroup 1a included 38 placentas from women who gave birth at 37-40 weeks, despite signs of termination of the current pregnancy. Subgroup 1b - placentas of 13 women who gave birth at a gestation period of 28-36 weeks + 6 days. Subgroup 1c - 9 placental samples from women who gave birth at a gestation period of 22-27 weeks + 6 days. The volumetric activity of the 137Cs in the placentas was measured using β-spectrometer. The histology of the placenta was studied using a standard technique. The following expressions were studied in placenta: CD31 / PECAM-1, CD45 / T200 / LCA, CD56 / NCAM-1, CEA / CD66e Ab-2, Vimentin, using indirect streptavidin peroxidase detection method. Placentas accumulate 137Cs. The different volumetric activity of the isotope correlates with scenarios of pregnancy. Due to the action of incorporated 137Cs with a specific mass of more than 1.1 Bq/kg, placental dysfunction develops. The consequences of placental dysfunction depend on the volumetric activity of the 137Cs and the preservation of adaptive and compensatory reactions in the placenta. Morphological and immunohistochemical features of placental damage to incorporated 137Cs were established, depending on the scenario of completion of pregnancy. A marker of unfavorable completion of pregnancy is the expression of a carcinoembryonic antigen (CEA) in the placenta. Premature termination of pregnancy (PTP) is a multifactorial pathology associated with pathological changes in immune and neuroendocrine regulation and hereditary, infectious, and environmental factors that disrupt the adaptation mechanisms in the mother-placenta-fetus system. Intraplacental irradiation of 137Cs is one of the factors in the multifactorial nature of reproductive losses. As a result of intraplacental irradiation of 137Cs, the architecture of the placenta is disturbed, the activity of pro-inflammatory cytokines CD45 and CD56 increases, and the coagulation cascade is activated. Extreme effects depend on the volumetric activity of the isotope incorporated in the placenta and the organ's compensatory capacity. Accumulation of up to 1.0 Bq/kg 137Cs does not affect the course of gestation. Internal irradiation with an activity of 4.5-10.4 Bq/kg 137Cs triggers late preterm labor. The nature of the damages corresponds to the category of «lesion of the maternal stroma» of the placenta. The volumetric activity of 137Cs over 10.4 Bq/kg is a probable cause of early preterm labor and antenatal fetal death. At the same time, the maternal and fetal structures of the placenta suffer damage. Expression of vimentin is a marker of placental destruction due to internal irradiation of 137Cs with a specific gravity of more than 4.5 Bq/kg. Expression of CEA in the structures of the placenta of women with PTP is a unique find and marker of premature birth and antenatal fetal death with intraplacental irradiation of 137Cs with an activity of more than 4.5 Bq/kg.

Pregnancy Outcome in COVID 19 Infected Patients: In a COVID Dedicated Hospital of Chattogram, Bangladesh

Background: Corona Virus Disease (COVID-19) a pandemic has become a global health concern. Pregnant women are at an increased risk due to physiologic changes in their immune, cardiopulmonary and coagulation systems. This study was designed to evaluate the fetomaternal outcome of the pregnant patients with COVID-19.
 Materials and methods: This cross-sectional type of observational study was conducted in Obstetric and Gynecology Department of Chittagong Medical College Hospital from July 2021 to September 2021. Total 51 hospitalized pregnant patients with confirmed COVID-19 were enrolled. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 26.
 Results: Total patients were 51 with a mean age of 28 years, 73.5% patients were in third trimester, 35.3% were in >37 weeks of gestation . Common symptoms were fever( 33.3%), cough (19.6%) and respiratory distress(29.4%). There were two maternal deaths who were treated in ICU. There were 2 spontaneous abortions. 69.23% underwent caesarean section, 30.77% underwent Normal Vaginal Delivery (NVD) 9.8% patients underwent premature termination of pregnancy. Ongoing pregnancy were 19 (37.3%). There were 17 live births and 3 Intrauterine Deaths (IUD) and 2 neonatal deaths. Among the mothers, 29(56.8%) had no associated complications, 19.65% had Preeclampsia and 5.9% had Gestational Diabetes Mellitus. About 10 babies had birth weight less than 2.5 kg and were transferred to NICU.
 Conclusion: During this study, it was found that pregnancy outcome was not good in COVID positive pregnant women . For the infected mothers early medical supervision and availability of ICU in critical condition is needed for better pregnancy outcome.
 JCMCTA 2021 ; 32 (2) : 95-99

Prevalence of premature birth in conditions of global warming

The dynamics and likely associative link between global warming and the prevalence of preterm births in Ukraine over the years 2009-2018 was studied. to form modern ideas about the prognosis and prevention of this pathology. Data on medical care for pregnant women, mothers and parturients and adverse effects of pregnancy on preterm birth (form 21) for the period 2009-2018 were obtained from the municipal non-profit enterprise "Ternopil Regional Center of Public Health of Ternopil Regional Council". The correlation between the number of premature births per 100 births according to the average annual air temperature according to the Global Historical Climatology Network from the US Department of Ocean and Atmospheric Research in the climatically homogeneous regions of Ukraine was estimated. Predictive analysis of time series was performed by the method of integrated auto-regression of the moving average (ARIMA). The model error was estimated by calculating the absolute percentage error of the mean (MAPE). Statistical processing of materials was performed using programs Statistica 6.0 (StatSoft, USA) and open statistical package "R". The study meets modern requirements of moral and ethical standards regarding the provisions of legislative acts of Ukraine. Analysis of these reports of women's counseling shows an increase in the average number of preterm births from 2.88 per 100 births in the total number of births in Ukraine – 491445 in 2009 to 3.33, per 100 births in the total number of 309191 in 2018, which testifies to a significant increase in premature births in our country. Since 2009, there has been an annual, varying degree of increase in average annual air temperature in Ukraine. As a result of the correlation analysis, a significant strong direct correlation was established between the average level of premature birth and the average annual air temperature in Ukraine (r=0.84, p<0.05). Regression analysis revealed a significant increase in the number of premature births (per 100 births) in 1, 2, 5, 6, 7, 8 and 10 climatically homogeneous regions and a tendency to increase in, respectively, 3, 4, 9, 11 and 12 climatically homoge­neous regions of Ukraine. Based on the analysis of data on the average annual air temperature in Ukraine for 2009-2018, the average annual air temperature in Ukraine is projected to increase by 0.3 ° С in 3 years (MAPE <10%, p<0.05). The annual number of premature births is expected to increase (cases per 100 births) in 3 years by 0.4 cases per 100 births (MAPE <10%, p <0.05). In the context of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature infants. Strong correlations have been established between the annual number of premature births and the average annual air temperature in Ukraine. Regression models of preterm birth showed a significant increase in 1, 2, 5, 6, 7, 8, and 10 cli­matically homogeneous regions and a tendency to increase in 3, 4, 9, 11 and 12 climatically homogeneous regions. The annual number of premature births in Ukraine is projected to increase by 2023 by 20 cases per 100 births compared to 2018. The strategy for preventing premature births and related adverse effects of pregnancy should include the identification of global warming as a risk factor for increasing level of this pathology.

New aspects in the pathogenesis of miscarriage in women with extragenital pathology

Study objective: to determine the dynamics of type 9 metalloproteinase (MMP-9) and its tissue inhibitor-1 (TIMP-1) in the pathogenesis of early miscarriage in women with chronic diseases of the hepatobiliary system.Materials and methods. The study included 39 women with a history of early pregnancy miscarriage, who were diagnosed with chronic liver diseases as a result of clinical, instrumental and laboratory studies (17 persons with steatosis and 22 persons with non-alcoholic steatohepatitis). The control group consisted of 8 women without somatic pathology and 8 pregnant women at the first trimester of gestation. MMP-9 and TIMP-1 value in the blood serum was determined by the enzyme immunoassay.Results. MMP-9 and TIMP-1 growth in the blood serum of women with a history of miscarriage was established in the pre-gravidar period. The most significant increase in the parameters of the intercellular matrix was found in patients with non-alcoholic steatohepatitis. MMP-9 and TIMP-1 increased in in blood serum in the first trimester in women with liver diseases. MMP-9 increased against the background of a decrease in the TIMP-1 activity in patients with the threat of premature pregnancy termination. Miscarriage was diagnosed in patients with a minimum value of a tissue inhibitor. Conclusions. There is an imbalance between MMP-9 and TIMP-1 in the blood serum in women with early miscarriage and chronic diseases of the hepatobiliary system. MMP-9 and TIMP-1 level in patients with hepatic steatosis is lower than in patients with non-alcoholic steatohepatitis. MMP-9 increased during physiological pregnancy, and the TIMP-1 activity practically did not change, which indicates the role of MMP-9 in the initial stages of placentation. MMP-9 value in women with a burdened premorbid background with a physiological course of pregnancy and threatening early spontaneous miscarriage was significantly different. The highest activity of MMP-9 was in women with the threat of spontaneous miscarriage in the early stages. TIMP-1 in the first trimester in women with chronic liver disease increased in those with a favorable course of pregnancy and decreased in the threat of spontaneous miscarriage. Such changes in MMP-9 and TIMP-1 in patients with miscarriage indicate the accumulation of intercellular matrix and sclerotic changes in the vessels that provide blood to the uterus.

Psychological сomponents of miscarriage. Ways to overcome

Habitual miscarriage is a stressful condition and a significant factor of frustration for married couples. The psycho-emotional state of the pregnant woman affects the course of the subsequent pregnancy and its outcome. Correction of the psychological component of habitual miscarriage is a promising direction for preventing reproductive losses. The aim of the work is to study the psychological components of miscarriage and determine the ways of their correction. Materials and methods. The level of chronic stress was studied in pregnant women with symptoms of miscarriage and a history of habitual reproductive losses (main group) based on indicators of psychoemotional state, the condition of the autonomic nervous system, and the degree of activation of stress-implementing systems. The results were evaluated with the scale PSS, PSM-25 as adapted by N. Ye. Vodopianova, Spielberger–Khanin inventory and the scale by L. D. Malkova, Baevsky index, cortisol content in the blood and urine. The pregnant women with a physiological course of pregnancy and uncomplicated history were included in the control group. Based on the fact that the etiology of habitual miscarriage is multifactorial, and the psychological component is amenable to correction, stress-protective therapy was included in the treatment complex of habitual miscarriage. To assess the effectiveness of treatment, the main group was divided into subgroups: 1 – with psychotherapy, 2 – without psychotherapy. Results. A high level of personal perception of stress, anxiety and asthenia determine the psycho-emotional state of the main group pregnant women, among whom two dominant psycho types were identified: A – a high level of anxiety and low neuropsychic resistance; B – poise and good adaptive ability against the background of stress. Non-drug stress-protective therapy in the complex of miscarriage treatment contributes to: a decrease in psycho-emotional stress in pregnant women with psycho type A – 2.6 times, anxiety level – 1.7 times, asthenia level – 2.3 times; and also: a decrease in similar indicators in pregnant women with psycho type B – 1.6 times, 3.9 times and 2.5 times, respectively (P < 0.05); a decrease in the frequency of premature termination of pregnancy by more than 11 %. Conclusions. The psychological component of miscarriage is a high level of personal perception of stress, anxiety and asthenia. Stress-protective therapy in combination with pathogenetic therapy of miscarriage improves pregnancy outcomes for the mother and the fetus. It is advisable to conduct pregravid training with the participation of a psychologist in women with a history of reproductive losses in order to overcome the psychological component of stress perception, expand adaptive potential, increase neuropsychic stability, and form a positive orientation toward pregnancy and motherhood.

NF-κB and Its Regulators During Pregnancy

The transcriptional factor NF-κB is a nuclear factor involved in both physiological and pathological processes. This factor can control the transcription of more than 400 genes, including cytokines, chemokines, and their modulators, immune and non-immune receptors, proteins involved in antigen presentation and cell adhesion, acute phase and stress response proteins, regulators of apoptosis, growth factors, other transcription factors and their regulators, as well as different enzymes; all these molecules control several biological processes. NF-κB is a tightly regulated molecule that has also been related to apoptosis, cell proliferation, inflammation, and the control of innate and adaptive immune responses during onset of labor, in which it has a crucial role; thus, early activation of this factor may have an adverse effect, by inducing premature termination of pregnancy, with bad outcomes for the mother and the fetus, including product loss. Reviews compiling the different activities of NF-κB have been reported. However, an update regarding NF-κB regulation during pregnancy is lacking. In this work, we aimed to describe the state of the art around NF-κB activity, its regulatory role in pregnancy, and the effect of its dysregulation due to invasion by pathogens like Trichomonas vaginalis and Toxoplasma gondii as examples.

Manifestation of oxidative stress during pregnancy in women with chronic diseases of hepatobiliary system against the background of reproductive losses

In the early stages of gestation the changes in the lipid peroxidation can lead to violations of regulatory and protective functions of biomembranes in pregnant women. The objective: to study the changes in the concentration of intermediate and final products of LPO during the first trimester of gestation in patients with early miscarriage against the background of chronic diseases of the hepatobiliary system. Materials and methods. 118 pregnant women in the first trimester of gestation (7-10 weeks), aged 22 - 39 y. o. (mean age 29.4 ± 2.7 years) have been examined.64 women (54.2%) were diagnosed with a risk of miscarriage, and 17 patients were diagnosed with involuntary miscarriage within 10-12 days. All women were diagnosed with non-viral and non-alcoholic chronic HBS paathology: hepatic steatosis had 38 patients (32.2%), 80 patients (67.8%) had non-alcoholic steatohepatitis; in 97 patients (82.2%) chronic non-calculous cholecystitis was diagnosed. The state of lipid peroxidation was assessed by the content of malonic dialdehyde spectrophotometrically, as well as diene conjugates in the blood The indicator of erythrocyte peroxide hemolysis was examined by the level of erythrocyte peroxide resistance. Results. A significant increase in intermediate and final products of lipid peroxidation in pregnant women with an unfavorable premorbid background in the form of chronic diseases of the hepatobiliary system and a history of reproductive losses. A significant increase of MDA and DC concentration was found at the risk of premature termination of pregnancy. The degree of PLO processes activation makes these parameters integrative criteria for the detection of systemic metabolic disorders during gestation in women with GBS extragenital pathology. Conclusion. During physiological pregnancy there is an accumulation of metabolites of lipid peroxidation, which is associated with an increase in basic metabolism in women and an increase in oxygen consumption from the blood.

Нарушение врожденного иммунитета и выраженности иммунокомплексных реакций у беременных с невынашиванием на фоне экстрагенитальной патологии

Изучены функциональная активность моноцитов и концентрация циркулирующих иммунных комплексов в кровибеременных с хронической патологией печени и репродуктивными потерями на раннем сроке в анамнезе. У беремен-ных в первом триместре гестации при неблагоприятном преморбидном фоне выявлено снижение показателей фагоци-тарной активности моноцитов, что свидетельствует о снижении функциональной способности макрофагов будущейматери. Наряду с недостаточностью неспецифической резистентности организма у обследованных пациенток отмеча-лось повышение циркулирующих иммунных комплексов за счет патогенных среднемолекулярных фракций. Наиболеенизкие показатели фагоцитарной активности моноцитов и существенное повышение концентрации циркулирующихиммунных комплексов выявлены у пациенток с обострением неалкогольного стеатогепатита, что могло спровоциро-вать преждевременное прерывание беременности в первом триместре.

Fetomaternal Outcome of Pregnancy with COVID-19: An Observational Study in A Tertiary Care Hospital of Bangladesh

Introduction: Corona virus is a new pathogen of high contagious abilities. Pregnant women are at an increased risk due to physiologic changes in their immune, cardiopulmonary and coagulation systems. This study was designed to evaluate the fetomaternal outcome of the pregnant patients with COVID-19.
 Methods: This retrospective observational study was conducted in CMH Dhaka from May 2020 to July 2020. Total 81 hospitalized pregnant patients with confirmed COVID-19 were enrolled. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20.
 Results: Total patients were 81 with a mean age of 27 years; 49.1% were in third trimester, 83% were in 35-40 weeks of gestation and 48% were asymptomatic. Common symptom severe cough (26%) and fever(14%); 7.4% patients had multiorgan failure, 81% hadlymphopenia, 7.4% patients under went chest CT and had in filtrates in both lungs. Mild to moderate disease was common and 7.4 % had severe disease, 3.7% needed mechanical ventilation. There was a single maternal death. Most (92.6%) patients were treated in Corona ward and 7.4% in Corona HDU and ICU. There were 3 spontaneous abortions; 64.2% delivered during the study period, 80.8% underwent a Caesarean section, 2.4% had hysterotomy, 15.1% underwent normal vaginal delivery (NVD), 15.4% patients underwent premature termination of pregnancy. Ongoing pregnancy was 26 (32.1%).Four neonates were found COVID-positive. There was 47 livebirths, 3 intrauterine deaths (IUD) and 2 neonatal deaths. Their hospital stay was 13.1 days (SD±6.37).Mean interval of breastfeeding was 13.3 days (SD±6.44).
 Conclusion: From the study findings, it can be concluded that, COVID-19 had adverse fetomaternal outcomes. COVID-19 pandemic has exerted immense stress on health care system. With this study we can further modify our treatment strategy and reduce the load on our health system.
 J Bangladesh Coll Phys Surg 2021; 39(2): 100-105