Prevention Of Perinatal Complications Research Articles

Analysis of congenital pneumonia incidence in newborns from high-risk mothers

Objective. To detect the incidence of congenital pneumonia in newborns from mothers with placental insufficiency in combination with premature amniotic fluid discharge
 Materials and methods. A retrospective analysis of 57 stories of newborn infants and their mothers was carried out. The newborns were divided into 3 groups: group 1 37 newborns from mothers with placental insufficiency and premature amniotic fluid discharge, group 2 9 infants from mothers with premature amniotic fluid discharge, group 3 11 infants born from mothers with placental insufficiency. The obstetric and gynecological history, the presence of extragenital pathology, the peculiarities of the course of pregnancy and childbirth, and the outcomes for newborns were analyzed.
 Results. Congenital pneumonia was more common in newborns from mothers with placental insufficiency and premature amniotic fluid discharge. In newborn infants of the first group, severe asphyxia occurred more often, being a risk factor. At the same time, the identification of markers of the systemic inflammatory reaction did not always reflect the presence of infectious-inflammatory pathology in newborns. In addition, in the presence of inflammation of the fetal part of placenta, in a large number of newborns pathological microflora is detected during microbiological examination.
 Conclusions. As a result of the study, the role of maternal pathology on the development of intrauterine infection and implementation of infection in the early neonatal period was revealed. The obtained data justify the need for pregravid preparation and prevention of perinatal complications in women with placental insufficiency.

Growth charts and prediction of abnormal growth - what is known, what is not known and what is misunderstood.

Assessment of fetal growth has an important effect on perinatal morbidity and mortality. To understand what tool to choose best for a given population a basic knowledge of how growth charts are developed and used has to be acquired. For this reason, this literature review was performed. An extensive literature review aimed at identifying articles related to the development of growth assessment in both spectrums of abnormal fetal growth - large and small. The analyzed articles were chosen and presented to show both the historical aspects of growth assessment, current trends and future considerations. Identification of both large and small fetuses and neonates is equally crucial. Definitions and methodology vary worldwide and there is an ongoing discussion on the best tool to choose for a given population. An important part of the debate is how to differentiate between the physiologically small fetus and the truly growth restricted fetus who is at risk of perinatal complication. Similarly, the diagnosis of a large fetus is important in prevention of perinatal complications and surgical deliveries. Many clinical settings still lack growth standards. Birthweight for gestational age charts are biased for weight in preterm birth. Prediction and management of outcome cannot be based solely on fetal size. Small is not the only problem, we have to think large as well. A common misunderstanding in clinical practice is not using uniform charts in defining growth.

Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes

Randomized trials have not focused on neonatal complications of glyburide for women with gestational diabetes. To compare oral glyburide vs subcutaneous insulin in prevention of perinatal complications in newborns of women with gestational diabetes. The Insulin Daonil trial (INDAO), a multicenter noninferiority randomized trial conducted between May 2012 and November 2016 (end of participant follow-up) in 13 tertiary care university hospitals in France including 914 women with singleton pregnancies and gestational diabetes diagnosed between 24 and 34 weeks of gestation. Women who required pharmacologic treatment after 10 days of dietary intervention were randomly assigned to receive glyburide (n=460) or insulin (n=454). The starting dosage for glyburide was 2.5 mg orally once per day and could be increased if necessary 4 days later by 2.5 mg and thereafter by 5 mg every 4 days in 2 morning and evening doses, up to a maximum of 20 mg/d. The starting dosage for insulin was 4 IU to 20 IU given subcutaneously 1 to 4 times per day as necessary and increased according to self-measured blood glucose concentrations. The primary outcome was a composite criterion including macrosomia, neonatal hypoglycemia, and hyperbilirubinemia. The noninferiority margin was set at 7% based on a 1-sided 97.5% confidence interval. Among the 914 patients who were randomized (mean age, 32.8 [SD, 5.2] years), 98% completed the trial. In a per-protocol analysis, 367 and 442 women and their neonates were analyzed in the glyburide and insulin groups, respectively. The frequency of the primary outcome was 27.6% in the glyburide group and 23.4% in the insulin group, a difference of 4.2% (1-sided 97.5% CI, -∞ to 10.5%; P=.19). This study of women with gestational diabetes failed to show that use of glyburide compared with subcutaneous insulin does not result in a greater frequency of perinatal complications. These findings do not justify the use of glyburide as a first-line treatment. clinicaltrials.gov Identifier: NCT01731431.

Характеристика маркерів метаболічного синдрому та особливості перебігу ранніх термінів гестації у жінок із загрозою невиношування вагітності залежно від їхньої маси тіла

The article gives a scientific and practical justification for the expansion of the diagnostic algorithm in pregnant women with the threat of miscarriage, taking into account the woman’s phenotype. The objective: was to study the basic patterns of the formation and disruption of the reproductive system in pregnant women with overweight and obesity and to evaluate possible criteria for the formation of endocrine and metabolic disorders for the timely diagnosis and prevention of perinatal complications in pregnant women, depending on their phenotype. Materials and methods. Clinical groups comprised 175 pregnant women of different body weight (120 women with overweight and obesity, who were observed from a small gestation period on the basis of the department of fetal medicine and the pathology of early pregnancy of the communal institution «Dnepropetrovsk Regional Perinatal Center with a hospital» in the city of Dnepr (I clinical group) and 55 pregnant women with normal body weight (II clinical group – comparison group)). Results. The dependence of the detection of menstrual cycle disorders in women with overweight and obesity is 1.5 times more often than in women with normal weight. The course of early gestation was analyzed. The necessity of lipid and carbohydrate profile estimation in these patients is substantiated. Authentic criteria of violations of carbohydrate metabolism are specified. Сonclusion. It is necessary to move from the assessment of the effects of obesity to the «Body Mass Index-Oriented Approach» to the assessment based on the «complicity approach». This will make it possible to individualize therapeutic tactics in pregnant women depending on their phenotype and reduce the incidence of gestational complications and perinatal losses. Key words: phenotype, pregnancy, loss of pregnancy, obesity, phenotype, carbohydrate profile, lipid profile, hormonal characteristics.

Oxidative stress and mitochondrial dysfunction in infected pregnant

The infected pregnant women have been various perinatal complications. The aim of the work was to clarify the role of oxidative stress and mitochondrial dysfunction in the development of perinatal complications in infected pregnant. Methods. The study included 68 pregnant women with signs of maternal-fetal infection (MFI) and 30 pregnant women who were found infected (control group). Later pregnant with MFI were divided into 2 groups: the first included 30 women who received traditional antibacterial and antiviral therapy, the second group consisted of 28 women who were additionally given an immunomodulator in combination with ozone therapy. Results. During pregnancy with MFI it is characterized the thrombophilic disorders, break immune homeostasis pregnant, endothelial dysfunction, which adversely affects perinatal indicators. Conclusions. The use of immunomodulators and ozone therapy in the complex treatment of MFI is pathogenetically substantiated effective treatment of oxidative stress and mitochondrial toxicity in the prevention of perinatal complications in infected women

The role of compensation of carbohydrate metabolism in pregnant women with type 1 diabetes mellitus in the development of perinatal complications

With DM1 morbidity reaching epidemic growth in young people including women of childbearing age, planning and managing pregnancy in patientswith disturbances of carbohydrate metabolism acquires increasingly greater significance. Of primary importance are evening mutual influence of DM1and pregnancy (a high-risk condition) and prevention of perinatal complications resulting from poor compensation of carbohydrate metabolism.

Transuterine Puncture of the Fetal Stomach Provides Access to the Small Bowel in the Rabbit

The prevention of perinatal complications of congenital gastrointestinal (GI) diseases such as cystic fibrosis may require prenatal treatment. New Zealand White rabbits were evaluated as a potential animal model to study gastrointestinal anatomy and transit in the fetus. The lengths of the GI tract of fetuses at 21/31 and 28/31 days gestation were established, and gastric volume was measured. Gastric volume at 28 days gestation averaged 2.6 mL, adequate to permit instillation of a solution into the fetal stomach. A study was then carried out to establish gastric emptying and delivery of the solution into the small bowel. Using ultrasound guidance, the stomachs of 26 fetuses from 7 litters were punctured and 0.5 mL of dilute barium was injected. A cesarean section was performed 4 h later and the progression of barium though the GI tract was measured. In 18/26 (69.2%) of the fetuses barium was successfully delivered to the lumen of the stomach. In these 18 fetuses, barium progressed to the duodenum in 15 (58%), the jejunum in 13 (50%), and the ileum in 8 (31%). The stomach of the 3.5- to 4-week-old fetus is large enough to allow transuterine delivery of a solution of dilute barium. Gastric and intestinal motility in the 25-day-old rabbit fetus is coordinated and results in delivery of barium to the small bowel in 50% of animals successfully injected. The results suggest that the rabbit is an acceptable model for the study of gastrointestinal delivery of therapeutic drugs or genes to the fetus.