Obstetric Problems Research Articles

СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ПОСЛЕРОДОВОМ ЭНДОМЕТРИТЕ (ОБЗОР ЛИТЕРАТУРЫ)

The review is based on the databases https://cyberleninka.ru/, PubMed, MedArt, and CNMB. Postpartum endometritis is the leading infectious and inflammatory disease of the postpartum period and one of the stable leading causes of maternal mortality. In Russia, the incidence of postpartum endometritis in the population is 3-8%, in pathological deliveries it is 10-20%, and in women with a high infection risk it is 13.3-54.3%. Infection occurs predominantly by the ascending route, as a rule, with active participation in associations of opportunistic pathogenic flora. The leading position among the risk factors of postpartum endometritis is taken by surgical delivery and, primarily, by cesarean section. Immune disorders play one of the key roles in the pathogenesis of this disease according to modern researchers. In case of insufficient effectiveness of empirical antibacterial therapy, the choice of antibacterial drugs must be made on the basis of blood cultures. The second local component of treatment of patients with postpartum endometritis is the evacuation of uterine cavity contents. Careful emptying is one of the most important criteria for choosing the method of evacuation. An immunomodulatory component should be included in the treatment to increase its effectiveness. Thus, postpartum endometritis is a serious obstetric problem, in the treatment of which gentle evacuation of the uterine cavity contents in combination with local use of immunomodulatory drugs is promising.

The Impact of Prenatal Diagnosis and Treatment on Early Neonatal Problems

OBJECTIVE: Obstetric problems have detrimental effects on both pregnancy and newborn. We aimed to examine the relationship between pregnancy complications and newborn morbidities. STUDY DESIGN: The newborns admitted to the neonatal intensive care unit between September 2019 and August 2022 were included in this retrospective cross-sectional study. Antenatal morbidities and neonatal complications including low APGAR-score (<5), bronchopulmonary dysplasia, early neonatal sepsis, and early neonatal death were evaluated. Pearson-χ2 cross-tabs were used to compare two variables. A p-value <0.05 was determined statistically significant. RESULTS: Among the 686 infants analyzed, 94 (13.7%) had early neonatal death, 264 (38.5%) had bronchopulmonary dysplasia, 259 (37.8%) had early neonatal sepsis, and 424 (61.9%) had feeding intolerance. Early neonatal sepsis was observed significantly higher in newborns whose mothers had urinary tract infection in the last two weeks (p<0.001), preterm premature rupture of membranes (p=0.006), or clinical chorioamnionitis (p<0.001). Early neonatal death was found significantly higher in pregnancies with preeclampsia (p<0.001), preterm premature rupture of membranes (p<0.001), clinical chorioamnionitis (p<0.001), or small-for-gestational-age (p<0.001). Preeclampsia and magnesium neuroprophylaxis were found significantly higher in neonates with feeding intolerance (p<0.001). Backward: LR logistic regression analysis based on early neonatal sepsis risk revealed that birth week, preterm premature rupture of membranes, clinical chorioamnionitis, small-for-gestational-age, and urinary tract infection were significant parameters affecting the risk of early neonatal sepsis (p<0.05). CONCLUSION: Preventing premature births and cautious management of pregnancy complications may be helpful in reducing adverse neonatal outcomes. Early detection of high-risk pregnancies and transfer to a tertiary center may be helpful to improve neonatal outcomes.

Assessment of color Doppler flow metric indices in first-trimester threatened abortion and to study their outcome at 20 weeks

Background: Threatened abortion is one of the major problems in obstetrics and applies to one-third of all pregnancies. Aims and Objectives: The aim of the study was to study the color Doppler flow metric indices of spiral artery blood flow in the first trimester (6–10 weeks) in cases of threatened abortion and normal pregnancies and to study their outcome at 20 weeks. Patients and Methods: Spiral artery was sonographically evaluated in 113 patients comprising two groups of 55 cases and 58 controls. The first group comprised patients presenting with threatened miscarriage. The second group included females who had no complications. Spiral artery flow velocity measurements were performed using color Doppler (pulsatility index [PI], resistive index [RI], and systolic/diastolic ratio) in the first trimester (between 6 and 10 weeks of gestation). Patients were followed till 20 weeks and color Doppler was performed. Color Doppler in the first trimester and at 20 weeks was studied and their relation and association with adverse pregnancy outcome at 20 weeks were studied. Significant differences were noted in the spiral artery Doppler values in the two groups in first trimester and at 20 weeks. In particular, the RI and PI were higher in cases of women with threatened miscarriage in first trimester. Statistical significance of RI and PI was seen with adverse pregnancy with Doppler indices at 20 weeks. Doppler values of spiral artery may be used as a useful factor in assessing the prognosis in cases presenting with threatened miscarriage. Conclusion: Doppler flowmetry can be used, as a routine screening test to identify the high-risk women in early first trimester to offer effective prophylactic management strategies and for close monitoring and follow-up of these patients so as to have a successful pregnancy.

Фето-материнский микрохимеризм: причина преэклампсии? Роль трофобласта в прогнозе течения беременности, осложненной преэклампсией

Preeclampsia is one of the most important problems in obstetrics. Every year, preeclampsia affects 6–8% of pregnant women in developed countries and over 20% pregnant women in developing countries. It is noted that together with obstetric bleeding and infectious complications, preeclampsia constitutes the so-called «deadly triad» and is the cause of the overwhelming number of maternal deaths. The possibilities of treating preeclampsia are limited only to symptomatic therapy, and in the absence of the desired effect, the patient is offered delivery. To date, new, pathogenetically determined, methods of treatment aimed at inhibiting the activity of membrane-attacking molecules are being considered. This literature review provides information on the role of the trophoblast in the pathogenesis of preeclampsia. The increase in the concentration of trophoblast cells in the mother’s blood leads to excessive activation of the complement system, which causes multiple endothelial damage, leading to multiple organ failure.

Diagnostic accuracy of Uterine Artery Doppler Velocimetry in Patients with Placenta Previa

Background; The placenta previa (PP) is an obstetric problem in which the placental tissue is improperly located inside the lower uterine segment. Aim and objectives: was to see how effective uterine artery Doppler velocimetry was in detecting unusually morbidly adhering placentas in patients who had had one or more prior caesarean sections with placenta previa. Subjects and methods; Cross-sectional research of 100 patients was undertaken in the Department of Gynecology and Obstetrics, El- Sayed Galal Hospital, AL- Azhar University. Result; Our results showed highly statistically significant correlation between the presence of abnormal lacunae and histopathological confirmation (P-value > 0.001). In addition, the overall Sensitivity, specificity, PPV, NPV and accuracy were 90%, 100%, 100%, 64.2%, 91.6%. This criterion showed very high sensitivity and specificity with very high positive predictive value and accuracy to become the most important criteria, Conclusion; As a result of this, we conclude that the accuracy of abnormal placental lacunae, loss of the reto-placental clear zone, myometrial thinning, and utero-vesical hypervascularity are the most critical ultrasound criteria for diagnosing placenta accreta in patients who had a previous CS with a placenta previa overlying the previous uterine scar.

Correlation of Qualitative Alpha1-microglobulin, Values of Interleukin 6, Cervicometry and Cervical Infection in Pregnant Women with Symptoms of Preterm Birth.

One of the problems in modern obstetrics is how to identify and select pregnant women who are most likely to give premature birth. In the last ten years, due to false-positive test results, i.e., tests with low positive predictive values, there is an increase in unnecessary hospitalization days as well as unnecessary therapy. The probability of preterm birth is 25% in a population of pregnant women with symptoms of preterm birth. The aim was to analyze diagnostic accuracy of tests for the purpose of predicting premature births in< 37th and <34th week of pregnancy.Incidence of preterm births in < 37th week of pregnancy was 28%, while the incidence of preterm births up until 34th week of pregnancy, was < 8%. We included two groups of pregnant women in a prospective study; one group with the symptoms of threatening preterm birth between 22nd and 37th week of pregnancyand the other one of the same gestation period with no symptoms. Each pregnant woman underwent test for placental alphamicroglobulin-1, cervical length screening, cervical sampling for microbiological analysis, blood sampling for IL6 and CRP analysis. There were 16% of preterm births, up until 7 days from hospitalization, and they were all PAMG-1 positive; There is 75% of preterm births if PAMG-1 is positive with cervical length under 25mm. Combining tests, we reached the best predictive accuracy with positive PAMG-1 test, cervical length under 15mm along with the increase of CRP values above 15.96%. Total number of hospitalization days was 29% with preterm births up to 71% with full term births regardless the symptomatology, which justifies further studies towards releasing the pressure from the health care system and from doctors as well in the process of reaching a decision on treatment of pregnant women with the signs of preterm birth.

CLINICAL PATHOGENETIC SUBSTANTIATION OF THE REGENERATIVE TREATMENT OF PARTURIENTS WHO SUFFERED FROM OBSTETRICAL HAEMORRHAGES

The publication is devoted to an urgent problem of modern obstetrics – the study of pathophysiological changes in the organism of parturients after obstetrical haemorrhages, improvement of restorative treatment, as well as reduction of complications in the puerperium and prevention of their occurrence. The aim of the study: to increase the effectiveness of restorative treatment of women in labor who suffered obstetric bleeding by studying the features of the clinical course, mechanisms of pathogenetic disorders, and their correction using ozone therapy. Materials and methods. A comprehensive clinical and laboratory examination of 150 women in labor was carried out, including 120 women (the main group) who suffered bleeding during childbirth and the early postpartum period. The control group consisted of 30 women with the physiological course of labor, childbirth and the early postpartum period. The state of lipid peroxidation (LPO) in parturient women was evaluated by the content of primary lipid products in the blood plasma – diene conjugates (DK) according to the method of B.V. Gavrilov (1983) and secondary molecular products – malondialdehyde (MDA) using the reaction with 2 thiobarbituric acid. The activity of the enzymatic link of the antioxidant system (AOS) was determined by the content of catalase in peripheral blood erythrocytes using the substrate hydrogen peroxide and glutathione peroxidase (GPO) using the P phenylenediamine substrate. The Spielberg–Hanin scale of state and trait anxiety was used to study the state of the psycho-emotional sphere in parturient women. Morphological examination of preparations of placentas and surgically removed uteri was carried out with staining of sections with hematoxylin and eosin, picrofuchsin according to Van Gieson. Results. Basic etiopathogenetic factors of the development of obstetric haemorrhages were examined, changes in the psychoemotional status of the patients were detected, haematological and metabolic indices, parameters of oxidation-antioxidation homeostasis and endogenic intoxication were studied, as well as morphofunctional disorders in placentas and uteruses. The efficacy of the restorative treatment of the parturients, who had moderate and massive haemorrhages during delivery, with the use of medical ozone in combined treatment versus traditional methods of treatment was studied. Conclusion. From the first day of the puerperium, free-radical lipid peroxidation increases, the activity of the enzymatic and non-enzymatic links of the antioxidant system increases, endogenous intoxication increases, and lactate and pyruvate levels increase. In the placentas of women in labor who suffered bleeding during labor, there is a violation of the synthesis of type IV collagen in the basal membranes of vessels and the phenomenon of endothelial dysfunction in the form of increased expression of endothelin by the endotheliocytes of the vessels of the decidual membrane (53.8 ± 2.9 µa) and the villous chorion (46.0 ± 2.6 μa). In the uterus, an increase in the expression of endothelin by endotheliocytes of the spiral arteries of the uterus (57.8 ± 8.56 µa) was detected, in combination with a violation of the synthesis of stromal collagen of type I and III and type IV in the basal membranes of vessels.

Evaluation of the vasorelaxant effect of Sugammadex on the arterial smooth muscle in rats

Although NMBAs (Neuro Muscular Blocking Agents) have been used for a long time, postoperative residual curarization is still a significant problem. Nowadays, an agent named Sugammadex is used for the reversal of curarization. It has been presented as a safer agent than its predecessor, neostigmine. The main purpose of this study is to investigate the effects of Sugammadex on rat thoracic aorta and enlighten the mechanism of action and potential benefits in surgical operations with general anesthesia. Twenty Wistar albino rats were used for the experiments. Thoracic aorta segments have been removed and mounted to the organ bath. Contraction and relaxation responses were presented as a percentage of phenylephrine (3x10-5 M) contraction. After recording contractile responses of Sugammadex (10-8-10-4 M), relaxation responses of Sugammadex (10-8-10-4 M) have been recorded both in the presence and absence of L-NAME (3x10-5 M) (Potent Nitric Oxide Sentase Inhibitor). Finally, relaxation responses of sugammadex-rocuronium have been recorded. Sugammadex caused slightly noticeable and concentration-dependent contraction on isolated thoracic aorta strips. Sugammadex also caused potent and concentration-dependent relaxation on isolated rat thoracic aorta. The relaxation response caused by Sugammadex has been diminished significantly in the presence of L-NAME. Administration of rocuronium with Sugammadex did cause neither relaxation nor any additional contractile effect on isolated rat thoracic aorta strips. Sugammadex is a promising agent in reversing rocuronium-induced neuromuscular block. Although the adverse effects of this agent are not studied in detail, it seems Sugammadex is safer than neostigmine. The side effects of anesthetic agents are one of the main problems of surgical procedures, including neurosurgery, gynecology, and obstetrics. Especially acute hypotension may be fatal in neurosurgery and gynecological operations. Sugammadex should be used carefully in adjusted and individualized doses to avoid hypotension-related adverse effects.

СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О РВОТЕ БЕРЕМЕННЫХ

This review discusses some aspects of the most common complication of the early gestational period – toxicosis. Vomiting of pregnant women (VP) is one of the frequent manifestations of early toxicosis. This disorder affects the quality of life of a pregnant woman, causes exhaustion, and contributes to the disruption of homeostasis, weakness, and dysfunction of various organs and systems. In addition, it may lead to miscarriage, placental insufficiency, insufficient weight gain during gestation, various perinatal pathologies in children, and other complications. Therefore, VP despite numerous studies conducted throughout the world, remains one of the urgent problems of obstetrics, the solution of which requires sufficient evidence-based research. Papers on various aspects of VP from the PubMed and Google Scholar electronic databases were analyzed. More than 500 sources were found, of which 50 were selected and included in the review, based on the selected keywords. Keywords: Pregnancy, changes in the body of a pregnant woman, pregnancy complications, pregnancy toxicosis, vomiting and nausea in pregnant women, perinatal outcomes.

ЭПИДЕМИОЛОГИЯ И ФАКТОРЫ РИСКА РАЗВИТИЯ МАТЕРИНСКОГО СЕПСИСА

In modern medicine suppurative diseases of puerperas are among the most significant medical and social problems of obstetrics, occupying a leading position in the structure of maternal morbidity and mortality throughout the world. High incidence, an upward trend, a growing number of cases of cesarean sections (CS), insufficient detection and registration, along with obstetric aggression characterize these formidable complications that can occur during pregnancy or in the postpartum period. According to the literature data, in spite of the high relevance of the problem, research on the incidence of postpartum purulent inflammatory complications, risk factors for their development, clinical picture, diagnosis, prevention, and treatment, as well as the algorithm for managing patients with these complications in Tajikistan is scarce. Keywords: Postpartum period, postpartum infection, postpartum suppurative diseases, sepsis, risk factors for sepsis. For citation: Saydalieva DA, Dodkhoeva MF, Abdullaeva RA. Epidemiologiya i faktory riska razvitiya materinskogo sepsisa [Epid

A Study on Birth Preparedness and Complication Readiness among Women Attending Antenatal Clinics in a Rural Area of Hooghly District, West Bengal

ABSTRACT Background: Globally, more than 40% of pregnant women experience acute obstetric problems and a large burden of it is shared by India. Birth Preparedness and Complication Readiness (BPCR) strategy is used to addresses these problems by encouraging women and communities to effectively plan for births, deal with birth emergencies. Objective: This study was conducted to assess the status of birth preparedness and complication readiness and to find out the factors associated with inadequate BPCR among pregnant woman in a rural area of West Bengal. Methodology: Institution based, observational study with cross-sectional design was conducted from January 2019 to September 2020 among pregnant women, attending antenatal care clinics in Singur block, Hooghly district West Bengal. Sample size was 272. Participants were chosen by systematic random sampling. Response rate was 94.5% (257). Data were collected using a predesigned pretested schedule and analyzed using Microsoft Excel version 2016 and SPSS version 16.0. Results: Overall, 60.3% mothers had inadequate BPCR. 66.1% mothers had poor BPCR knowledge and 72.8% mothers had poor BPCR practice. In multivariable logistic regression model, the odds of maternal morbidity [AOR = 2.03 (1.14 –3.62), P value = 0.16], ≤4 No. of ANC visits [AOR = 10.96 (4.82–22.9), P value = 0.001], first trimester USG [OR = 12.53 (5.8–24.5), P value = 0.001] showed significance with inadequate BPCR. Conclusion: Glimpse of BPCR is seen in government programmes like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK). Yet a big void exists among Indian pregnant women’s knowledge and practice of BPCR. Thus, there is a need to include BPCR in health care system to improve outcomes for pregnant women.

Diagnostic significance of autoantibody combination in fetal growth restriction with early and late manifestation

BACKGROUND: Fetal growth restriction (FGR) is one of the current problems in modern obstetrics and perinatology, which is associated with a large number of adverse perinatal outcomes.&#x0D; AIM: This study aimed to assess the diagnostic significance of the combination of autoantibodies (AAB) in the early and late FGR manifestation.&#x0D; MATERIALS AND METHODS: The study involved 117 pregnant women, classified into Group 1 (90 women with FGR) and Group 2 (27 women with a physiological course of pregnancy). Pregnant women with FGR were divided into two subgroups depending on the time of manifestation, i.e. FGR subgroups with early and late manifestation (45 patients each), respectively. Upon hospital admission, all patients of the study groups had blood sampling to determine autoimmune AABs using the ELI-P-test.&#x0D; RESULTS: An isolated increase in AABs to human chorionic gonadotropin (hCG) antigen, TrM (AAB markers of changes in vascular and hemostasis system), S100 protein, antineutrophil cytoplasm antibodies (ANCA), and KiMS (AABs to the cytoplasmic antigen of glomerular kidney cells) were observed in the early FGR manifestation when comparing the abnormal AAB spectrum in the early and late FGR manifestation, while a statistically significant isolated increase in the level of AABs to DNA and insulin was found in the late FGR manifestation.&#x0D; CONCLUSIONS: The study revealed the diagnostic significance of AAB combinations, as well as the combinations of increased AAB levels to hCG, S100, ANCA, and KiMS and an increase in AABs to DNA, collagen, and S100 protein in the early and late FGR manifestation, respectively.

How ya’ wanna roll with this? Tips and tricks for uterine tors

If you work with breeding livestock, obstetrical problems are inevitable. In bovine, there are numerous types of dystocias. Uterine torsions, rotation of the gravid uterine horn over the broad ligament, is one type that has a higher prevalence in the bovine. While the true underlying cause of torsions is not known, there are several factors that can increase the odds in­cluding pluriparous, deep-bodied dams, and increased move­ment of fetus during the beginning of parturition. Timeliness of assessing and determining direction and degree of torsion are important factors for determining options to resolve the torsion. Resolution options include cast-and-roll dam, manual detorsion or cesarean section. Each option has to be weighed with degree of torsion, stability of dam, facility and assistance availability. Complications that arise include uterine vascular complications, potential complication to the overall health of dam, and lack of cervical dilation after detorsion. With either of the two non-surgical approaches, vaginal evaluation during the process is warranted to determine progress. If the cervix is not dilated during detorsion, often surgical extraction of fetus is necessary. Outcome of dam and fetus depends on duration and extent of torsion and ability to intervene in a timely manner.

Prevalence of hemorrhagic ovarian cysts in patients with rare inherited bleeding disorders

BackgroundIn comparison with the general population, women with bleeding disorders are more prone to develop obstetrical and gynecological problems. However, no comprehensive evaluation has investigated the prevalence of hemorrhagic ovarian cysts (HOCs) in rare bleeding disorders (RBDs). In this study, we sought to determine the prevalence of HOCs in a large cohort of Iranian patients with RBDs. MethodsA total of 210 symptomatic patients suspected of HOCs with RBD were included. The median age of the study population was 24 years. Patients were diagnosed with fibrinogen disorders (n = 7, 3%), factor (F) II (n = 4, 2%), FV (n = 28, 13%), FVII (n = 4, 2%), FX (n = 6, 3%), FXIII (n = 122, 58%), combined FV and FVIII (n = 8, 4%), Glanzmann’s thrombasthenia (n = 10, 5%), and von Willebrand disease (VWD) type 3 (n = 21, 10%). ResultsFollowing further clinical and ultrasound examinations of these 210 patients, 68 (32.4%) were confirmed with a diagnosis of HOCs. Of which, FXIII deficiency with 46 cases (67.6%), followed by VWD type 3 (6 cases, 8.8%) showed the highest number. Other coagulation defects associated with HOCs were including fibrinogen deficiency (n = 2, 3%), FII (n = 2, 3%), FV (n = 4, 6%), FVII (n = 2, 3%), FX (n = 1, 1.5%), combined FV and FVIII (n = 2, 3%), and Glanzmann’s thrombasthenia (n = 3, 4.5%). ConclusionThis study found a high prevalence of HOCs in patients with RBDs, indicating the importance of early diagnosis and optimal management of obstetric and gynecological complications in these patients.

The Association Between Serum Homocysteine Levels and Placenta-Mediated Complications: A Narrative Review.

The most extremely unfavourable outcome of pregnancy is the death of the mother and newborn. Negative outcomes for mothers or babies can occur as a result of complications or issues during pregnancy, birthor the post-partum period. Early elevated maternal homocysteine (Hct) levels during pregnancy have been linked to altered placental development. There is evidence that suggests an elevated maternal blood Hct level is the new obstetrical risk factor, and the association between hyperhomocysteinemia (HHct) and numerous obstetrical problems was recently recognised. Hctis an essential amino acid, which contains sulphur and is formed from the metabolism of methionine. HHct has several known aetiologies, including genetic anomalies; a deficiency in folic acid, vitamin B6 and vitamin B12; hypothyroidism; old age; and renal illnesses. Vascular problems, coronary artery disease, atherosclerosis and embolic illnesses can all occur as a result of high blood levels of Hct. Hct levels are lower in normal pregnancies than it is in women who are not pregnant. Many pregnancy-related problems, including pre-eclampsia (PE), recurrent pregnancy loss (RPL), placental abruption, premature deliveryand foetal growth restriction (FGR) have been connected to HHct in recent research. We looked for pertinent literature using a thorough and systematic search from PubMed, Medline, Embase, Cochrane Library, Google, etc., and articles that were published before August 2022 based on serum Hct levels and various placenta-mediated complicationsfor this review. In this review,we describedthe synthesis andmetabolismof Hct in humans, Hct levels at various phases of normal pregnancyand the association between Hct and placenta-mediated pregnancy complications. The outcomes discovered can help obstetricians increase the likelihood of a successful pregnancy in cases where placenta-mediated issues are present. Lowering Hct levels with a high dose of folic acid tablets during the subsequent pregnancy may be useful for women who experienced these difficulties in prior pregnancies as a result of HHct.

Plasma miRNA Profile in High Risk of Preterm Birth during Early and Mid-Pregnancy.

In recent years evidence has been accumulated showing that miRNAs can act as potential biomarkers or targets for therapy of preterm birth, one of the most important problems in modern obstetrics. We have performed a prospective study of the miRNA profile in the plasma during the first and second trimesters in pregnant women with high risk of preterm birth (n = 13 cases and n = 11 controls). For the study group plasma blood samples at 9-13 weeks before diagnosis and at 22-24 weeks after start of therapy were selected. Using high-throughput sequencing technology we detected differences in the levels of 15 miRNAs (3 upregulated-hsa-miR-122-5p, hsa-miR-34a-5p, hsa-miR-34c-5p; 12 downregulated-hsa-miR-487b-3p, hsa-miR-493-3p, hsa-miR-432-5p, hsa-miR-323b-3p, hsa-miR-369-3p, hsa-miR-134-5p, hsa-miR-431-5p, hsa-miR-485-5p, hsa-miR-382-5p, hsa-miR-369-5p, hsa-miR-485-3p, hsa-miR-127-3p) (log2(FC) ≥ 1.5; FDR ≤ 0.05) during the first trimester compared with the control (non-high-risk of preterm birth pregnant women). All downregulated miRNAs in the first trimester from the placenta-specific C14MC cluster. During the second trimester no differentially expressed miRNAs were found. Our results suggest that the miRNA profile in plasma during early pregnancy may predict a high risk of preterm birth, which is important in preventing gestational problems as early as possible.

Endocrine Disorders and Preterm Labor

Preterm labor remains one of the most important problems in obstetrics and a common public health problem. It should be noted, that a large group of diseases associated with the development of prematurity are endocrine disorders and the share of various forms of endocrine disorders in pregnancy is increasing. Research objective: to study the structure and frequency of endocrine disorders in women with preterm labor. Materials and methods. A retrospective study was conducted to study the structure and frequency of endocrine disorders in 2,426 women with preterm labor. The frequency of endocrine disorders assessed, such as hyperandrogenism (polycystic ovary syndrome(PCOS), non-classic сongenital adrenal hyperplasia (CAH), Cushing’s syndrome), thyroid disorders (hypothyroidism, autoimmune thyroid disease, hyperthyroidism), hyperprolactinemia, diabetes mellitus, including gestational diabetes mellitus; hyperparathyroidism. Results. The study showed that endocrine disorders were observed in 37% of women with preterm labor (898 women out of 2,426 women with preterm labor). In particular, 364 (15%) women with preterm labor had diabetes mellitus, including gestational diabetes mellitus, 339 (13,8%) - PCOS, 170 (7%) - non-classic congenital adrenal hyperplasia (CAH), 3 (0.12%) - Cushing's syndrome. Hyperprolactinaemia was observed in 267 (11%) women with preterm labor, and hyperparathyroidism - in 2 (0.08%) women with preterm labor. Thyroid disorders occurred in 582 (23,9%) women with preterm labor. Among women with preterm labor and thyroid disorders, the largest group was women with mild thyroid dysfunction, such as subclinical hypothyroidism, isolated hypothyroxinemia, or TPOAb positivity - 379 (65%) women out of 582 women with thyroid disorders. It is significant, that women with preterm labor most often had uncontrolled endocrine disorders, whether poorly controlled pre-conception or first diagnosed during pregnancy - 503 (56%) women out of 898 women with ED. Conclusions. The high frequency of endocrine disorders among women with preterm labor (37%), revealed in our study, indicates that today endocrine disorders remain an important factor in preterm labor. In addition, results of our study showed, that among women with preterm labor and thyroid disorders, the largest group was women with mild thyroid dysfunction. It also implies that it is important to actively plan to assess early gestational thyroid function tests in women known to have thyroid disorders preconception. It is significant, that women with preterm labor most often had uncontrolled endocrine disorders, whether poorly controlled pre-conception or first diagnosed during pregnancy. This should be considered when developing a strategy for the prevention of preterm labor and planning a pregnancy in women with endocrine disorders.

MARKERS OF ENDOTHELIAL DYSFUNCTION AND THE EARLY PREGNANCY FAILURE

Introduction. Early pregnancy failure is one of the leading problems of obstetrics. Loss of the desired pregnancy is observed in 30% of cases [1]. A lot of recent publications indicate the great role of endothelial dysfunction and thrombophilia complications in reproductive losses [2].

Prevalence and Factors Associated with Premature Rupture of Membranes in Denpasar Bali

Premature rupture of membranes (PROM) is an obstetric problem which is one of the factors causing prematurity, infection, malpresentation, umbilical cord prolapse and perinatal mortality. This study aims to identify the relationship between sociodemographic and obstetric factors with the premature rupture of membranes in women giving birth. This cross-sectional study involved 274 people from 859 deliveries from January to December 2020, at a referral hospital in Denpasar, Bali. The sampling technique used is simple random sampling. The process of collecting data was taken from medical records and hospital registers. Data analysis using chi-square and logistic regression. Study found that the prevalence of PROM was 22.6%. The results of multivariate analysis found that age (p=0.733), occupation (p=0.816), gestational age (p= 0.055), parity (p= 0.477), and intra uterine pressure (p= 0.105 ) were not associated with PROM. Educational factors (p=0.021), hemoglobin level (p=0.000), and history of PROM (p=0.005) were significantly related to the premature rupture of membranes. There is a relationship between education factors, hemoglobin levels and a history of PROM with premature rupture of membranes. This information is important for service providers to understand so that they can carry out early detection and treatment efforts to prevent PROM. Keywords: premature rupture of membranes, maternity mother, hemoglobin, education.

MODERN VIEW ON CHRONIC RESPIRATORY DISEASES IN PREGNANT (review)

Disorders in the fetoplacental complex of pregnant women with chronic respiratory diseases (CRD) is one of the actual problems of modern obstetrics in medical, economic and social aspects. Respiratory diseases in the context of disorders of the fetoplacental complex (FPC) may be a comorbid process, a background to the pathology of pregnancy, or a premorbid condition that contributes to the development of placental dysfunction (PD) or even initiates it; morphophysiological changes characteristic of pregnancy also affect the state of the respiratory system, moderating the course of bronchoobstructive pathology. The presence of respiratory diseases in women, the impact of its treatment and features of the course and medical support of pregnancy in these conditions affect the condition of both the woman and the fetus, and in the future - the physical and neuropsychological development of the child.