Obstetric Problems Research Articles

Association of Premature Rupture of Membrane and Urinary Tract Infection among Pregnant Women

Background: Prelabour rupture of membranes among pregnant women is a common obstetrics problem encountered by the obstetricians. Objective: This present study was aimed to see the association of premature rupture of membrane and urinary tract infection among pregnant women. Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Enam Medical College, Savar, Dhaka, Bangladesh from January 2022 to December 2022 for a period of one year. Pregnant women with preterm premature rupture of membrane who were admitted in the Department of Obstetrics & Gynaecology at Enam Medical College, Savar, Dhaka, Bangladesh were selected as study population. Gravid women both primi & multi with preterm premature rupture of membrane, pregnancy of more than 23 weeks’ duration & less than 37 weeks or spontaneous rupture of the membranes were included in this study. All the clinical parameters, feto-maternal outcomes were recorded. Results: A total number of 83 pregnant women presented with premature rupture of membrane were recruited for this study. The mean with SD of the study population were 25.3±4.46 years with the range of 17 to 38 years. The most common comorbidities among the study population was urinary tract infection which was 78(94.0%) cases. In this study previous history of cesarean section was found in 28(33.7%) cases. Conclusion: In conclusion women presented with premature rupture of membrane is significantly associated with urinary tract infection. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):32-37

Level of knowledge of diabetic pregnant women about the pathology, signs and symptoms, alarm guidelines and treatment in a public hospital in Rosario during the period from October to November 2020.

Gestational diabetes (GD) is a disease that increases the risk of suffering obstetric problems and developing post-pregnancy diseases in both mother and child. A descriptive and cross-sectional study was carried out with the aim of evaluating the level of knowledge of diabetic pregnant women about gestational diabetes in the Maternity Inpatient Ward of the Hospital Provincial del Centenario during the period October-November 2020.Seventeen pregnant women with a confirmed diagnosis of GD participated in the study, of whom 8 patients were receiving insulin treatment and 9 were not receiving insulin therapy treatment. Confidentiality of personal and collected information was assured. The survey technique was used through a self-constructed collection instrument.The participants were between 19 and 43 years old, 71% of them had a diagnosis older than 30 days. Family history predominated in both groups. Regarding knowledge of GD, a little more than half did not identify the symptoms. Non-insulinized patients knew treatment guidelines in 44% and insulinized patients in 25% of cases, 38% reduced treatment to insulin therapy. Only 3 patients were aware of alarm guidelines.Seventy-six percent always comply with the glycemic control prescription indicated by the physician and insulinized patients were more aware of postpartum control (reclassification).Health education is recommended as an essential nursing task to improve the management of the disease by the patients, favor adherence to treatment and control of complications

Cравнительный анализ оказания медицинской помощи беременным женщинам с онкологическими заболеваниями в России и других странах.

Diagnosis and treatment of cancer during pregnancy represent a unique medical challenge that requires strict balance between the health of the mother and the safety of the fetus. This article presents a comparative analysis of treatment protocols used for pregnant women diagnosed with oncological pathology in Russia in comparison with other countries. Differences in treatment methods, interdisciplinary approaches and recommendations for the management of this complex category of patients were studied. Purpose to conduct a comparative analysis of the provision of medical care to pregnant women with oncological diseases in Russia and other countries. Materials and methods. A review of the literature by domestic and foreign authors published in the period 2018–2024 was conducted, dedicated to the problems of organizing oncological care for pregnant women in Russia and abroad. Results. The results demonstrate the need to develop individual strategies that take into account both oncological and obstetric problems, which indicates the importance of successful interaction between physicians of different specialties. In addition, psychosocial aspects of treatment, requiring complex support systems, are considered. Findings. Cancer care in pregnant women presents unique challenges that require a thorough understanding of both oncological and obstetric care. This comparative analysis highlights differences in treatment protocols between Russia and other countries, highlighting the need for improved guidelines and multidisciplinary approaches. Further research should focus on developing standardized protocols that integrate best practices from different countries, ultimately aimed at improving outcomes for pregnant women facing cancer. By prioritizing the needs of this vulnerable population and promoting collaboration among health care providers, we can ensure that pregnant women with cancer receive the comprehensive care they deserve.

Photoplethysmography in assessment of skin microcirculation in pregnant women with gestational arterial hypertension

Introduction. One of the urgent problems of modern obstetrics is gestational arterial hypertension (GAH), which entails a whole range of complications for both mother and fetus. In this regard, it is necessary to search for economically accessible, informative and safe methods for early diagnosis of uteroplacental blood flow disorders in pregnant women.The aim of the study was to investigate the features of peripheral and uteroplacental blood flow in pregnant women with GAH, to assess the state of the vascular wall of pregnant women using photoplethysmography and to determine its association with uteroplacental blood flow disorders. Materials and methods. A total of 78 patients with 22 to 40 weeks of pregnancy, divided into two groups, were clinically examined: the first group (n=42) were pregnant women with GAH, the second group the control group (n=36) consisted of patients with physiological course of gestation. The study included assessment of the objective clinical status of the pregnant woman, recording and contour analysis of photoplethysmograms, ultrasound examination of the uteroplacental and fetoplacental blood flow, and statistical processing of the results.Results. When comparing the anthropometric characteristics of the studied groups, an increase in BMI was found in the group of pregnant women with GAG (p<0.05). Contour analysis of photoplethysmography (PPG) data showed an increase in the augmentation index in pregnant women with GAG by 73.47 % (p=0.054), an increase in central arterial pressure by 3.6 % (p<0.05). Changes in peripheral hemodynamics in pregnant women with hypertensive disorder were associated with impaired fetoplacental blood flow (rxy = 0.52-0.86, p < 0.05), which was accompanied by lower fetal biometry parameters (p<0.05).Conclusion. Hemodynamic disturbances in the mother-placenta-fetus system correlate with changes in the parameters of peripheral circulation, which allows us to consider the additional use of the photoplethysmography method as promising in terms of early diagnostics and prevention of perinatal complications in mother and fetus.

PLACENTA ACCRETA SPECTRUM: MODERN APPROACH TO ORGAN-PRESERVATION

Pathologically invasive placenta has been a problem in obstetrics for several centuries. Recently, its importance has increased due to the growing number of women with a previously operated or compromised uterus, which is a direct risk factor for placenta accreta. In addition to the unpleasant development of events during childbirth for the obstetrician-gynecologist, this pathology is a danger to the mother's health. And this is not surprising, because even with quick action of the surgeon and prevention of massive blood loss after hysterectomy - a classic surgical procedure for implantation of the placenta - such women lose their reproductive organ, which can cause social and psychological discomfort. That is why organ-preserving operations are being developed today, the results of the evaluation of the effectiveness of one of them are given in this work. Aim: to compare the effectiveness of the proposed organ-preserving CLAP technique in women with placenta accreta spectrum compared to classic hysterectomy. Materials and methods: Women with placenta accreta spectrum underwent cesarean section and CLAP in the main group (n=19) and classical hysterectomy in the control group (n=18). Blood loss, neonatal outcome, and length of hospital stay were compared. Statistical analysis was performed using MedStat and Microsoft Excel software. Patients' rights were respected in accordance with the Declaration of Helsinki and the Universal Declaration of Bioethics and Human Rights (UNESCO). All pregnant women signed an informed consent form to participate in the study. Results: The two groups did not differ in terms of age, medical history and comorbidities. Statistically less blood loss was found in the main group (2377±322 ml vs. 3339±358 ml in the control group, p<0.001), while there was no difference in the condition of newborns, postpartum women, and length of hospital stay. Conclusions: The use of the CLAP technique in comparison with hysterectomy allows, in addition to the preservation of the female reproductive organ, to achieve less blood loss during surgical delivery of a pathologically invasive placenta, without changing the condition of the newborn, the postpartum woman, or the length of hospital stay. At the same time, in comparison with other organ-preserving techniques, CLAP does not require the use of special additional equipment and can be performed in any medical institution with sufficient qualifications of the surgeon.

Possibilities of an experimental approach in creating fetal growth restriction in animal models

The literature review was compiled to assess which animal models of intrauterine development disorders most adequately reflect the pathological processes in the clinic. Intrauterine growth restriction associated with placental insufficiency is an urgent scientific and practical problem of modern obstetrics and perinatology. According to World Health Organization, this complication occurs in 10% of pregnant women. The etiology and mechanisms of this pathology have been the focus of research for more than decades. Nevertheless, the methods of predicting and preventing this pathology are not very effective, as consensus in diagnostic approaches is only being formed, and there are practically no methods of correction. The results of experimental studies have made a significant contribution to the understanding of the pathophysiological foundations of the placental insufficiency and intrauterine growth restriction development. For this purpose, various laboratory animals are used, most often rats (Rattus norvegicus), chinchillas (Chinchilla lanigera), mice (Mus musculus), rabbits (Oryctolagus cuniculus), and guinea pigs (Cavia porcellus). Each of the above types of experimental animals has its own advantages for studying intrauterine growth restriction. There are three main methods used to simulate intrauterine growth restriction in animals: the surgical method (ligation of blood vessels), the method of placing in a chamber with a reduced oxygen concentration, and the method of lowering the caloric content and amount of food. Various models of intrauterine growth restriction have been proposed over a long study of the problem. However, these data differ greatly among themselves in the literature. The task of this review was to understand the most effective models and animal species to study fetal growth retardation, as well as ways to create this pregnancy complication.

Prospects for increasing the chances of successful vaginal delivery in women with a scar on the uterus after cesarean section

The review is devoted to one of the pressing problems of modern obstetrics — the delivery of women with a uterine scar after cesarean section. A scar on the uterus can cause various complications during pregnancy and childbirth. One of the main problems is scar failure. Pregnant women with a uterine scar, even after one cesarean section, should be considered at high risk for the development of complications. Visual diagnostic methods, such as ultrasound, magnetic resonance imaging, can only detect anatomical defects. Predicting the viability of a uterine scar is based, first of all, on a thorough analysis of data on a previous cesarean section. The choice of delivery method for pregnant women with a uterine scar is determined by its viability. It is not just the anatomical consistency of the uterine scar that is important, but also the functional one. The review presents criteria for diagnosing failure of the uterine scar according to ultrasound examination, data on the relationship between the initial thickness of the residual myometrium in the first trimester of pregnancy and the outcomes of pregnancy and childbirth. Considering that the functional viability of the uterine scar in subsequent pregnancies is largely determined by the course of reparative processes in the myometrium, especially the nature of angiogenesis, original studies are aimed at searching for diagnostic markers of the intensity of reparative angiogenesis. Generalization of existing knowledge about the possibilities of preclinical diagnosis of the consistency of the uterine scar will increase the number of vaginal births after cesarean section, reducing the number of abdominal births.

Recent Apprises on Predominant Disease and Disorders Detected in BAU Vet Clinic, Mymensingh, Bangladesh

The present study was accompanied at the Veterinary Teaching Hospital, BAU Mymensingh, since November 2023 to January 2024, to acknowledge the three months clinical study on animals. A total of 1765 clinical cases of which 427 goats, 211 cats, and 1127 cattle were examined. The clinical cases were divided into three groups: surgical, gynecological, obstetrical, and medicinal cases. In contrast with gynecological and obstetrical (cattle 3.82%, goats 7.26%, and cats 7.11%) and surgical (cattle 15.17%, goats 22.48%, and cats 19.91%) cases, the most significant percentage of cases were medicinal (cattle 81.01%, goats 69.79%, and cats 72.99%). Among the medicinal cases in cattle, parasite infestation most significant was (65.72%), than other infectious diseases (17.09%), general systemic (6.57%), and digestive disorders (3.83%). Additional cases counted like skin conditions (1.75%), respiratory disorders (1.64%), metabolic diseases (1.53%), eye disease (0.33%), urogenital disorders (0.55%), and musculoskeletal disorders (0.99%). In case of goats, general systemic diseases were maximum significant (24.16%), then parasitic diseases (21.14%), infectious diseases (20.13%), and digestive disorders (19.46%). Moreover, eye disease (5.37%), respiratory disorder (5.37%), skin conditions (2.68%), and musculoskeletal disorders (1.68%) were observed. In pet animals like cats infectious diseases were utmost significant (25.97%), compared to parasitic diseases (20.13%) and digestive disorders (19.48%). Additionally, skin diseases (11.69%), respiratory disorders (8.44%), eye disease (2.60%) and musculoskeletal disorders were (1.30%). The most prevalent gynecological and obstetric problems among the gynecological and obstetric cases were identified as repeat breeding (30.23%) in cattle, retained placenta (35.48%) in goats, and dystocia (60.00%) in cats. Hernia (26.32%) in cattle, Bone fracture (28.13%) in goats, and Bone fracture (23.81%) in cats were documented. In conclusion, the represented percentage of diseases was observed in BAU Vet Clinics and we hope that these data will support in the development strategies to regulate the most important diseases in the study area.

The role of progesterone preparations in the prevention of premature birth: a modern view of the problem

Despite significant progress achieved in healthcare, preterm birth is an urgent problem in modern obstetrics. The preterm birth can be caused by various risk factors: for example, an ascending infection can trigger the onset of uterine contractions, cervical shortening followed by infection of the fetal membranes, amniotic fluid, and, in rare cases, the fetus itself. In most cases, the infectious and inflammatory process is the etiopathogenetic factor of isthmic-cervical insufficiency (ICI), one of the common causes of late miscarriages and preterm births. The period between 14 and 20 weeks of gestation is the most critical time for the development of ICI. The dynamic ultrasound cervicometry once every 7–14 days from week 16 through week 24 of pregnancy is recommended to the patients with ICI, as well as pregnant women in the high-risk group. Most professional societies guidelines addressing this issue recommend all pregnant women to perform routine transvaginal cervicometry during the second ultrasound screening for the timely formation of risk groups and optimization of approaches to the patient management. The following groups of drugs are used to prevent preterm birth: micronized progesterone, slow calcium channel blockers, β-adrenergic agonists, and non-steroidal anti-inflammatory drugs. The use of progesterone drugs to prevent preterm birth has generated much debate. Thus, the availability of several forms of progesterone and various routes of administration determine the complexity of the drug therapy. Micronized progesterone is the only progesterone drug that was approved for use after 20 weeks of gestation. The vaginal micronized progesterone has been found to be highly effective in the prevention of preterm birth, significantly reduce neonatal mortality and improve infant morbidity outcomes.

The influence of celiac disease on fertility and pregnancy: an Italian survey.

Celiac disease (CD) is an inflammatory enteropathy that has been associated to obstetric and gynecological disorders. However, it is still not adequately tested by gynecologists due to the misconception that it is solely a gastrointestinal disease. This underestimation requires the development of targeted interventions. This study aims to evaluate the association between CD and obstetric/gynecological complications, highlight the importance of informing patients about CD manifestations, and assess the patient satisfaction with the information provided by healthcare professionals on the disease. A digital survey was administered to celiac women via the Italian Celiac Association's website. We analyzed 493 questionnaires. Obstetric and gynecological disorders led to the diagnosis of CD in 11.7% of interviewed. The study revealed that untreated CD patients are more predisposed to miscarriages (41.8% vs 34% before/after diagnosis, respectively, p = 0.111), anemia in pregnancy (71.4% vs 40.4% before/after diagnosis, respectively, p < 0.001) and the risk of low birth weight (newborns weighing < 1500g were 4.0% before and 1.1% after the gluten-free diet, p = 0.028). Women with CD, both before and after gluten-free diet, had higher infertility rates (about 19%) than the general population. Additionally, 73% of interviewees were dissatisfied with the information they received from health professionals about the reproductive implications of CD. Our research contributes to a deeper understanding of the intersection between CD and reproductive outcomes, highlighting the main obstetric and gynecological problems related to it. It emphasizes the importance of patient's perspective and the need for greater awareness about celiac disease from healthcare workers.

Most young female cancer survivors are at minimal risk for obstetric problems.

Most young female cancer survivors are at minimal risk for obstetric problems.

An Integral Assessment of Patient’s Condition in Postpartum Women with Critic Obstetric Complications

Introduction. Septic complications after critical obstetric conditions (COC) are a pressing problem in obstetrics. The aim of the study is to conduct an integral assessment of the severity of postpartum women with septic complications after COC.Materials and methods. We examined 39 postpartum women after COC (massive obstetric hemorrhage, severe preeclampsia). All patients were divided into 2 groups: the main group (n = 18) — with associated septic complications, the comparison group (n = 21) — without septic complications. The average age of the subjects was (29.80±6.48) years.Results. Obstetric bleeding was complicated by hemorrhagic shock in more than 75 % of patients in both groups. Premature detachment of a normally located placenta (PDNLP) was statistically significantly more often recorded in the main group (p = 0.04). All patients underwent total hysterectomy during childbirth or in the early postpartum period. Multiple organ failure syndrome (MODS) occurred in all women of the main group and in 17/21 (80.95 %) in the comparison group (p = 0.05). When assessing the condition of maternity hospitals using integral scales, a higher number of points were noted in the main group on the APACHE II scale (p = 0.02), SOFA (p = 0.001), NEWS2 (p &lt; 0.001). In the main group, septic complications developed on the 9 [4; 9] day after delivery.Conclusion. Risk factors for septic complications after COC are: MODS, renal failure, acute kidney injury, heart failure, respiratory distress syndrome, pneumonia. Maternity hospitals at risk of septic complications after COC initially show an increase in the number of points according to APACHE II, SOFA, NEWS2.

Investigating different dimensions of women’s childbirth experiences and its predictors among postnatal women: findings from a cross sectional study

Background and aimsChildbirth experience is an event in a woman’s life with short- and long-term effects on her physical and mental health. This study aimed to investigate different dimensions of women’s childbirth experiences and its predictors.MethodsThis cross-sectional study was conducted on 430 postnatal women with vaginal delivery in 2021 in Northern Iran. Data were collected using the Iranian women’s childbirth experience questionnaire (IWCEQ) and demographic and pregnancy-related characteristics questionnaire. Principal component analysis using Amos 24 and backward multiple linear regression using SPSS 22 were employed to analyze the data.ResultsThe mean score of childbirth experiences was 48.48 ± 19.09% out of 100 (95% CI: 46.68–50.28). The Principal Component Analysis revealed that the preparation (β = 0.84), positive perception (β = 0.78), and fear dimensions (β= -0.72) were the most important dimensions of women’s childbirth experiences. Moreover, education (B = -7.14, p = 0.001), spouse’s education (B = 7.40, p = 0.001), history of previous childbirth (B = 4.88, p = 0.001), obstetric problems of previous childbirth (B = − 7.73, p = 0.038), mother’s preferred type of delivery (B = 9.34, p = 0.001), the simultaneous delivery of another baby in the delivery room (B = -3.39, p = 0.017), and birth weight (B = -5.79, p = 0.005) explained 40% of the variance of the childbirth experience score.ConclusionChildbirth experience is a unique experience that influenced by positive and negative issues. More studies to identify related factors to dimensions of childbirth experience may have some insights for developing national and local- level health policies and clinical protocols.

Disorders of cervical maturation under wartime stressful conditions

Pregnancy itself is a prerequisite for stress reactions. Even in the physiological course, pregnancy has a certain impact on a woman’s psyche, and some authors even consider it as a crisis situation or a “period of psychological uncertainty”. Women have different types of reactions to pregnancy: from the absence of any psychological problems to neurotic personality development.All the hardships of wartime affect not only the mother’s organism and her psychological state, but also the state of the unborn fetus, which is programmed with certain physical and mental health characteristics for the rest of its life.To prevent these negative effects, pregnant women during the pregravid period and gestation should take preventive measures aimed at strengthening the organism’s defense reactions in adverse conditions. These include a rational nutritious diet, determination of a woman’s personality type by a perinatal psychologist and appropriate psychological practices, and sufficient supplementation of important vitamins and minerals with antioxidant and other protective properties.Pregnancy under the influence of prolonged chronic stress can be complicated not only by purely obstetric and perinatal problems, but also by disorders of the formation of the labour dominant and preparatory processes in the cervix. As a result, this can lead to miscarriage due to the development of tokophobia as a psychological component of these disorders.Cervical maturation before childbirth is a multifactorial process that includes numerous elements, complex processes at the psychological, systemic, tissue, cellular, gene and molecular levels. Comprehensive preparation of a woman’s organism for childbirth in conditions of chronic stress and certain tokophobia (a woman’s fear of childbirth and uncertainty of the future for her and her child during the war) is not only about preventing stressful effects during pregnancy (magnesium complexes with B vitamins – up to the 36th week), conducting a complex of psychoprophylactic therapy and psychophysiological preparation for childbirth from the 37th week, but also in local impact on the cervical state, taking into account changes in connective tissue and correction of the infectious factor at the same time of pregnancy. For this purpose it is advisable and reasonable to prescribe vaginal suppositories based on hyaluronic acid (HA) to accelerate preparatory changes in the cervical tissues by stimulating the synthesis of its own HA and with antibacterial effects due to a complex of plant extracts.

Maternal and fetal outcome of postdated pregnancy; A cross sectional study

Background: Postdated pregnancy refers to a pregnancy that extends beyond the expected date of delivery, which is 280 days. When a pregnancy surpasses 42 weeks (more than 294 days), it is termed as post-term pregnancy. Postdated pregnancy is one of the most common obstetric problems associated with increased maternal and foetal morbidity, and mortality. Gestational age is among the most important determinants of perinatal outcomes, but studies have focused more on preterm births (&lt;37 completed gestational weeks) and less on the understanding and prevention of post term births. Objectives: To assess the maternal and fetal outcome of postdated pregnancy. Material and Methods: Present observational descriptive cross sectional study was conducted for the period of 1 year from 1st April 2023 to 31st March 2024. Total 150 postdated pregnant women included in present study as per predefined after satisfying the inclusion and exclusion criteria. Results: During study period out of total deliveries 110 were postdated deliveries. Out of them 46.36% and 28.18% were of 21-25 years and 26-30 years of age respectively. The mean age of all participants was 25.51 ± 4.58 years. A statistically significant association was found between the gestational age of postdated women and their mode of delivery. Out of 110 postdated women, 68.18% and 31.81% had vaginal and caesarean deliveries, respectively. Conclusion: Adverse maternal and fetal outcomes of post-dated pregnancy should be anticipated and counseling of women at risk of post-term pregnancy and timely management for its prevention is recommended

Pregnancy outcomes and fertility after ligation of uterine artery only and hypogastric artery only in postpartum hemorrhage.

To determine and compare pregnancy outcomes after bilateral uterine artery ligation (BUAL) or bilateral hypogastric artery ligation (BHAL) for postpartum hemorrhage (PPH). This retrospective cross-sectional study was conducted from January 2010 to June 2018 at a tertiary referral hospital. Patients who had undergone arterial ligation for PPH were included in the study. Patients who had undergone BUAL and BHAL were compared with a control group in terms of fertility and pregnancy outcomes. A total of 156 patients were included, of whom 47 underwent BUAl, 59 underwent BHAL and 50 were in the control group. There was no significant difference between the groups in subsequent pregnancies in terms of the incidence of miscarriage, fetal growth restriction, preeclampsia, primary cesarean deliveries, and infertility (p>0.05). There was a significant difference between all groups in gestational age at birth and birthweight. Preterm birth was observed in 32.2% of patients in the BHAL group, and this rate was significantly higher than in the BUAL (12.8%) and control (6%) groups (p=0.001). PPH is a life-threatening obstetric problem. The effects of interventions performed to reduce pelvic blood flow in patients may lead to persistent problems, such as preterm birth and low birth weight in the next pregnancy. However, these interventions do not appear to affect the risk of miscarriage. In subsequent pregnancies of patients who received BHAL, special attention should be paid to preterm birth.

A novel case report of clockwise and counterclockwise uterine torsions during the same gestation period in a mare

SummaryUterine torsion (UT) is a common obstetrical problem in Straight Egyptian Arabian mares, causing a medical emergency for both the mare and the fetus. This case report describes, for the first time, the management of a case of UT in both directions during a single gestation period in a 5‐year‐old Straight Egyptian Arabian mare. The mare was 8 months pregnant and experienced intermittent unresponsive colic signs. Rectal examination revealed clockwise 180° UT and ultrasonography showed a viable fetus. The haematological findings were within the normal range. The mare was surgically treated immediately by standing flank laparotomy (SFL) on the right side. 4 days later, the mare was returned to the clinic with the same complaint. Rectal and ultrasonography examinations revealed counterclockwise 180° UT and a viable fetus. The animal was subjected again to SFL on the left side. After surgeries, the mare recovered well, foaled at term and gave birth to a viable filly. She was bred again and conceived. This case is documented to demonstrate the occurrence of a UT in both directions during the same gestation period in mares, as well as the efficacy of SFL in rectifying the condition and allowing both the mother and foal to survive.

Parameters of physical development of term newborns with Intrauterine Growth Retardation, born in a 3B Level Perinatal Centre of St. Petersburg State Pediatric Medical University in 2022

BACKGROUND: Intrauterine growth retardation of a newborn child is an current problem in neonatology, obstetrics and pediatrics. Due to intrauterine development disorders, these newborns have increased morbidity and mortality rates. In the presence of Intrauterine growth retardation, the likelihood of developing complications in the early neonatal period increases (birth asphyxia, meconium aspiration, hypoglycemia, polycythemia, etc.), and the risk of developing infections and neurological disorders) is increased. AIM: The aim of this study is to study the parameters of physical development of term newborns born in the Perinatal Centre 3B level of the St. Petersburg State Pediatric Medical University in 2022 year, to determine the frequency and structure of disorders associated with Intrauterine growth retardation and malnutrition depending on the gestational age of term newborns for a differential approach in the management of children with Intrauterine growth retardation by neonatologists and paediatricians. MATERIALS AND METHODS: There were analyzed 1000 hospital neonatal records of newborns children born at the Perinatal Centre of Level 3B of St. Petersburg State Pediatric Medical University in 2022 year. Of these, 55 term babies were born with Intrauterine growth retardation. The study examined the physical development of term newborns, determined the frequency and structure of disorders associated with intrauterine growth retardation and malnutrition, depending on the gestational age of term newborns. RESULTS: Retardation of intrauterine growth and development in newborn children born in level 3B centres are represented by low body weight in relation to gestational age in 63.6% of cases, trophic disorders with normal body weight and reduced weight/length ratio in 34.6% of cases, and low height index with normal body weight in 1.8% of cases. Severe physical developmental disorders were found only in children with low body weight: in 13% of cases of low birth weight for gestational age, and in 55% of cases of small fetal size for gestational age. CONCLUSIONS: the distribution of physical development disorders (ICD code P05.2) in term infants, depending on the degree of maturity has a linear trend and occurs with maximum frequency (50%) in late term newborns, which is associated with the onset of aging of the placenta and the intensification of existing, even compensated, placental insufficiency.

The current state of the problem, clinical-pathogenetic approaches to the diagnosis and management tactics of fetal growth restriction

Fetal growth restriction is a common complication of pregnancy with a complex etiology and limited possibilities of diagnosis and treatment. The relevance of this difficult obstetric problem is determined by various published diagnostic criteria, relatively low detection rates, and limited options for prevention and treatment.Fetal growth restriction is defined as the inability of the fetus to reach its genetically determined growth potential, most often due to abnormal placentation. Forms of fetal growth restriction with early or late onset are distinguished based on the gestational age determined during prenatal ultrasound diagnosis. According to most recommendations, the 32nd week of pregnancy is set as the cut-off point for distinguishing between early and late onset fetal growth restriction.The definition underlying this classification is based on differences between these two phenotypes of fetal growth restriction in severity, natural history, Doppler findings, association with hypertensive complications, placental features, and management. It is important to distinguish two separate conditions: fetal growth restriction and small-for-gestational fetus, which differ in short-term and long-term perinatal outcomes.A fetus is defined as small for gestational age if the estimated weight or weight of the fetus at birth is below the 10th percentile. Fetal growth restriction is diagnosed if the estimated fetal weight is below the 3rd percentile or a combination of pathological blood flow in the umbilical arteries and/or uterine arteries in fetuses with an estimated weight below the 10th percentile. It can also occur in fetuses and newborns with a body weight above the 10th percentile.The need to distinguish between fetal growth restriction and small-for-gestational-age fetus is related to the fact that fetal growth restriction is the main cause of stillbirth, neonatal death, higher perinatal morbidity, as well as increased risk of diseases in adulthood.The article analyzes the approaches to differentiating fetal growth restriction from small growth retardation in terms of fetal gestation period and further increasing the accuracy of diagnosis, as well as the modern concept of pathogenesis, with an emphasis on oxidant stress as a key molecular mechanism of adverse outcomes. Appropriate interventions during pregnancy to reduce perinatal complications should include antenatal monitoring and drug therapy.

Ophthalmological Disorders and Laboratory and Clinical Indicators in Women with Hypertensive Pregnancy Complications

Introduction. Hypertensive disorders during pregnancy, despite many epidemiological studies, scientific developments, and the improvement of laboratory and instrumental techniques for searching for predictors of preeclampsia, are a serious problem of perinatal obstetrics. One of these areas may be an in-depth ophthalmological examination.The aim of the work is to perform an analysis of ophthalmological disorders and laboratory, clinical parameters in women with hypertensive complications of pregnancy.Materials and methods. A retrospective analysis of 573 cases of hypertensive pregnancy complications was performed. The age of the patients ranged from 15 to 50 years. All patients received a standard general clinical and obstetric examination, examined by an ophthalmologist. A correlation analysis of some laboratory and clinical signs of arterial hypertension (AH) and preeclampsia (PE), including ophthalmological signs of PE, was carried out. Results: PE was accompanied by retinal angiopathy in 67 % of cases. In 9 cases (1.86 %), peripapillary edema was detected in PE. In the presence of peripapillary edema, earlier delivery dates and a lower Apgar score were observed in the newborn. Macular edema was registered in 3 cases (0.62 %) against the background of gestational diabetes mellitus.Conclusion. Comparative analysis has shown the presence of correlations between signs of hypertensive complications of pregnancy and changes in the organ of vision. The expansion of ophthalmological research may provide new markers-indicators for the differential diagnosis of hypertensive complications of pregnancy, assessment of the severity of the condition, dynamic monitoring and choice of management tactics for patients with hypertensive complications of pregnancy.