Threat Of Premature Birth Research Articles

Перинатальні особливості при рецидивній герпесвірусній інфекції

The aim of the study is to determine perinatal features in recurrent herpesvirus infection (HVI). Materials and methods. 160 pregnant women and their newborns were examined: 100 women with recurrence during pregnancy of herpes simplex virus type 1 and/or 2 (HSV-1 and/or HSV-2), 30 women seropositive for HSV-1 and/or HSV-2 without relapse during pregnancy, 30 women seronegative for HVI. Peculiarities of the perinatal period and the development of children at 1 year of life were studied. The obtained data were processed by the methods of variational statistics, using the Student's t-test and Fisher's angular transformation. The Microsoft Excel statistical analysis package was used. Results. Recurrent HVI during pregnancy is associated with a significantly increased frequency of pregnancy complications (threat of abortion in 52.0% of women, threat of premature birth in 21.0%, anemia of pregnancy in 54.0%, placental insufficiency in 72.0%, fetal distress in 24.0%), childbirth (abnormalities of labor in 28.0%, fetal distress in 15.0%), postpartum blood loss (5.0%). Children are more often born prematurely (6.0%), in a state of asphyxia (24.0%), with reduced body weight (28.0%). In the structure of complications of the neonatal period, infections typical for the perinatal period, damage to the nervous system, respiratory distress syndrome prevail. In the period of life up to 1 year, a quarter of children belong to the group of frequently and long-term patients, 14.0% are underweight, and a third are overweight. One third had anemia, 14.0% had exudative diathesis, 24.0% had a syndrome of movement disorders and increased neuro-reflex excitability. Delayed motor development in combination with delayed reduction of muscle tone, delayed language development, game skills, and communication skills were noted. Conclusions. Recurrent HVI during pregnancy causes a high frequency of perinatal disorders, which requires preconception counseling and pregnancy management in order to avoid recurrences of GVI, prevent stressful situations, join infections, and correct the psycho-emotional state. The study was carried out in accordance with the main provisions of GCP ICH and the Declaration of Helsinki, agreed with the Local Ethics Committee of the institution. All studies were performed after obtaining the informed consent of the women. The authors declare no conflict of interest.

INVESTIGATING INDICATORS OF ANXIETY, PSYCHOEMOTIONAL TENSION AND STRESS IN PREGNANT WOMEN DURING MARTIAL LAW

Introduction. Pregnancy is a vulnerable period marked by psychoemotional changes, ushering in a new stage with profound shifts in a woman's mental well-being. Elevated stress levels during pregnancy correlate with various adverse psychological and physiological outcomes for both the mother and child. In the current context, the ongoing war serves as an additional stressor for Ukrainian women. Pregnant women exposed to conflict face an increased risk of maternal mortality and a higher likelihood of delivering infants with health complications. Recognizing potential factors contributing to psychoemotional changes in pregnant women is a critical undertaking that should be initiated early in pregnancy.
 The purpose of this study is to assess indicators of anxiety, psychoemotional tension and stress in pregnant women during martial law
 Materials and methods. Psychometric testing of 50 pregnant women was performed by using three anxiety/stress scales: the Spielberger-Hanin Scale, the Psychological Stress Measure (PSM-25), and the Impact of Event Scale (IES-R). The participants were categorized into three groups: group 1 comprised pregnant women residing in areas directly impacted by the full-scale invasion, facing active hostilities or constant rocket fire without changing their residence (17 women, one experiencing occupation for < 1 month); group 2 included internally displaced women (13 individuals, two in settlements occupied for < 1 month); and group 3 encompassed 20 women residing in areas where active hostilities were not taking place.
 Results. According to the Spielberger-Hanin scale, the highest rate of reactive (46.2%, n=6) and personal anxiety (38.5%, n=5) was observed in the group of internally displaced women. The results of the IES-R were as follows, according to the invasion subscale: the highest level was observed in the group of women who were in settlements where there were no active hostilities (45%, n=9), avoidance was found in women who did not change their place of residence, where there was or continues to be active hostilities (58.8%, n=10), excitement – in internally displaced persons (46.2%, n=6). According to the PSM-25, no woman had a high level of stress, it was increased in women of the first group (23.5%, n=4). In the first studied group, complications were dominated by polyhydramnios (29.4%, n=5), fetal growth retardation syndrome (11.8%, n=2), umbilical cord localization pathology (5.9%, n=1), premature detachment a normally located placenta (11.8%, n=2) and one woman had surgery during pregnancy (5.9%, n=1). In the second group, there was a threat of abortion (30.8%, n=4). , preeclampsia in the first half of pregnancy (7.7%, n=1) and placenta localization pathology (7.7%, n=1). In the third group, there was a threat of premature birth (35%, n=7), preeclampsia (20% , n=4), oligohydramnios (25%, n=5), placental pathology (20%, n=4) and premature rupture of membranes (25%, n=5). Regarding the termination of pregnancies (table 4), the majority of pregnancies in all studied groups ended in term delivery, the highest percentage of premature deliveries (35%, n=7) was observed in the third group. In the group where there were women from the zone of active hostilities (group 1), one case of neonatal death was recorded, which was associated with significant fetal malformations.
 Conclusions. Stress is an adaptive process that induces changes in the body. This study revealed that each group experienced stress. It is noteworthy that stress during pregnancy is not solely attributed to war; factors such as the pregnancy itself, its parity, and the presence of somatic diseases also contribute. Consequently, there is a need to formulate measures for the psychoprophylaxis of women and to conduct further observations, assessing larger research cohorts.

Clinical assessment of the placenta function in women at risk and threat of premature delivery

Premature birth, despite the significant achievements of perinatal medicine in recent decades, remains an urgent global and national medical and social problem, as it is the leading cause of perinatal morbidity and mortality. According to modern views, placental dysfunction can be one of the causes of premature birth, and its frequency, according to randomized studies, can be from 78 to 91%, depending on the gestational age. At the same time, the research conducted to date does not provide a clear understanding of the role of timely diagnosis and prevention of placental dysfunction in preventing premature birth.The objective: to perform clinical evaluation of the prevalence of placental dysfunction in women at risk of preterm birth and with threat of preterm birth.Materials and methods. 180 pregnant women were took part in the study. To achieve the research aim, three research groups were formed. I group – 73 pregnant women with threat of premature birth; II group – 77 pregnant women with risk factors for premature birth. Women with risk factors for premature birth were included in the study at the stage of pregnancy planning (IIA subgroup, 39 women) or from the moment of applying to a women’s outpatient clinic to monitor the course of pregnancy (IIB subgroup, 38 pregnant women). The control group included 30 pregnant women with an uncomplicated course of pregnancy.Transabdominal ultrasound examination with color Doppler mapping, determination of free estriol, progesterone and placental lactogen levels in blood serum were performed at 18–21+6 and 28–30 weeks of gestation.Results. Analysis of the prevalence of risk factors for placental dysfunction and preterm birth in patients of the studied cohort showed that in pregnant women with preterm birth (I group), the combination of risk factors was 5.2; in pregnant women who received pre-gravid training (IIA subgroup) – 3.2; in pregnant women who were included in the study in the I trimester of pregnancy (IIB subgroup) – 4.7, while in pregnant women of the control group – only 0.8 (p<0.05).The threat of early spontaneous miscarriage with the formation of a retrochorial hematoma as a clinical manifestation of primary placental dysfunction was determined in 43.8% of pregnant women whose premature delivery was carried out for medical reasons. Placenta abruption in these patients can be considered as decompensation of the primary dysfunction of the placenta with the transition to acute placental insufficiency.The formation of chronic placental dysfunction, clinically manifested by the syndrome of fetal growth retardation, was most often observed in patients whose pregnancy ended in spontaneous premature birth at 34–36+6 weeks in the presence of an untouched amnion, – 68.6% compared to births at 28–33+6 weeks of gestation – 25.9% and with childbirth at 22–37+6 weeks – 13.3%.Conclusions. Clinical manifestations of placental dysfunction were detected in 30.6% of patients with premature birth, with morphological signs in 60.4% of cases, which indicates the hidden course of placental insufficiency before the development of premature birth.Morphological signs of placental dysfunction were determined in 87.5% of cases of premature births for medical reasons and in 100.0% of cases of spontaneous births at 22–27+6 weeks of gestation (with a combination of risk factors from 2.1 to 3.0), in 66.7% – with premature births at 28–33+6 weeks of pregnancy, in 40.0% – with premature births at 34–36+6 weeks of pregnancy and only in one (5.6%) case – with term births.The frequency of fixation of morphological characteristics of placental dysfunction correlates with the frequency of early pregnancy complications, primarily with the formation of retrochorial hematomas in the first half of pregnancy.

PERINATAL ASPECTS OF MEDICAL CARE WITH COVID-19

Purpose. To determine perinatal aspects of medical care for COVID-19. Materials and methods. 200 patients with confirmed SARS-CoV-2 hospitalized at the Kiev City Center for Reproductive and Perinatal Medicine were comprehensively examined: group 1 - 50 pregnant women with severe Covid-19 and group 2 - 150 pregnant women with moderate severity of the disease. Research results. Severe Covid-19 disease is observed in 12.2% of pregnant women, critical condition - in 7.5% of patients. Severe disease directly or indirectly determined a significantly higher incidence of pregnancy complications. First of all, this is placental insufficiency in the vast majority of patients (72.0%), which was manifested by fetal growth retardation and distress (in 32.0% and 48.0%). Half of the women experience oligohydramnios (50.0%), 38.0% have a threat of premature birth, and a third (30.0%) have premature birth. 44.0% of children are born in a state of asphyxia, 36.0% of children have manifestations of respiratory failure, and 16.0% have bilateral pneumonia. High incidence of neurological disorders (56.0%), gastrointestinal (50.0%), hypoglycemic (34.0%) and hemorrhagic (32.0%) syndromes. Testing of newborns for COVID-19 was positive in 6.0% of cases. 22.0% of children required intensive care unit care. Perinatal mortality was 0.4%. Conclusions. The identified high frequency of perinatal disorders in women with COVID-19 indicates the need for careful care for this category of pregnant women and their newborns, constant monitoring of vital functions, follow-up observation, and the development of clear algorithms for the actions of medical personnel depending on the patients’ condition.

Hormone imbalance of fetoplacental complex as a factor of premature birth

Despite the sufficient study of the pathogenetic factors of preterm birth, there is currently no consensus on the peculiarities of the pathogenesis of disorders of the functional state of the fetoplacental complex in this complication of pregnancy, no unified methodological approaches to early diagnosis have been developed, and there are no standards for the examination and treatment of pregnant women with detected disorders.The purpose of the work. To investigate the level of FPC hormones in pregnant women at risk of preterm birth.Materials and methods. The main group consisted of pregnant women with signs of placental dysfunction and a history of miscarriage (50 women). The control group consisted of 50 healthy pregnant women. Determination of hormones (progesterone, estradiol, placental lactogen) was carried out by the method of solid-phase enzyme immunoassay. The research was performed on an enzyme-linked immunosorbent assay according to the instructions for the specified sets of reagents.Results. The content of the hormones estradiol, progesterone and placental lactogen during pregnancy was determined to study the changes in the placental system hormonal function of pregnant women with a threat of premature birth. The concentration of estradiol in the blood serum of pregnant women of the main group was below the norm during the entire pregnancy period. It leads to a decrease in estrogens and progesterone synthesis by the corpus luteum of the ovary, and then by the placenta. A reduction of these hormone levels, which take a direct part in the flow of basic biochemical and physiological processes in the muscles of the uterus, leads to an increase in the contractile activity of the myometrium, which is shown by the phenomena of placental dysfunction and premature birth.Conclusion. Studying the levels of hormones of the fetoplacental complex in pregnant women at risk will allow predicting the development of premature birth.

The influence of the coronavirus disease transmitted during pregnancy on the course of gestation and changes in the main biotopes of a woman’s organism

The article presents literature data on the peculiarities of the pregnancy course and changes in the main biotopes in women who suffered from COVID-19 in different periods of gestation. Certain regularities regarding the association of perinatal complications with the severity of the disease, the presence of somatic and gynecological pathology in these pregnant women, in particular, obesity and chronic inflammatory diseases of the genital organs, were observed.According to research conducted on the basis of the department of pathology of pregnancy and childbirth of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. M. Lukyanova of the National Academy of Sciences of Ukraine», the risk group of a severe course of the coronavirus disease includes all the same factors as for any other diseases, not related to pregnancy: age over 35 years; the presence of concomitant pathology (diabetes, obesity, hypertension), work, lifestyle or housing conditions that increase the risk of infection. More frequent manifestations of obstetric pathology were found in older women and primipara women.Complicated obstetric anamnesis, namely, medical abortions and miscarriages, cervical pathology, previous inflammatory diseases, especially of the genital organs, are considered to be risk factors. The course of pregnancy and childbirth are accompanied by such complications as the threat of early miscarriage; anemia; combination of placental dysfunction, polyhydramnios and fetal distress; anomalies uterine activity, which increases the frequency of pathological childbirth in this contingent of women and requires repeated hospitalization during pregnancy.A review of scientific publications in recent years demonstrates the significant impact of COVID-19 on the composition of biotopes of the human organism. There are convincing data on the close relationship between the infection of the mucous membranes of the upper respiratory tract and the infection of the lungs with the SARS-CoV-2 virus. Lung hypoxia, typical for this infection, causes the growth of anaerobes and facultative anaerobes, which are part of the mentioned microbiomes during a person’s life. A significant number of observations have found the correlation of changes in the microbiocenosis of the respiratory tract and intestines in patients with SARS-CoV-2 and convalescents. At the same time, there is also a disorder in the vaginal microbiocenosis after the coronavirus disease, especially during pregnancy. A conclusion was made regarding the correlation between the severity of COVID-19 course and the number of lactobacilli in the vaginal biotope: the more severe course, the worse of the microflora composition. The gestation period is more often complicated by the threat of early pregnancy loss, placental dysfunction, polyhydramnios, fetal distress, and the threat of premature birth in those women who suffered a coronavirus infection in the I trimester. A large rate of polyhydramnios in most cases indicates the risk of intrauterine infection, so such women should be carefully monitored both for the impact of COVID-19 and for the activation of latent infections in the background of reduced immunity and, first of all, violations of the vaginal biotope. At the same time, a high frequency of obesity was found among these women, which worsens the course of infectious processes and the condition of the main biotopes.Therefore, for this contingent of women, the issue of timely detection and correction of violations of the genital tract microbiocenosis as a prevention of perinatal and obstetric complications becomes relevant. In order to avoid the negative impact of changes in the vaginal microbiocenosis on the condition of a woman and her child in the future, modern universal and safe preparations during pregnancy and lactation should be used for local treatment and strengthening of regenerative processes, which do not contain an antibacterial component, do not cause antibiotic resistance and are effective, available and convenient to use. The clinical experience of recent years allows to recommend for wide use in obstetrics and gynecology the complex safe and effective local preparations, which include chlorhexidine, chlorophyllipt and preparations with hyaluronic acid and plant extracts.

Modern approach to infusion therapy of pregnant women with gestational hypertension

To date, there are no effective treatment for placental dysfunction in pregnant women with gestational hypertension. Therefore, the purpose of our study was to investigate the clinical efficacy of proposed method of infusion therapy for pregnant women with gestational hypertension, which included a complex of drugs: pentoxifylline, arginine hydrochloride with levocarnitine and rheosorbilact. We observed 73 pregnant women with single fetation, starting from 28 weeks of gestation, who were observed before and during childbirth, and in the postpartum period by the time of discharge from the hospital. All examined women were divided into 3 groups. The first group included 30 pregnant women with gestational hypertension, who received (along with the basic therapy of methyldopa drugs) a complex of infusion solutions: pentoxifylline 0.05% – 100 ml; solution containing arginine hydrochloride 4.2% and levocarnitine 2.0% – 100 ml; reosorbilact preparation – 100 ml. The infusion was carried out once a day in the specified sequence for 10 days. The second group included 20 patients with gestational hypertension on basic therapy with methuldopa only. The control group included 23 women with physiological pregnancy. The data of our study show that in patients receiving the proposed infusion therapy there was a significant decrease in the development of placental dysfunction by 38.3%, the threat of premature birth – by 18.3% and fetal distress – by 30.0%, premature rupture of the membranes – by 35.0%, weakness of labor – by 28.3%, a decrease in the risk of perinatal central nervous system damage – by 33.3% and the frequency of cephalohematomas – by 30.0% compared with women who received only antihypertensive therapy.

Features of the clinical course of pregnancy, childbirth and the condition of newborns in women with HCV infection

The objective: to conduct a retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns in women with HCV infection.Materials and methods. A retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns was carried out according to the data of 351 birth histories of women with HCV infection based on the materials of the archive of the communal non-commercial enterprise “Kyiv Municipal Center of Reproductive and Perinatal Medicine” for the period from 2016 to 2021. The control group (CG) included 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 8.0”. Results. In women with HCV infection compared to the group of healthy pregnant women a significantly high frequency (p<0.001) of such pregnancy complications was found: threat of pregnancy interruption – 64 (18.2 %) patients versus 2 (4.0 %) persons, edema of pregnant women – 72 (20.5 %) and 4 (8.0 %), respectively; preeclampsia – 45 (12.8 %) versus 2 (4.0 %), gestational anemia – 131 (37.3 %) versus 6 (12.0 %), as well as placental insufficiency with fetal growth retardation syndrome (FGR) – 69 (19.6 %) versus 3 (6.0 %; p<0.05) and intrahepatic cholestasis of pregnant women – 42 (11.9 %) versus 1 (2.0 %; p<0.05). In 73 (20.8 %) pregnant women with HCV infection the childbirth was complicated by premature rupture of the membranes, of which almost half of the cases (42 (11.9 %) of the patients) finished with premature birth, while in CG only some women had such complications. Fetal distress during childbirth was reliably detected more often in pregnant women with HCV infection than in CG women (χ2=4.76; p=0.024). Caesarean section was performed in 86 (24.5 %) patients with HCV infection versus 2 (4.0 %) persons in CG (p<0.001).The newborns from mothers with HCV infection had lower indicators of physical development and decreased Apgar score assessment, increased frequency of conjugation jaundice.Conclusions. Pregnant women with HCV infection are characterized by a significant increase in the number of pregnancy complications, such as the threat of pregnancy interruption, the threat of premature birth, gestational anemia, placental dysfunction, fetal growth retardation syndrome, and preeclampsia; during childbirth – premature and antepartum rupture of amniotic membranes, premature birth, weakness of uterine activity in labor, increased blood loss. The condition of newborns from women with HCV infection is characterized by a significant increase in the frequency of asphyxia during childbirth, CNS hypoxic-ischemic damage, prematurity and conjugation jaundice.

Placental factors in the development of preterm birth in pregnant women with comorbidity

Premature birth (PB) is a polyetiological problem that depends on many factors, accompanied by violations of the placenta functional competence, changes in its metabolic, hormone-producing and protective functions. The objective: to establish the importance of placental factors in the development of PB in pregnant women with comorbid pathology. Materials and methods. The levels of fetal and placental proteins (placental alfa microglobulin-1, α2-microglobulin of fertility, trophoblastic β1-glycoprotein) and hormones (estriol, placental lactogen, progesterone) were determined in 33 pregnant women with threat of PB at 26–34 weeks of gestation (main group), who had concomitant comorbid pathology in the stage of unstable remission. The control group included 26 healthy pregnant women who were representative for gestational age. Results. In pregnant women with comorbid pathology a decrease of the placenta protein-synthesizing function and the hormone-producing function of the trophoblast was found, which makes it difficult to launch the syntoxic adaptation programs of the mother’s organism, which are responsible for maintaining the pregnancy with the subsequent development of placental dysfunction, the result of which is PB.The markers of these disorders are a 3-fold decrease in the level of trophoblastic β1-glycoprotein (p<0.0001) and a 1.7-fold decrease in the concentration of α2-microglobulin of fertility (p<0.0001) with a simultaneous 4-fold increase of placental alfa microglobulin-1 concentration (p<0.0001) and a decrease in the levels of placental lactogen by 1.6 times (p<0.0001), estradiol by 40 % (p<0.0001) and progesterone by more than 2 times (p<0.0001) compared to healthy pregnant women.Conclusions. In patients with comorbid pathology there are disorders in the secretion of pregnancy proteins due to a decrease in the levels of trophoblastic β1-glycoprotein and α2-microglobulin of fertility and an increase in the level of placental alfa microglobulin-1 and disorders of the hormone-producing function of the trophoblast due to a decrease in the secretion of placental lactogen, progesterone, and estradiol. The disturbance of the secretion of the pregnancy zone proteins and hormones are the early markers for the initiation of premature birth caused by placental dysfunction in pregnant women with comorbid pathology.

THE CYTOKINE SYSTEM IN THE SECOND HALF OF PHYSIOLOGICAL PREGNANCY AND DURING LABOR

A study was conducted to study the level of anti-inflammatory (IL-4) and pro-inflammatory (IL-1β, IL-6, IFNγ, TNFα) cytokines in 28 women with physiological pregnancy in the third trimester and in 23 women with incipient labor. It was found that in the prenatal period, the level of IL-1β and IL-8 increases sharply, and the level of IL-4 decreases sharply. The levels of IL-6 and TNFα are also slightly elevated. Therefore, the study of the level of pro- and anti-inflammatory cytokines in parturient women with a physiologically proceeding pregnancy is of great interest, since it is this mechanism of changes in the level of cytokines during incipient labor activity that is observed in a pathologically proceeding pregnancy with the threat of premature birth.

CHARACTERISTICS OF THE COURSE OF THE GESTATION PERIOD, CHILDBIRTH AND NEWBORN CONDITION IN PATIENTS AT THREAT OF PREGNANCY TERMINATION IN EARLY TERMS

Despite the successes of modern obstetrics and perinatology, stillbirth occupies one of the leading places inthe structure of perinatal morbidity and mortality. Today, every 5-6 women lose a pregnancy, and the majority of spontaneous miscarriages occur in the 1st trimester of pregnancy.The aim of the study is to examine the peculiarities of the course of the gestation period, childbirth and the condition of newborns in patients with a threat of early termination of pregnancy.Materials and methods. We carried out a retrospective analysis of 100 individual charts of pregnant and parturient women with a threat of abortion in the 1st trimester of pregnancy (the main group). In 40 patients (subgroup I), the threat of termination of pregnancy was accompanied by bleeding, in 60 – the threat of termination without bleeding was diagnosed (subgroup II).The control group consisted of 50 pregnant women with the physiological course of the first trimester of pregnancy. Statisticalanalysis was performed according to generally accepted methods of variational statistics. Reliability was assessed by Student's t-test.Differences were considered significant at a significance level of p≤0.05.The conduct of research was approved by the Ethics Committee of the BSMU, which is confirmed by the protocol of the Commission on Biomedical Ethics regarding the observance of moral and legal rules for conducting medical scientific research.Processing of personal data was carried out after receiving the patient's informed consent.Results and their discussion. The research groups were representative in terms of residence, social status, and education. Menstrual and reproductive anamnesis data in the main and control groups also did not differ significantly. The rate of spontaneous abortions and terminations of pregnancy according to medical indications was significantly higher in women with threatened termination of pregnancy both with and without bleeding compared to controls. Patients of the main group had a significantly higher history of both gynecological diseases and extragenital pathology.Pregnant women with retrochorial hematoma and bleeding accounted for 70%, in 30% of women in the 1st trimester of pregnancy, in the presence of bloody secretions, retrochorial hematoma was not diagnosed. The percentage of asymptomatic retrochorial hematomas was 15%. Anomalous location of the chorion in the 1st trimester of pregnancy was diagnosed much more often in the 1st and 2nd subgroups.The analysis of the further course of pregnancy in women with episodes of miscarriage in the early stages of gestation showed that in the main group the level of perinatal complications, such as the threat of premature birth (30%), placental dysfunction (38%), preeclampsia (11%), fetal distress (20%), SZRP (19%) was significantly higher. Accordingly, the rates of premature birth (13%), fetal distress (25%), and labor anomalies (10%) were higher in childbirth.When analyzing the condition of children at birth, the level of moderate asphyxia in the main group was higher than in the control group (8±2.7% and 0%, respectively). The average weight of full-term newborns in the study group was significantly lower (3020.0±21.4) than that of children in the control group (3685.0±28.1 g) (p<0.05).Conclusions.Pregnant women with a threat of miscarriage in the first trimester of pregnancy are a high-risk group for the occurrence of perinatal complications.The level of complications in the II and III trimesters of pregnancy is significantly higher if the threat of early termination of pregnancy was accompanied by bleeding.In pregnant women with bleeding earlier (up to 8 weeks), compared to patients with bleeding at 9-13 weeks, the frequency of threatened miscarriage in the II trimester of pregnancy, premature birth, placental dysfunction, preeclampsia, and SZRP was significantly higher.

Clinical effectiveness of preconception training in women with sexually transmitted infections after an IVF program

The objective: to prove the clinical effectiveness of preconception preparation of the women with a history of sexually transmitted infections (STIs) after pre-gravid training before assisted reproductive technology (ART) cycles.Materials and methods. 115 women received the suggested pre-gravid training, of which 56 women became pregnant after ART programme and were included in the 1st group and received medical and preventive measures offered by us; 132 women after standard pre-gravid training, of which 55 women became pregnant after ART program and were included in the II group and received generally accepted medical and preventive measures. A clinical analysis of the pregnancy course, childbirth and the condition of newborn children was conducted in 111 women (I and II groups). All patients in the I and II groups had STIs in medical history. Statistical processing of research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 8.0”. Results. The rate of threat of pregnancy interruption was significantly lower in the I group – 6 (10.7 %) patients than in the II group – 19 (34.5 %; p<0.001); missed abortion was determined in 3 (5.3 %) cases in the I group versus 6 (10.9%) cases in the II group; spontaneous pregnancy interruption in the I trimester was in 2 (7.1 %) patients in the I group versus 4 (7.3%) women in the II group. Pregnancy was terminated in 5 (8.9 %) pregnant women in the I group and 10 (18.2 %) – in the II group (p<0.05). The threat of late abortion in women in the I group was found significantly less than in patients in the II group – 4 (7.8 %) versus 12 (26. 7%) persons, respectively (p<0.05). Fetal growth retardation (FGR) was diagnosed significantly less in the pregnant women of the I group than in pregnant women of the II group, – 11 (21.6 %) versus 17 (37.8 %) individuals, respectively (p<0.05). The results of cardiotocography (CTG) demonstrated that the satisfactory fetal state was determined in 40 (78.4 %) pregnant women in the I group, which is statistically significantly more than in the II group – 23 (51.1 %; p<0.05) cases.Doubtful non-stress test data were found in the I group more less – 10 (19.6 %) patients versus 15 (33.3 %) cases the II group (p<0.05). Pathological data of CTG were registered in 1 (2.0 %) pregnant women in the I group versus 7 (15.6%) cases in the II group (p<0.05). The risk of fetal distress in the pregnant women in the I group was 13.9 % (95 % CI 7.8-20.0), RR=0.5 (95% CI 0.16-0.66; p=0.002), which confirms the effect of the pre-gravid complex of medical and preventive measures on the fetal distress reducing in the pregnant women of the I group.Premature births were observed significantly less in patients in the I group, than in the II group, which amounted to 6 (11.7 %) versus 12 (26. 7 %) persons (p<0.05). The condition of newborns in the I group was satisfactory in 49 (85.9 %) cases, and the total level of children born with asphyxia in the I group decreased by 2.5 times (p<0.05).Conclusions. Pathogenetically based pre-gravid preparation and therapy proved to be effective for the onset of pregnancy after ART method and positive pregnancy outcomes in 48.6 % of the women; it reduced the reproductive losses by 2 times, the threat of abortion by 3.2 times, the threat of premature birth by 1.6 times, preeclampsia and fetal growth retardation by 1.5 times, and fetal distress during delivery by 2.2 times.

The possibility of diagnosing intrauterine infection by the content of nitrite and non-thiolate nitroso compounds in maternal blood plasma.

The aim of the study is to develop a method for early diagnosis of intrauterine infection (IUI). A study of markers of inflammation in the venous blood of 60 pregnant women was conducted. The study was followed by a retrospective assessment of the outcomes of pregnancies and childbirth. Of these, 33 patients with a gestation period of more than 37 weeks (full-term pregnancy) and, accordingly, 27 patients from whom the blood sample was taken at a period of less than 37 weeks - patients with the threat of premature birth (PB). PB is the main factor contributing to the development of IUI. 27 patients were diagnosed with premature rupture of the membranes (PROM). Of these, 15 are with the threat of PB. 8 of them had a diagnosed IUI. In all cases of diagnosed PROM, including those with IUI, the concentration of nitrite and nontiolate nitroso compounds (NO2-+RNO) in the mother's blood plasma was 2.3±1.2 µM, while normally it does not exceed 0.1 µM (p<0.001). Regardless of the duration of pregnancy. The use of antibiotics in the case of PROM contributed to the normalization of the concentration (NO2-+RNO). Therefore, increasing of this indicator is result of bacterial infection. Indications of other markers of inflammation: the number of leukocytes in venous blood and in a smear of vaginal contents, the level of C-RB did not significantly change in both PROM and IUI (p>0.1). Since the concentration index (NO2-+RNO) increased in almost all cases of PREM, unlike all other clinical and biochemical indicators used in modern medicine, there is an obvious sense of its use for the current monitoring of the health of pregnant women. But it is still impossible to say unequivocally about the possibility of monitoring the fetal health by concentration (NO2-+RNO) in the mother's blood.

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.

Ефективність прегравідарної підготовки в пацієнток після невдалих спроб допоміжних репродуктивних технологій на тлі хронічного ендометриту

Purpose - to evaluate the effectiveness of the complex preconception preparation in patients after unsuccessful attempts at assisted reproductive technologies (ART) against the background of chronic endometritis. Materials and methods. At the stage of pregnancy planning, we conducted complex preconceptional training for 55 women of reproductive age with chronic endometritis and repeated unsuccessful attempts at ART. These women represented the first main group of the study. The group II (comparison) - 40 women of reproductive age with chronic endometritis and repeated unsuccessful attempts at ART, who did not use the preconception training developed by us. Results. The percentage of pregnancy by determining the level of human chorionic gonadotropin for embryo transfer was 47.2% (26 cases) in the group I versus 34.5% (19 cases) in the group II (p&lt;0.05). In the group I women, such complications of pregnancy as the threat of termination of the first half of pregnancy, the threat of premature birth, preeclampsia, placental dysfunction and the syndrome of fetal growth retardation and gestational anemia were significantly lower compared to women in the group II. Term delivery was observed in 21 (86.0%) of women of the group I, while in pregnant women without preconception preparation, the frequency of delivery on time did not exceed 11 (64.7%), (p&lt;0.05). Caesarean section in both groups, performed in almost half of the examined pregnant women (10 (40.0%) versus 9 (52.9%), respectively, p&lt;0.05), varied significantly depending on the indications for caesarean section. In a planned manner, caesarean section was performed in 9 (90.0%) of cases of pregnant women in the group I and 4 (44.4%) of cases in the group II (p&lt;0.05). Of the 28 newborns from mothers of the group I, full-term children were 23 (92.0%) and 5 (8.0%) were premature, of which 3 were born at gestational times of 33-36 weeks and one of the twins at 28-32 weeks. In the group II, term babies were 14 (70.0%) cases, and 6 (30.0%) cases were premature and all of them were twins: the first twins were born at 24-27 weeks, the second twins were born at 28-32 weeks and the third twin was born at 33-36 weeks (p&lt;0.05). Conclusions. The complex pregravid training in patients after unsuccessful attempts of ART against the background of chronic endometritis had a positive effect on the onset of pregnancy, a favorable course of pregnancy, childbirth in the postpartum period and the condition of newborns in this group of patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

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&lt;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.

Features of retrochoir hematomas and their effect on the course of pregnancy

The aim. Study of the features of retrochoir hematomas (RHG) and their influence on the formation of the placenta, the course of pregnancy, as well as the occurrence of premature birth.&#x0D; Materials and methods. 2 groups of pregnant women were selected depending on the frequency of RHG formation: 1 group – 60 pregnant women with recurrent RHG, group 2 – 50 pregnant women with RHG, which was detected only in the early stages of pregnancy. extragenital and genital pathology did not differ reliably. All the women studied were anamnesis, examined, and ultrasound and dopplerometry were performed.&#x0D; Statistical methods included an assessment of statistical significance using Student's t-criterion and criterion X2 and were considered significant at p&lt;0.05.&#x0D; Results. Supracervical localization of hematomas prevailed in the studied pregnant women, namely: in group 1 – 51.7 % (in 31 pregnant women) and 68 % (in 34 women) in group 2. The same pattern was observed regarding the involution of hematomas.&#x0D; Changes in the yolk sac were found in both groups with RHG (in 6.7 % of women (i.e., in 4 pregnant women) of group 1 and 4 % (in 2 pregnant women) of group 1.&#x0D; Mean values of the pulsation index (PI) of blood flow velocity curves in the uterine arteries (UA) and umbilical cord artery (UCA) in pregnant women with RHG were higher than the standard average for gestational age.&#x0D; In pregnant RHGs, a history of various types of fetal growth retardation (FGR) is detected. The number of early forms of URP was higher in group 1 (16.7 %, i.e. in 10 pregnant women) as opposed to group 2 (2.0 %, i.e. 1 case). The late form was approximately the same amount in both groups. Also, group 1 was characterized by a significantly larger number of FGR of 2-3 centuries.&#x0D; In addition, in both groups with RHG, such pathological conditions were identified during pregnancy as the threat of premature birth, premature placental maturation, placental hypoplasia, oligohydramnios, and hydramnios.&#x0D; Conclusions. Pregnant women with recurrent RHG compared to pregnant women with sporadic RHGs have a greater number of complications during pregnancy, including the threat of preterm labour, premature placental maturation, placental hypoplasia, oligohydramnios, hydramnios, FGR, impaired uterine-placental and placental-fetal blood flow.

Nonalcoholic steatohepatitis and obesity: influence of key risk factors on the development of obstetric and perinatal complications in pregnant women

The aim of our study is to assess the development of obstetric and perinatal complications in obese pregnant women with non-alcoholic steatohepatitis (NASH) depending on changes in blood lipid spectrum and body mass index (BMI). Materials and methods. We examined 98 pregnant women with non-alcoholic fatty liver disease (NAFLD) at the stage of NASH in combination with obesity. The control group consisted of 30 healthy pregnant women. All pregnant women with NAFLD and abdominal obesity were divided into 3 groups depending on BMI: Group I – 26 pregnant women with BMI 25.0–29.9 kg/m², Group II – 48 pregnant women with BMI 30.0–34.9 kg/m2, Group III – 24 pregnant women with BMI 35.0–39.9 kg/m2. Correlations of obstetric complications depending on changes in lipid metabolism and BMI were determined. Results. The analysis of obstetric complications revealed 3.4 times higher risk of early miscarriage in group I, 5.6 times – in group II, 7.5 times – in group III compared the control group (P &lt; 0.05); early gestosis occurred 1.9 times more often in group I, 2.5 times – in group II, 3.3 times – in group III as compared to that in pregnant women of the control group (P &lt; 0.05); the threat of premature birth was found 3.4 times more frequently in group I, 5.6 times – in group II, 7.5 times – in group III as compared with the control group (P &lt; 0.05). Group I patients developed placental dysfunction with a frequency of 2.3 times, group II – of 4.0 times, and group III – of 6.3 times greater than pregnant women of the control group (P &lt; 0.05), and moderate preeclampsia was diagnosed in overweight pregnant women, as well as in women with grade I and grade II–III obesity 2.3 times, 4.7 times and 5.6 times as often, respectively, as in the control group (P &lt; 0.05). Correlation analysis showed correlations between lipid metabolism indicators and an increase in BMI. Conclusions. Obese pregnant women with NAFLD at the stage of NASH were found to have significantly more frequent obstetric and perinatal complications as well as lipid profile abnormalities correlating with increased BMI, which may be due to the presence of NASH and functional liver failure.

Особливості перебігу коронавірусної хвороби у вагітних та частота виникнення перинатальних ускладнень залежно від ступеня тяжкості захворювання

Purpose - to analyze clinical and laboratory changes in women with mild to moderate coronavirus disease, the frequency of gestational complications depending on the course of the disease. Materials and methods. 120 pregnant women of the main group with coronavirus disease were involved in the clinical and laboratory examination. The control group consisted of 40 women with gestational age from 22 to 41 weeks, whose pregnancy was not complicated by coronavirus disease. The course of the disease and the impact of coronavirus infection on the course of pregnancy were evaluated by the results of general - clinical, laboratory and instrumental examinations. Results. The surveyed women underwent treatment in the period from 2021 to 2022 at the Communal Non-profit Enterprise «Kyiv City Center for Reproductive and Perinatal Medicine». The mild course of disease had 48 (40%) pregnant women, the course of coronavirus disease of moderate severity had 72 (60%) pregnant women. Symptoms of coronavirus disease observed in pregnant women: hyperthermia - body t≥37.0oC (85 (70.8%) women), general weakness (103 (85.8%) women), loss of smell and taste (27 (22.5%) women), catarhal phenomena (69 (57.5%) women). Decrease in saturation to 92-94% was noted at 18 (15%) pregnant women. The following complications of pregnancy were observed: the threat of premature birth, oligohydramnios, polyhydramnios, fetal growth retardation, structural changes in the placenta according to ultrasound examination of the fetus, violation of fetal-placental blood flow I-II centuries. Conclusions. Given the data of the analysis, it is possible to identify certain features of clinical and laboratory manifestations of coronavirus disease. The most common clinical manifestations are hyperthermia and general weakness. Features of changes in laboratory blood parameters are as follows: leukopenia, lymphocytopenia, increased C-reactive protein and D-dimer, decreased activated partial thromboplastin time, increased prothrombin time, increased total fibrinogen. The most common complications in pregnant women with mild to moderate coronavirus disease: the risk of premature birth, structural changes of the placenta and oligohydramnios. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author. Keywords: coronavirus disease, pregnant women, extragenital pathology, complications of pregnancy.

Parturition Premature Imminens Management : A Review Article

Introduction : Parturition Premature Imminens (PPI) or the threat of premature birth is the presence of uterine contractions accompanied by cervical changes in the form of dilatation and effacement before 37 weeks of gestation and can cause premature birth. Premature birth is a problem with a high prevalence in the world and is a challenge for doctors, especially obstetricians, to find out the causes and prevention of premature birth. The main problem with premature birth is the lack of success in its managemen. Discussion : The mechanism of preterm labor is not different from that of term labor, namely uterine contractility, cervical ripening, and membrane rupture. The fundamental difference is that the activation process in term labor is part of the physiological activation, whereas in preterm labor it is pathological. The usual path of delivery can be seen based on anatomy, biochemistry, immunology, endocrinology, and clinical symptoms. Prevention should be done in PPI management, as Performed prenatal care, diet, administration of vitamins, hygiene, Activity (work, coitus) is restricted in patients with a history of preterm labor, Immediate treatment if there is infection or comorbidities, Abdominal surgery and dental procedures are postponed until delivery. Special condition as Patients with multiple pregnancies should be on bed rest from the 28th to the 36th week. Fibromyoma, if there are complaints, can be treated with bed rest and analgesics. Surgery is avoided as much as possible. Placenta previa is treated with complete bed rest and blood transfusions to delay the birth of the baby until it is viable. Incompetent cervix should be sutured in the first part of the second trimester as long as all requirements are met. Elective SC and repeat is only done if it is believed that the baby is old enough. Medicines can be used to stop labor. Conslusion : In general, the management of preterm labor includes the administration of a single dose of corticosteroid in women 24-34 weeks' gestation with a risk of delivery within 7 days. In addition, magnesium sulfate can reduce the severity and risk of cerebral palsy in infants when born before 32 weeks of gestation. First-line tocolytics such as beta adrenergic agonists, calcium channel blockers, NSAIDs can be given for prolongation of pregnancy up to 48 hours (administration of antenatal steroids).