Threat Of Premature Birth Research Articles

Features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and assessment of perinatal outcomes

AIM: The aim of this study was to investigate the features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and to assess the choice of the optimal method of delivery and perinatal outcomes.
 MATERIALS AND METHODS: This study assessed ten cases of pregnancy and delivery in women with cerebrovascular pathology (arteriovenous malformation (50%), cavernous malformation (30%), and arterial aneurysms (20%)). All women were followed up, treated and delivered at the Obstetrics and Gynecology Clinic (Academician I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia) between 2018 and 2019.
 RESULTS: In eight out of ten women with cerebrovascular pathology, the course of pregnancy was complicated by the threat of premature birth, chronic placental insufficiency, and severe preeclampsia. In one case, the pathology of the cerebral blood vessels (cavernous malformation) manifested itself as a general hemorrhagic disturbance of the cerebral blood circulation during this pregnancy; in all other cases, cerebrovascular pathology was diagnosed before pregnancy. When analyzing the timing of delivery, it should be noted that only in one case with severe preeclampsia, the pregnancy was completed at 34 weeks and 1 day (emergency childbirth). The average delivery time for the remaining patients was 38 weeks 3 days (planned childbirth). The analysis of delivery methods showed that in 90% of cases (n = 9), pregnant women were delivered by caesarean section. Vaginal delivery occurred in one patient with a history of arteriovenous malformation of the left frontal lobe after subtotal embolization. The course of the postpartum period in all the patients was uneventful. During the next year, a planned consultation with a neurologist took place in three cases.
 CONCLUSIONS: It is required that a multidisciplinary team should develop tactics for pregravid preparation, pregnancy and postpartum management, with an assessment of long-term consequences in pregnant women with cerebrovascular disease, which will improve the efficiency of medical care and will contribute to the further implementation of reproductive functions in such patients. It is necessary to develop rehabilitation plans with the selection of personalized rehabilitation methods aimed at reducing complications associated with pregnancy and childbirth.

CERVICAL INSUFFICIENCY: ANAMNESIS, PREGNANCY AND CONSEQUENCES OF PREGNANCY (RETROSPECTIVE ANALYSIS)

Cervical insufficiency (CI) remains one of the leading causes of miscarriage and premature birth. Purpose of the study: to determine the frequency of CI, the characteristics of the anamnesis, the course of pregnancy, childbirth, the state of the newborn and the identification of potential risk factors. Material and research methods. 8728 birth histories were analyzed, among which 166 (1.9%) stories of women whose pregnancy was complicated by CI were found. The main group consisted of 166 pregnant women with CI, the control group included 55 women without CI and other severe obstetric- gynecological and somatic pathologies. The results obtained and their discussion. The incidence of CI on average over 5 years was 1.9%. With CI, there is a significantly lower percentage of young women, and at the age of 35 and over - 27.1% of pregnant women versus 10.9% in the control group. Only one third (33.7%) of women with CI can be considered somatically healthy. The morbidity structure is dominated by endocrine pathology (30.7%), among which metabolic syndrome / obesity (19.9%) and diseases of the urinary excretory system (27.7%) are distinguished. High frequency of pathology of the cardiovascular system (21.1%) and autonomic dysfunction syndrome (25.9%), hepatobiliary pathology (15.1%), gastrointestinal diseases (19.3), allergic manifestations (16.9%). A third of patients (28.9%) have a combination of two or more somatic diseases. Every fourth woman has a history of an infectious pathology of the urinary excretory sphere (25.9). In 27.7% of patients - a combination of several infectious pathologies. Half of the patients (53.0%) had a complicated gynecological history: cervical ectopy (33.7%), chronic infectious diseases of the genital area (16.3%) and PCOS: (13.9%), synechiae of the uterine cavity (6.6 %) and congenital malformations of the genitals (3.0%). The combination of several gynecological pathologies was observed in 18.1% of women. Every fourth woman underwent an excision of the cervix (25.9%), 42.8% - intrauterine interventions with the expansion of the cervical canal, 59.2% of them two or more times. According to the obstetric anamnesis, spontaneous miscarriages and medical abortions in 27.7% and 33.7% of women, in 18.1% - a missed pregnancy, every fourth patient has premature birth (25.9%), and every 10th patient has suffered injuries cervix. With a current pregnancy, the threat of premature birth is most often noted (51.2%), in second place is an exacerbation of infection of the genitourinary sphere (41.0%) and the threat of premature birth (38.0%). High incidence of placental dysfunction (30.7%), gestational diabetes (13.9%), fetal growth retardation (12.0%) and preeclampsia (7.3%). Premature birth in 38.0% of cases, in 31.9% - premature rupture of membranes, delivery by cesarean section in 19.3% of cases. Noteworthy is the high frequency of intrauterine infection (13.9%). Conclusion. Based on the results of a retrospective analysis, after a more detailed assessment of possible risk factors for CI, the most informative ones will be identified and proposed for use in clinical practice.

Efficiency of correction of vitamin D deficiency with DeviSol Strong at the preconception stage and during pregnancy

Research objective: to assess the course and consequences of pregnancy in women with vitamin D lack and deficit that is adjusted with DeviSol Strong at the pre-pregnancy preparation or during pregnancy.Materials and methods. The study involved 145 women aged 18 to 30 years. Experimental cohort (120 women with vitamin D deficiency) was divided into three groups: the first group – 40 pregnant women, the second group – 50 patients at the stage of pre-pregnancy preparation, comparison group – 30 pregnant women at 6–10 weeks of gestation. Control group consisted of 25 pregnant women with sufficient levels of vitamin D. 25(OH)D value in serum was determined by immunochemical method with chemiluminescent detection. DeviSol Strong dietary supplement was chosen to correct vitamin D deficiency. It was administered differently, based on 25(OH)D level.Results. Patients receiving 800 IU/day of cholecalciferol showed an increase in the vitamin D deficiency (from 46.7% to 76.7%). Vitamin D deficiency was reduced from 75.0% to 32.5% in women who received 2000 IU and 4000 IU of cholecalciferol for 3 months, the proportion of pregnant women with severe vitamin D deficiency decreased by 2,4 times. A rapid positive effect was achieved in 82.0% of pre-pregnancy patients receiving DeviSol Strong 4000 IU/day or 6000 IU/day (4000 IU + 2000 IU).Abortion risk before 12 weeks of gestation occurred in 23.3% of women in the comparison group, in 7.5% of pregnant women in group 1, in 4.0% in control group and in 2.0% in group 2. Early miscarriage occurred in 3,3% of patients in the comparison group. 13.3% of pregnant women in the comparison group, 5.0% from group 1 and 2.0% from group 2 were hospitalized with the threat of premature birth, premature birth occurred in one patient of the comparison group.Conclusions. Assessment of the first half of pregnancy with differentiated correction of vitamin D deficiency indicates the need for supplementation of cholecalciferol at the stage of pre-pregnancy preparation for prevention of gestation complications. DeviSol Strong is an effective drug for correcting vitamin D deficiency. Most effective dose in severe vitamin D deficiency is 6000 IU (4000 IU + 2000 IU), 4000 IU in lack and deficiency, which allowed achieving an adequate 25(OH)D level after 3 months in 82% of patients.

Pregnancy and delivery in women with undifferentiated connective tissue dysplasia: clinical and morphological aspects

Aim. This study aimed to identify peculiarities of the course of pregnancy, delivery, and morphology of the placenta in women with undifferentiated connective tissue dysplasia (UCTD).
 Materials and Methods. The main group included 60 pregnant women with UCTD, and the control group was composed of 30 somatically healthy women with physiological course of pregnancy. All patients were examined as regards the use of general clinical and laboratory methods. Moreover, 65 placentas were subjected to complex morphological examinations, including organometry, macro- and microscopic examinations, and immunohistochemistry.
 Results. Pregnancy and delivery in women with UCTD encounter various complications, such as threat of premature birth and miscarriage, pre-eclampsia, prenatal amenorrhea, and placental insufficiency manifested as fetal growth restriction syndrome and confirmed in the course of morphological examination. The structural basis of chronic placental insufficiency is associated various pathologies of the umbilical cord and disorders in maturation of the villous chorion with the underlying weak adaptive and compensatory processes. Connective tissue dysplasia in fetal membranes is manifested as disorders in histo- and cytoarchitectonics and in increased expression of matrix metalloproteinase-9 by amniocytes and cytotrophoblast cells.
 Conclusion. UCTD produces unfavorable effect on the course of pregnancy and delivery. The results of the clinical and morphological examinations demonstrate the multiorgan characteristics of injuries in the mother-placenta-fetus system, which necessitates further studies for the determination of complex prophylactic measures.

EPIDEMIOLOGY OF THE PREVALENCE OF PHENOTOPIC SIGNS UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA SYNDROME IN WOMAN WITH MISCARRIAGES

The aim: Study of the relationship between cervical insufficiency and dysplastic stigma in miscarriages. Materials and methods: 80 pregnant women were examined at 23-27 weeks of gestation.) Group I included 40 pregnant women with the threat of premature birth, with habitual miscarriage and correction of cervical insufficiency (CI) by using pessary in the anamnesis. Group II consisted of 20 pregnant women with the threat of premature birth and correction of CI by using pessary without the burden of habitual miscarriage, the control group of 20 almost healthy pregnant women. Results: The studies revealed phenotypic signs of dysplastic stigmatization in 39 (97.5 + 2.5%) pregnant women of group I, in 18 (90.0 + 6.9%) group II and in 4 (20.0 + 9.2%) control, which indicates a high prevalence of connective tissue dysplasia in women with CI, which also has a laboratory reflection in the form of increased excretion per day of oxyproline and a decrease in total glycosaminoglycans in both groups at risk of preterm birth. Conclusions: The most common gestational complication in women with connective tissue dysplasia is the risk of premature birth. Improving existing and finding new diagnostic and therapeutic measures for women with UDСTD will reduce the risk of preterm birth.

The level of fetal attachment in women with the threat of preterm birth in the third trimester of pregnancy and the psychomotor development of the first year of life considering mother-child interaction

The aim of the research is to study the level of attachment to the fetus of women with the threat of premature birth in the third trimester of pregnancy and psychomotor development of the baby in the first year of life. Materials and methods. The study included 150 pregnant women in the third trimester (23-37 weeks), and their men. Of these, the main group consisted of 120 women with the risk of preterm birth in the last trimester of pregnancy (MG). The comparison group consisted of 30 women with physiological pregnancy (CG). Results and discussion. Women with MG were found to have a maternal fetal attachment level of 71.0±1.0 (attachment disorder) and women with a CG of 51.0±2.0 (sufficient attachment level). Assessment of the psychomotor development of the child during the first year of life showed a tendency to lag its indicators in children of mothers from MG (after the second examination of MTG compared with the infants of women with CG and MGK during all periods of observation (p<0.05). Such a difference in indicators of psychomotor development was observed at the third survey: the level of development of children of mothers of CG was significantly higher than in women with MG. In the fourth survey, children of MTG mothers (29.0) showed better psychomotor development rates than infants of MCT women (27.5), but lower than those of CG (29.4). Subsequently, the level of psychomotor development of children with CG and MTG was almost equal to that of children of MCG (28.1), which were lower than in other groups. When reaching the age of one year, the children of MTG mothers showed the best level of psychomotor development (29.2), almost the same results were observed in children with CG (29.1), and indicators of MCG children were lower (28.5). Conclusions. Among the negative factors that provoke the formation of dyadic interaction disorders, psychological unpreparedness for motherhood and a low level of attachment to the fetus of women with the threat of premature birth during the third trimester of pregnancy are leading

THE EFFECT OF LIGHT DEPRIVATION ON FUNCTIONAL PROCESSES IN THE SYSTEM “MOTHER – PLACENTA – FETUS” IN CASE OF THREATENING PRETERM BIRTH AND ITS CLINICAL SIGNIFICANCE

Objective: to study the nature of uterine contractile activity, hormonal status, melatonin metabolism, blood flow in the uterine and fetal vessels, and the state of the fetus wellbeing before and after standard drug treatment and combination therapy involving the additional use of light deprivation. Materials and methods: a total of 547 women with threatening preterm birth were examined at 28 – 35 weeks of pregnancy. Among these, 198 pregnant women received standard therapy and 196 women received combined treatment, medical along with light deprivation. The control group consisted of 153 women with physiological pregnancy. We used cardiotocography to study the contractile activity of the uterus and the fetal cardiac rhythm, enzyme-linked immunosorbent assay methods to study the expression of hormones (ACTH, cortisol, progesterone, estriol, placental lactogen) in the blood and 6-sulfatoxymelatonin in the urine of pregnant women. Results: threatening preterm labor is accompanied by an increase in the level of generalized (bilateral) uterine activity, a decrease in the level of melatonin and an increase in the level of stress hormones. After using standard drug therapy, there is a suppression of any form of uterine activity, which leads to a deterioration of the fetus state in 30,2% of women, while combined therapy increases the level of melatonin, decreases the activity of stress-liberating subsystems of the mother’s body, and increases the level of right-sided uterine contractions that contribute to maintaining functional activity of the uteroplacental “pump”, contributing to the prevention of fetal distress. Conclusions: the studies indicate an improvement in the therapeutic effect with using light deprivation, as an additional method for tocolysis in women with the threat of premature birth.

Prevention and treatment of bacterial vaginosis in pregnant women with isthmic-cervical insufficiency

Purpose of the study was to evaluate the effectiveness of clindamycin in combination with metronidazole and miconazole in complex therapy in pregnant women suffering from vaginal dysbiosis with ischemic-cervical insufficiency with threat of premature birth, which used an unloading obstetric pessary.Materials and methods. 100 pregnant women with bacterial vaginosis in the III trimester of pregnancy with isthmic-cervical insufficiency, threat of premature birth and using of an obstetric pessary were examined. 50 women of group I (comparison) received therapy according to the orders of the Ministry of Health of Ukraine, and 50 women of group II (main) used the treatment and preventive measures proposed by study authors, which included Banbact® suppositories for 3 days, and then Gynex® Forte complex drug for 7 days, after which a probiotic of 7 days was prescribed.Results of the study. The clinical effect of treatment in main group was achieved in 100% of cases. The amniotest was negative in all cases after treatment. In both groups was a slight shift to the alkaline side of the vaginal contents (pH 5.0–5.5), in the comparison group 2.5 times more often than in the main one. A significant decrease in the vaginal pH was observed in persons of group II after treatment at 37–38 weeks of pregnancy, no increase in pH &gt;5.5 was detected; pH shift to the alkaline side was observed 3.5 times more often in group I.Most pregnant women in both groups achieved normocenosis after treatment. However, in group I a moderately expressed leukocyte reaction, the prevalence of leukocytes over epithelial cells, and a decrease in normal vaginal flora were noted 2.4 times more often (p &lt;0.05). In 10.0% of pregnant women in group I single spores and pseudo mycelium of fungi, coccal or mixed flora were revealed against the background of a moderate leukocyte reaction (p &lt;0.05).A pronounced leukocyte reaction was retained in 6 (12.0%) women of group II at 37–38 weeks, accompanied by a delay in the fetus development. Mixed flora persisted 3.7 times more often in women of group I. 22 species of microorganisms were identified in group I in the third trimester, while in pregnant women of group II – 14 species.Conclusions. The study revealed the high efficiency of complex treatment for bacterial vaginosis and normalization of the genital tract microflora in the third trimester in pregnant women with isthmic-cervical insufficiency. This helped to reduce the frequency of the threat of abortion, development of placental insufficiency, and delayed fetal development. The clinical efficacy of Banact® and Ginex® Forte was combined with their good tolerance; therefore these drugs are safe during pregnancy, which allows them to be used in practical obstetrics.

The Features of Pregnancy, Early Neonatal Period and Tactics of Surgical Treatment in Newborn with Hypoplastic Aortic Arch (First-Hand Experience)

Aortic pathology occurs in 10% of all newborn with congenital heart diseases (CHD). According to the data of various authors, in 50–80% of cases coarctation of aorta is accompanied by hypoplastic aortic arch. The newborn with such diagnosis represent a unique cohort of children who remain in severe condition and require immediate surgical intervention. Despite the significant development of diagnostic opportunities of radiographic methods, aortic arch patho­ logy remains one of the most difficult diagnoses in prenatal diagnostics.&#x0D; The objective of the study is to provide rationale for perinatal prognosis based on the analysis of pregnancy course, condition of the fetus and newborn in order to provide timely diagnosis and perform cardiosurgical interventions in patients with aortic arch pathology.&#x0D; Materials and methods. In the period from 2011 to 2019 at the State Institution “Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine” and State Institution “National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine” 121 pregnant women with fetal aortic arch hypoplasia were observed, followed and gave birth according to the algorithm developed by our team. The most optimal terms for fetus examination were weeks 20–22 and 30–32 of pregnancy. Patients with hypoplastic aortic arch as part of hypoplastic left heart syndrome were excluded from the analysis of tactics and results of surgical treatment since this category of patients requires separated study. Among 53 patients with hypoplastic aortic arch (36 patients with isolated hypoplastic aortic arch, and 17 patients with that combined with other CHD), 43 patients required surgical treatment after additional in-patient examination.&#x0D; Results and discussion. Analysis of the pregnancy course in women with fetal aortic arch hypoplasia showed that the number of multifetal pregnancies (including those having occurred after the use of extracorporeal technologies) was higher in pregnant women of the main group. Also, the percentage of threat of termination of pregnancy in the early term was high threatened miscarriage in the early stages of pregnancy was higher, and, vice versa, the threat of premature birth was lower. It is worth noting that 7 (5.7%) children had the appearance of “completely healthy child” in the first day of life, which confirms the importance of prenatal echocardiography in the timely diagnosis of critical CHD. To analyze the effectiveness of prenatal diagnosis and timely referral of patients to a specialized cardiac surgery center, it was found that the number of complications at the preoperative stage was statistically significantly higher in the group of patients without prenatal diagnosis.&#x0D; Conclusion. In case of diagnosed or suspected fetal aortic hypoplasia (isolated or combined with other abnormalities) a multidisciplinary case management team should be involved to determine further perinatal tactics and timing of cardiac surgery which will significantly reduce pre- and postoperative complications.

CLINICAL AND PARACLINICAL ASPECTS OF FORECASTING OF SEVERE FORMS OF HYPERBILIRUBINEMIA OF NEONATAL PERIOD

Modern clinical guidelines in neonatology consist list of risk groups of severe form of neonatal jaundice in newborns, but there is a lack of authenticityof clinical and paraclinical criteria’s, which could have allowed to forecast the severity ofpathological course and to define the predictors and early signs of dysfunction of hepatobiliary system for timely conducting of medical correction in neonatal period.&#x0D; Objective.To conduct the analysis of risk factors of somatic pathology, course of pregnancy andchildbirthof pregnant, clinical and paraclinical peculiarities of early neonatal adaptation of kids considering gestational age in time of birth for defining of risk groups of newborns with severe form ofhyperbilirubinemia.&#x0D; Materials and methods.Researched peculiarities of somatic anamnesis, gestational periods course and childbirth of 141 women, whose kids had clinical signs of neonatal jaundice. Main researched groups of newborns: I group includes mature newborns, whowere divided on two subgroups: subgroup IA (46 kids) – kids that had middle condition severity and subgroup IB (23 kids) – kids with severe condition. II (control) group consist of 72 healthy mature newborns. III group includes premature newborns with gestation period 34 – 37 weeks. Consequently, IIIA group consist of 28 newborns with middle condition severity, IIIB group – kids with severe general condition in neonatal period. IV group includes conditionally healthy newborns with defined gestation period. Criteria of excluding from research were: premature childbirth (gestation period &lt; 34 weeks), infectious genesis jaundice (P36), confirmed congenital organic pathology of hepatobiliary system, in particular: anomaly of development of gallbladder, atresia of bile duct (Q44), congenital viral hepatitis (P53.3)&#x0D; Result and discussions. Maternity factors that complicate the pregnancy course and had an importance for severity of pathological course in kids, who had a clinical sign of hyperbilirubinemia in perinatal pathology: age of pregnant, especially in premature childbirth, infertility and uncontrolled misbirthof anamnesis, placental dysfunction,threat of premature birth in this pregnancy by rhesus factor. According to scale “Risk Score for Neonatal Hyperbilirubinemia” (2004), was distinguished some tendency of increasing of severity risk of hyperbilirubinemia in perinatal pathology of mature newborns, but that tendency didn’t exist in premature newborns. The most frequent clinical symptoms in newborns with hyperbilirubinemia in perinatal pathology were: hepatosplenomegaly, bowels dysfunction, hypoglycemia, anemic syndrome, combined hemorrhagic disorders. Indicators of biochemical blood’s spectrum of newborns showed increased level of general bilirubinserum, mainly for non-conjugate fraction, decreased level of general protein,albumin and glucose, possible increasing of AsAT activity in middle severity of condition, that tells about its activation, decreasing of indicator in severe condition; AsAT activity of premature newborns had a tendency of increasing in both middle and severe condition of newborns. AlAT indicator had a possible increasing of activity in correlation with increasing of conditions severity of mature newborns and decreased ferment reaction – in premature newborns. Сonclusions. 1. Estimation of probability of severe hyperbilirubinemia development in newbornshas to be complex, considering risk factors of pregnant and her somatic, obstetric and gynecological anamnesis, course of pregnancy and of childbirth and with conducting of marks estimation of factors according recommendations of «Risk Score for Neonatal Hyperbilirubinemia» (2004). 2. Important role for prevention of development of severe form of hyperbilirubinemia has estimation of risks in newborns, considering nature of perinatal pathology course, timely detectionof clinical symptoms, existentin disorders of metabolism and transport of bilirubin.

Operative delivery in women with benign uterine tumors

Objective of the study: to determine the role of operative delivery in the childbirth tactics for women with benign uterine tumors based on the identification of pathogenetically substantiated criteria for operative birth, to prevent obstetric and perinatal complications.Materials and methods. In 110 women with uterine leiomyoma (LM) – 77 (70.0%) with one node (Group 1) and 33 (30.0%) with multiple nodes (Group 2) delivery tactics were defined. For this purpose, the type of LM, the location of the nodes relative to the placenta, complications of pregnancy, childbirth were revealed and analyzed.Study results and discussion. The revealed coincidence of the location for І–ІV types LM nodes and placenta in 33 (42.86%) cases of one node and in 23 (69.70%) of multiple LM caused complications in the gestational period: placental insufficiency – in 44.16% and 45.45%; threat of interruption – in 30.30% and 5.96%; partial detachment of the placenta – in 18.18% and 27.27%; myomectomy – in 7.70% and 15.15%; fetal distress – in 31.17% and 36.36%; the threat of premature birth – in 24.68% and 24.24% of cases with the one node and multiple LM respectively and necessitated the determination of delivery tactics. Caesarean section was done in 42 (38.18%) cases: in 28 (36.36%) women with one node and in 14 (42.42%) with multiple nodes. The tendency to a higher frequency of operative delivery with multiple LM is due to the greater frequency of coincidence of the nodes location and placenta and pregnancy complications. Urgent delivery was made in 28.57% cases with one node of LM and in 14.28% with multiple nodes due to premature detachment of the placenta and bleeding, fetal distress. A smaller percentage of urgent operative delivery is due to an increase frequency of elective caesarean section for LM.Conclusions. The coincidence of II–IV types LM node/nodes and placenta location is considered to be a pathogenetic factor in placental insufficiency, placental abruption in the gestational period and during childbirth, bleeding, fetal distress, and the prognostic criterion for obstetric and perinatal complications. Among pathogenetically substantiated criteria for operative delivery along with other factors consider: coincidence of the location of the placenta and II–IV types LM node or multiple І-ІV types LM nodes; myomectomy. Presence of these criteria determines the planned caesarean section by the method of choice in the childbirth tactics for women with LM.

Types of interaction in the triad mother–child–father at the threat of preterm birth at the last trimester of pregnancy and after the birth as a criterion of differentiation of the measures of their medical-psychological support

The study involved 150 women at 23–37 weeks of pregnancy: 120 women with the threat of premature birth (main group, MG), 30 women with the physiological course of pregnancy (comparison group, CG) and their husbands. The types of interaction in the mother–child–father triad with the threat of premature birth and after childbirth have been studied. A psychodiagnostic study revealed a reliably high level of the average value of reactive and personal anxiety in women with MG. The average indicator of the level of depression is higher in the MG, where there are cases of subdepressive state and severe depression, in the CG the latter was not revealed. According to the Cranley scale, at the first stage of the study, the level of attachment to the fetus in women from MG was (71,0±1,0) points (attachment disorder), in women from CG was (51,0±2,0) points (sufficient level of attachment), p&lt;0,05. With the help of the «Pregnant Attitude Test», the prevailing type of woman’s attitude to her unborn child was determined in terms of the course of pregnancy. It was found that in 20,8 % of women, the euphoric type predominates, 9,17 % had the optimal type, 9,17 % had hyponosognosic type, 2,5 % had anxious type, 3,33 % had depressive type. In 26,7 % of women, CG has the optimal type. There are no other types of attitudes towards pregnancy. In women with MG, disorientation prevails at all stages of the examination (41–46 people), the dependent type (35–36), autonomous (23–29), and avoidance of proximity much less often was (14–16), in women with CG, the autonomous type dominates (10–13), dependent type (8–10), and avoidance of proximity (4–9) little less often were and disorientation (3–4) much less often was. At each stage of the survey, the level of social support in the MG is reduced relative to that in the CG. It is noted that in both groups the level of social support on two scales such as the support of colleagues at work and public organizations is reduced.

Особливості перебігу вагітності за наявності єдиної пупкової артерії плода

Among the abnormalities in the number of umbilical cord vessels, the single umbilical artery (SUA) is most common. The influence of some endocrine, gynecological and general factors on the occurrence of SUA, the detection of SUA at different stages of pregnancy, as well as the effect of SUA on the course of pregnancy and the condition of the fetus are assumed. In most cases, according to different data – 57–75%, SUA is an isolated change and does not affect the course of pregnancy and childbirth, as well as the postnatal period. Other authors see a significant impact of SUA on the course of such pregnancy and childbirth. The article presents some features of the course of pregnancy with SUA compared with pregnant women with three umbilical cord vessels and physiological labor in the future. The objective: to study and analyze the peculiarities of pregnancy with SUA, to conduct a comparative description of the revealed features with such indicators among pregnant women with three umbilical cord vessels. Materials and methods. 31 pregnant with a single umbilical artery of the fetus (study group), 62 pregnant with 2 umbilical arteries of the fetus (control group). Results. In pregnant women with SUA, increased body weight, first blood group, and diseases of insulin-dependent diabetes mellitus were observed with greater frequency. In the history of pregnant women with SUA, artifactual abortions, spontaneous miscarriages, or missed pregnancies are more common than pregnant women who have two umbilical arteries of the fetus. Among pregnant women with SUA during pregnancy, the risk of miscarriage, fetal growth retardation, placental dysfunction, polyhydramnios, gestational diabetes and the threat of premature birth are significantly more common. Premature birth occurs in 12.9% of pregnant women with SUA. The reverse blood flow in the venous duct, detected by ultrasound at 12–13 weeks of gestation, was detected in 19.4% of pregnant women with EPA. According to Doppler, when comparing pregnant women with fetal EPA and two umbilical arteries, there are true negative changes in the direction of increased peripheral vascular resistance (according to the blood flow velocity in the aorta of the fetus) and a tendency to centralize blood circulation (according to cerebro-aortic index) in fetuses with SUA. The average Doppler indices of other vessels of the placental complex do not differ between the two studied groups of pregnant women. According to hormonal studies in pregnant women with SUA at the end of the first trimester of pregnancy in 26.8%, rates of PAPP-A were higher than the reference values (in the control group – 6.4%). Conclusions. Identified features among pregnant women with SUA, such as increased body weight, first blood group, diseases of insulin-dependent diabetes mellitus and a significant number of spontaneous miscarriages and missed abortion in history, can be cumulative risk factors for the occurrence of SUA. Among pregnant women with SUA during pregnancy, the threat of miscarriage, fetal growth retardation, placental dysfunction, polyhydramnios, gestational diabetes and the threat of premature birth are significantly more common. Premature birth occurs in 12.9% of pregnant women with EPA. In the period of 12-13 weeks, the reverse blood flow in the venous duct can be considered a marker of SUA. The features we found in terms of Doppler metrics indicate true negative changes in the direction of increasing peripheral vascular resistance (according to the blood flow velocity in the aorta of the fetus) in fetuses with SUA. An increase in PAPP-A can serve as a marker of the presence of SUA in the fetus in early pregnancy. Key words: single umbilical artery, fetal growth retardation, placental dysfunction, polyhydramnios, gestational diabetes, venous duct, dopplerometry, PAPP-A.

CURRENT OPPORTUNITIES FOR DETERMINING OF PREDICTORS OF THREATENED PRETERM LABOR

The aim of the study – to ascertain predictors of a threat of premature birth.&#x0D; Materials and Methods. 63 patients participated in the gestation period of 22–34 weeks in a prospective open study. Pregnant women were divided into two groups. Thus, the group I included 44 pregnant women, with the threat of PL, and the group II included 19 patients with normal course of pregnancy.&#x0D; All women were tested for body mass index (BMI), progesterone, insulin and cortisol on the day of admission.&#x0D; Statistical processing of materials was carried out by using the software package "Statistica 6.0" (StatSoft, USA) and MedCalc. 10.2.0.0. To determine the predictors of the occurrence of a TPL, the method of binary logistic regression analysis was used. All statistical tests were two-sided; the p-0.05 level was considered as significant.&#x0D; Results and Discussion. An analysis of the results of the observation of 63 pregnant women was provided. In 12 women, pregnancy ended in preterm labor, which was 19 % of the total. The following indicators fell to the dependent predictors of TPL occurrence: body mass index (BMI) ≤ 24 kg/m² significantly increased the odds ratio (OR) of TPL 7.76 times; insulin level &lt;8.65 µMU/ml significantly increased ORR of TPL 5.14 times; OR of TPL increases in 7.02 times, in case that the level of cortisol is less than 577.9 ng/ml; progesterone &lt;139.5 ng/ml increases the odds ratio of TPL in 4.39 times. Taking into account the data of univariate regression analysis, multivariate models of independent predictors of TPL were created. According to the first model (p = 0.0001), independent risk factors for miscarriage include: the age of pregnant women over 25 years, an insulin level more than 8.7 μMO/ml, and the level of cortisol less than 577.9ng/ml. According to the second model (p &lt;0.0001), independent risk factors which increase the risk of TPL occurrence are: BMI less than 24 kg/m2, insulin level more than 8.7 μMO/ml, cortisol level less than 577.9ng / ml. However, the most interesting is the third model (p &lt;0.0001) of independent risk factors for TPL. It includes four indicators: the level of progesterone, less than 139.5 ng/ml, the level of cortisol, less than 577.9 ng/ml, the BMI, less than 24 kg/m2 and the age of pregnant, more than 25 years.&#x0D; Conclusions. It was found that in pregnant women with a threat of preterm birth the age and BMI are the most informative, and in combination with the hormonal examination of women are of primary importance. The obtained results indicate the expedien­cy of inclusion to the standard examination of pregnant women with a threat of premature birth, a comprehensive determination of the level of progesterone, insulin and cortisol, which will enable to identify the risk group for this complication in time and to propose preventive measures.

THE STATE OF THE BLOOD COAGULATION SYSTEM IN PREGNANT WOMEN WITH THE THREAT OF PRETERM BIRTH WHEN USING METABOLIC THERAPY

Introduction. The frequency of preterm labor is remained unchanged for many years, despite numerous studies. The perinatal mortality rate of premature babies is almost 30 times higher compared with babies born at term. Changes in the hemostatic system during pregnancy (increased blood clotting) lead to the formation of microthrombus and hematoma in the vessels of the placenta, which impair blood circulation in it. Aim. To assess the state of hemostasis in pregnant women with the threat of premature birth, who received metabolic therapy and those who did not receive it. Material and methods.Clinical and laboratory examination of 130 pregnant women was carried out: I group – 67 pregnant women with threatened preterm labor who received standard integrated basic therapy in combination with metabolic therapy in the form of 300 mg of omega-3 PUFA per day was conducted, group II - 63 pregnant women with the threat of premature birth who received only standard complex basic therapy. To assess the effectiveness of the proposed therapy, hemostasis indicators were studied. Research results. The paper presents the results of the use of metabolic therapy in the complex treatment of the threat of preterm labor, which testify to its effectiveness, which contributed to the improvement of the rheological properties of blood. After the proposed therapy, in women who took metabolic therapy, the level of thrombocytes increased, fibrinogen and antithrombin III decreased, activated partial thromboplastin time increased, in contrast to the indicators of the group of women who did not take it. The frequency of preterm birth decreased by 1.5 times (58.2% versus 82.5%) and perinatal outcomes improved.Conclusions.The use of metabolic therapy in the complex treatment of the threat of preterm labor indicates it effectiveness and has contributed to the improvement of perinatal outcomes.

Condition of the hemostatic system in pregnant women with the threat of premature birth when using metabolic therapy

Condition of the hemostatic system in pregnant women with the threat of premature birth when using metabolic therapy

МОЖЛИВОСТІ ЛІКУВАННЯ ЗАГРОЗИ ПЕРЕДЧАСНИХ ПОЛОГІВ ПРИ БАГАТОПЛІДНІЙ ВАГІТНОСТІ З ВИКОРИСТАННЯМ СУБЛІНГВАЛЬНОЇ ФОРМИ МІКРОНІЗОВАНОГО ПРОГЕСТЕРОНУ

Мета дослідження – оцінити ефективність застосування сублінгвальної форми мікронізованого прогестерону (Лютеіна) у жінок із багатоплідною вагітністю з високим ризиком загрози передчасних пологів.Матеріали та методи. Обстежено 85 вагітних із двійнятами з ознаками невиношування у термінах 22–36 тижнів вагітності, котрі склали основну групу, сформовано дві підгрупи: Іа – 43 жінки, котрі отримували в комплексі лікування загрози передчасних пологів мікронізований прогестерон сублінгвально; підгрупа Іб – 42 вагітні, які не отримували під час лікування препарати прогестерону. Ретроспективно було проаналізовано 40 історій передчасних пологів при одноплідній вагітності (група порівняння). В основній групі було проведено загальноклінічне та біохімічне обстеження вагітних, визначення вмісту в сироватці крові АЛТ, АСТ, рівнів білірубіну та прогестерону. Проведений аналіз перебігу вагітності, пологів, післяпологового періоду та стану неонатальної адаптації новонароджених в обстежуваних вагітних.Результати дослідження та їх обговорення. Доведені основні чинники ризику розвитку передчасних пологів при багатоплідній вагітності, а також роль інфекційного анамнезу, даних трансвагінальної цервікометрії, неповного обстеження та несвоєчасного початку лікування загрози передчасних пологів, недостатньої профілактики ускладнень при багатоплідній вагітності. Динаміка вкорочення шийки матки була значно повільнішою у пацієнток Іа підгрупи, яким було призначено мікронізований прогестерон, це є ефективним методом профілактики та лікування невиношування у жінок із багатоплідною вагітністю, зниження частоти пізнього аборту та передчасних пологів, перинатальних втрат. Встановлено, що в жінок основної групи рівні АЛТ та АСТ, а також загального білірубіну не відхилялися від норми. Відмічено зниження рівня прогестерону в обох підгрупах. У вагітних Іа підгрупи на тлі лікування мікронізованим прогестероном відмічалося суттєве зростання рівня прогестерону у сироватці крові вже на 3-тю добу лікування до (1109±27) нмоль/л, а до кінця першого тижня лікування цей показник зростав до рівня (1280±39) нмоль/л, тоді як у Іб підгрупі його динаміка не змінювалась ((886±29) нмоль/л та, відповідно, (891±33) нмоль/л). Використання сублінгвальної форми мікронізованого прогестерону у період вираженої клінічної симптоматики загрози передчасних пологів при багатоплідній вагітності дозволяє отримати максимально швидкий терапевтичний ефект, що сприяє швидкому усуненню клінічних симптомів, регресу ультразвукових маркерів загрози переривання вагітності та запобігає подальшому прогресуванню структурних змін з боку шийки матки.Висновки. 1. При ознаках загрози передчасних пологів застосування сублінгвальної форми мікронізованого прогестерону дає можливість швидко відновити рівень прогестерону в сироватці крові до фізіологічних показників і тим самим знизити частоту передчасних пологів та покращити перинатальні наслідки у новонароджених. 2. Застосування сублінгвальної форми мікронізованого прогестерону у вагітних із загрозою передчасних пологів не впливає на функцію печінки. 3. Комплексна терапія загрози передчасних пологів із використанням мікронізованого прогестерону має високу ефективність терапевтичної дії та може бути рекомендована для широкого використання, сприяє коротшому періоду перебування в стаціонарі, зменшенню кількості ускладнень.

OPTIMIZATION OF TACTICS OF MANAGEMENT OF MULTIPLE PREGNANCY AND LABOR

A thorough analysis of the course of labor and perinatal outcomes was conducted in pregnant twins. It is proved that multiple pregnancy is a factor of high risk of perinatal complications. The features of the process of neonatal adaptation in twins are studied depending on the tactics of delivery. Goal: to improve perinatal outcomes in women with multiple pregnancies by optimizing the management of pregnancy.Material and methods. Examined 68 pregnant women with twins after IVF, who made up the I group of subjects, 62 pregnant women with spontaneous twins - group II, and 38 women with self-singleton pregnancy who entered the control group. Pregnant Groups I and II, depending on the treatment prescribed, were divided into two subgroups: IА (36 pregnant women) and IIA (32 pregnant women) received a standard amount of treatment and prophylactic measures. Subgroups IB (32 pregnant women) and IIB (30 pregnant women) received natural micronized progesterone (200 mg 3 times a day) in addition to standard treatment and prophylactic measures. All pregnant women underwent a complete clinical and laboratory examination using ultrasound, Doppler, and cardiotocography (CTG), and a biophysical profile of the fetus. The analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups were carried out. In the neonatal period, neurosonography was performed, a part of the newborns were followed by psychomotor development in the first six months of life. The obtained results were statistically processed using standard packages of applied statistical analysis (Statistic 6.0 for Windows, Statgraphics v. 7.0).Results. The results of pregnancy analysis in patients with IVF revealed a number of serious complications during pregnancy and childbirth: the threat of premature birth (66.2%), placental dysfunction (48.5%), iron deficiency anemia (51.5%), preeclampsia (52, 9%), premature rupture of amniotic membranes (17.6%), weakness of labor (27.9%), and a high incidence of operative delivery (30.9%). Against the backdrop of hormonal support, a decrease in the frequency of very early premature births in the first group was 1.6 times, early premature births by 1.5 times and an increase in the frequency of late premature births by 1.4 times, which is a favorable prognostic factor for reducing perinatal losses. Among the main methods of delivery, mention should be made of the high rate of cesarean section in the I A subgroup (55.6%) and the IIA subgroup (46.9%), each of which was significantly higher than the control group (10.5%) ( p &lt;0.05). Almost with the same frequency cesarean section was observed in women with independent multiplicity. Premature and deep morphofunctional immaturity were inherent in children from premature births, which significantly influenced the Apgar score, which was lower in the first group than in group II and control group (p &lt;0.05).Conclusions. A differentiated approach to the preparation and management of labor, careful observation of patients and dynamic monitoring of the fetus state allows to reduce the frequency of postnatal complications, contributing to the reduction of perinatal morbidity and mortality.

Патогенетичні підходи до лікування передчасних пологів на тлі хронічного вогнища інфекції

The objective was to study the effectiveness of the application of the sublingual form of micronized progesterone for the treatment and prevention of premature birth in women with concomitant risk factors against the background of the infectious inflammatory component in the anamnesis. Materials and methods. The study was conducted in two stages. At the first stage, 100 stories of pregnant women with preterm labor were analyzed at a period of 22-36 weeks, which were inpatient treatment in the Ternopil Regional Clinical Perinatal Center «Mother and Child». A comprehensive assessment of risk factors for the development of preterm labor and the effectiveness of their management was carried out. At the second stage of the study, 27 pregnant women (group 1) who were hospitalized with a threat of premature birth and had an anamnesis history, were treated with natural micronized progesterone Lutein in a dose of 100 mg sublingually twice a day. The comparison group (group 2) included 30 pregnant women, who before traditional hospitalization began traditional tocolytic therapy with calcium channel blockers. The control group included 20 pregnant women with a physiological pregnancy. Results. As a result of the proposed therapy, a decrease in the intensity of the pain syndrome in patients taking micronized progesterone was observed at 25 min faster (p &lt;0.05) than after conventional therapy (85.2 ± 7.4 min in the 1st group and 110.6 ± 9.8 min - in the second group). At the same time, anxiety level was 16.1 ± 1.8 points in patients of the 1st group, which corresponded to its absence, while the patients of the 2nd group continued to be in a state of moderate anxiety (19.3 ± 1.4 points). Pregnant women with a threat of preterm birth who had an inflammatory process of any localization in the past had a significant increase in the level of proinflammatory cytokines (IL-2, IL-6, TNF-?) and a decrease in the level of anti-inflammatory cytokines (IL-4, IL- 10) in comparison with the indicators of healthy pregnant women. The use of micronized progesterone and conventional therapy positively affects these indicators. Conclusion. The use of the sublingual form of micronized progesterone in the preparation of Lutein at a dose of 200 mg per day is pathogenetically grounded and provides a rapid arrest of the manifestations of premature birth in women with miscarriage in the background of chronic foci of infection. Key words: premature birth, inflammation, micronized progesterone.

ЗНАЧЕННЯ ПРЕГРАВІДАРНОЇ ПІДГОТОВКИ У ЖІНОК ІЗ СИНДРОМОМ ВТРАТИ ПЛОДА НА ФОНІ ВРОДЖЕНИХ ФОРМ ТРОМБОФІЛІЇ

Мета дослідження – аналіз значення прегравідарної підготовки у жінок із синдромом втрати плода на фоні генетично детермінованої форми тромбофілії.Матеріали та методи. Проведено ретроспективний та проспективний аналіз перебігу вагітностей у 42 пацієнток із синдромом втрати плода на фоні вродженої тромбофілії. З них 22 жінки отримували прегравідарну підготовку та 20 жінок, вагітність у яких наступила без запропонованої нами прегравідарної підготовки. Контрольну групу склали 30 жінок із фізіологічним перебігом вагітності. Використано такі методи дослідження як: клінічні, функціональні (ехографічні, кардіотокографічні, доплерометричні), гемостазіологічні та морфологічні.Результати дослідження та їх обговорення. Так, у жінок із генетично детермінованими формами тромбофілії, вагітність у яких настала без прегравідарної підготовки, були зафіксовані такі ускладнення як: передчасне відшарування нормально розташованої плаценти у 4,76 % (2) жінок, загроза мимовільних викиднів у 9 (21,4 %) осіб, загроза передчасних пологів у 7 (16,7 %) жінок, плацентарна дисфункція у 10 (2,4 %) пацієнток, в той час як у жінок із прегравідарною підготовкою даної патології виявлено менше (загроза мимовільного викидня у 5 (11,9 %) осіб, загроза передчасних пологів у 3 (7,1 %) жінок, плацентарна дисфункція у 4 (9,5 %)). УЗ-дослідження фетометричних показників плода та антенатальна оцінка структури плаценти дозволили діагностувати синдром затримки розвитку плода у 11,9 % (5) пацієнток із тромбофіліями без прегравідарної підготовки.Висновок. Отже, прегравідарна підготовка жінок із синдромом втрати плода на фоні генетично детермінованих форм тромбофілії дуже важлива і допомагає зменшити частоту гестаційних ускладнень.