Uncomplicated Course Of Pregnancy Research Articles

Reproductive effects of wartime stress and possibilities of their correction (Literature review)

The article presents modern literary data and data of own clinical observations regarding the effects of long-term chronic stress on reproductive processes with an emphasis on the effects of wartime. All stages of the reproductive cycle, from the regulation of the menstrual cycle, conception and implantation to the birth of a child, are energy-consuming and unprofitable for the body. All these processes require a lot of energy, but their purpose is to reproduce the species, not to maintain homeostasis. Therefore, the body temporarily slows down these processes, withdraws energy aimed at their support, and uses it to resist stress.The biological meaning of inhibition of reproductive function in stressful conditions is that if a woman becomes pregnant under unfavorable conditions, it is bad for her body, and for the offspring, and for the future prospects of the biological species as a whole. Therefore, from an evolutionary point of view, it is very beneficial to reduce the production of hormones, exclude ovulation and prevent implantation, and reduce libido during periods of high stress.Stress causes activation of the neuroendocrine and sympatho-adrenal systems, which leads to the release of such hormones as cortisol, adrenaline, norepinephrine into the blood. This helps to mobilize the body’s resources to overcome a threatening situation. However, prolonged stress depletes these systems and leads to maladjustment and increased risk of disease. Stress hormones affect all body systems, including the reproductive system. According to the literature, stress disorders occur three times more often in women than in men.In conditions of chronic stress, in particular during war, pregnancy complications can be caused by stress of various origins: metabolic, associated with micronutrient deficiency, psychological, physical, a combination of factors.Prenatal stress during wartime is a part of our existence, which reduces the quality of life of a pregnant woman and affects the intrauterine development of the fetus and the subsequent health of the child. Long-term chronic stress also leads to deterioration of the general state of health of the expectant mother: it reduces work capacity and appetite, causes lethargy, apathy, sleep disturbances, and increases the risk of obstetric complications.Stress negatively affects the state of immunity of the female population both before conception and during pregnancy, which can lead to the activation of latent infections, and makes the body of pregnant women more vulnerable to acute seasonal infections. This is also facilitated by the lack of necessary vitamins and trace elements with antioxidant properties in conditions of occupation, disruptions in the supply of medicines to certain problematic regions of the country, frequent changes of residence, etc.During pregnancy, all the negative effects of wartime can be realized in the form of major obstetric syndromes. In conditions of pronounced energy deficit caused by long-term stress, the body has to provide for itself to the detriment of the future child, which leads to ZRP, and in the most tragic cases – to intrauterine death. Violation of the psycho-emotional state of pregnant women today leads to the birth of “children of war” – insecure, low self-esteem, deeply ill babies with mental disorders.For the onset of pregnancy and its successful bearing, vitamins and micro/macroelements with antioxidant properties are needed in order to resist oxidant stress inherent in stressful conditions (vitamins of group B, vitamin D, iron, magnesium, omega-3 polyunsaturated fatty acids, L-arginine, L- carnitine). Rational management of pregnancy in today’s complex conditions should be complex and multi-vector. One of the promising directions in ensuring an uncomplicated course of pregnancy and successful perinatal outcomes is work with perinatal psychologists. At the same time, the use of additional psychosomatic effects of basic therapy should not be underestimated.

Transcriptional profile features in patients with early and late preeclampsia

Aim: to assess the molecular mechanisms in developing various clinical phenotypes of preeclampsia (PE) by analyzing specific placental tissue transcriptome patterns. Materials and Methods. The prospective observational comparative study in parallel groups enrolled 43 pregnant women divided into 2 groups: main group – 23 pregnant women with diagnosed PE and control group – 20 apparently healthy women with uncomplicated pregnancy course, delivery and the postpartum period. To examine PE phenotypic features, the main group of pregnant women with PE was subsequently divided into 2 subgroups according to the date of pathology onset: early (n = 10) and late (n = 13) PE. Using the whole-genome next-generation sequencing (NGS), a comparative analysis of altered 18 microRNA level in placental tissue was carried out. Results. Pregnant women with early PE compared to the control group were characterized by significantly low expression level for hsa-miR-656-3p (p < 0.001), hsa-miR-323a-5p (p = 0.017), hsa-miR-519c-3p (p = 0.019), hsa-let-7i-5p (p = 0.019), hsa-miR-433-3p (p = 0.019), hsa-let-7g-5p (p = 0.030), hsa-miR-214-5p (p = 0.030), hsa-miR-27a-5p (p = 0.031), hsa-miR-339-5p (p = 0.041), hsa-miR-524-5p (p = 0.045), hsa-miR-1283 (p = 0.049) and high expression for hsa-miR-151a-5p (p = 0.007), hsa-miR-4521 (p = 0.018), hsa-miR-30d-5p (p = 0.026), hsa-miR-548l (p = 0.027), hsa-miR-133b (p = 0.034), hsa-miR-424-5p (p = 0.042), hsa-miR-211-5p (p = 0.049). Patients with late PE had significantly decreased expression for hsa-miR-656-3p (p = 0.050) andhsa-miR-574-3p (p = 0.017) as well as a significantly higher for hsa-miR-211-5p (p = 0.001) compared to the control group. Subgroup of women with early vs. late onset PE was characterized by significantly decreased expression level for hsa-miR-323-5p (p = 0.007) and overexpressed hsa-miR-30d-5p (p = 0.002), hsa-miR-5481 (p = 0.027). Conclusion. The noted multidirectional expression for some microRNAs in subgroups of PE patients confirms the validity for stratification of such pathology based on two distinct phenotypic manifestations (early and late forms) and indicates the existence of different pathophysiological vectors in PE formation.

Sleep disorders and changes in melatonin concentrations in pregnant women with preeclampsia

Melatonin plays a significant role in the development of normal pregnancy, in particular, it contributes to the successful implantation of the fertilized egg, affects the act of childbirth, is actively produced by the trophoblast and placenta, reduces oxidative stress, in particular, with preeclampsia. In addition, melatonin is one of the essential hormones in the protection of the endothelium and stem cells from the oxidant stress. Objective – to study the mechanisms of development, terms of manifestation, and types of sleep disorders, as well as changes in the concentrations of melatonin in the blood of pregnant women with preeclampsia. Material and methods. 50 pregnant women at a mean age of 29.1±3.4 years who had preeclampsia in the 3rd pregnancy trimester were examined (experimental group). All women in the research group had a gestation term of 30-32 weeks of pregnancy. The control group consisted of 33 women with a mean age of 31.2±6.6 years who had an uncomplicated pregnancy. The presence of sleep disorders was established using a questionnaire: pregnant women were asked about the term of pregnancy in which complaints of sleep disorders appeared, the nature of sleep disorders, the frequency of episodes of sleep disorders (how many times a week such a condition was noted), etc. The concentration of melatonin in the venous blood of the examined pregnant women was also determined, for which IBL melatonin ELISA diagnostic kits manufactured by IBL, Germany were used. Blood was taken at 9:00 a.m., on an empty stomach, and all patients were analyzed at the same time of a day. Results and their discussion. The study showed that sleep disorders in pregnant women with pre-eclampsia, which complicates the pregnancy in the 3rd trimester, occurred earlier, compared to women with an uncomplicated course of pregnancy: pregnant women with pre-eclampsia were more likely to notice worsening of sleep, starting from 22-30 weeks of pregnancy (in 26.0 % of cases), while in pregnant women with a physiological course of gestation, similar complaints appeared mainly after 30 weeks. In the third trimester of pregnancy women with preeclampsia were more likely to wake up 2 or more times per night (in 68.0 % of cases) compared to controls (in 23.3 % of cases, p < 0.001) and 3 or more times per night per week (in 54.0 % of cases, in controls – in 16.7 % of cases, p < 0.001), which may be a consequence of a disorder of the function of the pineal gland. Women with preeclampsia were more likely (56.0 % vs. 13.3 % in the control group, p < 0.01) to use gadgets (electronic devices, mainly smartphones) for more than 2 hours after 9:00 p.m., which also negatively affects the function of the pineal gland. In pregnant women whose pregnancy was complicated by preeclampsia in the 3rd trimester, a significant (1.78-fold) decrease in the level of melatonin in venous blood taken at 9 a.m. was observed, compared to women with an uncomplicated pregnancy (p = 0.029). Conclusions. Sleep disorders in pregnant women with preeclampsia occur earlier and are more expressed compared to women with an uncomplicated course of pregnancy. The appearance of complaints of insomnia in the second trimester of pregnancy, in our opinion, can be considered a diagnostic sign of pineal gland dysfunction in preeclampsia. A decrease in the level of melatonin in pregnant women with preeclampsia, established against the background of minimal daily activity of the pineal gland (at 9 a.m.), indicates a decrease in the melatonin-producing function of the placenta which might have an impact on the condition of stem cells of fetus and placenta.

RISK FACTORS OF UMBILICAL CORD PATHOLOGY AND FACTORS OF NEGATIVE PERINATAL CONSEQUENCES AND NEWBORN INCIDENCE

According to literature sources, the real frequency of many umbilical cord pathologies differs significantly from the statistical data indicated by researchers in their works (from 15% to 38%). The implementation of a system of diagnostic and treatment and preventive measures, based on mandatory antenatal and postnatal assessment of the features and characteristics of the umbilical cord, allows to improve perinatal outcomes and reduce perinatal morbidity. The aim of the work was to identify the main risk factors of umbilical cord pathology and negative perinatal consequences; to develop elements of standardization of antenatal and postnatal diagnosis of umbilical cord pathology. Research materials and methods. A retrospective assessment of medical documentation data (3,280 individual medical records of pregnant women) made it possible to establish the frequency of umbilical cord pathology in the population. In the future, a more detailed extended antenatal and postnatal examination of the umbilical cord and placenta after delivery was carried out in 637 patients of reproductive age with pregnancy complicated by pathology of the umbilical cord (main group). The control group was formed by 40 patients with an uncomplicated course of pregnancy and live birth of full-term healthy children. The study was conducted taking into account the main principles of the Helsinki Declaration on Biometric Research and the powers of the GCH ICH, in accordance with biometric norms with compliance with the principles of confidentiality and ethics (excerpt from protocol No. 128/22 of the meeting of the Bioethics Commission dated September 29, 2022, Ivano-Frankivsk National Medical University, Ministry of Health of Ukraine).Data analysis was performed using the Statistica 7.0 package of statistical programs (StatSoftInc., USA). The association of independent variables with the condition being studied is presented as odds ratio (OR) and 95% confidence interval (CI).The materials of the article are the result of the research of the complex research work fragment of the Department of Obstetrics and Gynecology named after I.D. Lanovyi of the Ivano-Frankivsk National Medical University: “Development of diagnostic tactics and pathogenetic substantiation of effective methods of preserving and restoring reproductive potential and improving parameters of a woman’s quality of life in obstetric and gynecological pathology” (state registration number 0121U109269, implementation dates 2021-2026 ), the author is a co-executor of the topic.Research results and their discussion. The following data were noted: an excess of the population norm of the length of the umbilical cord, a high proportion of eccentric and marginal insertion of the umbilical cord (22.14%) and umbilical cord coiling (33.28%), a decrease in the proportion of the reference limits of the umbilical cord tortuosity index (15.86%), in 56.7% of observations, the specific gravity of the umbilical cord was lower. Probable risk factors for umbilical cord pathology with a predominance of age over 35 years, nicotine addiction in pregnant women, multiple fertility, use of IVF programs, change in the amniotic fluid index, overweight and obesity, other clinical conditions associated with metabolic disorders (gestational diabetes, insulin resistance) were identified. Conclusion. The share of the umbilical cord pathology both in the isolated type and in the combination of characteristic features of the umbilical cord is 40.98%. The increase in the risk of negative perinatal consequences has a close relationship with the umbilical cord pathology and the combination of different types of pathology, as well as the addition of gestational complications, which allows for the formation of screening programs and optimization of the diagnostic algorithm.

Acceptance of Pregnancy-Induced Disease and Intrapersonal Resistance Resources of Pregnant Women—Preliminary Report

The health problems complicating pregnancy are a source of anxiety and concern about the developing fetus' health and life. The aim of the study was to assess the acceptance of illness and selected intrapersonal resistance resources for women whose pregnancies are complicated by gestational diabetes or pregnancy-induced hypertension and their determinants. The study was conducted from April 2019 to January 2021 in 688 pregnant women who were patients of the pregnancy pathology department and gynecology-obstetrics outpatient clinics in Lublin (Poland), using a diagnostic survey method with the use of the following research tools: Acceptance Illness Scale, Generalized Self-Efficacy Scale, Multidimensional Health Locus of Control Scale, and the standardized interview questionnaire. The study group included 337 women with gestational diabetes and pregnancy-induced hypertension. The control group included 351 women with an uncomplicated course of pregnancy. The level of acceptance of illness in pregnant women with pregnancy-induced diseases is on the border between medium and high acceptance (29.36 ± 7.82). The respondents in the control group had lower levels of self-efficacy (28.47 vs. 29.62) and health locus of control in the internal dimension (24.61 vs. 26.25) (p < 0.05). Respondents with pregnancy-induced diseases are characterized by the internal dimension of locus of health control.

Стан імунної та гемокоагуляційної систем у динаміці вагітності після ДРТ у жінок з інфекціями, що передаються статевим шляхом, в анамнезі

Purpose - to analyze the dynamics of laboratory parameters of functioning of the immune and haemocoagulation systems in pregnant women with a history of sexually transmitted infections (STIs) after pregravid preparation before cycles of assisted reproductive technologies (ART). Materials and methods. The functioning analysis of the immune and hemocoagulation systems of 200 pregnant women with a history of STIs after ART has been conducted. Group I (main) consisted of 100 pregnant women with pregravid preparation before the ART cycle, obstetric and perinatal support and delivery in accordance with the medical and organizational algorithms developed by our team, prognostic methods and treatment and preventive schemes; Group II (main) - 100 pregnant women who were treated using generally accepted prognostic, therapeutic and preventive measures. The control group is 100 practically healthy pregnant women with a favorable reproductive history and an uncomplicated course of pregnancy. The women underwent an in-depth immunological examination. Statistical processing of research results was carried out with the use of programs «Microsoft Excel 5.0» and «Statistica 8.0». Results. It is demonstrated a significant decrease (p&lt;0.05) in lymphocyte levels with properties of natural killers (CD56+) during the gestational period in pregnant women of Group I against Group II; the level of total hemolytic activity of the classical complement activation pathway (CH50) in Group I of pregnant women increased steadily with increasing gestational age; at the end of the II trimester, there was a significant decrease in CH50; in the III trimester of pregnancy, the level of CH50 in Group II was 123±6.7, but in the Group I this figure remained higher. Throughout the II and III trimesters of gestation, there was a probable decrease (p&lt;0.05) of the immunoregulatory coefficient in Group I of pregnant women, due to adequate correction of derivative immunological disorders, compared with pregnant women of Group II. During the residual formation of the placental barrier in Group I pregnant women the active partial thromboplastin time increased significantly during the gestational period and differed significantly from the indicators of Group II; there was a general decrease in the active recalcification time during the II and III trimesters of pregnancy in women of the Group I; a gradual decrease in the level of fibrin and fibrinogen degradation products, unlike the analogous indicator in the Group II, which showed a gradual increase. The level of stable thromboxane metabolite (TxB2) in the II trimester decreased twofold and was lower than in Group II; the level of stable prostacyclin metabolite (6-keto-PGF1α) increased in the III trimester. This led to an increase of PgI2/TxA2 balance in Group I, which corresponded to the physiological requirements of systemic and organ hemodynamics during pregnancy. Conclusions. Development and implementation of effective pregravid preparation before ART cycles in women with a history of STIs and medical correction during pregnancy helps to increase an adaptive compensatory and an adaptive potential in the immune and haemocoagulatory homeostasis of the mother and perinatal protection of the fetus. The study was carried out in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution specified in the article. The study received informed consent from the women. No conflict of interests was declared by the author.

Стан провізорних органів у плодів при вітальних та летальних аномаліях (огляд літератури)

Provisional organs (placenta, umbilical cord, amniotic membranes, amniotic fluid) play a significant role during pregnancy. Their normal morpho3functional state is an important condition for normal development and well3being of the fetus, as well as for uncomplicated course of pregnancy. Congenital malformations (CM) and chromosomal abnormalities are major causes of perinatal morbidity and mortality. For fetuses with malformations, dysfunction of the provisional organs (PO) can become critical and affect survival. Expert correct examination of PO during a comprehensive prenatal examination can become a diagnostic and prognostic tool for specialized management of fetuses as patients, and newborns to optimize the system of prenatal dispensary evaluation. Literature review has shown that there are certain patterns of the PO pathology in cases of fetal abnormal development, which require changes in the tactics of prenatal observation and delivery. The variability of morphological/ultrasound changes and clinical outcomes makes it difficult to reach definite diagnosis and make correct decisions about the management of patients in specific cases. Further research is needed to optimize the protocols of ultrasound examinations and prediction of perinatal complications in the pathology of the PO in fetuses with normal and abnormal development. No conflict of interests were declared by the authors. Key words: prenatal diagnosis, provisional organs, placenta, umbilical cord, amniotic membrane, amniotic fluid, vital and lethal congenital malformations, perinatal consequences, fetus.

Analysis of modern views on the uterine fibroids and methods of its treatment

Despite a significant amount of research on the pathogenesis, diagnosis and treatment of uterine fibroids, many questions remain unanswered today. The appearance and progressive growth of this formation is the result of a whole complex of disorders in the female body: neurohumoral, genetic, inflammatory and others that suppress reproductive function and worsen the course of the disease. Given the number of key factors in the pathogenesis and pathophysiology of uterine fibroids, the treatment of this group of patients should be comprehensive, aimed at early detection, treatment of concomitant gynecological diseases and correction of hormonal disorders.In recent decades, hormone therapy has been widely used for the conservative treatment of uterine hyperplastic diseases. However, according to some data, the use of COCs or intrauterine hormonal releasing system has a slight blocking effect on fibroid growth processes. Pharmacotherapy of the disease can be both a stage for preoperative preparation on the organ, and an independent unit for stabilizing the nodes and getting rid of surgical treatment. And although the results of conservative treatments indicate their effectiveness, it should be stated that the main method of treatment of uterine fibroids is surgery.In the age of endoscopic surgery, this discussion has not exhausted itself and the modern approach to the treatment of uterine fibroids dictates the expansion of indications for organ-sparing operations. The choice of their methodology should be considered and determined by the size, location, clinical picture of the disease and the feasibility of preserving menstrual and reproductive function of women. Laparoscopic myomectomy is considered a minimally invasive and less traumatic intervention, contributes to a favorable course of the postoperative period and reduces pain. With effective organ-sparing surgical treatment of uterine fibroids in women of reproductive age, the menstrual cycle is normalized, reproductive function is restored, and pregnancies usually occur in 1,5-2 years after surgery.Endoscopic treatments are now successfully used both for planning a pregnancy and for its onset. A significant amount of patients have an uncomplicated course of pregnancy and childbirth, even in the presence of multiple and small nodes. Of course, pregnant women with fibroids can not be considered as a homogeneous group of patients, clearly recommending the preservation of pregnancy. The predominant location and size of the tumor, the degree of pathological changes in the myometrium, the duration of the disease, the state of health of the woman, the age of the woman giving birth for the first time, determine different degrees of risk of pregnancy and childbirth for mother and fetus. The division of patients into risk groups allows to differentiate the question of the feasibility of maintaining pregnancy, to carry out appropriate clinical and laboratory examinations and preventive measures to prevent complications.

A Prognostic Model of the Development of Postpartum Purulent-Inflammatory Diseases

Background: Currently, postpartum purulent-inflammatory diseases continue to be a prominent issue in medicine. As a result, numerous scientific publications were devoted to finding the solution to this issue. Primarily these solutions included the idea of optimisation of antibiotic-based disease prevention and therapies. However, the early diagnosis and prognosis of these pathologies were unfortunately overlooked. The Aim of the Study: To build a prognostic model of the development of postpartum purulent-inflammatory diseases. Material and Methods: The main focus of our research was establishment of methods of early diagnosis and prognosis of purulent-inflammatory diseases. The main cohort consisted of 170 women diagnosed with purulent-inflammatory diseases while the control cohort was made of 40 women with an uncomplicated course of pregnancy; patient’s blood serum was analysed using fluorescence spectroscopy. Additionally, we implied a variety of standardised algorithms used during clinical and laboratory examination of the patients with postpartum endometritis. Results: Fluorescence spectra were studied for 40 women of control group and 170 women of the main group. Based on the data obtained using fluorescence spectroscopy and data from clinical and laboratory examinations (extragenital pathology, gynecology-related diseases, risk of miscarriage, surgery, TORCH-infections, colpitis, labour duration > 12 hrs, labour anomalies, maximum blood serum fluorescence spectrum values, fluorescence spectrum ≤ 0.845, age, number of bed days, fetal distress), we have derived a prognostic model of the development of postpartum purulent-inflammatory diseases. Conclusion: As a result, we derived a prognostic model based on the main 13 factors, which contribute to development of postpartum purulent-inflammatory diseases. This model was determined correct with a probability of over 99% (р 2 = 174.74; df = 13).

Successful Vaginal Delivery in a Woman with Previous Caesarean Scar Ectopic Pregnancy: A Case Report and Literature Review

Background: Caesarean scar implantation is a rare form of ectopic pregnancy. Subsequent pregnancies following CSP is usually associated with complications such as first or second trimester miscarriage, placenta previa or accreta causing life threatening haemorrhage, emergency hysterectomy and uterine rupture threatening lives of mother and fetus. Given the lack of consensus on treatment modalities of CSP and subsequent pregnancy, babies are usually delivered by caesarean section at term. We report on a case describing uncomplicated pregnancy course and successful vaginal delivery of a woman who had had caesarean scar ectopic pregnancy previously. Case: We report on a case of 38 year old, Gravida 7 P2+4, who was diagnosed with a CSP in her 5th pregnancy and was managed by evacuation of caesarean scar ectopic pregnancy. She presented to us again on her 7th pregnancy in early pregnancy assessment unit (EPAU) at 7+6 weeks. As she had recurrent miscarriage, Aspirin, Tinzaparin and Cyclogest were started after dating scan. She also developed gestational diabetes, hence, Metformin and Insulin was initiated. She was induced with Dinoprostone at 37+3weeks of pregnancy. Labour was conducted under epidural analgesia and the fetus was continuously monitored throughout labour. Obstetric management was largely based upon current literature and professional experience as there are not sufficient relevant cases published in literature neither specific guideline for the management in subsequent pregnancy after CSP. Results: A Healthy baby of birth weight 3.19kg was delivered without complications with second degree perineal tear. Conclusion: Although, subsequent pregnancy following caesarean scar pregnancy is associated with significant morbidity at all stages of pregnancy, hence, is recommended to deliver women by caesarean section at term, this case demonstrates that vaginal delivery is an option with careful case selection, close monitoring and informed consent from patient

СОСТОЯНИЕ ЗДОРОВЬЯ НОВОРОЖДЕННЫХ ОТ МАТЕРЕЙ С ХРОНИЧЕСКИМ ПРОСТЫМ БРОНХИТОМ В СТАДИИ РЕМИССИИ И УГРОЗОЙ НЕВЫНАШИВАНИЯ

The state of health of 100 full-term newborns from mothers with uncomplicated course of pregnancy and with chronic simple bronchitis in remission was studied. The first group consisted of 30 newborns from mothers with physiological pregnancy. The second group consisted of 38 children of a similar age from mothers who were diagnosed with simple chronic bronchitis without exacerbation in the period of gestation. The third group was represented by 32 newborns with antenatal history, burdened with chronic simple bronchitis in remission and the threat of miscarriage in their mothers in the second trimester of pregnancy. It was shown that in children of the third group, in comparison with the second group, there was a lower score on the Apgar scale at 5th minute (7.7±0.14 and 8.1±0.12 points, respectively, p&lt;0.05); cerebral ischemia of moderate severity (n=7 and n=1, respectively, p&lt;0.05) and vesiculosis (n=8 and n=1, respectively, p&lt;0.05) were registered oftener. Only the third group of newborns showed signs of respiratory distress syndrome of moderate (n=2) and severe (n=2) degree, as well as aspiration of amniotic fluid (n=2). This indicates the role of chronic simple bronchitis in remission, associated with the threat of miscarriage in the second trimester of gestation, and in disturbance of delivery of oxygen and metabolites to the intrauterine patient, as well as in changing the conditions of antenatal development of its central nervous and respiratory systems.

Pregnancy and Labors at Women with Preeclampsia Against Early Endothelial Dysfunction

The objective: to study features of course of pregnancy and labors at women with preeclampsia against endothelial dysfunction.Materials and methods. For the solution of goal we conducted complex examination of 90 pregnant women who were divided into three groups. The control (1) group was made by 30 patients without endothelial dysfunction with the uncomplicated course of pregnancy and labors. The 2nd group – pregnant women with the early endothelial dysfunction (n=30) which pregnancy proceeded without clinical symptoms of preeclampsia at which mild disturbances in hemodynamic system mother–placenta–fetus were taped. The 3rd group (main) – pregnant women with early endothelial dysfunction (n=30), with clinical implications of preeclampsia, passed pregnancy with disturbances in maternal and fetus hemodynamic, ended with the birth of children with hypoxia signs.Results. Results of the conducted researches testify that the majority of pregnant women of the main group were primapara. 73,3% of women had an extragenital pathology, mainly vegeto vascular dystonia, anemia, an obesity, diseases of kidneys. Pathology of genesial system was presented by inflammatory diseases and hormonal disturbances. The course of the previous pregnancy became complicated relapsing threat of discontinuing, placental dysfunction, a fetal infection and a fetus hypoxia, and also puerperal infectious complications. Premature births were in 46,7% of cases, and pathological hemorrhage took place at 53,3% of women. All newborns of this group were born with signs of an acute hypoxia of varying severity. Infectious complications in the puerperal period developed at nearly a half of puerperas. The extract of women came from maternity hospital for 6–10 days after the delivery. About a third of newborns it was transferred to the second stage of nursing.Сonclusion. The received results are for us the basis for carrying out further researches of this scientific problem.

Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics.

Venous hemodynamics and volume homeostasis are important aspects of cardiovascular physiology. However, today their relevance is still very much underappreciated. Their most important role is maintenance and control of venous return and, as such, cardiac output. A high-flow/low-resistance circulation, remaining constant under physiological circumstances, is mandatory for an uncomplicated course of pregnancy. In this article, characteristics of normal and abnormal venous and volume regulating functions are discussed with respect to normal and pathologic outcomes of pregnancy, and current (non-invasive) methods to assess these functions are summarized. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Декомпенсована плацентарна дисфункція: діагностика і тактика розродження

The objective: depression of frequency of perinatal pathology at women with decompensation form of placental dysfunction by improvement of the main diagnostic and treatment-and-prophylactic actions. Patients and methods. 154 pregnant women in gestation term from 22 to 40 weeks were surveyed. Depending on features of course of pregnancy and families of all surveyed it was divided into 4 groups. The group of the retrospective analysis was made by 45 pregnant women with decompensation placental dysfuction, the group of prospective research included 109 pregnant women of whom the main group was made by 38 women with decompensation form of placental dysfunction, the group of comparison included 47 pregnant women with the compensated form of placental dysfunction. The control group was made by 24 pregnant women with the uncomplicated course of pregnancy and labors. The complex of the conducted researches included clinical, ehografical, dopplerometrical, laboratory, morphological and statistical methods. Results. Use of advanced algorithm of diagnostic and treatment-and-prophylactic actions allows to increase efficiency of diagnostics of decompensation form of placental dysfunction for 33.3%, and rational tactics of a delivery leads to depression of perinatal pathology for 22.7%. Conclusion. Decompensation placental dysfuction is one of the main reasons for perinatal mortality and a case rate at the present stage. Use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows major factors of risk of this complication and the indication for change of tactics and delivery times. Key words: decompensation placental dysfunction, diagnostics, delivery tactics.

The reference intervals of main parameters of urine for analyzers SYSMEX UF 1000I/500I in dynamics of uncomplicated pregnancy.

The analyzer Sysmex UF1000i/500i were used to measure 8 parameters of urine of pregnant women; the upper reference values were formed. The women (n=158) with uncomplicated course of pregnancy were examined. No calculation of reference intervals was applied to leukocytes, erythrocytes, pavement and transitional/renal epithelium, cylinders (pathological ones included) due to their correspondence to similar values for non-pregnant women. for indices of bacteria and crystals proper upper reference thresholds were calculated that in trimesters I, II and III amounted to 452,8, 687,9 и 571,4 u/mkl for bacteria, and 0,59, 0,92 и 0,7 u/mkl for salts correspondingly.

F2. Maternal body fluid composition in uncomplicated pregnancies and preeclampsia: a bioelectrical impedance analysis

Introduction: Body fluid composition (BFC) changes during the course of pregnancy and evidence is growing that these changes are different in uncomplicated pregnancies compared to hypertensive pregnancies.Methods: The aim of this study was to evaluate the changes in maternal BFC during the course of uncomplicated pregnancy (UP) using bioimpedance analysis, as a reference to measurements in hypertensive pregnancies. BFC was assessed using a multiple frequency bioelectrical impedance analyser. Five hundred and seventeen measurements were performed in 276 patients with UP. Single measurements were performed at diagnosis in 34 patients with gestational hypertension (GH), 35 with late onset preeclampsia (LPE) and 11 with early onset preeclampsia (EPE). Longitudinal linear mixed model based analysis and ANOVA with a post hoc Bonferroni was performed as appropriate.Results: Total body water (TBW), extracellular water (ECW) and ECW/ICW significantly increase during the course of pregnancy, whereas intracellular water (ICW) does not (Figure 1).Significant differences between uncomplicated pregnancies and the hypertensive groups are presented in Table 1 (mean ± standard deviation).Conclusions: BFC changes during the course of uncomplicated pregnancies and differs in and between hypertensive pregnancies.

Systemic lupus erythematosus: strategies to improve pregnancy outcomes.

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with a high prevalence in females of childbearing age. Thus, reproduction in SLE patients is a major concern for clinicians. In the past, SLE patients were advised to defer pregnancy because of poor pregnancy outcomes and fear of SLE flares during pregnancy. Investigations to date show that maternal and fetal risks are higher in females with SLE than in the general population. However, with appropriate management of the disease, sufferers may have a relatively uncomplicated pregnancy course. Factors such as appropriate preconception counseling and medication adjustment, strict disease control prior to pregnancy, intensive surveillance during and after pregnancy by both the obstetrician and rheumatologist, and appropriate interventions when necessary play a key role. This review describes the strategies to improve pregnancy outcomes in SLE patients at different time points in the reproduction cycle (preconception, during pregnancy, and postpartum period) and also details the neonatal concerns.

Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes.

BackgroundOcular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed underlying familial or acquired thrombophilia associated with spontaneous abortion, eclampsia, or maternal thrombosis.Specific aimWe describe OVO, first diagnosed during pregnancy or immediately postpartum, in three young females (ages 32, 35, 40) associated with previously undiagnosed familial thrombophilia.ResultsBranch retinal artery occlusion (BRAO) occurred at 9 and 13 weeks gestation in two females, aged 32 and 35. Central retinal vein occlusion occurred immediately postpartum in a 40-year-old. One of the two females with BRAO subsequently developed eclampsia, and one had a history of unexplained first trimester spontaneous abortion. All three females were found to have previously unexplained familial thrombophilia. The two females with BRAO had low first trimester free protein S 42 (41%), lower normal limit (50%), and one of these two had high factor VIII (165%, upper normal limit 150%). The woman with central retinal vein occlusion had high factor XI (169%, upper normal limit 150%). Enoxaparin (40–60 mg/day) was started and continued throughout pregnancy in both females with BRAO to prevent maternal–placental thrombosis, and of these two females, one had an uncomplicated pregnancy course and term delivery, and the second was at gestational week 22 without complications at the time of this manuscript. There were no further OVO events in the two females treated with enoxaparin or in the untreated patient with postpartum eclampsia.ConclusionOVO during pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent thrombophilia evaluation and institution of thromboprophylaxis to prevent adverse maternal and fetal–placental thrombotic events.

Subsequent pregnancy following B-Lynch suture, bilateral ligation of uterine arteries, utero-ovarian arteries and internal iliac arteries due to uterine atony – A case report

Abstract Introduction Postpartum hemorrhage is currently the leading cause of death of birthing mothers in Poland. Uterine atony remains one of its major causes. Treatment of uterine retraction failure consists of application of B-Lynch suture, O-Leary uterine artery ligation, utero-ovarian arteries ligation and internal iliac arteries ligation. Aim The aim of this work was to present a case of a patient, in whom conservative surgical treatment for uterine atony allowed preserving fertility and subsequent pregnancy. Case study The authors report a case of a patient, in whom after cesarean delivery a postpartum hemorrhage was diagnosed during the fourth stage of labor due to uterine atony. After unsuccessful pharmacological attempts and performing dilation and curettage procedure, a decision about surgical treatment was made. During relaparotomy B-Lynch suture was applied and bilateral ligation of uterine arteries, its ovarian branches and internal iliac arteries was performed. After 19 months the patient was diagnosed with early pregnancy. During subsequent weeks uncomplicated course of pregnancy with normal fetal development was observed. Results and discussion Implementation of conservative surgical treatment in the course of postpartum hemorrhage allowed preserving fertility and subsequent pregnancy. The authors have analyzed the available literature on the conservative surgical treatment in postpartum hemorrhage. Conclusions In a group of selected patients with postpartum hemorrhage a risk of conservative surgical treatment, that gives the chance to preserve fertility, can be taken. This is of particular importance in women with further procreative plans.

HORMONAL REACTIONS OF PLACENTA IN WOMEN WITH THE THREAT OF MISCARRIAGE IN EARLY TERMS OF GESTATION

30 women with an uncomplicatedcourse of pregnancy and 49 women with the signs ofmiscarriage in the 1st trimester were examined. Theserum levels of hormones (estrasdiol, progesterone,cortisol, as well as testosterone and prolactin) andhormonal reactions of placenta were studied. Aconclusion has been arrived that pathologic typesof hormonal reactions are more frequently observedin patients with threat of miscarriage in the 1stpregnancy trimester, in comparison with healthypregnant women