Pub Date : 2023-03-31DOI: 10.30841/2708-8731.2.2023.278152
Igor Victorovich. Lakhno
The pandemic of COVID-19 changed the traditional approaches to the management of gestational complications. Today there is still a lack of information about the impact of COVID-19 on the pregnancy course, in particular, about its role in relation to Rh-conflict during pregnancy.The paper focused on a rare presentation of Rh-conflict pregnancy and COVID-19. 32 years old G3 P2 pregnant women with Rh-negative had a third pregnancy. The injection of anti-D immunoglobulin after the first abortion was not performed. The second pregnancy finished with a term delivery and the birth of a fetus with hemolytic disease. During the third pregnancy, the woman fell ill with COVID-19 in the 26th week. The bilateral pneumonia was diagnosed.The treatment included antibiotics, antiviral, antithrombotic, and anti-inflammatory drugs. No signs of fetal hemolytic disease were found via ultrasonography. But the abnormal level of anti-D antibodies – 1:1024 was detected. From the 28th weeks of pregnancy till the delivery the test for anti-D antibodies was constant – 1:4. The variables of utero-placental, fetal (blood flow velocity in a middle cerebral artery), and umbilical hemodynamics were normal during the third trimester. But fetal moderate hepato- and splenomegaly were found at 36 weeks of gestation. The patient delivered at 38 weeks of gestation a female newborn 3100 g, 52 cm with a 7→8 Apgar score. The laboratory investigation detected a hemoglobin value of 202.6 mg/dL in a child. The blood analysis showed total bilirubin of 44.2 mg/dL, direct bilirubin of 1.0 mg/dL, and a negative result on the direct Coombs test. The baby received phototherapy for 3 days. Total bilirubin was decreased (15.2 mg/dL). The newborn was discharged from a hospital with the mother on the fifth day.COVID-19 could change the placental permeability and increase the titer of anti-D antibodies. But it did not contribute to fetal and newborn hemolytic disease.
{"title":"COVID-19 mimicked fetal hemolytic disease: a case report","authors":"Igor Victorovich. Lakhno","doi":"10.30841/2708-8731.2.2023.278152","DOIUrl":"https://doi.org/10.30841/2708-8731.2.2023.278152","url":null,"abstract":"The pandemic of COVID-19 changed the traditional approaches to the management of gestational complications. Today there is still a lack of information about the impact of COVID-19 on the pregnancy course, in particular, about its role in relation to Rh-conflict during pregnancy.The paper focused on a rare presentation of Rh-conflict pregnancy and COVID-19. 32 years old G3 P2 pregnant women with Rh-negative had a third pregnancy. The injection of anti-D immunoglobulin after the first abortion was not performed. The second pregnancy finished with a term delivery and the birth of a fetus with hemolytic disease. During the third pregnancy, the woman fell ill with COVID-19 in the 26th week. The bilateral pneumonia was diagnosed.The treatment included antibiotics, antiviral, antithrombotic, and anti-inflammatory drugs. No signs of fetal hemolytic disease were found via ultrasonography. But the abnormal level of anti-D antibodies – 1:1024 was detected. From the 28th weeks of pregnancy till the delivery the test for anti-D antibodies was constant – 1:4. The variables of utero-placental, fetal (blood flow velocity in a middle cerebral artery), and umbilical hemodynamics were normal during the third trimester. But fetal moderate hepato- and splenomegaly were found at 36 weeks of gestation. The patient delivered at 38 weeks of gestation a female newborn 3100 g, 52 cm with a 7→8 Apgar score. The laboratory investigation detected a hemoglobin value of 202.6 mg/dL in a child. The blood analysis showed total bilirubin of 44.2 mg/dL, direct bilirubin of 1.0 mg/dL, and a negative result on the direct Coombs test. The baby received phototherapy for 3 days. Total bilirubin was decreased (15.2 mg/dL). The newborn was discharged from a hospital with the mother on the fifth day.COVID-19 could change the placental permeability and increase the titer of anti-D antibodies. But it did not contribute to fetal and newborn hemolytic disease.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86261592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-31DOI: 10.30841/2708-8731.2.2023.278287
S. Koval, M. Kyrylchuk, A. Husieva
Immune thrombocytopenia (ITP) is an autoimmune disease which is characterized by antibody-mediated destruction of platelets by the reticuloendothelial system. The rate of ITP is 3.3 per 100,000 adults per year with a prevalence of 9.5 per 100,000 adults. Pregnancy does not increase the frequency or severity of ITP, but ITP can significantly affect pregnancy and cause bleeding in women.Pregnancy requires regular control of the number of platelets: monthly in the I and II trimesters, every 2 weeks – in the III trimester, and weekly control near the delivery date. Indications for treatment are determined by the pregnant woman condition, not the fetus, since it has not been proven that the treatment reduces the risks of thrombocytopenia in newborns with the development of cerebral hemorrhage.The drug of the first line of treatment of such pathology is prednisolone at a dose of 1 mg/kg orally once a day. An increase in the number of platelets is usually observed within 3-7 days, the maximum response is determined after 2-3 weeks. If necessary, the dose can be increased. When the required level of platelets is reached, the dose can be gradually reduced by 10-20 % to the minimum dose necessary to maintain the number of platelets at an acceptable level.Thrombocytopathy can be the cause of primary hemostasis disorders, even if the number of platelets in the blood is normal. For diagnosis, tests are carried out to detect the aggregation ability of platelets. In addition, flow cytometry can be used, which makes it possible to detect the defects of surface membrane receptors, as well as defects of the end point of secretion.ITP is a common cause of thrombocytopenia after viral infections. The onset of this pathology is more often detected in the second and third weeks after the onset of COVID-19. The treatment aim is to prevent the significant bleeding in patients with COVID-19.The article presents a clinical case of a pregnant woman with ITP and thrombocytopathy, whose pregnancy was complicated by COVID-19. The patient complained on bleeding gums, the appearance of hematomas on the skin. Medical treatment of the main disease included prednisolone, eltrombopag, intravenous human immunoglobulin, transfusion of platelet concentrate. At 34–35 weeks of pregnancy alive boy was born with a body weight of 2800 g, length of 49 cm, 7–8 points on the Apgar scale.
{"title":"A rare combination of immune thrombocytopenia and disaggregation thrombocytopathy: course and termination of pregnancy complicated by COVID-19 (Clinical case)","authors":"S. Koval, M. Kyrylchuk, A. Husieva","doi":"10.30841/2708-8731.2.2023.278287","DOIUrl":"https://doi.org/10.30841/2708-8731.2.2023.278287","url":null,"abstract":"Immune thrombocytopenia (ITP) is an autoimmune disease which is characterized by antibody-mediated destruction of platelets by the reticuloendothelial system. The rate of ITP is 3.3 per 100,000 adults per year with a prevalence of 9.5 per 100,000 adults. Pregnancy does not increase the frequency or severity of ITP, but ITP can significantly affect pregnancy and cause bleeding in women.Pregnancy requires regular control of the number of platelets: monthly in the I and II trimesters, every 2 weeks – in the III trimester, and weekly control near the delivery date. Indications for treatment are determined by the pregnant woman condition, not the fetus, since it has not been proven that the treatment reduces the risks of thrombocytopenia in newborns with the development of cerebral hemorrhage.The drug of the first line of treatment of such pathology is prednisolone at a dose of 1 mg/kg orally once a day. An increase in the number of platelets is usually observed within 3-7 days, the maximum response is determined after 2-3 weeks. If necessary, the dose can be increased. When the required level of platelets is reached, the dose can be gradually reduced by 10-20 % to the minimum dose necessary to maintain the number of platelets at an acceptable level.Thrombocytopathy can be the cause of primary hemostasis disorders, even if the number of platelets in the blood is normal. For diagnosis, tests are carried out to detect the aggregation ability of platelets. In addition, flow cytometry can be used, which makes it possible to detect the defects of surface membrane receptors, as well as defects of the end point of secretion.ITP is a common cause of thrombocytopenia after viral infections. The onset of this pathology is more often detected in the second and third weeks after the onset of COVID-19. The treatment aim is to prevent the significant bleeding in patients with COVID-19.The article presents a clinical case of a pregnant woman with ITP and thrombocytopathy, whose pregnancy was complicated by COVID-19. The patient complained on bleeding gums, the appearance of hematomas on the skin. Medical treatment of the main disease included prednisolone, eltrombopag, intravenous human immunoglobulin, transfusion of platelet concentrate. At 34–35 weeks of pregnancy alive boy was born with a body weight of 2800 g, length of 49 cm, 7–8 points on the Apgar scale.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81897991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-31DOI: 10.30841/2708-8731.2.2023.278154
І. Mironyuk, G. Slabkiy, O. Shcherbinska, I. V. Rozhkova, Yu.M. Shen
The social economic and medical demographic significance of malignant neoplasms in women is determined by the high morbidity and mortality rates of the female population of working and reproductive periods. Visual forms of malignant neoplasms in women, which are diagnosed in the early stages, can be treated effectively.The objective: to determine and analyze the indicators of diagnosis of visual malignant neoplasms forms of the genital organs in late stages and during preventive examinations in women of Chernihiv region in the dynamics of five years.Materials and methods. The official statistical data for 2017–2021 of administrative territories of Chernihiv region and Ukraine were used. The medical-statistical method and the method of structural logical analysis were used.Results. It was established that the rate of female malignant breast neoplasms which were diagnosed in late stages during 2017-2021 has a tendency to decrease (24.9-23.9 %), while the frequency of malignant neoplasms of the cervix that were detected in late stages, has an upward trend (43.6–43.8 %). At the same time, only 29.0 % of breast malignant neoplasms and 19.1 % of malignant neoplasms of the cervix were diagnosed during preventive examinations in 2021.The rate of malignant neoplasms diagnosis of the above locations during preventive examinations in the study years (2017–2021) decreased. All the indicated indicators have significant differences in the administrative territories of the region.Conclusions. In Chernihiv region of Ukraine in 2017–2021, a high level of diagnosis of visual malignant neoplasms forms of the genital organs in late stages and a low level of detection of malignant neoplasms during preventive examinations were established, which requires improvement of preventive measures both at the regional level and at the level of administrative territory
{"title":"The morbidity of visual malignant neoplasms forms of the genital organs in the female population of Chernihiv region: late stages and diagnosis during preventive examination","authors":"І. Mironyuk, G. Slabkiy, O. Shcherbinska, I. V. Rozhkova, Yu.M. Shen","doi":"10.30841/2708-8731.2.2023.278154","DOIUrl":"https://doi.org/10.30841/2708-8731.2.2023.278154","url":null,"abstract":"The social economic and medical demographic significance of malignant neoplasms in women is determined by the high morbidity and mortality rates of the female population of working and reproductive periods. Visual forms of malignant neoplasms in women, which are diagnosed in the early stages, can be treated effectively.The objective: to determine and analyze the indicators of diagnosis of visual malignant neoplasms forms of the genital organs in late stages and during preventive examinations in women of Chernihiv region in the dynamics of five years.Materials and methods. The official statistical data for 2017–2021 of administrative territories of Chernihiv region and Ukraine were used. The medical-statistical method and the method of structural logical analysis were used.Results. It was established that the rate of female malignant breast neoplasms which were diagnosed in late stages during 2017-2021 has a tendency to decrease (24.9-23.9 %), while the frequency of malignant neoplasms of the cervix that were detected in late stages, has an upward trend (43.6–43.8 %). At the same time, only 29.0 % of breast malignant neoplasms and 19.1 % of malignant neoplasms of the cervix were diagnosed during preventive examinations in 2021.The rate of malignant neoplasms diagnosis of the above locations during preventive examinations in the study years (2017–2021) decreased. All the indicated indicators have significant differences in the administrative territories of the region.Conclusions. In Chernihiv region of Ukraine in 2017–2021, a high level of diagnosis of visual malignant neoplasms forms of the genital organs in late stages and a low level of detection of malignant neoplasms during preventive examinations were established, which requires improvement of preventive measures both at the regional level and at the level of administrative territory","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77577065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-31DOI: 10.30841/2708-8731.2.2023.278153
V. V. Bila, O. Zahorodnia, V. Baryshnikova
In the conditions of rapid social and economic changes such society categories as pregnant women, women after labour and newborns are especially helpless. Lactation onset is extremely sensitive to stress. Instead, under the stressful conditions breastfeeding is the key to safe nutrition and protection from the emotional stress of the child and mother. One of the modern technologies for supporting breastfeeding is breast milk banks (BMB), the first of which in Ukraine is functioning on the basis of the Perinatal Center in Kyiv. This article is devoted to the peculiarities of the BMB’s work in the conditions of a full-scale war.The objective: to study the main indicators of BMB work in Kyiv Perinatal Center for 2022 and compare them with the indicators of the previous periods.Materials and methods. The reports on the activities of the BMB in Perinatal Kyiv Center for 2020, 2021 and 2022 were analysed.Results. During 2022, there was a tendency to increase the number of breast milk donors who delivered in other institutions, but the number of donors was similar (26.4 % in 2022 versus 5.7 % and 4.6 % in 2021 and 2020, respectively). In 2020, the recipients of breast milk were 400 newborns, in 2021 – 560 newborns, in 2022 – 2010. A decrease in the quantity of premature newborns in the structure of recipients of donor breast milk was also found – 12.7 % in 2022 versus 74 % and 82 % in previous years.An increase in the number of full-term newborns who received donor breast milk during the lactation is a significant result that corresponds to the social situation. The volume of harvested breast milk decreased from 990 litres in 2020, 980 litres in 2021 to 660 litres in 2022.Conclusions. The Breast Milk Bank (BMB) of the Kyiv Perinatal Center continues to play its role in preserving the life and health of Ukrainians and restoring our country. The volumes of breast milk received from donors in the hard year of 2022 were less than in previous years (660 l vs. 990 l), but an increased number of newborns who received it was found (2010 children in 2022 vs. 560 children in 2021), and the predominance of full-term recipients among them (87.3% of all recipients in 2022 versus 26% in 2021) was observed.Among breast milk donors, women who had premature births continue to dominate – 77 %. The main task of BMB is to involve women with term births to donation. This will allow both to increase the volume of donor breast milk and to improve its quality from the point of view of benefits for the growth of a newborn.
{"title":"Breast Milk Bank of Kyiv Perinatal Center – experience in 2022","authors":"V. V. Bila, O. Zahorodnia, V. Baryshnikova","doi":"10.30841/2708-8731.2.2023.278153","DOIUrl":"https://doi.org/10.30841/2708-8731.2.2023.278153","url":null,"abstract":"In the conditions of rapid social and economic changes such society categories as pregnant women, women after labour and newborns are especially helpless. Lactation onset is extremely sensitive to stress. Instead, under the stressful conditions breastfeeding is the key to safe nutrition and protection from the emotional stress of the child and mother. One of the modern technologies for supporting breastfeeding is breast milk banks (BMB), the first of which in Ukraine is functioning on the basis of the Perinatal Center in Kyiv. This article is devoted to the peculiarities of the BMB’s work in the conditions of a full-scale war.The objective: to study the main indicators of BMB work in Kyiv Perinatal Center for 2022 and compare them with the indicators of the previous periods.Materials and methods. The reports on the activities of the BMB in Perinatal Kyiv Center for 2020, 2021 and 2022 were analysed.Results. During 2022, there was a tendency to increase the number of breast milk donors who delivered in other institutions, but the number of donors was similar (26.4 % in 2022 versus 5.7 % and 4.6 % in 2021 and 2020, respectively). In 2020, the recipients of breast milk were 400 newborns, in 2021 – 560 newborns, in 2022 – 2010. A decrease in the quantity of premature newborns in the structure of recipients of donor breast milk was also found – 12.7 % in 2022 versus 74 % and 82 % in previous years.An increase in the number of full-term newborns who received donor breast milk during the lactation is a significant result that corresponds to the social situation. The volume of harvested breast milk decreased from 990 litres in 2020, 980 litres in 2021 to 660 litres in 2022.Conclusions. The Breast Milk Bank (BMB) of the Kyiv Perinatal Center continues to play its role in preserving the life and health of Ukrainians and restoring our country. The volumes of breast milk received from donors in the hard year of 2022 were less than in previous years (660 l vs. 990 l), but an increased number of newborns who received it was found (2010 children in 2022 vs. 560 children in 2021), and the predominance of full-term recipients among them (87.3% of all recipients in 2022 versus 26% in 2021) was observed.Among breast milk donors, women who had premature births continue to dominate – 77 %. The main task of BMB is to involve women with term births to donation. This will allow both to increase the volume of donor breast milk and to improve its quality from the point of view of benefits for the growth of a newborn.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79914202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.30841/2708-8731.1.2023.276248
І. Mironyuk, Hennadіy O Slabkiy, O. Shcherbinska, I. V. Rozhkova, Yu.M. Shen
Malignant neoplasms of genital organs and mammary glands in women adversely affect the economic condition and demographic situation in most of the countries of the world, since a significant proportion of women affected by these diseases at working and reproductive age.The objective: to study and analyze the five-year dynamics of the incidence of for malignant neoplasms of the female genital organs and mammary glands in Chernihiv region.Materials and methods. The official data of sectoral statistical reporting for the period 2017–2021 of administrative territories of Chernihiv region and Ukraine were used. The medical statistical method and the method of structural and logical analysis were applied.Results. The analysis of the incidence for malignant neoplasms of the female genital organs and mammary glands in women in the Chernihiv region demonstrated that in the dynamics of the years 2017–2021, the incidence rate per 10 thousand female population as a whole tended to increase from 75.3 to 79.4 (in 1.05 times). At the same time, the incidence rate of malignant neoplasms of the mammary glands increased from 67.2 to 72.0 in (in 1.07 times); the frequency of cervical malignant neoplasms increased from 14.7 to 18.0 (in 1.22 times); the incidence rate of ovarian malignancies increased from 19.8 to 21.2 (1.07 times). In 2021, all the mentioned indicators in the region had higher values than in Ukraine as a whole. In the regional administrative territories these indicators had significant differences.Conclusions. High incidence rates for malignant neoplasms of the female genital organs and mammary glands in women in Chernihiv region for 2017–2021 were revealed, that requires optimization of preventive activities of the health care system at the regional level.
{"title":"Analysis of malignant neoplasms morbidity of the female genital organs and mammary glands in Chernihiv region","authors":"І. Mironyuk, Hennadіy O Slabkiy, O. Shcherbinska, I. V. Rozhkova, Yu.M. Shen","doi":"10.30841/2708-8731.1.2023.276248","DOIUrl":"https://doi.org/10.30841/2708-8731.1.2023.276248","url":null,"abstract":"Malignant neoplasms of genital organs and mammary glands in women adversely affect the economic condition and demographic situation in most of the countries of the world, since a significant proportion of women affected by these diseases at working and reproductive age.The objective: to study and analyze the five-year dynamics of the incidence of for malignant neoplasms of the female genital organs and mammary glands in Chernihiv region.Materials and methods. The official data of sectoral statistical reporting for the period 2017–2021 of administrative territories of Chernihiv region and Ukraine were used. The medical statistical method and the method of structural and logical analysis were applied.Results. The analysis of the incidence for malignant neoplasms of the female genital organs and mammary glands in women in the Chernihiv region demonstrated that in the dynamics of the years 2017–2021, the incidence rate per 10 thousand female population as a whole tended to increase from 75.3 to 79.4 (in 1.05 times). At the same time, the incidence rate of malignant neoplasms of the mammary glands increased from 67.2 to 72.0 in (in 1.07 times); the frequency of cervical malignant neoplasms increased from 14.7 to 18.0 (in 1.22 times); the incidence rate of ovarian malignancies increased from 19.8 to 21.2 (1.07 times). In 2021, all the mentioned indicators in the region had higher values than in Ukraine as a whole. In the regional administrative territories these indicators had significant differences.Conclusions. High incidence rates for malignant neoplasms of the female genital organs and mammary glands in women in Chernihiv region for 2017–2021 were revealed, that requires optimization of preventive activities of the health care system at the regional level.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85064096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.30841/2708-8731.1.2023.276255
I. Sudoma, Y. Goncharova, B. Dons’koy
The objective: to determine the effectiveness of intrauterine administration of granulocyte colony-stimulating factor depending on endometrium immune phenotype in patients with repeated implantation failures in embryo transfer programs.Material and methods. Endometrial biopsy during the implantation window in an artificial cycle before and (in some patients) after intrauterine administration of granulocyte colony-stimulating factor (G-CSF) was performed in 42 patients with repeated implantation failures and gestational carriers (20 women) as a control group. Flow cytometry was used to count classes and subclasses of endometrial lymphocytes in endometrial tissue samples.Results. The population of endometrial immune cells in patients with repeated implantation failures and fertile women was compared. Pregnancy and live birth rates depending on endometrium immune phenotype in patients with repeated implantation failures after intrauterine administration of granulocyte colony-stimulating factor in embryo transfer program were determined and the effect of intrauterine administration of granulocyte colony-stimulating factor on endometrial immune phenotype was evaluated.High expression of HLA-DR and CD16 on uterine natural killers is reliably associated with successful implantation after intrauterine administration of granulocyte colony-stimulating factor in an embryo transfer program. It was established that in the group with an immature immune endometrial phenotype the frequency of pregnancy (53.8 %) and the frequency of live births (53.8 %) were twice higher compared to the rest of the patients with other variants or the absence of changes in the immune profile (pregnancy rate and frequency live birth rate – 26.9 %).Conclusions. One-third of patients with repeated implantation failures in genetically tested embryos transfer programs have a unique immune status of endometrium characterized by high expression of HLA-DR and CD16 on uterine natural killers. Intrauterine administration of granulocyte colony-stimulating factor leads to decrease of HLA-DR and CD16 expression on uterine natural killers and promotes successful implantation in embryo transfer program in this group of patients.
{"title":"Immunomodulatory effect of granulocyte colony-stimulating factor in repeated implantation failures in embryo transfer programs","authors":"I. Sudoma, Y. Goncharova, B. Dons’koy","doi":"10.30841/2708-8731.1.2023.276255","DOIUrl":"https://doi.org/10.30841/2708-8731.1.2023.276255","url":null,"abstract":"The objective: to determine the effectiveness of intrauterine administration of granulocyte colony-stimulating factor depending on endometrium immune phenotype in patients with repeated implantation failures in embryo transfer programs.Material and methods. Endometrial biopsy during the implantation window in an artificial cycle before and (in some patients) after intrauterine administration of granulocyte colony-stimulating factor (G-CSF) was performed in 42 patients with repeated implantation failures and gestational carriers (20 women) as a control group. Flow cytometry was used to count classes and subclasses of endometrial lymphocytes in endometrial tissue samples.Results. The population of endometrial immune cells in patients with repeated implantation failures and fertile women was compared. Pregnancy and live birth rates depending on endometrium immune phenotype in patients with repeated implantation failures after intrauterine administration of granulocyte colony-stimulating factor in embryo transfer program were determined and the effect of intrauterine administration of granulocyte colony-stimulating factor on endometrial immune phenotype was evaluated.High expression of HLA-DR and CD16 on uterine natural killers is reliably associated with successful implantation after intrauterine administration of granulocyte colony-stimulating factor in an embryo transfer program. It was established that in the group with an immature immune endometrial phenotype the frequency of pregnancy (53.8 %) and the frequency of live births (53.8 %) were twice higher compared to the rest of the patients with other variants or the absence of changes in the immune profile (pregnancy rate and frequency live birth rate – 26.9 %).Conclusions. One-third of patients with repeated implantation failures in genetically tested embryos transfer programs have a unique immune status of endometrium characterized by high expression of HLA-DR and CD16 on uterine natural killers. Intrauterine administration of granulocyte colony-stimulating factor leads to decrease of HLA-DR and CD16 expression on uterine natural killers and promotes successful implantation in embryo transfer program in this group of patients.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91210308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.30841/2708-8731.1.2023.276246
V. Siusiuka, N.Y. Boguslavska, O.D. Kyrylyuk, A. Shevchenko, O. Babinchuk, O.I. Bachurina, L.V. Kyrychenko
The objecticve: to analyze peculiarities of pregnancy course, childbirth and the condition of newborns in women, depending on the gestation period on the basis of clinical and statistical analysis.Materials and methods. An analysis of pregnancy course, childbirth and perinatal outcomes has been carried out in 137 pregnant women. Patients were divided into 2 groups depending on the gestational age: 41 patients (I group) delivered in 37–40 weeks of gestation and 96 patients (II group) – in 41-42 weeks of pregnancy. Functional assessment of the fetal condition was performed using a cardiotocographic examination with cardiomonitors «Oxford Team 8000» and Hewlett Packard according to the generally accepted method, ultrasound examination – by ultrasound machine «Biomedica Au-530» with a linear sensor of 3.5 MHz frequency. Variational and statistical processing of the results has been carried out using licensed standard packages of multivariate statistical analysis application programs «STATISTICA 13».Results. An evaluation of anamnestic data allowed to establish that the majority of patients in the II group (53.13 %) had extragenital pathology that was in 2 times more than in the I group (24.39 %). The frequency of chronic salpingo-oophoritis was also significantly higher in the II group compared to the I one (12.50 % and 2.44 %, respectively), and such pathology as uterine leiomyoma (7.29 %) and cervical dysplasia (4.17 %) were diagnosed only among the women in the II group.A higher rate of pregnancy loss, anemia during pregnancy and disorders of uteroplacental bloodflow in patients in the II group was determined. The frequency of obstetric complications in the II group was in 4 times higher compared to the I group. This had a direct impact on the increase in the rate of cesarean section and vacuum extraction of fetus. Thus, fetal distress during childbirth was diagnosed in 13.54 % of women in the II group and in 7.32 % in the I group, and the weakness of labor activity (8,3 %) and clinically contracted pelvis (5.21 %) were determined only in the II group. Trauma of the birth canal was found in 37.5 % of women in the II group, which was almost 4 times higher than in the group I (9.76 %). The frequency of postpartum bleeding was also higher in the group II (15.6 %) and exceeded the indicator in the I group (4.88 %) in 3 times.The signs of prolonged pregnancy were found in 7.32 % newborns in the I group and 13.54 % – in the II group. It should be noted that the clinical features of early adaptation, which are characterized by a low Apgar score at birth, as well as higher morbidity, including high frequency of damage to the nervous system were determined in the newborns in the II group.Conclusions. Results of the study indicate the importance of constitutional and age characteristics, as well as concomitant somatic pathology and genital inflammatory diseases in women with a delivery date of 41–42 weeks of pregnancy, which can increase the probability of
{"title":"Obstetrical and perinatal consequences of birth in women depending on the term of gestation","authors":"V. Siusiuka, N.Y. Boguslavska, O.D. Kyrylyuk, A. Shevchenko, O. Babinchuk, O.I. Bachurina, L.V. Kyrychenko","doi":"10.30841/2708-8731.1.2023.276246","DOIUrl":"https://doi.org/10.30841/2708-8731.1.2023.276246","url":null,"abstract":"The objecticve: to analyze peculiarities of pregnancy course, childbirth and the condition of newborns in women, depending on the gestation period on the basis of clinical and statistical analysis.Materials and methods. An analysis of pregnancy course, childbirth and perinatal outcomes has been carried out in 137 pregnant women. Patients were divided into 2 groups depending on the gestational age: 41 patients (I group) delivered in 37–40 weeks of gestation and 96 patients (II group) – in 41-42 weeks of pregnancy. Functional assessment of the fetal condition was performed using a cardiotocographic examination with cardiomonitors «Oxford Team 8000» and Hewlett Packard according to the generally accepted method, ultrasound examination – by ultrasound machine «Biomedica Au-530» with a linear sensor of 3.5 MHz frequency. Variational and statistical processing of the results has been carried out using licensed standard packages of multivariate statistical analysis application programs «STATISTICA 13».Results. An evaluation of anamnestic data allowed to establish that the majority of patients in the II group (53.13 %) had extragenital pathology that was in 2 times more than in the I group (24.39 %). The frequency of chronic salpingo-oophoritis was also significantly higher in the II group compared to the I one (12.50 % and 2.44 %, respectively), and such pathology as uterine leiomyoma (7.29 %) and cervical dysplasia (4.17 %) were diagnosed only among the women in the II group.A higher rate of pregnancy loss, anemia during pregnancy and disorders of uteroplacental bloodflow in patients in the II group was determined. The frequency of obstetric complications in the II group was in 4 times higher compared to the I group. This had a direct impact on the increase in the rate of cesarean section and vacuum extraction of fetus. Thus, fetal distress during childbirth was diagnosed in 13.54 % of women in the II group and in 7.32 % in the I group, and the weakness of labor activity (8,3 %) and clinically contracted pelvis (5.21 %) were determined only in the II group. Trauma of the birth canal was found in 37.5 % of women in the II group, which was almost 4 times higher than in the group I (9.76 %). The frequency of postpartum bleeding was also higher in the group II (15.6 %) and exceeded the indicator in the I group (4.88 %) in 3 times.The signs of prolonged pregnancy were found in 7.32 % newborns in the I group and 13.54 % – in the II group. It should be noted that the clinical features of early adaptation, which are characterized by a low Apgar score at birth, as well as higher morbidity, including high frequency of damage to the nervous system were determined in the newborns in the II group.Conclusions. Results of the study indicate the importance of constitutional and age characteristics, as well as concomitant somatic pathology and genital inflammatory diseases in women with a delivery date of 41–42 weeks of pregnancy, which can increase the probability of ","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82438024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.30841/2708-8731.1.2023.276243
O. Makarchuk, O. Zhurakivska, O. Ostrovska, M. Rymarchuk, N. Henyk, S. O. Ostafiychuk
In recent years, scientific views on perinatal protection of fetus have shifted to earlier periods of pregnancy – to the I trimester, because from this stage the formation of the fetoplacental complex and laying of organs and tissues take place, which in most cases determines the further course of pregnancy. The objective: to clarify the role of the imbalance of angiogenic growth factors as one of the pathogenetic mechanisms in the development of placental dysfunction, and to conduct a postnatal macromorphometric study of placenta and umbilical cord in women with pathology of the fetal environment. Materials and methods. The object of the study were 80 pregnant women (the main group) with a singleton pregnancy, selected from the cohort of patients from the risk group for the development of preeclampsia and miscarriage. Among them, at 30–32 weeks of gestation oligohydramnios was diagnosed in 40 patients (the first group) and polyhydramnios – in 40 women (the second group). The control group included 30 somatically healthy pregnant women with a normal volume of amniotic fluid and a physiological course of pregnancy.The concentrations of placental growth factor (PlGF), vascular endothelial growth factor-1 (VEGF-1), and an anti-angiogenic marker of neovasculogenesis, soluble fms-like tyrosine kinase (sFlt-1), were performed at 12–16 and 28–32 weeks of pregnancy by enzyme immunoassay method. The study of the structural and functional features of the placenta and umbilical cord included sonographic and organometric methods. The variational statistical method of analysis of the obtained results was carried out using the «STATISTICA for Windows®-6.0» package.Results. In the women of the main group in the I trimester the ultrasound signs of pathology of the embryo and extraembryonic structures were significantly more often observed: low placement of the fertilized egg (33.8 %), its deformation (27.5 %), and partial detachment of the chorion (28.5 %). At 12–16 weeks of pregnancy, a pronounced vascular imbalance was established with a 2.5-fold decrease in the concentration of PlGF in the case of oligohydramnios compared to control data, a 1.8-fold decrease in the level of free VEGF-1 (in the case of oligohydramnios), and an increased level of antiangiogenic growth factors (sFlt-1).The postnatal examination of the placenta and umbilical cord showed that in the pregnant women of the main group a predominance of abnormal forms of placenta (16.3 %), a predominance of eccentric and marginal types of attachment of the umbilical cord (53.8 %), main and intermediate types of vascular branching (63.7 %), changes in the diameter of the umbilical cord (17.5 %), a combination of these features in a third of cases (31.3 %) were found. In the women of the main group, there was a decrease of the placental-fetal coefficient compared to the individuals of the control group, which was especially pronounced in pregnant women with oligohydramnios (up to 0.11±0.01 units comp
近年来，关于围产期胎儿保护的科学观点已经转移到妊娠早期-妊娠晚期，因为从这个阶段开始，胎儿胎盘复合体的形成和器官和组织的形成，在大多数情况下决定了妊娠的进一步进程。目的:阐明血管生成生长因子失衡在胎盘功能障碍的发病机制之一中的作用，并对胎儿环境病理的妇女进行胎盘和脐带的产后大形态计量学研究。材料和方法。本研究的对象是从子痫前期和流产风险组患者队列中选取的80例单胎妊娠孕妇(主要组)。其中，妊娠30-32周诊断羊水过少40例(第一组)，羊水过多40例(第二组)。对照组为30例身体健康、羊水量正常、妊娠生理过程正常的孕妇。在妊娠12-16周和28-32周采用酶免疫分析法测定胎盘生长因子(PlGF)、血管内皮生长因子-1 (VEGF-1)和新生血管生成的抗血管生成标志物可溶性纤维样酪氨酸激酶(sFlt-1)的浓度。胎盘和脐带的结构和功能特征的研究包括超声和器官测量方法。使用«STATISTICA for Windows®-6.0»软件包对所得结果进行变分统计分析。在妊娠1个月的主组妇女中，胚胎和胚胎外结构的超声病理迹象更常被观察到:受精卵位置低(33.8%)，受精卵变形(27.5%)，绒毛膜部分脱离(28.5%)。在妊娠12-16周时，与对照数据相比，羊水过少患者的PlGF浓度下降了2.5倍，游离VEGF-1水平下降了1.8倍(羊水过少的情况下)，抗血管生成生长因子(sFlt-1)水平增加。胎盘和脐带的产后检查显示，主组孕妇以胎盘异常型为主(16.3%)，脐带偏心型和边缘型附着型为主(53.8%)，主型和中间型血管分支型为主(63.7%)，脐带直径改变(17.5%)，三分之一的病例(31.3%)合并这些特征。在主组妇女中，胎盘-胎儿系数较对照组个体降低，特别是羊水过少的孕妇(与对照组的0.16±0.01单位相比，高达0.11±0.01单位)。在妊娠12-16周期间，在30-32周被诊断为围产期环境病理的患者在胎盘阶段建立了血管失衡。特别是，羊水过少时，PlGF浓度比对照组降低2.5倍，VEGF-1水平降低1.8倍，抗血管生成生长因子(sFlt-1)升高，这成为胎盘功能障碍发生的先决条件。胎盘和脐带的产后检查结果成为胎盘条件的间接反映。他们证明了异常形式的优势，脐带偏心和边缘型附着的优势，主要和中间类型的血管分支，脐带病理(Warton 's jelly缺位，脐带血管异常)的发生率增加，胎盘-胎儿比例降低在羊水病理的妇女中，这在羊水过少的情况下尤为明显。
{"title":"Angiogenic imbalance as a starting point for the development of placental dysfunction and pregnancy complications in patients with pathology of the fetal environment","authors":"O. Makarchuk, O. Zhurakivska, O. Ostrovska, M. Rymarchuk, N. Henyk, S. O. Ostafiychuk","doi":"10.30841/2708-8731.1.2023.276243","DOIUrl":"https://doi.org/10.30841/2708-8731.1.2023.276243","url":null,"abstract":"In recent years, scientific views on perinatal protection of fetus have shifted to earlier periods of pregnancy – to the I trimester, because from this stage the formation of the fetoplacental complex and laying of organs and tissues take place, which in most cases determines the further course of pregnancy. The objective: to clarify the role of the imbalance of angiogenic growth factors as one of the pathogenetic mechanisms in the development of placental dysfunction, and to conduct a postnatal macromorphometric study of placenta and umbilical cord in women with pathology of the fetal environment. Materials and methods. The object of the study were 80 pregnant women (the main group) with a singleton pregnancy, selected from the cohort of patients from the risk group for the development of preeclampsia and miscarriage. Among them, at 30–32 weeks of gestation oligohydramnios was diagnosed in 40 patients (the first group) and polyhydramnios – in 40 women (the second group). The control group included 30 somatically healthy pregnant women with a normal volume of amniotic fluid and a physiological course of pregnancy.The concentrations of placental growth factor (PlGF), vascular endothelial growth factor-1 (VEGF-1), and an anti-angiogenic marker of neovasculogenesis, soluble fms-like tyrosine kinase (sFlt-1), were performed at 12–16 and 28–32 weeks of pregnancy by enzyme immunoassay method. The study of the structural and functional features of the placenta and umbilical cord included sonographic and organometric methods. The variational statistical method of analysis of the obtained results was carried out using the «STATISTICA for Windows®-6.0» package.Results. In the women of the main group in the I trimester the ultrasound signs of pathology of the embryo and extraembryonic structures were significantly more often observed: low placement of the fertilized egg (33.8 %), its deformation (27.5 %), and partial detachment of the chorion (28.5 %). At 12–16 weeks of pregnancy, a pronounced vascular imbalance was established with a 2.5-fold decrease in the concentration of PlGF in the case of oligohydramnios compared to control data, a 1.8-fold decrease in the level of free VEGF-1 (in the case of oligohydramnios), and an increased level of antiangiogenic growth factors (sFlt-1).The postnatal examination of the placenta and umbilical cord showed that in the pregnant women of the main group a predominance of abnormal forms of placenta (16.3 %), a predominance of eccentric and marginal types of attachment of the umbilical cord (53.8 %), main and intermediate types of vascular branching (63.7 %), changes in the diameter of the umbilical cord (17.5 %), a combination of these features in a third of cases (31.3 %) were found. In the women of the main group, there was a decrease of the placental-fetal coefficient compared to the individuals of the control group, which was especially pronounced in pregnant women with oligohydramnios (up to 0.11±0.01 units comp","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74140346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.30841/2708-8731.1.2023.276250
I. Ventskivs’ka, V. Kupchik
The objective: to study the activity of the p65 subunit of the nuclear factor – NF-κB and effector caspase-3, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) in pregnant women with placental disorders and various clinical types of the course of premature labor (with premature rupture of the membranes and without it).Materials and methods. At the clinical base of the Department of Obstetrics and Gynecology No. 1 of O. O. Bogomolets National Medical University, which is located in the non-commercial enterprise “Perinatal Center of Kyiv”, during 2019–2022, a case-control study was conducted with the involvement of 90 pregnant women: 60 women of the main group with placental disorders and the development of spontaneous premature labor in the period of 24–34 weeks of gestation (I group – 30 women with premature labor and premature rupture of membranes, II group – 30 women with premature rupture of the membranes) and 30 women of control group (CG) with term normal delivery and the physiological course of the pregnancy.In pregnant women, the number of total and activated fractions of the p65 subunit of nuclear factor NF-κB and caspase-3 was determined by enzyme-linked immunosorbent assay (ELISA) in placenta lysates with further calculation of their activity based on these data, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) using the polymerase chain reaction.Results. In women with placental disorders and preterm birth a significantly higher values of fraction content and activity of p65 NF-κB and caspase-3 were found, with some peculiarities within the groups compared to the control group. Women of the I group were characterized by a higher activity of p65-subunit of nuclear factor (I group — 61.6 % with 95 % CI 59.7–64.2; II group — 33.8 pg/ml with 95 % CI 31.2-35.2; CG — 27.3 pg/ml, 95 % CI 26.4–28.6; p<0.05). Pregnant women of the II group had higher values of caspase-3 activity (II group — 59.2 % with 95 % CI 57.4–59.8, I group — 39.5 % with 95 % CI 38.5–40.5, CG — 31.2 %, 95 % CI 30.4–31.9; p<0.01). It was established that the presence of the T allele at position 936 of VEGF gene polymorphism is a risk factor for the development of placental disorders with the development of premature labor, the rate of this allele in the main group was 11.7 % versus 1.7 % – in the control cohort (p<0.05).Conclusions. Pregnant women with placental disorders and the development of premature birth are characterized by an increased activity of the p65 subunit of nuclear factor κB and caspase-3 compared to the control group: in women without premature rupture of the fetal membranes, a significant 2.2-fold increase in p65 NF-κB activity was found, and caspase-3 activity – by 1.3 times; in the group of pregnant women with preterm premature rupture of membranes the level of caspase-3 activity exceeded the control group by 1.9 times, and the level of p65-subunit of nuclear factor activity — by 1.
目的:研究核因子- NF-κ b的p65亚基和效应因子caspase-3的活性，以及VEGF基因的单核苷酸多态性(936C/T)在胎盘疾病孕妇和不同临床类型的早产过程(有胎膜早破和无胎膜早破)中的存在。材料和方法。2019-2022年期间，在位于非商业企业“基辅围产期中心”的O. O. Bogomolets国立医科大学第一妇产科临床基地，对90名孕妇进行了病例对照研究:选取24-34周妊娠期胎盘功能障碍并发生自发性早产的主组60例(ⅰ组- 30例出现早产及胎膜早破，ⅱ组- 30例出现胎膜早破)，对照组(CG) 30例足月正常分娩及生理妊娠过程的妇女。在孕妇中，采用酶联免疫吸附法(ELISA)测定胎盘裂解物中核因子NF-κB和caspase-3 p65亚基的总和活化组分的数量，并根据这些数据进一步计算其活性，同时采用聚合酶链反应检测VEGF基因(936C/T)的单核苷酸多态性。在胎盘疾病和早产的妇女中，发现p65 NF-κB和caspase-3的含量和活性显著高于对照组，并且在组内具有一些特殊性。I组女性的特点是核因子p65亚基活性较高(I组- 61.6%，95% CI 59.7-64.2;II组:33.8 pg/ml, 95% CI 31.2 ~ 35.2;CG - 27.3 pg/ml, 95% CI 26.4-28.6;p < 0.05)。II组孕妇caspase-3活性值较高(II组- 59.2%，95% CI 54.4 - 59.8, I组- 39.5%，95% CI 38.5-40.5, CG - 31.2%， 95% CI 30.4-31.9;p < 0.01)。结果表明，VEGF基因多态性936位T等位基因的存在是早产发生时胎盘功能障碍发生的危险因素，该等位基因在主组的发生率为11.7%，而在对照组为1.7% (p<0.05)。与对照组相比，有胎盘疾病和早产发展的孕妇的特点是核因子κB和caspase-3的p65亚基活性增加:在没有胎膜早破的妇女中，发现p65 NF-κB活性显著增加2.2倍，caspase-3活性增加1.3倍;早破胎孕妇组caspase-3活性水平超过对照组1.9倍，核因子活性亚基p65-水平超过对照组1.9倍936(C/T)血管内皮生长因子基因单核苷酸多态性在胎盘疾病和早产妇女中更为常见(研究组为11.7%，而CG为1.7%，p<0.05)， VEGF基因携带者上的T等位基因可能与这些妊娠并发症的发生有关。然而，需要对更大的妇女样本进行研究才能获得明确的结果。
{"title":"Role of p65 NF-κB, caspase-3 activities and VEGF gene polymorphisms on the development of preterm labor in women with placental dysfunction","authors":"I. Ventskivs’ka, V. Kupchik","doi":"10.30841/2708-8731.1.2023.276250","DOIUrl":"https://doi.org/10.30841/2708-8731.1.2023.276250","url":null,"abstract":"The objective: to study the activity of the p65 subunit of the nuclear factor – NF-κB and effector caspase-3, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) in pregnant women with placental disorders and various clinical types of the course of premature labor (with premature rupture of the membranes and without it).Materials and methods. At the clinical base of the Department of Obstetrics and Gynecology No. 1 of O. O. Bogomolets National Medical University, which is located in the non-commercial enterprise “Perinatal Center of Kyiv”, during 2019–2022, a case-control study was conducted with the involvement of 90 pregnant women: 60 women of the main group with placental disorders and the development of spontaneous premature labor in the period of 24–34 weeks of gestation (I group – 30 women with premature labor and premature rupture of membranes, II group – 30 women with premature rupture of the membranes) and 30 women of control group (CG) with term normal delivery and the physiological course of the pregnancy.In pregnant women, the number of total and activated fractions of the p65 subunit of nuclear factor NF-κB and caspase-3 was determined by enzyme-linked immunosorbent assay (ELISA) in placenta lysates with further calculation of their activity based on these data, as well as the presence of a single nucleotide polymorphism of the VEGF gene (936C/T) using the polymerase chain reaction.Results. In women with placental disorders and preterm birth a significantly higher values of fraction content and activity of p65 NF-κB and caspase-3 were found, with some peculiarities within the groups compared to the control group. Women of the I group were characterized by a higher activity of p65-subunit of nuclear factor (I group — 61.6 % with 95 % CI 59.7–64.2; II group — 33.8 pg/ml with 95 % CI 31.2-35.2; CG — 27.3 pg/ml, 95 % CI 26.4–28.6; p<0.05). Pregnant women of the II group had higher values of caspase-3 activity (II group — 59.2 % with 95 % CI 57.4–59.8, I group — 39.5 % with 95 % CI 38.5–40.5, CG — 31.2 %, 95 % CI 30.4–31.9; p<0.01). It was established that the presence of the T allele at position 936 of VEGF gene polymorphism is a risk factor for the development of placental disorders with the development of premature labor, the rate of this allele in the main group was 11.7 % versus 1.7 % – in the control cohort (p<0.05).Conclusions. Pregnant women with placental disorders and the development of premature birth are characterized by an increased activity of the p65 subunit of nuclear factor κB and caspase-3 compared to the control group: in women without premature rupture of the fetal membranes, a significant 2.2-fold increase in p65 NF-κB activity was found, and caspase-3 activity – by 1.3 times; in the group of pregnant women with preterm premature rupture of membranes the level of caspase-3 activity exceeded the control group by 1.9 times, and the level of p65-subunit of nuclear factor activity — by 1.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91525607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.30841/2708-8731.1.2023.276252
P. Lakatosh, Yu. M. Melnyk, I. Poladich, V. Lakatosh, M.I. Antonuk, O. Dola
Pathological placentation (placenta previa and placenta accreta) is one of the main problems in modern obstetrics, which negatively affects maternal and perinatal mortality rates. The use of modern technologies for the timely diagnosis of this pregnancy complication and the correct route of the patient allow to reduce blood loss significantly, to save not only the life of the mother and the child, but also to save the uterus in some cases.The objective: to evaluate the diagnostic possibilities of ultrasound examination of pathological placentation.Materials and methods. An ultrasound examination was performed in 86 pregnant women with pathological placentation. Ultrasound signs of pathological placentation are divided into two groups depending on the gray or color image.Results. In 92 % of examined pregnant women with pathological placentation, the clear zone was lost. In patients with placenta previa a loss of the hypoechoic retroplacental zone was found in 70 % of cases, a significant number of placental lacunae of various shapes and sizes – 87 %, segmental thinning of the myometrium <1 mm – 50 %.Protrusion of the uterus into the surrounding tissues is often observed due to placenta accreta, in cases of placenta percreta – the exophytic mass indicates the invasion of the placental tissue through the myometrium into the extrauterine organs. 80 % of pregnant women with placenta previa and 75 % of patients with placenta accreta have hypervascularization within or under the placental bed.Conclusions. Ultrasound examination is an affordable and effective method of visualization of pathological placentation. The following criteria for placenta accreta were established and confirmed: myometrial thinning <1 mm, placental lacunae, bladder wall rupture, loss of the lunate zone, placental protrusion, subplacental vascularization, uterovesicular hypervascularization, and vessels that vascularize the lacunae.
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