Is it possible the prediction of placental dysfunction?

2016 ◽  
pp. 23-27
Author(s):  
S.I. Zhuk ◽  
◽  
Yu.M. Melnik ◽  
N.V. Pehnio ◽  
◽  
...  
Keyword(s):  
Growth Factor ◽  
Pregnant Women ◽  
Dynamic Control ◽  
Clinical Signs ◽  
Control Group ◽  
Morphological Examination ◽  
Endothelin 1 ◽  
Pregnancy And Childbirth ◽  
Placental Dysfunction ◽  
Complicated Pregnancy

The purpose of the study: the study of the initiating mechanisms of development of violations of the fetal-placental relationship to develop prognostic criteria, tactics of pregnancy and delivery in women at high risk. Materials and methods. In the period from 2013 to 2015 a comprehensive examination of 334 pregnant women, which depending on the peculiarities of pregnancy and childbirth were divided into groups. The control group consisted of 236 pregnant women with uncomplicated gestational period, no morphological signs of placental dysfunction. The main group (OG) included 98 patients with a complicated pregnancy who had revealed violations of the fetal-placental relationship, which was confirmed by morphological examination of the placenta immediate postpartum period. Depending on options of course of gestation period pregnant OG were divided into subgroups: subgroup I – 31 pregnant signs of preeclampsia of different severity; subgroup II – 33 pregnant women with clinical and morphological signs of placental dysfunction, subgroup III – 34 pregnant women with threatened miscarriage and premature birth. In addition, to evaluate the effectiveness of prediction and diagnosis of disorders of fetal-placental relationship was highlighted in the comparison group (GP), which included 32 pregnant women with risk factors for placental dysfunction, which carried out the monitoring of the pregnancy by the proposed algorithm. Results. Due to the datas of high-frequency dopplerometry was determined that decline of cerebro-placental index can be the sign of placental dysfunction (p<0.05). At women with placental insufficiency the reliable increase of endothelin-1 (p<0.05), decline of vascular endothelial growth factor (p<0.05) and placental growth factor (p<0.05), increase of interleukin-1b maintenance (p<0.05) and interleukin-3 reduction (p<0.05) were set. It was proven that during placental dysfunction with an absence of high variableness episodes and STV value less than 4,0 points immediate delivery was necessary. Conclusion. It was developed the monitoring, that based on the prognostic markers determination and dynamic control of pregnancy and it allowed to predict placental dysfunction and decrease its clinical signs during pregnancy in 2,5 time and unfavorable delivery outcomes in 1,7 times. Key words: placental dysfunction, prediction, endothelin-1, growth factor, interleukin, dopplerometry, cardiotocography.

Early predictors of placental dysfunction

2016 ◽  
pp. 25-28
Author(s):  
J.M. Melnik ◽  
◽  
A.A. Shlyahtina ◽  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Pregnant Women ◽  
Umbilical Artery ◽  
Placental Growth Factor ◽  
Vascular Endothelial ◽  
Endothelin 1 ◽  
Placental Dysfunction ◽  
Early Predictors ◽  
Endothelial Growth Factor

The article presents the predictors of placental dysfunction on the early stage of pregnancy. The objective: the search for prognostic markers and criteria for the occurrence of placental insufficiency in the early stages of the gestational process to optimize the pregnancy and labor with improved perinatal outcomes. Patients and methods. To solve this goal in the period from 2013 to 2015 were conducted a comprehensive survey of 334 pregnant women, which depending on the peculiarities of pregnancy and childbirth were divided into groups. The control group consisted of 236 pregnant women with uncomplicated gestational period, no morphological signs of placental dysfunction. The study group included 98 patients with a complicated pregnancy who had revealed violations of the fetal-placental relations, which was confirmed by morphological examination of the placenta in the postpartum period. Results. It was found that pregnant women with placental insufficiency in the first trimester of pregnancy have higher levels of interleukin-1B (IL-1v) and interleukin-3 (IL-3) in comparison with physiological pregnancy, as well as there is a direct significant correlation between IL-1v and pulsative index (PI) in the spiral (r=0.84) and uterine artery (r=0.77), and the inverse correlation between the level of IL-3 and PI in the terminal branches of the umbilical artery (r=-0.69). Verified an inverse relationship between the concentration of endothelin-1, the level of vascular endothelial growth factor (r=-0.87) and placental growth factor (r=-0.73), and also a direct link between the content of endothelin-1 and PI in spiral arteries (r=0.89), uterine artery (r=0.83) and the terminal branches of the umbilical artery (r=0.79). Conclusion. Thus, it is proven that early predictors of placental dysfunction can be considered the concentration of endothelin-1, vascular endothelial growth factor, placental growth factor, interleukin-1, interleukin-3, and the indices of pulsative index. Key words: placental dysfunction, predictors, endothelin-1, vascular endothelial growth factor, placental growth factor, interleukin, pulsative index.

scholarly journals BASIC CLINICAL AND PATHOGENETIC ASPECTS OF DEVELOPING THE COMPLICATIONS DURING MULTIPLE PREGNANCIES

2019 ◽  
Vol 72 (1) ◽  
pp. 52-55
Author(s):  
Volodymyr I. Boiko ◽  
Alla V. Boychuk ◽  
Irina M. Nikitina ◽  
Tetyana V. Babar ◽  
Alesya V. Boiko ◽  
...  
Keyword(s):  
Growth Factor ◽  
Pregnant Women ◽  
Solid Phase ◽  
First Trimester ◽  
Enzyme Analysis ◽  
Control Group ◽  
Multiple Pregnancies ◽  
Placental Dysfunction ◽  
First Trimester Of Pregnancy ◽  
A Prospective Study

Introduction: In order to evaluate the value of the Placenta Growth Factor (PlGF) in the developing the gestational complications during multiple pregnancies, a study of this indicator in serum of 320 pregnant women with multiple pregnancies in the first trimester, as well as 40 pregnant women with single pregnancy, constituted a control group. The aim: of the study is to investigate the effect of the placental growth factors on gestational process during multiple pregnancies. Materials and methods: A prospective study of maternity pregnancy in 320 females with multiple pregnancies was conducted, which comprised the main group of the subjects and 40 healthy women with unipolar pregnancy. The level of PlGF in serum was determined by solid phase enzyme analysis using monoclonal antibody sets in the first trimester of pregnancy. Indicators of the hemostasis system (vascular thrombocyte and coagulation link) were evaluated according to generally accepted methods. Dopplerometry of placental and fetal blood flow was performed in uterine arteries, arteries and umbilical cord veins, middle cerebral artery of the fetus. Results: Women with multiple pregnancies are at the risk of gestational complications - premature births in 67.8% (p <0.01), feto placental dysfunction, pre eclampsia - in 17.5% (p <0.05) cases. The revealed violations of the vascular thrombocyte and coagulation homeostasis in the first trimester of pregnancy are the main risk factors for early premature abortion. It has been shown that the low level of placental growth factor in serum of pregnant women with multiple pregnancies in the case of premature labor, feto placental dysfunction and pre-eclampsia (111.23 ± 8.4, 203.24 ± 6.4 and 305.86 ± 7.4 pg / ml) compared with the corresponding indicators for single-pregnancy (418.2 ± 10.4 pg / ml) is a prognostic marker for the development of gestational complications. Conclusions: Timely medical correction of gestational complications during multiple pregnancies with the use of micronized progesterone, low molecular weight heparins, angio protectants allowed prolonging the pregnancy with mono choric type of placentation by 3.2 weeks (up to 34.2 ± 2.4 weeks), and in the case of dichoric twins - to full-term pregnancy.

Decompensation placental dysfunction: diagnostics and delivery tactics

2017 ◽  
pp. 66-68
Author(s):  
V.I. Boyko ◽  
◽  
S.A. Tkachenko ◽  
Keyword(s):  
Pregnant Women ◽  
Key Words ◽  
Retrospective Analysis ◽  
Control Group ◽  
Present Stage ◽  
Placental Dysfunction ◽  
Perinatal Pathology ◽  
Delivery Times ◽  
Case Rate ◽  
Major Factors

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.

Optimisation of tactics of conducting pregnancy and labours at women after auxiliary reproductive technologies

2016 ◽  
pp. 160-164
Author(s):  
D.N. Maslo ◽  
Keyword(s):  
Pregnant Women ◽  
Resistance Index ◽  
First Trimester ◽  
Reproductive Technologies ◽  
Premature Delivery ◽  
Control Group ◽  
Uterine Arteries ◽  
Placental Dysfunction ◽  
Placental Blood ◽  
Two Stages

The objective: frequency decrease perinatal pathologies at women after ART on the basis of studying clinical-ehografical, endocrinological, biochemical, dopplerometrical, cardiotokografical and morphological researches, and also improvement of algorithm of diagnostic and treatment-and-prophylactic actions. Patients and methods. The work basis is made spent by us from 2012 on 2015 by complex inspection of 300 pregnant women from which 250 were after ART and 50 – firstlabours which pragnency without ART, and also their newborns. For the decision of an object in view of research spent to two stages. At 1 stage spent prosperctive research which included 150 pregnant women: з them 100 women pregnancy at which has come out ART (1 group) and 50 healthy women (control group). At 2 stage spent prospective randomization in which result of patients after ART have divided on two equal groups by therapy principle: 2 basic group - 75 pregnant women after ART at which used the algorithm improved by us; 3 group of comparison - 75 pregnant women after ART which have been spent on the standard treatment-and-prophylactic actions. Results. The results suggest that women after using ART is a high frequency of reproductive losses in the first trimester (10.0%), 3.0% of spontaneous abortion from 16 to 22 weeks, and 3.0% "early" premature delivery (22 to 28 weeks of pregnancy). The frequency of violations of the functional state of placenta in women after using IVF is 63.0%, which is the main cause of high levels of perinatal losses (40.0 ‰), and delivery by cesarean section (96.0%). Placental dysfunction in women after using ART characterized by retrohorialnyh hematoma (21.0%); size mismatch fruit (30.0%) and hypertonicity of the uterus (73.0%) against changes in fruit-placental blood flow - increased resistance index in umbilical artery and increased vascular resistance in the uterine arteries. Endocrinological and biochemical changes in placental dysfunction in women after using IVF starting from 28 weeks of pregnancy and are in significant reduction in progesterone, placental b1-microglobulin, B2-microglobulin of fertility and trophic в-glycoprotein. Conclusion. The received results: use of the algorithm of diagnostic and treatment-and-prophylactic actions improved by us allows to lower frequency of spontaneous interruption of pregnancy till 22 weeks – from 13.0% to 5.7%; «early» premature birth – from 3.0% to 1.0%; placentary dysfunction from 63.0% to 40.6%; cesarean sections – from 96.0% to 56.5%, and also perinatal losses – from 40.0‰ to 16.2‰. Key words: pregnancy, childbirth, auxiliary reproductive technologies.

scholarly journals Peculiarities of pregnansy and childbirth in patients with a burdened gynecological anamnesis

2020 ◽  
Vol 5 ◽  
pp. 5-10
Author(s):  
T. P. Andriichuk ◽  
A. Ya. Senchuk ◽  
V. I. Chermak
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Control Group ◽  
Careful Monitoring ◽  
Pregnancy And Childbirth ◽  
History Of ◽  
High Level ◽  
Adaptive Reactions

The objective: to study the features of pregnancy, childbirth, postpartum period, fetal status and newborns in patients with a history of chronic salpingo-оophoritis.Materials and methods. Conducted a retrospective study of 150 birth histories and neonatal development maps. All patients were divided into two groups. The main group includes 100 patients with chronic salpingo-оophoritis, for which they received anti-inflammatory treatment from 1 to 3 times before pregnancy. The control group included 50 pregnant women who did not suffer from chronic salpingo-оophoritis.Results. Our analysis of pregnancy, childbirth, fetal and neonatal status in women with chronic salpingo-оophoritis indicates that such patients have a complicated obstetric and gynecological and somatic history, which forms an unfavorable basic condition of organs and systems, imperfect adaptation to pregnancy, high risk of failure of adaptive reactions. The result is a violation of the formation and development of the mother-placenta-fetus system and, as a consequence, a high level of complications during pregnancy, childbirth and perinatal pathology.Conclusion. Patients suffering from chronic salpingo-oophoritis should be considered at high risk of possible complications during pregnancy and childbirth. This category of women needs quality preconception training and careful monitoring during pregnancy.

scholarly journals CARDIAL MANIFESTATIONS OF NON-DIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA AND THEIR INFLUENCE ON PREGNANCY

2021 ◽  
pp. 14-22
Author(s):  
V. Yu. DOBRIANSKA ◽  
S. M. HERYAK ◽  
L. M. MALANCHUK ◽  
M. I. SHVED ◽  
I. V. KORDA
Keyword(s):  
Mitral Valve ◽  
Connective Tissue ◽  
Ventricular Arrhythmia ◽  
Pregnant Women ◽  
Mitral Valve Prolapse ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Adequate Treatment ◽  
Pregnancy And Childbirth ◽  
Connective Tissue Dysplasia

Among the visceral manifestations of NDST in pregnant women most often diagnosed mitral valve prolapse (20-25%) that accompanied by more cardiovascular and obstetric complications during pregnancy. It demonstrates the high clinical significance of the problem of connective tissue dysplasia with mitral valve prolaps for pregnancy and requires adequate treatment programs for prevention of complications and management of pregnant women with connective tissue dysplasia. Aim. Determination of the frequency of pregnancy pathology in women with clinical signs of NDST and MVP complicated by extrasystolic arrhythmia. Materials and methods. 138 pregnant women with MVP and concomitant signs of NDST and 54 healthy pregnant women were selected for analysis. Clinical manifestations of NDST, different variants of arrhythmias and the total number of complications of pregnancy and childbirth were evaluated. Results. In pregnant women with clinical signs of NDST and MVP complicated by extrasystolic arrhythmia, cases of frequent sinus extrasystole were significantly more often compared to frequent ventricular arrhythmia (47.8% vs. 18.1%, p<0.001) and cases of combination of frequent sinus extrasystole and ventricular arrhythmia (13.3 % vs. 1.5%, p <0.05). They significantly more often identified both symptoms of arrhythmological nature and symptoms that indicated a violation of autonomic status. The presence of NDST syndrome is more often accompanied by the development of complications of pregnancy and childbirth. These pregnant women have genetic and phenotypic risk factors for the development of pathological pregnancy and childbirth, birth trauma, disability of mother and newborn, which justifies such patients in a separate risk group for individualized programs of the prevention and treatment of visceral (cardiac) manifestations of NDST and possible complications of pregnancy and childbirth. Conclusions. 3.1% of pregnant women are diagnosed with phenotypic signs (stigma) of undifferentiated connective tissue dysplasia, and the most common visceral cardiac manifestation is mitral valve prolapse. The presence of mitral valve prolapse and extrasystolic arrhythmia in pregnant women with NDST is accompanied by significantly more frequent development of pregnancy and childbirth complications in these patients.

scholarly journals The Effect of Educational Media Development in Increasing Knowledge and Attitudes on Pregnancy Complications at Sayang Rakyat Hospital in Makassar

2020 ◽  
Vol 8 (T2) ◽  
pp. 196-199
Author(s):  
Stang Stang ◽  
Debora Selin ◽  
Suriah Suriah ◽  
Sumarni Marwang ◽  
Hasanuddin Ishak
Keyword(s):  
Pregnant Women ◽  
Intervention Group ◽  
Control Group ◽  
Educational Media ◽  
Media Development ◽  
Pregnancy And Childbirth ◽  
Knowledge And Attitudes ◽  
Before And After ◽  
Quasi Experimental ◽  
Increasing Knowledge

BACKGROUND: Each pregnancy and childbirth has complication risks. These complications are accompanying pathological incidences that might cause maternal mortality. AIM: This research aims to determine the effect of educational media development in increasing knowledge and attitudes about complications of pregnancy and childbirth in pregnant women. METHODS: This research method passed through several stages as follows: First stage consisted of the development of educational media (leaflets), and second stage consisted of development test with leaflet media using a quasi-experimental research design. The samples were Trimester I to Trimester III pregnant women who visited Sayang Rakyat Hospital Makassar, which consisted of 30 people as intervention group and 30 people as control group. The intervention group was provided leaflets while the control group was provided books on maternal and child health. Data analysis used Wilcoxon Signed Ranks Test and Mann–Whitney test. RESULTS: The results showed that there are differences in case of knowledge and attitudes of pregnant women regarding complications of pregnancy and childbirth before and after being provided with leaflet intervention with a value of p = 0.000. Likewise, there are differences in the case of knowledge and attitudes of pregnant women regarding pregnancy and childbirth complications between the intervention and control groups with p = 0.041 and 0.001, respectively. CONCLUSION: Educational media on knowledge and attitudes about complications of pregnancy and childbirth has a positive effect in pregnant women at Sayang Rakyat Hospital in Makassar.

scholarly journals GENETIC ASPECTS OF PREGNANCY MISCARRIAGE

2019 ◽  
pp. 71-76
Author(s):  
K. M. Lisova ◽  
I. V. Kalinovska ◽  
O. M. Yuzko
Keyword(s):  
Pregnant Women ◽  
Molecular Genetic ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Control Group ◽  
Molecular Genetic Study ◽  
Immunological Parameters ◽  
Fetoplacental Complex ◽  
Maternal Genotype ◽  
A1166c Polymorphism

Pregnancy miscarriage is a consequence of many factors. The aim of the study was to analyze the effect of miscarriage gene on embryometric, ultrasound, hormonal, immunological parameters in pregnant women, and to evaluate its prognostic value. The main group includes 31 pregnant women who had clinical signs of miscarriage in current or previous pregnancy. The control group consists of 32 healthy pregnant women whose clinical-paraclinical parameters served as a control to compare the data of the pregnancy survey of the main surveillance group. A general clinical examination and a special obstetrical examination (complaints, anamnesis, general medical examination, obstetric examination), biochemical studies (determination of hormones of the fetoplacental complex in blood serum of pregnant women), ultrasound, immunological studies, histological studies of the placenta, molecular genetic study A1166C polymorphism of the AGTR1 gene were made. In the course of the research, the genetic determinism of miscarriage was discovered. The polymorphism of the A1166C of the AGTR1 gene was considered as a prognostic marker of miscarriage in early gestational term and preeclampsia in the second half of pregnancy. A reliable marker of abortion was the maternal genotype 1166AC for the genome AGTR1. The risk of occurrence of clinical manifestations of abortion increased five times. At simultaneous influence of all prognostic factors the risk of abortion increased 6,25 times. Detection of genetic markers of pregnancy miscarriage will allow early correction of this pathology and prevent perinatal loss.

scholarly journals Role of calcitriol in modulating of placental dysfunction in pregnant women with chronic kidney disease

2020 ◽  
Vol 17 (4) ◽  
pp. 493-499
Author(s):  
G. S. Manasova ◽  
N. V. Didenkul ◽  
L. V. Mnich ◽  
Z. V. Chumak ◽  
N. V. Kuzmin
Keyword(s):  
Vitamin D ◽  
Kidney Disease ◽  
Pregnant Women ◽  
Kidney Diseases ◽  
Active Form ◽  
Decisive Role ◽  
Control Group ◽  
National Academy Of Sciences ◽  
Placental Dysfunction ◽  
Group I

The pleiotropic effects of vitamin D (VD), whose active form is synthesized in the kidneys, play a certain role both in forming and functioning the feto-placental system, including various pregnancy complications. The aim of the study was to evaluate the vitamin D status in pregnant women with placental dysfunction (PD) and chronic inflammatory kidney disease (CIKD). During 24–34 pregnancy weeks, 56 pregnant women with PD were examined (main group ‒ I); 24 patients (42.85 %) had chronic pyelonephritis (group IA). The control group (group II) had 31 conditionally healthy pregnant women. The total VD level in the blood was determined by ELISA; in addition to the general clinical standard examination, the urine also underwent bacteriological examination. The VD mean level in pregnant women with PD and CIKD was significantly lower than that in the control group (31.08 ± 7.2 and 45.42 ± 9.67 ng/ml (p <0.01)). Only 33.33 % of pregnant women in group IA had a VD optimum, as well as 93.55 % (p < 0.01) in the control group and 17.86 % in group I. 8.33 % of pregnant women had a VD deficiency in group IA (RR = 2.09; CI 95 % ‒ 1.8‒2.42). The patients with a VD-deficiency were absent in the control group. 58.33 % of women in group ІА had a suboptimal VD level and 6.45% in the control group (RR = 3.57; CI 95 % ‒ 1.62‒7.88). Bacteriuria was observed in all pregnant women with a VD-deficient or suboptimal level. At the optimum VD level, bacteriuria was diagnosed twice less (χ2 = 66.67; p <0.01). In patients with an inadequate VD level, CIKD was diagnosed 3.8 times more (RR = 3.57; CI 95 % ‒ 1.62‒7.88). 494 Proceedings of the National Academy of Sciences of Belarus. Medical series, 2020, vol. 17, no. 4, pp. 493–499 A significantly calcitriol reduction in pregnant women with placental dysfunction suggests that the deficiency or the suboptimal level of vitamin D and inflammatory kidney diseases may be the interdependent processes that play a decisive role in the formation of placental dysfunction.

scholarly journals A study of vascular endothelial growth factor in the cord blood of pre-eclamptics and healthy pregnant women

2017 ◽  
Vol 8 (1) ◽  
pp. 21-25
Author(s):  
Anita Rawat ◽  
Anil Kumar Gangwar ◽  
Archana Ghildiyal ◽  
Neena Srivastava ◽  
Sunita Tiwari ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Cord Blood ◽  
Pregnant Women ◽  
Assay Method ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Vascular Endothelial ◽  
Cord Serum ◽  
Endothelial Growth Factor

Background: Pre-eclampsia(PE) is  the  most  frequently encountered  medical  complication  during  pregnancy. In developing countries PE   is a principal cause of maternal mortality. A disturbance  in  the  angiogenic/antiangiogenic  factors  and  in  the  hypoxia/placental re-oxygenation  process,  seems  to  activate a maternal  endothelial  dysfunction.Aims and Objective: To estimate Vascular Endothelial Growth Factor ( VEGF )  level  in the cord blood of healthy and Preeclamptic ( PEc ) pregnant women and to associate this with Preeclamptic pregnancy.Material and Methods: A case-control study ofUmbilical cord serum VEGF levels from women with uncomplicated pregnancies (control group, n=60) and pregnancies complicated by Pre-eclampsia (n=40). VEGF in the cord serum was estimated by SANDWICH Enzyme Linked Immunosorbent Assay method by using ELISA Kit and then compared between the two groups.Results: The mean VEGF concentrations in the women who had pre-eclampsia  (578.62±468.3)  were lower than in the control group( 625.75±533.1) , but the difference was not statistically significant ( p= 0.8548).  Conclusion VEGF plays a key role in the instability between endothelial dysfunction and angiogenesis that occurs during Preeclampsia.  VEGF levels might be a useful tool for the early diagnosis of Pre-eclampsia.Asian Journal of Medical Sciences Vol.8(1) 2017 21-25

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