Peculiarities of circulation of interleukins of different classes in multiple pregnancy depending on the method of fertilization and the term of gestation

The article is devoted to the detection of interleukin circulation of different classes in women with multiple pregnancies depending on the method of fertilization and gestational age.The study found that the concentration of pro-inflammatory cytokines IL-1 (126.8 pg/mg) and IL-8 (176.4 pg/mg), determined in the 22nd week of pregnancy in the serum of patients with multiple pregnancies due to using ART, probably exceeded the control group (48.7 and 39.3 pg/mg) and spontaneous multiple pregnancy (49.3 and 40.6 pg/mg). Concentrations of cervical IL-1 and IL-8 were also elevated in pregnant women receiving ART compared with women with spontaneous multiple births and controls. These changes were observed in the dynamics of pregnancy. Under the influence of our recommended therapy, there was a gradual decrease in IL-1 and IL-8, which no longer differed from those of women with spontaneous multiple pregnancies and the control group. Administration of natural micronized progesterone for immunosuppression (normalization of the cytokine profile) to patients with multiple pregnancies due to the use of ART, reduced the incidence of preterm birth (from 83.3 to 43.7%), weakness of labor (33.3 and 21.9%, respectively), PRPO (22.2 and 12.5%, respectively), to reduce perinatal morbidity from 45.5 to 19.7% and mortality from 43.1 to 9.5%, which was not detected in patients with spontaneous fertility.Determining the features of cytokine imbalance in women with multiple pregnancies depending on the method of fertilization provides new approaches to the prevention and treatment of miscarriage, which will benefit mothers in different clinical situations.

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FEATURES OF THE COURSE OF MULTIPLE PREGNANCY AGAINST THE BACKGROUND OF FETAL GROWTH RETARDATION

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2020;8(4):433-438 ◽

2020 ◽

Vol 8 (4) ◽

pp. 433-438

Author(s):

A.B. Sukharev ◽

T.V. Kopytsia ◽

V.I. Boyko

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Multiple Pregnancy ◽

Placental Insufficiency ◽

Multiple Births ◽

Growth Delay ◽

Control Group ◽

Multiple Pregnancies ◽

Group I

In most European countries in recent years, the frequency of multiple births ranges from 11 to 14 per 1000. These pregnancies have a high number of complications. Perinatal mortality in multiple births is more than 6 times higher than in singleton pregnancies. Severe neurological abnormalities under the age of 1 year have from 10% to 25% of twins. According to most researchers, the main cause of perinatal losses in multiple births is deep prematurity and severe fetal growth delay. It has now been proven that placental insufficiency is the main reason of developmental delay, discordant fetal growth, antenatal death of one of the fetuses. A fetus that develops and is born in conditions of chronic placental insufficiency is more vulnerable and at high risk of developing perinatal pathology. The purpose of the research was to study the frequency and structure of complications of the pregnancy and labor of women with multiple pregnancies, complicated uteroplacental insufficiency and fetal discordance. The study was carried out at the city clinical maternity house during 2013–2019. The information was gathered from literature and by interviewing pregnant women with twins. 20 pregnant women (group I) with dichorionic, diamnionic twins with the presence of placental insufficiency and fetal discordance of more than 20%. Group II consisted of 20 pregnant women with twins but fetal discordance did not exceed 20%. However, the control group ІІІ consisted of 30 women without complications and ended in physiological labor. The general, somatic, obstetric and gynecological anamnesis, especially the course of pregnancy, childbirth, the state of the cervix by vaginal and ultrasound examination were studied. The results of the study show that in the anamnesis of pregnant women with fetal discordance, take place in vitro fertilization and infections of the respiratory and urinary tract. Multiple pregnancies which were accompanied by fetal discordance exceeding 20% is accompanied by impaired uteroplacental circulation. Labor with twins complicated by impaired uteroplacental circulation occurs in a large number of complications. The results can be applied to the using various medications for the correction of disorders of the uteroplacental circulation.

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Errors in Birth Registrations and Coding of Twins and Higher Order Multiples

Twin Research ◽

10.1375/twin.5.4.270 ◽

2002 ◽

Vol 5 (4) ◽

pp. 270-272 ◽

Cited By ~ 3

Author(s):

Peter O.D. Pharoah

Keyword(s):

Infant Death ◽

Death Certificate ◽

Multiple Pregnancy ◽

Higher Order ◽

Multiple Births ◽

Multiple Birth ◽

Multiple Pregnancies ◽

England And Wales ◽

Parental Counselling

AbstractDizygotic compared with monozygotic conceptions are at decreased risk of fetal and infant death and serious morbidity in surviving infants. Different sex twin maternities must be dizygotic but miscoding and incorrect registration of sex and number of fetuses may lead to an incorrect assignment of zygosity. The aim of the study was to validate the coding and registration of number and sex of births in multiple pregnancies. Fetal and infant death registrations from all multiple maternities in England and Wales 1993–1998 were examined. There were 51,792 twin, 1627 triplet and 51 higher order multiple maternities that were registered. Among these there were 1926 fetal deaths, 58 of which were registered as being of indeterminate sex but were coded as male in 56 and female in 2 cases. A fetus papyraceous was registered as male in 19 and as female in 19 cases. Other fetal deaths weighing ≤100g, with no mention of papyraceous on the death certificate, nevertheless, likely to be of indeterminate sex, were registered as male in 26 and as female in 23 cases. In 13 maternities, the number of infants registered at birth was less than the number mentioned on the registration certificate. It cannot be assumed that multiple births of different registered sex are dizygotic. As surviving infants from a monozygotic multiple birth are at much greater risk of infant death and serious morbidity than dizygotic multiple births, incorrect assignment of sex has important implications for parental counselling and may have medicolegal relevance when attributing negligence as the cause of morbidity in a survivor from a multiple pregnancy.

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Perinatal outcomes of multiple births conceived through in vitro fertilization compared with spontaneous multiple births

SHS Web of Conferences ◽

10.1051/shsconf/20185102008 ◽

2018 ◽

Vol 51 ◽

pp. 02008

Author(s):

Irisa Zile ◽

Inga Jefremova ◽

Iveta Gavare

Keyword(s):

In Vitro Fertilization ◽

Congenital Anomalies ◽

Perinatal Outcomes ◽

Perinatal Period ◽

Population Based ◽

Multiple Births ◽

Control Group ◽

Multiple Pregnancies ◽

Vitro Fertilization

Pregnancies that occur after assisted reproduction procedures constitute high-risk pregnancies. There is a lack of sufficient epidemio-logically based data on this issue in Latvia. The aim of this study was to compare the maternal and perinatal outcomes of multiple pregnancies conceived by in vitro fertilization (IVF) in comparison with spontaneous multiple pregnancies. This retrospective cohort study (2007–2014) analysed data from population-based Medical Birth Register (MBR). There is a statistically significant increase of multiple births from IVF pregnancies – an average 2% per year (p< 0.01). Newborns of IVF multiple births have higher odds of low birth weight (OR = 1.2) and congenital anomalies (OR = 1.6). Maternity characteristics showed that mothers in the IVF group were significantly older than those in the control group (≥35 years) (OR = 2.1) and primipara births (OR = 4.1). Multiple births conceived by IVF have similar outcomes as spontaneously conceived multiples in the perinatal period, although the rates of congenital anomalies after IVF are just slightly higher than in control group.

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Ciąża mnoga i wieloraczki w starożytności

10.31338/uw.9788323550280 ◽

2021 ◽

Author(s):

Dominika Lewandowska

Keyword(s):

Middle East ◽

Multiple Pregnancy ◽

Roman Law ◽

Multiple Births ◽

Multiple Pregnancies ◽

The Subject ◽

Written Sources

The book concerns multiple pregnancy and multiple births in Antiquity. The analysis of written sources from the Middle East (Mesopotamia, Egypt, the Levant, Anatolia) as well as from Greece and Rome allows looking at the subject from several perspectives: the author investigated myths about semi-divine twins and numerous multiple births, medical and astrological concepts of multiple pregnancies and the consequences of multiple births in the Roman law.

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Opting for Twins in In Vitro Fertilization

10.1093/oxfordhb/9780199981878.013.27 ◽

2016 ◽

Author(s):

Bonnie Steinbock

Keyword(s):

Learning Disabilities ◽

Multiple Pregnancy ◽

Reproductive Technology ◽

Multiple Births ◽

Fertility Treatment ◽

Ethical Question ◽

Multiple Pregnancies ◽

Vitro Fertilization ◽

Twin Pregnancies

Multiple births are an unfortunate consequence of assisted reproductive technology, causing risks to both fetuses and pregnant women. The central ethical issue raised by multiple pregnancy is the conflict between the fertility patient’s desire to get pregnant and the increased risks to offspring. Although extreme cases in which many embryos are transferred to the woman’s uterus are very rare—and represent negligence—twin pregnancies are still common. Many women undergoing fertility treatment reportedly express a preference for twin pregnancies to reduce the costs and risks of the procedure while increasing their opportunities for having more than one child. However, risks to the offspring are significant and underappreciated, including prematurity, low birth weight, cerebral palsy, and learning disabilities. Even though many multiple pregnancies result in good outcomes, the ethical question is whether the risks are justifiable in order to improve the chances of pregnancy when transfer of a singleton embryo is an available alternative.

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Efficacy of progestogens in the management of threatened miscarriage in women with multiple pregnancies resulting from assisted reproductive technologies

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2021-1-47-54 ◽

2021 ◽

Vol 20 (1) ◽

pp. 47-54

Author(s):

O.N. Bespalova ◽

◽

M.G. Butenko ◽

M.O. Bakleycheva ◽

O.V. Kosyakova ◽

...

Keyword(s):

Assisted Reproductive Technologies ◽

Multiple Pregnancy ◽

Supportive Therapy ◽

First Trimester ◽

Reproductive Technologies ◽

Obstetric Complications ◽

Comprehensive Treatment ◽

Multiple Pregnancies ◽

Threatened Miscarriage ◽

Micronized Progesterone

Women with multiple pregnancies resulting from assisted reproductive technologies (ART) demonstrate higher incidence of miscarriage and obstetric complications than women in the general population. Gestagens are the mandatory therapy to prevent miscarriage in women with single pregnancies (level B evidence). Objective. To evaluate the efficacy of different progestogens (dydrogesterone and micronized progesterone) for the treatment of threatened miscarriage in women with multiple pregnancies resulting from ART. Patients and methods. This prospective cohort study included 75 women with multiple pregnancies resulting from ART and threatened miscarriage in the first trimester. Group 1 comprised 46 patients who received oral dydrogesterone at a dose of 40 mg/day. Group 2 comprised 29 patients who received oral micronized progesterone at a dose of 600 mg/day. In both groups, the symptoms of threatened miscarriage were eliminated within 2 weeks. All patients gave their informed consent for long-term supportive therapy with progesterone agents (dydrogesterone at a dose of 20 mg/day and micronized progesterone at a dose of 200 mg/day) up to 26 weeks of gestation without interruptions. Results. Treatment of threatened miscarriage in the first trimester using progestogens was effective in 93.6% of patients from both groups. Patients receiving progesterone developed cervical shortening twice as often as patients receiving dydrogesterone (55.2% vs 26.1%). Patients receiving vaginal progesterone were 4 times more likely to have bacterial vaginosis. Conclusion. Administration of dydrogesterone and micronized progesterone as a part of comprehensive treatment to prevent miscarriage in the first trimester with subsequent progestogen support up to 26 weeks of gestation was highly effective. Dydrogesterone was significantly more effective in prevention of obstetric complications. Key words: multiple pregnancy, assisted reproductive technologies, pregnancy after ART, posttransfer support, threatened early miscarriage, cervical weakness, dydrogesterone, micronized progesterone

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The role of inflammatory cytokines in the pathogenesis of premature labor in multiple pregnancy as a result of ART

HEALTH OF WOMAN ◽

10.15574/hw.2016.111.73 ◽

2016 ◽

pp. 73-76

Author(s):

B.M. Ventskivskiy ◽

◽

I.V. Poladych ◽

S.O. Avramenko ◽

◽

...

Keyword(s):

Assisted Reproductive Technology ◽

Inflammatory Cytokines ◽

Proinflammatory Cytokines ◽

Local Level ◽

Multiple Pregnancy ◽

Reproductive Technology ◽

System Level ◽

Premature Labor ◽

Pro Inflammatory Cytokines

In recent years there has been an increase in the frequency of multiple pregnancies and the associated perinatal losses. It is a result of multiple pregnancy in ART refers to a high-risk gestation, at which premature births occur in 2 times more often than in singleton pregnancies. The objective: to determine the role of pro-inflammatory cytokines in the pathogenesis of premature labor in multiple pregnancy, as a result of assisted reproductive technology. Patients and methods. to determine the pro-inflammatory cytokines that all pregnant with bagtopliddyam held immunosorbent assay, defined concentrations of interleukin (IL) in serum and cervical mucus. Results. The analysis of the levels of pro-inflammatory cytokines (IL-1, IL-8) in the test environment, found high concentrations in the surveyed women with multiple pregnancy, due to the use of ART, compared with spontaneous multiple and singleton pregnancy. Increased concentration of proinflammatory cytokines in patients with multiple pregnancy by ART is associated with their synthesis at the system level, it stimulated foci of inflammation in the female genitals and extragenital localization. This correlates with the clinical data and statistical analysis, patients with multiple pregnancy as a result of ART had weighed infectious-inflammatory history. Conclusion. The study showed that elevated levels of proinflammatory cytokines in the systemic and local level in patients with multiple pregnancy due to ART, typical for women with miscarriage, because of the physiological course of pregnancy characterized by the predominance of anti-inflammatory cytokines that prevent rejection of the fetus as a foreign factor. Based on the data obtained proved the role of systemic inflammatory factors in the genesis of preterm labor in women with a multiple pregnancy, as a result of assisted reproductive technology. Key words: multiple pregnancy, assisted reproductive technology, premature birth, interleukine-1, interleukine-8.

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Clinical and microbiological aspects of vaginal microbiota at pregnant with threat of late miscarriages during treatment with vaginal gestagens forms

HEALTH OF WOMAN ◽

10.15574/hw.2017.117.68 ◽

2017 ◽

pp. 68-73

Author(s):

I.P. Polishchuk ◽

Keyword(s):

Pregnant Women ◽

Therapeutic Effect ◽

Local Treatment ◽

Vaginal Microbiota ◽

Control Group ◽

Before And After ◽

Low Efficiency ◽

Late Miscarriage ◽

Microbiological Aspects ◽

Micronized Progesterone

The objective: was to examine the effectiveness of treatment of late miscarriage threat by micronized form of progesterone for 100 mg – 3 times a day in the form of gelatin pills and vaginal tablets with lactose. Patients and methods. Under our supervision there were 70 pregnant women with normocenosis of vagina (NCV) without extragenital pathology, which were not performed systemic or local treatment with antibacterial drugs in the last 4 weeks. Among them 25 pregnant women with TLSM treated by gelatin tablets of micronized progesterone (GTP) (group 1); 25 pregnant women with TLSM, treated by vaginal micronized progesterone tablets (VPT) (2nd group) and 20 healthy women with physiological pregnancy – PV (control group). The distribution of women in the group adhered to the principles of randomization. The age of examined women ranged from 19 to 32 years, most pregnant women were aged under 30 years (89.02%). General clinical examination was carried out according to the standard scheme according to the Order MH of Ukraine № 620. Results. During the research we have determined the colpocytologcal dynamics and state of vaginal microbiota in pregnant women with threatened late miscarriage with initial vaginal normocenosis before and after treatment whit vaginal forms of progesterone. Conclusion. The received results showed low efficiency of micronized progesterone gelatin dragee at threat of the late miscarriage that at small therapeutic effect has led to the development of vaginal dysbiosis in all surveyed. In contrast, the use of micronized progesterone vaginal tablets – the maximally rapid therapeutic effect without disturbance of vaginal normocenosis. Key words: the threat of a late miscarriage, vaginal micronized forms of progesterone.

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Delayed interval delivery of the second and third fetuses in multiple pregnancy triplet (Сase report)

HEALTH OF WOMAN ◽

10.15574/hw.2016.111.148 ◽

2016 ◽

pp. 148-152

Author(s):

Y. Dubossarskaya ◽

◽

L. Padalko ◽

L. Zakharchenko ◽

E. Savel’eva ◽

...

Keyword(s):

Preterm Delivery ◽

Multiple Pregnancy ◽

Bed Rest ◽

Perinatal Morbidity ◽

Perinatal Complications ◽

Triplet Pregnancy ◽

Satisfactory Condition ◽

Nulliparous Women ◽

Perinatal Center ◽

Delayed Interval Delivery

This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

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IDENTIFICATION AND ASSESSMENT OF RISK FACTORS ROLE IN MYOCARDIAL INFARCTION DEVELOPMENT

Wiadomości Lekarskie ◽

10.36740/wlek201905111 ◽

2019 ◽

Vol 72 (5) ◽

pp. 779-783

Author(s):

Victor A. Ognev ◽

Anna A. Podpriadova ◽

Anna V. Lisova

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiovascular Disease ◽

Cardiovascular System ◽

Control Group ◽

Biological Factors ◽

Prevention And Treatment ◽

High Level ◽

Social Importance ◽

The Impact

Introduction:The high level of morbidity and mortality from cardiovascular disease is largely due toinsufficient influence on the main risk factors that contribute to the development of myocardial infarction.Therefore, a detailed study and assessment of risk factors is among the most important problems of medical and social importance. The aim: To study and evaluate the impact of biological, social and hygienic, social and economic, psychological, natural and climatic risk factors on the development of myocardial infarction. Materials and methods: A sociological survey was conducted in 500 people aged 34 to 85. They were divided into two groups. The main group consisted of 310 patients with myocardial infarction. The control group consisted of 190 practically healthy people, identical by age, gender and other parameters, without diseases of the cardiovascular system. Results: It was defined that 30 factors have a significant impact on the development of myocardial infarction.Data analysis revealed that the leading risk factors for myocardial infarction were biological and socio-hygienic. The main biological factors were: hypertension and hypercholesterolemia. The man socio-hygienic factor was smoking. Conclusions: Identification of risk factors provides new opportunities for the development of more effective approaches for the prevention and treatment of myocardial infarction.

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