Changes in the level of fetoplacental complex hormones in pregnant women with miscarriage

The purpose of the study was TO analyze the fetoplacental complex hormone levels and changes in their dynamics in pregnant women with miscarriage and the impact of these features on the subsequent course of pregnancy. Hormone levels were determined at different stages of gestation in 50 healthy women with a physiological course of pregnancy (control group) and 50 pregnant women with a history of miscarriage (main group). The women of the main group had a significantly slower rate of increase in hormones and a lag in quantitative indicators than the control group. The estradiol level indicators were 4.1 times (76.0%) and 2.89 times (65.5%) lower in women with miscarriage in the embryonic and late fetal period, respectively, compared to healthy women. Indicators of the level of placental lactogen and chorionic gonadotropin in the embryonic period in women with miscarriage were lower by 39.1% and 50.9%, respectively, compared to healthy women. In the late fetal period, the level of these hormones was lower by 72.9% and 35.4%, respectively. In the embryonic and late fetal periods, progesterone levels were lower by 67.4% and 68.4%, respectively, compared to the control group. The data obtained are evidence of a pronounced hormonal abnormality of the placenta, and hence a marker of fetoplacental dysfunction, which on the background of miscarriage develops at the early stages and continues to progress with the course of pregnancy.

Causes and clinical picture of very early preterm birth

The objective: the determination of the risk factors, causes and clinical features of very early preterm birth.Materials and methods. The data of anamnesis, the course of pregnancy, childbirth and perinatal outcomes in 166 women of reproductive age with very early preterm birth at 22–27 weeks of gestation were analyzed. The fact of childbirth at these terms of pregnancy is the main criterion of inclusion. The patients were divided into two groups depending on the criteria of live birth: 1 group — 79 women, whose labor was regarded as late miscarriage (retrospective study); 2 group — 87 women with very early preterm (prospective study). Exclusion criteria: congenital malformations of the fetus. Results. The main risk factors for the development of very early preterm labor are urogenital infections (83.7 % and 78.9 % in 1 and 2 groups, respectively). A combination of pathogens was found in almost half of the subjects (43 % in 1 group, 44 % in 2 group). The patients in both groups had a complicated general and obstetric anamnesis, in particular, a significant frequency of inflammatory processes of the genital organs (50.0 % – in 1 group and 59.2 % – in 2 group), surgical interventions (50.0 % and 59.2 %, respectively), as well as hormonal disorders and related diseases (ovarian dysfunction – 27.8 % and 27.6 %, uterine fibroids – 16.4 % and 17. 2%, ovarian cysts – 11.4 % in both groups). 35.4 % of patients in 1 group and 28.7 % of patients in 2 group had a history of chronic foci of infections, pathology of the urinary system – 30.3 % and 28.7 %, respectively, of the digestive tract – 24 % and 22.98 %, hypertension – 32.9 % and 31 %. The main complications of gestation in pregnant women in both groups in the II trimester were the threat of abortion (43 % and 30 %, respectively) and dysfunction of the fetoplacental complex (22.7 % and 21.8 %). This caused fetal growth retardation in both groups – 66 % and 63 % of newborns, respectively.Conclusions. Analysis of the general and obstetric history, the presence of infectious factor in combination with extragenital pathology confirm the polyetiology of the causes that leads to very early preterm birth. Considering the main risk factors of preterm birth, a complete examination for urogenital infections in women before and during pregnancy, followed by treatment and restoration of normal vaginal biocenosis, as well as the study of fetoplacental system function from early pregnancy is neseccary.Preventive measures and timely treatment of fetoplacental disorders should prolong pregnancy for the terms in which there is the best way to improve perinatal outcomes.

Features of the functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections

The objective: a study of the features for the formation and functioning of the fetoplacental complex in pregnant women with a history of sexually transmitted infections.Materials and methods. We examined 50 pregnant women with a history of sexually transmitted infections (I group – the main group). The control group consisted of 30 pregnant women without somatic and gynecological pathology, who had vaginal delivery. All pregnant women underwent a comprehensive clinical examination, taking into account complaints, medical history, objective and additional methods of examination. The levels of estriol, cortisol, placental lactogen and progesterone in the blood serum of pregnant women and the state of fetoplacental complex in terms of 18–20th, 28–30th and 38–40th weeks were determined.Results. In the pregnant women in I group, starting from the 18th weeks there was a significant decrease in the secretion of progesterone (160,8±15,9 nmol/L versus 202,4±5,5 nmol/L, respectively; p<0,05), placental lactogen (77,5±13,2 nmol/L versus 91,3±23,8 nmol/L)/ This means that already in these stages of pregnancy there are signs of placental dysfunction in pregnant women with a history of sexually transmitted infections. The changes in the functional state of the fetoplacental complex at the 28–30th weeks are more pronounced, as evidenced by an increase in the frequency of early intrauterine growth restriction (12.0 %), disorders of fetal breathing (11.0 %) and fetal movements (18.0 %) (according to the biophysical profile score assessment); premature of the placenta, increased hormonal insufficiency of the fetoplacental complex and the first signs of hemodynamic disorders (an increased blood flow in the umbilical artery and uterine arteries and a slight decrease in blood circulation in the middle cerebral artery of the fetus). At the final assessment of the condition of the fetoplacental complex at the 38–40th weeks in pregnant women with a history of sexually transmitted infections, a satisfactory condition was observed in 24 % of cases, compensated ultrasound changes occurred in 46.0 % of cases; subcompensated – in 20.0 % and decompensated – in 10.0 % of cases, respectively, which causes a high frequency of obstetric and perinatal complications in this group of pregnant women.Conclusions. The formation and functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections, from early pregnancy is characterized by a significant level of functional disorders of the fetus, placenta and the amount of amniotic fluid on the background of pronounced hemodynamic and endocrinological disorders, which requires prevention in the pre-pregnancy period.

Prevention of the fetoplacental complex disorders in women at risk and the risk of preterm birth (Literature review)

The obstetrician-gynaecologist practitioners consider a woman’s health from her reproductive potential support standpoint, and the problem of miscarriage is considered as one of the most important health problems in the world. The difficulty in solving the premature birth problem is the presence of many factors and preconditions that determine the risks of miscarriage. The article provides an overview of current international guidelines for assessing the root causes and preconditions for preterm birth. The problem of preterm birth risks is discussed, taking into account both the socio-economic living conditions of pregnant women and the factors that accompany the formation of the pathogenesis of preterm birth (placental dysfunction). There were examination and evaluation of the clinical significance of the factors that can lead to dysfunction of the fetoplacental complex (partial placental abruption, low placentation, placental dysfunction, premature placental maturation, placental malnutrition/hypertrophy, polyhydramnios/dehydration, placental abruption syndrome and growth retardation syndrome, fetal-placental blood flow, acute/chronic fetal distress). It was noted that hemodynamic disorders in the placenta depend on both the nature and duration of adverse factors. Those factors are pregnancy in unfavourable terms for the birth of children (up to 18 and after 40 years), high frequency of extragenital pathology, complicated reproductive history, genital infectious diseases (chlamydial infections, trichomoniasis, urogenital mycoplasmosis), smoking during pregnancy, the impact of environmental and economical character.Attention is paid to the hemodynamic disorders assessment (vascularization of the lower uterus) in pregnant women and determination of their role in the fetoplacental dysfunction development. The role of the hemodynamic disorders in the placenta is considered as the morphological and biochemical adaptive reactions abnormality.

Early prediction of placental insufficiency in obese women

Obesity is one of the most important problems in modern health care. The high prevalence of this pathology also affects women of reproductive age, which leads to an increase in the prevalence of obesity in pregnant women. Purpose of the work ‒ analysis of the effect of adipokine indicators on predicting the development of placental insufficiency in obese women. Materials and methods. 225 women were examined who were subdivided by such a parameter as obesity into 4 groups: 3 main and 1 control. The control group consisted of 55 pregnant women with an initially normal BMI value (18.5‒24.9 kg/m2). Group 1st included 109 pregnant women with grade I obesity (BMI 31.88 1.4 kg/m2), group 2nd ‒ 34 pregnant women with grade II obesity (BMI 36.6 1.1 kg/m2), group 3rd ‒ 31 pregnant women with grade III obesity (BMI 42.2 1.9 kg/m2). We studied the data of the anamnesis of pregnant women (somatic and obstetric-gynecological), indicators of adiponectin and omentin, peculiarities of the course of pregnancy and childbirth (data of cardiotocography (CTG), ultrasound markers of disturbances in the formation and functioning of the fetoplacental complex), indicators of labor activity, parameters of newborns (mass-growth, state on the Apgar scale, ponderal index, fetal-placental ratio) and the course of the postpartum period. When conducting statistical analysis in the case of comparing two dependent (paired) samples of parameters, the paired Students t-test was used. The results were considered statistically significant if the р was less than 0.05. With this indicator, the value of the probability of difference between the compared categories was more than 95%. Results. The possibility of predicting the development of placental insufficiency depending on the concentrations of omentin and adiponectin was confirmed. The development of placental insufficiency is most likely with omentin values in the range of 177.6‒191.2 g/ml and adiponectin in the range of 16.0‒22.5 g/ml. Conclusion. Determination of adipokine levels at 8‒9 weeks gestation may be practically significant in predicting the development of placental insufficiency in obese women.

Condition of the mother–placenta–fetal system in pregnant women with a general gynecological anamnesis

The objective: based on the results of cardiotocographic (CTG) and ultrasound methods to determine the features of the fetoplacental complex (FPC) in pregnant women with a burdensome gynecological anamnesis.Materials and methods. 150 patients at 37–41 weeks of gestation were examined. The main group includes 100 pregnant women with chronic salpingo-ophoritis, the control group – 50 healthy pregnant women of the physiological obstetrics department. CTG monitoring of the fetus, ultrasound feto- and placentography, Doppler uterine-placental-fetal blood circulation were used to assess the state of FPC in pregnant women.Results. Analysis of fetal CTG and hemodynamic parameters in the uterine artery and umbilical vessels in pregnant women with chronic salpingo-ophoritis suggests that the course of pregnancy on the background of chronic salpingo-ophoritis in the mother is a factor that adversely affects the fetus and requires active pregnancy. Carrying out treatment-and-prophylactic measures for the purpose of improvement of perinatal results. The combination of unfavorable results of the examination by these methods, as well as adverse results after the usual comprehensive treatment in pregnancy 37–42 weeks is, in our opinion, an indication for emergency delivery according to the indications of the fetus.Conclusion. Identified disorders of uteroplacental and placental-fetal circulation should be regarded as those that correspond to the first degree of severity (disorders of uteroplacental with preservation of placental-fetal circulation). The results indicate the need to include women with chronic salpingo-ophoritis in the group of increased risk of placental dysfunction (PD) in order to prevent it in a timely manner, thereby reducing perinatal morbidity and mortality.

Justification of the choice of diosmin vasoprotective as a preventive agent of pre-eclampsia

In this study, the effectiveness of vasoprotective Diosmin for the prevention of pre-eclampsia in pregnant women of high-risk group with severe forms of placental insufficiency was evaluated. The choice of prophylactic agent in the clinical group is justified by close pathogenetic relationship between placental insufficiency and pre-eclampsia on the one hand, and proved fetoprotective action of Diosmin in case of placental insufficiency on the other hand. It is shown that a normalizing effect on the uterine-placental- fetal blood flow, the functional state of the endothelium of blood vessels, the production of growth factors, the induction of apoptosis of immunocompetent cells by trophoblasts, metabolism and angiogenesis in the placenta, contributes to clinically significant reduction in the frequency of implementation of fetoplacental complex pathology and pre-eclampsia.

HYPODYNAMIA AS A FACTOR MODIFYING FUNCTIONAL MORPHOLOGY OF HUMAN PLACENTA

The aim: Study of the functional morphology of placenta in a sedentary lifestyle of a woman during pregnancy. Materials and methods: Object of the study: placentas obtained as a result of deliveries at term from women, urban residents, aged 20–40 years old, leading a sedentary lifestyle, and patients with a sufficiently high level of physical activity, the criteria of which corresponded to WHO recommendations. Immunohistochemical and morphometric studies of the placentas were carried out, followed by statistical analysis Results: Prerequisites for reducing the efficacy of the functioning of fetoplacental complex with a sedentary lifestyle were sclerosis, the formation of intervillous fibrinoid and fibrinoid substitution of terminal villi. The inclusion of compensatory mechanisms in the form of placental hypertrophy, angiomatosis, sinusoidal transformation of the capillaries of terminal villi, thinning of the syncytiocapillary membrane associated with an increase in the content of von Willebrand factor in the villus syncytiotrophoblast, in aggregate, normalizes the exchange between maternal and fetal blood and creates certain prerequisites for the successful completion of pregnancy. However, thinning of the syncytiocapillary membrane increases the risk of rupture and direct contact of the internal media of the mother and the fetus. Conclusions: Sedentary lifestyle of a pregnant woman leads to structural and functional changes in the placenta, which can be a serious prerequisite for the development of pathological abnormalities in the function of the “mother-placenta-fetus” system. To a certain extent, these changes are leveled due to compensatory processes in the placenta, the margin of efficacy of which needs further investigation.

Fetoplacental complex parameters’ changes during repeated increase of the blood volume in female rabbits

One of the mandatory stages of introducing new drugs into obstetric practice is preclinical trials, the purpose of which is to study the effect of drugs on the development of fetuses and placentas. When conducting experimental studies, the main group of animals receiving the drug is compared with the control group of animals that do not receive drugs. At the same time, the volume of the test drug itself can significantly change the blood volume (BV) of an experimental animal, especially a small one, and such administration repeated repeatedly over several days can accumulate this effect, having an adverse effect on the functional state of the fetus. A model of chronic placental insufficiency created on the 18th day of pregnancy in female rabbits by ligating 1/3 of the preplacental vessels in one uterine horn was used to study the effect on the development of the brain and placenta of normally developed and retarded fetuses of multiple daily (1928 days of pregnancy) infusions of saline solution to females in a volume of 6% of the animals BV and comparable to the volume of medications used in the treatment of placental insufficiency in clinical practice (main group of rabbits). It was found that repeated daily administration of saline solution to a female rabbit in the second half of pregnancy, which is about 6% of the BV, causes a violation of the functional state of her normally developed and, to an even greater extent, retarded fetuses. This is manifested by a 1.4-fold reduced survival rate of fetuses in the intact horn of the uterus and a more pronounced violation of brain metabolism in fetuses of the intact and experimental horns compared to those of the control group of females.