The Effect of HSV-1 Seropositivity on the Course of Pregnancy, Childbirth and the Condition of Newborns

The goal of this research was to evaluate seropositivity to HSV-1 among pregnant women and its effect on the course of pregnancy, childbirth and the condition of newborns. Methods: The serological status, socio-demographic characteristics, parity of pregnancy and childbirth and condition of newborns in women seronegative and seropositive to HSV-1 with recurrent infection and its latent course during pregnancy were analyzed. Newborns from these mothers made up the corresponding groups. Results: Low titers of IgG antibodies to HSV-1 in women in the first trimester of pregnancy are associated with threatened miscarriage, anemia in pregnancy and chronic placental insufficiency. High titers of IgG antibodies to HSV-1 in women in the second trimester of pregnancy are associated with late miscarriages and premature births, anemia in pregnancy, chronic placental insufficiency, labor anomalies, early neonatal complications (cerebral ischemia, respiratory distress syndrome) and localized skin rashes. Low titers of IgG antibodies to HSV-1 in women in the third trimester of pregnancy are associated with premature birth, anemia in pregnancy, chronic placental insufficiency, endometritis, complications of the early neonatal period and localized skin rashes. Conclusions: Our research showed that low or high titers of IgG antibodies to HSV-1, determined by the timing of recurrence of infection during pregnancy, are associated with a high incidence of somatic pathology and complications in pregnancy, childbirth and the neonatal period.

The use of the drug mildronate in obstetrics

The report contains data on positive influence of mildronatum infusion (10% NaCl) on uterine-placental and fetoplacental circulation in women with chronic placental insufficiency in the third trimester of pregnancy.

An analysis of the pathological states of pregnant women in ante-intranatal fetal death in kharkov during 2016-2019

Background. In Ukraine among perinatal losses, a high proportion of stillbirth remains, the level of which depends on many factors, including the presence of somatic and genital pathology in a woman, pathological conditions during pregnancy, including eclampsia (PE), iron deficiency anemia of pregnant women (IDA), chorioamnionitis (CA). These conditions can be combined with each other, which increases the risk of fetal death during pregnancy or childbirth. Objective. To conduct a somatic and gynecological diseases, complications of pregnancy in pregnant women with preeclampsia (PE), iron deficiency anemia (IDA) and chorioamnionitis (CA), whose pregnancy ended in ante-intrapartum fetal death at 30-40 weeks of gestation. Methods. We investigated 58 cases of stillbirth at 30-40 weeks of gestation from pregnant women with PE (n = 16), IDA (n = 16), CA (n = 26) on the basis of the Communal non-profit enterprise "City Perinatal Center "Kharkov. The clinical data of the mothers, the protocols of the pathological examination of the placenta were studied. Results. Based on the study, it was found that in women whose pregnancy was complicated by PE and IDA, the most frequent types of somatic pathology were hypertensive disorders (32% and 12.5%, respectively) and chronic diseases of the digestive system. (25% and 12.5%, respectively), among gynecological diseases, uterine leiomyoma and endocervicosis were more common, among complications of pregnancy and childbirth - premature birth (50% each, respectively) pathology of the placenta (50% and 68.8%, respectively) and disorders of the content amniotic fluid (31.3% and 18.8%, respectively).The extragenital pathology in pregnant women with CA was presented with the infectious diseases (30.7%), an acute respiratory viral infections (19.2%), the cardiovascular pathology (11.5%), and the chronic inflammatory diseases of various localization (7.6%). The most frequency gynecological pathology were inflammatory genital diseases (23.21%). The pregnancy and labor were often complicated with the placental pathology (50%), premature birth (38.5%), preeclampsia (19.2%), and anemia (19.2%). During pregnancy, placental dysfunction diagnosed only in 31.3% of cases with PE, 25% with IDA and 3.8% with CA, but in pathological examination, morphological signs of placental insufficiency recorded in almost every case of all groups. Conclusion. In pregnancy, aggravated by PE, IDA or CA, the presence of extragenital pathology, gynecological diseases, and other complications of pregnancy were additional factors that increased the severity of placental insufficiency and fetal hypoxia, which was the cause of its death. Timely diagnosis of placental dysfunction and the implementation of therapeutic measures aimed at reducing the associated negative impact on the fetus can help reduce perinatal mortality.

ANALYSIS OF ANAMNESIS FEATURES IN PREGNANT WOMEN WITH PLACENTAL DYSFUNCTION

The article examines the analysis of the anamnesis of pregnant women with placental dysfunction, the results of the studies made it possible to conclude that with impaired uteroplacental blood flow from 18-22 weeks, showed a high level of development of late gestosis (84.7%). Timely treatment of placental insufficiency and prophylaxis of late gestosis made it possible to reduce the incidence of complications.

Features of the morphological structure of the placenta in pregnant women with preeclampsia

To study morphological features of the placenta in women in labor, pregnancy which complicated by preeclampsia we studied 26 placentae, of which 17 were from pregnant women with mild to moderate preeclampsia (basic group) and 9 from healthy women (control group). Histologically the study was conducted with methodically recommendations of T.D. Zadorozhnaya et al. for light microscopy. During the study of morphological features of the placenta in women in labor with preeclampsia were installed morphological changes in the placenta, which reflect a tendency to develop compensatory-adaptive reactions following their stress and exhaustion, which is a sign of placental insufficiency. Received data allow claiming a high frequency of development placental insufficiency in pregnant women with risk factors such as chronic salpingo-oophoritis, anemia, late preeclampsia, and inflammation diseases kidney.

Clinical significance of predictive and diagnostic indices of fetal pathology associated with placental insufficiency in women with endometriosis

BACKGROUND: Modern achievements of pharmacology, surgery and reproductive medicine have determined an increase in the implementation of reproductive function in endometriosis of various localization. The onset of pregnancy in presence of impaired endometrial receptivity and progesterone resistance, pro-inflammatory and pro-thrombotic status, abnormal functioning of the immune system, structural changes in the reproductive organs leads to impaired formation of the embryo (feto) placental system, early reproductive losses, complicated pregnancy and adverse perinatal outcomes. In this regard, the endometriosis and pregnancy issue requires close study and specific proposals to optimize pregnancy management. AIM: The aim of this study was to develop predictive (PIs) and diagnostic (DIs) indices of placenta-associated fetal pathology in pregnant women with endometriosis, to determine their prognostically and diagnostically significant parameters. MATERIALS AND METHODS: This prospective study in the dynamics of gestation included a comprehensive clinical and laboratory examination of 175 pregnant women with endometriosis (100 subjects with adenomyosis and 75 subjects with ovarian endometriosis). To develop PIs and DIs, two comparison groups with fetal pathology due to placental insufficiency were retrospectively identified, depending on the location of endometriosis. Group I consisted of 49 pregnant women with adenomyosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia; Group II comprised 29 pregnant women with ovarian endometriosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia. The control group (Group III) included 30 healthy pregnant women with a normal course of gestation. The examination was performed at 10-14 weeks, 20-24 weeks, and 28-34 weeks of gestation and included an assessment of placental insufficiency markers such as placental growth factor (PlGF), placental -1-microglobulin (PAMG-1), tumor necrosis factor (TNF), lymphocytes with membrane receptor FasR (L CD95+), C-reactive protein, placental alkaline phosphatase (PAPh), and fetal hemoglobin (HbF). The information value of individual parameters and indices was determined by ROC analysis, odds ratio, and clinical epidemiology tests. RESULTS: Pregnancy in presence of endometriosis in 100% of cases was complicated by placental insufficiency of varying severity (with fetal pathology in 81.5% of cases), the frequency of which had statistically significant differences between the groups of pregnant women with adenomyosis and ovarian endometriosis (2 = 4.06, p = 0.04). To predict growth retardation and / or chronic fetal hypoxia, we have developed PI I (PlGF / TNF 100) and PI II (PAMG-1 / PlGF 100), which characterize the state of placental angio-and vasculogenesis depending on systemic inflammatory response level. For early diagnosis of fetal pathology, we have proposed DI I (CRP / PAPh 100), DI II (HbF / PlGF 100) and DI III (L CD95+ / PAPh 100), which allow for diagnosing placental alterations with impaired placental energy supply due to an increase in inflammatory status. Evaluation of prognostic and diagnostic significance of PIs and DIs showed that the most informative tools are PI I (Se = 86.1%, Sp = 80.5%) and DI I (Se = 88.3%, Sp = 83.7%). CONCLUSIONS: The use of PIs allows for risk stratification of pregnant women from the 1st trimester of gestation to address the issue of the prevention method. The clinical capabilities of DIs optimize obstetric tactics for the timely prescription of therapy for placental insufficiency and targeted diagnosis of fetal pathology. Pregnant women with endometriosis should be classified as a high perinatal risk group, and therefore the proposed PIs and DIs should be included in the dynamic examination complex.

IMMUNOLOGICAL AND PATHOMORPHOLOGICAL ASPECTS OF EARLY AND LATE PREECLAMPSIA

Preeclampsia (PE) is one of the most common complications of pregnancy, and it can be after 20 weeks of gestation. It ends only with a complete dissection of afterbirth. Traditionally, PE is subdivided into the early one, taking place through 34 weeks of pregnancy (EOPE) and the late one, which is after 34 weeks of gestation (LOPE). Clinical manifestations are similar in both cases however, risk factors and the severity of PE are different . It has been established that EOPE is determined by impaired trophoblast invasion and transformation of the spiral arteries of the uterus in early pregnancy, and late onset of PE is associated with oxidative stress of syncytiotrophoblast, which occurs secondarily, with limited gas exchange and insufficient intake of nutrients. Numerous studies have noted a significant contribution of immune responses to the pathogenesis of preeclampsia, however, the state of B-lymphocytes in EOPE and LOPE has not been studied. A comprehensive assessment of the condition of women with early (up to 34 weeks of pregnancy inclusive) and late (after 34 weeks) development of preeclampsia was carried out, taking into account clinical and anamnestic characteristics, the peculiarities of the formation of the structural components of the placenta, as well as determining the nature of differentiation and functional activity of B-lymphocytes. In peripheral venous blood, the content of CD19+, CD20+, CD19+CD27+IgD±, CD19+CD20- CD38+, CD20+CD5+-cells and serum levels of IL-5, IL-9, IL-13 were examined. Morphological examination included gross description, organometry, survey histology, and transmission electron microscopy. In the group of women with early preeclampsia in history, there were more often perinatal losses, premature births and medical abortions, and in the current pregnancy, intrauterine infection, oligohydramnios, placental insufficiency and fetal growth retardation. With late preeclampsia, metabolic syndrome, anemia, and a history of arterial hypertension were more often observed. In the peripheral blood of all women with preeclampsia, there was an increase in the content of CD20+CD5+-cells in comparison with those in uncomplicated pregnancy, more pronounced in the late onset of preeclampsia. Only in women with early preeclampsia blood levels of CD19+CD20- CD38+ and CD19+CD27+IgD±-cells, IL-5, IL-9 and IL-13 increased. Studies of the placenta in early preeclampsia indicated impaired implantation and pathological placentation with the development of primary placental insufficiency, which becomes chronic. In late preeclampsia, the development of placental insufficiency was determined by chronic disorders of maternal and fetal hemocirculation with increased deposition of fibrin and fibrinoid in the basal lamina and in the zones of villous epithelium necrosis. The study showed that the timing of the manifestation of preeclampsia is determined by the action of factors of the clinical history, structural rearrangements in the placenta and immune responses of B-lymphocytes are closely interrelated.