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

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.

TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

POSSIBILITIES OF THERAPY OF PAIN SYNDROME IN ENDOMETRIOSIS

Therapeutic tactics of endometriosis are aimed primarily at overcoming the pain syndrome, the absence of recurrence of the underlying disease, maintaining fertility and improving the psycho-emotional state of women. The objective to develop, pathogenetically substantiate treatment and rehabilitation measures taking into account pathogenetic preconditions in women with endometriosis in combination with pain. Materials and methods 85 patients with genital endometriosis with severe pelvic pain (VAS 7-10 points) (n = 44) - group I and moderate (VAS 4-6 points) (n = 41) - group II. The mean age of women in clinical trials I and II of the study was 37.71 ± 0.93 and 41.05 ± 1.08 (M ± m) years, respectively. The choice of treatment tactics was determined on the basis of immunohistochemical markers: estrogen receptors (ER), progesterone (PGR), proliferation index (Ki-67), vasculoendothelial growth factor (VEGF), cyclooxygenase-2 (COX-2) in eutopic acid., psychoemotional characteristics and intensity of pelvic pain. Rеsultes of treatment in the examined patients a significant (p <0.05) reduction of pelvic pain was determined, both in the short and long term. After 6 months, the level of personal anxiety decreased - by - 38.62%, after 12 months. – at - 48.15% (p <0.05). The rate of decrease in the level of depressive disorders on the Hamilton scale of all studied women was: - 32.2% after 6 months and -42.15% after 12 months (p <0.05). Conclusion our approach to treating endometriosis helped to overcome pain in 83.53% of women, improve psycho-emotional and general condition, normalize sleep - was determined in 88.3% of women, reduce reactive anxiety and depressive disorders in 84.7% of patients, indicates the effectiveness proposed therapy.

CERVICAL INSUFFICIENCY: ANAMNESIS, PREGNANCY AND CONSEQUENCES OF PREGNANCY (RETROSPECTIVE ANALYSIS)

Cervical insufficiency (CI) remains one of the leading causes of miscarriage and premature birth. Purpose of the study: to determine the frequency of CI, the characteristics of the anamnesis, the course of pregnancy, childbirth, the state of the newborn and the identification of potential risk factors. Material and research methods. 8728 birth histories were analyzed, among which 166 (1.9%) stories of women whose pregnancy was complicated by CI were found. The main group consisted of 166 pregnant women with CI, the control group included 55 women without CI and other severe obstetric- gynecological and somatic pathologies. The results obtained and their discussion. The incidence of CI on average over 5 years was 1.9%. With CI, there is a significantly lower percentage of young women, and at the age of 35 and over - 27.1% of pregnant women versus 10.9% in the control group. Only one third (33.7%) of women with CI can be considered somatically healthy. The morbidity structure is dominated by endocrine pathology (30.7%), among which metabolic syndrome / obesity (19.9%) and diseases of the urinary excretory system (27.7%) are distinguished. High frequency of pathology of the cardiovascular system (21.1%) and autonomic dysfunction syndrome (25.9%), hepatobiliary pathology (15.1%), gastrointestinal diseases (19.3), allergic manifestations (16.9%). A third of patients (28.9%) have a combination of two or more somatic diseases. Every fourth woman has a history of an infectious pathology of the urinary excretory sphere (25.9). In 27.7% of patients - a combination of several infectious pathologies. Half of the patients (53.0%) had a complicated gynecological history: cervical ectopy (33.7%), chronic infectious diseases of the genital area (16.3%) and PCOS: (13.9%), synechiae of the uterine cavity (6.6 %) and congenital malformations of the genitals (3.0%). The combination of several gynecological pathologies was observed in 18.1% of women. Every fourth woman underwent an excision of the cervix (25.9%), 42.8% - intrauterine interventions with the expansion of the cervical canal, 59.2% of them two or more times. According to the obstetric anamnesis, spontaneous miscarriages and medical abortions in 27.7% and 33.7% of women, in 18.1% - a missed pregnancy, every fourth patient has premature birth (25.9%), and every 10th patient has suffered injuries cervix. With a current pregnancy, the threat of premature birth is most often noted (51.2%), in second place is an exacerbation of infection of the genitourinary sphere (41.0%) and the threat of premature birth (38.0%). High incidence of placental dysfunction (30.7%), gestational diabetes (13.9%), fetal growth retardation (12.0%) and preeclampsia (7.3%). Premature birth in 38.0% of cases, in 31.9% - premature rupture of membranes, delivery by cesarean section in 19.3% of cases. Noteworthy is the high frequency of intrauterine infection (13.9%). Conclusion. Based on the results of a retrospective analysis, after a more detailed assessment of possible risk factors for CI, the most informative ones will be identified and proposed for use in clinical practice.

CLINICAL FEATURES AND LABORATORY PARAMETERS IN PREGNANT WOMEN WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND OBESITY

Today, non-alcoholic fatty liver disease (NAFLD) is a common pathology and pressing problem in pregnant women, especially among overweight, as the incidence of obese women of childbearing age is rapidly increasing. Disorders of lipid metabolism, which is an integral part of this disease, lead to pathological changes in the functional state of the liver, which in turn have a negative impact on pregnancy and lead to the formation of obstetric and perinatal complications. THE AIM OF OUR STUDY was to evaluate the clinical and laboratory markers of liver disorders in pregnant women with NAFLD depending on body mass index. MATERIALS AND METHODS. We’ve examined 98 pregnant women with NAFLD at the stage of non-alcoholic steatohepatitis (NASH) in combination with obesity. The age of the examined women ranged from 21 to 35 years (mean age 30.5 ± 1.5 years). The control group consisted of 30 almost healthy pregnant women. Depending on the body mass index (BMI), all surveyed women are divided into three groups: Group I - overweight pregnant women, Group II - pregnant women with grade I obesity, Group III - pregnant women with grade II obesity. We evaluated the incidence of major clinical complaints and changes in blood biochemical parameters in pregnant women depending on the increasing of BMI. RESULTS. When comparing the clinical manifestations of NAFLD on the stage of NASH in pregnant, the highest frequency is observed in the group of examined women with severe obesity compared with the group of patients with moderate obesity and overweight: symptoms of asthenic syndrome (increased fatigue, sleep disturbances, emotional lability, decreased and increased appetite) in 91.6.0%, 79.1% and 61.5% of patients (p<0.05), manifestations of dyspepsia (constipation, nausea, flatulence) - in 87.5%, 54% and 34.6% patients (p <0.05), feeling of heaviness or moderate pain in the right hypochondrium - in 62.5% 50% and 30.7% of patients, respectively (p <0.05). CONCLUSIONS. It has been established that pregnant women with non-alcoholic fatty liver disease on the stage of nonalcoholic steatohepatitits have pronounced clinical picture of the disease, which depends on the increase in BMI. It was found that in pregnant women with NAFLD liver dysfunction occurs on the background of grade I obesity, which can be considered as an early marker of steatohepatitis and risk of obstetric complications.

EXPERIENCE OF IMMUNOCORRECTIVE TREATMENT IN THE MANAGEMENT OF PATIENTS WITH CERVICAL INTRAEPITHELIAL NEOPLASIA ON THE BACKGROUND OF GENITAL PAPILLOMAVIRUS INFECTION

Introduction. Human papillomavirus (HPV), its highly oncogenic types, is considered to be the initiating factor in the development of dysplasia and cervical cancer The role of immunomodulatory therapy in reducing the risk of cervical cancer in women with cervical intraepithelial neoplasia (CIN) associated with HPV infection remains in the focus of researchers. Aim of the study: to evaluate the effectiveness of the use of the immunomodulator Allokin-alfa in the complex treatment of cervical intraepithelial neoplasia against the background of genital papillomavirus infection. Materials and methods. We examined 60 women who received CIN1- 2 treatment on the background of HPV infection of high oncogenic risk in the multidisciplinary medical center of the Odessa National Medical University. The patients were divided into 2 groups: 1 (main) group consisted of 30 women who received cold plasma ablation of cervical dysplasia in combination with immunomodulatory therapy with alloferon, group 2 (comparison) consisted of 30 patients who received standard cold plasma ablative treatment without immunomodulators. The control group consisted of 30 healthy women. All women underwent cytomorphological examination of the cervical epithelium, HPV testing, colposcopy, and targeted biopsy. Immunological status was assessed by indicators of cellular and humoral immunity, the content of α- and γ-interferon. Results. In patients with CIN1-2 against the background of HPV, an increase in the level of serum Ig A, CD8 level, a decrease in the CD4 content and immunoregulatory index, CD19 content were revealed, which indicated immunosuppression. Immunocorrective therapy witn alloferon (Allokin-alfa) in complex, with cold plasma ablation, treatment of CIN1-2 promoted the normalization of the parameters of immunity and interferon status, which contributed to the acceleration of epithelialization, (OR — 15,48; 95% CІ: 2,05-136,45; р=0,0094). a decrease in the frequency of residual lesions, and a HPV elimination. Conclusions. Complex treatment of CIN1-2 using cold plasma ablation and immunocorrection by perioperative administration of alloferon (Allokin-alfa) is accompanied by better functional results, compared only with the use of cold plasma ablation: accelerated epithelialization, improved colposcopic picture, decreased frequency of relapses, elimination of HPV, normalization of immunе and interferon status.

FEATURES OF THE CLINICAL COURSE OF PREGNANCY, CHILDBIRTH IN WOMEN WITH COVID-19 AT DIFFERENT PERIODS OF GESTATION

The study of the features of the clinical course of pregnancy, childbirth in women who have had COVID-19 at different periods of gestation is relevant, especially in the context of a modern pandemic. Purpose of work. To determine the features of the clinical course of pregnancy, childbirth in women with COVID-19 at different periods of gestation. Materials and methods. 57 women who were ill with Covid-19 at different stages of pregnancy were examined. Results and discussion. The peculiarities of the clinical course of pregnancy, childbirth in women who have undergone Covid-19 diseases in the 1st trimesterinclude the syndrome of threatened abortion (73.6 %), placental dysfunction (100%), fetal growth retardation syndrome (42.9 %); in the second trimester - syndrome of threatened premature birth (55.6 %), placental dysfunction (100 %), amniotic fluid pathology (63.2 %); in the third trimester - anemia - in 100 %, antenatal fetal distress - in 42.1 %, pareclampsia - in 47.4 %, pathological blood loss - in 26.3 %. Conclusions. The course of pregnancy and childbirth in women who have undergone COVID-19 diseases in different trimesters of gestation have certain clinical features. Gestational complications in women who were ill in the early stages of the first trimester include the syndrome of threatened abortion, spontaneous abortion, missed abortion, premature birth in the second trimester, fetal growth retardation syndrome in the second and third trimesters. The gestational complications in women who were ill in the second trimester include the syndrome of threatened abortion, premature birth, pathology of amniotic fluid (amniotic fluid of «black» color), the phenomenon of angiitis in the abdominal cavity, placental dysfunction, fetal growth retardation syndrome, distress fetus, antenatal fetal death. The gestational complications in women who were ill in the third trimester include the syndrome of threatened premature birth, placental dysfunction, and fetal distress.