In recent years, there has been an increase in the number of operations on the uterus in women of reproductive age with the formation of "uterine scarring syndrome" (USS), which can lead to complicated pregnancy and childbirth. To assess of anatomical and functional features of uterine scar, pregnancy and perinatal outcomes in USS women. A prospective analysis of clinical anamnestic data, pregnancy and childbirth in 398 USS women was conducted; ultrasound and Doppler assessment of morpho-functional status of the uterus using the Accuvix V20 Prestige (Samsung Medison, Republic of Korea) was made. Statistical analysis was performed using Statistica 13.0 (Dell Inc., USA) software. In 74.62 % of 398 women, the scar on the uterus is due to a previous caesarean section (CS), in 24.11 % due to conservative myomectomy (CME), in 1.25 % –because of endoscopic interventions for incomplete uterine septum, in 25.87 % of women it was the result of "small" gynecological surgery. In 97 % of women with a scar on the uterus after the previous CS, there was no "passport of surgery": ultrasound revealed the localization of the scar in the lower uterine segment in 96.48 % of 398, corporate scar – in the remaining 3.51 % of women; ultrasound signs of relative "anatomic" scar failure were noted in 10.80 % of pregnant women. In 48.73 % of women pregnancy was complicated by the threat of abortion or premature birth, in 30.40 % anemia was diagnosed, in 24.87 % of the women under observation placental dysfunction took place. 78.1 % of women had delivery at term, 13.2 % had premature birth, 97.3 % had births CS, and 2.7 % of women had labours through canalis obstetricus. In 1.3 % of women labor was complicated by uterine hypotension, and uterine devascularization procedures was performed. The most common reasons for the formation of USS are cesarean section, conservative myomectomy and various "small" intrauterine operations. Pregnancy with this syndrome is most often complicated by the threat of its termination and childbirth before term, anemia, placental dysfunction and Intrauterine growth retardation . The choice of delivery tactics is conditioned by the totality of hystory, the status of the scar on the uterus, obstetric status and the wishes of the woman herself. It is advisable to look for methods to assess the morpho-functional status of the operated uterus and predict the perinatal consequences of pregnancy in these women at the stage of preconception preparation.
Introduction. The hormonal system “vitamin D/vitamin D receptors” (VD/VDR) is involved in the regulation of numerous physiological processes. VD lack or deficiency is associated with a number of different diseases, including pregnancy complications.Purpose of the study: to determine VD status and its effect on the course of the gestational process in women from the southern region of Ukraine.Materials and methods. 459 women were examined, 318 (69.3%) of them were the main group and 141 (30.7%) were the comparison group.In addition to standard general clinical examinations, ELISA on a COBAS Integra 400 Plus analyzer (Roche Diagnostics, Switzerland) the VD level was determined in the blood.Results and discussion. 49.9% of the pregnant women in the main group had insufficient VD level (25.45 ± 4.63 ng/ml), in 19.4% it corresponded to a deficit (15.28 ± 4.78 ng/ml). VD concentration in the comparison group was 43.38 ± 9.67 ng/ml (p <0.01). Significantly more frequent pregnancy complications in the main group were threatening abortion (45.6% VS 9.9%; F = 0.00001; p <0.01), preeclampsia (13.5% VS 2.8%; F = 0.0093; p <0, 05), placental dysfunction (32% VS 7%; F = 0.00001; p <0.01), vaginal dysbiosis (64.4% VS 18.4%; F = 0.00001; p <0.01), pregnant anemia (43.7% VS 20.6%; F = 0.0008; p <0.01) and signs of inflammation of the amniotic membranes (38.3% VS 13.4%). Syndrome of intrauterine growth retardation diagnosed in 9% women in the main group; in the comparison group none case was noted.Conclusion. 70% of pregnant women in Odesa region have a lack or deficiency of VD. Pregnancy course is characterized by a significantly greater frequency of preeclampsia (4.8 times more often), placental dysfunction (4.5 times), threat of miscarriage (4.6 times more often), intrauterine infection (2.8 times more often), gestational anemia (2.5 times more). It seems promising to conduct further research on the possibility of preventing complications of the gestational process by correcting VD status.
Одеський національний медичний університет ЗНАЧЕННЯ ДЕФІЦИТУ ВІТАМІНУ D ТА РІВНЯ ПРОКАЛЬЦИТОНІНУ В ПРОГНОЗУВАННІ ПЛАЦЕНТАРНОЇ ДИСФУНКЦІЇ У ВАГІТНИХ З РИЗИКОМ ВНУТРІШНЬОУТРОБНОГО ІНФІКУВАННЯ Плацентарна дисфункція (ПД)-поліетіологічна патологія, яка продовжує залишатися основною причиною дистресу і антенатальної загибелі плоду. Патогенетичні механізми розвитку ПД активно вивчаються і ймовірними фоновими процесами можуть бути синдром дефіциту вітаміну D (VD) та інфікуванням фетоплацентарного комплексу. Мета дослідження. Визначення рівня прокальцитоніну і вітаміну D та їх можливого взаємозв'язку з плацентарною дисфункцією у вагітних з ризиком внутрішньоутробного інфікування (ВУІ). Матеріали и методи дослідження. Обстежено 56 жінок з ПД з ризиком реалізації внутрішньоутробного інфікування (основна група) та 40 жінок із фізіологічним перебігом вагітності. Методом ІФА в сиворотці крові визначали рівень прокальцитоніну та рівень загального вітаміну D (25(ОН)D). Результати дослідження. У вагітних основної групи рівень прокальцитоніну був достовірно вище ніж серед жінок контрольної групи (0,24 ± 0,15 нг / мл та 0,063 ± 0,19 нг / мл; р < 0,05). В контрольній групі показник рівня прокальцитоніну не перевищував показники норми в жодному з випадків. У жінок основної групи з VD дефіцитним статусом рівень прокальцитоніну був значно вищим, ніж у жінок з оптимальним рівнем VD в сиворотці крові (0,47 ± 0,079 нг / мл VS 0,143±0,076 нг/мл; p < 0,05). Висновки. Вітамін D-дефіцит або його недостатність асоційовані з підвищенням рівня прокальцитоніну при плацентарній дисфункції у вагітних з наявністю факторів ризику внутрішньоутробного інфікування. Визначення прокальцитоніну, ймовірно, може бути перспективним напрямком в можливості прогнозування розвитку плацентарної дисфункції у цієї групи жінок. Ключові слова. Вагітність, вітамін D, прокальцитонін, плацентарна дисфункція.
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.
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