BACKGROUND: Placental adhesive disorder is associated with a high risk of massive bleeding during pregnancy and caesarean delivery. Abnormal trophoblast invasion and pathological hypervascularization detected in these patients may be due to the imbalance of angiogenic factors such as PlGF and sFlt-1, which makes their study an important area of scientific and clinical practice. AIM: The aim of this study was to evaluate sFlt-1 and PlGF levels in women with placenta accrete spectrum and to compare the data with the results in women with normal pregnancy. MATERIALS AND METHODS: This case-control study included 71 pregnant women in the third trimester of pregnancy. The main group (n = 32) consisted of patients with prenatally diagnosed placenta previa and abnormally invasive placenta; the control group (n = 39) included patients with normal pregnancy. In the study groups, the levels of sFlt-1 and PlGF were determined, with ultrasound and MRI characteristics evaluated. Statistical analysis was performed using IBM SPSS Statistics 26.0. RESULTS: Serum sFlt-1 and PlGF levels in the study group differed as compared to controls. In women with placenta accreta spectrum, the median sFlt-1 level was 2886.0 [2175.04127.0] pg/ml vs. control: 1890.0 [1807.02205.0] pg/ml (р 0.001); the median PlGF level was 233.5 [171.4460.5] pg/ml vs. control: 880.9 [746.61210.0] pg/ml (p 0.001). A correlation was revealed between the angiogenic factor levels and the degree of pathological hypervascularization and collaterization according to MRI data. When comparing the probability of abnormally invasive placenta (PAS Grades 2 or 3) and the sFlt-1/PlGF ratio, an ROC curve was obtained with the AUC of 0.74 0.13 (95% CI: 0.481.0; p = 0.021). CONCLUSIONS: Patients with placental adhesive disorder had increased sFlt-1 levels and decreased PlGF levels compared to patients with normal pregnancy. The above levels correlated with the degree of pathological hypervascularization and collaterization detected by MRI. A prognostic model has been obtained, according to which the threshold value of the sFlt-1/PlGF ratio of 4.22 allows for distinguishing patients with deep placental invasion (PAS Grades 2 or 3).
Background: Osteopenia is a common condition. Therefore, identification of groups for prevention of osteoporosis and restoration of bone mineral density (BMD) remains relevant. Aim: to assess the factors contributing to development of osteopenia in puerperas. Methods: prospective cross-sectional study. We examined 112 patients aged 20-35, 3-5 days after delivery. To assess possible factors for BMD decrease, we analyzed medical history, lifestyle, nutrition, anthropometric data, obstetric and gynecological history, and pregnancy course. We also assessed serum levels of 25-hydroxycalciferol (25-OH-D) and PTH. BMD was measured by dual energy x-ray osteodensitometry. We considered Z-score from -1 to -2.5SD as osteopenia, below -2.5 SD-as osteoporosis. Results: based on Z-score values, two groups were formed: 1 (n=70) - puerperas with osteopenia, 2 (n=42) - puerperas with normal BMD. In the first group, osteopenia in the distal radius was observed in 48%, in the lumbar spine in 16% and in the proximal femur in 36%. Influence of the following possible factors in group 1 was established: BMI in 15-20 years ≤ 18 kg/m2 (p<0.013), BMI ≥ 25 kg/m2 (p<0.018), 25-OH-D less than 25 ng / ml (p < 0.0018), calcium intake less than 800 mg/day (p<0.041). Menstrual disorders (p<0.052) and preeclapsia (p < 0.042) affected lumbar spine BMD. In group 1, vitamin D deficiency was detected in 82% of women, 18% showed vitamin D insufficiency; in group 2, vitamin D deficiency was found in 16%, deficiency in 70%, in 14% vitamin D was normal. In women with a combination of factors such as BMI≤ 18 kg/m; calcium intake lower than 800 mg/day, menstrual cycle disorders, vitamin D deficiency - osteopenia in the distal radius occured 11 times more often (OR=11,47059; CI 95%=[4,0326; 32,627]). Conclusion: most significant impact on BMD decrease in puerperas can be expected if patient has the following risk factors: BMI≤18 kg/m2; 25-OH- D<25 ng/ml ; nutrition with calcium intake <800 mg per day, preeclampsia. Combination of these factors may increase the risk of osteopenia in the distal radius.
Relevance. Pre-eclampsia is the most difficult and important problem in obstetrics, it ranks third in the structure of maternal mortality. Until now, there is no single idea of the mechanisms of development of this pathological process. The study of the concentration of MMP-12 in pregnancy will determine its possible role in the development of pre-eclampsia. Aim. Сompare the dynamics of the concentration of matrix metalloproteinase-12 (MMP-12) in pregnancy complicated and not complicated by preeclampsia. Materials and methods. A prospective study of two groups of women: the main group is pregnant (n = 17) with preeclampsia (moderate (n = 11) and severe (n = 6)), the comparison group is women whose pregnancy was not complicated by preeclampsia (n = 83). The concentration of matrix metalloproteinase-12 was determined by the method of enzyme immunoassay in serum at 11-13, 22-24, 32-34 weeks of gestation. Results. In the group of pregnant women without preeclampsia, there was a sharp decrease in the concentration of MMP-12 from the I trimester to II (p = 0.0001), followed by a slight increase to the III trimester. In the group of pregnant women with preeclampsia, an increase in the concentration from the I trimester to II (p = 0.0001) was established. A significant difference in the concentration of MMP-12 between groups in the first trimester of pregnancy was shown (p = 0.0001). Conclusion. Thus, the results of the study indicate the role of MMP-12 in the initial stages of placentation.
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