Aim. To identify informative predictors of severe cerebral ischemia in preterm neonates.Materials and Methods. Study sample consisted of 80 preterm infants with intrauterine hypoxia or perinatal asphyxia delivered on the 28th-34th week of gestation. Levels of matrix metalloproteinase-9 (MMP-9) and thiobarbituric acid reactive substances (TBARS) as well as activity of antioxidant enzymes superoxide dismutase, catalase, and glutathione peroxidase in cord blood plasma of premature infants were evaluated immediately after birth.Results. As compared to other newborns, neonates with severe cerebral ischemia had higher levels of MMP-9 (MMP-9 > 305.6 ng/mL in 14.6% versus 69.7%, respectively) and TBARS in cord blood plasma.Conclusion. MMP-9 and TBARS measured in cord blood plasma of preterm infants may be utilised in diagnostics of severe cerebral ischemia.
The aim of the research is to assess the epidemiology of premature birth and measures for organizing medical evacuation of patients from agricultural regions in vast territory of the Tyva Republic and Altay Territory for the period 2015-2019. Material and methods. Th e statistical reports data on the work of obstetric service in the Tyva Republic and Altay Territory for the period 2015-2019 are analyzed. Th e frequency, structure, dynamics of premature birth, features of organizing medical evacuation have been studied. Th e analysis of the information received was carried out using absolute, relative and intensive fi gures. Th e statistical signifi cance of the temporal dynamics of data was assessed using regression analysis with calculation of determination coefficient. Results. The analysis showed that premature birth frequency in two agricultural regions with a vast territory and diff erent nationalities in the Tyva Republic and Altay Territory over the past 5 years has no tendency to decrease (2019 – 6.2 % and 7.1 %, respectively) and the data are comparable with an average Russian indicator (2018 - 6.0 %). Distribution of PB by clinical phenotype and gestational age in the studied territories does not diff er and correspond to global indicators. Th e share of very early premature births (22-27 weeks of gestation) is not more than 7 %. A distinctive feature of Altai Territory in comparison with the Tyva Republic is a rarer (p <0.001) obstetric delivery of patients with PB in obstetric hospitals, level III (63.3 % and 96.8 %, respectively), which is associated with high frequency of late PB (53.1 %) and suffi cient capacity of medical organizations, level II. During medical evacuation in the regions, beta-adrenergic agonist ginipral (95 %) was used for acute tocolysis. Conclusion. Organization of medical evacuation in the Tyva Republic is characterized by more frequent use of air ambulance for patient transportation to obstetric hospital, level III, which is explainable by 7 times lower population density compared to Altay Territory with the same schemes of acute tocolysis.
Background: Hypoxic brain injury is the most common pathology in newborns. New criteria of viability and progress of perinatal technologies results in high neurological morbidity of surviving very early preterm infants. The aim of the study: To assess the level of oxidative stress, the activity of the system of matrix metalloproteinases (MMP-1 and MMP-9) and their tissue inhibitor (TIMP-1) in the amniotic fluid of low birth weight premature newborns after abdominal delivery. Materials and methods: The study included 142 women, 102 of whom were delivered by caesarian section within 28-33.6 weeks of gestation because of severe obstetric and/or perinatal complications (main group). The comparison group comprised 30 patients with term abdominal delivery, for obstetric indications. In 32 women of the main group and 30 of the comparison group the concentration of thiobarbitate-reactive products (TBRP) in amniotic fluid was determined by the photometric method on the KFC-3 spectrophotometer at 532 nm wavelength by changing the optical density, due to the coloring complex of the malone dialdehyde (MDA) with thiobarbitic acid Оригинальная статья Original article
Background. Multiple pregnancy is a well-established risk factor for preterm birth. Prevention of early termination of pregnancy is a priority problem in obstetric practice.The aim. To evaluate the role of an obstetric pessary and micronized progesterone in the prevention of early preterm labor in patients with multiple pregnancies.Materials and methods. A prospective controlled study was conducted with the inclusion of 146 pregnant women with multiple pregnancies, which, depending on the methods of treatment, were divided into three groups: Group I (n = 67) – pregnant women who received micronized progesterone in combination with an obstetric pessary; Group II (n = 57) included women who received micronized progesterone; Group III (n = 22) consisted of patients with multiple pregnancies without therapy.Results. In Group I, the complex of an obstetric pessary and micronized progesterone allowed to reduce the frequency of preterm birth by 2.3 times (p = 0.008) in comparison with Group III, the frequency of births at gestational age ≤ 34 weeks – by 8.1 times (p = 0.005) in compared with Group III and 2.7 times (p < 0.01) compared with Group II. In 70.4 % of pregnant women, the use of a complex of an obstetric pessary with micronized progesterone made it possible to prevent the formation of isthmiccervical insufficiency, which, according to sonography, was expressed in the dynamics of the utero-cervical angle towards a more obtuse one.Conclusion. The use of an obstetric pessary with micronized progesterone made it possible to reduce the risks of isthmic-cervical insufficiency by 7.7 % compared with patients who received only micronized progesterone therapy, and by 17.1 % compared with pregnant women who did not receive therapy.
AIM: This study was aimed to determine predictors of severe lesions of the central nervous system in newborns from mothers with preterm labor complicated by premature rupture of membranes, and to develop a model for predicting adverse outcomes based on clinical data and biochemical markers. MATERIALS AND METHODS: At the first, retrospective, stage of the study, in order to determine clinical predictors of severe cerebral injury, we studied anamnesis data and features of pregnancy and delivery in 101 patients with premature rupture of membranes, expectant management tactics and subsequent delivery at 2633.6 weeks of gestation. At the second stage, in the prospective study, which included 33 patients, we evaluated the level of neuron-specific enolase in the amniotic fluid and determined its diagnostic significance as a predictor of severe lesions of the nervous system. RESULTS: The following factors were determined as clinical predictors of severe cerebral ischemia in premature infants: delivery time, duration of the latency period, the proportion of stab leukocytes in the leukocyte formula, and the presence of funiculitis in the histological examination of the placenta. A prognostic model with sensitivity of 98% and specificity of 80%, including clinical predictors and neuron-specific enolase, was developed. CONCLUSIONS: Prediction of severe cerebral ischemia and correction of the latency period allows for improving perinatal outcomes in premature infants and starting rehabilitation measures after birth in a timely manner.
Aim. To study complications and perinatal outcomes of multiple pregnancy in women of the Altai Region.Materials and Methods. We recruited 678 consecutive pregnant women, including 378 with multiple pregnancy, with the subsequent analysis of clinical and ultrasound examination data as well as perinatal outcomes.Results. Women with multiple pregnancy were characterised by a significantly higher rate of gynecological and somatic diseases including pregnancy-related anemia (20.2% versus 4.3% in women with multiple and singleton pregnancy, respectively, OR = 6.0, 95% CI = 3.2-11.3). Further, multiple pregnancy was a significant risk factor for preterm birth (62.26% and 21.82%, respectively, OR = 5.9, 95% CI = 4.2-8.4, p ≤ 0.001). Application of cervical pessary was able to prolong the multiple pregnancy for 4 weeks.Conclusion. Prevention of threatening preterm birth in women with a multiple pregnancy using a cervical pessary improves perinatal outcomes.
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