Comparative analysis of serum concentrations of chorionic gonadotropin (hCG) associated with the pregnancy of plasma protein A (PAPP-A) and alpha-fetoprotein (AFP), based on the results of a survey of women as part of a standard screening program (the results were expressed as a MoM - multiply of the median), found a significant increase in the performance of all the studied specific pregnancy proteins in women with a scar on the uterus and placenta acctera (75 patients) compared with the data of the group of pregnant women without scar on the uterus and without abnormalities of attachment of the placenta (150 women). AFP indices were 1.68 ± 0.76 and 1.19 ± 0.43 MoM (p = 0.0018), hCG - 1.62 ± 1.48 and 1.23 ± 0.76 MoM (p = 0, 0112), PAPP-A - 1.93 ± 1.24 and 1.23 ± 0.67 MoM (p <0.0001). Using the ROC analysis, the diagnostic thresholds for the concentrations of AFP, hCG and PAPP-A were calculated. The risk of placenta accreta in women with a scar on the uterus in cases of exceeding the diagnostic threshold of AFP concentration (1.64 MoM) increased 2.5 times (RR = 2.5; 95% CI 1.17-5.36, p = 0, 0185), hCG (1.41 MoM) - 1.6 times (RR = 1.59; 95% CI 1.09-2.32, p = 0.0147), PAPP-A (1.41 MoM) - 2.65 times (RR = 2.65; 95% CI 1.76-3.99, p <0.0001). Determination of the level of specific pregnancy proteins can be used in the system of complex prediction of placental growth in pregnant women with a scar on the uterus as an addition to the assessment of clinical and anamnestic risk factors.
The estimation of pregnancy, childbirth, postpartum and newborn state of the offspring in the second generation (study group), the progenitors of which were in the area of radiation exposure. The study group included data on 112 women. In the control group were assigned 53 women who themselves, their parents and grandparents were not exposed to ionizing radiation. Extragenital pathology is characterized by the predominance of the main group of diseases of the circulatory system, urinary system, blood and blood-forming organs, diseases of the endocrine system. Among gynecological diseases prevailed chronic inflammatory diseases of the pelvic organs. The high rate of complications during pregnancy, premature birth, subcompensated form of placental insufficiency in patients of the main group.
Aim: to assess the efficacy of prenatal screening in women those children were diagnosed with chromosomal aberrations postnatally. Patients and Methods: this descriptive cross-sectional retrospective study was performed to analyze medical records, obstetric gynecological database, and the results of prenatal screening in women (Altay Region residents) who gave birth to children with chromosomal aberrations in 2017–2019. The examination also included the calculation of the individual risk of fetal chromosomal aberrations using Astraia and PRISCA software. Results: in 2017–2019, sixty-nine children with chromosomal aberrations were born in the Altay Region. Most (90%) children were diagnosed with Down’s syndrome. More girls were born than boys (1.7:1). The mean age of women who gave birth to children with chromosomal aberrations diagnosed postnatally was 35 years. In 4.3%, mean mother’s age was 21.3 years. In 40.6%, mean mother’s age was 31.2 years. Every second woman (55.1%) was older than 35 years. A retrospective analysis of pathological prenatal markers and automated calculation of individual risk have demonstrated that the risk of fetal chromosomal aberrations was moderate to high in 79.7%. In this risk score, the diagnosis can be verified prenatally. Sonographic and biochemical markers of fetal chromosomal aberrations were lacking in 20.3%. Early prenatal screening was not performed in 20.3% due to late referral to the maternity clinic. Sonographic markers, diagnosed congenital anomalies, and biochemical tests in the second trimester were the most effective prenatal markers of chromosomal aberrations. Conclusions: following the technology of prenatal screening to identify fetal chromosomal aberrations allows for verifying the diagnosis and granting the families the right to decide on the utility to prolong pregnancy. KEYWORDS: prenatal screening, chromosomal aberrations, congenital anomalies, karyotyping, genetic counseling, noninvasive prenatal testing. FOR CITATION: Dudareva Yu.A., Shipilov A.A. Efficacy of prenatal diagnostic in mothers of children with chromosomal aberrations diagnosed postnatally. Russian Journal of Woman and Child Health. 2021;4(1):42–45. DOI: 10.32364/2618-8430-2021-4-1-42-45.
The main objective of this paper was to review the current studies that consider changes in concentrations of various biologically active substances at the local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. Many biological markers, such as proinflammatory cytokines (interleukins [IL-2, IL-6, IL-10, IL-1] and tumor necrosis factor ), are considered prognostic markers. Changes in their concentrations in various biological media (serum, cervical mucus, amniotic fluid) may indicate a cellular immunological imbalance in the "motherplacentafetus" system, which is often the main pathogenesis link of late spontaneous miscarriage. Changes in concentrations of fetoplacental complex hormones such as progesterone, estradiol, and human chorionic gonadotropin have also been described. The concentrations of hypoxia-induced factor HIF1a in amniotic fluid and exosomal HIF1a in patients with cervical incompetence as one of the most common causes of late spontaneous miscarriage are presented as markers. Thus, the review shows the role of changes in concentrations of various biologically active substances at local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. The following methodology was used during work on the article: selection of publications using modern information databases, analysis of the obtained information, systematization of materials, and presentation of conclusions. An electronic search was conducted using publications identified in the following databases: eLIBRARY.RU, Google Scholar, and PubMed.
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