This article presents current data on the impact of COVID-19 (SARS-CoV-2) on pregnancy and perinatal consequences. The working theories of the pathogenesis of obstetric and fetal complications due to infection during pregnancy, already proven to date, are considered.Symptoms of COVID-19 disease, the risk of their development, and frequency of severe disease in non-pregnant and pregnant women of reproductive age do not differ significantly. However, there are powerful studies that have shown that this infection in pregnant women leads to a high probability of a dramatically severe and fulminant course. Pregnant women with SARS-CoV-2 infection have an increased risk of preeclampsia, incl. severe, hemolysis, thrombocytopenia and increased levels of liver enzymes compared with pregnant women without infection. Women who have COVID-19 are twice as likely to have preterm rupture of the membranes and three times as likely to have a preterm birth compared to the not infected pregnant women.Vertical transmission of the virus from mother to fetus is likely, but data are insufficient to be certain. There is also insufficient evidence of an increased miscarriage rate and teratogenic effects of the COVID-19 virus. However, antenatal fetal death is statistically significantly more common in infected pregnant women than in uninfected pregnant women. Morphological and functional disorders in the chorion/placenta are the main pathogenetic factor in the development of preeclampsia, intrauterine growth retardation, antenatal fetal death and impaired state of the fetus and children born by women with COVID-19.Many studies report that mothers with confirmed COVID-19 infection has asymptomatic babies. At the same time, some studies indicate adverse complications in newborns from infected mothers. The most common neonatal disorders in babies from pregnant women with COVID-19 are tachypnea, hyperthermia, and gastrointestinal disorders, in particular vomiting and flatulence.
The article presents the results of an improved method of antenatal surveillance of pregnant women with varicose disease which included the national medical drug that is a combination of 50 mg hesperidin and 450 mg diosmin (Normoven, PC «Kyiv Vitamin Factory»). Patients and methods. The study involved 49 pregnant women with varicose veins, which were divided into the basic and comparative group depending on the received treatment. The clinical and functional parameters, laboratory and instrumental methods were studied. The control group consisted of 23 pregnant women without varicose veins. Results. The absence of progression of clinical symptoms of the disease in 87.5% of pregnant women with varicose veins and improvement of the hemostatic parameters reflects the effectiveness of this therapy for the correction of the rheological properties of blood. The inclusion of hesperidin and diosmin to the complex therapy in pregnant women allowed to decrease the percentage of progression of changes in the venous system of the lower extremities almost twice. The normalization of processes of biosynthesis placental hormones in pregnant women shows the feasibility of using the drug with the systemic effects. The increase of the amplitude of instantaneous oscillations and the amplitude and duration of accelerations (p<0.05) according to the cardiotocographical observation indicates in favor of improving the state of the fetus in pregnant women. Conclusions. The inclusion of diosmin and hesperidin to the complex treatment of varicose veins in pregnant women is pathogenetically justified as it improves the degree of clinical manifestations of disease, hemostatic parameters , hormonal function of the placenta and fetus state. Key words: pregnancy, varicose veins, placental hormones, hemostatic parameters, hesperidin, diosmin.
The objective: a determination of the spread of somatic pathology and polymorphism of the MSM6 gene in the development of chronic recurrent vulvovaginitis in girls. Materials and methods. The study involved 54 girls 1–6 years old. Inclusion criteria: complaints of patients on itching or pain in the genital area, dysuria, the presence of synechiae of the vulva, clinical manifestations of vulvitis during the visual examination. General laboratory diagnostic methods were used (blood test, general urine analysis with determination of ketone bodies, bacterioscopic examination of vaginal smears, vaginal culture for flora and antibiotic sensitivity, determination of glucose levels in blood serum and urine). For diagnosis of lactose malabsorption by polymerase chain reaction, a mutation in the MCM6 gene was studied, the genetic marker of which is C (-13910). Results. The somatic status of patients with chronic vulvovaginitis was presented by pathology of the gastrointestinal digestive tract in 68.5 % cases, atopic dermatitis – 53.7 %, diseases of the respiratory system – 33.3 %, infectious processes of the kidneys and urinary tract – 24.1 %. 77.6 % of girls had nondiabetic acetone syndrome, 75.9 % – dysmetabolic nephropathy. The presence of lactose malabsorption was revealed by homozygosity for the MCM6 gene mutation (C/C) in 26.1% of patients, heterozygosity for the MCM6 gene mutation (C/T) - in 56.5 %, the absence of the MCM6 gene mutation (T/T) was in 8 (17.4 %). Conclusions. In girls in the neutral period of life with chronic vulvovaginitis, non-infectious forms of the disease were found, which were not independent pathology, but associated with other pathological processes of metabolic disorders. Taking into account the obtained data on lactose malabsorption, we consider to include in the examination the algorithm of the verification of the MCM6 gene mutation and examination of urine for lactosuria and blood with lactose load.
The article provides an overview of modern Ukrainian and foreign publications on the etiopathogenesis and pharmacotherapy of varicose disease (VD) during pregnancy. The issues of the prevalence of VD in pregnant women, the peculiarities of the venous system in the physiological and pathological course of pregnancy, modern views on the mechanisms of venous hemodynamic disturbance and its influence on the state of the fetoplacental complex are considered. Attention is paid to the local activation of the hemostasis system in case of damage to the endothelium in the presence of venous hypertension under the influence of activated neutrophilic granulocytes and monocytes. The analysis of extragenital pathology in pregnant women with VD was carried out. The role of connective tissue dysplasia in the genesis of VD and the necessity for timely diagnosis and prevention of complications of pregnancy and the development of placental disorders in women with VD, and for the determination of the endothelial dysfunction markers were established. The emphasis is made on the role of the state of the reproductive system and chronic foci of vaginal and cervical infection in the progression of VD and obstetric complications, which is explained by the development of oxidative stress and tissue hypoxia and deterioration of preimplantation conditions and a promising scenario for gestation. The modern classification of VD by morphological changes in the venous bed and the consequences of phlebohemodynamic disorders and the clinical class of lower extremity vein disease used in obstetric practice are presented. The main directions of diagnostics and conservative treatment of pregnant women with VD in Ukraine (compression therapy, systemic pharmacotherapy and local topical therapy) according to the international standards are presented. The attention is paid to the special effect of diosmin on the reduction of the symptoms of VD and endothelial dysfunction in the presence of immune-inflammatory damage of the endothelium and vein walls on the background of oxidative stress. This effect is confirmed by the improvement in the state of the intrauterine fetus and perinatal outcomes in pregnant women with placental disorders.
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