The objective — To assess the effectiveness of including NIPT in the structure of prenatal diagnostics in Moscow. Material and Methods — Totally 5,181 pregnancies undergoing screening for fetal trisomy using NIPT during the period from 01.04.2020 to 30.09.2020 in Russia. According to the results of biochemical blood test, the patients were divided into two groups: group of high risk (cut-off ≥1:100) (n=208) and group of intermediate risk (cut-off 1:101 – 1:2500) (n=4,973). Patients at high-risk cell-free DNA (cfDNA) were offered an invasive procedure, followed by genetic analysis (cytogenetic or molecular karyotyping). Results — Among the analysed samples, 117 (2.3%) had a high risk of the following common fetal chromosome abnormalities by NIPT: trisomy 21 in 50 cases, trisomy 18 in 17 cases, trisomy 13 in 5 cases, and sex chromosome aneuploidy (SCA) in 22 cases. Additionally, rare autosomal trisomies and/or subchromosomal arrangements were revealed in 23 cases. We found associations between cfDNA concentration and high risk of aneuploidies (particularly trisomy 21) and fetal sex and between low fetal fraction (FF) and body mass index (BMI) as well as maternal weight. Additionally, a high risk of trisomy 21 was associated with the term gestation. Conclusion — The effectiveness of technological resources that are based on cfDNA testing for detecting abnormal fetal chromosome numbers and other chromosomal anomalies is high and reduce rates of false positive results. Therefore, NIPT should be more widely used as a first-line screening method.
Background A fast adoption of a non–invasive prenatal testing (NIPT) in clinical practice is a global tendency last years. Firstly, in Russia according a new regulation it was possible to perform a widescale testing of pregnant women in chromosomal abnormality risk. The aim of the study—to assess efficiency of using NIPT as a second-line first trimester screening test in Moscow. Methods Based on the first trimester combined prenatal screening results 12,700 pregnant women were classified as a high-risk (cut-off ≥ 1:100) and an intermediate-risk (cut-off 1:101 – 1:2500) groups followed by whole genome NIPT. Women from high-risk group and those who had positive NIPT results from intermediate-risk group were considered for invasive prenatal diagnostic. Results 258 (2.0%) samples with positive NIPT results were detected including 126 cases of trisomy 21 (T21), 40 cases of T18, 12 cases of T13, 41 cases of sex chromosome aneuploidies (SCAs) and 39 cases of rare autosomal aneuploidies (RAAs) and significant copy number variations (CNVs). Statistically significant associations (p < 0.05) were revealed for fetal fraction (FF) and both for some patient’s (body mass index and weight) and fetus’s (sex and high risk of aneuploidies) characteristics. NIPT showed as a high sensitivity as specificity for common trisomies and SCAs with an overall false positive rate 0.3%. Conclusions NIPT demonstrated high sensitivity and specificity. As a second-line screening test it has shown a high efficiency in detecting fetus chromosomal anomalies as well as it could potentially lower the number of invasive procedures in pregnant women.
Introduction. Diseases that are not directly related to obstetric pathology and childbirth fade into the back-ground and are not always included in the maternal mortality, but their significance can hardly be overes-timated. A special group of such pathologies comprises infectious diseases, the prevalence of which varies significantly in different countries. As a rule, these diseases are characterized by a severe course and are life-threatening for the mother and the child. The most relevant among them are HIV infection, tuberculosis, infectious endocarditis, and sepsis. The aim of the study was to consider the leading extragenital causes of maternal mortality and to assess the importance of infectious pathology based on the pathological findings. Materials and methods. The study included 38 pathological autopsies, 10 of which are described in more detail. Medical documentation, autopsy protocols for deceased pregnant women, women in labor, and women in childbirth were examined. Causes of death were classified according to the ICD-10 criteria. A clinical and morphological study was carried out, and supportive laboratory techniques were used (microbiological, histobacterioscopic, molecular genetic, serological, and cytological tests). Results. As it follows from the autopsy report data from 2013 to 2019 in Moscow, the extragenital pathology accounted for 38 lethal cases (46.9% of all maternal deaths), of which 10 (26.3%) cases were associated with infectious pathology. Conclusion. Extragenital pathology, although not a leading cause of maternal mortality, remains a crucial obstetric problem. Infectious diseases, primarily HIV infection, are the significant cause of extragenital morbidity. Keywords: maternal mortality, extragenital infectious pathology, tuberculosis, HIV infection, infectious endocarditis, drug addiction, Kaposi’s sarcoma
For several decades, among all possible pathogens of neonatal infections, group B streptococcus has been one of the leading positions. Sepsis, meningitis, and pneumonia are among the most common clinical manifestations of neonatal infection associated with group B streptococcus. In this review, our goal was to analyze the literature demonstrating a worldwide approach to the prevention of vertical transmission of group B streptococcus from mother to child. When writing the review, scientific publications of foreign and domestic authors from the PubMed database were studied. The review considers the drugs of choice for intranatal antibiotic prophylaxis, and their pharmacodynamic, and pharmacokinetic features. The analysis details the problem of the growth of resistance of group B streptococcus to antibacterial drugs. The antimicrobial activity of lactoferrin was noted at a minimum inhibitory concentration of 500 μg/ml. The presented review also reflects the protective and therapeutic effects of oral intake of probiotics containing Lactobacillus acidophilus, Lactobacillus salivarius, Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14 . Based on the analysis, it can be concluded that penicillin G and ampicillin have the most pronounced bactericidal effect against group B streptococcus. At the same time, the most common side effects of β-lactam penicillins include an allergic reaction with the possible development of anaphylactic shock. Given this, the antibiotics of the first-line reserve group include cefazolin, clindamycin, and vancomycin. At the same time, it is important to take into account the decrease in the therapeutic concentration of clindamycin with a change in the alpha-1-acid glycoprotein in the blood of the mother and fetus, the nephrotoxic effect of vancomycin and the cross-a llergic reaction of cefazolin with antibiotics of the penicillin group. A promising direction in solving the problem of group B streptococcus is the development of new strategies for the prevention of perinatal infection of the fetus and newborn based on a more detailed study of the effects of lactoferrin and probiotics.
Prevention of postpartum haemorrhage is one of the important tasks of modern obstetrics, anesthesiology and intensive care. Objective. To assess the efficacy and safety of terlipressin usage as a means of postpartum haemorrhage development prevention during caesarean section in high-risk pregnant women. Patients and methods. From February to December 2020, a multicenter comprehensive cohort study, in which 5 medical centers participated, was conducted. The study included 454 pregnant women who underwent caesarean section and who were divided into two groups: control group I (n = 351) and study group II (n = 103), with the use of terlipressin injected into myometrium. Evaluation of the preventive effect of the drug was carried out in several main directions: the volume of blood loss, the need for additional methods of surgical hemostasis, the safety of intraoperative use. Results. Considerable differences were found in the assessment of significant risk factors for the development of postpartum haemorrhage, associated pathologies and comorbidity between the groups. The study group turned out to be more threatened by the postpartum haemorrhage development. In the control group, additional measures of surgical hemostasis were more often used, including hysterectomy (2.6% versus 1.9%) and relaparotomy (1.9% versus 1%). The median blood loss was statistically lower in the study group (700 ml versus 800 ml). Nevertheless, the considerable spread of data on the volume of blood loss should be noted, with a maximum blood loss of 10,000 ml in the control group and 4,500 ml in the study group. There were no serious complications in both groups. Conclusion. The study showed that the use of terlipressin can reduce the volume of blood loss in women with high risk factors for postpartum haemorrhage, as well as reduce the number of hysterectomies and relaparotomies. It is necessary to continue the prospective part of the study with an increase in the randomized sample of patients. Key words: obstetric haemorrhage, caesarean section, terlipressin
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