Clinical manifestations in the abdominal cavity of a woman in labor, discovered during an urgent cesarean section at 41 weeks of gestation 2 months after an acute form of COVID-19, are described. The materials of medical documentation were analyzed and the features of the course of pregnancy by trimester, urgent cesarean section, postoperative period, laboratory parameters, ultrasound data, cardiotocography, fetal condition at birth and three days later were determined.Presentation of case. 33-year-old pregnant woman (pregnant for the first time) had COVID-19 at 26 weeks of gestation. At a cesarean section for urgent indications at 41 weeks of gestation during the revision of the abdominal cavity was found that the visceral peritoneum of the uterus along the anterior and posterior surfaces, fallopian tubes, wide and round uterus ligaments, ovaries and parietal peritoneum of the pelvis, areas of the serous intestinal layer were with expressive signs of edema covered with vesicular rash, in places in the conglomerate, which were bleeding. There was no abdominal effusion.The child was born with 7–8 points Apgar score and had a negative PCR result for COVID-19. Placenta measuring 25 x 21 x 5.0 x 0.5 cm with multiple petrification, single red heart attacks. The shells are distinctly yellow-gray-green in color. The umbilical cord is 70 cm long and usual color. Amniotic fluid is clear. The early and late postoperative periods and the postpartum period proceeded without complications. At once the disorders in the blood coagulation system, immune system, positive COVID-19 IgG and IgM were identified in mother. Videin, Magniсum-antistress, preparations of acetylsalicylic acid and for the comprehensive support of the physiological state of the intestine were used in the complex treatment of the postpartum period.Conclusion. COVID-19 disease is pathology with many unknowns. Therefore, each clinical observation is important for studying of its course. Post-COVID syndrome and long-COVID syndrome have individual characteristics. Collective experience will contribute to the definition of an algorithm for the therapy of patients and personalized dispensary observation after an acute period.
Congenital malformations are pathology with a multifactorial etiology. Among their many endogenous, exogenous factors and hereditary predisposition are important. In particular a decrease in follicular enzymes (MTHFR, MTR, MTRR) activity at the genetic level, as well as a deficiency of vitamins and vitamin-like compounds of group B.Objective: to provide a pathogenetic justification for personified correction of disorders in the folate cycle in biological parents preparing for pregnancy to prevent congenital malformations in their children by using folates containing metafolin (5-MTHF).Materials and methods. The study involved 75 women and 75 men (biological parents) who had children/fetuses with congenital malformations in previous pregnancies, and 75 newborn children of these couples. All of them used the proposed preconceptional preparation. Alleles of folate cycle enzyme genes (MTHFR, MTR, MTRR) were determined by polymerase chain reaction in blood and saliva.Results. A high frequency of polymorphism of the folate cycle enzyme genes was observed in men among subjects (father, mother, child). The indicator was 77.7% compared with 68.7% in mothers and 60.7% in their children. The frequency of homozygous alleles was highest in parents (men) – 19.6%, lower in mothers – 13.1% and in children – 12.7%. Result of heterozygous alleles decreased from children indicator (87.3%) to their mothers (86.7%) and parents (80.4%).Conclusions. Obtained results emphasize the practical importance for determining the alleles of the folate cycle enzyme genes (MTHFR, MTR, MTRR) at the stage of preconception preparation for pregnancy in biological parents and then in their newborn children from the standpoint of preventive medicine. Reduced activity of the corresponding enzymes pathogenetically explains the feasibility of using folate complexes containing active folate metafolin (5-MTHF) in order to prevent congenital malformations.
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