Fetal Infections Optimization of Pregnancy and Delivery Introduction

Abstract

The aim: Improving perinatal outcomes in pregnant women at high risk of intrauterine infection by developing diagnostic criteria and algorithms for managing pregnancy and childbirth. Materials and methods: The study of pregnancy and childbirth was conducted in 72 patients at high risk of IUI, which formed the main group. The control group consisted of 64 patients with a low infectious risk of IUI. Culture, bacterioscopic and biochemical methods were used to identify microorganisms. Peculiarities of infection in the examined women were investigated by determining the concentration of Ig M and IgG in the blood serum and performed polymerase chain reaction for measles virus, cytomegalovirus, parvovirus B19. Serum for the presence of specific immune globulins to these pathogens was examined by ELISA. Comprehensive ultrasound examination in B-mode was performed to determine the feto metry of the fetus and assess its development with the determination of the estimated mass, location, size and structure of the placenta, the amount of amniotic fluid. To determine the condition of the fetus, a Doppler study of blood flow in the uterine arteries, umbilical artery, middle cerebral artery of the fetus and venous duct. Results: Analyzing the course of this pregnancy in women of the studied groups threatened miscarriage and the threat of premature birth occurred in 24 (33.3%) cases, with signs of isthmic-cervical insufficiency were diagnosed in 13 (18.1%) patients. In the control group of patients, the threat of abortion was diagnosed in 15 (23.4%) patients. According to ultrasound examination, patients in the main group in 12 (16.7%) cases were diagnosed with fetal growth retardation, in 25 (34.7%) patients at high risk of IUI there were changes in the placenta, namely, hyper echogenic inclusions in the placenta occurred in 7 (9.7%) cases, dilation of the intervillous space in 8 (11.1%) cases, placental hyperplasia in 7 (9.7%) cases, polyhydramnios was diagnosed in only 5 (6), 9%) cases, with 1 (1.4%) acute polyhydramnios in patients with signs of acute respiratory viral infection during pregnancy. Conclusions: Women at high risk for IUI require close monitoring of the fetus due to the increased frequency of hemodynamic changes in uteroplacental-fetal circulation, including fetal-placental – 22.2% and the occurrence of intrauterine growth retardation. Women with suspected cytomegalovirus infection require determination of seroconversion; in case of immunologically confirmed infection, it is desirable to recognize PCR for cytomegalovirus in the amniotic fluid in order to determine further management and monitoring of this pregnancy.

Pregnancy, childbirth and perinatal outcomes in isthmic-cervical insufficiency, depending on the method of delivery

“…Как известно, к факторам риска развития ИЦН, помимо органических и функциональных изменений шейки матки [23][24][25][26], относят воспалительные заболевания женских половых органов, сердечно-сосудистую патологию и ожирение [27][28][29][30], что подтверждается и результатами нашего исследования. Цервикальная патология в виде эктропиона шейки матки и эндоцервицита выявлялась у каждой второй женщины с ИЦН, хронический сальпингоофорит -у каждой четвертой, вегетососудистая дистония имела место более чем у 60% беременных, а ожирение -у 50%.…”

“…Вместе с тем суммарно удельный вес родоразрешения беременных с ИЦН через естественные родовые пути существенно превышал (в 2,4 раза) частоту выполнения КС (p < 0,001). При этом оперативное родоразрешение статистически значимо возрастало при ранних ПР (28)(29)(30)(31)6 нед. -в 2,5 раза, p < 0,001), а при поздних ПР увеличивалась частота консервативных родов (34)(35)(36)6 нед.…”