Vol 7, No 3 (2020)

Preterm birth remains an acute medical and socio-economic problem. The successful course of pregnancy and its completion by timely delivery is directly dependent on an adequate balance of immune interactions between the mother and the fetus throughout the pregnancy, respectively, any failure of this system can lead to catastrophic consequences. The level of cytokine expression is genetically determined. Polymorphism of a gene affects the level of cytokines in its expression and functionality. Thus, polymorphism of cytokine genes can have an effect on the development of various pregnancy complications leading to its premature termination.

This study aimed to analyze the mode of delivery intrauterine death and analysis of factors that determine the choice. We analyzed 96 cases of intrauterine death in a singleton pregnancy during the 2016–2018. Two groups were formed: the 1st group (n = 32) of cesarean delivery, the 2nd group (n = 64) with vaginal delivery. The stillbirth rate for the region was 6.2% [95% CI 4.88–8.84], for the Russian Federation — 5.82% [95% CI 5.17–7.39]. The proportion of cesarean sections in intrauterine death is higher than in live births (33.3% and 31.8% respectively). When analyzing the timing of delivery, it was found that the characteristic peaks occur at 25–27 weeks (25.0% of all births) and 37–39 weeks (35.0%). Obstetric risk factors for cesarean section: placental abruption: OR — 9.64 [95% CI 3.25–28.63]; p = 0.000; uterine scar after cesarean section: OR — 7.51 [95% CI 2.52–22.39]; p = 0.000; preeclampsia: OR — 4.17 [95% CI 1.12–15.47]; p = 0.023. Non-obstetric risk factors: parity of 3 or more births: HR — 7.24 [95% CI 1.36–38.40]; p = 0.009; overweight: HR — 3.37 [95% CI 1.22–9.33]; p = 0.016; the history of the pelvic inflammatory disease: HR — 2.78 [95% CI 1.12–15.47]; p = 0.023. The presence of intrauterine growth retardation reduces the frequency of surgery: HR — 0.56 [95% CI 0.22–1.43]; p = 0.221. There is an urgent need to develop and implement in clinical practice appropriate national clinical guidelines for the management of childbirth with intrauterine death, including all aspects of this category of care. It is necessary to further study the role of the crisis stages of gestation, which are characterized by the manifestation of intrauterine death (the end of the second and third trimesters).

The article discusses the results of researches about existence of narcotic drugs in biological environment of women.

The purpose — to explore the influence of drug addiction on the pregnancy and perinatal terminations.

Material and methods. The group of 57 pregnant women was screened by gas chromatography method with a mass-selective detection on the base of the Maternity Hospital № 3, Ufa.

Results. In process of research it was relieved, that drug abuse leads to increasing of infection disease, share of prematurity, Caesarean section, pneumopathies and antenatal death of fetus.

Conclusion. Narcotic substances have an adverse influence on pregnancy and perinatal terminations.

Objective — evaluate maternal factors in preconception and early gestation periods in women with a high risk of prenatal diagnosis.

Methods and patients. Features of the development of preconception and early gestation periods were studied, including the first prenatal screening (PS), in 443 women with singleton pregnancy. Women were divided into 2 clinical groups: group 1 (n = 235) with a high risk (HR) of complications; subgroups: 1A (n = 69) — fetal chromosomal abnormalities (after exclusion confirmed cases); 1B (n = 66) — the development of preeclampsia; 1C (n = 48) — fetal growth restriction; 1D (n = 52) — preterm birth (PB). 2nd control group (n = 208) — women with low risk of complications.

Results. A high PS risk in the 1st group, especially in subgroups 1A, 1B, were in patients with hypertonic disease of 1-2 degrees (p < 0.05). Chronic kidney disease was leading in 1A, 1C (p < 0.05). Varicose veins of the lower extremities in the 1st group prevailed in the 1A, 1B, 1C (p < 0.05). A history of ovarian tumors and uterine myoma during pregnancy prevailed in 1A, 1B, cycle dysfunction in 1B, 1D (p < 0.05). GR was observed in nulliparous women with a history of miscarriages in 1B, 1C, 1D and artificial abortions in 1A (p < 0.05). PB in the anamnesis were significantly increased in the 1st gr. (p < 0.001). In the 1st trimester, the threatened miscarriage, bleeding and progesterone were frequent in the 1st group (p < 0.05).

Conclusion. Based on the obtain results a high risk of PS calculated according to the Astraia program using standard markers was noted in patients with somatic pathology, ovarian tumors, miscarriages, medical abortions and PB in the anamnesis, myoma during pregnancy, threatened miscarriage, bleeding, progesterone intake during 1st trimester. These factors should be considered when preparing for pregnancy.

The aim of the study was to evaluate the association of gene polymorphism of matrix metalloproteinase 2 (MMP2), MMP3, MMP9, urokinase plasminogen activator (PLAU) and transforming growth factor β1 (TGF-β1) with the occurrence of infertility.

Material and methods. 84 women planning pregnancy were examined. Of these, 47 did not become pregnant in six months (the first group), 37 had a pregnancy, and lasted more than 22 weeks (second group). The single-nucleotide polymorphisms (SNPs) of rs2285052 and rs243865 of the MMP2 gene, rs3025058 of the MMP3 gene, rs17576 and rs3918242 of the MMP9 gene, rs4065 and rs2227564 of the PLAU gene, rs1800469 of the TGF gene were analyzed in all patients. Statistical analysis of genetic associations was carried out using the SNPStats program.

Results. Patients with the A allele rs2285052 and the T allele rs243865 of the MMP2 gene had an increased risk of infertility (for rs2285052 in the group of patients without pregnancy, СС 27.7%, AС 51.1%, AA 21.3%; in the pregnant group СС 54%, AС 40.5%, AA 5.4%; for rs 243865 in the group of patients without pregnancy СС 57.5%, CT 40.4%, TT 2.1%; in the pregnant group СС 81.1%, CT 18, 9%, TT 0%). With the log-additive variant of inheritance, the OR (95% CI) was 0.38 (0.19–0.77) (p = 0.0043) for rs2285052 and 0.32 (0.12–0.84) (p = 0.015) for rs243865.

No statistically significant differences were found between the main group and the comparison group in allele frequencies rs3025058 of the MMP3 gene, rs17576 and rs3918242 of the MMP9 gene, rs4065 and rs2227564 of the PLAU gene, rs1800469 of the TGF-β1 gene.

Conclusions. In the studied sample of patients SNPs rs2285052 and rs243865 of the MMP2 gene were associated with a risk of infertility: the presence of the A allele rs2285052 and the T allele rs243865 of the MMP2 gene were associated with an increased risk of infertility.

Feto-maternal hemorrhage (FMH) is a rare, potentially dangerous event characterized by the passage of fetal blood into the maternal circulation, complicating pregnancy or childbirth. Diagnosis of this condition is based on objective signs: cardiotocography, fetal ultrasound, fetal Doppler, Kleihauer–Betke test (KB) and subjective: assessment of fetal movement activity. If a pregnant woman complains of decreased fetal movement, an experienced doctor should not forget to exclude this dangerous condition. Massive FMH is associated with high perinatal morbidity and fetal mortality.