Vol 9, No 3 (2022)

Placental in-growth is a severe obstetric pathology characterized by invasive placentation and associated with a high-risk of life-threatening hemorrhage. Despite the widespread use of instrumental methods of examination, timely diagnosis of placental in-growth is a challenging issue. Here, we reviewed the existing biochemical markers used for early detection and confirmation of placental in-growth, their specificity and sensitivity, and correlation with gestational age. Significant results were found for the following substances: pregnancy-associated plasma protein A (PAPP-A) in the first trimester, alpha-fetoprotein (AFP) and human beta-chorionic gonadotropin (Beta-hCG) in the second trimester, brain natriuretic peptide, antithrombin III, plasminogen activator inhibitor type I, soluble Tie-2 receptor (endothelial cell-specific tyrosine kinase receptor), and soluble vascular endothelial growth factor receptor-2. Our findings support the use of the aforementioned biomarkers as screening method for placental in-growth in medical practice.

INTRODUCTION: Polycystic ovarian syndrome (PCOS) is currently one of the most common diseases in women. Ovarian dysfunction (irregular menstrual cycle and anovulation), hyperandrogenism, and polycystic ovarian morphology are the most frequent manifestations of the syndrome. Its main macroscopic sign is bilateral enlargement of the ovaries with multiple cystic and atretic follicles. Moreover, an ovarian biopsy is usually performed in addition to clinical examination allowing for an accurate diagnosis and management.

AIM: In this study, we sought to analyze the morphological verification of PCOS.

MATERIALS AND METHODS: We analyzed 121 patients admitted to Moscow hospitals for surgical treatment diagnosed of PCOS by pathologists. Initially, PCOS was diagnosed at the outpatient examination. Thus, 121 women of reproductive age were included in the study after excluding tubal-peritoneal factors, male infertility factors, and menstrual dysfunction. Intraoperatively, all patients (n=121) were sampled for histological examination.

The patients were referred to different gynecological hospitals: a municipal clinical hospital (group 1, n=54), a research center (group 2, n=48) and a commercial clinic (group 3, n=19). We processed data using parametric and non-parametric me thods in the STATISTICA Base software package. Arithmetic means, standard deviations, medians, and percentiles were equally determined. Confidence intervals for the arithmetic mean were determined using on the Student-t distribution. Moreover, we determined the 95% confidence intervals to the frequencies and the significance of differences in frequencies between the groups using binomial distribution and the Chi-square test, respectively.

Some indicators exhibited significantly different distributions from the norm; therefore, non-parametric Mann-Whitney (p²) and Wilcoxon criteria were further applied. Differences were considered significant at p <0.05.

RESULTS: Histological findings in 121 (100%) women of reproductive age with a clinical diagnosis of PCOS after surgical treatment were analyzed. After primary analysis, the clinical diagnosis was not confirmed in 78 (64%) patients, and histological findings of PCOS or PCOS that could not be excluded were obtained for only 43 (36%) women. Re-examination of histological samples from these 43 women let to the identifying of two groups of patients: group 1 with a typical histological pattern of PCOS (n=6, 14%) and group 2 with the so-called PCOS-like conditions (n=37, 86%).

CONCLUSIONS: Significant differences were found between the morphological pattern of true PCOS and PCOS-like conditions. Thus, the final diagnosis should made clinically and through imaging, as well as through mandatory morphological examination of ovarian biopsy specimens after surgical treatment.

AIM: We aimed at assessing the status of newborns in the early neonatal period in a group of mothers at high prenatal risk for preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PTB), and fetal chromosomal abnormalities (FCA).

MATERIALS AND METHODS: We prospectively analyzed the status of 435 singletons. Mothers in the first-trimester underwent prenatal screening with risk assessment. Group 1 (study group, n=231) included high-risk subgroups for FCA (subgroup 1A, n=67), maternal PE (subgroup 1B, n=66), FGR (subgroup 1C, n=46), and PTB (subgroup 1D, n=52). We excluded risk combinations. Group 2 (controls) included 204 children of low-risk women.

RESULTS: Group 1 had a higher incidence of mild-to-moderate asphyxia compared with group 2 (p <0.05) and was more frequent in 1B, 1C, and 1D subgroups. Moreover, the frequency of severe asphyxia was similar between the groups (p >0.05). Intrauterine growth restriction (IUGR) and developmental delay were more frequent in group 1 than in group 2 (p <0.05). Moreover, group 1 children required monitoring and treatment more frequently that in group 2 (p <0.05). The frequency of infectious complications in group 1 and 1A, 1B, and 1C subgroups was equally higher than that of group 2 (p <0.05), while respiratory distress syndrome predominated in group 1 (subgroup 1D) and was not observed in group 2. The discharge rate was 95.7% in group 1 and 84.0% in group 2 (p <0.05). On days 3 to 5, 16% and 3.4% of children in groups 1 and 2, respectively, were transferred to the second stage of aftercare (p <0.05).

CONCLUSIONS: In the early neonatal period, children born to high-risk mothers, as opposed to those born to low-risk mothers, were significantly more likely to have asphyxia, IUGR, infectious complications, and indications for continued treatment in the second stage of nursing.

AIM: We aimed at assessing the significance of first-trimester biochemical screening of pregnancy-associated plasma protein A (РАРР-А) and human chorionic gonadotropin (hCG) in predicting the recurrence of preeclampsia (PE) in pregnant women with early and late history of gestational PE.

MATERIALS AND METHODS: A retrospectively included 94 labor histories and prenatal medicals records of pregnant women (2020–2021). Moreover, their first-trimester biochemical screening parameters (РАРР-А and hCG) with a gestational PE history were performed to predict the recurrence of PE. They were divided into three groups (two study groups and a control group). Groups 1 and 2 included 31 labor histories each with late- and early-onset PE, respectively. Group 3 (controls) consisted of 32 labor histories with uncomplicated pregnancies.

RESULTS: In the groups with a gestational PE history and recurrence, a significant decrease in РАРР-А levels was found at 11–14 weeks of gestation. We equally observed high levels of first-trimester hCG in late-onset PE, most probably due moderate degrees of PE recurrence and not gestational age. However, severe degrees of recurrence prevailed in early-onset PE.

CONCLUSIONS: A decrease in РАРР-А levels measured at 11–14 weeks of gestation is a significant predictor of recurrence of PE in the group of pregnant women with a gestational PE history.