THE ROLE OF INFECTION UNDER ANTENATAL FETAL LOSSES OF PREGNANT WOMEN

Gromova A. M., Liakhovska T. Yu., Ketova O. M., Nesterenko L. A., Martynenko V. B.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The level of antenatal fetal death (AFD) among perinatal losses remains high and is almost 50%. In Ukraine, the level of AFD is 54%. Detection of the main cause of AFD remains a difficult task in 60% of cases of stillbirth, despite on the using of modern methods in diagnosing the causes of fetal death. Presently increasing frequency of intrauterine infections (IUI) is obvious in the structure of both obstetric and perinatal pathology. A comprehensive assessment of the vaginal biocenosis, afterbirth, ultrasonography will allow the develop of a pathogenetic valid algorithm for the examination and monitoring of pregnant women, aimed at preventing antenatal fetal death. Purpose. Research the state of microbiocenosis of the vagina, morphological peculiarities of placenta’s structure, ultrasound data in pregnant women with antenatal fetal death. Object and methods. We examined 30 pregnant women with antenatal fetal death (main group) and 25 pregnant women with birth of live children (control group). We applied bacterioscopy, bacteriological methods, PCR-diagnostics from the cervical canal. Analysis of morphological characteristics and microbiological conclusions of 55 afterbirths (placenta, membranes, umbilical cord) were carried out. An ultrasound study was conducted to all pregnant women on the Toshiba (Eccocee) SSA-340 (Japan) device with a 3.5 MHz sensor frequency. Results and discussion. Women with AFD had 2.4 times higher morbidity rate than in the control group and the reproduction system was impaired 2,9 times higher than in the control group. Poligidramnios was diagnosed 5.8 times, oligohydramnios 3.1 times more often in the main group, compared with the control group (p <0,05). 80% (24/30) patients of the main group, have been detected with the conditionally pathogenic flora, 63.3% (19/30) of them have been detected in association with two, three, four kinds of aerobes and anaerobes, and the ureaplasma appeared 4,1 times, chlamydia in 3,3 times more often than in the control group (p <0,05). Women of the main group had the thickness of the placenta by 15.1% more, the volume – by 22.5% more, and the area – by 19,6% more than in the control group (p <0,05). Infectious and inflammatory changes were detected during the microscopic examination of the placenta in 26 (86.7%) women cases of the main group and in 4 (16%) cases of the control group (p <0.05). The most common ultrasonography signs of infection were placenta edema, its thickening (50%), dilatation of the placenta vessels and intervillous space (40%), contrast of the basal plate (23.3%), hyperehogenic inclusions in the placenta structure (40%), fitting the echographic picture of placenta. Conclusions. The main factors leading to infected fetuses among pregnant women with AFD are the presence of chronic infectious diseases, functional damage of reproduction system, complications during this pregnancy, and the presence of vaginal dysbiosis. Activation of conditionally pathogenic flora and prolong action of an infectious agent developed infectious and inflammatory changes in the placenta in 86.7% cases detected by microscopy. The obtained data will allow us to develop a pathogenetically valid algorithm for the examination and monitoring of pregnant women, aimed at preventing antenatal fetal death.

infection, pregnancy, antenatal fetal death.

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«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 97-101 pages, index UDK 618.333

10.29254/2077-4214-2019-2-2-151-97-101