SEPTIC PREGNANCY AND LABOUR COMPLICATIONS BY ISTHMIC-CERVICAL INSUFFICIENCY TREATMENT

Kolesnik N.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Cervical incompetence (CI) is considered to be a diagnostic criteria of preterm labour, espesialy because of availability of diagnostic ultrasound method. Data of global randomized trial showed a direct relationship risk of premature birth by reducing the length of the cervix, as defined in 16-20 weeks. Becouse this complication is the cause of about a third of all premature births, we odserve active development and improvement of treatment methods, including the currently relevant are circulage and obstetric pessarium. A special place in the treatment of CI holds vaginal use of natural progesterone that is pathogenetically justified. The increasing concentration in the cervical mucus proinflammatory interleukin-8 yas been shown, and biological effects of natural progesterone includes depressive effect on the local synthesis of this cytokine. Large meta-analyzes have shown that the effectiveness of these tools is identical speaking about prolongation of pregnancy. However, he pathogenic role of inflammation in structural changes in the cervix, it is necessary to assess its laboratory manifestations and frequency of septic complications of childbirth and the postpartum period CI. The study involved pregnant women with CI, being diagnosed at 28 weeks gestation. Cervical concentration of proinflammatory cytokine — interleukin-8 in the cervical mucus was defined in all cases. Pregnant women with CI were distributed depending on the concentration of proinflammatory cytokines in cervical mucus — 40 pregnant women with IL-8 content of less than 50 pg/ml and 32 patients containing IL-8 in cervical mucus 50 pg\ml and more. All patients with confirmed diagnosis of CI had used obstetric pessary. Higher concentrations of IL-8 — a powerful proinflammatory cytokine — is one of the leading pathogenetic factors of CI. Under the influence of pro-inflammatory bioactive substances a cascade of reactions is indused — activation of prostaglandin synthesis initiates contractile activity of the myometrium, many enzymes — collagenase, metalloproteases — violate the normal structure of the connective tissue of the cervix. The result is smoothing and shortening of the cervix, the gradual dilatation of uterus. As the results of the research, more than half of pregnant women with CI characteristic had elevated concentrations of proinflammatory IL-8, confirming the role of local inflammation in the genesis of CI. These results matched randomized international studies underlying purpose of scientific evidence vaginal forms of natural progesterone for treatment of CI of functional origin. Instead, the use of obstetric pessariy to correct CI has based the mechanical impact — supporting the fetal presenting part, preventing gradual lowering of the birth canal, located in the vagina structure of biologically inert material prevents further shortening of the cervix, including by small its sacralization. However, this concept has several drawbacks, chief among them — the permanent residence of a foreign body in the vagina, provoking a local inflammatory process, inevitably resulting in a even greater activation of IL-8 synthesis of cytokines and other proinflammatory action of the mucous membrane and connective tissue matrix cervix. Considering the above, naturally is a higher incidence of premature births in the group, that demonstrated higher concentrations of IL-8. In addition, the flow of labor analysis showed that pregnant women with CI and high concentrations of IL-8 in cervical mucus more often had premature rupture of membranes. Frequency of septic complications study showed, that in the case of CI by higher cervical concentrations of proinflammatory cytokines hyperthermia in labor, perineal wound infected, endometritis are more common. Thus, solving the issue of the use of obstetric pessaries to correct CI, it is reasonable to study cervical mucus cytokine status.

cervical insufficiency, obstetric pessary, interleukin-8, septic postpartum complications

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«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 175-178 pages, index UDK 618.146-008.64-08-06