A comparative morphological study was carried out to analyze the number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 categorized by the disease ...severity. The number of syncytial knots was assessed on specimens stained with hematoxylin and eosin. VEGF expression was determined by immunohistochemical analysis in syncytiotrophoblast and villous endothelial cells. Morphological study of the placenta tissue of parturient women with COVID-19 showed increased numbers of syncytial knots in the villi, indicating the development of preplacental hypoxia. High VEGF expression in syncytiotrophoblast and vascular endotheliocytes reflects a stereotyped response to hypoxia and can underlie the development of a preeclampsia-like syndrome. The number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 depended on the disease severity.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We compared the expression profiles of α2,3- and α2,6-sialoglycans in the glycocalyx of the placental barrier structures in early and late forms of preeclampsia and fetal growth restriction using the ...method of lectin histochemistry. It was found that the expression of α2,3-sialoglycans in the syncytiotrophoblast and fetal endothelium of the terminal villi of the placenta was reduced in preeclampsia in comparison with normal placenta and, on the contrary, was increased in fetal growth restriction. Significant differences were found in both clinical phenotypes of preeclampsia and fetal growth restriction. Changes in the expression pattern of α2,6-sialoglycans in the endothelium of terminal villi were more pronounced than in syncytiotrophoblast. In early and late-onset preeclampsia, a significant increase in the expression of α2,6-sialoglycans was revealed only in the fetal endothelium; in early fetal growth restriction, the expression of α2,6-sialoglycans was reduced in the endothelium, but increased in syncytiotrophoblast in late fetal growth restriction. The features of the expression of sialoglycans in structures of the placental barrier in preeclampsia and fetal growth restriction were revealed, which may indicate the pathogenetic involvement of sialoglycans in the inflammatory activation cascade in fetal growth restriction, and in preeclampsia, apparently, they are associated with impaired fetal tolerance.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We performed a comparative morphological analysis of placental villi in parturient women with mild and moderate COVID-19 infection. The area and perimeter of terminal villi, their capillaries, and ...syncytiotrophoblast were assessed on immunohistochemical preparations with antibodies to CD31 using an image analysis system; the parameters of fetal vascular component in the placental villi were also assessed. Changes in the studied parameters differed in parturient women with mild and moderate COVID-19 infection. The observed increase in the total perimeter with a simultaneous decrease in the total capillary area and the degree of vascularization of the placental villi in parturient women with COVID-19 indicates impairment of circulation in the fetal compartment and the development of placental hypoxia, which can be the cause of unfavorable neonatal outcomes.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta. The ...aim of our study was to identify the risk factors for placenta praevia associated with PAS disorders and the efficacy of distal haemostasis during Cesarean delivery.
This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 (n = 52), patients underwent bilateral uterine artery ligation. In Group 2 (n = 33), we used the combined compression haemostasis approach including the placement of tourniquets and insertion of an intrauterine balloon for controlled tamponade. In Group 3 (n = 79), we used the combination of surgical haemostasis with the controlled intrauterine tamponade using the vaginal and intrauterine Zhukovsky balloon.
PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries (р = .001). According to the FIGO classification, 53.8% of women with placenta praevia observed during the Cesarean had РА1 and 46.2% PA2. With regards to the PAS disorders observed in 30.8% of patients, 38.4% had PAS3, 34.7% PAS4, 18.3% PAS5 and 8.5% PAS6. The histology analysis showed normal placental attachment in 42.9% of the total number of study participants, placenta accreta in 28.2%, placenta increta in 16.7%, and placenta percreta in 12.2%. In Group 1, we performed the resection of uterine wall with the attached portion of the placenta in 13.5% of women, in Group 2 in 30.3% women, and in Group 3 in 50.6% women. There was a significant 4.8-fold reduction in the number of hysterectomies in Group 3 versus Group 2 (р = .043) and a 4.4-fold reduction in Group 2 versus Group 1 (р = .003). In Group 2, the volume of blood loss was 1.3-fold lower and in Group 3 1.5-fold lower than in Group 1. Conclusion: The techniques of compression distal haemostasis evaluated in this study in women with PAS are efficacious in the reduction of adverse maternal outcomes and should be used more widely in clinical practice.
Habitual miscarriage is a fairly common complication of early pregnancy. In the opinion of most authors, the term habitual miscarriage is used to describe a loss of two or more pregnancies during the ...first 22 weeks of pregnancy. Issues of terminology and management continue to be relevant and debatable in medical professional communities and need further discussion. In addition to the medical sides of the issue, habitual miscarriage has a significant psychological impact on women and their partners. Regardless of the gestational age, the loss of pregnancy for most couples is similar in importance to the loss of a newborn and is associated with the loss of hope and plans that future parents connected with a baby who has not yet been born. After repeated losses, bereavement and emotional upheaval are further exacerbated irrespective of the term of abortion. Repeated pregnancy loss is a significant negative event in the life of a couple both from a medical and psychological point of view, that’s why the provision of adequate medical care is one of the objectives of a specialist managing pregnancy. This also involves the choice of effective disease management. Previously it was shown that luteal phase deficiency might be the cause of this phenomenon, and that hormonal deficiency had to be replenished. Many modern publications confirm that progesterone and its derivatives have an important immunomodulatory role in the habitual miscarriage. The article describes the role of progesterone in maintaining pregnancy and the results of studies devoted to the role of dydrogesterone. It also presents data of international studies on the treatment of women with habitual miscarriage.
Experimental data on the diffusion combustion of round hydrogen microjet in concurrent coaxial flows are presented. The effects on combustion of the concurrent flow of air and that of air premixed ...with nanopowder of TiO2 are of interest. The hydrogen microjet is emanated from a round micronozzle which is surrounded by a coaxial slit to produce the concurrent flow. Combustion events found in the present conditions are similar to those observed in the previous studies on diffusion combustion of hydrogen microjets at subsonic and supersonic velocities. In a subsonic range, the so-called "bottleneck-flame region" is generated close to the nozzle exit, while in high-speed conditions the flame separates from the nozzle. At increasing velocity of both the hydrogen microjet and the concurrent flow, the "bottleneck-flame region" is still found and the combustion becomes more intense. The "bottleneck-flame region" is suppressed at the microjet velocity approaching transonic values.
In the present paper we show our recent experimental data on diffusion combustion of a round hydrogen microjet in a cocurrent flow of air mixed with nanoparticles of TiO2. The hydrogen microjet is ...emanated from a round micronozzle which is surrounded by a coaxial slit to produce the cocurrent flow. Combustion events found in the present conditions are similar to those observed in the previous studies on diffusion combustion of hydrogen microjets at subsonic and supersonic velocities. In a subsonic range, the so-called "bottleneck-flame region" is generated close to the nozzle exit, while in high-speed conditions the flame separates from the nozzle. At increasing velocity of both the hydrogen microjet and the cocurrent flow, the "bottleneck-flame region" is still found and the combustion becomes more intense. The "bottleneck-flame region" is suppressed at the microjet velocity approaching transonic values.
The experimental research results on diffusion combustion of a round hydrogen microjet flowing from a slit micronozzle at subsonic and supersonic speeds are presented. For the first time, four ...scenarios of diffusion combustion of a round hydrogen microjet have been identified, including supersonic combustion in the presence of supersonic cells both in air and in hydrogen. It has been found that flame stabilization for a subsonic microjet velocity of hydrogen is associated with the presence of a “bottleneck flame region” leading to the nozzle choking phenomenon, and flame stabilization for a supersonic microjet flow is associated with the presence of supersonic cells. A hysteresis of the diffusion combustion process of a plane microjet of hydrogen is found depending on the method of ignition of the microjet (near or far from the nozzle exit) and the direction of change in the rate of its outflow (growth or decrease).
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Preeclampsia (PE) continues to be one of the main reasons of maternal mortality even in countries with a high level of medical care. Current PE treatment can be etiological and symptomatic. ...Therefore, active investigation into etiology and pathogenesis of this pregnancy complication is on the way. Identification of new pathways in PE is of vital importance because it could provide clues to pathogenesis-related treatment and consequent reduction in mortality. It is especially in the mainstream nowadays, when leading world perinatal institutions have focused on prolongation of pregnancy in early onset PE (EPE) to improve neonatal outcomes. Obstructive sleep apnea (OSA) syndrome and early small airway obstruction have been proposed as pathophysiological pathways of PE. In this review article we present the association between pregnancy and sleep-related breathing dysfunction, as well as between OSA and hypertensive disorders of pregnancy. Common mechanisms for arterial hypertension in PE and OSA have been proposed, and additional potential treatment approaches are discussed aimed at pregnancy prolongation in EPE. We have formulated unresolved issues related to studies of obstructive sleep apnea in pregnancy in general and in PE patients in particular.
Background. Pregnancy in paroxysmal nocturnal hemoglobinuria (PNH) patients has historically been a high-risk situation. The combination of chronic complement-mediated hemolysis caused by the disease ...and physiological activation of the complement system during pregnancy, significantly worsened the prognosis for the life. For a long time, there were no effective methods for the PNH treatment, and pregnancy in patients seemed to be extremely risky, as it significantly increased the risk of life-threatening complications. The advent of targeted therapy with eculizumab turned the prognosis of this disease upside down: patients began not only to survive, but also to live comparable to healthy people. A comparative analysis of the course and outcomes of pregnancy in patients with PNH treated with eculizumab and in patients without targeted therapy was carried out.
Aim. The study was to evaluate the course and outcomes of pregnancy in patients with PNH, depending on the therapeutic approach.
Materials and methods. We analyzed data from 57 pregnancies in 49 women (31 used eculizumab, 26 with supportive care only) observed at the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology or with remote consultation (23 clinics from 19 cities of Russia).
Results. The high probability of pregnancy complications and its adverse outcomes outside of targeted therapy indicates the vital need for its use: all observations were accompanied by complications of varying severity. The course of pregnancy with the eculizumab is generally more favorable: an apparently higher rate of live births and a lower likelihood of complications are registered. Without increasing the incidence of complications, eculizumab significantly improves pregnancy outcomes for both mother and fetus, and does not adversely affect the health of newborns.
Conclusion. Thus, eculizumab allows not only to increase the survival rate of patients with PNH, but also to comprehensively improve their quality of life, including the possibility of safe childbirth.
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