BACKGROUND: One of the tasks of modern medicine is to reduce the level of perinatal losses, for which it is necessary to know their main causes.
AIM: To determine the course of an infectious disease ...in the genesis of perinatal losses.
MATERIALS AND METHODS: In order to determine the role of infection in the genesis of perinatal losses, a retrospective study was conducted with two groups: the main group 307 women with perinatal fetal death, the control group 357 women without perinatal losses. An analysis was also made of the data of the statistical form No. 32 (annual) Information on medical care for pregnant women, women in childbirth and puerperas, presented by the Medical Information and Analytical Centers of St. Petersburg and the Leningrad Region for 20062018 and annual reports of the Leningrad Regional Pathological Anatomical Bureau for 20062016.
RESULTS: In 20062018, the leading causes of perinatal death were intrauterine hypoxia and asphyxia during childbirth (ICD 10: P20, P21), that is, not diseases, but symptomatic conditions. Such features of reporting documentation complicate the analysis of the causes of perinatal losses and the implementation of a set of preventive measures, including at the state level. Also, according to the official report, it is impossible to assess the contribution of a specific virus and a specific localization of the lesion to the genesis of perinatal losses. In the main group, hematogenous viral and ascending bacterial infection of the placenta was detected 4 times more often. With a combination of bacterial and viral infection of the placenta, the risk of a fatal outcome increases. Infectious pathogens most frequently encountered in perinatal losses have been established.
CONCLUSIONS: The cause of more than half of the cases of perinatal losses in women who gave birth in maternity hospitals in St. Petersburg and Leningrad Region in 20092018 is an infectious pathology: viral, bacterial and viral-bacterial, and not intrauterine hypoxia/asphyxia during childbirth, as stated by the official statistics. In this regard, the main direction in the prevention of perinatal losses is the timely detection and treatment of infectious pathology.
The experience of introducing a hybrid intermittent heating system for educational institutions is presented. The analysis of theoretical and experimental research, modern energy technologies for the ...integration of renewable energy sources into innovative and existing heat supply systems for buildings. The adaptation of modern developments of hybrid systems to buildings operating both in permanent and intermittent operation mode (administrative institutions, educational institutions and other public buildings) has been carried out. The conditions for increasing the efficiency of using heterogeneous renewable energy sources in combined heat supply systems have been established. For the proposed combined heat supply system, a hybrid heat generation is provided using low-potential renewable heat sources in the heat pump cycle and high-potential traditional heat sources in a pellet boiler. A mathematical model of the operating modes of a combined heat supply system using renewable heat sources is proposed, which can be used for numerical modeling of thermal processes in a variable heat supply mode for public buildings. The study of the dynamics of heating the premises when changing the climatic conditions of different regions of Ukraine, including the southern regions, is done. This makes it possible to analyze the efficiency of using alternative energy sources for heat supply and substantiate the conditions for including heat accumulators in the circuit. The research results are relevant because allow to achieve significant energy savings for heat supply of public buildings, characterized by a low level of energy efficiency. The proposed solutions indicate that the combined use of the capabilities of heterogeneous renewable energy sources can be effective only with a hybrid method of heat generation using a heat pump and a pellet boiler, taking into account the operating mode of buildings. As a result of theoretical and experimental studies, it was established: the dynamics of heating and cooling of premises with a high accumulation capacity; the share of replacement of the consumed thermal power in the hybrid use of heat generators. The conditions for the most effective use of heat accumulators in a combined heat supply system have been established. The results obtained make it possible to increase the efficiency of the use of renewable energy sources for public buildings, taking into account the mode of their operation, in which the heat supply system operates in an intermittent mode
BACKGROUND: The need for resuscitation at birth depends on the gestational age — the shorter the gestational age, the more often resuscitation is required. AIM: to determine risk factors and possible ...methods for preventing preterm birth. MATERIALS AND METHODS: A retrospective analysis of medical documentation data was carried out on 12,342 women whose delivery was carried out at the Perinatal Center of the Pediatric University. The main group included 680 patients whose pregnancy ended with delivery at 22 weeks — 36 weeks 6 days, the control group included 11,662 patients whose pregnancy ended with term birth. RESULTS: When analyzing anamnestic factors, it was found that the age of the patients at the time of registration for pregnancy in the main group was statistically significantly higher, height was statistically significantly lower, the serial number of both pregnancy and childbirth was statistically significantly higher, VI or more pregnancies, IV or more births, obesity, arterial hypertension, and a burdened obstetric history (miscarriage, premature birth) are statistically significantly more common than in the control group. In the main group of symptoms, the following are most often noted: pregnancy resulting from the use of assisted reproductive technologies, moderate and severe preeclampsia, isthmic-cervical insufficiency, abnormal indicators of the umbilical cord artery, breech presentation of the fetus. Meconium staining of amniotic fluid was 2 times more common in full-term pregnancies. CONCLUSIONS: Ascending infection of the placenta, mycoplasma, herpetic and chlamydial choriodeciditis, sub- and decompensated chronic placental insufficiency were statistically significantly more common in premature births. Based on discriminant analysis, a model for predicting the risk of preterm birth was built.
BACKGROUND: It is traditionally believed that the mortality of children operated on in the first days of life depends on the severity of congenital malformation and gestational age.
AIM: The aim of ...the study was to analyze the causes of death of children in the neonatal period, after surgical interventions performed in the perinatal period, in order to develop a set of measures to reduce mortality.
MATERIALS AND METHODS: A retrospective study was conducted between two groups: the main group included 77 newborns who underwent surgery in the Perinatal Center of St. Petersburg State Pediatric Medical University in the perinatal period (the first 168 hours of extrauterine life) and died in the first 28 days of life, the control group included 287 children operated on in the perinatal period and survived 28 days.
RESULTS: It has been established that the cause of death in more than half of the newborns operated on in the perinatal period are infectious agents (viruses, bacteria and their combinations). The infectious process aggravates the course of the postoperative period and increases the number of complications of the underlying disease, which, as a result, leads to the death of the child in the neonatal period. Significant contributors include: chlamydial infection, toxoplasmosis, cytomegalovirus infection, and infection caused by Herpes simplex 1, 2. The most common causes of death in newborns in the postoperative period were microorganisms of the Staphylococcaceae family, the genus Mycoplasma, as well as Klebsiella pneumoniae and Enterococcus faecalis.
CONCLUSIONS: The cause of death in more than half of newborns operated on during the perinatal period is infectious agents (viruses, bacteria and their combinations). The infectious process makes the postoperative period more difficult and increases the number of complications of the underlying disease, which ultimately leads to the death of the child in the neonatal period. The high prevalence rate in the population, infection of the placenta, tissues and organs of the fetus, as well as the high role in the genesis of death in newborns, indicate the need for examination for Human herpesvirus 1 and 2, Chlamydia trachomatis, Toxoplasma gondii and Cytomegalovirus in pregnant women with prenatally diagnosed congenital malformations and in newborns requiring surgical treatment in the perinatal period.
BACKGROUND: The main cause of early neonatal death is neonatal asphyxia. Asphyxia transferred during childbirth can lead to damage of the brain, respiratory disorders, hemodynamic disorders, and ...impaired renal function.
AIM: The aim of the study is to determine the factors predisposing to the birth of a child in a state of asphyxia.
MATERIALS AND METHODS: A retrospective study was conducted, which included the analysis of medical records of 11,662 women who gave birth at the Perinatal Center of the Saint Petersburg State Pediatric Medical University (level IIIB obstetric institution), whose pregnancy ended in urgent delivery. The main group included patients who gave birth to full-term babies in a state of moderate and severe asphyxia (n = 70), the control group included patients who gave birth to children without asphyxia (n = 11,592).
RESULTS: Factors predisposing to the birth of a full-term baby in a state of moderate and severe asphyxia were identified, which can be used to develop a system for predicting the birth of a child in a state of asphyxia and a set of preventive measures.
CONCLUSIONS: More frequent ascending infection of stage II and III makes it necessary to timely identify and treat a bacterial infection in all full-term pregnant women. A prognostic model for the birth of a full-term baby in a state of asphyxia has been constructed. Women at risk should undergo an additional examination at 37 weeks of pregnancy: sowing from the cervical canal for flora and sensitivity to antibacterial drugs to identify pathogenic and opportunistic microflora, childbirth should be carried out under mandatory constant monitoring control.
As a research result, characteristic indicators of the efficiency of using various heat sources in combined heat supply systems were determined. During the study, various schemes for integrating heat ...accumulators in heat supply systems were considered. Water was used as a battery, which also acts as a coolant. Mathematical modeling of processes in combined heat supply systems using intermittent heating is carried out. The characteristic operating modes of the elements of heat supply systems that take into account the operating modes of heat consumers are determined. Mathematical modeling was carried out using a software package that allows to obtain the distribution of heat power of the heat supply system by its main elements and its characteristic operation modes. According to the research results, a coefficient of thermal power reduction and a coefficient of efficiency of using the heat accumulator volume were proposed. These coefficients allow to evaluate the efficiency of heat sources and the efficiency of using the volume of the heat storage tank. Based on the obtained data, the task was set to optimize the daily load of the heat source, taking into account the installation of the storage tank.
The research results can be used for the reconstruction of heat supply systems of buildings with a two-period operation mode (operation duty) using both traditional and renewable heat sources. This will significantly increase the efficiency of the use of elements of the heat supply system, even out the daily heat generation schedule and increase the service life of the main equipment
BACKGROUND: In the presence of meconium in the amniotic fluid, childbirth is usually classified as a high-risk group, which leads to an expansion of indications for operative delivery. Also in the ...literature there are indications of an increase in the frequency of the birth of a child in a state of asphyxia, with premature rupture of amniotic fluid.
AIM: The aim of this study is to determine the significance of the influence of meconium color of amniotic fluid and the duration of the anhydrous period on the birth of a child in a state of asphyxia.
MATERIALS AND METHODS: A retrospective study was conducted between the two groups in 12,342 women delivered at the Perinatal Center of the Pediatric University.
RESULTS: Meconium coloration of amniotic fluid was 2 times more common in the presence of hypoxia, and 5 times more common in the presence of severe fetal hypoxia during full-term pregnancy, while in premature pregnancy, the child was born in a state of asphyxia, regardless of the color of the amniotic fluid. Premature rupture of amniotic fluid occurred at the birth of a full-term baby in a state of asphyxia statistically significantly more often, although the duration of the anhydrous period did not have statistically significant differences in the groups.
CONCLUSIONS: Premature rupture of amniotic fluid at the birth of a premature baby had no differences in the groups with and without asphyxia, however, the duration of the anhydrous period was statistically significantly longer in patients who gave birth to children in a state of asphyxia. With an anhydrous interval of 26 hours or more, the risk of having a child in a state of moderate and severe asphyxia increased. The risk of ascending infection of the placenta of the third stage during preterm labor increased with an anhydrous interval of more than 53 minutes, which confirms the feasibility of prescribing antibiotic therapy for premature rupture of amniotic fluid during preterm pregnancy at the time of diagnosis of this condition, regardless of the planned obstetric tactics.
As a result of research, the conditions for the effective use of the volume of heat accumulator based on solid materials were determined. In the course of research, various schemes of the device of ...tubular heating elements for charging the channel elements of the heat accumulator were considered. Fire clay was used as a heat-accumulating material, capable of operating in a wide temperature range (up to 600 °С). Mathematical modeling of temperature change in the process of discharge over the cross section of the heat-accumulating unit has been carried out. Mathematical modeling was carried out using an application package that allows to obtain the temperature distribution over the cross section of the heat accumulator at key points of its work. The obtained simulation results were tested on an experimental setup consisting of four heat-accumulating units during the charging process and during the discharge of the heat accumulator. According to the research results, the most effective layout of the heating elements was determined, which allows to make the most of the volume of the heat-accumulating material. The dependencies to determine the exponent and the averaging coefficient of the heat flux are also found, which allow a more rational use of the volume of the accumulating nozzle.
The research results can be used to reconstruct decentralized heat supply systems for both residential buildings and public buildings. This will significantly align the schedule of electricity consumption during the day and reduce the consumption of hydrocarbon fuels.
BACKGROUND: The mortality rate of children operated on in the early neonatal period remains high, despite the combined efforts of surgeons, anesthesiologists, clinical pharmacologists, and many other ...specialists.
AIM: to determine the risk of death of children in the period of birth, after surgical interventions carried out in the period of the neonatal period.
MATERIALS AND METHODS: A retrospective study was conducted between two groups of children treated at the Perinatal Center of the Pediatric University. The main group included 77 newborns operated on in the early neonatal period and died in the first 28 days of life. The control group included 287 children operated on in the perinatal period and survived 28 days.
RESULTS: In the main group, the percentage of defects detected prenatally was statistically significantly lower; statistically significantly more often multiple congenital malformations and congenital malformations of the cardiovascular system were diagnosed. Risk factors for the death of newborns after surgery performed in the perinatal period have been established: features of the somatic status of mothers (chronic nicotine intoxication, hypertension and arterial hypertension, chronic serum hepatitis B and C, pathology of the urinary system and thyroid gland, cervical ectopia), obstetric gynecological history (chronic inflammation of the organs of the lower floor of the genital tract, two or more abortions in multiparous women, placental insufficiency in history during a previous pregnancy, previous delivery by caesarean section), course of pregnancy (threatening abortion, acute respiratory viral infections, exacerbations of chronic infectious diseases, early toxicosis, carriage of Cytomegalovirus and Herpes simplex types 1 and 2, asymptomatic bacteriuria, gestational anemia, circulatory failure, fetal malnutrition, abnormalities in the amount of amniotic fluid diagnosed by ultrasound study in the 3rd trimester of pregnancy), childbirth (breech presentation of the fetus and meconium staining of amniotic fluid), afterbirth conditions (chlamydial and ascending infection).
CONCLUSIONS: In pregnant women with prenatally diagnosed congenital malformations of the fetus, it is necessary to conduct bacteriological studies, emergency histological examination of the placenta to identify possible microbial damage, as well as timely examination and treatment of newborns and upcoming / undergone surgery.
The article presents the data of a complex analysis of the course of the early period of the newborn in children born to 456 women who were delivered in the maternity hospitals of St. Petersburg and ...the Leningrad Region in 2009-2016. These patients were divided into the main group (99 women who gave birth to live children who died in the first 7 days of life) and a comparison group (357 women who gave birth to live children who survived the first 7 days). Estimated the duration of pregnancy at the time of delivery, clinical features of newborn children in the group of patients with perinatal losses, in comparison with the control group, were analyzed. The article compares the anthropometric data of newborns (weight and height at birth), Apgar scores, and the frequency of fetal hypotrophy. The results of the clinical analysis of the blood of newborn children of the patients of the main and control groups (hemoglobin, erythrocytes, leukocytes, platelets and venous blood glucose) were also evaluated. A number of significant differences in the main group and comparison group that can be regarded as predictors of perinatal fetal death have been identified. Thus, the risk group for perinatal fetal death includes preterm newborns with hypotrophy, low body weight, smaller body length, a low Apgar score, changes in the clinical analysis of blood (lowering of hemoglobin, erythrocytes and platelets, and an increase in the level of venous blood glucose). The level of leukocytes in peripheral blood in newborns in both groups is not significantly different.
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