Ukrainian Journal of Perinatology and Pediatrics

Informed medical trauma and toxic stress in intensive neonatology

T.V. Kurilina, A.O. Pysarev — Sat, 28 Dec 2024 00:00:00 +0200

The neonatal period and the first years of life are a critical and sensitive period of a child's development, and traumatic events play a decisive role in disrupting the trajectory of physical, emotional, and behavioral development.

Аim - to highlight current views on the neurobiology of stress and features of medical trauma in intensive neonatology from the point of view of possible epigenetic influences on the trajectory of child's development. The definition of trauma-informed medical care, so as concepts of neonatal allostasis, allostatic load and toxic stress were considered. Critical components of neonatal model of medical trauma are separation from parents, untreated or undiagnosed pain, and excessive allostatic load. In NICU setting, organizing family-centered care from the point of TIMC’s view must be reviewed as a philosophy that benefits the entire family, not just the child.

The consequences of the modifying cumulative effect of intensive treatment on the nervous system development are considered, with discussion of mechanisms of the unique plasticity of brain during critical periods in newborns and infants. Three main brain structures and their contribution to the formation of stress response are presented. The structural and functional consequences of toxic stress and the level of disorganization of the developing brain architecture are adduced. The way to overcome medical trauma in neonatology is biobehavioral synchrony between parents and newborn, which supports the constant regulation of allostasis, prevents the development of allostatic load into toxic stress with violation of plastic brain architecture. The pathology of the newborn is also an important risk factor for perinatal post-traumatic stress disorder in parents after infant's staying in NICU, which requires its timely detection and correction. Organization of neonatal care in terms of FFC and informed medical trauma is a preventive way of epigenetic influences on the child's developmental trajectory. Partnership between families and staff has high potential for obtaining information about the nature and source of medical trauma in newborns, as well as for systemic transformation of intensive care neonatology.

No conflict of interest was declared by the authors.

Functional anatomy of the hand

I.G. Biryuk, T.V. Khmara, T.V. Komar, I.I. Zamorskyi, T.B. Sykyrytska — Sat, 28 Dec 2024 00:00:00 +0200

The last war years led to a significant increase in interest in the anatomy and surgery of the hand and fingers, which became the object of a separate scientific specialization. The study of the anatomy of the hand and fingers has evolved into a functional anatomy focused on every day and professional activities. Modern hand anatomy is important both for understanding normal function and for treatment and recovery from traumatic injuries.

Аim - analyze and summarize modern data on the functional capabilities of the hand.

The analysis of patterns of functioning of the upper extremities becomes extremely important in the context of training surgeons and orthopedists. Prosthetics of the hands have a significant potential for success, especially if based on a deep understanding of their functional anatomy. Knowing the anatomy of the hand allows you to design and adjust prostheses in such a way that they reproduce natural movements and functions as much as possible. The important role of the thumb in providing support and mobility of the other fingers when grasping objects is noted, which is emphasized as an important feature of the anatomy of the human hand. The process of opposing the thumb to other fingers is described, which allows a person to control the taken objects according to his intentions. It is noted that the absence or incomplete development of any element of movement limits the possibilities of grasping and work of the hand.

Conclusions. А deep understanding of the functional anatomy of the hand contributes to the improvement of prosthetic technologies to significantly improve the lives of patients after various types of traumatic injuries.

No conflict of interests was declared by the authors.

Features of the endothelial system in pregnant women with gestational diabetes

V.S. Yavir, D.О. Govsіeіev — Sat, 28 Dec 2024 00:00:00 +0200

Pregnancy causes adaptive changes in a woman's body to support fetal development. Gestational diabetes is associated with impaired glucose metabolism and insulin resistance, which affects the endothelial vasculature and placental circulation and can lead to serious complications for both mother and child, including preeclampsia, preterm birth, and diabetic fetopathy.

Aim - assessment of features of the endothelial system in pregnant women with different stages of gestational diabetes according to indicators of prostanoids (prostaglandins, prostacyclin and thromboxane), endothelin-1, L-arginine and nitric oxide.

Materials and methods. Endothelial function was assessed using prostaglandin E₂, prostaglandin F_2α, prostacyclin, thromboxane B₂, endothelin-1, nitric oxide and L-arginine in 120 pregnant women. The main group consisted of 90 patients with gestational diabetes, among whom 50 women had class A1 (subgroup I), and 40 women had class A2 (subgroup II). The control group included 30 women with a physiological course of pregnancy.

Results. In women with gestational diabetes, a decrease in indicators of substances with a depressant effect was recorded when compared with healthy pregnant women: the level of prostaglandin E₂ was 2.60±0.46 ng/ml against 5.91±0.37 ng/ml, prostacyclin - 57.8±1.32 pg/ml versus 101.8±10.3 pg/ml, nitric oxide - 2.1±0.4 γ/mol versus 3.5±0.5 γ/mol and L-arginine - 39.2±6.2 mmol/l versus 60.4±2.5 mmol/l. An increase in vasoconstrictor substances was noted: prostaglandin F_2α in women of the main group was 0.9±0.4 ng/ml, in the control group - 0.42±0.04 ng/ml, thromboxane B₂ - 75.4±17.2 pg/ml and 46.5±5.2 pg/ml, respectively, endothelin-1 - 17.2±5.4 pg/ml and 8.3±1.4 pg/ml, respectively. These changes were aggravated with insulin-dependent gestational diabetes and the addition of preeclampsia.

Conclusions. Dysfunction of the endothelial system due to an imbalance between substances involved in the regulation of vascular tone and coagulation was found in pregnant women with gestational diabetes. Control of endothelial function in such women is important for timely detection and impact on possible complications.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all patients.

No conflict of interests was declared by the authors.

Characteristics of perinatal care in Ukraine during martial law

Y.G. Antypkin, R.V. Marushko, О.О. Dudina, N.Y. Bondarenko, L.O. Polyanska — Sat, 28 Dec 2024 00:00:00 +0200

Armed conflicts have a detrimental effect on public health and destabilize health care systems, including perinatal care.

Aim - to determine the impact of adverse factors of the full-scale war of the Russian Federation against Ukraine on the effectiveness of perinatal care.

Materials and methods. The study was based on data from the scientific literature and medical statistics on the activities of perinatal care institutions subordinated to the Ministry of Health of Ukraine. The methods of systematic approach, bibliosemantic comparative analysis, and statistical data processing were used.

Results. The analysis of the results showed a deepening during martial law of the violation of certain determinants of medical care and maternal health - a decrease in the frequency of timely coverage of pregnant women with early (up to 12 weeks of pregnancy) dispensary supervision - 87.82% in 2021 and 84.81% in 2023, OR from 95% CI: 1.29 (1.26-1.31), normal births - 62.03% and 60.40%, OR from 95% CI: 1.06 (1.05-1.08), with an increase in the incidence of syphilis among women - 2.7 and 3.2 per 100 thousand female population, OR with 95% CI: 1.18 (1.06-1.32), frequency of pregnant women’s anemia - 24.75% and 26.72%, OR with 95% CI: 1.08 (1.07-1.09), miscarriage - 6.2 and 6.7, OR with 95% CI: 1.01 (1.01-1.02), cesarean sections - 267.01 per 1000 births and 290.48, OR with 95% CI: 1.16 (1.14-1.18), low birth weight rate - 5.99% and 6.09%, OR with 95% CI: 1.04 (1.01-1.07), sick and diseased newborns - 196.93 per 1000 live births and 269.47, OR with 95% CI: 1.48 (1.46-1.50).

Conclusions. The study confirmed the hypothesis of destabilization of perinatal care during martial law.

The authors declare no conflict of interest.

Implementation of the Infection prevention and infection control program at the level of healthcare facility in Donetsk and Luhansk regions in 2021-2022 and prospects for recovery in the post-war period

A.V. Aleksandrin — Sat, 28 Dec 2024 00:00:00 +0200

The aim of the work was to assess the implementation of the Infection prevention and control (IPC) program and water supply, sanitation and hygiene programs in healthcare facilities in Donetsk and Luhansk regions and to assess the further development of these programs in the regions.

Materials and methods. To evaluate the implementation of the IPC program in health care institutions of Donetsk and Luhansk regions and to analyze the main trends and priority directions for the development of infection prevention programs at the level of health care facilities (HCF), two rounds of comprehensive evaluation of the IPC program at the level of health care facilities were conducted in 2021 and 2022 using the Infection prevention and control assessment framework (IPCAF) and Water, sanitation and hygiene (WASH FIT) tools.

The assessment results showed that the implementation of the IPC in 11 HCF in Donetsk and Luhansk regions is at the basic level and in 6 HCF at an insufficient level (<200 points), the average value is 220,7 points, (95% confidence interval (CI 95%) 191.9 - 249.6 points). The least implemented component was Epidemiological surveillance for healthcare-associated infections (HAI) - 7.8 points (CI 95%: 2.6-13.0), Multimodal strategies - 10.6 points (CI 95%: 8.6-12.5) and IPC Monitoring - 18.1 (CI 95%: 14.0 - 22.2). The most implemented components of the IPC were the IPC Infrastructure 53.7 points (95% CI: 46.3 - 61.1). The assessment of water supply, sanitation and hygiene services showed similar results of the implementation of these services in the HCF of Donetsk and Luhansk regions, the average indicator was 52% (95% CI: 49.9-54.4). The most implemented were Energy Supply - 80% (95% CI: 74.7 - 84.9) and Water Supply - 69% (95% CI: 64.1-73.6).

Conclusions. The evaluation of the IPC program at the level of the HCF in 2021-2022 in Donetsk and Luhansk regions showed that the majority of HCF had a basic (64%) or insufficient level of implementation of IPC (36% of institutions). Implementation of water, sanitation and hygiene services was at the level of 49,9-54,4% of the recommended level. The conducted assessment helped to form the priority directions of the development of the IPC program in HCFs, particularly in the context of post-war reconstruction.

The author declares no conflict of interest.

The significance of thrombophilia as a risk factor of fetal loss syndrome

S.V. Demianiuk — Sat, 28 Dec 2024 00:00:00 +0200

Despite significant advancements in modern obstetrics in understanding the factors contributing to perinatal loss and associated pathologies, the role of hemostatic disorders in pregnant women remains insufficiently studied.

Aim - to study the frequency and spectrum of thrombophilic disorders in patients with fetal loss syndrome (FLS).

Materials and methods. A retrospective cohort study was conducted involving 83 women of reproductive age (21 to 42 years; mean age: 30.86±5.02 years) with a history of fetal loss syndrome who sought medical care at obstetric and gynecological hospitals in Vinnytsia between 2017 and 2022. Reproductive function was studied: age at menarche, somatic, gynecological, and obstetric history, and the results of thrombophilia gene polymorphism studies. Genetic forms of thrombophilia were identified using the polymerase chain reaction (PCR) method. Statistical analysis of the data was performed using the "SPSS 21" software.

Results. Thrombophilia was identified in the majority of patients with fetal loss syndrome (66.3%), accounting for 63.3% of cases in patients with early miscarriages, 65% in late miscarriages, and 66.7% in cases of antenatal or early neonatal fetal death. The most common forms of thrombophilia in patients with FLS included heterozygous polymorphism of PAI-1 (43.6%), circulating antiphospholipid antibodies (34.5%), heterozygous mutation of Factor V (14.5%), and fibrinogen polymorphism (14.5%). It was determined that the most common form of thrombophilia among women with early miscarriages was antiphospholipid syndrome, whereas in women with late miscarriages, genetic forms of thrombophilia predominated.

Conclusions. Given the pathogenic role of genetic and acquired defects in the hemostatic system in the development of reproductive losses, women with a history of fetal loss syndrome should be screened for thrombophilia.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the author.

Modern approaches to the treatment of obstetric surgical wound infection in postpartum women

A.B. Рrуlutska, L.I. Martynova, О.L. Kisilenko, D.О. Govsіeіev — Sat, 28 Dec 2024 00:00:00 +0200

Aim - to determine the effectiveness of treating obstetric surgical wound infection in parturient women with drugs with both sorption-detoxification and immunomodulatory properties

Materials and methods. To achieve the goal of the study, 115 women in labor with purulent wounds of the anterior abdominal wall (after cesarean section) and perineum (episiotomy, perineotomy) were examined and treated, who, depending on the treatment method, were divided into groups. The Group I - 42 women in labor with purulent wounds, who were treated with the organosilicon sorbent Gentaxan (application sorption); the Group II - 45 women in labor with purulent wounds, who were treated with the organosilicon sorbent Gentaxan (application sorption) and the immunomodulator Laferon (intramuscularly); the Group III (control) - 28 women in labor with purulent wounds, who were treated with traditional methods. To determine the course and effectiveness of treatment of purulent wounds, the structure of biological media (blood, wound exudate) and substrate - biopsy from the wound in the solid phase, which were taken before, during (3, 5-6, 8-9 days) and after treatment.

Results. The analysis of crystallograms of blood smears and wound biopsy showed the advantage of complex treatment with gentaxane and laferon over monotherapy with gentaxane and traditional treatment methods, due to an additional reduction in the healing time of the wound (by 1.5 - 2 days; by 5-6 days), which allowed us to recommend it for use in the treatment of purulent wounds in obstetric departments.

Conclusions. Thus, complex therapy of purulent wounds with drugs with sorption-detoxification and immunomodulatory properties increases the effectiveness of treatment, accelerating the course of reparative processes in the wound, which prevents contamination of wounds of women in labor with hospital infection and further spread of the inflammatory process.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent of the parents of women in labor was obtained for the study.

The authors declare no conflict of interest.

Changes in the psychological state of pregnant women with an allogenic fetus due to communication with a perinatal psychologist

T.G. Romanenko, N.V. Yesyp — Sat, 28 Dec 2024 00:00:00 +0200

Aim - to determine psychological state changes of pregnant women with an allogeneic fetus after preventive and treatment measures performed by perinatal psychologist.

Materials and methods. The psychological state of 80 women participating in assisted reproductive technologies (ART) programs using donor oocytes with formation of allogeneic fetus was evaluated. They were divided into two groups: I - 40 women receiving pregravid and pregnancy management according to newly developed improved algorithm, II - 40 women whose management was carried out according to generally accepted algorithm. The improved algorithm included weekly meetings with perinatal psychologist working with cognitive-behavioral, body-oriented therapy techniques. The following questionnaires for psychological state assessment were offered: the Spielberger-Hanin questionnaire, a questionnaire for operative assessment of well-being, activity and mood, the Edinburgh Postnatal Depression Scale (EPDS).

Results. In the first group the proportion of women with high state anxiety level decreases significantly. The number of patients with high state and trait anxiety level in the third trimester, the EPDS score more than 9 points at 28 weeks of pregnancy and in postpartum period are lower in the first group compared to the second. Well-being and activity scores in second, third trimesters, mood scores in third trimester were significantly higher in patients of the first group compared to the second.

Conclusions. The implementation of psycho-corrective measures improves psychological state of pregnant women with an allogeneic fetus. Further research and implementation of effective methods are necessary.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the author.

Endocrine-immune factors in patients of reproductive age with hyperproliferative diseases of the uterus against the background of the threat of early abortion

O.V. Shevchuk, A.E. Dubchak, L.E. Tumanova — Sat, 28 Dec 2024 00:00:00 +0200

The main causes of adverse perinatal outcomes are miscarriage, placental dysfunction, gestosis, which are caused by hyperproliferative diseases of the uterus (HPD), past inflammatory diseases of the internal genital organs (IDIGO) and stress.

Aim - to study endocrine-immune factors in pregnant women with HPD and the threat of abortion in the first trimester of pregnancy.

Materials and methods. 64 pregnant women of reproductive age with HPD (uterine leiomyoma and adenomyosis) against the background of the threat of early abortion and past IDIGO before pregnancy (main group) were examined. The control group consisted of 30 pregnant women without HPD and no history of IDIGO. The cytokine profile was studied in the blood serum of pregnant women - TNFα, IFNγ, IL-8, IL-6, IL-4, the content of progesterone, prolactin and cortisol.

Results. In the first trimester of pregnancy, the average progesterone level in the main group was 13% lower than in the control group, which indicated a pronounced insufficiency of the function of the corpus luteum of pregnancy. An increase in cortisol and prolactin levels was also found, almost twice as high as in the control group (p<0.05). The TNFα/IL-4 ratio was almost 3 times higher than in the control group, and the IFNγ/IL-4 ratio was almost 2 times higher. IL-8 was increased in the main group almost twice as high, and IL-6 by 25.5% (p<0.05).

Conclusions. An increase in proinflammatory cytokines in pregnant women with HPD against the background of the threat of early abortion may indicate a shift in the cytokine profile in this pathology of pregnancy towards the inflammatory type and indicates a long course of IDIGO before pregnancy. Increased cortisol and prolactin may indicate a strain on the stress-realizing link of adaptive reactions in the conditions of martial law in Ukraine and may contribute to the threat of early abortion.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

The authors declare that there is no conflict of interest.

Features of pregnancy and childbirth in pregnant women with different vitamin D statuses

I.V. Poladych, D.O. Govsieiev — Sat, 28 Dec 2024 00:00:00 +0200

Vitamin D is an essential element for human health, and its deficiency has become a global concern, particularly among pregnant women. According to data, the prevalence of vitamin D deficiency reaches 58% in European countries, while in Ukraine, 81.8% of the population suffers from its deficiency. Vitamin D plays a critical role in pregnancy physiology, and its deficiency is associated with significant obstetric and perinatal complications.

Aim - to determine the vitamin D status of pregnant women and its role in the occurrence of gestational complications.

Materials and methods. The study, conducted at the Perinatal Center in Kyiv, aimed to assess the vitamin D levels in pregnant women and its impact on the development of obstetric complications. A total of 540 pregnant women were examined and divided into groups based on their vitamin D levels.

Results. Vitamin D deficiency was observed in 46.8% of pregnant women, insufficiency in 37.1%, and only 16.1% had optimal levels. Women with deficiency had an average vitamin D level of 15.48±2.69 ng/mL, while those with insufficiency had 24.32±3.68 ng/mL (p<0.05 compared to the deficiency group). Women with vitamin D deficiency more frequently suffered from gastrointestinal and musculoskeletal disorders, with the risk of musculoskeletal pathology being increased by 4.38 times (p<0.05). The study found that vitamin D deficiency significantly raises the risk of preeclampsia (58.1%), preterm birth (50.2%), and fetal growth restriction (32.9%). Women with normal vitamin D levels more often delivered vaginally (57.1%). Cesarean surgeries were more often encountered in women with vitamin D deficiency.

Conclusions. This study highlights the importance of timely diagnosis and correction of vitamin D deficiency in pregnant women to reduce the risk of adverse maternal and neonatal outcomes.

The study was conducted following the principles of the Declaration of Helsinki. The study protocol was approved by the ethics committee of the participating institution. Informed consent was obtained from all patients for the research.

The authors declare no conflict of interest.

Efficacy and safety of postoperative vaginal laser therapy in women with an implanted TVT-O sling for the treatment of stress urinary incontinence

Sat, 28 Dec 2024 00:00:00 +0200

Modern surgical treatment of stress urinary incontinence in women is sling surgery, the effectiveness of which ranges from 52% to 90%. The search for opportunities to improve the results of such surgical interventions remains a relevant direction in modern gynecology.

Aim - to study the effectiveness and safety in surgical treatment of using the transobturator location of the prolene loop TVT-Obturator (Tension Free Vaginal Tape - Obturator - TVT-О) combined with vaginal laser therapy in the postoperative period.

Materials and methods. The data of urination diaries and evaluations according to the ICIQ-SF questionnaire were compared in two representative groups of patients: in the I group, 28 women with stress urinary incontinence underwent plastic free synthetic loop (TVT), in the II group (n=30) - TVT-O was performed and vaginal laser therapy in the postoperative period. Statistical data processing was carried out using the SPSS 21 program.

Results. 2 years after surgery, objective cure and subjective improvement were found in 96.7% and 100% of women in the TVT-O group who received laser therapy in the postoperative period, which is significantly higher than 78.6% and 82.1% in the TVT group. A significant decrease in the average number of urinary incontinence episodes according to urination diaries and the average weight of pads was found.

When evaluating the subjective indicators, no statistically significant differences between the groups were found, however, according to the ICIQ-SF questionnaire, the frequency of improvement in the quality of life was significantly more frequent in the group of TVT-O and vaginal laser therapy.

Conclusions. When evaluating the results of treatment 2 years after the intervention, the effectiveness of TVT-O surgery, combined with postoperative vaginal laser therapy according to objective criteria, is statistically significantly higher than the effectiveness of TVT surgery.

No conflict of interest was declared by the authors.

Predicting the success of gestation in women of reproductive age

N.A. Rynda-Dziuryi, D.O. Govsieiev, O.L. Hromova, I.V. Sokol — Sat, 28 Dec 2024 00:00:00 +0200

Miscarriage is a fairly common complication in world medicine. A multidisciplinary approach to the diagnosis and treatment of miscarriage in the first trimester makes it possible to provide timely medical care and predict complications of the neonatal period and perinatal mortality.

Aim - to investigate the level of immunoglobulin G to the proteins HSP60 and GroEL in the blood serum of pregnant women in the first trimester, to conduct a comprehensive analysis of clinical and instrumental examinations of the course of pregnancy, predicting the risks of reproductive loss.

Materials and methods. Materials and methods. The study included 94 pregnant women in the first trimester. Serum sampling for anti-HSP60 and anti-GroEL antibodies was carried out at the first appearance. Pregnant women were divided into two groups. The first group included 33 pregnant women who had no previous pregnancy and childbirth complications at the time of application and in their history. The second group included 61 pregnant women who had a history of habitual miscarriages, the threat of termination of previous pregnancies, pathological childbirth, and at the time of blood donation, there was a threat of termination of pregnancy.

Results. The level of significance of the difference in the comparison groups differed in terms of anamnestic data (woman's age, total number of pregnancies, number of births and abortions). The ultrasound examinations confirmed a statistically significant difference between the groups in terms of fetal biometrics, chorionic location, myometrial structure and the presence of pathological echo inclusions, the state of the appendages and the length of the cervix. A dependence of an increase in anti-GroEL in the blood serum of pregnant women of the first trimester of gestation has been recorded.

Conclusions. The results of the study supported the assumption that the determination of serum levels of heat shock proteins in early pregnancy has diagnostic value and may play a role in determining the success of pregnancy prognosis. Markers of the risk of a complicated pregnancy are the age of the mother, the total number of pregnancies, the number of births and abortions. The risks of a complicated course of pregnancy increase with changes in fetal biometrics, disorders of the structure of the myometrium and chorion, the presence of pathological echo inclusions, and the state of the uterine appendages.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent was obtained from the patients for conducting the study.

The authors declare no conflict of interest.

Evaluation of the state of the endometrium depending on the method of pregnancy termination and post-abortion period management

Sat, 28 Dec 2024 00:00:00 +0200

Preserving women's reproductive health after early artificial abortion is an extremely relevant task for modern healthcare systems.

Aim - to investigate the functional state of the endometrium depending on the method of pregnancy termination and the peculiarities of post-abortion period management.

Materials and methods. A prospective controlled study was conducted involving 160 women aged 18 to 43 years who underwent either medical abortion (Group I) or pregnancy termination by vacuum aspiration (Group II). Each group was further divided into two subgroups of 40 women each. Women in subgroups IA and IIA participated in a therapeutic and rehabilitation program aimed at preserving reproductive health after pregnancy termination, while women in the subgroups IB and IIB (control) received standard post-abortion care. Transvaginal sonography was performed on days 1-3, 14 days after the abortion, and on days 20-24 of the subsequent menstrual cycle. One month after the abortion, CD138, a marker of chronic endometritis, was assessed in endometrial biopsy samples. Statistical analysis was performed using SPSS 21.

Results. Women experienced a decrease in endometrial thickness following pregnancy termination. It was found that a significantly lower proportion of women who participated in the proposed therapeutic and rehabilitation program had an endometrial thickness of less than 7 mm on days 20-24 of the next menstrual cycle after medical abortion and after vacuum aspiration. Furthermore, there was a significantly lower incidence of chronic endometritis among women who received the therapeutic and rehabilitation protocol after vacuum aspiration compared to the control subgroup: 1 case (2.5%) versus 6 cases (15.0%).

Conclusions. The results indicate that effective preservation of women's reproductive health after artificial abortion requires a comprehensive approach, including a clear diagnostic algorithm and pathogenetically substantiated treatment and rehabilitation measures.

No conflict of interest was declared by the authors.

Placenta previa: hospital observation or outpatient management

O.B. Yaroshchuk, N.V. Gerevich, D.O. Govsieiev — Sat, 28 Dec 2024 00:00:00 +0200

Women with placenta previa are at an increased risk of adverse maternal, fetal, and neonatal outcomes, including antepartum and intrapartum hemorrhage, necessitating urgent surgical delivery, often before fetal maturity. Optimizing the management algorithm considering risk factors for obstetric complications has the potential to improve maternal and neonatal outcomes.

Aim - to identify and analyze risk factors for antepartum hemorrhage to justify the timing of planned hospitalization.

Materials and methods. A retrospective analysis of 21,390 birth histories of pregnant women between 22 and 41 weeks of gestation at the Municipal Non-Profit Enterprise "Perinatal Center of Kyiv". The study considered a history of uterine surgeries, including cesarean section, pregnancy resulting from assisted reproductive technologies, placental location, and previous childbirth history.

Results. The presence of prior uterine surgeries, including cesarean section, as well as anterior placental location, increases the risk of placenta accreta, antepartum hemorrhage, and urgent preterm delivery.

Conclusions. Based on the analysis, specific risk factors were identified, allowing differentiation between pregnant women who, without a high risk of complications, can be monitored on an outpatient basis and those for whom inpatient management is preferable.

No conflict of interest was declared by the authors.

Impact of alcohol abuse and stress on vaginal microbiota in women with sexually transmitted infections: a microbiological and behavioral study

Sat, 28 Dec 2024 00:00:00 +0200

Aim - to assess the impact of alcohol consumption and stress on the vaginal microbiota in women with sexually transmitted infections (STIs).

Materials and methods. The study involved 60 women with diagnosed STIs and alcohol dependence, divided into three groups according to stress level (high, medium, low), along with a control group of 30 healthy women. Upon first mention, terms were spelled out (for example, sexually transmitted infections (STIs)), and thereafter only abbreviations were used. Vaginal swabs were cultured on differential diagnostic media to detect bacteria and fungi. Using standard microbiological methods, quantitative parameters of beneficial lactic acid bacteria Lactobacillus spp. and pathogenic microorganisms, in particular Staphylococcus aureus, Candida spp. fungi, and various enterobacteria, were determined. Data were statistically processed using Microsoft Excel.

Results showed that women with high stress levels and intensive alcohol consumption exhibited a significant increase in pathogenic bacteria and fungi accompanied by a notable depletion of protective lactobacilli. The reduction in Lactobacillus spp. count correlated with an increased susceptibility to bacterial vaginosis and other infections. With a reduction in stress levels, dysbiosis indicators decreased, although they still differed from the healthy state.

Conclusions. The obtained data indicate the combined negative impact of alcohol and stress on the vaginal microbiota, highlighting the need to develop targeted measures aimed at preventing and correcting dysbiosis. A comprehensive approach is proposed, including stress management, reduction in alcohol consumption, and the use of probiotics to restore a normal microbiota.

The authors declare no conflict of interest.

Optimization of recurrent respiratory infections prevention in preschool children

O.M. Voloshin, Yu.V. Marushko, I.I. Savchenko, I.O. Kashtan — Sat, 28 Dec 2024 00:00:00 +0200

Recurrent respiratory infections (RRIs) have been, are, and will likely remain a significant challenge in pediatric practice.

Aim - to evaluate the efficacy of the use of bacterial lysate (BL), mineral complex (MC) and symbiotic (SB) for the prevention of RRIs in preschool children.

Materials and methods. The prospective study included 60 children aged 30-42 mos. They had 6 or more episodes of acute respiratory infection (ARI) within the previous year. All the children were divided into a control group (CG, n=30) and an experimental group (EG, n=30). The CG included patients who did not receive any medications to prevent RRI. The EG consisted of children who were prescribed BL, MK and SB according to the original regimen for 3 mos. The results of the study in CG and EG were analyzed at 6 and 12 mos. after the start of the study according to the following criteria: 1) the number of ARI episodes and 2) the total severity score (TSS) of RRIs. Statistical processing of the obtained data was performed using IBM SPSS Statistics 28 software.

Results. The use of BL, MK and SB in preschool children was associated with a marked reduction in the number of ARI episodes during the first 6 mos., as well as a significantly lower the total severity score of RRIs during 12 mos. The calculation of χ² and φ_c coefficients showed an average degree of positive effect of the mentioned prophylactic agents on the accounting clinical indicators. Besides, the odds ratio showed that the use of this prophylactic complex in patients was associated with a 5-fold and 3.6-fold reduction in the probability of their belonging to the subgroup with more frequent ARI episodes after 6 mos. and 12 mos., respectively.

Conclusion. The applied prophylactic complex can be recommended both for children who have previously experienced a recurrent course of ARIs and those with a high susceptibility to such a course, especially in preschool age.

The study was conducted in accordance with the principles of the Declaration of Helsinki.

The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. An informed parental consent was obtained for the study in children.

No conflict of interests was declared by the authors.

Evaluation of postvaccination reactions after simultaneous administration of vaccines against different infections

A.M. Pugach, A.V. Bondarenko — Sat, 28 Dec 2024 00:00:00 +0200

Aim - to evaluate the course of the postvaccination period after the simultaneous use of different vaccines in different combinations.

Materials and methods. The study was conducted from January 2020 to October 2023. The records in the logs of post-vaccination reactions after immunization, made according to the data of routine monitoring of the child's condition after vaccination, were analyzed. Were selected 690 children for the analysis, divided into groups depending on the combination of different vaccines during the vaccination cycle and the first revaccination.

Results. Most children in all study groups had a complaint-free post-vaccination period (60-94%). Although, according to the results of comparing postvaccination reactions in the case of combinations with different vaccines, differences were observed, but statistically unreliable. The simultaneous administration of vaccines against different infections in one visit was not accompanied by an increase in postvaccination reactions, but rather by a decrease.

Conclusions. The number of simultaneously administered vaccines against different infections does not affect the frequency and severity of postvaccination reactions. The simultaneous administration of vaccines against different infections in one visit is not accompanied by an increase in postvaccination reactions, therefore it is justified, which contributes to the observance of optimal dose intervals and maximum protection of the child within the regulated time.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the Shupyk National University of Health of Ukraine. The consent of each patient, parent or guardian was obtained for the processing of personal data.

The authors declare no conflict of interest.

Analysis of risk factors and their effects on the early neonatal period of newborn infants from mothers who had COVID-19 during pregnancy

O.V. Vorobiova, O.O. Melnyk, Yu.V. Marushko — Sat, 28 Dec 2024 00:00:00 +0200

Аim - to determine the leading ante-, perinatal factors of risk and assess their impact on postnatal adaptation during the early neonatal period in newborns from mothers with COVID-19 at different periods of pregnancy.

Materials and methods. 141 histories of labor and newborn development charts of the State Institution of Ukrainian Center of Maternity and Childhood of the National Academy of Sciences of Ukraine, were retrospectively analyzed 2021-2023. The main study group included children (n=116) from mothers with COVID-19 in the 1-3 trimesters of pregnancy (subgroups I-III), the control group consisted of 25 healthy newborns. Anamnestic, clinical, laboratory and instrumental examinations were evaluated.

Results. All pregnant in the main group had complications during pregnancy, regardless of the time of COVID-19 infection, p<0.001. The leading ante-, perinatal factors were kidney disease, p=0.021, the presence of bacterial vaginosis, p<0.001 in women's anamnesis; long anhydrous period ˃12h in subgroups III (25.6%) and II (16.7%), p=0.011; contaminated amniotic fluid, p=0.019; fetal distress, p=0.002; the premature labor, p=0.005; placental dysfunction, p=0.050. Disorders of daptation were more found in boys, p=0.049. In the examined subgroups, the most frequent disruption of the course of early adaptation was in newborns whose mothers had become ill during the 1 and 3 trimesters of pregnancy, every 3 children from these subgroups required observation or treatment. The following postnatal adaptation disorders were often noted: respiratory distress, intrauterine pneumonia, cardiopathies, neonatal encephalopathies, infectious changes of organs.

Conclusions. Identification of the risk factors and their impact on the course in newborns from mothers with COVID-19 will allow timely prediction of the condition of children's risk from birth, timely correction of potential adaptation disorders using modern strategies to prevent the implementation of short and long-term complications in infants.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the ethics committee for all participants in the process. Informed consent was obtained from the parents for the participation of newborns.

No conflict of interests was declared by the authors.

A rare case of polyneoplasia of giant Brenner's tumour and pancreatic adenocarcinoma

Sat, 28 Dec 2024 00:00:00 +0200

Brenner's tumours (mucoid fibroadenomas) are rare ovarian epithelial tumours, the incidence of which among ovarian epithelial neoplasms is 1-5%, and among all ovarian tumours - 1.4-2.5%. Their histogenetic origin is not fully understood, but it is believed that they originate from parovarian Walthard's nests. In 30% of cases, mucoid fibroadenomas are associated with other ovarian tumours. Malignant Brenner's tumours, characterised by decreased cellular differentiation, uncontrolled growth with invasion and destruction of neighbouring structures, are an even rarer and more unpredictable scenario faced by gynaecologists and oncologists. The diagnosis of this disease is difficult due to the lack of specific clinical, laboratory and imaging signs. As with any other epithelial ovarian tumours, the main treatment for Brenner's tumours is surgery.

Aim - to analyze a clinical case of polyneoplasia of Brenner's tumour and pancreatic adenocarcinoma

Clinical case. The clinical case of surgical intervention for right ovarian cyst in a 55-year-old patient is described. Pathological examination revealed that the removed neoplasm was a Brenner's tumour with the formation of a multicompartmental smooth-walled cyst lined with a single-layer metaplastic mucinous epithelium without signs of proliferation. The malignant nature of the tumour was diagnosed on the basis of morphological confirmation of implantation metastasis of the glandular component of the ovarian tumour into the parietal peritoneum of the anterior abdominal wall. The peculiarity of this case is polyneoplasia, namely the development of pancreatic tail adenocarcinoma and abdominal carcinomatosis, diagnosed 17 months after the initial surgical intervention for Brenner's tumor.

Conclusions. Brenner's tumour is a rare clinical entity in gynaecological oncology practice. Despite the fact that the vast majority (93-95%) of such mucoid fibroadenomas are benign, the likelihood of malignancy should be carefully assessed and tumor markers should be used in preoperative examination of patients, surgical staging should be performed during surgery, immunohistochemical examination should be used, especially in cases of large tumours. It should also be remembered that Brenner's tumours can be associated with malignant neoplasia of other localisation.

This study did not involve any experiments on animals or humans. Written informed consent for treatment and publication of this case was obtained from the patient.

No conflict of interests was declared by the authors.

Clinical and diagnostic significance of homocysteine metabolism disorders in pregnancy complications in a woman with severe preeclampsia combined with extragenital pathology (а case report)

T.T. Naritnik, O.Yu. Kostenko, O.B. Malanchuk, I.A. Dukmas, D.O. Govsieiev — Sat, 28 Dec 2024 00:00:00 +0200

The relevance of studying homocysteine (Hcy) metabolism disorders lies in their significant impact on maternal and perinatal health, especially in pregnancy complications such as preeclampsia (PE) and diabetes mellitus (DM).

Aim - to evaluate the clinical and diagnostic significance of Hcy metabolism disorders in pregnancy complications in a woman with severe PE combined with DM.

Clinical case. A 35-year-old pregnant woman with chronic arterial hypertension, type II diabetes, and class III obesity. Her obstetric history includes two pregnancies ending in preterm labor (at 30 and 26 weeks), placental dysfunction, intrauterine growth restriction, cesarean section, and perinatal death. Genetic testing revealed homozygous mutations in the SERPINE1 and ITGA2 genes, heterozygous mutations in the ITGB3 gene, homozygous mutations in the methionine synthase reductase (MTR) gene, and heterozygous mutations in the methylenetetrahydrofolate reductase (MTHFR) gene. Anti-phosphatidylserine antibodies were detected. Morphological and histological examination confirmed disturbances in the placental blood circulation system.

Conclusions. Homocysteine metabolism disorders are significant risk factors for both severe PE and vascular complications in pregnant women with DM. Genetic mutations, such as homozygous MTR and heterozygous MTHFR mutations, may contribute to pregnancy complications. Mutations in the SERPINE1, ITGA2, and ITGB3 genes increase the risk of thrombophilia, which, in the context of Hcy metabolism disorders, can worsen pregnancy outcomes. Histological findings confirm that thrombophilia resulting from Hcy metabolism disturbances adversely affects the uteroplacental blood circulation, leading to intrauterine growth restriction.

The authors declare no conflict of interest.