Репозиторий Университета

© 2020 Objective: The association between the most severe types of placenta accreta spectrum disorders and caesarean scar pregnancy (CSP) poses the question of whether early diagnosis may impact the clinical outcome of these anomalies. The aim of this study is to report the outcome of cesarean scar pregnancy (CSP) diagnosed in the early (≤9 weeks) versus late (>9 weeks) first trimester of pregnancy. Study design: Medline, Embase and Clinicaltrail.gov databases were searched. Studies including cases of CSP with an early (≤9 weeks of gestation) compared to a late (>9 weeks) first trimester diagnosis of CSP, followed by immediate treatment, were included in this systematic review. The primary outcome was a composite measure of severe maternal morbidity including either severe first trimester bleeding, need for blood transfusion, uterine rupture or emergency hysterectomy. The secondary outcomes were the individual components of the primary outcome. Random-effect meta-analyses were used to combine data. Results: Thirty-six studies (724 women with CSP) were included. Overall, composite adverse outcome complicated 5.9 % (95 % CI 3.5−9.0) of CSP diagnosed ≤9 weeks and 32.4 % (95 % CI 15.7−51.8) of those diagnosed >9 weeks. Massive hemorrhage occurred in 4.3 % (95 % CI 2.3−7.0) of women with early and in 28.0 % (95 % CI 14.1−44.5) of those with late first trimester diagnosis of CSP, while the corresponding figures for the need for blood transfusion were 1.5 % (95 % CI 0.6−2.8) and 15.8 % (95 % CI 5.5−30.2) respectively. Uterine rupture occurred in 2.5 % (95 % CI 1.2−4.1) of women with a prenatal diagnosis of CSP ≤ 9 weeks and in 7.5 % (95 % CI 2.5−14.9) of those with CSP > 9 weeks, while an emergency intervention involving hysterectomy was required in 3.7 % (95 % CI 2.2−5.4) and 16.3 % (95 % CI5.9−30.6) respectively. When computing the risk, early diagnosis of CSP was associated with a significantly lower risk of composite adverse outcome, (OR: 0.14; 95 % CI 0.1−0.4 p < 0.001). Conclusions: Early first trimester diagnosis of CSP is associated with a significantly lower risk of maternal complications, thus supporting a policy of universal screening for these anomalies in women with a prior cesarean delivery although the cost-effectiveness of such policy should be tested in future studies.

© 2019 Elsevier Ltd The aim of the study was to investigate the content and distribution of fucosylated sugar residues and Lewis Y (LeY) in the endothelial glycocalyx (eGC) in placental tissue at early and late onset fetal growth restriction (FGR). Our findings demonstrated that the changes of the fucosylated glycans of type 2 (H2)/LeY in the vascular endothelium of the villi may reflect alteration of villi maturation, or adaptation to hypoxia through the change of cell proliferation potential and induction angiogenesis. Early onset FGR differs from late onset FGR by a markedly increased LeY expression, being associated with more severe pathological state.

© 2018 Dynasty Publishing House. All rights reserved. Exosomes (vesicles with the size of 30-150 nm) are formed in multivesicular bodies (MVB) by invagination of early endosome membranes and mediate intercellular interactions. Exosomes are secreted by various kinds of cells, their content might be represented by proteins, lipids and nucleic acids, which reflect the functional state of donor cells. The effect of exosomes on recipient cells depends on their quantity and characteristics of their «load». Comparatively recently, placental exosomes secreted by various placental cells have been isolated from blood of pregnant women. A specific protein - placental alkaline phosphatase (PLAP) - has been determined for these exosomes. PLAP-positive exosomes can be found in maternal blood as soon as in the first trimester of pregnancy, their number increases with maturation of the foetus and reaches its maximum by the moment of birth. Although the functional significance of placental exosomes is still investigated, some authors relate changes in the placental exosome profile (their number and composition) to placental dysfunction underlying the development of complications of pregnancy. Isolation of exosomes from blood of pregnant women (fluid biopsy) and determination of their biological characteristics might be regarded as early noninvasive diagnosis of structural and functional placental abnormalities. The appearing evidence of blastocyst-secreted exosomes and their role in modulating maternal immunity and endometrial receptiveness during implantation are also promising. The review presents data about the biogenesis, structure and functions of exosomes and the role of placenta-associated exosomes in the development of physiological and complicated pregnancy, and also about the possibility of using exosomes as a marker of the state of the blastocyst in assisted reproductive technologies, in particular, in oocyte donation and surrogate motherhood.

© 2018, Bionika Media Ltd. All rights reserved. Aim. To investigate the clinical features of the course and outcomes of pregnancy and placental morphology in HIV-infected pregnant women. Material and methods. This study is a retrospective analysis of 29 pregnant women. The study group comprised 14 pregnant women with antenatal human immunodeficiency virus infection. Fifteen women with a physiological course of pregnancy made up a control group. The mean age of patients in the study and control group was 28.0 ± 2.6 and 21.1±2.3 years, respectively. The analysis included gynecological history, the course of pregnancy and childbirth, and perinatal outcomes of newborns. The morphological study of placenta included macroscopic and histological examinations, and immunohistochemical studies using antibodies targeting CCR5 receptors. Results. Pregnant women in the study group had a gynecological history of sexually transmitted infections. The most frequent complications of the second and third trimesters of pregnancy were anemia (78.6%), the threatened preterm birth (35.7%), and preeclampsia (28.6%). Complications of labor were premature rupture of membranes (35.7%) and uncoordinated uterine activity (14.3%). Placental morphology showed signs of inflammation and hypoxia. Immunohistochemical studies identified a higher expression of CCR5 in chorionic villi. Conclusion. The findings indicate increased levels of CCR5 expression and the development of chronic placental insufficiency in HIV-infected pregnant women, which indicates the need for dynamic monitoring of this group of patients.