Wiadomosci Lekarskie

Wiadomosci
Lekarskie
Czasoplsmo Polskiego Towarzystwa Lekarskiego
TOMLXIX, 2016, Nr 3 (cz. II)
Pam ifd
dra Wtadyslawa
Biegariskiego
Rok zalozenia 1928
Aluna Publishing
Wiadomosci
Lekarskie
Pohznictwo i ginekologia
Prof, dr hab. med. Jan Kotarski
Redaktor naczetny
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(SUM Katowice)
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Stomatologie)
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(UM Lublin)
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Polskie Towarzystwo Lekarskie
dr n. med Lesia Rudenko
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Rada naukowa
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Chirurgia
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(University of Illinois USA )
Choroby wewnetrzne
Prof, dr hab. med. Ryszarda Chazan, pneumonologia i alergologia
(UM Warszawa)
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(CM UJ Krakow)
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(SUM Katowice)
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(Prezes Hotiorowy PTL)
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Index Copernicus, PBL, Scopus
Wiadomosci Lekarskie 2016, tom LXIX, nr 3 (cz. Ilj
© Aluna
SPISTRESCI
PRACE ORYGINALNE/ORYGINAL PAPERS
Iwona Marika-Gaca, Beata tabuz-Roszak- Agnieszka Machowska-Majchrzak, Zbigniew Kalarus, Beata Sredniawa, Krystyna Pierzchala
interictal heart rate in patients with epilepsy
t z f sfosc akcji serca a diorych na p a d a ak f w okresie migdzynapadowym
443
Monika Bgk-Sosnowska, Sebastian Kolodziej, Krzysztof Gojdz, Violetta Skrzypulec-Piinta
Zachowania zdrowotne polskich lekarzy
Health behavior of Polish physicians
449
Алексей В. Богданов, Юлия М. Гришко, Виталий А. Костенко
Механизмы дизрегуляции нитроксидергичной сиаемы в тканях пародонта крыс при избыточном
поступлении нитрата и фторида натрия
Mechanisms of nltroxide-ergic deregulation in tissues of parodontium in rats under combined excessive
sodium nitrate and fluoride intake
457
Maryna I. Omytrenko, Vira D. Kuroiedowa
Electromyographic characteristic of orbicularis oris in patients with dental crowding in permanent occlusion
462
Лариса Ф. Матюха, Тетяна А. Титова, Тетяна М. Бухановська, Богдан 0. Смаль
Український досвід медичної допомоги пацієнтам з цукровим діабетом
Ukrainian experience o f health care fo r patients with diabetes
465
Alla B. Guryeva, Vilyuya A. Alekseyeva, Palmira G. Petrova
Characteristics of the anthropometric measures and biological age of girls
ofyakut ethnicity depending on tanner's index
471
Natalia I. Chekaiina, Yuri M. Kazakov, Tatyana V. Mamontova, Ludmila E. Vesnina, Igor P. Kaidashev
Resveratrol more effectively than quercetin reduces endothelium degeneration and level
of necrosis factor a in patients with coronary artery disease
475
Nicholay A. Shcherbina, Liudmyla A.Vygovskaya
Ultrasonographic peculiarities of fetoplacental complex in pregnancy complicated by intrauterine infection
480
Agata Kornek, Alicja Kucharska, Katarzyna Kamela
A n a iiza profiiu kwasow ttuszczowych dietywegetarian і niewegetarian w kontekscie profiiaktyki
wybranych chorob dietozaleznych
Analysis of the fa tty acid profile of vegetarian and non-vegetarian diet in the context
o f some diet-related diseases prevention
483
439
Wiadomosci Lekarskie 2016, tom LX1X, nr 3 (cz. il)
© Aluna
Ultrasonographic peculiarities of fetoplacental complex
in pregnancy complicated by intrauterine infection
Nicholay A. Shcherbina, Li ud my la A, Vygovskaya
KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
ABSTRACT
in t r o d u c t io n : th e relevance o f in tra u te rin e in fe ctio n s is de te rm in e d by sig n ific a n t p e ri- and po stnatal loss as w e ll as h e a lth im p a irm e n t, w h ich o fte n results
in d is a b ility and reduced q u a lity o f life . U ltraso nograp hy is em ployed in order to p rovide a re liab le assessm ent o f th e fu n c tio n a l state o f th e fetoplace ntal
system secondary to in tra u te rin e fe ta l infe ctio n in th e course o f pregnancy. U ltrasound im a g in g is essential in diagnosis o f various p re d in ica l co m p lica tion s o f
pregn ancy and d e te c tio n o f a b n o rm a litie s in th e de ve lo p in g fetus.
T h e a im o f th e stu d y was to p e rfo rm u ltrasono gra phic assessm ent o f fe to p la ce n ta l co m p le x in pregnancy co m plicated by in tra u te rin e in fe ctio n .
M a te r ia ls a n d m e th o d s : th e stu d y involved 30 4 p re g n a n t w o m e n w h o u n d e rw e n t u ltrasono gra phic and b a cteriolog ical so m a to genic e x a m in a tio n . The
w o m e n w ere divid e d into th e fo llo w in g groups depend in g on th e presence and na tu re o f th e diagnosed in fe ctio n ; Group 1 - 50 pa tie n ts w ith n o rm a l pregnancy,
w h o w ere n o t fo u n d to have signs o f in fe ctio n (control group ), Group 2 - 50 p re g n a n t w o m e n w ith vira l in fe ctio n s (CMV and herpes sim plex virus) : Group 3 - 5 0
p re g n a n t w o m e n w ith bacteria! in fections (chlam ydia, ureaplasm a, m ycoplasm a), Group 4 - 1 5 4 pa tie n ts w ith m ixed vira l and ba cterial infections. Clinical
groups w ith in tra u te rin e in fe ctio n s (IUI) w ere considered m ain ones.
R e s u lts : increased ech o g e n icity o f th e e n d o th e liu m o f intern al and provisional organs was considered to be th e m ain ultra so n o g ra p h ic sign o f in tra u te rin e fe ta i
infections as these changes w ere equally observed in pregn ant w om en o f th e m ain group. M ain sym ptom s o f viral infections included ventriculom egaly, hypoplasia
o f th e chest, echogenic fib ro u s inclusions in th e p a p illa ry m uscles and valve flaps, he patom egaly, placental hypoplasia, olig o h yd ra m n io s. D olichocephalic skull,
ch oro id plexus cysts, gastrom egaly, placental calcifications, po lyh yd ra m n io s w ere m ore co m m o n in bacterial infections. Pregnant w o m e n w ith m ixed viral and
bacteria! in fe ctio n s w ere fo u n d to have those and o th e r signs o f in fe c tio n in equal m easure.
C o n c lu s io n : u ltra s o n o g ra p h ic so m a to genic e x a m in a tio n is o f g reat dia g n o stic im p o rta n ce in p re dinica l diagnosis o f in tra u te rin e in fe ctio n . T im e ly de te ction
o f changes in fe tu s an d pro visio n a l organs provides a d iffe re n tia te d approach to a d m in is tra tio n o f p a th o g e n e tic a lly ta rg e te d tre a tm e n t o f th is group o f
pa tients.
K e y w o r d s : pregnancy, in tra u te rin e in fe ctio n , u ltrasono gra phic so m a to genic e x a m in a tio n , fetop la ce n ta l com plex.
W ia d L e k 2 0 1 6 , 6 9 , 3 (cz. II) , 4 8 0 -4 8 2
IN T R O D U C T IO N
An increase in the incidence of intrauterine infections in
both obstetric and perinatal practice has been observed recently.
Intrauterine infections remain a major challenge not only for
obstetricians, perinatologists and pediatricians, but for health
care in general, as they are one of the main causes of perinatal
m orbidity and m ortality [1]. Intrauterine infections largely
determine the level of infant mortality, accounting for 11 -45%
of perinatal loss [2]. The significance of intrauterine infections
is firstly stipulated by a considerable level of peri - and postnatal
mortality, and secondly, by disorders which often result in disability
and reduced quality of life.
Intrauterine infection is the cause of the entire range of
antenatal abnorm alities, particularly infectious diseases of
the fetus, intrauterine growth delay, malformations, stillbirth,
miscarriage, development o f fetoplacental insufficiency'' [3].
Recently7 scientists have placed greater focus on the study7 of
intrauterine infection as an etiological factor in the development
of fetoplacental insufficiency [4].
Intrauterine infection is accompanied by an im pairm ent
of placental membranes and deposition of immune complexes
480
in tissues, triggering disintegration of the functional system
“m other-placenta-fetus”, disruption of redox processes and
development of placental insufficiency [5]. Placental dysfunction
in exposure to microbial toxins and their metabolites triggers
the development of fetal hypotrophy, reducing its resistance to
infectious agents [6,7].
Ultrasonographic examination is perform ed for a reliable
assessm ent o f the functional state of fetoplacental system
against the background of in tra u terin e fetal infection in
the course of pregnancy. Despite the absence of definitive
u ltra so n o g ra p h ic c rite ria o f in tra u te rin e in fectio n ,
ventriculomegaly, hyperechogenk endothelium of the intestine,
increased echogenicity7of placenta, expansion of intervillous
space, oligohydram nios, polyhydram nios an d congenital
m alform ations are considered the m ost inform ative indices.
U ltrasound imaging gives a possibility to provide predinical
diagnosis of various com plications of pregnancy and fetal
abnorm alities as well as to identify echographic m arkers
of in tra u terin e infection, signs an d severity of placental
insufficiency, necessary for early treatm ent and determination
of therapeutic approach in each case.
U ltraso nograp hic p e culiaritie s o f fe to p la ce n ta l co m p le x in pregnancy co m p lica te d by in tra u te rin e infection
T H E A IM O F T H E S T U D Y
To perform ultrasound assessment of fetoplacental complex
in pregnancy complicated by intrauterine infection.
M A T E R IA L S A N D M E T H O D S
Tlie study implied examination of 304 pregnant women using
bacteriological and ultrasonographic somatogenic methods.
Infectious pathogens were identified by bacteriological and
virological studies, as well as polymerase chain reaction. As
a result of examinations, patients were divided into 4 groups
depending on the presence and nature of the infection. Group 1
included 50 patients with norma! pregn ancy who were not found
to have signs of infection. This group was the control one. Group
2 comprised 50 pregnant patients with viral infections (CMV
and herpes simplex virus); Group 3 involved 50 pregnant women
Table 1. Changes in th e
with bacterial infections (chlamydia, ureaplasma, mycoplasma)
and Group 4 amounted for 154 patients with mixed viral and
bacterial infection. The groups of patients with intrauterine
infection (IUI) were considered main ones. Ultrasonographic
somatogenic study was conducted using MINDRAY DC-8
ultrasound scanner.
Statistical data were processed using general-purpose software
system Statistica for Windows version 6.1 (Russified version).
RESULTS A N D D IS C U S S IO N
Ultrasonographic somatogenic findings in pregnant women
of both control and main groups corresponded to the data
of fetal nomograms elaborated by E.A.Yakovenko (1994) [8].
Control group patients were not found to have any changes in
the internal and provisional organs.
in te rn a l and provision al organs in w o m e n o f th e m a in group (absolute n u m b e r
Ultrasonographic findings
----------
(%±A), w he re A- error % )
Main clinical group
:• (n -50)
1 (n—50)
+/
-:!
w ,;,
** '
3{o=154)
Fetal head and brain structures
Increased e c h o g e n icity o f th e v e n tric u la r system
26 (52±7.1)
35 (70±6.5)
42 (84±5.2)
38 (76+6)
14(28±6.3)
39 (78±5.9)
14(9±2.3)
16(10+2.5)
45 (29±3.7)
C horoid plexus cysts
-u n ila te ra l
-b ila te ra l
11 (22±5.9)
5(10+4.2)
22 (44±7.0)
16 (32±6.6)
18 (12±2.6)
12 (8±2.2)
41 (82±5.4)
36 (72±6.3)
7 (14±4.9)
38 (76±6.0)
22 (44±7.0)
18 (36±6.8)
10 (20±5.7)
36 (72±6.3)
36 (23+3.4)
30 (19±3.2)
14 (9±2.3)
46(30+3.7)
27(54+7.0)
15 (30±6.5)
38 (25+3.5)
N ep hro m e galy
11 (22±5.9)
31 (62+6.9)
24 (48±7.1)
14 (28±6.3)
10 (20±5.7)
20(40+6.9)
19(38±6.9)
17 (34±6.7)
46 (30±3.7)
31 (20±3.2)
23 (15±2.9)
Pyelectasis
-u n ila te ra l
-b ila te ra l
5 (10±4.2)
19 (38±6.9)
7 (14±4.9)
16 (32±6.6)
24(16±2.9)
32 (21±3.3)
32 (64±6.8)
30 (60+6.9)
73 (47±4.0)
19 (38±6.9)
36 (72±6.3)
42 (84±5.2)
33 (66±6.7)
44 (88±4.6)
40 (80±5.7)
45 (29±3.7)
62 (40±4.0)
73 (47±4.0)
37 (74±6.2)
H ypoplasia o f placenta
29 (58±7.0)
23 (46±7.0)
H yperplasia o f placenta
-
Expansion o f in te rv illo u s space
16 (32±6.6)
26 (52±7.1)
17 (34±6.7)
10(20±5.7)
21 (42±7.0)
24(48±7.1)
14(28±6.3)
41 (27+3.6)
46 (30±3.7)
40 (26±3.5)
52 (34+3.8)
69 (45±4.0)
28 (18±3.1)
D olichoceph alic skull
V e n tric u lo m e q a ly
Chest
H ypoplasia o f th e chest
H ypoplasia o f th e lungs
C ardiom egaly
Increased e c h o g e n icity o f th e lungs
Echogenic fib ro u s inclusions in p a p illa ry m uscles
and va lve leaflets
Abdom en
H ypoplasia o f th e ab dom en
H ep ato m egaly
Perivascular in filtra tio n o f th e liv e r
increased e c h o g e n icity o f th e pelvicalyceal system
and renal parenchym a
G astrom egaly
Increased e c h o q e n id ty o f ga stric contours
Increased e c h o g e n icity o f th e inte stin e
-
Provisional organs
Increased e c h o g e n icity o f placenta
C alcifications o f placenta
E nlargem en t o f sinuses o f th e basal veins
-
481
N lchoiay A, Shcherbina, Liu d m yla A, Vygovskaya
Main group patients had changes in the internal and provisional
organs and changes in the am ount of amniotic fluid (Table I).
In the assessment of ultrasound data on the amount of amniotic
fluid, oligohydramnios was diagnosed in cases when numerical
values of the amniotic index were below the 5thpercentile. The
depth of the largest amniotic fluid pocket in this case was less
than 2 cm. Polyhydramnios was characterized by an increase in
numerical values of the amniotic fluid index by more than 97.5
percentile, and the depth of the largest amniotic fluid pocket
by more than 8 cm. Thus, the patients under investigation were
most frequently found to have oligohydramnios - in 42% of cases
in Group 2 with viral urogenital infections and up to 28% in
Group 3 (mixed infections). Alternatively, polyhydramnios was
observed in 40% and 26% in the group with bacterial infections
(Group 3) and mixed type (Group 4), respectively.
Increased echogenicity of the endothelium in provisional and
internal organs was considered to be the main ultrasonographic
sign of intrauterine fetal infection as it was equally common
in pregnant women of the main group. Such ultrasound signs
as increased echogenicity of the endothelium in internal and
provisional organs, ventriculomegaly, choroid plexus cysts,
hepatomegaly, gastromegaly, nephromegaly, pyelectasis were
observed in the same patient.
Tire main symptoms of viral infections included ventriculomegaly,
hypoplasia of the chest, echogenic fibrous inclusions in the
papillary muscles and valve leaflets, hepatomegaly, hypoplasia of
placenta, oligohydramnios. Dolichocephalic skull, choroid plexus
cysts, gastromegaly, calcifications in placenta, polyhydramnios
were more com mon in bacterial infections. Pregnant women
with mixed viral and bacterial infections were equally found
to have these and other signs of infection.
C O N C L U S IO N
Ultrasonographic somatogenic study has a high diagnostic
value in preclinical diagnosis of intrauterine fetal infections.
Timely detection of changes in the fetus and provisional
organs gives a possibility to provide differentiated approach
to adm inistration of pathogenetically targeted treatm ent of
these patients.
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ADDRESS FOR CORRESPONDENCE
Liudmyla A. Vygovskaya
[email protected]
+380509675487
Nadestano: 11.04.2014
Zaakceptowano: 26.07.2016
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