CESAREAN SECTION IN CASES OF STRESS-COMPROMISED PREGNANCY IN WOMEN WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA.

OBJECTIVE: The aim: Assessment of abdominal delivery by cesarean section in preterm pregnancies in women with undifferentiated connective tissue dysplasia. PATIENTS AND METHODS: Materials and methods: Analyzed were 3,371 cases of cesarean section deliveries in preterm pregnancies complicated by undifferentiated connective tissue dysplasia (UCTD). Based on a scoring assessment of external and visceral UCTD markers, three groups were identified: Group 1 included 466 patients with no signs of UCTD, Group 2 consisted of 798 patients with mild UCTD, and Group 3 comprised 2,107 patients with moderate to severe UCTD. The severity of connective tissue dysplasia manifestations was assessed based on external and internal signs of connective tissue dysplasia, as well as gynecological and obstetric history, indications for abdominal delivery in preterm pregnancies, and maternal and perinatal outcomes of the deliveries. RESULTS: Results: It has been established that in 71.4% of patients with stress-compromised pregnancies resulting in preterm birth and delivered by cesarean section, the most common indications were: inability of the uterine scar in 23.8%, breech presentation of the fetus in 19.1%, and detachment of the normally placed placenta in 4.9%. An unfavorable factor was moderate to severe connective tissue dysplasia, which led to a 5-fold increase in the likelihood of requiring a cesarean section. In addition, severe hypoxia in newborns was significantly more frequently observed in the first minutes of life in cases of moderate and severe UCTD. CONCLUSION: Conclusions: The conducted studies have shown that cesarean sections in cases of stress-compromised pregnancies resulting in preterm birth are performed significantly more often in cases of moderate to severe undifferentiated connective tissue dysplasia (UCTD). Moderate and severe UCTD have a substantial impact on obstetric and perinatal outcomes of deliveries, both at present and in the future.

MONITORING ASSESSMENT OF THE EARLY PROCESS ON THE BACKGROUND OF TES THERAPY.

OBJECTIVE: The aim: To investigate and evaluate the effect of TEC therapy on the wound process. PATIENTS AND METHODS: Materials and methods: On the models of clean, purulent and purulent-necrotic wounds in a comparative aspect, the wound process in the dynamics of wound healing in dental patients was studied in 233 patients, of which 105 were treated with TES therapy and 128 were treated with traditional treatment. A monitoring evaluation of the wound process was carried out based on the screening of the cytological picture of the wound contents, the study of the types of cytograms of smears-imprints from the wound on the 3rd, 6th and 9th days after surgical interventions. RESULTS: Results: It was established that against the background of TEC therapy, compared to traditional therapy, a positive trend of reparative processes in the wound was noted starting from the 3rd day. Destructive forms of granulocytes were significantly reduced with a simultaneous increase in the quantitative and qualitative composition of macrophages and an increase in the number of fibroblasts. The transition of the inflammatory phase to the regeneration phase was observed in the smear-imprints. CONCLUSION: Conclusions: The positive effect of TEC therapy on regenerative processes, both on clean and purulent and purulent-necrotic wounds at all stages of healing, has been estab¬lished. The cytological picture of the wound contents, the type of cytogram of smears-imprints are sensitive markers of regenerative processes in the wound, regardless of its type. These criteria for evaluating the course of the wound process can be successfully used for prognostic purposes.

MORPHOFUNCTIONAL PECULIARITIES OF THE PLACENTA IN WOMEN WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA SYNDROME.

OBJECTIVE: The aim: The impact of undifferentiated connective tissue dysplasia on the formation of the placenta. PATIENTS AND METHODS: Materials and methods: The morphostructure of 50 placentas with the undifferentiated connective tissue syndrome and 50 placentas of women with physiological pregnancy and absence of connective tissue pathology was studied. RESULTS: Results: The results of morphological studies have shown that the main pathogenetic link of placental dysfunction with highly resistant blood flow in the umbilical arteries in pregnant women with undifferentiated connective tissue dysplasia syndrome is a disorder of functional differentiation of the villous tree.In these cases the dominats were large and medium-sized villi with narrowed lumen in arterial, venular and capillary vessels and arterial spasm and venous plethora, as well as with numerous chaotically sclerosed villi, indicating stage I and II of placental. There is a large amount of fibrins in intervillous space which narrows it and leads to violation of microcirculation and placenta tissue hypoxia. CONCLUSION: Conclusions: The morphological basis of high flow resistance in the umbilical artery with the undifferentiated connective tissue dysplasia syndrome in pregnant women is a pathological immaturity of the placental villous tree. Morphological study of the architecture of the stem and intermediate placental villi revealed a violation of the structure of collagen fibers in the form of lack of crosslinks of bundles of collagen fibers.

PECULIARITY OF ADAPTATION OF BABIES ARE BORN PREMATURELY FROM MOTHERS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA.

OBJECTIVE: The aim: To evaluate the peculiarity of clinical manifestations of neonatal respiratory distress syndrome (NRDS) in deeply premature infants from mothers with phenotypic markers of undifferentiated connective tissue dysplasia (UCTD). PATIENTS AND METHODS: Materials and methods: The study represent the results of a retrospective clinical and statistical analysis of 268 premature birth report card and newborn report sheet. .The main (1 group) included 50 pregnants with obvious phenotypic markers of UCTD, the comparison group (group 2) consisted of 50 pregnant women without phenotypic markers of UDCTD. RESULTS: Results: According to the study, in 12 (24%) pregnant women of the main group at the time of admission to the clinic had contractions,which required specific therapy. Cervical cerclage was performed in 38 (76%) patients of the main group due to the presence of cervical insufficiency (CI). In these cases, the severity of the CI on the Steinber scale was 7.2 ± 0.4 points in the main group against 4.4 ± 0.2 points in the comparison group (p <0.05). Group I patients were more likely to have complications of labor such as:premature rupture of membranes, uterine contraction abnormalities and fetal distress, which required in most cases cesarean delivery (7% and 2%), respectively (p <0.05). The incidence of neonatal complications requiring respiratory support was 67% in group I and 48% in group II. According to our observations, the clinical manifestations of bronchopulmonary dysplasia were twice as high in infants of the main group (66%) against (44%) of the comparison group (p <0.05). CONCLUSION: Conclusions:1.Neonatal respiratory distress syndrome in premature infants is more often associated from mothers with UDCTD. 2. The high importance of steroid prophylaxis of NRDS and antioxidant therapy in reducing the frequency of mechanical ventilation and the development of bronchopulmonary pathology, especially in infants from mothers with UDCTD syndrome, has been proven. 3. The possibility of diagnosing disorders of functional maturation of the lungs in the fetal period using a non-invasive method of ultrasonography has been confirmed.

EPIDEMIOLOGY OF THE PREVALENCE OF PHENOTOPIC SIGNS UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA SYNDROME IN WOMAN WITH MISCARRIAGES.

OBJECTIVE: The aim: Study of the relationship between cervical insufficiency and dysplastic stigma in miscarriages. PATIENTS AND METHODS: Materials and methods: 80 pregnant women were examined at 23-27 weeks of gestation.) Group I included 40 pregnant women with the threat of premature birth, with habitual miscarriage and correction of cervical insufficiency (CI) by using pessary in the anamnesis. Group II consisted of 20 pregnant women with the threat of premature birth and correction of CI by using pessary without the burden of habitual miscarriage, the control group of 20 almost healthy pregnant women. RESULTS: Results: The studies revealed phenotypic signs of dysplastic stigmatization in 39 (97.5 + 2.5%) pregnant women of group I, in 18 (90.0 + 6.9%) group II and in 4 (20.0 + 9.2%) control, which indicates a high prevalence of connective tissue dysplasia in women with CI, which also has a laboratory reflection in the form of increased excretion per day of oxyproline and a decrease in total glycosaminoglycans in both groups at risk of preterm birth. CONCLUSION: Conclusions: The most common gestational complication in women with connective tissue dysplasia is the risk of premature birth. Improving existing and finding new diagnostic and therapeutic measures for women with UDСTD will reduce the risk of preterm birth.