PLACENTAL BIOMARKERS: PP13, VEGF IN DIAGNOSTICS OF EARLY AND LATE PREECLAMPSIA.

OBJECTIVE: The aim: To investigate role of CD23, VEGF and PP13 in diagnostics of early and late preeclampsia, and their benefit for prediction of preeclampsia. PATIENTS AND METHODS: Materials and methods: Investigation included 40 placentas from deliveries in women with preeclampsia (main group) and 40 placentas from physiological delivery in somatically healthy women, who had no complications during pregnancy (control group). Placentas in the main group were devided into two sub-groups (20 in each) - with early and late preeclampsia. Each group underwent both hystomorphometrical and immunohystochemical investigation with biomarkers CD23, VEGF and PP13. RESULTS: Results: Positive immunohystochemical reaction to PP13 was determined in all samples of syncitiotrophoblast of villi of chorion. Investigations showed that expression of PP13 in sub-groups with early and late preeclampsia was a lot lower comparing to control group (normal pregnancies). Positive immunohystochemical reaction to VEGF was determined in all samples of endothelia of the capillaries of the villi of chorion. Our investigation showed that expression of VEGF in sub-groups with early and late PE was a lot lower comparing to a control group. Immunohystochemical reaction to CD23 was comperatively lower in all samples in endothelia of the capillariesof the villi of chorion and cyncithiotrophoblast. CONCLUSION: Conclusions: Determined specialties of the expression of angiogenic factors ( PlGF, VEGF, endoglin) and production of PP13, by altered expression of VEGF, PlGF in first trimester of pregnancy, which is associated with lowest production of PP13, accompanied by placental dysfunction and preeclampsia.

THE CLINICAL ASSESSMENT OF THE CERVICAL PERFORATED PESSARY FOR THE PREVENTION OF PRETERM LABOR IN WOMEN WITH PRIOR PRETERM BIRTHS.

OBJECTIVE: The aim: The assessment of clinical effectiveness the cervical perforated pessary (CPP) used for prevention of preterm labor. PATIENTS AND METHODS: Materials and methods: Caucasian women with prior SPL who were randomized to receive a CPP (clinical group) or without pessary (control group) was conducted at the Vinnytsya maternal hospital №1, from 2014 through 2018. Eligible women were those referred to the institution for a diagnosis of cervical incompetence between 16 weeks and 18 weeks +6 days. Outcomes will be PTL before 28, 32, 35, and 37 weeks of gestation; a composite of poor perinatal outcomes. RESULTS: Results: The incidence of SPL at less than 37 weeks of gestation was occurred in 14,1% vs 29,3% (RR 0,48, 95% CI, 0,23-0,99), lower rate of SPL at less than 35 weeks of gestation (RR 0,30, 95% CI, 0,10-0,88), longer gestational age (Dif. -1,4, 95% CI, -2,30 to -0,50), higher birth weight (Dif. -197,9, 95% CI, -307,6 to -88,15), lower incidence of adverse composite perinatal outcome (RR 0,28, 95% CI, 0,1-0,81) from the pessary and control group respectively. The participants pessary clinical group had a higher rate than the control group of increased vaginal discharge (RR 1,31, 95% CI, 1,01-1,69), but no differences in pelvic discomfort (RR 0,54, 95% CI, 0,14-2,18), chorioamnionitis (RR 0,30, 95% CI, 0,06-1,44). CONCLUSION: Conclusions: The women with prior SPL use of a CPP, resulted in a lower rate of SPL. The component in the successful results of preventive strategy SPL is consideration of vaginal microbiota and role of special trained staff for installation and care cervical pessary.

Cardiovascular remodeling in patients with hypertension with different degrees of cognitive impairment.

OBJECTIVE: Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. PATIENTS AND METHODS: Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. RESULTS: Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. CONCLUSION: Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.