ASSOCIATION BETWEEN NEW CORONAVIRUS INFECTION AND FETAL GROWTH RESTRICTION.

Objective: To investigate the laboratory and instrumental characteristics of fetal growth restriction (FGR) secondary to novel coronavirus infection (NCI) to identify pathogenetically relevant predictive markers. Material(s) and Method(s): During the epidemic activity of the NCI Delta strain, 140 high-risk pregnant women were tested at 18-21 weeks and 26-34 weeks of gestation. Retrospectively, taking into account the fact of NCI disease and the exclusion of severe somatic and obstetric comorbidities, 2 groups were formed. Group 1 (n=32) included pregnant women with FGR, without a history of NCI. Group 2 (n=41) included pregnant women with FGR who recovered from NCI by the end of the second and third trimesters. Thirty healthy pregnant women served as the controls. In addition to ultrasound assessment of the fetal placental unit, patients underwent testing for markers of inflammation, endothelial hemostasis dysfunction, decidualization, placental angiogenesis, and pathological insulin resistance. Result(s): Pregnant women with a history of NCI had a higher incidence of FGR (1.3 times;OR 2.41 [95% CI 1.12-5.17]), more severe forms of FGR (2 times;OR 3.27 [95% CI 1.22-8.76]), more severe fetal-placental blood flow abnormalities (3.5-fold;OR 11.07 [95% CI 3.68-33.27]), and oligohydramnios (4.5-fold;OR 8.94 [95% CI 3.65-30.17]). The impact of NCI on the formation of placental insufficiency was expressed by an increase in systemic changes (thrombopoiesis, apoptosis), modulation of local processes (decidualization, placental angiogenesis), and the development of pathological insulin resistance and hyperinsulinemia, an immunopathological process of endotheliocytes. The identification of the most informative markers of FGR due to NCI allowed the development of a predictive index. Conclusion(s): An in-depth study of the impact of NCI on the formation of FGR has important scientific and practical implications for the optimization of FGR prediction, which may help identify appropriate patient management strategies for high-risk pregnant women.Copyright © 2023, Bionika Media Ltd.. All rights reserved.

ASSOCIATION BETWEEN NEW CORONAVIRUS INFECTION AND FETAL GROWTH RESTRICTION.

Objective: To investigate the laboratory and instrumental characteristics of fetal growth restriction (FGR) secondary to novel coronavirus infection (NCI) to identify pathogenetically relevant predictive markers. Material(s) and Method(s): During the epidemic activity of the NCI Delta strain, 140 high-risk pregnant women were tested at 18-21 weeks and 26-34 weeks of gestation. Retrospectively, taking into account the fact of NCI disease and the exclusion of severe somatic and obstetric comorbidities, 2 groups were formed. Group 1 (n=32) included pregnant women with FGR, without a history of NCI. Group 2 (n=41) included pregnant women with FGR who recovered from NCI by the end of the second and third trimesters. Thirty healthy pregnant women served as the controls. In addition to ultrasound assessment of the fetal placental unit, patients underwent testing for markers of inflammation, endothelial hemostasis dysfunction, decidualization, placental angiogenesis, and pathological insulin resistance. Result(s): Pregnant women with a history of NCI had a higher incidence of FGR (1.3 times;OR 2.41 [95% CI 1.12-5.17]), more severe forms of FGR (2 times;OR 3.27 [95% CI 1.22-8.76]), more severe fetal-placental blood flow abnormalities (3.5-fold;OR 11.07 [95% CI 3.68-33.27]), and oligohydramnios (4.5-fold;OR 8.94 [95% CI 3.65-30.17]). The impact of NCI on the formation of placental insufficiency was expressed by an increase in systemic changes (thrombopoiesis, apoptosis), modulation of local processes (decidualization, placental angiogenesis), and the development of pathological insulin resistance and hyperinsulinemia, an immunopathological process of endotheliocytes. The identification of the most informative markers of FGR due to NCI allowed the development of a predictive index. Conclusion(s): An in-depth study of the impact of NCI on the formation of FGR has important scientific and practical implications for the optimization of FGR prediction, which may help identify appropriate patient management strategies for high-risk pregnant women.Copyright © 2023, Bionika Media Ltd.. All rights reserved.

ASSOCIATION BETWEEN NEW CORONAVIRUS INFECTION AND FETAL GROWTH RESTRICTION.

Objective: To investigate the laboratory and instrumental characteristics of fetal growth restriction (FGR) secondary to novel coronavirus infection (NCI) to identify pathogenetically relevant predictive markers. Material(s) and Method(s): During the epidemic activity of the NCI Delta strain, 140 high-risk pregnant women were tested at 18-21 weeks and 26-34 weeks of gestation. Retrospectively, taking into account the fact of NCI disease and the exclusion of severe somatic and obstetric comorbidities, 2 groups were formed. Group 1 (n=32) included pregnant women with FGR, without a history of NCI. Group 2 (n=41) included pregnant women with FGR who recovered from NCI by the end of the second and third trimesters. Thirty healthy pregnant women served as the controls. In addition to ultrasound assessment of the fetal placental unit, patients underwent testing for markers of inflammation, endothelial hemostasis dysfunction, decidualization, placental angiogenesis, and pathological insulin resistance. Result(s): Pregnant women with a history of NCI had a higher incidence of FGR (1.3 times;OR 2.41 [95% CI 1.12-5.17]), more severe forms of FGR (2 times;OR 3.27 [95% CI 1.22-8.76]), more severe fetal-placental blood flow abnormalities (3.5-fold;OR 11.07 [95% CI 3.68-33.27]), and oligohydramnios (4.5-fold;OR 8.94 [95% CI 3.65-30.17]). The impact of NCI on the formation of placental insufficiency was expressed by an increase in systemic changes (thrombopoiesis, apoptosis), modulation of local processes (decidualization, placental angiogenesis), and the development of pathological insulin resistance and hyperinsulinemia, an immunopathological process of endotheliocytes. The identification of the most informative markers of FGR due to NCI allowed the development of a predictive index. Conclusion(s): An in-depth study of the impact of NCI on the formation of FGR has important scientific and practical implications for the optimization of FGR prediction, which may help identify appropriate patient management strategies for high-risk pregnant women.Copyright © 2023, Bionika Media Ltd.. All rights reserved.

FAVORABLE MATERNAL AND PERINATAL OUTCOMES OF PREGNANCY IN A COVID-19 PATIENT WITH TOTAL LUNG DAMAGE

Background: The course and prognosis of the novel coronavirus infection (SARS-CoV-2) in pregnant women are unpredictable;at the same time, the clinical presentation can be vague and non-specific;a critical condition can suddenly develop in the presence of the stable course of the disease. In the literature, there are data on survival rates with 100% lung damage caused by SARS-CoV-2 delta variant;however, the experience of managing pregnant women with total lung damage is not presented. Case report: A female patient was admitted to the hospital at 33 weeks of gestation on day 7 of the novel coronavirus infection (SARS-CoV-2). On the 4th day of inpatient treatment, there was a progressive deterioration in the condition of the pregnant woman with a complication as severe bilateral polysegmental interstitial pneumonia. She received combined antibacterial, glucocorticoid, hepatoprotective, infusion, anticoagulant therapy and non-invasive ventilation with the postpartum transition to mechanical ventilation. Taking into consideration the signs of progressive fetal hypoxia, her baby was delivered by cesarean section. The boy was alive premature who had signs of morphofunctional immaturity. After 88 days of inpatient treatment (49 days after 100% lung disease), the female patient was discharged with respiratory support with humidified O2 using a portable concentrator. The patient had been in the intensive care unit for 65 days, of which 46 days on mechanical ventilation. The newborn was discharged home in a satisfactory condition. The clinical case demonstrates favorable gestational and perinatal outcomes with 100% lung involvement, as evidenced by computed tomography. Management of a near-miss pregnant or puerperant woman required an interdisciplinary approach. Specialists used the possibilities of telemedicine for consulting the patients. Conclusion: The accumulation of knowledge and clinical experience in the management of pregnant and puerperant women with SARS-CoV-2 and total lung tissue damage will undoubtedly be able to optimize medical strategies and to prevent maternal and perinatal critical conditions and deaths.