Biochemical markers and effectivity of the preventive therapy of the fetal distress and preterm delivery in pregnant women with polyhydramnios
Polyhydramnios in pregnant women are one of the most frequent pathologies in obstetrics, which is caused by an increase in the use of ultrasound screening of pregnant women and ranges from 1–3 to 8%. The aim of the study was to evaluate changes in blood biochemical parameters, biophysical profile of the fetus and the health status of newborns in pregnant women with polyhydramnios during the prophylactic therapy of this pathology and to estimate the frequency of polyhydramnios occurrence under the influence of preventive therapy in pregnant women at risk of polyhydramnios. We examined 120 pregnant women at gestational age from 20 to 38 weeks between the ages of 20 and 39 years: 1 group consisted of 30 healthy pregnant women, 2 group — 90 pregnant women with chronic polyhydramnios, which was divided into two subgroups: 40 pregnant women without fetal distress in 1 subgroup and 50 pregnant women with fetal distress in 2 subgroups. 1 subgroup of pregnant women received prophylactic Magnerot, Tivortin, Larnamine, Lymphomyosot and vitamin D3. The 2nd subgroup of pregnant women received traditional treatment according to the clinical protocol of the Ministry of Health of Ukraine №900 dated December 27, 2006, №782 dated December 29, 2005. Prenatal diagnosis was carried out by the method of enzyme-linked immunosorbent assay: the metabolite level of vitamin D-25 OH(D) was determined, anti-inflammatory cytokines IL–10, IL–6, vascular endothelial growth factor VEGF, malonic aldehyde, carbonyl groups of proteins, superoxide dismutase, serum protein content. Conducted ultrasound examination of the fetus and dopplerometry of uterine-placental vessels, cardiotocography of the fetus, evaluated the biophysical profile of the fetus. The significance of the difference between the compared groups was determined using Student's t test. In pregnant women with chronic polyhydramnios, a decrease in endogenous glutathione antioxidant reserves, a decrease in the activity of the superoxide dismutase antioxidant enzyme, an increase in the activity of the pro-oxidant enzyme xanthine oxidase and the presence of cytokine imbalance have been found. It is shown that among all biochemical changes in the body of pregnant women with chronic polyhydramnios, vitamin D deficiency, inflammation and disturbance of angiogenesis play the most important role in the development of fetal distress. Pregnant women at high risk of polyhydramnios who received the proposed preventive therapy for fetal distress, improved fetoplacental blood flow, decreased the percentage of placental dysfunction by 1.8 times, fetal distress — by 1.5 times, premature birth — by 2 times, decreased asphyxia in newborns 1.7 times, the rate of perinatal morbidity in newborns decreased 1.9 times, compared with the group of pregnant women receiving traditional therapy. Thus, the positive effect of preventive therapy of pathology of pregnant women with polyhydramnios was confirmed clinically and biochemically.
2. Baskakov, P. M., & Dubovenko, D. V. (2011). Taktika vedennya zhinok z distresom ploda i metabolichnim sindromom [Tactics vedennya znok with fetal distress and metabolic syndrome]. Zdorove zhenshiny – Women's Health, 8 (64), 147–148.
3. Vladimirov, Yu. V., & Archakov, A. I. (1972). Perekisnoe okislenie lipidov v biologicheskih membranah [Lipid peroxidation in biological membranes]. Moskva: Nauka.
1. Voronenko, Yu. V., & Moskalenko, V. F. (Red.). (2000). Sotsialna medytsyna ta orhanizatsiia okhorony zdorovia [Social medicine and health care organization]. Ternopil: Ukrmedknyha.
2. Haistruk, N. A., Dubas, L. H., & Ponyna, S. Y. (2017). Osoblyvosti perebihu vahitnosti ta stan ploda u vahitnykh z bahatovoddiam [Features of pregnancy and fetal status in pregnant women with polyhydramnios]. Bukovynskyi medychnyi visnyk – Bukovyna Medical Bulletin, 21, 3 (83), 15–21. DOI:10.24061/2413-0737.XXI.3.83.2017.90.
3. Haistruk, N. A., Dubas, L. H., & Topolnytskaia, S. V. (2017). Osoblyvosti perebihu vahitnosti ta stan ploda u vahitnykh z bahatovoddiam [Features of pregnancy and fetal status in pregnant women with polyhydramnios]. Odeskyi medychnyi zhurnal – Odessa Medical Journal, 4 (162), 24–29.
4. Znamenskaya, T. K. (2011). Prioritetnie napravleniya razvitiya perinatalnoj sluzhbi v Ukraine [Priority areas for the development of perinatal services in Ukraine]. Neonatologiya, hirurgiya ta perinatalna medicina – Neonatology, hirurgiya and perinatal medicine, 1 (2), 6–10.
5. Kostyuk, V. A., Potapovich, A. I., & Kovaleva, Zh. V. (1990). Prostoj i chuvstvitelnyj metod opredeleniya aktivnosti superoksiddismutazy, osnovannyj na reakcii okisleniya kvercitina [A simple and sensitive method for determining the activity of superoxide dismutase, based on the oxidation reaction of quercetin]. Voprosy medicinskoj himii – Questions of medical chemistry, 2, 88.
6. Kochetov, G. A. (1980). Prakticheskoe rukovodstvo po enzimologii [Practical Guide to Enzymology]. Moskva: Vysshaya shkola, 223–224.
7. Lasytchuk, O. M. (2013). Bahatovoddia: akusherska taktyka ta zakhody profilaktyky [Amphibians: Obstetric Tactics and Prevention]. Zhurnal klinichnykh ta eksperymentalnykh medychnykh doslidzhen – Journal of Clinical and Experimental Medical Research, 1 (3), 292–300.
8. Lekhan, V. M., & Hinzburh, V. H. (2012). Perynatalna smertnist v Ukraini: dosiahnennia ta problemy [Perinatal mortality in Ukraine: achievements and challenges]. Ukraina. Zdorovia natsii – Nation Health, 1 (21), 1 (21), 15–25.
9. Chaj, V. B., & Fadeev, S. V. (2008). Vzaimosvyaz mezhdu kolichestvennoj patologiej okoloplodnoj sredy i sostoyaniem ploda [The relationship between the quantitative pathology of the amniotic fluid and the condition of the fetus]. Zhurnal ROAG – ROAG Magazine, 4, 22–23.
10. Shevchuk, S. V., Pentiuk, O. O., Musin, R. A., & Zaichko, N. V. (2003). Patent Ukrainy na vynakhid №58110A, MPK 7 A61K35/16. Sposib vyznachennia karbonilnykh spoluk v syrovattsi krovi [Method for determination of carbonyl compounds in serum]. Derzhavne patentne vidomstvo Ukrainy [State Patent Office of Ukraine].
11. Asaoka, K., & Takahashi, K. (1981). An enzymatic assay of reduced glutathione using glutathione S-aryltransferase with O-dinitrobenzene as a substrate. J. Biochem., 90 (5), 1237–1242.
12. Gaistruk, N. A., Dubas, L. G., Ponina, S. I., & Rud, V. A. (2017). Risk factors of perinatal mortality related to premature ruptured membranes in case of polyhydramnios. Одеський медичний журнал, 6 (164), 29–33. Retrieved from http://files.odmu.edu.ua/journal/OMJ_2017.06/m176_29.pdf.
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