Ukrainian Journal «Health of Woman»

Placental location and invasion: current state of the problem, illustration of medical support and management used in Perinatal Center of Kyiv

N.V. Gerevich — 2025-04-28

Placental anomalies in terms of localization and anatomy include low placentation, placenta previa (PP) and placenta accreta spectrum (PAS).

Aim - systematize modern scientific data on the pathogenesis of placenta invasion anomalies, placenta location; to study the world and analyze our own experience in the prevention and medical support of pregnancy and childbirth in this pathology.

Placental abnormalities create the risk of antenatal, intrapartum and postpartum massive, life-threatening bleeding for the mother and fetus, causing fetal impairment. The above-mentioned pathological conditions are characterized by a high level of maternal morbidity and mortality (over 7% in PAS), primarily due to catastrophic bleeding and peripartum hysterectomies. Medical care for these patients should be provided exclusively in a level III or higher institution with constant access to highly qualified obstetric and interdisciplinary personnel and with experience in intensive care. In accordance with modern trends in medical support for pregnancy and childbirth in pregnant women with placental abruption and invasion, we analyzed all cases of pregnancy and childbirth with clinical diagnoses of PP and PAS identified in 2024. The age, gestational age at delivery, the ratio of planned and urgent operative delivery, the scope of surgical intervention, intraoperative conditions and complications, the frequency of changes in previously planned operative delivery, the uterine-sparing method of delivery in pregnant women with PAS, which is used in the 1st Clinical Hospital "Perinatal Center of Kyiv", was described and evaluated.

Conclusions. Analysis of literature data and our own research allows us to conclude that the correctly chosen time and tactics of delivery of pregnant women with PP and PAS help in the vast majority of cases to avoid the occurrence of complications typical of PP and PAS.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the participating institution. Informed consent of the patients was obtained for the research.

The authors declare that there is no conflict of interest.

Analysis of the association of lipid profile parameters in women with first trimester pregnancy loss depending on PAI-1 gene polymorphism

V.V. Panov — 2024-04-28

Aim - to analyse the levels of lipid metabolism indicators as markers of induction of the inflammatory response, depending on the variant of the detected polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene, and to study the associations between these indicators, PAI-1 levels and obstetric complications.

Materials and methods. The selected patients (n=115) were divided into 3 groups according to the type of polymorphism: Clinical group I (n=20) - patients with wild-type polymorphism of the РAI-1 gene (675 5G>5G), group II (n=53) - women with heterozygous polymorphism of the РAI-1 gene (675 5G>4G), group III (n=42) - women with homozygous pathological polymorphism of РAI-1 (675 4G>4G). The study was based on bibliosemantic analysis; anamnestic data were evaluated; polymerase chain reaction was used to determine thrombophilia gene polymorphisms; enzyme-linked immunosorbent assay to determine the level of РAI-1 in the blood serum; enzymatic colourimetric method for determining the levels of total cholesterol and its fractions, triglycerides.

Results. The average age of women in the thematic groups was comparable and amounted to 32.5±0.9, 33.9±0.7 and 33.6±0.7 years, respectively. The study of the association between plasma RAI-1 concentration, PAI-1 gene polymorphisms and lipid profile parameters in the case study pregnant women confirmed the presence of significant correlations between them. In particular, it was found that elevated levels of total cholesterol and its low-density lipoprotein cholesterol fraction directly correlated with both high PAI-I concentration and PAI-1 gene polymorphisms.

Conclusions. Hypercholesterolemia suggests the possibility of forming zones of atherosclerotic damage to the blood vessels. In the context of early reproductive losses, this fact is important in predicting the possible development of endothelial dysfunction in the uterine spiral vessels. The synergistic effect of high levels of RAI-1, cholesterol and its fractions contributes not only to early and late pregnancy loss, but can also be considered as a cause of ideopathic infertility and in vitro fertilisation failure.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Immuno-clinical determinants of successful labor induction in prolonged pregnancy risk: a comprehensive assessment beyond 41 weeks of gestation

A.M. Martych — 2025-04-28

Aim - to evaluate the predictive value of serum levels of interleukins IL-6 and IL-8, combined with clinical and anthropometric characteristics, for forecasting the success of labor induction in women at risk of post-term pregnancy.

Materials and methods. This prospective cohort study included 201 pregnant women at ≥41 weeks’ gestation undergoing labor induction at the Kyiv Perinatal Center between January 2023 and December 2024. Pre-induction serum IL-6 and IL-8 levels, Bishop score, and other clinical parameters were recorded. Multivariate logistic regression was used to identify independent predictors of successful induction.

Results. Among 201 patients, 145 (72.1%) had successful induction. IL-6, IL-8, and Bishop score were identified as independent predictors. The model demonstrated high predictive accuracy (AUC=0.966; sensitivity — 86.2%; specificity — 96.4%).

Conclusions. Serum levels of IL-6 and IL-8, when combined with the Bishop cervical score, are reliable tools for predicting the outcome of labor induction in post-term pregnancy. Our findings underscore the pivotal role of inflammation in the mechanisms of labor, and serum IL-6, together with the clinical cervical assessment, may serve as a practical marker for risk stratification before induction. These results lay the groundwork for an individualized approach to managing post-term pregnancies.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution cited in the manuscript, and written informed consent was obtained from all participants.

The authors declare no conflicts of interest.

Features of the endocrinological status of patients who have suffered endometritis after cesarean section

O.S. Kuzmych — 2025-04-28

Aim - to identify the main types of disorders of the functional state of the hypothalamic-pituitary brain, hormonal function of the ovaries and adrenal glands in women who have suffered endometritis after cesarean section.

Materials and methods. Examined 60 women who had endometritis after cesarean section (CS) were examined: Group I - 40 women who received hormone replacement therapy (HRT), Group II - 20 women who did not receive it. The control group (CG) consisted of 20 women who had delivered by CS without complications in the postoperative period. Clinical and laboratory hormonal examination was carried out for 2 years with an interval of every 6 months. Statistical processing of research results was carried out using standard programs "Microsoft Excel 5.0" and "Statistica 8.0".

Results. Тhen examining patients 6 months after delivery in the first phase of the menstrual cycle (MC), we observed an increase in the content of estradiol in the Groups 1 and 2; prolactin and cortisol against the background of a decrease in follicle-stimulating hormone (FSH). The use of HRT in the complex of restorative treatment allowed, after 12 months, to normalize the content of estradiol to 863.7±72.5 pmol/l, progesterone - to 30.2±1.8 pmol/l; against the background of generally accepted therapy in the Group II of patients, the content of estradiol did not change, and progesterone remained at 10.4±1.0 pmol/l. Further endocrinological studies conducted after 12 months and 24 months indicate the normalization of the above changes when using the restorative treatment developed by us in patients of the Group I.

Conclusions. HRT for 6 months in the complex of restorative treatment of women who suffered endometritis after CR contributed to a significant decrease in the level of estradiol, prolactin, cortisol against the background of an increase in FSH the first phase of the MC and a significant decrease in the level of luteinizing hormone, prolactin, cortisol, aldosterone with a simultaneous increase in the level of progesterone in the second phase of the MC.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Mechanisms of developing recurrent miscarriage: the role of posttraumatic stress disorder

I.L. Kharun — 2025-04-28

The rapid deterioration of the demographic situation in Ukraine highlights the particular significance of recurrent pregnancy loss (RPL). An insufficient assessment of the impact of post-traumatic stress disorder (PTSD) represents a significant gap in the current practices of diagnosis, treatment, and prevention of RPL.

Aim - to identify the relationship between PTSD and RPL, and to establish a probable correlation between the severity of PTSD and dysfunction in various systems of the female body.

Materials and methods. The study involved 150 women diagnosed with RPL. Depending on the presence of PTSD, participants were divided into four groups. Standardized psychodiagnostic tools (Posttraumatic Stress Disorder Checklist for Civilians (PCL-C), Clinician-Administered PTSD Scale (CAPS-5) a structured interview, Beck Depression Inventory) were used alongside clinical-laboratory, immunological, and hormonal assessment methods.

Results. A statistically significant association was found between PTSD and elevated levels of NK cells, indicating activation of innate immunity. Women with PTSD more frequently presented with thyroid dysfunction, antiphospholipid syndrome, and lifestyle-related risk behaviors, such as excessive caffeine intake, alcohol consumption, and smoking.

Conclusions. PTSD is an important risk factor for RPL and should be considered within interdisciplinary support programs for women with reproductive failures. The findings underscore the relevance of a comprehensive approach, including mandatory psycho-emotional assessment and intervention.

The author declares no conflict of interest.

Vitamin D deficiency and preterm birth: results of a clinical study

I.V. Poladych — 2025-04-28

Vitamin D plays a crucial role in maintaining reproductive health and ensuring a normal course of pregnancy. Its deficiency is associated with an increased risk of preterm birth, gestational diabetes, preeclampsia, and low birth weight in newborns.

Aim - to assess 25(OH)D levels in pregnant women and determine their association with gestational age at birth (term or preterm). A comparative analysis of 25(OH)D concentrations was conducted between mothers who delivered at term and those who experienced preterm birth.

Materials and methods. The study was conducted from October 2023 to September 2024. A total of 116 pregnant women participated, divided into two groups: the main group (64 women) with preterm birth (<37 weeks) and the control group (52 women) with term birth (≥37 weeks). Serum 25(OH)D levels were measured using enzyme-linked immunosorbent assay.

Results. The mean 25(OH)D level in women of the main group (14.9±7.3 ng/mL) was significantly lower than in the control group (23.6±8.5 ng/mL). The proportion of women with severe 25(OH)D deficiency (<10 ng/mL) was notably higher in the main group (34.4% vs. 23.1%). Newborns from preterm births also had lower 25(OH)D levels (15.8±8.1 ng/mL) compared to those in the control group (20.3±9.2 ng/mL). Women who experienced preterm birth had a lower BMI, lower body weight, and were more likely to require cesarean delivery (65.6% vs. 30.8%). This may be linked to vitamin D deficiency, which affects metabolism, placental function, and inflammatory processes.

Conclusions. 25(OH)D deficiency is a significant risk factor for preterm birth. Women with lower levels of this metabolite were more likely to deliver preterm, and their newborns had lower birth weight and reduced 25(OH)D concentrations. The findings support the need for monitoring and correcting vitamin D levels during pregnancy to reduce the risk of obstetric complications.

The authors declare no conflict of interest.

Diagnosis and prognosis of pre-eclampsia in women with retrochorionic haematomas

Yu.M. Duka — 2025-04-28

Aim - to develop a method for predicting the development of PE in women with retrochorionic haematomas (RCH) in the first trimester.

Materials and methods. The selected patients (n=164) were divided into 3 groups: Group I - 60 women with confirmed RCH in the first trimester, group II - 77 women with a threat of miscarriage without RCH, group III - 27 pregnant women with RCH in the first trimester and PE, which complicated the course of pregnancy. In the study bibliosemantic analysis was used; anamnestic data were evaluated; polymerase chain reaction was used to determine gene polymorphisms

thrombophilia and angiogenesis genes; enzyme-linked immunosorbent assay to determine hormone levels; instrumental methods (ultrasound examination to determine the to determine the state of the fetus with uterine artery Doppler).

Results. The average age of women in the study groups was comparable. As a result of the study, clinical and anamnestic factors that can serve as predictors of PE development in women with RHG were identified. It was proved that the development of PE significantly correlates with pregnancy parity, primarily with the fact of the first pregnancy, and obesity, especially in patients with late PE: for the first pregnancy. The analysis of perinatal risk indicators according to the Alberta Perinatal Health Programme (APHP) scale proved the effectiveness of using this scale to assess the risk of developing PE. The study showed that the most important is the multifactorial genesis and polymorphism of genetic forms of thrombophilia and angiogenesis.

Conclusions. According to ROC analysis and univariate logistic analysis, the high prognostic significance of the adapted Alberta Perinatal Health Programme antenatal risk scale was confirmed. Significant predictors of PE development in women with RCH included pregnancy parity, body mass index >30 kg/m², heterozygous or pathological polymorphisms of the genes F7, PAI-1, ITGB3-β, NOS3 and their combinations. Mutations of the thrombophilia genes F13A1, ITGB3-β and the presence of 4-6 polymorphisms of the haemostasis system genes, changes in biochemical screening parameters are of prognostic value for the development of early PE.

No conflict of interests was declared by the authors.

The role of ultrasonographic and elastographic predictors of labor induction effectiveness in nulliparous women with term premature rupture of membranes

V.V. Burenko — 2025-04-28

Aim - to determine the role of ultrasonographic and elastographic parameters of the cervix in predicting the effectiveness of labor induction in nulliparous women with term premature rupture of membranes (PROM).

Materials and methods. A prospective cohort study was conducted involving 79 nulliparous women with term PROM who underwent labor induction. Clinical and ultrasonographic data, including cervical length, morphometric parameters, and elastographic characteristics of the cervix, were collected before the onset of induction. Logistic regression analysis was used to evaluate the prognostic factors for successful labor induction.

Results. Ultrasonographic and elastographic parameters of the cervix, including the hardness ratio, IOS/EOS ratio, cervical length, and estimated fetal weight, showed a significant association with the outcome of labor induction in nulliparous women with term PROM. Multivariate logistic regression models built using these parameters demonstrated high diagnostic accuracy (AUC>0.8), surpassing the prognostic value of the traditional Bishop score.

Conclusions. Ultrasound cervical elastography, combined with morphometric and clinical parameters, significantly improves the accuracy of predicting the effectiveness of labor induction in nulliparous women with term PROM compared to the traditional Bishop score.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Committee on bioethics and deontology of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

The impact of forced relocation and war-related stress on the functional state of the autonomic nervous system in pregnant women

M.Y. Malachynska — 2025-04-28

Military conflicts and related social disruptions significantly impact public health, particularly among vulnerable populations such as pregnant women.

Aim - examines changes in the functional state of the autonomic nervous system (ANS) in pregnant women who experienced forced relocation due to the war in Ukraine.

Material and methods. A total of 1000 pregnant women were assessed and categorized into three groups: (1) women who relocated from active combat zones, (2) those who moved from relatively safer regions, and (3) a control group with no relocation experience. The ANS status was evaluated using a modified A.M. Wayne questionnaire and physiological indicators such as blood pressure, heart rate, and the Kerdo autonomic index.

The results revealed that the most severe ANS dysfunction was observed in the group 1, characterized by predominant sympathetic activity (tachycardia, elevated blood pressure, reduced salivation) and high stress levels. The group 2 also exhibited ANS disturbances, though to a lesser extent. The control group demonstrated significantly better autonomic balance.

Conclusions. These findings indicate a substantial negative impact of forced relocation and war-related stress on the autonomic homeostasis of pregnant women. The high prevalence of autonomic dysfunction in the groups 1 and 2 highlights the urgent need for implementing medical and psychological support programs to mitigate the adverse effects of stress and promote maternal and fetal health.

The author declares no conflict of interest.

Angiogenic imbalance and prognostic criteria in the development of fetal growth restriction

Yu.O. Yarotska — 2025-04-28

Among the main obstetric complications that contribute to perinatal morbidity and mortality, fetal growth restriction (FGR) is an important one, the proportion of which ranges from 25% among full-term infants to 18-40% among premature newborns.

Аim - to evaluate the diagnostic value of biomarkers of placental dysfunction and certain angiogenesis factors in pregnant women with FGR and preterm delivery.

Materials and methods. A clinical and laboratory examination was performed in 88 patients aged 18 to 35 years with manifestations of FGR. The main group included 44 patients with FGR and early delivery, and the comparison group included 44 patients with FGR and urgent delivery. The control group consisted of 30 conditionally healthy pregnant women. The level of serum markers was assessed: PAPP-A and β-subunit of chorionic gonadotropin (β-hCG), and certain angiogenesis factors (PlGF, sFlt-1, VEGF).

Results. In the main group, the proportion of surgical delivery was 35.2%, preterm delivery - 52.3%, and low Apgar score - 47.7%. The risk of preterm delivery was 3.4 times higher in the case of early FGR. In the main group, the level of PAPP-A was consistently low (2.5 times), hCG β-subunit - by 2.4 times, and two thirds (70.5%) were diagnosed with haemodynamic disorders up to 28-30 weeks. The PlGF levels are already lower than normal at 12-14 weeks of pregnancy (47.7%), at 20-22 weeks (61.4%), VEGF-1 concentration is reduced by 1.9 times, and sFlt-1 levels increase by 1.9 times. In the case of an increase in the sFlt-1/PlGF ratio by 100 conditional units during 10-14 days of monitoring, the risk of haemodynamic disorders of feto-paternal circulation in patients with FGR increased by 3.0 times.

Conclusions. The data on the dynamics of secretion of certain placental proteins and growth factors can be used to formulate screening programmes. In women with FGR, PlGF content demonstrates low parameters, deviations in the proangiogenic factor VEGF-1, imbalance of vascular factors in the dynamics of pregnancy and an increase in the angiogenic coefficient, which can be considered as a prognostic marker of incomplete trophoblast invasion and the risk of placental dysfunction.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from participant.

The authors declare no conflict of interest.

Gender peculiarities of the prevalence of dental hyperesthesia

I.S. Lisetska — 2025-04-28

Dental hyperesthesia is an increased sensitivity of hard tooth tissues to various stimuli, which indirectly manifests itself in pain, discomfort and difficulty eating, which emphasises the importance of treatment and prevention of this disease. There are several theories of this pathology, and most often, hypersensitivity is diagnosed in non-carious lesions and dental caries, as well as periodontal tissue diseases. Since this pathology is relevant today, it is worth paying attention to its prevention and treatment.

Aim - to investigate the gender peculiarities of the prevalence of dental hyperesthesia among different age groups for the purpose of further development of a scheme of treatment and prevention measures.

Materials and methods. To achieve the aim of the study, the prevalence of dental hyperesthesia was assessed by a questionnaire survey using a specially designed questionnaire among 95 people aged 18 to 55 years (47 men and 48 women) in a confidential setting.

Results. The analysis of the respondents' answers revealed a high prevalence of dental hyperesthesia among the study participants, namely, 68.4% of respondents answered positively to the question ‘Are you concerned about increased tooth sensitivity?’. A negative answer or difficulty in answering was given by 31.6% of survey participants. The majority of respondents (89.9%) indicated that pain or discomfort occurs under the influence of irritants. Only 10.1% of respondents said that pain occurs spontaneously. In general, the majority of respondents who indicated the presence of hyperesthesia rated the pain as moderate in intensity. The second place was taken by answers indicating mild pain. However, 6 people reported very severe pain and only 1 person reported unbearable pain.

Conclusions. It has been established that dental hyperesthesia is an urgent problem that affects dental health and signals various diseases of the dentoalveolar system, and has different ways of occurrence and development. Mostly female participants of the survey complained about the presence of tooth sensitivity. A detailed analysis of the results of the survey made it possible to identify gender differences in the nature and intensity of pain that occurs in response to stimuli or spontaneously, as well as the number of teeth that are sensitive to stimuli.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Bioethics and Deontology Committee of the institution mentioned in the paper. Informed consent was obtained from the respondents.

The authors declare no conflict of interest.

Treatment of an acne patient with comorbid chronic chlamydial urethrocervicitis and immune deficiency

A.E. Alatorskykh — 2025-04-28

Aim - demonastration of the possibility of using a patient-centered approach to medical care in clinical practice in the treatment of comorbid acne, chronic chlamydial urethrocervicitis and immunodeficiency of the first degree.

Clinical case. A patient-centered approach was used in the supervision of patient H., 25 years old, who turned to a multidisciplinary medical institution for specialized dermatovenereological care. The diagnosis was established: acne, papulo-pustular form, moderate severity, immune deficiency of the first degree, chronic chlamydial urethrocervicitis in the acute stage. Acne treatment was carried out with the help of isotretinoin and a set of cosmetic measures. Elimination of Chlamydia trachomatis was carried out by the consistent use of antibacterial drugs linezolid and levofloxacin, and immunomodulation was carried out with the preparation of antimicrobial regulatory peptides derived from bovine embryonic tissue.

Chlamydia trachomatis was completely eliminated from the genitourinary system, and immunogram indicators were almost completely restored to the level of reference values. At the end of the 6th month of treatment with isotretinoin as part of complex therapy, inflammatory rashes on the patient's face completely stopped, post-acne phenomena decreased significantly.

Conclusions. In a clinical case, the use of a patient-centered approach to medical care in the treatment of comorbid acne, chronic chlamydial urethrocervicitis and immunodeficiency of the first degree was demonstrated. The success of treatment was due to well-chosen antibiotic therapy, the use of a complex of cosmetic measures, the use of isotretinoin in a dose appropriate to the clinical picture of acne and the use of Propes as an immunomodulatory means.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from participant.

The author declares no conflict of interest.