Wiadomosci Lekarskie Czasoplsmo Polskiego Towarzystwa Lekarskiego P am ifd dra W tadyslawa Biegariskiego TOMLXIX, 2016, Nr 3 (cz. II) Rok zalozenia 1928 Aluna Publishing Wiadomosci Lekarskie Redaktor naczetny Prof, dr hab. med. Wladyslaw Pierzchala (SUM Katowice) Zastepca redaktora naczelnego Prof. zw. dr hab. med. Aleksander Sieroii (SUM Katowice) Redaktor statystyczny dr n. med Lesia Rudenko Rada naukowa Redaktorzy tematyczni: Chirurgia Prof, dr hab. med. Krzysztof Bielecki (CMKP Warszawa) Prof, dr hab. med. Stanislav Czudek (Onkologickie Centrum J.G. Mendla Czechy) Prof, dr hab. med. Marek Rudnicki (University of Illinois USA ) Choroby wewnetrzne Prof, dr hab. med. Ryszarda Chazan, pneumonologia i alergologia (UM Warszawa) Prof, dr hab. med. Jacek DubieL. kardiologia (CM UJ Krakow) Prof, dr hab. med. Zbigniew Gtjsior, kardiologia (SUM Katowice) Prof, dr hab. med. Marek Hartleb, gastroenterologia (SUM Katowice) Prof, dr hab. med. 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MX>SW i : Index Copernicus, PBL, Scopus mailto:a.luczynska@wydawnictwo-aluna.pS http://www.wiadomoscilekarskie.pl http://www.aluna.waw.pl mailto:a.rosa@tvydawnictwo-aluna.pl mailto:l.rudenko@wydawnictwo-aluna.pl mailto:amarosa@wp.pl mailto:prenumerata@wydawnictwo-aluna.pl http://www.wiadomoscilekarskie.pl/prenumerata © Aluna Wiadomosci Lekarskie 2016, tom LXIX, nr 3 (cz. Ilj SPISTRESCI PRACE ORYGINALNE/ORYGINAL PAPERS Iwona Marika-Gaca, Beata tabuz-Roszak- Agnieszka Machowska-Majchrzak, Zbigniew Kalarus, Beata Sredniawa, Krystyna Pierzchala interictal heart rate in patients with epilepsy tz f sfosc akcji serca a diorych na padaakf w okresie migdzynapadowym 443 Monika Bgk-Sosnowska, Sebastian Kolodziej, Krzysztof Gojdz, Violetta Skrzypulec-Piinta Zachowania zdrowotne polskich lekarzy Health behavior of Polish physicians 449 Алексей В. Богданов, Юлия М. Гришко, Виталий А. Костенко Механизмы дизрегуляции нитроксидергичной сиаемы в тканях пародонта крыс при избыточном поступлении нитрата и фторида натрия Mechanisms of nltroxide-ergic deregulation in tissues of parodontium in rats under combined excessive sodium nitrate and fluoride intake 457 Maryna I. Omytrenko, Vira D. Kuroiedowa Electromyographic characteristic of orbicularis oris in patients with dental crowding in permanent occlusion 462 Лариса Ф. Матюха, Тетяна А. Титова, Тетяна М. Бухановська, Богдан 0. Смаль Український досвід медичної допомоги пацієнтам з цукровим діабетом Ukrainian experience of health care fo r patients with diabetes 465 Alla B. Guryeva, Vilyuya A. Alekseyeva, Palmira G. Petrova Characteristics of the anthropometric measures and biological age of girls ofyakut ethnicity depending on tanner's index 471 Natalia I. Chekaiina, Yuri M. Kazakov, Tatyana V. Mamontova, Ludmila E. Vesnina, Igor P. Kaidashev Resveratrol more effectively than quercetin reduces endothelium degeneration and level of necrosis factor a in patients with coronary artery disease 475 Nicholay A. Shcherbina, Liudmyla A.Vygovskaya Ultrasonographic peculiarities of fetoplacental complex in pregnancy complicated by intrauterine infection 480 Agata Kornek, Alicja Kucharska, Katarzyna Kamela A n a iiz a profiiu kwasow ttuszczowych dietywegetarian і niewegetarian w kontekscie profiiaktyki wybranych chorob dietozaleznych Analysis of the fa tty acid profile of vegetarian and non-vegetarian diet in the context o f some diet-related diseases prevention 483 439 Wiadomosci Lekarskie 2016, tom LX1X, nr 3 (cz. il) © Aluna Ultrasonographic peculiarities of fetoplacental complex in pregnancy complicated by intrauterine infection Nicholay A. Shcherbina, Li ud my la A, Vygovskaya KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE A B S T R A C T in t r o d u c t io n : th e re levance o f in trau te rine in fec tions is de te rm in ed by s ign ifican t p e ri- and postnata l loss as w e ll as hea lth im p a irm en t, w h ich o ften results in d isa b ility and reduced q u a lity o f life . U ltrasonography is em ployed in order to p rov ide a re liab le assessment o f th e fu n c tio n a l sta te o f th e fe top lacenta l system secondary to in tra u te rin e fe ta l in fection in the course o f pregnancy. U ltrasound im ag ing is essential in diagnosis o f various p red in ica l com p lica tions o f pregnancy and d e te c tion o f ab no rm a litie s in th e deve lop ing fetus. T h e a im o f th e s tud y was to pe rfo rm u ltrasonograph ic assessment o f fe top lace n ta l com p lex in p regnancy com plica ted by in tra u te rin e in fec tion . M a te r ia ls a n d m e th o d s : th e s tud y involved 304 p regn an t w om en w ho u n d e rw e n t u ltrasonograph ic and bac terio log ica l som atogen ic exam ina tion . The w om en w ere d iv ided in to th e fo llo w in g groups depend ing on th e presence and na tu re o f th e diagnosed in fec tion ; Group 1 - 50 pa tien ts w ith no rm a l pregnancy, w h o w ere n o t foun d to have signs o f in fec tion (contro l g roup), Group 2 - 50 p regn an t w om en w ith v ira l in fec tions (CMV and herpes s im p lex virus) : Group 3 -5 0 p regn an t w o m e n w ith bacteria ! in fections (ch lam ydia, ureaplasm a, m ycoplasm a), Group 4 - 1 5 4 pa tien ts w ith m ixed v ira l and bacteria l in fections. Clinical groups w ith in tra u te rin e in fec tions (IUI) w ere considered m ain ones. R e s u lts : increased echogen ic ity o f th e endo the lium o f in te rna l and provis ional organs was considered to be th e m ain u ltrasonograph ic sign o f in tra u te rin e fe ta i in fections as these changes w ere equally observed in pregnant w om en o f the m ain group. M ain sym ptom s o f vira l infections included ventricu lom egaly, hypoplasia o f th e chest, echogenic fib rou s inclusions in th e p a p illa ry muscles and va lve flaps, hepatom ega ly , p lacental hypoplasia, o ligohydram n ios. D olichocephalic skull, choro id plexus cysts, gastrom egaly, p lacenta l ca lc ifications, po lyhyd ram n ios w ere m ore com m on in bacteria l in fections. Pregnant w om en w ith m ixed vira l and bacteria ! in fec tions w ere fo u n d to have those and o th e r signs o f in fec tion in equal m easure. C o n c lu s io n : u ltrasonograph ic som atogenic exam ina tion is o f g rea t d iagnostic im portance in p red in ica l d iagnosis o f in tra u te rin e in fec tion . T im e ly de tection o f changes in fe tu s and prov is iona l organs provides a d iffe re n tia te d approach to a d m in is tra tio n o f pa th o g e n e tica lly ta rg e te d tre a tm e n t o f th is group o f pa tien ts. K ey w o rd s : pregnancy, in tra u te rin e in fec tion , u ltrasonograph ic som atogen ic exam ina tion , fe top lacen ta l com plex. W ia d Le k 2 0 1 6 ,6 9 ,3 (cz. I I ) , 4 8 0 -4 8 2 IN T R O D U C T IO N An increase in the incidence of intrauterine infections in both obstetric and perinatal practice has been observed recently. Intrauterine infections remain a major challenge not only for obstetricians, perinatologists and pediatricians, but for health care in general, as they are one of the main causes of perinatal morbidity and m ortality [1]. Intrauterine infections largely determine the level of infant mortality, accounting for 11 -45% of perinatal loss [2]. The significance of intrauterine infections is firstly stipulated by a considerable level of peri - and postnatal mortality, and secondly, by disorders which often result in disability and reduced quality of life. Intrauterine infection is the cause of the entire range of antenatal abnormalities, particularly infectious diseases of the fetus, intrauterine growth delay, malformations, stillbirth, miscarriage, development o f fetoplacental insufficiency'' [3]. Recently7 scientists have placed greater focus on the study7 of intrauterine infection as an etiological factor in the development of fetoplacental insufficiency [4]. Intrauterine infection is accompanied by an impairment of placental membranes and deposition of immune complexes in tissues, triggering disintegration of the functional system “mother-placenta-fetus”, disruption of redox processes and development of placental insufficiency [5]. Placental dysfunction in exposure to microbial toxins and their metabolites triggers the development of fetal hypotrophy, reducing its resistance to infectious agents [6,7]. Ultrasonographic examination is performed for a reliable assessment of the functional state of fetoplacental system against the background of in trau terine fetal infection in the course of pregnancy. Despite the absence of definitive u ltrasonog raph ic c rite ria o f in tra u te rin e in fection , ventriculomegaly, hyperechogenk endothelium of the intestine, increased echogenicity7 of placenta, expansion of intervillous space, oligohydram nios, polyhydram nios and congenital malformations are considered the most informative indices. U ltrasound imaging gives a possibility to provide predinical diagnosis of various complications of pregnancy and fetal abnorm alities as well as to identify echographic markers of in trau terine infection, signs and severity of placental insufficiency, necessary for early treatment and determination of therapeutic approach in each case. 480 U ltrasonographic pe cu lia ritie s o f fe top lacen ta l com p lex in p regnancy com p lica ted by in tra u te rin e in fection T H E A IM O F T H E S T U D Y To perform ultrasound assessment of fetoplacental complex in pregnancy complicated by intrauterine infection. M A T E R IA L S A N D M E T H O D S Tlie study implied examination of 304 pregnant women using bacteriological and ultrasonographic somatogenic methods. Infectious pathogens were identified by bacteriological and virological studies, as well as polymerase chain reaction. As a result of examinations, patients were divided into 4 groups depending on the presence and nature of the infection. Group 1 included 50 patients with norma! pregn ancy who were not found to have signs of infection. This group was the control one. Group 2 comprised 50 pregnant patients with viral infections (CMV and herpes simplex virus); Group 3 involved 50 pregnant women with bacterial infections (chlamydia, ureaplasma, mycoplasma) and Group 4 amounted for 154 patients with mixed viral and bacterial infection. The groups of patients with intrauterine infection (IUI) were considered main ones. Ultrasonographic somatogenic study was conducted using MINDRAY DC-8 ultrasound scanner. Statistical data were processed using general-purpose software system Statistica for Windows version 6.1 (Russified version). RESULTS A N D D IS C U S S IO N Ultrasonographic somatogenic findings in pregnant women of both control and main groups corresponded to the data of fetal nomograms elaborated by E.A.Yakovenko (1994) [8]. Control group patients were not found to have any changes in the internal and provisional organs. Table 1. Changes in th e in te rn a l and provis iona l organs in w om en o f th e m a in group (abso lu te num ber (%±A), w here A - error %) Ultrasonographic findings ---------- 1 (n—50) Main clinical group :• (n -50) +/ -:! w ,;, ** ' 3{o=154) Fetal head and bra in structures D olichocephalic skull 26 (52±7.1) 38 (76+6) 14(9±2.3) V en tricu lom eqa ly 35 (70±6.5) 14(28±6.3) 16(10+2.5) Increased echoge n ic ity o f the ve n tricu la r system 42 (84±5.2) 39 (78±5.9) 45 (29±3.7) Choroid plexus cysts -u n ila te ra l -b ila te ra l 11 (22±5.9) 5(10+4.2) 22 (44±7.0) 16 (32±6.6) 18 (12±2.6) 12 (8±2.2) Chest Hypoplasia o f th e chest 41 (82±5.4) 22 (44±7.0) 36 (23+3.4) H ypoplasia o f th e lungs 36 (72±6.3) 18 (36±6.8) 30 (19±3.2) Cardiom ega ly 7 (14±4.9) 10 (20±5.7) 14 (9±2.3) Increased echogen ic ity o f th e lungs 38 (76±6.0) 36 (72±6.3) 46(30+3.7) Echogenic fib rou s inclus ions in p a p illa ry muscles and va lve lea fle ts 27(54+7.0) 15 (30±6.5) 38 (25+3.5) Abdom en Hypoplasia o f th e abdom en 11 (22±5.9) 10 (20±5.7) - H epatom egaly 31 (62+6.9) 20(40+6.9) 46 (30±3.7) Perivascular in f ilt ra t io n o f th e live r 24 (48±7.1) 19(38±6.9) 31 (20±3.2) N ephrom ega ly 14 (28±6.3) 17 (34±6.7) 23 (15±2.9) Pyelectasis -u n ila te ra l -b ila te ra l 5 (10±4.2) 19 (38±6.9) 7 (14±4.9) 16 (32±6.6) 24(16±2.9) 32 (21±3.3) increased echogen ic ity o f th e pe lv icalyceal system and renal parenchym a 32 (64±6.8) 30 (60+6.9) 73 (47±4.0) G astrom egaly 19 (38±6.9) 33 (66±6.7) 45 (29±3.7) Increased e c h o q e n id ty o f gastric contours 36 (72±6.3) 44 (88±4.6) 62 (40±4.0) Increased echoge n ic ity o f th e in testine 42 (84±5.2) 40 (80±5.7) 73 (47±4.0) Provisional organs Increased echoge n ic ity o f placenta 29 (58±7.0) 37 (74±6.2) 41 (27+3.6) H ypoplasia o f p lacenta 23 (46±7.0) - 46 (30±3.7) H yperp lasia o f placenta - 10(20±5.7) 40 (26±3.5) Expansion o f in te rv illo u s space 16 (32±6.6) 21 (42±7.0) 52 (34+3.8) C alcifications o f p lacenta 26 (52±7.1) 24(48±7.1) 69 (45±4.0) Enlargem ent o f sinuses o f th e basal veins 17 (34±6.7) 14(28±6.3) 28 (18±3.1) 481 Nlcho iay A, Shcherbina, L iudm yla A, Vygovskaya Main group patients had changes in the internal and provisional organs and changes in the amount of amniotic fluid (Table I). In the assessment of ultrasound data on the amount of amniotic fluid, oligohydramnios was diagnosed in cases when numerical values of the amniotic index were below the 5th percentile. The depth of the largest amniotic fluid pocket in this case was less than 2 cm. Polyhydramnios was characterized by an increase in numerical values of the amniotic fluid index by more than 97.5 percentile, and the depth of the largest amniotic fluid pocket by more than 8 cm. Thus, the patients under investigation were most frequently found to have oligohydramnios - in 42% of cases in Group 2 with viral urogenital infections and up to 28% in Group 3 (mixed infections). Alternatively, polyhydramnios was observed in 40% and 26% in the group with bacterial infections (Group 3) and mixed type (Group 4), respectively. Increased echogenicity of the endothelium in provisional and internal organs was considered to be the main ultrasonographic sign of intrauterine fetal infection as it was equally common in pregnant women of the main group. Such ultrasound signs as increased echogenicity of the endothelium in internal and provisional organs, ventriculomegaly, choroid plexus cysts, hepatomegaly, gastromegaly, nephromegaly, pyelectasis were observed in the same patient. Tire main symptoms of viral infections included ventriculomegaly, hypoplasia of the chest, echogenic fibrous inclusions in the papillary muscles and valve leaflets, hepatomegaly, hypoplasia of placenta, oligohydramnios. Dolichocephalic skull, choroid plexus cysts, gastromegaly, calcifications in placenta, polyhydramnios were more common in bacterial infections. Pregnant women with mixed viral and bacterial infections were equally found to have these and other signs of infection. C O N C L U S IO N Ultrasonographic somatogenic study has a high diagnostic value in preclinical diagnosis of intrauterine fetal infections. Timely detection of changes in the fetus and provisional organs gives a possibility to provide differentiated approach to administration of pathogenetically targeted treatment of these patients. REFERENCES 1. Infektsii v akusherstve i ginekologii / pod red. 0. V. Makarova, V. A, Aleshkina, T, N. Savchenko. - 2-e izd. - M.: MYeDpress-inform, 2009. - 464 s. 2. Vnutriutrobnaya infektsiya: sovremennoe sostoyanie problemy / N. M. Podzolkova, M. Yu. Skvortsova, N, I. Melnikova, i. F.Ostreykov/7 Akusherstvo i ginekoiogiya. - 2009. - № 3 .-S . 27-32. 3. Borovkova Ye. I. Vzaimodeystvie vozbuditeley infektsii s organizmom beremennoy kak faktor riska vnutriutrobnogo infitsirovaniya ploda / Ye. I. Borovkova / / Zdorove zhenshchiny. - 2013. - № 2. - S. 95-98. 4. Toirova M. A. Vliyanie infektsii na gemodinamicheskie pokazateli sistemy «mat - platsenta - plod» u beremennykh s platsentarnoy nedostatochnostyu / M. A Toirova / / Vrach-aspirant. - 2014. - № 1, - S. 30-36. 5. Kulakov V. I. Platsentarnaya nedostatochnost i infektsiya: rukovodstvo dlya vrachey / V. I. Kulakov, N. V. Ordzhonikidze, V. L. Tyutyunnik. - M „ 2004. - 494 s. 6. Vikhiyaeva Ye. M. Doklinicheskie proyavieniya sistemnykh narusheniy, klinicheskie iskhody i otdalennye posledstviya preeklampsii / Ye. M. Vikhiyaeva / / Akusherstvo I ginekoiogiya. -2009. - № 1 ,- S. 3 -6 . 7. Makarov 1.0. Osobennosti platsentarnoy nedostatochnosti pri nalichii vnutriutrobnoy infektsii / 1.0. Makarov, S. M. Voevodin,T. V. Shemanaeva //Vrach-aspirant. - 2012. - № 1 .2 .-S . 253-258. 8. Yakovenko Ye. A. Izuchenie regionalnykh nomogramm ploda dlya diagnostiki vnutriutrobnoy zaderzhki rosta /Ye. A. Yakovenko / / Ultrazvukovaya perinatalnaya diagnostika. -1994 . - Vyp. 4 -5 .-S . 29-37. ADDRESS FOR CORRESPONDENCE Liudmyla A. Vygovskaya liudmilavygovskaya@gmail.com +380509675487 Nadestano: 11.04.2014 Zaakceptowano: 26.07.2016 mailto:liudmilavygovskaya@gmail.com Zasady prenum eraty Zamowienia na prcnumcrate przyjmuje Wydawnictwo Aluna: - e-mailem: prenumerata@wydawnictwo-ahma.pl - listownie na adres: Wydawnictwo Aluna ul. Z.M. Przesmyckiego 29, 05-510 Konstancin-Jeziorna Pro'inn о dokonywanie wplat na numer rachunku Wydawnictwa: Credit Agricole Bank Polska S. A.: 82 1940 1076 3010 7407 0000 0000 Cena prenumeraty czterech kolejnych numerow: 100 zl/rok (w tym 5% VA Седа prennineraty zagranicznej: 60 euro/rok. Ciena pojedynezego numeru - 25 zl (w tym 5% VAT) t kos/.t przesvlki. Przed dokonaniem wplaty prosimy о zlozenie zamowienia. mailto:prenumerata@wydawnictwo-ahma.pl