Современные аспекты и перинатальные результаты ведения преждевременных родов

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra Obstetrică-Ginecologie (FECMF)Preterm labour remains one of the unresolved problem of obstetrics, in most cases aggravates the evolution of the pregnancy and labor with severe repercussions on the fetus. In this paper are presented the results of retrospective study on 328 cases of preterm birth (24-34 weeks) hospitalized in Municipal Clinical Hospital nr1. in 2011-2012. The aim of the study was to determine the optimal method of birth management, evaluating the cesarean section performance in decrease of perinatal mortality. The caesarian section performed at 29-32 weeks of gestation is more favorable for the fetus vs. natural delivery.Преждевременные роды остаются одной из неразрешенных проблем акушерства, в большинстве случаев отягощая течение беременности и родов с серьезными последствиями для новорожденного. В статье представлены результаты ретроспективного исследования, которое включило 328 женщин с преждевременными родами (до 34 недель), госпитализированных в ГКБ №1 гор. Кишинева в 2011-2012гг. Целью исследования стало определение оптимального метода ведения родов, оценка возможностей кесарева сечения в улучшении перинатальных показателей. Одним из выводов стало, что данная операция, произведенная при преждевременных родах в сроках 29-32 недели, является более щадящей для плода в сравнении с родами через естественные родовые пути

Инфекция как этиопатогенетический фактор преждевременных родов

USMF „Nicolae Testemiţanu”, Catedra Obstetrică şi Ginecologie FECMFPremature birth is the leading cause of perinatal morbidity and mortality in the world. The effectiveness of prognosis and prevention of preterm labor remains low, despite the huge amount of research and work in this area. Premature birth can be considered as a polyethiologic syndrome with clinical manifestations as regular uterine contractions, cervical dilatation, or premature rupture of membranes. Trigger factors of preterm labor are infection of the lower pole of amniotic membranes and, as a consequence, ischemic-cervical insufficiency and premature discharge of amniotic fluid, uterine overgrowth and immune aggression. If the aforementioned etiopathogenetic factors are predicted and prevented, then the threat of premature birth will not lead to termination of pregnancy. It follows that in the delivery mechanism there can be a potentially reversible and another irreversible phase that leads to premature labor. In addition, persistent infection of the mother causes the appeaence of a syndrome of an inflammatory response in the fetus, which is the cause of severe intrauterine and neonatal morbidity, leading to cerebral palsy and other chronic pathologies or mortality. Преждевременные роды являются ведущей причиной перинатальной заболеваемости и смертности в мире. Эффективность прогнозирования и профилактики преждевременных родов остается невысокой, несмотря на огромное количество исследований и работ в этой области. Преждевременные роды можно рассматривать как полиэтиологичный синдром с клиническими проявлениями в виде регулярных маточных сокращений, раскрыти- ем маточного зева или разрывом мембран. Триггерными факторами преждевременных родов является инфек- ция нижнего полюса амниотических мембран и, как следствие, истмико- цервикальная недостаточность и пре- ждевременное отхождение околоплодных вод, перерастяжение матки и иммунная агрессия. Если вышеназван- ные этиопатогенетические факторы будут прогнозированы и профилактированы, то состояние угрозы пре- ждевременных родов, не приведет к прекращению беременности. Из этого следует, что в механизме родов мо- жет быть потенциально обратимая и другая необратимая фаза, которая ведет к завершению беременности и родов как таковым. Помимо этого, персистирующая инфекция матери вызывает формирование -синдрома вос- палительного ответа у плода, что является причиной тяжелой внутриутробной и неонатальной заболеваемо- сти, приводящей к церебральному параличу и другим хроническим патологиям или смертности

Obstetrical aspects of perinatal mortality in 1000 g and less birth weight children

Catedra Obstetrică şi Ginecologie (rezidenţiat)The prematurity continues to maintain a high level of perinatal mortality and morbidity in Republic of Moldova, especially after including of 500 g and 1000 g weigh birth newborns in perinatal indicators. The aim of this study was to evaluate the obstetrical aspects of perinatal morbidity in these children. In this study an insufficient antenatal management of pregnant women with premature child was determinate, especially in complicated obstetrical anamnesis (spontaneous abortions, premature births). The high rate of neonatal precoce mortality (714%0) in extremely low birth weight children was appreciated in first 48 hours of live. The most important risk factor of neonatal mortality is birth weight, every day of life enlarging the premature survival. Prematuritatea continuă să menţină un nivel înalt al mortalităţii şi morbidităţii perinatale în Republica Moldova, în special după includerea născuţilor cu masa între 500 şi 1000 g în indicatorii perinatali. Scopul acestui studiu a fost evaluarea aspectelor obstetricale ale mortalităţii perinatale la copiii născuţi cu masa între 500 şi 999 g. În cadrul studiului s-a observat o conduită antenatală insuficientă a gravidelor care au născut prematur, în special a celor cu anamneză obstetricală agravată prin pierderi reproductive anterioare (avorturi spontane, naşteri premature). Vom remarca nivelul net major al mortalităţii neonatale precoce (714‰) printre nou-născuţii cu masa extrem de mică la naştere, majoritatea cazurilor de deces fiind înregistrate în primele 48 ore de viaţă. Drept urmare, cel mai important factor de risc al mortalităţii neonatale îl putem considera masa la naştere, fiecare zi de viaţă intrauterină mărind şansele prematurului la supravieţuire

Оценка менеджмента случаев послеродового кровотечения завершенных гистерэктомией

2Catedra Obstetrică şi ginecologie nr. 2, USMF „NicolaeTestemiţanu”, Catedra Anesteziologie şi reanimatologie nr. 2, USMF “NicolaeTestemiţanu”, IMSP Spitalul Clinic Municipal nr. 1, IMSP Institutul Mamei şi Copilului, Policlinica MAI, Chişinău, Republica MoldovaPost-partum hemorrhage (HPP) is a current problem, being a direct cause of maternal deaths in 27% globally, especially in developing countries. The purpose of the conducted descriptive retrospective study was to evaluate the management of 45 cases with HPP finalized by hysterectomy, which was located at the Institute of Mother and Child and Municipal Clinical Hospital no.1 during 2014-2016. In 24 cases (53,3%), a complicated obstetrical history was determined and 16 patients (35,5%) had scars on the uterus. In 33 cases (57,9%), patients presented complicated somatic history. In 33 cases (57,9%), patients presented complicated somatic history. In 33 cases (73,3%) the pregnancy was completed by caesarean section. Causes related to placental pathology were confirmed in 11 (24,4%) cases by placenta accreta, in 8 (17,8%) cases by placenta praevia, and in 5 (11,1%) cases by abruptio placentae. HPP due to uterine atony was identified in 2 cases (4,4%). Other 9 patients (20%) suffered deep vaginal lacerations and in one case (2,2%) there was a rupture of the uterus. The estimated volume of hemorrhage was: 3000 ml – in 4 (8,9%) cases. The underestimation of the bleeding volume was 500 ml in 4 cases (8,9%), between 500-1000 in 6 cases (13,3%), and ≥1000 ml – in 2 cases (4,4%). DIC syndrome was established in 29 patients (64,4%). In conclusion, it can be mentioned that HPP, in almost half of the cases, is favored by the pathology of placenta insertion, the latter being determined by the increase of the rate of births by caesarean section. Mortality and maternal morbidity can be reduced if birth is done by a competent multidisciplinary team that provides specialized health care through a standardized approach.Послеродовое кровотечение (ПРК) представляет собой актуальную проблему, являясь прямой причиной материнской смертности в 27% во всем мире, в особенности в развивающихся странах. Было проведено ретроспективное исследование 45 случаев родов, с ПРК и гистерэктомией, ведение которых проводилось в условиях Института Матери и Ребенка и Муниципальной Клинической больницы N1 в период 2014-2016 гг. В 24 случаях (53,3%) был выявлен осложненный акушерский анамнез. Рубец на матке встречался у 16 женщин (35,5%). В 33 случаях (57,9%) у пациенток наблюдался осложненный соматический анамнез. В 33 случаях (73,3%) было проведено кесарево сечение. Патология плаценты также являлась причиной ПРК: 11 случаев (24,4%) – приращение плаценты, 8 (17,8%) – предлежание плаценты и 5 случаев (11,1%) преждевременная отслойка нормально расположенной плаценты. ПРК также наблюдалось в результате задержки частей последа в полости матки в 4 случаях (9%) и в двух случаях (4,4%) ПРК было следствием атонии матки. У остальных 9 пациенток (20%) роды осложнились глубокими разрывами влагалища, а у одной пациентки (2,2%) – разрывом матки. Среди плацентарной патологии наблюдалось 11 случаев (24,4%) приращения плаценты к мышечному слою (placenta accretа). Объем кровопотери был подсчитан следующим образом: ≥2000 мл – в 16 случаях (35,6%); 2000-2500 мл – в 18 случаях (40%); 2501-3000 мл – в 7 случаях (15,6%) и более 3000 мл – 4 случая (8,8%). А вот объем кровопотери 500 мл наблюдался у 4 пациенток (8,9%), 500-1000 мл – у 6 (13,3%) и ≥1000 мл – у одной пациентки (2,2%). У 29 пациенток (64,4%) был диагностирован ДВС-синдром. В заключении необходимо отметить, что ПРК практически в половине случаев вызвано патологией прикрепления плаценты, что является следствием роста частоты повышения процента оперативного родоразрешения путем кесарева сечения. Материнскую заболеваемость и смертность в результате ПРК возможно снизить, если роды будет координировать мультидисциплинарная, компетентная команда, которая оказывает специализированную медицинскую помощь посредством стандартизированного подхода

Adult respiratory distress syndrome in the peripartum period: a case report

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Spitalul Clinic Republican, Spitalul Clinic Municipal nr. 1Patologia respiratorie în perioada peripartum implică un risc major, atât pentru viaţa mamei, cât şi a copilului. Insuficienţa pulmonară acută creşte rata mortalităţii materne în sarcină până la 90%, comparativ cu 50-60% în afara sarcinii. Rata insuficienţei pulmonare primare este mică comparativ cu alte patologii asociate sarcinii, constituind în mediu 5%. În marea majoritate a cazurilor ea apare secundar, ca component al insuficienţei poliorganice. Modificarea fiziologiei pulmonare în perioada peripartum necesită optimizarea conduitei individuale atât în timpul sarcinii, cât şi la naştere. Tratamentul contemporan al insuficienţei respiratorii este destul de costisitor, necesitând un monitoring sofisticat şi individualizat.Respiratory pathology in pregnancy and labor involves a double risk, both for mother’s and child’s life. Acute pulmonary failure increases the rate of maternal mortality up to 90% during the pregnancy in comparison with 50-60% out of pregnancy. The incidence of pulmonary insufficiency is rather low in comparison with the other associated pregnancy pathology, established to 5%. In the most of the cases it occurs secondary as a compound of MODS. Pulmonary physiology is essentially modified in pregnancy, raising the necessity of peculiar pregnancy and labor management applied. The contemporary treatment of pulmonary insufficiency is rather expensive, requiring advanced and individualized monitoring

Инфекция как этиопатогенетический фактор преждевременных родов

USMF „Nicolae Testemiţanu”, Catedra Obstetrică şi Ginecologie FECMFPremature birth is the leading cause of perinatal morbidity and mortality in the world. The effectiveness of prognosis and prevention of preterm labor remains low, despite the huge amount of research and work in this area. Premature birth can be considered as a polyethiologic syndrome with clinical manifestations as regular uterine contractions, cervical dilatation, or premature rupture of membranes. Trigger factors of preterm labor are infection of the lower pole of amniotic membranes and, as a consequence, ischemic-cervical insufficiency and premature discharge of amniotic fluid, uterine overgrowth and immune aggression. If the aforementioned etiopathogenetic factors are predicted and prevented, then the threat of premature birth will not lead to termination of pregnancy. It follows that in the delivery mechanism there can be a potentially reversible and another irreversible phase that leads to premature labor. In addition, persistent infection of the mother causes the appeaence of a syndrome of an inflammatory response in the fetus, which is the cause of severe intrauterine and neonatal morbidity, leading to cerebral palsy and other chronic pathologies or mortality.Преждевременные роды являются ведущей причиной перинатальной заболеваемости и смертности в мире. Эффективность прогнозирования и профилактики преждевременных родов остается невысокой, несмотря на огромное количество исследований и работ в этой области. Преждевременные роды можно рассматривать как полиэтиологичный синдром с клиническими проявлениями в виде регулярных маточных сокращений, раскрытием маточного зева или разрывом мембран. Триггерными факторами преждевременных родов является инфекция нижнего полюса амниотических мембран и, как следствие, истмико- цервикальная недостаточность и преждевременное отхождение околоплодных вод, перерастяжение матки и иммунная агрессия. Если вышеназванные этиопатогенетические факторы будут прогнозированы и профилактированы, то состояние угрозы преждевременных родов, не приведет к прекращению беременности. Из этого следует, что в механизме родов может быть потенциально обратимая и другая необратимая фаза, которая ведет к завершению беременности и родов как таковым. Помимо этого, персистирующая инфекция матери вызывает формирование -синдрома воспалительного ответа у плода, что является причиной тяжелой внутриутробной и неонатальной заболеваемости, приводящей к церебральному параличу и другим хроническим патологиям или смертности

Преждевременные роды в 22-28 недель гестации, медицинские и социально-демографические аспекты

Universitatea de Stat de Medicină şi Farmacie ”Nicolae Testemiţanu”, Catedra Obstetrică şi Ginecologie, FECMFIntroduction: This article presents the results of retrospective research that included 830 preterm births between 22-28 gestation weeks and 853 extremely low birth weight newborns (500-1000 g). The goal of the study: During this particular study were analyzed all the medical and socio-demographic particularities of the pregnant women, determining the incidence of such births, the evidence of particularities in pregnancy and birth evolution, perinatal losses establishment, and survival rate of newborns dependent on the terms of gestation and birth weight. Materials and methods: It was used the information from the Statistic wear book of the National Bureau of Statistics of the Ministry of Health, the clinical and laboratory data obtained from the observation records of mother’s, newborns of Neonatal Department of Intensive Care and Resuscitation, and the data from the observation questionnaire. The materials were processed computerized. Results: The study results established a 0,4% incidence of premature births between 22-28 weeks gestation terms out of a total number of births and 9,2% from the number of premature births. Most pregnant women included in the survey belonged to disadvantaged social groups, with a low level of education (64,9%) and a compromised reproductive potential (21,6%). One of five pregnant women was not on the recorded evidence of a family doctor and the first time that they asked for medical care was in the early process of triggering the birth with premature rupture of the amniotic membranes preterm. Each patient’s obstetric history was compounded with 2,6-3,1 reproductive losses, repeated miscarriages, and premature births. The most encountered causes that induced premature birth at 22-24 weeks of gestation were urinary and vaginal infections, repeated abortions in early pregnancy terms, complications during pregnancy evolution, pregnancy-induced hypertension, preeclampsia, placental pathology, polyhydramnios, multiple pregnancies, premature rupture of the amniotic membranes preterm. Conclusions: The studied perinatal losses among children born with extremely low birth weight 500-1000 g., showed a far lower rate (26,2%) of survival compared with similar indicators in the economically developed countries. Of all children born till 25 weeks of gestation, the survival rate was 10,3%. From 527 newborns alive, 60% died in the early neonatal period. Taking into consideration the results, conclusions and recommendations were formulated, aimed to improving the medical care of pregnant women with eminent abortion, as well as of children born with extremely low birth weight 500-1000 g, 22-28 weeks of gestation terms.Введение: в этой работе представлены результаты ретроспективного анализа 830 случаев преждевременных родов при сроках беременности 22-28 недель и 853 детей, рожденных с экстремально низкой массой тела (ЭНМТ) (500-1000 г.). Материалы и методы: были изучены медико-социальные и демографические особенности беременных, частота родов, особенности течения беременности и родов, перинатальные потери и степень выживаемости детей в зависимости от срока гестации и массы при рождении. Цель исследования: определить медицинские, социальные и демографические особенности при преждевременных родах в сроках гестации 22-28 недель. Результаты: результаты исследования показали, что большинство беременных женщин – 64,9%, принадлежали низкому социальному классу и уровню образования. Более 37% женщин не состояли официально в браке. Каждая пятая женщина не находилась под наблюдением медицинских работников, несмотря на отягощенный соматический, акушерский и гинекологический анамнезы. У каждой женщины были зарегистрированы по 2,6 репродуктивных потерь. Выводы: полученные результаты показали высокий уровень перинатальных потерь, низкую частоту выживаемости детей с экстремально-низкой массой – 26,2%, из рожденных детей в сроке 22-24 нед. не выжил ни 1 ребенок, а выживаемость рожденных в сроке 25 нед. составила 10,3%

Controversal aspects in the management of multiple deliveries

Catedra de Obstetrică şi Ginecologie rezidenţiat USMF “Nicolae Testemiţanu”In the last years multiple pregnancies reached a high level of importance for the medical practice. This is due to the increased risks that accompany multiple pregnancy and labour for both mother and fetus, and its increased incidence due to the implementation of assisted reproduction methods. The goal of our study was to determine the maternal and fetal results related to the mode of delivery. In the study were included 441 patients with multiple pregnancies hospitalized in the Municipal Clinical Hospital No. 1 during 2000-2007. In this period were recorded 41,443 births, the incidence of multiple gestations is 1.06%. In Conclusion: 1. We consider that the optimal mode of delivery must be determined for each woman in particular; depending on the term of gestation, zigocity, fetus presentation, and the body mass of the second fetus. 2. In case of cranial presentation of the first fetus and non cranial of the second one, the caesarian operation is prior if the mass of the second fetus is 25% higher then of the first one. 3. The term for the finalization of the multiple gestations with 2 fetuses must not exceed 37-38 weeks and with triplex 36 weeks. We consider that after this term the placental insufficiency establishes and as a result the fetal metabolic and respiratory needs are no longer satisfied. In the same time the maternal organism is -. The complications risk and the perinatal mortality are elevated. 4. Our results confirm the decrease of the perinatal mortality and morbidity after the enlargement of the Caesarian operation indications. Au fost analizate toate sarcinile multiple (441) internate în Spitalul Clinic Municipal nr. 1 pe parcursul anilor 2000-2007. În perioada respectivă s-au înregistrat 41443 de naşteri, incidenţa sarcinilor multiple fiind de 1,06%. Pacientele au fost împărţite în două loturi de studiu în funcţie de modul de terminare a sarcinii. Scopul studiul nostru a fost orientat spre aprecierea rezultatelor materne şi fetale dependent de modalitatea finalizării naşterii, elaborarea unor algoritme. Concluzii 1. În cazurile de sarcină multiplă modul optimal de naştere trebuie apreciat individual, dependent de termenul de gestaţie, zigocitate, situsul şi prezentaţia feţilor. 2. În caz de prezentaţie craniană la primul făt şi noncraniană la cel de al doilea, se acordă prioritate operaţiei cezariene dacă masa fătului doi e cu 25% mai mare ca a primului făt. 3. Termenul de finalizare a sarcinilor multiple cu doi feţi nu trebuie să depăşească 37-38 săptămâni, iar cu tripleţi 36 săptămâni Considerăm că după acest termen se instaliază insuficienţa placentară şi prin urmare necesităţile metabolice şi respiratorii fetale nu mai sunt satisfăcute. Totodată este suprasolicitat organismul matern. Riscurile complicaţiilor după acest termen şi mortalitatea perinatală crescând semnificativ. 4. Lărgirea indicaţiilor operaţiei cezariene în sarcina multiplă a contribuit la scăderea morbidităţii şi mortalităţii perinatale. Sarcina multiplă a căpătat în ultimii ani o mai mare importanţă pentru practica medicală. Acest lucru se explică prin riscurile crescute ce însoţesc sarcina şi naşterea multiplă atât pentru mamă cât şi pentru fât, precum şi prin creşterea incidenţei acesteia datorită implementării metodelor de reproducere asistată2,3,12. Conform datelor Centrului Naţional de Reproducere Asistată şi Genetică Medicală, din numărul total de sarcini survenite asistat, fiecare a patra e multiplă. Incidenţa sarcinilor multiple iatrogene va fi în continuă creştere luând în consideraţre faptul că în Republica Moldova ponderea cuplurilor sterile pe parcursul a 10 ani s-a majorat de 2 ori şi reprezintă peste 15%. Sarcina multiplă a fost încadrată întotdeauna în categoria sarcinilor cu risc crescut, doar 15-30% din sarcinile multiple evoluează şi se termină fiziologic, incidenţa complicaţiilor fiind mai mare la cele surenite asistat. Mortalitatea perinatală e de multe ori mai mare în cazul sarcinilor multiple decât în cele cu un singur făt

Comparing Recent Pulsar Timing Array Results on the Nanohertz Stochastic Gravitational-wave Background

\ua9 2024. The Author(s). Published by the American Astronomical Society. The Australian, Chinese, European, Indian, and North American pulsar timing array (PTA) collaborations recently reported, at varying levels, evidence for the presence of a nanohertz gravitational-wave background (GWB). Given that each PTA made different choices in modeling their data, we perform a comparison of the GWB and individual pulsar noise parameters across the results reported from the PTAs that constitute the International Pulsar Timing Array (IPTA). We show that despite making different modeling choices, there is no significant difference in the GWB parameters that are measured by the different PTAs, agreeing within 1σ. The pulsar noise parameters are also consistent between different PTAs for the majority of the pulsars included in these analyses. We bridge the differences in modeling choices by adopting a standardized noise model for all pulsars and PTAs, finding that under this model there is a reduction in the tension in the pulsar noise parameters. As part of this reanalysis, we “extended” each PTA’s data set by adding extra pulsars that were not timed by that PTA. Under these extensions, we find better constraints on the GWB amplitude and a higher signal-to-noise ratio for the Hellings-Downs correlations. These extensions serve as a prelude to the benefits offered by a full combination of data across all pulsars in the IPTA, i.e., the IPTA’s Data Release 3, which will involve not just adding in additional pulsars but also including data from all three PTAs where any given pulsar is timed by more than a single PTA