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Obstetrical and perinatal complications in HIV-infected pregnant women with herpes virus infection
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
where they further investigated and started her on oral combined oral contraceptive pill. Discussion and review of literature: POI is defined as depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years, and it has previously been referred to as premature menopause or primary ovarian failure or premature ovarian failure. Hence achieving a heightened level of awareness of symptomatology, timely diagnosis, counselling and intervention may alleviate few of the consequences and long term sequelae. A greater understanding of female reproductive biology and the physiologic effect of primary ovarian insufficiency enable health care providers to offer counselling for these young women. http://dx.doi.org/10.1016/j.ejogrb.2016.07.156 Infections in obstetrics and gynaecology Poster Presentation Obstetrical and perinatal complications in HIV-infected pregnant women with herpes virus infection Vyacheslav Kaminskiy 1,∗ , Oleksii Zhdanovich 2 , Tetiana Anoshina 1 1 P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine 2 State institution «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy).
According to results of some authors the increasing of incidence of obstetrical and perinatal complications in HIV-infected women is the sequence of HIV-associated infections, but not native HIV. The clinical and statistical analysis of 1177 records of pregnancy women with HIV delivered in Reprudoctology and Perinatal Medicine Kyiv’s City Center from 2009 to 2013 was performed. The control group consists from 200 gravid females with physiological course of gestation and labor. It was revealed that 5-years incidence of human herpes virus infection (HVI) was 42.3% among HIV-infected pregnancy women and 28.0% in control group (p < 0.05). The primary infection of HVI was noted in 8.5% of HIV-infected pregnant women and the reactivation of infection in 27.2% and this was interpreted as important risk factor for obstetrical and perinatal complications. The course of such gestation was complicated in 84.3% pregnancy women from group of observations. The incidence of fetal distress in women with HVI was increased both during gestation and labor (22.3 vs. 16.5% in HIV-infected women without HVI, p < 0.05). The incidence of cesarean section in HIV-infected gravid with HVI was 26,2% vs. 18.1% (p < 0.05). Preterm labors in HIV infection presence were noted in 15.4% women with HVI and in 9.0% without HVI (p < 0.05). Preterm labors at gestational age up to 34 weeks were occurred in 4.2 and 1.5%, respectively. Five-year perinatal lethality was established in 12 cases – 8 (21.5 ‰) women with HVI; 6 (16.1 ‰) and 2 (5.4 ‰) – in antenatal and perinatal period, respectively. The health of infants delivered by HIV-infected mothers with HVI also was worse: heavy asphyxia neonatorum has 12.1% vs. 6.2% infants from mothers without HVI (p < 0.05), and hypotrophy – 31.3 vs. 25.7%, respectively (p < 0.05). It should be noted that in 14 (3.8%) infants from HIV-infected mothers with HVI and in 4 (0.8%) infants from mothers without HVI (p < 0.05) the congenital pneumonia was diagnosed at the end of 1 day of life. Analysis results (illustration) show that at inactive form of infection the incidence of studied complications was similar to HIV-infected gravid without HVI, but during primary infection
e53
or reactivation phase the increasing at 1.5–2 times was noted. Performed analysis demonstrated the negative effect of herpesvirus on course of gestation/labor, health of fetal and newborns in HIVinfected women. The mechanisms of such effect and methods of its minimization or prevention are subjects for further research. http://dx.doi.org/10.1016/j.ejogrb.2016.07.157 Assisted reproduction Poster Presentation The role of vascular deregulation in induction of perinatal disorders among the women with high-risk inducted pregnancy Vyacheslav Kaminskiy ∗ , Anatolij Kaminskiy, Tetiana Kolomiichenko, Oleksandra Boychuk P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy). Currently the endothelium dysfunction is considered as general trigger mechanism of reproductive disorders with involving vascular transformations in disturbances of the placentation processes. In females with infertility and hepatobiliary system disorders we find out the genetic predisposition to endothelial dysfunction. In consideration of the abovementioned we consider necessary to explore in this women the levels of nitrogen oxide donor l-arginine, endothelium impairment factor homocysteine, and angiogenesis factor – placental growth factor (PlGF). The 50 gravid females after assisted reproductive technology (ART) with hepatobiliary system disorders (study group), 50 pregnancy women after ART without such disorders (comparison group), and 50 somatically healthy females with spontaneous pregnancy (control group) at a gestational age 14–16 weeks were studied. In women of study group it was noted the significant reduction of l-arginine up to 44.2 ± 1.1 mmol/L vs. 52.6 ± 1.4 mmol/L in control group (p < 0.05) and increasing of homocysteine. It should be noted the essential reduction of PlGF levels in blood (91.4 ± 8.6 vs. 132.4 ± 11.5 pg/mL in women of control group, p < 0.05), which confirmed the negative effect of angiogenesis process abnormalities on growth and functioning of placenta with such sequences as pregnancy complications and fetal distress. The study group included two subgroups: first subgroup – 19 females with remarkable obstetrical and gynecological abnormalities (miscarriages and non-developing pregnancies, severe preeclampsia, decompensated fetal distress); second subgroup – 31 women without such abnormalities. The study demonstrated the severe compromising of gestation after ART programs (table) in women with hepatobiliary system disorders who at early terms of gestation have the influences of endothelial dysfunction, negative action of homocysteine and abnormalities of angiogenesis processes on the growth and formation of placenta. Thereby these factors may be used as early prognostic markers of severe obstetrical and perinatal disturbances of induced pregnancy in the women with hepatobiliary system disorders. Under homeostatic imbalance conditions in this population the pathogenesis of reproductive, obstetrical and perinatal complications is determined by the endothelium abnormalities and deregulation of vascular factors. This is theoretical prerequisite for the development of pathogenetically-based package of measures for treatment and preventing of such complications with the correction of detected abnormalities. http://dx.doi.org/10.1016/j.ejogrb.2016.07.158
where they further investigated and started her on oral combined oral contraceptive pill. Discussion and review of literature: POI is defined as depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years, and it has previously been referred to as premature menopause or primary ovarian failure or premature ovarian failure. Hence achieving a heightened level of awareness of symptomatology, timely diagnosis, counselling and intervention may alleviate few of the consequences and long term sequelae. A greater understanding of female reproductive biology and the physiologic effect of primary ovarian insufficiency enable health care providers to offer counselling for these young women. http://dx.doi.org/10.1016/j.ejogrb.2016.07.156 Infections in obstetrics and gynaecology Poster Presentation Obstetrical and perinatal complications in HIV-infected pregnant women with herpes virus infection Vyacheslav Kaminskiy 1,∗ , Oleksii Zhdanovich 2 , Tetiana Anoshina 1 1 P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine 2 State institution «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy).
According to results of some authors the increasing of incidence of obstetrical and perinatal complications in HIV-infected women is the sequence of HIV-associated infections, but not native HIV. The clinical and statistical analysis of 1177 records of pregnancy women with HIV delivered in Reprudoctology and Perinatal Medicine Kyiv’s City Center from 2009 to 2013 was performed. The control group consists from 200 gravid females with physiological course of gestation and labor. It was revealed that 5-years incidence of human herpes virus infection (HVI) was 42.3% among HIV-infected pregnancy women and 28.0% in control group (p < 0.05). The primary infection of HVI was noted in 8.5% of HIV-infected pregnant women and the reactivation of infection in 27.2% and this was interpreted as important risk factor for obstetrical and perinatal complications. The course of such gestation was complicated in 84.3% pregnancy women from group of observations. The incidence of fetal distress in women with HVI was increased both during gestation and labor (22.3 vs. 16.5% in HIV-infected women without HVI, p < 0.05). The incidence of cesarean section in HIV-infected gravid with HVI was 26,2% vs. 18.1% (p < 0.05). Preterm labors in HIV infection presence were noted in 15.4% women with HVI and in 9.0% without HVI (p < 0.05). Preterm labors at gestational age up to 34 weeks were occurred in 4.2 and 1.5%, respectively. Five-year perinatal lethality was established in 12 cases – 8 (21.5 ‰) women with HVI; 6 (16.1 ‰) and 2 (5.4 ‰) – in antenatal and perinatal period, respectively. The health of infants delivered by HIV-infected mothers with HVI also was worse: heavy asphyxia neonatorum has 12.1% vs. 6.2% infants from mothers without HVI (p < 0.05), and hypotrophy – 31.3 vs. 25.7%, respectively (p < 0.05). It should be noted that in 14 (3.8%) infants from HIV-infected mothers with HVI and in 4 (0.8%) infants from mothers without HVI (p < 0.05) the congenital pneumonia was diagnosed at the end of 1 day of life. Analysis results (illustration) show that at inactive form of infection the incidence of studied complications was similar to HIV-infected gravid without HVI, but during primary infection
e53
or reactivation phase the increasing at 1.5–2 times was noted. Performed analysis demonstrated the negative effect of herpesvirus on course of gestation/labor, health of fetal and newborns in HIVinfected women. The mechanisms of such effect and methods of its minimization or prevention are subjects for further research. http://dx.doi.org/10.1016/j.ejogrb.2016.07.157 Assisted reproduction Poster Presentation The role of vascular deregulation in induction of perinatal disorders among the women with high-risk inducted pregnancy Vyacheslav Kaminskiy ∗ , Anatolij Kaminskiy, Tetiana Kolomiichenko, Oleksandra Boychuk P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy). Currently the endothelium dysfunction is considered as general trigger mechanism of reproductive disorders with involving vascular transformations in disturbances of the placentation processes. In females with infertility and hepatobiliary system disorders we find out the genetic predisposition to endothelial dysfunction. In consideration of the abovementioned we consider necessary to explore in this women the levels of nitrogen oxide donor l-arginine, endothelium impairment factor homocysteine, and angiogenesis factor – placental growth factor (PlGF). The 50 gravid females after assisted reproductive technology (ART) with hepatobiliary system disorders (study group), 50 pregnancy women after ART without such disorders (comparison group), and 50 somatically healthy females with spontaneous pregnancy (control group) at a gestational age 14–16 weeks were studied. In women of study group it was noted the significant reduction of l-arginine up to 44.2 ± 1.1 mmol/L vs. 52.6 ± 1.4 mmol/L in control group (p < 0.05) and increasing of homocysteine. It should be noted the essential reduction of PlGF levels in blood (91.4 ± 8.6 vs. 132.4 ± 11.5 pg/mL in women of control group, p < 0.05), which confirmed the negative effect of angiogenesis process abnormalities on growth and functioning of placenta with such sequences as pregnancy complications and fetal distress. The study group included two subgroups: first subgroup – 19 females with remarkable obstetrical and gynecological abnormalities (miscarriages and non-developing pregnancies, severe preeclampsia, decompensated fetal distress); second subgroup – 31 women without such abnormalities. The study demonstrated the severe compromising of gestation after ART programs (table) in women with hepatobiliary system disorders who at early terms of gestation have the influences of endothelial dysfunction, negative action of homocysteine and abnormalities of angiogenesis processes on the growth and formation of placenta. Thereby these factors may be used as early prognostic markers of severe obstetrical and perinatal disturbances of induced pregnancy in the women with hepatobiliary system disorders. Under homeostatic imbalance conditions in this population the pathogenesis of reproductive, obstetrical and perinatal complications is determined by the endothelium abnormalities and deregulation of vascular factors. This is theoretical prerequisite for the development of pathogenetically-based package of measures for treatment and preventing of such complications with the correction of detected abnormalities. http://dx.doi.org/10.1016/j.ejogrb.2016.07.158