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Role of intracellular membranes in the appearance of obstetric pathologies
MONDAY,
SEPTEMBER
4
FC1.27.06 PROPHYLAXIS OF POSTPARTUM PURULENT INFLAMMATORY COMPLICATIONS. L.I.Karuan, L.Martynova, N.Novikova, National Medical University, Ribalska 10,5, Kiev, Ukraine, 01011. The clinical-statistical analysis of 2125 delivery medical records for 1997, among which 62 post-delivery women had postpartum purulent-inflammatory complications. Data on women with Cesarean section were not included. Following factors were taken into consideration: age, social status, hazardous habits, existence of the extra-genital and gynecological diseases, number of abortions, whether pregnancy and delivery were complicated in the given women group. Results: Delivery was complicated in 50% of postpartum women by lactation mastitis, in 6,66% by uterus sub-involution, in 16,66% by postpartum metro-endometritis; by stitch divergence of the episiotomic wound - in 13,66%, of lochiometr - in 3,33%; by placental polyp in 3,33%. Combination of the postpartum complication was seen in 13,33% of postpartum women. The most pronounces risk factors in the development of the postpartum purulent - inflammatory complications were the following: professional hazards, existence of the chronic infection reservoirs of the genital and extra-genital infection, aggravated obstetric-gynecological anamnesis on the background of extra-genital pathology, complicated delivery. Conclusions: Data of the applied method gave the possibility to predict postpartum purulent - inflammatory diseases and the timely introduction of the prophylaxis measures decrease the frequency of this pathology by 10%.
FC1.27.07 USE OF LOCHIA CYTOLOGIC EXAMINATION FOR THE EVALUATION L.Martvnova, LKarpan, National Medical University, Geroyev Stalingrada 41,2, Kiev, Ukraine. The internal surface of uterus after the separation of afterbirth is a great wound surfase. Among the objective criteria of wound process course evaluation cytologic examination takes an important place. This method is a reliable and technically simple mode of uterine state evaluation. When evaluating the results 5 types of cytograms are distinguished: necrotic, degenerative-inflammatory, inflammatory-regenerative, inflammatory, regenerative. The course of puerperium in healthy puerperas and women with risk factors of puerperal purulent-septic complications development was studied. Among risk factors the iron deficiensy anemia usually occurred. On the 3rd day of puerperium the inflammatory type of cytologic smear was characteristic for puerperas. Such type of cytogram suggests the normal course of the first phase of wound process-inflammation phase. The inflammatory reaction in endometrium is obviously caused by mechanical injury due to placental detachment as well as the presence of decidual tissue residues in uterine cavity. On the 5-6th day the inflammatory-regenerative type of cytogram indicating the positive course of the second phase of wound processwound healing was noted in 90,0*5,47% of healthy puerperas. The examination of lochia on the 5-6th day of puerperal period in puerperas with risk factors of development of puerperal purulent-septic complications revealed that the inflammatory-regenerative type of cytogram was determined in 71,11*6,75% of women. In 28,88*6,75% of women the delay of regeneration beginning was observed (characteristic inflammatory and degenerative-inflammatory type of smear was noted).
FC1.27.08 ROLE OF INTRACELLULAR MEMBRANES IN THE APPEARANCE OF OBSTETRIC PATHOLOGIES Z. Chiladze, V. Bakhutashvili, L. Gogiashvili, S. Rigvava, A. Chiladze, E. Khosiashvili, S. Zurabishvili, Georgian Obstetrics, Gynecology and Reproduction Association, (GOGRA) Tbilisi, Georgia. Uro-genital infection plays a significant role in the process of many obstetric pathologies, including gestosis. Serologic investigations of pregnant women were conducted alongside immunologic and
67
bacteriologic ones, in order to determine the presence of toxins and antibodies against bacteria distributed most of all in patients. A certain definite role is attributed to blood coagulation system connected with local immune status according to the period of pregnancy and the alteration of circulating and fixed immune complex of cytotoxic action. The present paper is an attempt to elucidate one of the causes of pathogenesis of pathologies such as gestosis and atonic uterus blood loss. Study of microstructure of myometry and liver tissue in patients revealed accumulation of a great quantity of fibrine fiber and fibrous thrombus between myometry of perivascular and interstitial gaps, associated with cell membrane in the form of layer with dissociated myocites. Morphologically, hypercaogulemia is expressed in the cortical substance of liver in the form of derangement of intravascular coagulation and appearance of microthrombuses. Prophylactic application of antibacterial preparations and namely of modulators Plaferon and Geparin in 6 pregnant women with liver pathology and hypercoagulemia helped to avoid develpment of gestosis. Study of a microstructure of miometry in this group of pregnant women did not reveal the above stated changes (studies were conducted when the births ended with Cesarean section).
FC1.28 PERINATAL
MORTALITY
FC1.28.01 PERINATAL DEATHS IN THE DONETSK REGION, UKRAINE AND IN DENMARK. Boedker B, Mogilevkina I, Langhoff-Roos .I, Larsen S, Lindmark G, and Orda A. Rigshospitalet University hospital, Copenhagen, Denmark. Done&k State Medical University, pr.Ilicha, Done&k, Ukraine. Hvidovre University Hospital, Copenhagen, Denmark. Uppsala University Hospital, Sweden. Done&k Health Care Administration, Ukraine. Objectives: To analyse and compare which subgroups of perinatal deaths contribute to perinatal mortality (PM) in the Done&k Region, Ukraine and in Denmark. Study Methods: All cases of perinatal deaths of non-malformed infants in the Done&k region 1997-98 and Denmark 1996 were identified by local and national registers and classified according to the Nordic Baltic Perinatal Death Classification. Case reports were studied, and potentially avoidable deaths were identified, and differences in perinatal health care and organisation in the two countries were described. Results: The perinatal mortality rate in Done&k 1997-1998 was 16.111000. In Denmark 1996 it was 8.0. When subgroups were compared it was found that antenatal death-rates of single normal-weight fetuses were the same in the two regions (OR 1.0). Subgroups with higher mortalities in the Done&k region were antenatal deaths of growth retarded infants (OR 2.6), intrapartum deaths (OR 2.7) and neonatal deaths of term infants with normal Apgar scores (OR 2.2). Finally, neonatal mortality of infants with low Apgar scores was much higher in the Ukraine (OR 15.6 for preterm infants, OR 4.6 for term infants). Conclusion: The overall perinatal mortality was twice as high in the Ukraine as in Denmark. The rates of antepartum deaths of nonmalformed, normal-weight fetuses were the same in the two countries, which also indicate that these deaths are not related to social conditions or health care. The biggest differences between the regions were found in the groups considered potentially avoidable, and specific measures to improve health care are suggested.
FC1.28.02 ANALYSIS OF PERINATAL DEATHS (1991.1999) IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA A. Reni, P. Jasper, M. Mathai, A. Peedicayil, .I. Lionel Christian Medical College Hospital, Vellore, India, Objectives: To analyze and compare the perinatal mortality rates (PMR) and causes of perinatal deaths during 1991-1995 and 1996-1999. Study Methods: Data on perinatal deaths were obtained from labor records and analyzed. Results: PMR in Booked patients were found to be 19.0 and 20.0 during 1991-95 and 1996-99 respectively. In Unhooked patients the
SEPTEMBER
4
FC1.27.06 PROPHYLAXIS OF POSTPARTUM PURULENT INFLAMMATORY COMPLICATIONS. L.I.Karuan, L.Martynova, N.Novikova, National Medical University, Ribalska 10,5, Kiev, Ukraine, 01011. The clinical-statistical analysis of 2125 delivery medical records for 1997, among which 62 post-delivery women had postpartum purulent-inflammatory complications. Data on women with Cesarean section were not included. Following factors were taken into consideration: age, social status, hazardous habits, existence of the extra-genital and gynecological diseases, number of abortions, whether pregnancy and delivery were complicated in the given women group. Results: Delivery was complicated in 50% of postpartum women by lactation mastitis, in 6,66% by uterus sub-involution, in 16,66% by postpartum metro-endometritis; by stitch divergence of the episiotomic wound - in 13,66%, of lochiometr - in 3,33%; by placental polyp in 3,33%. Combination of the postpartum complication was seen in 13,33% of postpartum women. The most pronounces risk factors in the development of the postpartum purulent - inflammatory complications were the following: professional hazards, existence of the chronic infection reservoirs of the genital and extra-genital infection, aggravated obstetric-gynecological anamnesis on the background of extra-genital pathology, complicated delivery. Conclusions: Data of the applied method gave the possibility to predict postpartum purulent - inflammatory diseases and the timely introduction of the prophylaxis measures decrease the frequency of this pathology by 10%.
FC1.27.07 USE OF LOCHIA CYTOLOGIC EXAMINATION FOR THE EVALUATION L.Martvnova, LKarpan, National Medical University, Geroyev Stalingrada 41,2, Kiev, Ukraine. The internal surface of uterus after the separation of afterbirth is a great wound surfase. Among the objective criteria of wound process course evaluation cytologic examination takes an important place. This method is a reliable and technically simple mode of uterine state evaluation. When evaluating the results 5 types of cytograms are distinguished: necrotic, degenerative-inflammatory, inflammatory-regenerative, inflammatory, regenerative. The course of puerperium in healthy puerperas and women with risk factors of puerperal purulent-septic complications development was studied. Among risk factors the iron deficiensy anemia usually occurred. On the 3rd day of puerperium the inflammatory type of cytologic smear was characteristic for puerperas. Such type of cytogram suggests the normal course of the first phase of wound process-inflammation phase. The inflammatory reaction in endometrium is obviously caused by mechanical injury due to placental detachment as well as the presence of decidual tissue residues in uterine cavity. On the 5-6th day the inflammatory-regenerative type of cytogram indicating the positive course of the second phase of wound processwound healing was noted in 90,0*5,47% of healthy puerperas. The examination of lochia on the 5-6th day of puerperal period in puerperas with risk factors of development of puerperal purulent-septic complications revealed that the inflammatory-regenerative type of cytogram was determined in 71,11*6,75% of women. In 28,88*6,75% of women the delay of regeneration beginning was observed (characteristic inflammatory and degenerative-inflammatory type of smear was noted).
FC1.27.08 ROLE OF INTRACELLULAR MEMBRANES IN THE APPEARANCE OF OBSTETRIC PATHOLOGIES Z. Chiladze, V. Bakhutashvili, L. Gogiashvili, S. Rigvava, A. Chiladze, E. Khosiashvili, S. Zurabishvili, Georgian Obstetrics, Gynecology and Reproduction Association, (GOGRA) Tbilisi, Georgia. Uro-genital infection plays a significant role in the process of many obstetric pathologies, including gestosis. Serologic investigations of pregnant women were conducted alongside immunologic and
67
bacteriologic ones, in order to determine the presence of toxins and antibodies against bacteria distributed most of all in patients. A certain definite role is attributed to blood coagulation system connected with local immune status according to the period of pregnancy and the alteration of circulating and fixed immune complex of cytotoxic action. The present paper is an attempt to elucidate one of the causes of pathogenesis of pathologies such as gestosis and atonic uterus blood loss. Study of microstructure of myometry and liver tissue in patients revealed accumulation of a great quantity of fibrine fiber and fibrous thrombus between myometry of perivascular and interstitial gaps, associated with cell membrane in the form of layer with dissociated myocites. Morphologically, hypercaogulemia is expressed in the cortical substance of liver in the form of derangement of intravascular coagulation and appearance of microthrombuses. Prophylactic application of antibacterial preparations and namely of modulators Plaferon and Geparin in 6 pregnant women with liver pathology and hypercoagulemia helped to avoid develpment of gestosis. Study of a microstructure of miometry in this group of pregnant women did not reveal the above stated changes (studies were conducted when the births ended with Cesarean section).
FC1.28 PERINATAL
MORTALITY
FC1.28.01 PERINATAL DEATHS IN THE DONETSK REGION, UKRAINE AND IN DENMARK. Boedker B, Mogilevkina I, Langhoff-Roos .I, Larsen S, Lindmark G, and Orda A. Rigshospitalet University hospital, Copenhagen, Denmark. Done&k State Medical University, pr.Ilicha, Done&k, Ukraine. Hvidovre University Hospital, Copenhagen, Denmark. Uppsala University Hospital, Sweden. Done&k Health Care Administration, Ukraine. Objectives: To analyse and compare which subgroups of perinatal deaths contribute to perinatal mortality (PM) in the Done&k Region, Ukraine and in Denmark. Study Methods: All cases of perinatal deaths of non-malformed infants in the Done&k region 1997-98 and Denmark 1996 were identified by local and national registers and classified according to the Nordic Baltic Perinatal Death Classification. Case reports were studied, and potentially avoidable deaths were identified, and differences in perinatal health care and organisation in the two countries were described. Results: The perinatal mortality rate in Done&k 1997-1998 was 16.111000. In Denmark 1996 it was 8.0. When subgroups were compared it was found that antenatal death-rates of single normal-weight fetuses were the same in the two regions (OR 1.0). Subgroups with higher mortalities in the Done&k region were antenatal deaths of growth retarded infants (OR 2.6), intrapartum deaths (OR 2.7) and neonatal deaths of term infants with normal Apgar scores (OR 2.2). Finally, neonatal mortality of infants with low Apgar scores was much higher in the Ukraine (OR 15.6 for preterm infants, OR 4.6 for term infants). Conclusion: The overall perinatal mortality was twice as high in the Ukraine as in Denmark. The rates of antepartum deaths of nonmalformed, normal-weight fetuses were the same in the two countries, which also indicate that these deaths are not related to social conditions or health care. The biggest differences between the regions were found in the groups considered potentially avoidable, and specific measures to improve health care are suggested.
FC1.28.02 ANALYSIS OF PERINATAL DEATHS (1991.1999) IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA A. Reni, P. Jasper, M. Mathai, A. Peedicayil, .I. Lionel Christian Medical College Hospital, Vellore, India, Objectives: To analyze and compare the perinatal mortality rates (PMR) and causes of perinatal deaths during 1991-1995 and 1996-1999. Study Methods: Data on perinatal deaths were obtained from labor records and analyzed. Results: PMR in Booked patients were found to be 19.0 and 20.0 during 1991-95 and 1996-99 respectively. In Unhooked patients the