ART OF MEDICINE 2017
INFLUENCE OF INTRAUTERINE INFECTION AT A FREQUENCY OF REPRODUCTIVE LOSSES, THE FETUS AND DELIVERY
L.M. Kusa, R.Ya. Shovhenjuk, M.P. Bendas, N.V. Drogomuretska, S.O. Ostafijchuk
Ivano-Frankivsk National Medical University, Ukraine
Abstract. Nowadays, the term «intrauterine infection» points to the development of inflammatory processes in one or more organs of the fetus, associated with perinatal exposure to an infectious agent. Control of intrauterine infection is one of the most important medical-and-social problems in obstetrics and perinatology, concerned with fetal disorders, and is largely the consequence of some bacterial-and-viral infections. They take the considerable place within maternal mortality and lead to adverse perinatal outcomes. Some viral infections play certain role in sporadic spontaneous pregnancy loss. However, the significance of infectious agents in miscarriages is not fully determined.
Some infectious agents may be transmitted from the mother to the baby at various stages of pregnancy, starting with the intrauterine period and then during perinatal life. The cause of infection transmission may be either mother’s primary chronic infection or its exacerbation. It may be potentially dangerous for the fetus or newborn and may cause reproductive loss, congenital abnormalities, fetal death, intrauterine growth restriction or severe neonatal disease.
The undertaken investigation allowed us to study the peculiarities of fetoplacental complex and sate of the fetus, as well as specific indices of local immunity, level of acute-phase proteins in women at risk of fetal infection. Alterations in cellular and humoral immunity in women with bacterial and viral infections may cause immune alterations in the fetus, which has an underdeveloped system of immunological response, leading to failure in the course of early adaptive period in newborns and development of neurologic, somatic or endocrine disorders in infants.
This article analyzes current problem of intrauterine infections, immune status alterations, course of gestation, state of the fetus, postpartum period records under the conditions of probable intrauterine infection. 130 patients with high level of probable intrauterine infection have undergone infectious screening by means of bacterioscopic and bacteriologic checkup, along with identification of TORCH-group agents using enzyme-linked immunoassay and DNA-polymerase-chain reaction. Immunoassay of the patients was conducted with the help of standard methods of the first and second levels of immunologic assessment; while the levels of a number of cytokines (IL-1ß, IL-4, IL-6, TNF-α, IFN-γ) in blood serum, amniotic fluid and cervical mucus were identified by means of enzyme-linked immunosorbent assay.
The obtained results of perinatal outcomes, in women at risk of intrauterine infection, point to the substantial proportion of reproductive loss, stillbirth, prematurity and premature birth. The percentage of infants with intrauterine growth restriction and operative delivery has also increased. The most considerable and complex perinatal outcomes were associated with pregnancy in women with intrauterine infection from study group III, where the number of premature birth, stillbirth, fetal distress, as well as fetal congenital malformations has considerably increased.
Data analysis shows considerable influence of perinatal infectious factors particularly in the dynamics of gestational process and is accompanied by various disorders in the system of local immunity, manifesting itself in the depression of sIgA synthesis along with the increase of IgG and IgM concentration, that may point to the formation of secondary local immunodeficiency in the studied category of women.
Immune status alterations in pregnant women with high risk of intrauterine infection are of immunodeficient character and locally trigger a combination of adverse immune interactions, which show up as the depression of sIgA synthesis, more pronounced predominance of pro-inflammatory cytokines, mainly IL-6 and TNF-α over the regulatory ones, as well as interferon deficiency, and presupposes the exhaustion of body’s immune defenses in this category of women.
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- Внутриутробное инфицирование плода: современный взгляд на проблему / У.Р. Хамадьянов, Л. А. Русакова, А. У. Хамадьянова [и др.] // Рос. вестн. акушера-гинеколога. – 2013. – № 5. – С. 16–20.
- Жадан И. А. Роль внутриутробных инфекций в развитии перинатальной патологии / И. А. Жадан // Междунар. мед. журнал. – 2002. – Т.8, №3. – C. 60–62.
- Васильєва Н. А. TORCH-інфекції і вагітність / Н. А. Васильєва // Інфекц. хвороби. – 2010. – № 2. – С. 5–12.
- Вовк Л. М. Роль основних представників TORCH-комплексу в розвитку перинатальної патології. Частина 2 / Л. М. Вовк // Клін. імунологія. Алергологія. Інфектологія. – 2011. – № 3. – С. 11–21.
- Иммунологические критерии внутриутробного инфицирования плода / Т.И.Долгих, Ю. И. Тирская, С. В. Баринов, Т Н. Белкова // Бюл. Вост.-Сиб. науч. центра Сиб. отд-ния Рос. акад. мед. наук. – 2012. – № 3, ч. 2. – С. 75–78.
- Содержание цитокинов в амниотической жидкости, пуповинной крови и сыворотке крови женщин с внутриутробной инфекцией / В. И. Кулаков, Г. Т. Сухих, Н. Е. Кан [и др.] // Акушерство и гинекология. – 2005. – № 5. – С. 14–17.
- Evaluation levels of cytokines in amniotic fluid of women with intrauterine infection in the early second trimester / Y. Suzuki, T. Yamamoto, K. Kojima [et al.] // Fetal Diagn. Ther. – 2006. – Vol. 21, N 1. – Р. 45–50.