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Hemodynamics features investigation in research groups of pregnant women mother-placenta-fetus system
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Radjabova Zulola Abdukhakimovna, Postgraduate student, Department of Obstetrics and Gybecology No. 2, Tashkent Institute of postgraduate medical education E-mail: radjabova.z@yandex.com
Karimova Feruza Djavdatovna, DM, Professor, Head of Department of Obstetrics and Gybecology No. 2, Tashkent Institute of postgraduate medical education
Hemodynamics features investigation in research groups of pregnant women mother-placenta-fetus system
Abstract: Currently, herpes virus infection is a serious problem of modern medicine. This is due to the steady increase in the frequency of herpes virus infection, its decisive influence on reproductive health, leading role in the development of intrauterine infection, leading to perinatal and infant morbidity and mortality. Keywords: herpes, pregnancy, fetoplacental insufficiency, fetus, placenta.
The prevalence of genital herpes in Russia are also very high. Its frequency has been growing steadily and is 7.4 per 100 thousand population [2; 7]. The current situation is contagious, according to experts, primarily related to the expansion of diagnostic capabilities as well as an absolute increase in the number ofpatients with genital herpes [3; 5].
In recent years there has been a tendency to a predominantly asymptomatic (latent) flow of herpesvirus diseases. A frequency of recurrent herpes genital infections primarily in young, sexually active people increased twice. This contributes not only to the wide and uncontrolled spread of infection with the herpes simplex virus, but further negative impact on the possibility of a normal pregnancy and birth of a healthy baby [1; 6; 7]. Herpesvirus disease are generally highly contagious, transmission path are very diverse, but the infection often occurs during close physical contact. This is a horizontal transmission path, which is carried out mostly domestic, air-borne and sexually transmitted [4; 5; 8]. Vertical transmission path of infection from mother to fetus is tipical for herpes viruses: prenatal transplacental infection of the fetus and during labor when there is an infection of the child during the passage through the infected birth mother's ways. Intrauterine transplacental infection of the fetus is a cause of antenatal mortality, miscarriage, premature birth, and early disability children (deafness, blindness, epilepsy, microcephaly, heart defects, splenomegaly, and others). Up to 70 % of cases of prenatal herpes infection is associated with the child's mother, having a latent herpes virus infection [1; 7]. Manifestation of herpes infections in newborns frequently observed in the first 2 weeks of life proceeds in the form of disseminated disease with severe skin lesions, mucous membranes, lungs, central nervous system, liver, accompanied by development of thrombus syndrome. Mortality in infants with herpes virus infection as high as 80 %. In this context, alertness obstetricians about testing pregnant women
becoming particularly urgent in order to identify infection by herpes simplex viruses, as well as the development of tactics prenatal conduct and prenatal preparation of infected pregnant women, which will greatly reduce the likelihood of intrapartum injury of the child and thus reduce the risk of severe herpetic disease in neonates.
The aim of our study was evaluation of fetoplacental complex and fetus functional state during recurrent herpes infection.
Research materials and methods
The study involved 144 pregnant women with herpes infection. Clinical observations carried out on the basis of urban maternity hospitals in Tashkent. The control group consisted of 60 healthy women without herpes infection. The investigation of the fetus status was made by using ultrasound dopplerometric methods.
Increased fetal vascular resistance due to their spasm, is one of the compensatory mechanisms — centralization of circulation with the primary blood supply to vital organs with increasing hypoxia and metabolic disorder. With the development of placental insufficiency opposite changes in the blood flow state in comparison to the aorta artery and the umbilical cord occurs in fetal cerebral arteries. The value of diastolic blood flow in the cerebral vessels initially remains unchanged and then increases, resulting in a reduction of the numerical values of the indices of vascular resistance [3; 8].
The increase in fetal hypoxia associated with reduced resistance of cerebral vessels, ensuring its adequate oxygenation. Preferential blood flow of the fetal brain in the condition ofpulsation index (PI) progression has been called «brain-sparing effect» [8].
Doppler study analysis in the I-main group revealed significant differences of hemodynamic parameters in the mother-placenta-fetus as compared with those in the control and comparison group (Table 1).
There was a significant violation of utero-placental blood flow at 46.67 ± 9.11 % of pregnant women in the main group.
Section 5. Medical science
Table 1. - Systolic diastolic ratio (SDR) indicators of surveyed vessels of pregnant women with herpes infection and control group
Vessels Main group (n = 69) Comparison group (n = 75) Control group (n = 60)
Uterine artery 2.90 ± 0.08* ** 1.90 ± 0.06 1.93 ± 0.04
Umbilical artery 3.27 ± 0.20*** 2.20 ± 0.11 2.21 ± 0.06
Middle cerebral artery 1.89 ± 0.18* ** 3.83 ± 0.10 3.86 ± 0.10
Note: further on in this document: * — Statistically significant difference between groups I and II ^ < 0.001); ** — Statistically significant difference between the control group and I ^ < 0.001).
From this table it is clear that the main group of patients when compared with blood flow velocity curves (BFVC) of utero-pla-cental blood flow was determined by a significant increase in the SDR (2.90 ± 0.08), PI (1.643 ± 0.06) and resistance index (RI) (0.67 ± 0.03) in comparison with indicators of the comparative group and the control group (p < 0.001).
Thus, revealed pathological changes of hemodynamic parameters in the uterine arteries in the study group reveal a violation of the process of ensuring adequate oxygenation and nutrition of the developing fetus.
It is known that pathological BFVC in the arteries of the umbilical cord of the fetus characterized by a decrease in end diastolic velocity of blood flow, which indicates a significant increase in peripheral vascular resistance of fetal part of the placenta, and is expressed in increasing vascular resistance index higher than normative values.
During Doppler research of feta-placental and fetal hemodynamics pregnant women with unaltered feta-placental blood flow and cerebral blood flow were identified in the comparison group were:
- Fetal hemodynamics without pathological changes on 36.24 ± 4.76 % of observations;
- Fetal hemodynamics changes on 63.76 ± 3.24 % of observations.
In the analysis of hemodynamic features of the fetus in 36.24 ± 4.76 % of observations there was no significant difference
from those of its parameters in the control group, so that feta-pla-cental blood flow was normal.
When analyzing the dopplerometric data of feta-placental blood flow in 44 (63.76 ± 3.24 %) was revealed significant differences in the basic group of pregnant women compared to the comparison group and the control group. There were abnormal changes SDR, RI and PI in these fetuses. Increased systolic-diastolic ratio in the umbilical artery is due to the reduction in diastolic blood component, reflecting the slowing of blood flow in diastole phase due to increased vascular resistance of the fetal part of placenta. When comparing how to determine the tendency to increase "angle independent" index (RI and PI) in the umbilical artery of the fetus in patients of the main group compared to the control group.
Identification of increased vascular resistance in umbilical artery in 44 pregnant women (63.76 ± 3.24 %) of the main group draws much attention. At the same time an increase in vascular resistance in feta-placental link characterized by SDR in umbilical artery (UA) more than 3.0, RI — more than 0.67, PI — more than 0.90.
Patients of the main group in the umbilical artery showed significant changes in the SDR (3.27 ± 0.20), RI (0.73 ± 0.03) and PI (1.05 ± 0.05). In the comparison group, these figures were: SDR (2.20 ± 0.11), RI (0.53 ± 0.02) and PI (0.75 ± 0.04), (p < 0.001).
Analysis of the research showed that assessment of BFVC in the umbilical artery of the fetus of the main group is more characterized by increasing ofvascular resistance index.
Table 2. - RI indicators of surveyed vessels of pregnant women with herpes infection and control group
Vessels Main group (n = 69) Comparison group (n = 75) Control group (n = 60)
Uterine artery 0.67 ± 0.03 0.48 ± 0.02 0.49 ± 0.01
Umbilical artery 0.73 ± 0.03* ** 0.53 ± 0.02 0.59 ± 0.02
Middle cerebral artery 0.78 ± 0.01 0.79 ± 0.01 0.81 ± 0.02
The definition of «angle independent» index in umbilical artery showed that the study group was determined significant decrease in feta-placental blood flow (FPBF) (P < 0.001), with a significant increase in the values set PI (1.05 ± 0.05) and RI (0.73 ± 0.03) compared to control group indicators. The increase in RI in the umbilical artery, exceeding the norm, a sign of violations of FPBF on dopplerograms. In the comparison group, violation of feta-placental blood flow was observed in 10 % of cases, while in both cases there was a questionable fetal biophysical profile. In 90 % no any violations were found (p < 0.001). Noteworthy is the fact that the decrease in the intensity of the FPBF in the main group in all cases accompanied by chronic intrauterine hypoxia (100 %). Unlike umbilical artery pathological BFVC in the middle cerebral artery is not characterized
by decrease but by increase in diastolic blood flow velocity, so when the fetus suffering a decline of numerical values of the indices ofvas-cular resistance in cerebral vessels.
Doppler study of curves velocity in the middle cerebral artery (MCA) was conducted. In the study of dopplerometric indicators the following features have been identified in the main group:
- Isolated increase in vascular resistance in feta-placental link (SDR in the umbilical artery > 3.0, RI > 0.67) 33.33 ± 8.61 % of observations;
- Increase in vascular resistance in feta-placental link (SDR in UA > 3.0, RI > 0.67) in combination with a reduction in vascular resistance in the MCA (SDR < 2.3, PI < 1.0) — 26.67 ± 8.67 % of observations.
Table 3. - PI indicators of surveyed vessels of pregnant women with herpes infection and control group
Vessels Main group (n = 69) Comparison group (n = 75) Control group (n = 60)
Uterine artery 1.43 ± 0.06* ** 0.65 ± 0.04 0.69 ± 0.03
Umbilical artery 1.05 ± 0.05* ** 0.75 ± 0.04 0.72 ± 0.03
Middle cerebral artery 0.98 ± 0.03** 1.61 ± 0.05 1.62 ± 0.03
Genetic associations of S282T polymorphism of the gene Nat2 with parkinsonism: clinical and molecular comparisons
As shown in the table in the main group SDR was 1.89 ± 0.06, PI — 0.98 ± 0.03, (p < 0.001), RI — 0.78 ± 0.01.
In the comparison group, the vascular resistance index in the MCA were within standard values and do not exceed 95 percentile:
SDR — 3.83 ± 0.10, PI — 1.61 ± 0.05, RI — 0.79 ± 0.01.
In the control group these figures were — 3.86 ± 0.10, 1.62 ± 0.03 and 0.81 ± 0.02 respectively.
Conclusion
As you can see from the above data, the restructuring of the fetal hemodynamics leads to increased cerebral blood flow (reduction of vascular resistance index in the middle cerebral artery). During comparative analysis of the vascular resistance in the UA there is increase up to 6 times in the main group relative to the comparison group. It should be emphasized that in this case combined disturbance in placental blood flow detected.
Thus, the Doppler study of blood flow parameters in the feta-placental link of the main group showed that the umbilical artery isolated increase in vascular resistance (SDR above 3.0) is occurs in 33.33 %, combined disturbance of blood flow in the umbilical artery and middle cerebral artery occurs in 26.67 % of observances. It should be noted that generally placental blood flow disturbances in the control group is detected overall in 10 %, and in the main group — 60 %, which is six times more often. Changes in feta-placental blood flow (increased rates of resistance index in umbilical artery and the decline in vascular resistance in the MCA), reflect the current fetal hypoxemia.
In general, as shown by our study, the frequency of adverse perinatal outcomes is increasing in the main group, which are exacerbating by the detection of changes in fetus hemodynamics during dopplerometry.
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1. Karimov A. K. Doppler examination with physiological pregnancy//Zh. Patologiya. - 2004. - № 3. - P. 37-38.
2. Krasnopolskiy V. I. Monitoring of pregnant women with family of herpes viral infections: medical technology/V. I. Krasnopolsky and others. - M.: Ministry of Health of the Russian Federation Ministry of Health and Ministry of Defense, 2006. - P. 38.
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4. Newton E. R. Diagnosis or perinatal TORCH infections//Clin. Obstet. Gynaecol. - 2004. - Vol. 42, № 1. - P. 59-70, 174-175.
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6. Radjabova Z. A., Karimov F. D. Fetoplacental system at pregnant women with herpes infection. - Association of Physicians of Uzbekistan, 2013.
7. Radjabova Z.A. Features of histomorphology placental tissue with herpes virus infection//Medical Journal of West Kazakhstan. -2014. - № 1(41). - P. 134-136.
8. Radjabova Z. A., Karimov F. D. Neurologic complications in infants born by mothers with herpes infection/The collection of materials of the Congress of Neurologists of Uzbekistan. - Tashkent, May 22-23, 2014. - P. 142.
Raimova Malika Mukhamedjanovna, Tashkent State Dental Institute, Uzbekistan E-mail: malikamed-74@yandex.ru
Genetic associations of S282T polymorphism of the gene Nat2 with parkinsonism: clinical and molecular comparisons
Abstract: There have been carried out the molecular genetic studies of patients with Parkinson's disease (PD) and vascular parkinsonism (VP) among the people of Uzbek nationality. The association of different genotypes of S282T polymorphism of NAT2 gene with Parkinson's disease was studied. There were revealed significant differences in the frequency of the genotype m/m among the main and control groups (x2 = 4.9; p = 0.02). Homozygous for mutant alleles of the S282T polymorphism of NAT2 gene was reliably associated with increased risk of PD, the development of akinetic-rigid form and the rapid rate of progression.
Keywords: parkinsonism, Parkinson's disease, NAT2 gene.
Parkinson's disease (PD) is one of the four most common neurodegenerative disease of elders. In average, from 120 to 200 per 100 000 population worldwide is susceptible to this disease [1; 9; 10].
Over the past decade tremendous efforts have made to study the etiology and pathogenesis of Parkinson's disease. Numerous foreign and domestic researches have shown that the basis for the development of PD are complex interactions of genetic and environmental factors [2; 3; 4].
Alongside of the development of molecular genetic technologies, opportunities for the formalization of the genetic components of susceptibility to PD were opened, a significant number of data on the involvement of different polymorphic genes in the predisposition to the formation of PD were accumulated [4; 5; 6; 7; 8; 11].
However, despite the achievements of world scientific society in the human genome studies and the development ofhigh-resolution methods of DNA analysis, still we know relatively small number of genes, which in aggregate only partially explain some of the links in the pathogenesis of PD [6; 12; 13; 14].
Many works indicate the influence of NAT2 acetylation polymorphism on the development ofvarious diseases, including some of the neurological, in particular Parkinson's disease [3; 5; 6; 8]. One of the researches [3] informs about the increasing frequency of polymorphism in the "slow acetylators" in the PD group compared with the control group in the UK, but this relationship was not confirmed after the introduction of corrections for multiple comparisons. These results prompted us to further investigation of
