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9The features of the course of pregnancy and childbirth of women with fetal
macrosomia
SaberullinaS. V., BystritskayaT.S.
Amur State Medical Academy, Blagoveshchensk, Russia
Summary: The aim of the study was to estimate the pregnancy, childbirth and neonatal status in women with large fetus. The retrospective analysis of individual maps of pregnancy, the labor histories and stories of born of 150 women who gave birth to large children (study group) and 150 women with normal weight of the children (control group) was done. We studied history, which included the transferred somatic diseases, bad habits, menstrual and reproductive function. The clinical examination was done: height, weight, body mass index (BMI) in the planning of this pregnancy. We have also evaluated the complications of pregnancy, childbirth and neonatal status in the early neonatal Apgar scores at 1 and 5 minutes, and physical development indicators: weight, height, head circumference and chest circumference. It was found that for the patients who gave birth to large babies major characteristics were: the growth of >165 cm, mean BMI at pregnancy planning 24,4 kg/m2, a history of major child labor, lack of bad habits (smoking) during pregnancy, overweight and obesity I degree. The course of pregnancy and childbirth is often complicated by preeclampsia mild and clinically narrow pelvis. The childbirth has a longer course, usually it is performed by caesarean section.
Keywords: pregnancy, childbirth, large fetus
A newborn weighing 4000 grams or more is considered to be the largest. The relevance of a large fetus due to an increase in the frequency of this disease from 8,2% to 16,5%, as well as the lack of tendency to reduce the number of complications in childbirth, perinatal loss and damage to newborns [3,5,7,8]. For large infants have higher rates of asphyxia (9,2%), birth trauma (10,9 -24%) than children with normal birth weight. The childbirth of large fetus is more often complicated by the weakness of labor, the size mismatch of the fetal head and the mother's pelvis, hypotonic bleeding in the early postpartum period, birth trauma [6,9].
The aim of the study was to evaluate the course of pregnancy, childbirth and neonatal status in women with large fetus. Materials and Methods
The retrospective analysis of individual maps of pregnancy, the labor histories and stories of born of 150 women who gave birth to large children (study group) and 150 women with normal weight of the children (control group) was done. We have evaluated the clinical examination: height, weight, body mass index (BMI). We have studied the clinical history, including bad habits (smoking) during pregnancy, transferred somatic diseases, menstrual and reproductive function. We have also evaluated the course of pregnancy, childbirth and neonatal status in the early neonatal period according to Apgar scores at 1 and 5 minutes, and physical development indicators: weight, height, head circumference and chest circumference.
Mathematical treatment of the data was carried out using Microsoft Office Excel 2007 and statistical software package Statistica 6.0. The final results of the analyzed parameters of each sample are presented in the form of M ± A, where M is the arithmetic mean. To find the unknown quantities we have done the intermediate calculations: the error of the arithmetic mean (m). The differences of the two compared values were considered statistically significant if the probability of their identities was less than 5% (p<0, 05). Assess of the statistical significance of differences in the study of quantitative indicators was performed using the parametric Student's t test for independent samples. The significance of differences in the relative performance was assessed using non-
parametric Pearson's x 2 with continuity correction. When the frequency of occurrence of feature was 5 or less for a comparison of the data, we used Fisher's exact test. Results and Discussion
Age pregnant of the main group was 26,66±0,48 years, the control - 27,03±0,63 years (p>0,05). In the analysis of mass-height indices of patients of the main group of the height was 167±1,26 cm in the control group - 163 cm±0,45 (p<0,05). BMI when planning pregnancy was 24,4 ± 0,38 kg / m 2 and 23,0±0,49 kg / m 2 (p<0,05), respectively. Overweight and obesity I is much more frequently diagnosed in 40,1% of the study group than the control - 27, 7% (p<0,001).
At smoking during pregnancy the patients of the main group pointed less 16 (10,5%) than the control group - 36 (24%) (p<0,05). One of the reasons for the possible formation of a large fetus is lack of harmful effects of nicotine and tobacco smoke on the developing fetus. Women, smoking during pregnancy, had etiopatogenic factor, affecting the fetus such as carboxyhemoglobin, which violates the rheological properties of blood, resulting in placental insufficiency [2].The study group was a higher frequency of somatic diseases compared with the control group, dominated cardiopsychoneurosis hypertension type (9,4% vs. 1,8%, p<0,01) and obesity grade 1 (13,3% vs. 3,7%, p<0,05).
The age of menarche in patients of the main group was 13,6±0,20 years, the control -13,1±0,18 years (p>0,05). In the general population of girls of the Amur Region the average age of menarche was 13,3±0,6 years [1]. In the analysis of parity it was noted that the number of re-birthpatients in the study group greater (p<0,05). Multiparous patients in the groups were not found. 28,8% of patients of the main group the previous generations took a major child (p<0,05). The frequency of abortions, spontaneous and failed miscarriages in the groups did not differ (Table 1).
Table 1
Reproductive function of pregnant with large fetus and normal fetal weight
Ratios (%) Core Group(n = 150) Control group(n = 150)
Primigravida 39,4 27
Multigravida 60,6 73
Re-birth 39,3 * 26,7
Medical abortion 66,0 76,4
Spontaneous abortion 8,9 11,8
Attempted abortion 3,6 5,9
Childbirth largest fetus in the history 28,8 * 7,5
Note: * - the level of statistical significance of differences between the study and control group, * -p <0,05.
With each subsequent pregnancy women get a rich vascular network of the walls of the uterus developed, which contributes to the favorable development of the process of placentation and fetal growth. In multiparous, this pattern is not observed [4].
The frequency of complications during pregnancy in the 1 -st and 2-nd trimesters of groups did not differ. In the 3-rd trimester of pregnancy the patients of the main group were more often diagnosed with mild preeclampsia, which had every second pregnant with overweight and obesity. Threatening preterm birth of women with large fetus were diagnosed less frequently than in cases with patients with normal fetal weight (Table 2).
All the patients, the groups being compared have given birth at term. In the study group vaginally gave birth 73,4% of pregnant women, in the control group - 88,7% (p>0,05). Length delivery in the study group was 8,5±0,41 h, in the control - 6,8±0,29 h (p <0,05). By cesarean section 40 (26,6%) women gave birth in the main group, in the control group - 17 (11,3%)(p<0,001). The most frequent indication for elective caesarean section in the study group was a large fetus and breech fetus, to the emergency - obstructed, due to the large fetus. The state of newborns in the study and control groups was assessed as satisfactory. Apgar score at the end of 1st minute was 7,9±0,07 and 7,7±0,14, at the end of the 5-th minutes 8,57±0,06 and
8,40±0,11respectively (p<0,05). Body weight, height, head circumference and chest of infants of the main group were significantly higher than the control group (Table 3).
Table 2
The frequency of complications of pregnancy of patients with large fetus and with normal fetal _weight_
Complications of pregnancy (%) Core Group(n = 150) Control group(n = 150)
I II III I II III
Vomiting of pregnancy 6,2 - - 5,6 - -
Iron deficiency anemia 5,2 19,7 23,9 1,9 12,9 24,0
Threat of termination 14,5 13,6 3,1 16,6 22,2 14,8 *
Mild preeclampsia - - 41,6 * - - 24,0
Placental insufficiency - - 50,5 - - 53,7
Note: * - the level of statistical significance of differences between the study and control group, * -p <0,05; I, II, Ill-trimester of pregnancy.
Table 3
Physical performance of large babies and norma -weight babies
The main indicators Core Group Control group
(n = 150) (n = 150)
Body weight, g 4237,2 ± 26,33 *** 3442,0 ± 45,07
Height, cm 55,3 ± 0,15 *** 52,4 ± 0,24
Head circumference, cm 35,7 ± 0,06 *** 34,0 ± 0,11
Chest circumference, cm 34,7 ± 0,07 *** 33,1 ± 0,13
Note: * - the level of statistical significance between the study and control group; *** - p<0,001.
Findings
Therefore, mothers with a BMI > 25 kg/m 2 and a growth of over 165 centimeters often reveal large fetus. Risk factors for the formation of a large fetus were: the largest fetus in the birth history, re-birth, no bad habits (smoking) during pregnancy, overweight and obesity of the 1-st degree. The course of pregnancy and childbirth of women with large fetus is more often complicated by preeclampsia mild and clinically narrow pelvis. The childbirth has a longer course and it is usually performed by caesarean section. References
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Production of mesothelial cells
Semenov D. A.
Amur State Medical Academy, Blagoveschensk, Russia
Mesothelial cells and extracellular matrix play regulating role during kompensatorno-adaptive reactions of a pleural cavity. Mesothelial cells cosecrete: macromolecular components of an extracellular matrix also will organise it in a mature matrix; phagocytosis particles; fibrinolitic and procoagulationfactors; factors of a chemotaxis of neutrophils and monocytes that can be important for mobilisation of inflammatory cells in a pleural cavity [2, 6, 11]. Mesothelial cells produce cytokines, such, as transformed growtnal factor - бета, epidermal growtnalfactor, thrombocytonalgrowtnalfactor, playing the important role in a pleural inflammation and a fibrosis [8]. Mesothelial cells synthesise colonies stimulating factor of macrophages - granulocytes for a proliferation and a differentiation of granulocytes and monocytes, strengthens phagocytic and cytotoxic activity of granulocytes and eosinocytes. Migration of neutrophils in a pleural cavity is carried out under the influence of some chimokin, in particular, interleukin(SILT) 1, 6, 8. A place of synthesis IL8are the mesothelial cells involved in inflammatory process and their villus. It survey as a biomarker in differential diagnostics of inflammatory and cancerogenic processes [1]. Mesothelial cells contain vimentin, cytokeratin, ICAM-1 (a molecule of intercellular adhesion of 1 type) and molecules CD44. ICAM-1 the TNF - a (the factor of a necrosis of a tumour) (100 U/ml) has been strengthened by application. Application the TNF - a in mesothelial cells has considerably enlarged their affinity to peritoneal mononuclear leucocytes, while the pretreatment TGF - p (transforming factor of growth P) (2 ng/ml) prevents soldering formation. Cultivation within 3 weeks has led to a proliferation, differentiations and taped monocytes/macrophages on a mesothelial surface [7].
Mesothelial cells and extracellular matrix play regulating role during is inflammatory-reconstructive reaction of serous membranes, and integrinserve as cellular receptors for these processes [5, 9]. The pleural mesothelial cell has a critical role in restoration mesothelium after wound drawing through its ability to make a macromolecule of a connecting tissue. For this purpose rat pleural mesothelial cells have been treated to action to various combinations of the factor of a necrosis of a tumour, interleukin1, interferon - у and okisnitrogen in a current of 24-48 hours. In these conditions collagen production was considerably slowed down by a cytokine. Collagen inhibition corresponded to dynamics of enlarged production mesothelial cells okisnitrogen. Окись nitrogen can play a role of the mediator activating production of collagen at the expressed pleural inflammation [10].
Mesothelial cells produce gyaluronan, express keratin microfilaments, are painted negatively with antibodies specific to an epithelium (BerEP4, B72.3, Leu. M1, CEA), that is important for identification of cells in a pleural exudate [16]. The pleural liquids received from patients with an empyema, contain much higher levels of the colony stimulating factor of granulocytes [15]. On literary data patterns of formation of pleural exudates of a various genesis with participation of proinflammatory and antiinflammatory cytokines [12, 13] are taped. Detection of the factor of growth - p1 in a pleural exudate is important immunomodulator, thus its concentration in exudative pleural exudates higher, than intranssudatonalexudates [14]. Concentration leukotriene a metabolite of eicosanoid B4 (LTB4) were much higher in a pleural liquid at a pneumonia, a tuberculosis and a cancer concerning a congestive heart failure [17].
Products of cyclooxygenase of cultivated human mesothelial cells play the important role in an inflammatory serous and tumoral pathology of a pleura. Product cyclooxygenase 2 is the
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