Vol 64, No 5 (2015)

Thrombotic microangiopathy is one of the most serious thrombotic complications characterized by microvascular thrombosis in various organs and accompanied by thrombocytopenia and hemolytic anemia. The term thrombotic microangiopathy has incorporated several nosology, which are characterized by different mechanisms of microvascular thrombosis. Currently thrombotic microangiopathy include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), heparin-induced thrombocytopenia, HELLP-syndrome. Pregnancy presents one of the key triggers to the development of thrombotic microangiopathy. This fact gives us a significant opportunity to study the pathogenesis of thrombotic microangiopathy in the context of the physiological changes of hemostasis during pregnancy. At the same time the discovery of molecular mechanisms of thrombotic microangiopathy allows for a new research on the field of pathogenesis of thrombotic complications associated with pregnancy, as well as the pathogenesis of so-called placental obstetric complications, including severe preeclampsia, premature detachment of normally situated placenta, septic shock.

Elevated levels of homocysteine in the blood is an important marker of the occurrence of various obstetric pathology. As a result of hyperhomocysteinemia impairs processes of microcirculation in the placenta. This in turn can lead to defects of implantation resulting in miscarriage. One of the factors contributing to the increase in the level of homocysteine in the blood is a hereditary predisposition. The purpose of this study is to analyze the influence of gender, age, number of spontaneous miscarriages, the genotype of MTHFR and MTRR genes with folate cycle homocysteine in the blood, the couple with miscarriages.

The aim was to study the peculiarities of the placental status of women under the influence of exogenous and endogenous factors. We performed immunohistochemical, histological and immunomorphological study of 384 samples of placenta of women with the most common conditions (asthma, smoking, metabolic syndrome and obesity). We studied the expression of immunohistochemical markers, that indicate the presence of immune inflammation in placenta - CD31, CD35, CD57, CD83, alpha-amylase (α-Amyl) and melatonin receptor 1B (Rc-M-1B), identified C3 complement fraction, fibrinogen, IL-4, IL-6, IL-10, IgA, IgM, IgG. The largest number of immune deposits, fixed in the placenta that damage the the placental barrier (endothelium of vessels of chorionic villi and basal membrane of syncytiotrophoblast) were found in cases of moderate and severe asthma, in cases of who smoked throughout the pregnancy and was more common in cases with metabolic syndrome, while compared with obesity group. We had shown that various antigenic factors influencing on the pregnant woman revealed a similar pathogenetic impact of the pathogenic immune complex (PIC) on the membrane structures of the placenta. Destruction of the membrane structures of placental barrier at the areas of PIC leads to dystrophic and necrotic lesions of the placenta and impaired immune homeostasis, development of immunopathological process and placental insufficiency, which correlates with pregnancy and labour complications, and may be predictors of the possible development of allergic diseases in childhood.

Aims of this article consists in analysis of the rate of the most important reasons of miscarriages and in estimation of effectiveness of pregravid therapy of wemen with miscarriages in the past who were patients of Center in 2014. The most important reasons were the infection of genital tract (60 %), inherited thrombophilia (95 %) and AFS (3,2 %), endocrine diseases with secondary or initial insufficiency of corpus luteum (35 %), chronic endometritis (60 %). There were presented results of the investigation of the significance of insulin resistance in the pathogenesis of miscarriages and the efficiency of the treatment with metformin patients with prediabetes. There were analysed the course and results of pregnancy in 354 women with miscarriages in the past. In 92 % of women the pregnancy complete by delivery of alive baby. This results demonstrate the effectiveness of pregravid preparation of women with miscarriages in the past.

Purpose: the frequency of antiphospholipid in patients with reproductive failures was defined. The algorithm of the treatment of these patients was presented. Materials and methods: the study included 2150 patients: 1650 with a history of the repeated pregnancy losses; 450 with sterility and 50 healphy women. Results: the high levels of AFA were founded in 24 % of patients with spontaneous abortions and in 20 % of patients with sterility. Conclusion: Pregravid preparation and permanent monitoring the state of patients reduce frequency of unfavorable ends of pregnancy effectively.

Objective: on the basis of a systematic review, clarify the role of overweight and obesity as a predictor of gestational diabetes mellitus (GDM). Materials and methods: an analysis of the literature data of the leading bibliographic sources - MEDLINE, Cochrane col., EMBASE. To evaluate the body mass index and standards of weight gain during pregnancy used the WHO guidelines and criteria of the Institute of Medicine (2009). The frequency and the odds ratio (OR) of developing GDM was estimated separately for each of the three groups in BMI. Results: A systematic review included 23 different design studies involving 740 510 women. It was found that the odds ratio of the risk of GDM in a group of pregnant women with excess weight is doubled - 2.22 (95 % CI 1.72 - 3.64), and almost four in obesity - 3.88 (95 % CI 2.97 - 5.32). The incidence of GDM in a group of pregnant women with normal body mass index - 3.77 % in the group with excess body weight - 6.59 %, in the group with obesity - 9.88 %. Conclusions: The obtained strong evidence of a direct connection between the linear increase in maternal BMI and the risk of developing gestational diabetes. Pregnant women with excess weight and obesity are at high risk for carbohydrate disorders during pregnancy.

We discuss the case of a family carriers of structural chromosomal aberration del(6)(q24) in two generations. For the first time revealed in 2 year old girl, the aberration has become a reason for family medical and genetic examination, including prenatal cytogenetic diagnosis. The results of clinical and genetic testing of the proband were compared with published data.