Zagorodnia A. Preterm labour - pathogenesis, prognostication and perinatal losses prevention.

The study deals with preterm labour activity pathogenesis research. Basing on the search of pathogenic differences in diverse pregnancy terms, the peculiarities of interleukin balance is studied. A special attention is payed to system and local proinflammatory interleukin secretion before and after 28 gestational weeks. The identified difference consists in mainly normal or even decreased serum concentration of proinflammatory cytokines by labor before 28 gestational weeks and acute increased ones - after this term. Considering role of antiinflammatory interkeukins increased secretion in normal gestational processes, serum concentrations of these cytokines are investigated. Decreased level of antiinflammatory cytokines, found in part of patients with preterm labor after 28 weeks is considered to be a special pathogenic mechanism. According to high frequency of trombophilic clinical signs among patients the circulation of antiphospholipid antibodies is studied. This circulation is mainly popular in groups of patients with preterm labor after 28 weeks. Because of high correlation between antiphospholipid antibodies and anti-inflammatory interleukin level the trombophilic depending mechanism of preterm labor activity is proposed. Decreased concentration of mucin-16, also revealed by labor activity after 28 weeks, being an endothelial dysfunction marker, is considered to be an easy and available diagnostic sign of this mechanism. Genetic polymorpfism is investigated in a study. High frequency of follate metabolism enzymes mutations among women with preterm labor is identified. The feature of labor after 28 gestational weeks is mutant genes in homozygote state prevalence, what is correlating with higher level of proinflammatory cytokines, patients with labor in 24-27 weeks more often have mutant genes in heterozygote state. Moreover a lot of newborns with gestational age upper 28 weeks have homozygote form of mutation. An alternative mechanism of pregnancy complications by follate metabolism disorders, besides diffuse thrombosis, based on inflammatory agents hypersecretion, is proposed.