Puziy Y. Prevention of bacterial-associated perinatal complications in preterm premature rupture of membranes

Similar patterns of a significant association with perinatal losses were found for serum vitamin 25(OH)D levels: rs = -0.306; p<0.001. The median level of vitamin 25(OH)D in the blood of women with live birth was 28.3 (21.7; 33.8) ng/ml, which was 2.4 times higher than in mothers with fetal loss – 11.9 (4.0; 18.8) ng/ml (p<0.001). According to the results of correlation and comparative analysis of the levels of β-defensin 2 expression in the blood of the expectant mother and histological characteristics of the infectious and inflammatory nature of the placenta, inverse relationships between these indicators were established. Thus, the acute placental insufficiency (PI) according to the results of pathological examination of the placenta was associated with a 1.2-fold lower level of ß-defensin 2 expression in the mother’s blood serum (rs=-0.263; p=0.05), which averaged 68.6 (33.7; 80.7) pg/ml in the development of acute PI versus 81.2 (77.2; 90.3) pg/ml in other cases (p=0.038). Against the background of a reduced level of ß-defensin 2 expression in the blood of pregnant women, the frequency of involvement of the umbilical cord vessels and stroma in the inflammatory process (rs=-0.367; p=0.005), the placental intervillous space (rs=-0.264; p=0.05) and other elements of the placenta (rs=-0.283; p=0.035) is significantly increased. The median level of ß-defensin 2 expression in the blood of mothers with funiculitis in histological preparations of the umbilical cord was 78.6 (62.5; 80.9) pg/ml, while in the absence of inflammation in the umbilical cord the index was 1.1 times higher – 82.9 (79.0; 91.1) pg/ml (p = 0.007). It was noted that morphological changes of the inflammatory nature in the membranes, placenta and umbilical cord structures were inversely correlated with the Apgar score at the 1st and 5th minute (rs from -0.265 to -0.469) and the weight of the newborn baby (rs from -0.262 to 0.304) and were directly associated with the development of neonatal respiratory distress syndrome (rs from 0.270 to 0.437). According to the results of univariate logistic regression analysis, it was determined that the risk (odds) of stillbirth increased when the discriminating criterion determined by ROC analysis was met at gestational age up to 27 weeks – by 18.6 (95% CI: 3.4-103.7) times, at β-defensin 2 expression level ≤79 pg/ml – by 37.2 (95% CI: 1.9-718.1) times, at serum vitamin 25(OH)D level ≤15.1 ng/ml – by 22.3 (95% CI: 3.9-125.5) times at p<0.001. Thus, the following may be reliable predictors of perinatal losses in pregnancy complicated by PPROM gestational age of 23 to 27 weeks, β-defensin 2 expression level in the pregnant woman's serum ≤79 pg/ml and vitamin 25(OH)D ≤15.1 ng/ml, presence of moderate anaemia at the time of delivery, premature abruption of placenta, and lack of preventive measures for neonatal respiratory distress syndrome. Multivariate prognostic models were built to calculate the individual risk (probability) of perinatal loss using multiple logistic regression analysis with relatively high diagnostic performance indicators – sensitivity (62.5–75.0%), specificity (100%), prognostic accuracy (97.3–98.2%). All studies were conducted in accordance with the principles of bioethics and the moral and ethical standards of the Helsinki Declaration. All procedures, including the collection of personal data, were carried out after obtaining the patient's informed agreement.