The dissertation is the author's own intellectual practice and is devoted to the study of the impact of the coronavirus disease-2019 on pregnant women and the negative impact on the fetus.
Patients diagnosed with COVID-19 also had a diagnosis of acute tracheobronchitis in 44% and community-acquired viral-bacterial pneumonia (mild and moderate course without respiratory support) in 32%. When evaluating laboratory parameters, it was shown that the group with COVID-19 was significantly different from the control in terms of erythrocyte sedimentation rate (p=0,004) and C-reactive protein (p<0,001). When constructing the ROC curve for C-reactive protein indices, the area under it was 0.696 (p<0,001), which indicates the average quality of the classifier. A moderate strength of correlation was determined (0.343 at p<0,001) between COVID-19 and the C-reactive protein indicator. No significant differences were found in the comparison group and the group of pregnant women with a mild and moderate course of COVID-19 when determining other indicators of a general blood test, biochemical analysis, coagulogram, data of a general urine analysis, biochemical markers of prenatal screening and ultrasound parameters of the evaluation of the fetoplacental complex in the first trimester.
Supplemented scientific data in the process of ultrasound screening of the second trimester, when examining the fetoplacental complex in pregnant women with a COVID-19-related anamnesis, hyperechoic foci, hyperechoicity of the basal plate, placental hyperplasia, the presence of placental lacunae, high-resistance blood flow in the uterine arteries are more often detected.
There was further developed study of the frequency and characteristic dopplerographic and fetometric changes in the diagnosis of the fetoplacental complex during the third screening in pregnant women with a burdened history of COVID-19, where hyperechoic foci, placental lacunae, hyperplasia, changes in the level of amniotic fluid and hemodynamics in the uteroplacental system were found to be significantly more frequent and feto-placental blood flow and the discrepancy of the expected fetal weight with the gestational age of the fetus. During the morphological analysis of the placenta tissues in women with prenatally sonographically diagnosed FGR, signs of massive perivillous fibrin deposits, fibrin deposits around the stem villi, obliteration of vessels of the stem villi, high-grade villitis, and the presence of T-lymphocytes were reliably detected.
The scientific concepts regarding the morphological substrate of changes in the placenta after COVID-19 were expanded and the correlation of the identified morphological postpartum signs with the previously diagnosed ultrasound findings of the placenta was established, namely, 6 or more points on the scale of ultrasound signs were correlated with 9 or more points scored on the scale of morphological evaluation of the placenta.
For the first time the threshold of the sonographic criteria for the assessment of the fetoplacental complex of women with a burdened history of SARS-CoV-2 infection, which require further morphological assessment of the postpartum biomaterial of the placenta, has been determined.
Key words: COVID-19, SARS-CoV-2, ACE-2, pregnancy, ultrasound, placental morphology, dopplerography, fetoplacental insufficiency, depression, fetal growth restriction, small-for-gestational-age fetus, anxiety, pneumonia, psychoemotional state, stress.
