Systemic endotheliitis in terms of novel coronavirus infection COVID-19: gender-related and perinatal risks

The review considers some physiological features that reflect gender differences in the susceptibility to a novel coronavirus infection. Up-to-date information on the impact of COVID-19 on the course of pregnancy and perinatal outcomes is presented. The debatable issues of the possibility of vertical transmission of the SARS-CoV-2 virus are highlighted based on the analysis of available literature data and recommendations of international professional communities.

Indicated Opioids in Pregnancy: Guidance on Providing Comprehensive Care

In modern obstetric practice, providers will encounter patients for whom opioid use in pregnancy is reasonable or even necessary. A “one-size-fits-all” approach to the counseling and management of such patients is misguided. Understanding indications for ongoing opioid use in pregnancy is essential to patient-centered care. Specifically, recognition of the nuanced differences between opioid dependence and opioid use disorder is crucial for appropriate diagnosis, screening for common concurrent conditions, adequately counseling about individualized maternal and perinatal risks, and accurate documentation of diagnoses and medical decision-making. In this paper, we explore the current typical scenarios in which opioid use in pregnancy may be encountered, ongoing opioid prescribing should be considered, and provide a guide for the obstetric provider to navigate the antepartum, intrapartum, and postpartum periods. Key Points

MEDICAL ASPECTS OF SURROGATE MOTHERHOOD

Surrogacy is associated with a wide range of factors that increase maternal and perinatal risks. The use of in vitro fertilization and embryo transfer technologies determines the higher frequency of multiple pregnancies that enhances the risk of cesarean section, premature birth, low body weight in newborns, etc. in case of surrogacy. Genetic differences and immunogenetic reactions increase the risk of pre-eclampsia, placental pathology, abortion, intrauterine growth retardation. Hormonal disbalance under the effect of adverse factors during surrogate pregnancy may initiate prenatal reprogramming of morphogenesis through epigenetic mechanisms. This can affect the organogenesis and predispose to susceptibility to various diseases. Psychological factors and emotional link between a surrogate mother and a fetus are associated with increased levels of hormones of stress-releasing systems, which affect the formation of neurohumoral systems of the fetus and can modulate its mental development.

PERINATAL RISKS, GENDER CHARACTERISTICS AND POSSIBLE WAYS TO PREVENT COMPLICATIONS IN COVID-19

The article presents modern data on the features of the development, course and influence on the health of a pregnant, a woman in labor, a fetus and a newborn of SARS-COV-2 virus. Some of the protocols for the prevention of infection and treatment of COVID-19 that exist today in the world have been analyzed and a modification adapted for pregnant has been proposed. A method is proposed for the prevention of one of the most frequent and dangerous complications of COVID-19 in pregnant women - miscarriage and correction of nutritional deficiencies.

The Severity of Neurological Dysfunction in Preschool Children, Secondary to Damage Generated During the Perinatal Period, is Associated With a Pro-Inflammatory Pattern of Serum Molecules

Disorders in the child’s neurological development caused by perinatal risks can lead to long-term altered neurological signs that begin at an early age and involve persistent functional disorders. Recent data suggest that tissue dysfunction, not just acute damage, may initiate or perpetuate an inflammatory response. The aim of this study was to find out if any neurological dysfunction in preschool children secondary to damage generated during the perinatal period is associated with the magnitude of perinatal risks and long-term modifications in the serum concentrations of inflammatory molecules. The participants, aged 1–4 years, were on neurodevelopmental follow-up and rehabilitation therapy from the first three months of life and had no acute disease data. We classified the children into three groups according to the importance of their perinatal risks: low, medium, and high. The results show that 1) the magnitude of perinatal risks correlated with the severity of neurological dysfunction; 2) the greatest changes in the concentrations of the molecules of the inflammatory process were associated with the most altered neurological signs. This suggests that persistent nervous system dysfunction keeps inflammatory responses active even in the absence of an acute process of infection or damage.

The Relevant Relationship Between Umbilical Cord Blood Gas and Acid Base Analysis and Dynamic Thiol (Sh)/Disulphide (S-S) Balance in Neonatal Babies with Different Perinatal Risks and Newborn Diseases

Background: Oxidative stress is a pathogenic stress factor in preterm infants. Dynamic thiol/disulphide balance has a critical role in antioxidant defense, detoxification, apoptosis, transcription and cellular signal transport mechanisms. Oxidant/antioxidant balance state is a process beginning before birth and premature infants are especially vulnerable to oxidative stress. Objectives: In this study, we aimed to evaluate dynamic thiol/disulphide homeostasis by umbilical blood gas analysis, compare term and preterm infants, evaluate its relation with Apgar score, perinatal risks with mother and occurrence of NEC (necrotizing enterocolitis), sepsis and ROP (Retinopathy of Prematurity). Methods: A total of 108 (51 female and 57 male) newborn infants were included in this prospective cohort study. Of them, 31 were term and 77 were preterm. Demographic variables, Apgar score, NEC, sepsis and ROP intervention data were collected. Disulfide, native thiol, total thiol, index 1 (disulphide/native thiol × 100), index 2 (disulphide/total thiol × 100) and index 3 (native thiol/total thiol × 100) were calculated. Serum total ischemic modified albumin (IMA) and albumin were measured. Bloodgas analysis was performed within 2 minutes following birth. Results: Preterm infants had lower disulphide levels and index 1 and 2 ratios, but higher index 3 ratios. Acidotic infants, index 1 and 2 and disulphide levels were higher and index 3 was lower than patients with normal pH. Disulphide, index 1 and 2 were lower in patients taken to NICU (Neonatal Intensive Care Unit) compared to ones who were not, whereas index 3 values were higher, twenty one patients (19.4%) with scores < 7 had higher index 3 values at 5th minute. Disulphide levels, index 1 and 2 levels were lower in patients with NEC and index 3 levels were higher. Index 3 ratios were higher in septic infants. Index 3 was higher in patients born from preeclamptic mothers compared to ones without preeclampsia. Albumin levels were higher in patients with maternal placental anomalies. Conclusions: We believe that evaluation of thiol-disulphide homeostasis in preterm and term infants may be demonstrative for oxidant capacity of the newborn, hence the oxidative stress.