RU2532391C1 - Method for assessing threatened spontaneous miscarriage following aggravated cytomegalovirus infection at early stages of gestation resulting in lower peripheral blood progesterone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely diagnostics and can be used for assessing threatened foetal death following the aggravated cytomegalovirus infection at the early stages of gestation. To this effect, with the underlying cytomegalovirus infection, peripheral blood of a pregnant woman is analysed to measure the anti-cytomegalovirus IgG antibody titre and progesterone level. If the anti-cytomegalovirus IgG titre is 1:1600, and the progesterone level is 18.5±0.8 nmole/l, a threatened spontaneous miscarriage is stated.

EFFECT: method enables stating the threatened spontaneous miscarriage if any at the early stages of gestation.

Description

The invention relates to medicine, in particular to the problem of creating new methods for diagnosing the threat of spontaneous miscarriage during especially dangerous viral infections during pregnancy, such as cytomegalovirus.

Progesterone is one of the most important progestins produced in a woman's body. It is secreted throughout the menstrual cycle, but during the follicular phase, its concentration remains low. Progesterone is secreted by the ovaries and adrenal cortex, and is also formed in the placenta from pregnenolone [2]. The main pathway of progesterone metabolism is conversion to pregnanediol.

Progesterone promotes secretory transformation of the endometrium, which ensures its preparation for implantation of a fertilized egg. After the fertilization process ends, the placenta becomes the main source of hormone production. However, a small amount is synthesized by the adrenal glands.

It is believed that the main effect of progesterone in the first trimester of pregnancy manifests itself on the uterus and the development of blastocysts [5]. Progesterone creates favorable conditions for implantation of the embryo, activating enzymes that can lyse the outer shell of the developing embryo - zona pellucida. Along with this, under the influence of progesterone, the induction of factors that contribute to the proliferation of decidual shell cells and the formation of the embryotroph, which provides nutrition to the embryo in the first weeks of its development, occurs. Under the influence of progesterone is the formation of blood vessels and differentiation of the vascular endothelium [3, 4].

Thus, progesterone is an essential hormone in the initial stages of gestation, providing implantation of the embryo into the uterine mucosa, the formation of conditions for its nutrition before the development of villi through the embryotroph, the formation and development of the placenta, and delivery processes [1].

However, the problem of determining the threat of spontaneous miscarriage during cytomegalovirus infection remains unresolved to date.

The aim of the present invention was to develop a method for assessing the threat of spontaneous miscarriage during exacerbation of cytomegalovirus infection in the early stages of gestation, depending on the content of progesterone in the peripheral blood.

The technical result achieved is the determination of the threat of spontaneous miscarriage during exacerbation of cytomegalovirus infection in the early stages of gestation, depending on the progesterone content in the peripheral blood.

The claimed method has the following techniques:

1. The studies were carried out on the basis of the obstetric department of the Federal State Budgetary Institution "Far Eastern Scientific Center of Physiology and Pathology of Respiration" SB RAMS. 25 pregnant women with gestational age of 8–9 weeks at the age of 18–25 years with chronic cytomegalovirus infection in the acute stage (main group) and 15 pregnant women with the same gestational age without such pathology (control group) were examined. In pregnant women, symptomatic cytomegalovirus infection manifested itself as an acute respiratory disease, accompanied by rhinopharyngitis. The clinical diagnosis - exacerbation of cytomegalovirus infection - was established during a comprehensive study of peripheral blood for the presence of IgM or a fourfold or more increase in the titer of IgG antibodies in paired sera over time after 10 days, avidity index more than 65%, as well as cytomegalovirus DNA. The studies were carried out taking into account the requirements of the Helsinki Declaration of the World Medical Association “Ethical Principles for Conducting Scientific Research Based on Man” as amended in 2000 and the rules of clinical practice in the Russian Federation, approved by Order of the Ministry of the Russian Federation No. 266 of 06/19/2003.

2. Verification of cytomegalovirus, determination of type-specific antibodies IgM and IgG, avidity index was carried out by enzyme-linked immunosorbent assay on a microplate reader “Stat Fax - 2100” using test systems of CJSC “Vector-Best” (Novosibirsk), detection of cytomegalovirus DNA by PCR using DT -96 using sets of NPO DNA Technology (Moscow).

3. The progesterone content in peripheral blood and villous chorionic homogenate was determined using test systems of NVO Immunotech CJSC (Moscow) on a Stat Fax - 2100 microplate reader (USA).

Studies have shown that with exacerbation of cytomegalovirus infection in the early stages of gestation (8-9 weeks), which was characterized by the presence of IgM to cytomegalovirus, IgG antibody titer of 1: 1600, avidity index of 87% and a cytomegalovirus DNA virus replication marker in the scraping of the cervical canal, in the peripheral the blood of pregnant women was determined by a decrease in progesterone to 18.5 ± 0.8 nmol / L with a control of 25.6 ± 0.7 nmol / L. In the study of the villous chorionic homogenate obtained during a medical abortion with a period of 8-9 weeks of gestation due to exacerbation of cytomegalovirus infection in 15 women, a decrease in hormone levels to 22.7 ± 1.0 nmol / L was noted with a control of 45.0 ± 1, 2 nmol / L. In the remaining 10 cases, the pregnancy ended in spontaneous miscarriage for a period of 8-9 weeks.

Thus, an exacerbation of cytomegalovirus infection is accompanied by a violation of hormonesynthetic processes both in the pregnant woman’s body and in the villous chorion, which is characterized by a decrease in the level of progesterone in the pregnant woman’s peripheral blood and leads to spontaneous miscarriage at 18.5 ± 0.8 nmol / L.

Literature

1. Kobozeva N.V., Gurkin Yu.A. Perinatal endocrinology. L .: Medicine. 1986. 310 p.

2. Serov VN, Prilepskaya VN, Ovsyannikova T.V. Gynecological endocrinology. M .: Medpressinform. 2000.520 s.

3. Falke G.P., Andersen J., Dixon D. Etiology and pathogenesis of uterine leomyomas: a review // Environ Health Perspect. 2003. Vol. 111, No. 8. P. 1037-1054.

4. Graham J.D., Clarke C. L. Physiological action of progesterone in target tissues // Endocrine Reviews. 1997. Vol. 18, No. 4. p.502-519.

5. Rothchild I. Role of progesterone in initiating and maintaining pregnancy. In: Bardin C.W., Milgrom E., Mauvais-Jarvis R. editor. Progesterone and progestins. New York: Raven Press. 1983. P. 219-229.

Claims (1)

A method for assessing the threat of embryo death during exacerbation of a cytomegalovirus infection in the early stages of gestation and a decrease in progesterone in the peripheral blood of a pregnant woman, including measuring the titer of cytomegalovirus IgG antibodies and the level of progesterone in a pregnant woman at the time of exacerbation in the peripheral blood, and with an IgG titer of 1: 1600 and level progesterone 18.5 ± 0.8 nmol / L determine the presence of a threat of spontaneous miscarriage.