ABSTRACT
The paper shows the changes that have determined the features of modern obstetrics. A sharp decline in birth rates and the elements of depopulation in the country have created new conditions for reforming healthcare and modern obstetrics. Each pregnancy and each child have acquired a special value. In the country, prenatal diagnosis has been introduced and neonatology has evolved. The obstetric strategy has become more active;surgical delivery has increased significantly. Caesarean sections are performed 8—10 times more often. The intensive care and rehabilitation of premature and sick newborns are being actively improved. Maternal and infant mortalities have decreased by 8—10 and 5—6 times, respectively. However, there have been new problems: an increase in the number of bleedings due to placenta previa and placenta increta in pregnant women who have undergone a caesarean section. Antibiotics have become less effective;the number of postpartum infectious diseases has increased. More and more babies are being born premature. The role of extragenital diseases in obstetric pathology has increased;this is especially clearly manifested during the coronavirus pandemic. Treatment for infertility has been improved;assisted reproductive technologies, including in vitro fertilization, are being actively developed. In recent years, much has been done to improve and develop the foundation of obstetrics;93 perinatal centers are functioning, all obstetric facilities have been provided with modern diagnostic and medical equipment. Conclusion: Modern obstetrics has a perinatal direction. Obstetricians are actively involved in solving the demographic problems facing the country. Modern obstetric strategies can reduce maternal and infant morbidity and mortality.
ABSTRACT
The paper analyzes the data available in the literature on placental lesions in pregnant women with SARS-CoV-2 infection. The placenta is noted to be a potential target organ for SARS-CoV-2 due to that it has coronavirus receptors: angiotensin-converting enzyme-2, transmembrane serine protease 2 (TMPRSS2), and CD147. An immunohistochemical study and in situ hybridization showed the presence of SARS-CoV-2 proteins in the syncytiotrophoblast, vascular endothelium, and villous stromal macrophages. The data available in the literature on main placental lesions are summarized. The placenta most often exhibited vascular disorders, such as decidual vasculopathy, accelerated villous maturation and distal villous hypoplasia, as well as perivascular fibrin deposits, intervillous thrombi, and villous infarcts. The development of fetal thrombotic vasculopathy and avascular villi is also described. There are quite frequently occurring inflammatory placental changes as chorioamnionitis and villitis of unknown etiology. Differences in the degree of placental lesion were noted in pregnant women with clinical manifestations of COVID and in those with an asymptomatic course. Villous infarcts and villous chorangiosis, perivascular fibrinoid deposits, and blood clots in the intervillous space were more common in the symptomatic course of the disease;distal villous hypoplasia, fetal vascular disorders, chorioamnionitis, and villitis were in the asymptomatic course. It is emphasized that placental lesions in SARS-CoV-2 infection can cause pregnancy, fetal, and maternal complications. At the same time, an indication is given to the ambiguity of the literature data on transplacental (vertical) transmission of infection from mother to fetus.