Effect of exacerbation of cytomegalovirus infection in women in the third trimester of pregnancy on utero-placental, fetal-placental and fetal blood flow

Aim. To study the effect of exacerbation of cytomegalovirus infection (CMVI) in women in the third trimester of pregnancy on utero-placental, fetal-placental and fetal blood flow.

Materials and methods. 120 women were examined at 31-34 weeks of pregnancy, uncomplicated and complicated by CMV exacerbation. The first group consisted of 30 seronegative women with physiological pregnancy, the second one had 30 women of the same gestation period with latent CMVI, the third one included 30 women with CMVI exacerbation and the fourth one had 30 patients who had CMVI exacerbation combined with symptoms of threatened miscarriage.

Results. It was found out that in the second group the systolic-diastolic ratio (SDR) in the right uterine artery was 1.96 [1.74 -2.43] relative units, and in the left one it was 1.98 [1.81-2.16] relative units (in the first group it was 1.72 [1.61-2.22] relative units, p=0.0060 and 1.65 [1.55-2.23] relative units, p=0.0026, respectively). At the same time, the value of SDR in the umbilical artery and the middle cerebral artery did not differ significantly in these groups. In women of the third group, compared to the second group, there was an increase in SDR in the right uterine artery to 2.43 [1.14-3.11] relative units (p=0.00006), in the left uterine artery to 2.49 [1.91-3.51] relative units (p=0.0069). At the same time, vascular resistance in the umbilical artery increased to 3.26 [2.913.91] relative units and vascular resistance (SDR) decreased in the middle cerebral artery to 4.43 [3.79-4.59] relative units (in the second group it was 2.66 [2.48-3.03] relative units, p=0.000005 and 5.1 [4.59-5.90] relative units, p=0.000008, respectively). In the fourth group, in comparison with the third one, the highest values of SDR, pulsator index (PI) and resistance index (RI) were registered in the right uterine artery: SDR was 3.18 [2.55-3.60] relative units, p=0.0073; PI was 1.37 [1.07-1.58] relative units, p=0.010; RI was 0.68 [0.61-0.72] relative units, p=0.010; in the left uterine artery: SDR was 3.08 [2.53-3.60] relative units, p=0.0096; PI was 1.38 [1.06-1.58] relative units, p=0.012; RI was 0.68 [0.61-0.72]) relative units, p=0.010; and in the umbilical artery: SDR was 3.86 [3.38-4.35] relative units, p=0.0027; PI was 1.30 [1.211.51] relative units, p=0.0017; RI was 0.74 [0.72-0.80] relative units, p=0.0043 against the background of lower SDR values in the middle cerebral artery (3.95 [3.08-4.23] relative units, p=0.0083; RI was 0.75 [0.67-0.76] relative units, p=0.0063).

Conclusion. An increase in vascular resistance in the right and left uterine arteries may indicate a change in the structural and functional state of the endothelial lining of the uterine arteries and a violation of the morphological structure of the spiral arteries, and in the umbilical artery - an increase in resistance to blood flow in the terminal branches of the chorion villi. In the pathogenesis of decreased vascular resistance in the middle cerebral artery, the expansion of fetal cerebral blood vessels against the background of an exacerbation of CMVI associated with the threat of miscarriage in pregnant women is played an important role.

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