Наукові праці. Кафедра акушерства та гінекології № 3
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Publication Editorial: The repercussions of maternal inflammation in pre-eclampsia on fetal health and neurodevelopment(Frontiers, 2024-05-29) Lakhno, Igor; Reyes-Lagos, José Javier; Adam, Ishag; Brownfoot, Fiona C.Inflammation is a crucial and inevitable biological response in humans, playing an essential role in defense against infections and tissue repair. It is known as a basic pathological process. Inflammatory response is involved in the pathogenic scenario of several obstetrical syndromes. The main trigger for maternal inflammation is a disturbed placentation. HLA (Human Leukocyte Antigen) incompatibility between maternal and fetal tissues significantly influences the risk of preterm birth and pre-eclampsia. Therefore, immune-induced inflammation is a part of pre-eclampsia.Publication The relationship between fetal and maternal hemodynamic oscillations in normal and growth restricted fetuses(Athens Institute for Education & Research (A World Association of Academics and Researchers), 2017-03-15) Lakhno, IgorThe study was aimed to the investigation of the maternal heart rate variability involvement in regulation of fetal circulatory system in case of healthy pregnancy and in fetal growth restriction. 98 patients at 34-40 weeks of gestation were enrolled in the study. And 30 of them were involved in Group I (control). In Group II 34 pregnant women with fetal growth restriction and normal Doppler indices were observed. 34 patients with decreased values of hemodynamic indices were monitored in Group III. The circulatory abnormalities in the utero-placental bed in patients with fetal growth restriction induced maternal and fetal autonomic response. The development of fetal compromise was due to an increased sympathetic and decreased parasympathetic tones. The fact of the considerable relationship between fetal and maternal heart rate variability in healthy pregnancy demonstrated the oscillatory nature of their interaction. Placental bed pathology in patients with fetal growth restriction and abnormal circulatory indices contributed to failed hemodynamic fluctuations exchange between mother and fetus.Publication HRV descriptors for fetal distress assessment in pregnancy with fetal growth restriction(CSREA Press, 2018-07-16) Guzmán-Velázquez, Bertha Patricia; Lakhno, Igor; Díaz-Méndez, AlejandroThis paper focused on the fetal wellbeing assessment, through the selection of HRV descriptors as evident markers of fetal distress. The study of behavior in experiments with control groups of healthy pregnant women and pregnant women with fetal growth restriction allows obtaining quantitative descriptors that help assess the loss of fetal well-being. The results show that SI (Sp=1, Se=0.9882), and AMo (Sp=0.8118, Se=0.9882) are evident markers of fetal distress.Publication Maternal respiratory sinus arrhythmia captures the severity of pre-eclampsia(Polish Society of Perinatal Medicine, 2016-07-15) Lakhno, IgorPre-eclamsia is a gestational disease that leads to hemodynamic disorders, hypoperfusion of end organ and multiple organ failure. Respiratory sinus arrhythmia is known to be participated in regulation of heartrate, cardiac output, blood pressure and peripheral vascular tone. The study was aimed to the survey of respiratory sinus arrhythmia involvement in the maternal cardiovascular system regulation in PE. 116 patients at 28-38 weeks of gestation were enrolled in the study. 30 women with healthy pregnancy were included in Group I (control).In Group II, 49 pregnant women with mild-moderate pre-eclampsia were observed. 37 patients with severe preeclampsia were monitored in Group III. The types of maternal central hemodynamics and maternal heart rate variability were investigated. The decreased autonomic tone was found in pre-eclamptic patients. The increased sympathetic activity in the mild-moderate pre-eclampsia could contribute to better perfusion of end organ. The explored autonomic modulations were associated with gradual decrease of respiratory sinus arrhythmia. Severe pre-eclampsia was featured by dramatic sympathetic overactivity. High peripheral vascular resistance and hypovolemia caused hypoperfusion of end organ in severe pre-eclamptic patients. Therefore, the decreased respiratory sinus arrhythmia was a sign of cardiac failure. Maternal respiratory sinus arrhythmia was an evident biophysical marker of pre-eclampsia and could be used as an additional criterion of its severity.Publication The impact of preeclampsia on fetal ECG morphology and heart rate variability(Polish Society of Perinatal Medicine, 2014-03-15) Lakhno, IgorThe aim of the investigation was a survey of the fetal HRV and ECG parameters in preeclampsia. It was performed fetal noninvasive ECG recordings in 94 pregnant women at 34-41 weeks of gestation and 66 of them were preeclamptic patients. The fetal deterioration in preeclampsia was characterized by lowered fetal heart rate variability and all its fractal components. The autonomic tone was diminished in direct proportion to the severity degree of preeclampsia. The mean value of short term vagal mediated parameters: RMSSD (root mean square of successive differences), pNN50 (the proportion of the number of pairs of successive NNs that differ by more than 50 ms divided by total number of NNs), HF (high frequency) and STV (short term variability) was also decreased. The relative predominance of the central sympathetic baroreflex mediated regulation of fetal hemodynamic was the main event in the preeclampsia induced scenario. The increased value of AMo (the amplitude of mode) and SI (stress index) was associated with abnormal myocardial adrenergic stimulation. It has induced pQ and QT shortening, increased T/QRS ratio and decelerations appearance. The augmented sympathetic tone played the significant role in fetal rigid rhythm and decelerations appearance and has formed the fetal myocardium hypoxic injury and suppressed sinus node response.Publication Dysautonomia involvement in maternal cardiac arrhythmia(Balkan Medical Union, 2022-03-08) Lakhno, Igor; Kniazkova, Iryna; Lakhno, Olga; Uzel, KemineIntroduction. The role of autonomic imbalance in maternal cardiac arrhythmia (CA) is still debatable. The objective of the study was to assess the relationship between maternal autonomic tone and CA in pregnant women. Materials and methods. The cross-sectional study was carried out among pregnant women admitted to Kharkiv Municipal Perinatal Center between 1 December 2015 and 31 July 2020. 117 patients at 28-36 weeks of gestation were enrolled. 20 of them had sinus rhythm and were included in Group I (control). In Group II, 55 pregnant women with CA and cardiovascular comorbidity were observed. 42 patients with idiopathic CA were monitored in Group III. The daily electrocardiogram and heart rate variability (HRV) were obtained. The density of ectopic beats (DEB) was defined as the percentage of ectopic to total beats. Results. The investigation of the HRV revealed heterogeneity in the groups of study. The enhanced sympathetic activity was determined in women with CA and structural heart disease. Pregnant women with idiopathic CA demonstrated a parasympathetic pattern of autonomic nervous regulation. The revealed relations between DEB and sympathetic or parasympathetic regulation demonstrate an increased sympathetic tone in patients with structural heart disease. In women with idiopathic CA, parasympathetic regulation played a significant role in the scenario of cardiac ectopy. Conclusions. The idiopathic CA could be the result of abnormally elevated parasympathetic regulation in the second half of pregnancy.Publication A novel trophotropic mechanism of fetal wellbeing(Yerevan State Medical University, 2014-01-12) Lakhno, IgorThe spectral characteristics of maternal and fetal heart rate variability and umbilical vein hemodynamics were investigated in 63 pregnant women with preeclampsia that was associated with the suppression of the vagal tone. Sympatovagal value above 2.0 was a marker of pregnancy complication. It was determined that fetal compromise in preeclamptic patients was accompanied with decreased total spectrum power and fractal components of heart rate variability and the relative predominance of central sympathetic control. The resulting state influenced negatively on fetal myocardial metabolic response and was characterized with T/QRS ratio above 1.5. The autonomic nervous regulation reduction of the fetus demonstrated the loss of independence from the maternal hemodynamics that had synchronized the maternal and fetal heart rate by increased vagal tone power. The fetal distress development marked an increased regulatory role of maternal origin slow-wave processes and depletion of the proper myogenic umbilical cord arrangements which reinforced the penetrating of umbilical vein pulsative waves.Publication Monitoring fetal maturation - Objectives, techniques and indices of autonomic function(IOP Science, 2017-04-18) Hoyer, Dirk; Żebrowski, Jan; Cysarz, Dirk; Goncalves, Hernani; Pytlik, Adelina; Amorim Costa, Célia; Bernardes, Joao; Ayres-de-Campos, Diogo; Witte, Otto; Schleußner, Ekkehard; Stroux, Lisa; Redman, Christopher; Georgieva, Antoniya; Payne, Stephen; Clifford, Gari; Signorini, Maria; Magenes, Giovanni; Andreotti, Fernando; Malberg, Hagen; Zaunseder, Sebastian; Lakhno, Igor; Schneider, UweMonitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of "fetal programming", also known as "developmental origins of adult disease hypothesis", e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) Electrocardiographic (ECG) recordings allowed a stable heart beat detection in the maturation periods between 20 to 28 weeks of gestation only, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.