PREVENTION OF REPRODUCTIVE LOSSES ASSOCIATED WITH INTRAPLANTAR ACCUMULATION OF RADIONUCLIDES
Authors:   State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine», Zhyvetska-Denysova A. A. , Vorobiova I. I. ,   State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine», Rudakova N. V. ,   State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine», Lozova L. A. ,   State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine», Shamayeva O. V. ,   State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine», Stryzhak S. K. ,   State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine»
Published: December 2023

The materials of the article are based on the results of our past studies of morphological and immunohistochemical features of placental damage due to 137Cs incorporation. Objective: to determine the effectiveness of radioprotective therapy in preventing reproductive losses and perinatal consequences associated with the incorporation of radionuclides in the placenta. Materials and methods. According to the research design, the first group consisted of 153 women with reproductive losses in anamnesis and signs of termination of the current pregnancy. The control consisted of 30 women with a physiological pregnancy and an uncomplicated history. Based on the fact that one of the causes of premature termination of pregnancy is the vulnerable effect of 137Cs incorporated in the placenta, «Apple Pectin Antioxidant» (the «APA») with a high sorption potential was included in preventive measures regarding reproductive losses and perinatal consequences. The effectiveness of therapy with the inclusion of «Apple Pectin Antioxidant» was evaluated based on indicators of the fetoplacental complex and pregnancy scenarios. The results were compared with the effectiveness of standard treatment for habitual miscarriage of pregnancy. Results. It was established that the destructive effect of incorporated 137Cs leads to placental dysfunction and fetal distress. Therapy with the inclusion of «APA» more significantly than standard treatment increases the progesterone-synthesizing function of the placenta, microcirculation, adaptation potential, and antioxidant protection of cells with the efficiency of 7.5 %, 10.7 %, 17.7 %, and 43.4 %, respectively. «APA» has a positive effect on the scenarios of pregnancy. «APA» in the composition of therapy to preserve pregnancy contributed to a decrease in the frequency of premature births by 11.4 % and an extension of their term to 34 weeks of gestation. Extending the gestational age of preterm birth reduced the frequency of severe asphyxia by 18.7 %, hypoxic-ischemic central nervous system injury by 13.5 %, respiratory distress by 17.3 %, and intraventricular hemorrhage 2nd and 3rd degrees by 12.7 %. All children were born alive due to the preservation of the compensatory ability of the placenta. Conclusions. Termination of pregnancy is a universal reaction of the mother and the fetus to negative exogenous and endogenous influences. Placental dysfunction is the most frequent cause of reproductive losses. Incorporated 137Cs is one of the factors that disturb the architecture of the placenta. Extreme effects depend on the number of incorporated 137Cs and the compensatory capacity of the placenta. Today, the possibility of internal exposure to 137Cs is associated due to consumption of agricultural products. Unfortunately, the level of food contamination with radionuclides remains higher than permissible. Living in an area with a standard radiation background does not guarantee a person the radiation safety of agricultural products. The confirmation is the accumulation of 137Cs in the placentas of women from different regions of Ukraine. The high efficiency of therapy with «APA» is associated with the removal of radionuclides and the minimization of the effect of internal irradiation, which made it possible to reduce the frequency of termination of pregnancy by 28.0 % due to the reduction of cases of premature births (-11.4 %), spontaneous abortions (-11.0 %), termination of pregnancy (-5.5 %). The «APA» is advisable to prescribe from pregravid and during pregnancy to all women, regardless of the region of residence. Key words: a habitual miscarriage of pregnancy, reproductive losses, placental dysfunction, 137Cs, and pectin therapy.