Ultrasound and clinical and morphological evaluation of intrauterine infection in pregnant women: A retrospective study

Background. Intrauterine infection (IUI) remains an urgent obstetric problem. Aim. Identification of modern, reliable markers of intrauterine infection. Materials and methods. We conducted a retrospective analysis of 510 ultrasound (US) examinations and clinical, microbiological, and morphological data of 54 pregnant women (main group) with symptoms of placental insufficiency (PI) and IUI confirmed after childbirth. The control group included 48 patients with a normal course of pregnancy and childbirth. Results. Valuable and accessible markers of IUI and PI were identified in the main group using sonography: structural changes in the placenta [n=25 (46.3%)] and umbilical cord [n=15 (27.8%)], abnormal changes in the internal organs of the fetus (nonimmune hydrops [n=9 (16.7%)], calcifications [n=8 (14.8%)], etc.), oligohydramnios [n=26 (48.1%)], fetal growth retardation [n=11 (20.4%)], impaired fetoplacental blood flow [n=41 (75.9%)]. These changes occurred in patients with a history of pelvic inflammatory diseases [n=30 (55.6%)], mother's somatic diseases (history of urinary tract infections [n=19 (35.2%)], pregnancy complications: threatened miscarriage [n=19 (35.2%)], threatened premature birth [n=26 (48.1%)], infectious diseases in newborns. The study of afterbirth in the main group showed signs of purulent chorioamnionitis in 30 (55.6%) cases. Conclusion. Maternal infectious diseases through the transplacental and ascending pathways increase the risk of miscarriage, preterm delivery, and fetal and neonatal disease and lead to adverse perinatal outcomes. Ultrasound predictor marker of the initial complications of PI and IUI is early oligohydramnios detected using the method of maximal vertical pocket by 3D/4D echography [in the main group, n=24 (44.4%)], which precedes the development of early fetal growth retardation [n=4 (7.4%)] and decompensation of fetoplacental blood flow [n=7 (13%)]. The timely use of ultrasound markers of IUIs helps to choose the effective approach for prenatal care and delivery.