Lazurenko V. V., Ovcharenko O. B., Zhelezniakov O. Yu., Tertyshnyk D. Yu., Kudin I. D., Komova V. O.

PREMATURE PLACENTAL ABRUPTION IN A PREGNANT WOMAN WITH TETRAPARESIS AND INTRAUTERINE INFECTION (A CLINICAL CASE)

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Lazurenko V. V., Ovcharenko O. B., Zhelezniakov O. Yu., Tertyshnyk D. Yu., Kudin I. D., Komova V. O.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

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According to the literature, 30–35% of bleeding episodes during the gestational process are associated with premature placental abruption (PPA), which complicates 0.6–1.2% of pregnancies. In most cases, PPA results from an acute or chronic inflammatory process in the maternal and fetal organisms. The aim of the study was to clarify the pathogenesis of PPA considering the data on maternal and fetal infection through a detailed analysis of a clinical case of preterm delivery in a pregnant woman with tetraparesis and subsequent observation of the newborn’s condition. The presented clinical case describes PPA in a 41-year-old pregnant woman M. with tetraparesis, sphincter dysfunction, cervical spinal stenosis after total removal of an extramedullary spinal cord tumor (C6) at the age of 16 years, and class II obesity. During inpatient examination, urine bacterial culture revealed Escherichia coli 10⁴; IgG antibodies to cytomegalovirus infection were positive. A decreased VEGF level (59.4±4.2 pg/mL) and increased ET-1 level (1.77±0.12 pg/mL) in the pregnant woman’s blood indicated alterations in endothelial status. Hyperexpression of proinflammatory cytokines was also detected (IL-1β – 19.2±2.8 pg/mL, IL-6 – 9.7±0.8 pg/mL, TNFα – 13.1±1.4 pg/ mL), indicating the presence of an inflammatory or infectious process in the maternal organism. Due to hemorrhage resulting from PPA, a cesarean section was performed, and a live premature female infant was delivered with an Apgar score of 3–4 points. The early postpartum period was complicated by hypotonic hemorrhage with the development of DIC syndrome, requiring relaparotomy, hysterectomy with adnexa, bilateral ligation of the internal iliac arteries, and drainage of the abdominal cavity. Bacteriological examination of the uterus and placenta revealed chronic purulent endomyometritis (Enterococcus faecalis 10⁵, Escherichia coli 10⁷), chronic cervicitis (Enterococcus faecalis 10⁶, Escherichia coli 10⁴), chronic purulent placentitis (Enterococcus faecalis 10⁵, Escherichia coli 10⁷), and chronic purulent salpingo-oophoritis. In the newborn, blood bacterial culture, CRP assessment, and complete blood count were also performed (CRP – 11.6 mg/dL (normal <5.0 mg/dL); leukopenia in the complete blood count (leukocytes – 8.4×10⁹/L, normal range 9.4–32.2×10⁹/L); blood culture positive for E. coli). The obtained clinical and laboratory data indicated signs of early neonatal sepsis of escherichial etiology, and antibacterial therapy was prescribed according to the antibiotic sensitivity of the identified flora. The presented case of PPA in a pregnant woman with tetraparesis who had been bedridden or wheelchairbound for 25 years demonstrates the combined influence of multiple factors on the development of complications, particularly chronic infectious lesions of the female reproductive system (purulent placentitis, endomyometritis, intrauterine infection), reduced mobility caused by neurological pathology with impaired autonomic innervation, which resulted in decreased uterine contractility after delivery and the development of hypotonic hemorrhage, as well as the presence of cytokine imbalance, endothelial dysfunction, and impaired eryptosis processes.

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Bibliography:

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 2, 181, 178-183 pages, index UDC 618.36-007.281-027.15-06:[616.831-009.12-031.37/38+618.33-022.6/9]

DOI:

10.29254/2077-4214-2026-2-181-178-183