MORPHOLOGICAL RESEARCH OF PLACENTA IN WOMEN WITH PRETERM LABOR

Preterm labor is one of the most current problems of modern medicine. Preterm labor is defined as the birth of a child in the gestation period less than 37 full weeks of gestation and is the second most common cause (after congenital anomalies) of neonatal mortality [3]. The highest percentage of morbidity and mortality occurs in children born to gestational age less than 32 weeks, although the proportion of these newborns is 16 % of all preterm infants [4]. Preterm labor is a polyetiology problem that depends on many factors. One of the major problems is the formation of placental dysfunction, which manifests itself by morphofunctional changes in the placenta associated with violation of uterine-placental circulation. 
The aim of the study – to obtain the peculiarities of placentas’ histological condition in women with burdent anamnesis and preterm labor with different Apgar point scale of newborn. 
Materials and Methods. A total of 19 placentas of women with preterm labor were observed in Maternal Hospital No. 5 of Odesa, Ukraine. We studed their residence areas, obstetrical and gynacology anamnesis, current pregnancy and labor anamnesis. We exa­mined the ultrasound datas of the newborns, studied their anthropometric, Apgar scale and histology of placentas’ datas. All interviewed women were devided into two groups: less than 35 years old – 12 women of the group 1 and more than 35 years old – 7 women, it was the group 2. The average age of the examined groups was 31.3 years old. Statistical datas processing was carried out by using the Fisher angular transformation. The degree of probability (P) between two comparative values was considered to be statistically valid when P<0.05. 
The research results showed that all elder women were married, lived in ecoregions of the city, had more often revolved to artificial reproductive technologies, had singleton gestation compared to younger group of patients. Newborns of women afer 35 had better points of Apgar scale and no one had IUGR compared to newborns of the younger women. Signs of placenta dysfynction were detected in placentas of both groups of women. 
Conclusions. In our investigation the women of different age groups with preterm labor had signs of placenta dysfunction but women after 35 years had better datas of newborn babies according to Apgar scale and absence of IUGR. Probably, it is connected with residency, official marriage and better preconceptional preparation in this group.

INTRODUCTION Preterm labor is one of the most current problems of modern medicine. Preterm labor is defined as the birth of a child in the gestation period less than 37 full weeks of gestation and is the second most common cause (after congenital anomalies) of neonatal mortality [3]. The highest percentage of morbidity and mortality occurs in babies born to gestational age less than 32 weeks, although the proportion of these newborns is 16 % of all preterm infants [4]. Preterm labor is a polyetiology problem that depends on many factors. One of the major problems is the formation of placental dysfunction, which manifests itself by morphofunctional changes in the placenta associated with violation of uterine-placental circulation. Placental dysfunction and fetoplacental malnutrition as the main one with its manifestations, which completely influences intrauterine development and fetal formation, is manifested by changes in all structural units and is the result of the immaturity of the villous tree. The result is a violation of the growth and development of the fetus in different trimesters of pregnancy and its premature termination [3]. An important role in the structural stability of the villous tree is played by the complex system of ties, which includes anchor villi, secondary fibrinoid compounds of the branches with basal plate, membranes and a choroid plate, as well as with each other and the villi of the neighboring cotylonone [1,2].
The aim of the study -to obtain the peculiarities of placentas' histological condition in women with burdent anamnesis and preterm labor with different Apgar point scale of newborn.
MATERIALS AND METHODS Under observation in connection with preterm labor, there were 19 women in the Maternity Hospital No. 5 in Odesa in the period from September to December 2018. The features of their place of residence, obstetrical and gynecological and family history, features of the pregnancy and childbirth were studied. The results of ultrasound examinations of children were studied and the anthropometric data of newborns were obtained, their assessment on the Apgar scale was given and a histological analysis of the placentas of newborns was performed. Women in group I gave birth from 25 to 36 weeks of gestation, from 25 to 32 weeks accounted 49 %. In women of the group 2, childbirth was observed from 29 to 36 weeks, and in 57 % of cases childbirth was in the period from 29 to 31 weeks of gestation.
RESULTS AND DISCUSSION An average from 8 to 10 years of females in groups 1 and 2 suffered from infertility, 42 % were residents of the central regions of Odesa, 33 % lived in residential areas of the city and 25 % lived in the ecoregions of Odesa city, 67 % of them were officially married. Among women of group 2, 14 % lived in the central regions of the city, 28 % -in the bedroom suburb and 58 % were residents of Odesa regions, 100 % of the interviewed of older age group were officially married. Pregnancy as a result of ART was reported in 25 % of women in group 1,29 % of women in group 2 used ART, that is because of burdent obstetrical and gynacology anamnesis. In this case, in elderly women, in all cases, singleton gestation were obtained, and in women under the age of 35, in all cases, used ART multiple pregnancies were observed. Vaginal delivery occurred in 67 % of young women and 71 % of older women. The average duration of delivery of women in the group 1 amounted to 8 hours 03 minutes, and women in the group 2 -6 hours 28 minutes, because of the parity, 58 % of the group 1 and 57 % of the group 2 gave birth as nulliparas.
The pathological quantity of amniotic fluid (oligo-or poly) was noted in 75 % of women in the group 1 and 71 % of women in babies in women younger than the age group and in 14 % of babies of women older than age. Female babies were more often born in women of the group 2 -57 %, and in women of the group I of our study, male were born in 87 % of cases. The average weight of infants at birth in younger women was 2107 g, the average height of children was 45 cm, and in women of the older age group the average weight of children was 2039 g, the average height was also 45 cm. The average score of the newborns of women in the group 1 on the Apgar scale on the first minute was 7 points, on the fifth -7 points. For women of the group 2, the average score on the first minute of life was 7 points, on the fifth minute -8 points that can indicate on better intrauterine and intrapartum conditions of these babies compared with newborns of the first women's group. Intrauterine growth restriction (IUGR) in women of the group 1 was observed in 33 % of cases, in women of the group 2, was not found, placenta dysfunction, which was confirmed histologically suspected in 26 % of women in the group 1 and 32 % in women of the group 2, that means that placental compensation opportunities in these cases were better. The taking of material for morphological research was carried out in accordance with generally accepted recommendations [5]. The fragment of the placenta was fixed in 10 % formalin solution. Paraffin sections on which the histological study was performed, painted using the following methods: a) coloration with hematoxylin-eosin -this technique gives a general idea of the structure of the body, well revealing all cellular elements and some non-cellular structures. On the glass, pour a filtered solution of Bemer's hematoxylin, leave for 5-10 minutes. Pour the hematoxylin back into the flask, immerse the cuts in water for 1-10 minutes. Illuminate 1 % with hydrochloric acid and again immerse in clean tap water until the slicing is done (30 min.). Colors 1 % of eosin for 1-2 min. And they are immersed in water, and then at 70 ° and 96 ° in the alcohols. Dip it with filter paper and immerse it in xylene to illuminate the sections, and then enclose the balm. The nuclei acquire a reddishpurple color with a distinct nucleolus and chromatin, and the cytoplasm is moderately pinkish-yellowish (E. Pearce, 1962); b) staining with Pikrofusin for Van Gison -this technique can detect fibrin among the masses of fibrinoid. On the glass, pour one part of the official solution of iron and two parts of the ferruginous hematoxylin for 5 minutes. Pour the paint, rinse with water and immerse it in water. Illuminate with 1 % hydrochloric acid and immerse in water for a twist of sections -15-30 minutes. Pyrofuksin color -3-5 minutes. Immerse cuts in water for 1 to 10 minutes and brighten with 1 % hydrochloric acid and then again immerse in clean tap water to make the slices smooth -30 min. then at 70 ° and 96 ° the alcohols. Dip it with filter paper and immerse it in xylene to illuminate the sections, and then enclose the balm.
In the group 1, the oval form of the placenta prevailed, while in the group 2 it was a round form. The central attachment of the umbilical cord in the group 1 occurs in every third woman, and in the group 2 in each second woman. The first attachment of the umbilical cord to the group 1 was found in 3 cases, and in the group 2 -in one case. Paracentral fixation occurred in group 1 in each second woman, in the group 2 also in each second woman. In each group there was a swelling of the umbilical cord. In the group 2, in one case, the fertile membranes were stained green. All children were born alive. In a microscopic study, hemodynamic disorders (blood in the intervertebral space, hypo-and abacular villi) were determined in the constellations, and in group 1 in both cases and in group 2, in one case, there were infarctions in the form of villous necrosis with clearly delimited dense areas surrounded by blood in between the pharynx space. In two cases in the group 1 and in one case in the group 2, there was retroplacental hematoma with characteristic changes in the basal plate in the form of swelling with plasmorrhagia and the presence of trommel. In 4 cases, in the group 1 and in 2 cases in the group 2, the involutivedystrophic processes were determined in the form of functionalinactive syncytial nodes, which merged into homogeneous masses of nuclei, had no clear boundaries, were petrified, and painted for Van Gizon collagen fibers acquired a yellow color and folding in places of fibrinoid changes. Stroma villi lost its structure, homogeneous masses were determined in separate sites with the phenomena of karyorhexis. In the intervertebral space there were areas with a small number of red blood cells, and in places completely filled with blood. Hyperplasia of the villi was accompanied by hyperplasia of the vessels in them (5-8 vessels), most of which formed syncytocapillary membranes. In the study of the umbilical cord, edema was observed, with the formation of large cavities, in the lumen of the vein there was a peptide epithelium, thickening of the venous wall. In the study of the membranes, the thickening of the compact layer was determined.
CONCLUSIONS The results of the study confirmed that women over 35 years of age are more likely to have induced pregnancies than younger women. Signs of placental dysfunction were identified in both groups. Women of the group 2 had better datas of Apgar scale of their newborns and absence of intrauterine growth restriction. That may be explained with better placental compensatory function, better residency, official marriage and better preconceptional preparation in this women.
Prospects for further research In further research, we aim to continue our study of the preterm labor, reccurent pregnancy losses problems with in-depth study of its genetically acquired and immune factors acquired throughout life.