Journal of obstetrics and women's diseases

BACKGROUND: Currently, there is an elevation in the incidence of uterine fibroids in increasingly younger women of reproductive age. Taking into account the current trend of late motherhood, this cohort of patients is interested in using reliable reversible contraception. Combined hormonal contraceptives meet these criteria and are able to neutralize the clinical manifestations of uterine fibroids, thereby improving the quality of life of patients. At the same time, some combined hormonal contraceptives users may experience a decrease in libido and a change in their psycho-emotional state as a manifestation of the side effects of these drugs.

AIM: The aim of this study was to assess the effect of combined hormonal contraceptives on the quality of life in patients with uterine fibroids.

MATERIALS AND METHODS: This study involved 100 patients with uterine fibroids (F3–F6 according to classification of the International Federation of Gynecology and Obstetrics, without indications for surgical treatment) and 30 healthy women aged 18 to 49 years. For contraceptive purposes, 40 participants with uterine fibroids used combined hormonal contraceptives containing ethinyl estradiol (group I) and 60 patients with uterine fibroids did not use any medications (group II). The following validated questionnaires were used for patients with uterine fibroids — at the beginning and after 6 months, and for healthy women in the control group (group III) — once upon entry into the study: Short Form-36, Female Sexual Function Index, and Beck Depression Inventory. A comparative statistical analysis of the studied parameters over time was carried out.

RESULTS: At baseline, a lower quality of life was noted in patients with uterine fibroids compared to the control group (Short Form-36): 94 ± 6 vs 102 ± 11 points, respectively (p < 0.05). After 6 months, patients in group I showed positive dynamics with increasing in the total Short Form-36 from 95 ± 4 to 98 ± 5 points (p < 0.05) compared to patients in group II: 94 ± 6 and 93 ± 5 points (p > 0.05). We revealed no changes in the Female Sexual Function Index in the study groups — at baseline: 24.8 ± 8.9 (group I), 23.9 ± 9.5 (group II), and 27.8 ± 4.7 (group III); and after 6 months: 26.4 ± 9.2 (group I) and 23.9 ± 10.0 (group II) (p > 0.05 for all comparisons). When comparing the results of a questionnaire on the Beck scale, no dynamics were determined in patients with uterine fibroids, including those who used combined hormonal contraceptives.

CONCLUSIONS: The study demonstrated a lower quality of life in patients with uterine fibroids compared to healthy women and an improved quality of life in patients with uterine fibroids using combined hormonal contraceptives. We showed no negative effects of contraceptive drugs on libido and emotional state in women with uterine fibroids who used combined hormonal contraceptives for 6 months.

BACKGROUND: The fetal liver plays a central role in energy metabolism and is supplied mainly by the vessels of the umbilical-portal venous system. Redistribution of blood flow in this system is a key adaptive response of the fetus to environmental change.

AIM: The aim of this study was to evaluate the hemodynamic redistribution in the fetal umbilical-portal venous system in pregnant women with pregestational diabetes mellitus, gestational diabetes mellitus and in healthy pregnant women.

MATERIALS AND METHODS: This prospective cohort single-center study was conducted at the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg between February 2022 and September 2023. The study included 188 patients who made up the following comparison groups: pregestational diabetes mellitus (n = 86), gestational diabetes mellitus (n = 44), and control (n = 58). Patients underwent ultrasound from 30⁺⁰ to 41⁺³ weeks with assessment of venous hemodynamics in the vessels of the umbilical-portal venous system such as the umbilical vein, left portal vein, right portal vein, main portal vein, and ductus venosus.

RESULTS: The umbilical vein volumetric blood flow in the I group exceeded that in the II group by 23.60 ml/min/kg and that in the control group by 30.35 ml/min/kg (p < 0.001). The total liver volumetric blood flow in patients with pregestational diabetes mellitus (106.85 ml/min/kg) also exceeded that in the gestational diabetes mellitus group by 28.04 ml/min/kg and that in the control group by 33.73 ml/min/kg (p < 0.001). The umbilical vein and total fetal liver blood flows increased to full-term pregnancy, but, when normalized by the estimated fetal weight, the both flows showed a downward trend at 37–41 weeks of gestation (p < 0.001). No significant differences were revealed in the ductus venosus volumetric blood flow in the study groups. However, there was a significant decrease in the ductus venosus shunt fraction in patients with pregestational diabetes mellitus (16.83 %) by −8.34 % compared to the control group (24.56 %) and by −5.65 % compared to the II group (22.89 %). The downward trend persisted throughout the third trimester of pregnancy and reached its maximum at full-term (p < 0.001).

CONCLUSIONS: With pregestational diabetes mellitus, there is a priority redistribution of highly oxygenated blood from the umbilical vein to the right lobe of the fetal liver, accompanied by a decrease in the ductus venosus shunt fraction. This may underlie the pathogenesis of such complications as fetal macrosomia and diabetic fetopathy.

BACKGROUND: To date, the risks of pelvic inflammatory diseases, including chronic endometritis, associated with the use of various intrauterine contraceptives, have remained debatable.

AIM: The aim of this study was to conduct a comparative analysis of the endometrial status in women of reproductive age after the use of copper- or levonorgestrel-releasing intrauterine device.

MATERIALS AND METHODS: Morphological and immunohistochemical studies of endometrial biopsies obtained by aspiration Pipelle biopsy were performed after intrauterine device extraction in 18 patients who used a copper-containing intrauterine device and in 12 women who used the levonorgestrel-releasing intrauterine device Mirena. Monoclonal mouse antibodies to CD20, CD138, and α-smooth muscle actin (DAKO, Denmark) were used. Criteria for inclusion of patients in the study are reproductive age, use of an intrauterine device for five years, absence of complications associated with the intrauterine device during its use. Exclusion criteria are a history of pelvic inflammatory diseases, sexually transmitted infections, habitual miscarriage, two or more intrauterine interventions.

RESULTS: After using a copper-containing intrauterine device, signs of chronic inflammation were found in the endometrium such as cytogenic stroma fibrosis with pronounced infiltration by inflammatory cells, positive expression of CD138 (33.3% of observations), CD20 (88.9% of observations with an average number of 27.4 ± 5.7), α-smooth muscle actin (up to 70% of the cytogenic stroma area), and the presence of lymphatic follicles consisting of B lymphocytes (33.3% of observations). During the use of the levonorgestrel-releasing intrauterine device, decidual transformation of cytogenic stroma cells, as well as secretion and atrophy of the glandular epithelium, were found in the endometrium. CD20-positive cells were detected in five out of 12 cases (41.6% of observations with an average number of 12.8 ± 4.6). Expression of CD138 and α-smooth muscle actin was not detected in any of the cases.

CONCLUSIONS: The use of a copper-containing intrauterine device is associated with a high risk of developing chronic endometritis. The absence of signs of chronic inflammation in the endometrium after the use of a levonorgestrel-releasing intrauterine device is probably due to the protective effect of levonorgestrel on the uterine mucosa. Thus, levonorgestrel-releasing intrauterine devices, in comparison with copper-containing intrauterine devices, have a favorable safety profile relative to the endometrium and can be recommended for women of reproductive age, including those who have not given birth.

BACKGROUND: The coronavirus pandemic has been a powerful and long-term stressor, and pregnant women are among the most vulnerable groups in the population. Modern foreign studies have shown an increase in the level of anxiety, depression, and post-traumatic stress disorder in women during pregnancy and after childbirth in the COVID-19 coronavirus pandemic, which, in turn, can affect both the course of pregnancy and childbirth and the development of the child. Meanwhile, there are currently very few domestic studies of these characteristics and their dynamics in women in the pre- and postnatal period.

AIM: The aim of this study was to assess the characteristics and dynamics of the emotional condition and mental health of women during pregnancy and after childbirth in the COVID-19 coronavirus pandemic.

MATERIALS AND METHODS: In this study, we used the State-Trait Anxiety Inventory by Ch.D. Spilberger, adapted by Yu.L. Khanin; the Achenbach System of Empirically Based Assessment (Adult Self-Report 18–59) by T. Achenbach and L. Rescorla, adapted by E.R. Slobodskaya; the Impact of Event Scale-Revised by D.S. Weiss and C.R. Marmar, adapted by N.V. Tarabrina; socio-biographical questionnaire during pregnancy and after childbirth; and postpartum interview. At the I stage, the study included 248 pregnant women, with the average age of 30.7 (18–44) years and the average gestational age of 31.1 (4–40) weeks. At the II stage, we enrolled 98 women from the initial sample four to six months after childbirth.

RESULTS: Our study showed the presence of predominantly average levels of anxiety, a high frequency of depressive disorder and avoidance, cognitive problems and withdrawal, as well as somatic problems during pregnancy. Pandemic-related post-traumatic stress disorder was identified in 7.7% of pregnant women and 6% of women after childbirth. Analysis of the dynamics of the emotional condition and mental health disorders in women before and after childbirth revealed a significant decrease in the levels of post-traumatic stress disorder (p < 0.01), depressive (p < 0.05) and somatic (p < 0.01) disorders, and avoidance disorder (p < 0.05). Predictors of the emotional condition, post-traumatic stress disorder and mental health disorders in women after childbirth are the same as those during pregnancy.

CONCLUSIONS: The study showed a high incidence of post-traumatic stress disorder, depression and avoidance disorders with an average level of anxiety in pregnant women during the pandemic. After childbirth, patients experienced a decrease in depressive, somatic and avoidance disorders, as well as post-traumatic stress disorder.

BACKGROUND: Fetal growth restriction, which is considered as a multifactorial pathology, is a critical problem in obstetrics. The role of mitochondrial dysfunction in the pathogenesis of fetal growth restriction is not yet clear. However, it is known that it leads to oxidative stress, damage to cells and tissues, and dysfunction of key mechanisms for maintaining energy balance, the outcome of which may be the development of placental insufficiency. It is likely that AT-rich interactive domain-containing protein 1A (ARID1A) is involved in the development and function of the human placenta and may be an important marker in the development of fetal growth restriction.

AIM: The aim of this study was to evaluate ARID1A protein expression in the placental villous tree in late fetal growth restriction.

MATERIALS AND METHODS: This study included 50 placentas from children born at full-term gestation (37–40 weeks). The main study group consisted of placentas with late fetal growth restriction and without major extragenital pathology (n = 35). The control group comprised 15 placentas without fetal growth restriction (n = 15). Histological (n = 50) and immunohistochemical examinations of placentas (15 placentas in the main group and 10 placentas in the control group) using primary monoclonal antibodies to ARID1A were performed.

RESULTS: In the study group with fetal growth restriction, chronic placental insufficiency was verified in all cases, dissociated chronic placental insufficiency (25 cases; 71.4%) being predominant, of which 23 cases (92%) were compensated, including 16 cases (69.6%) with moderate circulatory disorders. Hypoplastic chronic placental insufficiency was diagnosed in ten cases (28.6%) and was subcompensated with the presence of pronounced circulatory disorders. In the arteries of the stem villi, the ARID1A protein expression area did not differ between the study groups (p = 0.096), while in the veins in the stem villi with fetal growth restriction, we verified a decrease compared to control (p = 0.05). In the vascular bed of the villi with subcompensated dissociated chronic placental insufficiency, ARID1A protein expression was higher compared to hypoplastic chronic placental insufficiency (p = 0.041).

CONCLUSIONS: Chronic placental insufficiency combined with fetal growth restriction is a serious complication of pregnancy with the development of structural and functional abnormalities and dysregulation of placental mechanisms. The ARIDA1A protein expression data obtained, depending on the degree of compensation for chronic placental insufficiency, may indicate the activation of compensatory metabolic mechanisms to maintain the functional activity of the placenta and preserve the viability of the fetus.

New genetic technologies that have emerged and been introduced into practice over the past 20 years, including 16s rRNA sequencing, have significantly expanded our understanding of the microbial composition of the human body. The gut is one of the most densely populated microbial niches in the human body. Numerous studies have shown the relationship of the gut microbiome with various non-communicable diseases, including diabetes mellitus, obesity, allergies and even mental disorders. The perinatal period, as one of the most hormonally dependent ones in human ontogenesis, has a direct impact on the composition of the intestinal microbiota, just as the microbiota itself can be a precursor and etiological cause of pregnancy complications.

In this regard, the aim of this review article was to systematize data on the gut microbiota of the maternal body in normal and pathological pregnancy, as well as to analyze data on the interaction of the maternal gut microbiome with the fetal immune system.

The review presents data on changes in the maternal intestinal microbiome in normal pregnancy, during infertility, as well as in pregnancy complicated with obesity, gestational diabetes mellitus and preeclampsia. The review also shows how the maternal microbiome is able to “educate” the fetal immune system in utero, thereby preparing the child, who develops in a sterile womb, for extrauterine life surrounded by a large number of various microorganisms. These mechanisms include the direct effect of not only the microorganisms themselves, but also, even largely, their metabolites — primarily short-chain fatty acids.

All these presented data allow for concluding that the maternal microbiome is essentially a separate regulatory homeostatic system, along with the immune, endocrine and cardiovascular systems, which may determine the development of certain complications of pregnancy and shape the health of the unborn child. Interventions in the composition of the maternal gut microbiota may be a way to modulate the course of pregnancy and prevent major obstetric syndromes.

Inflammaging, an age-associated inflammation, is a cellular stress response caused by DNA damage, activation of oncogenes or inactivation of tumor suppressors, oxidative stress, chemotherapy, mitochondrial dysfunction, or epigenetic changes. Damage to macromolecules leads to the cessation of proliferation due to the activation of pathways such as p53/p21CIP1 and p16INK4a/RB. These form the senescence-associated secretory phenotype (SASP), the molecular/cellular manifestations of which in endometrial cells have features similar to those observed in endometriosis. Presently, there are no uniform diagnostic criteria or established molecular markers that can predict the development and course of endometriosis. In this regard, it is relevant to develop new minimally invasive examination methods, statistically based criteria and molecular markers for early diagnosis and prognosis of endometriosis.

This review article is devoted to identifying molecular markers that characterize the pathogenesis of endometriosis during inflaming. The aim of the study was to consider modern ideas about the mechanisms of inflaming and its role in the development of endometriosis to determine possible molecular markers for predicting the course of the pathology. We used the PubMed, Scopus and Google Scholar databases to analyze and systematize the literature over the past ten years. Our review reflects the main molecular mechanisms and prognostic criteria that characterize the development of endometriosis during inflaming.

This article presents a rare case of a woman having bilateral anogenital mammary-like glands, lactating in the postpartum period, and a surgical solution to the problem. The histology of the removed tissue corresponded to the morphology of the breast during lactation. No complications occurred after surgery.

This review article describes the acquisition and installation of an organ in a scientific and educational medical institution. For the first time, an organ was installed at the Imperial Clinical Midwifery Institute in 1904. The beginning of the ХХ century was marked by the development of music therapy. This could not go unnoticed by the director of the institute D.O. Ott. Nowadays, there is an increasing interest in music therapy. This article touches on the history of the appearance and further fate of the Walcker organ, acquired for the Imperial Clinical Midwifery Institute. We herein discuss the issues of music therapy and its healing effects on patients.