Obstetrics and Gynecology

The article presents an analysis of the literature data on the diagnosis of chorioamnionitis and its role in the complications during pregnancy and fetal development. Currently there are several terms referring to inflammation of the amniotic cavity and membranes: clinical chorioamnionitis, histological (subclinical) chorioamnionitis and Triple I (intrauterine inflammation or infection or both); the criteria for their diagnosis are given as well. The literature data indicate that clinical and laboratory manifestations of the disease are not always accompanied by morphological detection of inflammatory neutrophil infiltration of tissues and positive microbiological studies. Amniotic fluid infection including chorioamnionitis has been noted to be either an initiating event or a common final pathway resulting in childbirth in more than a third of such patients. The detection rate of chorioamnionitis is inversely proportional to the duration of pregnancy. Chorioamnionitis is associated with an increased risk of developing various maternal infectious complications, including bacteremia, endometritis, septic thromboembolism, pelvic abscess and sepsis, uterine atony and postpartum bleeding. Adverse neonatal outcomes include fetal inflammatory response syndrome, neonatal sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, cerebral palsy, necrotizing enterocolitis.

Conclusion: Chorioamnionitis remains the main cause of premature birth, maternal and neonatal morbidity. The available up-to-date findings on the links in the pathogenesis of chorioamnionitis should become the basis for the development of methods for its prevention, diagnosis and treatment, as well as management of pregnancy and childbirth.

The urinary microbiota is similar to other human microbial communities in terms of its organization: there is no single normal state, however, despite serious interindividual differences in composition and diversity, there are some trends in their organization. The composition of the urinary microbiota depends on gender, age, lifestyle, diet, medications taken by a patient, and hormonal status.

This review presents new scientific data on the principles of organizing the urinary microbial community in healthy women. The most common urotypes of the urinary microbiota are described.

The review shows the results of studies proving the close link of the urinary microbiota with the microbial community of the vagina and gastrointestinal tract. The analysis of the clinical studies demonstrates that the presence of Lactobacillus in the bladder is one of the protective mechanisms of the urinary tract from uropathogens, therefore quantitative and qualitative changes in the urinary microbial community in postmenopausal women are likely to increase the risk of urinary tract diseases.

The results of studies on the role of the urinary microbiota in the development of an overactive bladder syndrome and urgent urinary incontinence are discussed.

Conclusion: It is necessary to continue studying the principles of the organization of the urinary microbiota in a healthy woman and the changes occurring in the urinary microbial community under pathological conditions, since it may contribute to the development of new preventive, diagnostic and therapeutic strategies for a wide variety of diseases.

Kisspeptin is a neuropeptide that is produced in the hypothalamus and has a diverse effect on the body. The role of kisspeptin is still under study.

The objective of the presented review is to analyze recent publications on the effect of kisspeptin in the body in normal and pathological conditions.

The literature search was carried out according to the following criteria: the keyword ‘kisspeptin’ was used, publications were chosen mainly for the last 5 years; Russian literature sources were searched mainly in the publications reviewed by the State Commission for Academic Degrees and Titles, foreign sources were in the databases and services, namely PubMed, Google, and Scope.

Kisspeptin has been shown to stimulate the production of gonadotropin-releasing hormone of the hypothalamus and cause its pulsating secretion. In normal conditions, it initiates the onset of puberty, causes the development of egg cells, ovulation in women, high-quality spermatogenesis in men; moreover, it participates in conception, implantation of a fertilized egg, embryo development, placentation, provides energy homeostasis in a pregnant woman, childbirth. During pregnancy, kisspeptin is also produced by the placenta. Kisspeptin secretion is impaired in polycystic ovary syndrome, endometriosis, obesity, pregnancy complications (preeclampsia, gestational diabetes mellitus, risk of miscarriage). The role of kisspeptin in carcinogenesis is studied. Anorexigenic properties of kisspeptin have been revealed. The review includes a description of the synthesized drugs of kisspeptin and its receptor agonists.

Conclusion: In the future, it is possible to use kisspeptin in the treatment of anovulation, infertility, hypogonadism, obesity, pregnancy complications, non-alcoholic fatty liver disease and probably cancer.

Relevance: Noninvasive prenatal screening (NIPS) for aneuploidies in maternal blood is a highly sensitive and specific method for screening trisomies 21, 18, and 13, as well as sex chromosome aneuploidies in singleton pregnancies. Although the use of NIPS in multiple pregnancies appears promising, the number of published studies on this subject is limited.

Objective: This study aimed to investigate the feasibility of detecting trisomy 21 using NIPS in multiple pregnancies.

Materials and methods: This study included 89 pregnant women with twins and one pregnant woman with triplets who underwent NIPS between May 2018 and December 2023 using high-throughput sequencing to identify common aneuploidies in their fetuses.

Results: The study identified a high risk of trisomy 21 in 6 cases, including 4 cases in the fetuses of dichorionic twins, one case possibly in a fetus of monochorionic twins, and one case in a fetus of trichorionic triplets. In five cases, the results were confirmed, and in one case there was the death of one of the fetuses in a twin pregnancy. Seventy-three patients with low risk according to the NIPS gave birth to phenotypically healthy children. The study showed that NIPS had almost 100% sensitivity and specificity for the detection of trisomy 21 in multiple pregnancies. The risk for major aneuploidies could not be assessed in only six patients (6.7%) due to low fetal fractions at the time of repeat blood sampling.

Conclusion: This study demonstrated the high accuracy of NIPS for trisomy 21, suggesting that NIPS could be offered to all pregnant women with twins. The introduction of this technology into clinical practice will likely improve the management of pregnant women with multiple gestations and, consequently, enhance perinatal outcomes in this group of patients.

Successful preparation of the female body for childbirth, carried out through various mechanisms of labor initiation and activities aimed at early delivery, is necessary to reduce obstetric and neonatal complications. These mechanisms, which combine the inflammatory response in the myometrium, fetal signaling, and physiological aging of membranes, are based on processes and signaling pathways. Coordinated regulation of these processes is performed using microRNAs (miRNAs).

Objective: This study aimed to investigate the expression of maternal and fetal tissues and exosomal miRNAs as signaling molecules for the initiation of labor during cervical ripening.

Materials and methods: This pilot study assessed maternal and fetal tissue and exosomal miRNA expression using quantitative real-time reverse transcription-PCR in 22 pregnant women divided into two cohorts: «labor without pre-induction» (cohort I, n=10) and «pre-induction of labor» (cohort II, n=12). Cohort I was further divided into two groups: pregnant women with spontaneous labor (group Ia, n=5) and pregnant women who underwent a planned cesarean section before the onset of labor (group Ib, n=5). Cohort II included pregnant women with a positive response to pre-induction of labor (group IIa, n=5) and pregnant women who did not achieve this effect (group IIb, n=7).

Results: The study found that the initial level of exosomal miR-181a-5p in the blood plasma before the pre-induction of labor was significantly different (p = 0.03) in pregnant women with a good response (cervical ripening and onset of labor) compared to those with no response. The level of exosomal miR-92a-3p in umbilical cord blood was higher than that in maternal blood before pre-induction (p=0.009). The expression of miR-454-3p and miR-548g-5p was detected only in umbilical cord blood samples, indicating their fetal origin. A pairwise comparison between the groups revealed a significantly higher level of let-7b-5p expression in the membranes in the successful pre-induction group than in the planned cesarean section group (p=0.02) and the group with no effect from pre-induction of labor (p=0.01). Similarly, in the myometrium, the expression of let-7b-5p was significantly higher in the successful pre-induction group than in the planned cesarean section group (p = 0.05).

Conclusion: The identified differences in the expression of tissue and exosomal miRNAs may be due to the highly coordinated regulation of different signaling pathways and the corresponding target genes involved in the mechanism of communication between the maternal and fetal compartments. This provides a basis for further research using larger cohorts of pregnant women.

Objective: This study aimed to investigate the amino acid profiles of blood plasma and follicular fluid in women with infertility and diminished ovarian reserve.

Materials and methods: The study included 115 women aged 18–42 years with infertility, referred to as V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia for infertility treatment using ART (IVF/ICSI) and meeting the inclusion criteria. The groups were stratified according to ovarian reserve as follows: group 1 – 50 patients with diminished ovarian reserve (AMH <1.2 ng/ml, AFC<5); group 2 – 65 patients with normal ovarian reserve (AMH ≥1.2 ng/ml, AFC≥5) and matched for age. Analysis of amino acid levels in the blood plasma and follicular fluid on the day of oocyte aspiration was conducted using liquid chromatography with mass spectrometric detection.

Results: Analysis of the amino acid profile revealed a statistically significant decrease in sarcosine and tryptophan in women with diminished ovarian reserve compared to women with normal ovarian reserve. Additionally, there was a statistically significant decrease in the concentrations of lysine, asparagine, methionine, phenylalanine, and tryptophan in the follicular fluid of women with diminished ovarian reserve. Correlation analysis showed a strong correlation between amino acid levels in the plasma and follicular fluid, as well as between amino acid levels in the plasma and follicular fluid. It also revealed a moderate positive correlation between antral follicle counts and indicators of oogenesis and early embryogenesis, and the levels of amino acids, specifically lysine and sarcosine in blood plasma and asparagine, tryptophan, and aminobutyric acid in follicular fluid.

Conclusion: This study found a significant reduction in amino acid levels in infertile women with diminished ovarian reserve, which may serve as a marker for assessing ovarian reserve and oocyte development potential to enhance outcomes in ART programs.

Advancements in machine learning (ML) have resulted in the development of numerous supporting software products for reproductive medicine. Predicting the performance of assisted reproductive technology (ART) using ML can be accomplished using different algorithms, depending on the type of data and specific task at hand.

Objective: This study aimed to compare the predictive ability of logistic regression, decision tree algorithm, and Random Forest in relation to the likelihood of pregnancy based on the clinical, anamnestic, and embryologic data of patients undergoing ART.

Materials and methods: This retrospective study included 854 married couples and analyzed clinical and laboratory data as well as parameters of the stimulated cycle in relation to the effectiveness of the ART program using three ML algorithms: logistic regression, decision tree, and Random Forest.

Results: The most accurate algorithm for predicting pregnancy rates in the ART program was the Random Forest model, which identified the significance of the following predictors: embryonic arrest, triggering of final oocyte maturation, number of embryos of excellent and average quality, duration of stimulation, infertility factor, body mass index, FSH, and AMH levels. The model confirmed the significance of the predictors determined in the previous stages of the study using a decision tree algorithm, including the presence/absence of a history of previous pregnancies, parameters of the stimulated cycle (number of MII oocytes), spermogram indicators on the day of the puncture, number of embryos of excellent and good quality, and quality of the embryo according to morphological evaluation criteria.

Conclusion: To enhance the prediction of ART effectiveness, this study suggests the need for better mathematical models with an integrated approach to solve the problem using a large sample of patients with various input data presented in a balanced volume. Additionally, this study suggests the inclusion of additional markers that determine ART effectiveness, thereby improving the accuracy of the software product.

Objective: To study the effect of an oral contraceptive containing estetrol 15mg and drosperinone 3mg (Esteretta) on the sexual function and the quality of life in women of reproductive age.

Materials and methods: A total of 40 women were examined whose average age was 29.5±4.2 years; they were administered a combined oral contraceptive (COC) containing estetrol 15 mg and drospirenone 3 mg. Before taking the medication and six months after it, a survey was conducted on the issues of the Female Sexual Function Index (FSFI) and on the SF-36 (Short Form Medical Outcomes Study) questionnaire about the quality of life.

Results: There was an improvement in the following parameters of quality of life in six months: PF (physical functioning) increased by 14.45 scores; role physical (RP) increased by 34.5 scores; perception of bodily pain (BP) decreased; initially low score of general health (GH) increased from 52 scores to 77.5 scores; vitality (VT) increased by 11 scores; social functioning (SF) increased by 6 scores; role emotional (RE) increased by 38 scores; low parameters of mental health which were associated with the presence of depression, anxiety, and mental ill-being increased by 18 scores. According to the results of FSFI, the number of women without difficulty in lubrication increased significantly, the number of women who had orgasm increased, and number of patients with discomfort and pain during sexual intercourse decreased.

Conclusion: The combined oral contraceptive containing estetrol 15 mg and drospirenone 3 mg significantly improved the quality of life and affected the clinical manifestations of sexual disorders.

Objective: The primary aim of the study was to evaluate the effect of Indinol Forto on pain syndrome in various benign breast diseases. The secondary aims included the assessment of the effect on the number and size of cysts in the mammary glands and evaluation of additional data on safety in routine clinical practice.

Materials and methods: These are the results of a prospective observational study “APHRODITE” of the drug Indinol Forto (indolcarbinol) which was conducted in 9 research centers of the Russian Federation with the participation of 100 women over the age of 18.

Results: Indolcarbinol therapy had a positive effect on reducing pain syndrome (mastodynia) after 3–6 months of treatment. The results of the ultrasound assessment and mammography showed a decrease in the total size of cysts, as well as a decrease in the proportion of women with dilated ducts of the mammary glands after 3 months of treatment. Longer use of indolcarbinol (6 months) was associated with a stronger effect. The patients tolerated indolcarbinol well and did not have undesirable or side effects.

Conclusion: The results of the study showed that indolcarbinol (Indinol Forto) caused a decrease in pain syndrome in patients with mastodynia in benign mammary dysplasia after 3–6 months of treatment. Indolcarbinol also resulted in a decrease in the total size of cysts and decrease in dilated ducts of the mammary glands in some women after 3 months of treatment. Thus, indolcarbinol appeared to be the only non-hormonal drug at the moment with a proven effect on the structure of breast tissue according to the results of the BI-RADS assessment.

The normal course and successful outcome of pregnancy are due to a carefully coordinated interaction between mother and fetus. Type I interferons refer to the key mediators of these interactions as they contribute to the uncomplicated course of gestation and protect the mother and fetus from various infections. According to the statistical data, the incidence of acute respiratory viral infections including influenza and COVID-19 in pregnant women exceeds more than twice the incidence of these diseases in non-pregnant women of the same age, while 33% of all hospitalizations of mothers are associated with acute respiratory viral infections.

The objective of the study is to analyze the sources of modern literature on the role of interferons in maternal antiviral immunity, in the prevention and treatment of acute respiratory viral infections, influenza and COVID-19. The databases and services, namely PubMed, PubMed Central, Scopus, MEDLINE, ScienceDirect, Cochrane Library, eLibrary were searched for publications of the national and foreign scientists for the period from 2013 to December 2023.

The review presents the current information on the role of interferons in the gestational change of the maternal body, in providing the normal course of pregnancy and anti-infective protection of the mother and fetus. The paper also presents the results of evaluating the effectiveness and safety of the use of recombinant interferon alpha-2b drugs as a means of preventing and treating various acute respiratory infections including influenza and COVID-19 in pregnant women.

Conclusion: Due to the persistent epidemiological risk associated with the circulation of various respiratory viruses that cause the development of mixed infections, systematization of data on the role of interferons during gestation and fetal development, understanding the pathogenesis of respiratory viral diseases of the mother will help the doctors to choose the appropriate methods of prevention and therapy of acute respiratory viral infections in pregnant women.

Relevance: Currently, different types of the contracted pelvis are mainly determined with the help of radiological diagnostic methods before pregnancy or in the antenatal period. Intranatally, biomechanism of childbirth characterizes the form of the pelvic contraction. In order to obtain objective manual data, a combined transabdominal and transperineal ultrasound assessment is proposed, as it an effective, safe and accurate method for monitoring the ratio of the fetal head and the birth canal.

Case report: The article presents a clinical case of a patient whose transperineal ultrasound scanning revealed that labor started with asynclitic insertion of the fetal head with a sagittal suture in the conjugate of the pelvic inlet. The occipital posterior presentation was diagnosed and the type of the transversely contracted pelvis was suspected. The progress of the fetal head in labor was evident due to an increase in the angle of progression from 106° to 125°, while the sagittal suture remained in the conjugate of the true pelvis. When the cervix was fully dilated and the angle of progression was 154°, the rotation of the head by 180° began in the plane of the pelvic outlet. The birth occurred with the anterior occipital cephalic presentation.

Conclusion: The patients with the transversely contracted pelvis may give birth spontaneously only if fetus takes the anterior occipital cephalic presentation. In case of initial posterior presentation, giving birth will occur naturally through the birth canal, only when the fetal head is rotated 180° and the fetus takes the anterior presentation. The high direct position of the fetal head is accompanied by signs of clinical inconsistency. The use of ultrasound criteria made it possible to establish a type of the contracted pelvis, which was confirmed by MRI, and it was also possible to provide evidence of the likelihood of the spontaneous birth.