No 5 (2020)

The new coronavirus infection, which was identified in Wuhan (Hubei province, China) in late 2019, caused an outbreak of severe pneumonia. The disease quickly spread throughout China and was followed by a dramatic increase in number of new cases in other countries of the world. Certain population groups that require particular attention include pregnant women due to the fact that pneumonia is the third-leading indirect cause of maternal mortality. Among the controversial issues in the management of pregnant women with COVID-19, special attention should be paid to the tactics of prolonging pregnancy and approaches to childbirth. The available scientific and clinical data are currently insufficient to perform a complete assessment of perinatal outcomes in pregnant women with COVID-19. Researchers and practical healthcare specialists have more questions than answers due to the limited time and number of studies, lack of evidence of vertically transmitted infection from mother to fetus, absence of clear understanding of viral pathogenesis during pregnancy, as well as the level and degree of initiation of SARS- CoV-2 pathological processes in the mother and fetus that can have a negative influence on the perinatal outcome. This review is devoted to the analysis of pregnancy and childbirth outcomes, presentation of current approaches to the management of women with novel coronavirus infection COVID-19 during pregnancy and childbirth on the basis of the available literature data in the domestic and foreign clinical guidelines.

This summary paper presents a generalized action plan for hospitals and outpatient clinics during the COVID-19 coronavirus pandemic. Now the pandemic is the most relevant global challenge. Taking into account that the medical world does not have much clinical experience with COVID-19 and other coronaviruses, such as SARS-CoV and MERS-CoV, thoroughness and caution in assessing and treating pregnant women is an extremely urgent topic. The authors of this article summarized the world experience in managing patients with coronavirus disease and brought it into a unique algorithm that was considered most rational.

Consideration of the clinical manifestations of severe preeclampsia (PE) and HELLP syndrome in the context of thrombotic microangiopathy allows a fresh look at the pathogenesis of these gestational complications. There is new evidence for a similar mechanism for endothelial damage in severe PE, HELLP syndrome, and atypical hemolytic uremic syndrome (aHUS), which is realized due to the excessive activation of the alternative complement pathway. An investigation of the role of complement factors in the pathogenesis, course and progression of PE with realization in the HELLP syndrome will be able to further consider them as markers for predicting severe PE complications.

The paper summarizes the Russian and foreign experience with indole-3-carbinol. The anticarcinogenic and antiestrogenic effects of indole-3-carbinol are due to its ability to repair damaged DNA, to inhibit the activity of cell cycle stimulants, to influence nuclear transcription factors, and to induce apoptosis. The unique combination of antiestrogenic and antiproliferative effects of indole-3-carbinol enables us to use the drug for the treatment of various estrogen-dependent conditions of the female reproductive system, such as uterine myoma, endometriosis, endometrial hyperplasia, mastopathy.

Birth weight discordance in multiple pregnancies is not uncommon, and signif icant birth weight difference is a risk factor for adverse outcomes. Aim. To investigate perinatal outcomes of twin pregnancies with significant (over 25%) birth weight discordance. Material and methods. The study comprised 485 pregnant women and their 959 newborns. Two groups were formed based on the presence or absence of birth weight discordance, in which the antenatal and neonatal periods were analyzed. Results. Birth weight discordance was detected in 18.8% of twins. The antenatal mortality rate in groups with and without birth weight discordance was 6.6% and 1.3%, respectively, p = 0.008. The median gestational age of twins with and without birth weight discordance was 33.6 and 36.0 weeks, respectively, p <0.001. Twins with birth weight discordance had significantly lower birth weight (1654g) than concordant twins (2386g), p <0.001. The neonatal mortality rate of twins with birth weight discordance was 9.1% compared with 1% in concordant twins, p <0.001. Discordant twins had higher neonatal morbidity (21.6%) than concordant twins (6.1%), (p = 0.002). Conclusion. Twin birth weight discordance is a risk factor for antenatal death, premature birth, and surgical delivery. At the same time, birth weight discordance is associated with high neonatal morbidity (respiratory and neurological disorders) and mortality.

Objective. To compare the effectiveness of different methods of controlled hypothermia in complex therapy for hypoxic ischemic encephalopathy in infants with birth asphyxia. Materials and methods. The data was collected from 73 birth records and histories of newborns with signs of moderate or severe asphyxia. The newborns were divided into two groups: group I included 46 newborns treated with craniocerebral hypothermia (CCH); group II included 27newborns treated with total hypothermia (TH). Results. During the first hours of life, convulsive activity was observed in 39 (84.8%) and 23 (85.2%) newborns of groups I and II, respectively (p=1.00). According to electroencephalography readings, convulsive activity was confirmed in 33 (84.6%) and 18 (78.3%) infants, respectively (p=0.77). During hypothermia, convulsive activity persisted in 39 (100%) and 4 (17.4%) newborns treated with CCH and TH, respectively (p<0.001). By the end of controlled hypothermia, there was a cessation of convulsions in 11 (28.2%) and 19 (82.6%) newborns treated with CCH and TH, respectively (OR 0.34, 95% CI: 0.23- 0.60), (p<0.001). All the newborns survived and were provided with the second stage of developmental care. Positive dynamics in newborn’s neurological status was observed in 23 (50%) infants of group I and 26 (96.3%) infants of group II at the discharge from hospital after the second stage of developmental care (OR 0.53, 95% CI: 0.49- 0.72, p<0.001); to one year of age dynamics was observed in 9 (28.1%) and 26(96.3%) newborns (OR 0.34, 95% CI: 0.23-0.60, p<0.001), respectively. Conclusion. When CCH and TH are applied in complex therapy for full-term infants with moderate to severe birth asphyxia, they can help prevent the development of severe neurological consequences. TH has advantages over CCH due to the decreased period of newborn’s artificial lung ventilation, faster control of convulsions and favorable outcomes for children during the first year of life.

Aim. To compare the effectiveness of extragenital endometriosis (EGE) treatment regimens with and without interferon-alpha-2b (IFN-α2b). Materials and methods. The study comprised 46patients with stage I and II EGE. Twenty-one patients in the study group received standard six months therapy with gonadotropin-releasing hormone agonists (GnRHa) concurrently with IFN-α2b, while 25patients in the control group were administered GnRHa monotherapy. Before surgery and six months after the treatment initiation, the composition of the lymphocyte subpopulations in the peripheral blood was determined by flow cytofluorometry. Results. Compared to the control group, combination therapy of patients with EGE using IFN-α2b was associated with an increase in peripheral blood T and B lymphocyte counts, preservation of NK cell activity with a decrease in their number. Conclusion. The effect ofIFN-α2b as part of combination therapy on the composition of the lymphocyte subpopulations is associated with better immune response toward heterotopic endometrial cells and protective effect against recurrent endometriosis, compared with monotherapy.

Objective. To investigate the pharmacological activity of a drug with the active substance indole-3-carbinol on a rat model of endometriosis. Materials and methods. An experiment was carried out on on pubertal female rats (n = 60). According to pathology modeling and therapy, the animals were divided into groups. Group 1 consisted of falsely operated animals receiving starch solution. Group 2 included falsely operated ones given indole-3-carbinol at a dose of111 mg/kg. In Groups 3 to 5, endometriosis was modelled by autologous transplantation of endometrial tissue into the peritoneal cavity. Group 3 animals received 1% starch solution; Groups 4 and 5 had the active substance at doses of 37 and 111 mg/kg, respectively. Reactions to pain were studied in the animals and implants were also histologically assessed at 30 and 60 days. Results. The untreated animals with induced pathology showed a more pronounced pain response than falsely operated animals. Histological estimation revealed that endometrial hyperplasia tended to reduce in the groups of females that had received the active substance compared with that in the control groups. Conclusion. The investigation showed that indole-3-carbinol administered to the animals effectively decreased the size of an endometrioid focus and the degree of endometrioid heterotopies, thereby indicating the therapeutic effect on endometriosis-induced pain syndrome.

Objective. To develop and evaluate the efficiency of differentiated correction of the vaginal microbiocenosis in women with nonspecific cervicovaginitis in the f irst trimester of pregnancy. Subjects and methods. The vaginal microflora was studied in 25 patients in the first trimester of pregnancy after using an antiseptic at Stage 1 of cervicovaginitis therapy (light electron microscopy, x1000, Gram staining). According to the status of the vaginal microflora, differentiated correction of the vaginal microbiocenosis was made in 24 women with nonspecific cervicovaginitis at 13-14 weeks’ gestation (a study group). In 26 patients (a comparison group), vaginal microbiocenosis was restored, without taking into account the pattern of microflora after the first stage of treatment. Results. In the study group, recurrent cervicovaginitis was noted in 12.5% of cases; in the comparison group, the recurrence rate was 38.5% (p = 0.037). Preterm birth was observed in 19.2% of cases only among the patients of the comparison group (p = 0.05). Conclusion. Differentiated correction of the vaginal microbiocenosis, according to the status of vaginal microflora, can reduce the rate of recurrent cervicovaginal infections and premature birth.

Recently, the use of platelet-rich plasma has become an increasingly popular treatment in different fields of medicine. It is successfully used in traumatology and orthopedics for wound healing, in dentistry and cosmetology. Recently, this treatment has also begun to be introduced into gynecological practice. This literature review presents the experience in and efficiency of using platelet-rich plasma to treat different gynecological diseases.

Postmenopausal women are at risk for different endometrial abnormalities in the presence of involutional changes in the reproductive system and features of the somatic status. 40-60% of women receiving low-dose and microdose menopausal hormone therapy may notice vaginal bleeding of various intensities, which is not organic and, on the one hand, results in discontinuation of therapy and a reduction in its adherence, and, on the other, in psychological impairment. The literature review presents data from randomized controlled studies analyzing the minimally effective and safe dose of menopausal hormone therapy and its impact on the endometrium. Literature was searched for in Russian (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. The priority was free access to the full-text articles published in 2014 to 2020.

Background. Placenta increta is a relevant problem of contemporary obstetrics. Over the past decade, the rate of this abnormality has increased by 50 times. The importance of the problem is increasing due to massive bleeding, in which the maternal mortality rate is as much as 7%. Placenta increta is one of the most severe abnormalities resulting from the partial or complete absence of the spongy layer of the decidua due to endometrial atrophic processes. Case report. The article describes a clinical case of a patient with pregnancy induced by an assisted reproductive technology (surrogacy) program and placenta increta. It describes in detail the mechanisms of pathogenesis, as well as delivery methods for abnormal placental invasion. Conclusion. The given clinical case is a demonstration of successfully applying a team approach during delivery in a woman with placenta increta: the introduction of current diagnostic and therapeutic blood-saving technologies and a surgical delivery method that does not require an additional uterine incision.