No 2 (2021)

The authors have carried out a systematic review of the literature devoted to the current state of and prospects for the use of artificial intelligence (AI) in the field of maternal and fetal health. They have revealed the concept of AI and the ways of its development in medicine. It has been noted that AI does not replace a physician, but it is a tool for improving medical activity. The article shows the possibilities of AI use in obstetrics and gynecology and highlights its areas: medical image recognition; prediction and assistance to physicians in determining the diagnosis; creation of recommendation systems for selecting a treatment; robotization of medical manipulations and augmented reality; optimization of the routine functions of healthcare workers; services for interaction and training of physicians and patients. In addition, AI can be used for scientific purposes to understand complex multifactorial mechanisms for the development of diseases; to create disease information models, new classif ications of diseases, and models of therapeutic effects. AI is also able to automatically retrieve new medical information from clinical case reports and scientific publications. The paper gives specific examples of developments in these areas. It considers the expected difficulties in introducing AI systems and describes immediate steps for their implementation. The development of AI systems requires physicians’ direct participation, including the selection and preparation of data, the formulation of medical tasks, and their translation into the language of machine learning specialists. It is concluded that AI-based applications in obstetrics and gynecology have already become a reality, and in the near f uture they will reduce the burden on medical professionals, improve the effectiveness of diagnosis, prediction, and treatment, and prevent medical errors. It is promising to use AI in telemedicine systems to provide assistance to physicians and patients outside the locations of large medical complexes. Conclusion. The results of the review can be used to identify promising researches, to develop a national program for AI introduction in obstetric and gynecological practice and in educational programs, and to improve the qualification of healthcare workers.

To improve the effective«ess of assisted reproductive tech«ologies is a key problem i« modern medici«e. Therapeutic approaches to reducmg the likelihood of «otgett'mgpreg«a«t are i«evitably associated with mfertility-related risk factors. Wome« with good reproductive health mostly become mothers «aturally, apart from bei«g influenced by the malefactor or resorti«g to medical decisio«s through perso«al reaso«s. Amo«g the sta«dard risk factors that lead to a decrease i« the effective«ess of assisted reproductive tech«ologies, there are obesity a«d late reproductive age. The paper considers the mecha«isms for the «egative effects of these features of the a«am«esis a«d the ways to reduce/overcome their harmful effects o« preg«a«cy. A« a«alysis of i«formatio« sources has identified the possibilities of increasing the effectiveness of the onset a«d preservatio« of induced preg«a«cy in the prese«ce of the above risk factors. It has bee« fou«d that it is «ecessary to orga«ize a comprehe«sive preparation of a womans health before reproductive intervention in order to «ormalize weight a«d the hormo«e backgrou«d. O«ly a cha«ge in lifestyle a«d consolidation of «ew behavior ca« sig«ifica«tly reduce the «egative impact of obesity o« a womans reproductive health. Treatment should be performed taki«g into accou«t co«comita«t diseases, in particular diabetes mellitus, polycystic ovary syndrome, etc. The successes of pharmacological treatment for obesity i« reduci«g the level of i«flue«ce of i«fertility a«d i« i«creasi«g the effective«ess of assisted reproductive tech«ologies are a«alyzed separately. Conclusion. It has been found that there are very few drugs that can be used to correct weight during pregnancy when planning due to side effects. Before planning a pregnancy at late reproductive age, there is a need for exhaustive analysis of the female reproductive system, including an evaluation of the ability to ovulate and the state of the endometrium. Exogenous hormonal background correction must be done. The negative effect of obesity or late reproductive age depends on many individual characteristics of the patient's history. Therefore, whether there is a prevalence of the influence of one or another factor in their combination remains unresolved and causes discussion.

Secondary infertility is one of the most pressing health problems often resulting from endometrial injury after abortions or complicated delivery, as well as in hormonal dysregulation, Asherman’s syndrome (AS) is the most severe form, in which there are uterine synechiae, the adhesions connecting the opposite uterine walls, which complicates a normal menstrual process. Existing approaches can help some women with AS become pregnant and carry a baby, but the eff iciency of therapy remains relatively low, which requires further investigation. The review considers new promising approaches to treating AS, by using tissue engineering, cell technologies, and biologically active substances. Tissue engineering techniques can contribute to the restoration of one's own tissue or organ. The body is able to regenerate damaged tissue in the presence of the matrix that is the supporting framework for the functional cells of the endometrium in the event of damage to the cells of the uterus. W hen designing the biomaterials that promote the restoration of damaged tissue, the thing that matters is a material and the latter’s incorporated biologically active components with regenerative activity. The biomaterials should ensure mechanical support for tissue repair, partially mimicking the natural environment through the metered release of extracellular vesicles, growth factors, and other signaling molecules. The review gives data on the efficiency of using the populations of stem cells and progenitor cells derived from bone marrow, endometrium, and umbilical cord Wharton’s jelly for the treatment of endometrial diseases.

Aim. To assess the morbidity, clinical course, maternal and perinatal outcomes of COVID-19 in pregnant women in the Far Eastern and Siberian Federal Districts. Materials and methods. The latest information on COVID-19 in pregnant, parturient and puerperal women was analyzed. The data were presented by chief obstetricians-gynecologists of these Districts in the period from 11 March to 25 December 2020. Results. During the specified period, 8485 cases of COVID-19 were registered in pregnant, parturient and puerperal women. The rate of morbidity was 3 times higher among these women compared to the general population: 5933.2 versus 1960.8 per 100,000 people. In 27.4% of mothers, SARS-CoV-2 infection was asymptomatic; in 52.7% it was mild; in 16.6% - moderately severe, in 2.5% - severe and in 0.5% - very severe. Pregnant women were more often hospitalized and stayed in intensive care and anesthesiology units compared to patients in the general population (3.57% vs 2.24%, р<0.001), and invasive mechanical ventilation (IMV) was used less often (0.48% vs 1.05%, р<0.001). 27.97% (2373) of patients delivered their babies. Preterm delivery was in 18.3% of women, cesarean section - in 42.0%, operative vaginal delivery - in 0.2%. 12 mothers (0.14%) with COVID-19 died (mortality rate was 1.95% in the general population, р<0.001). Maternal mortality rate was 505.69per 100,000 live births. Perinatal losses were registered in 37cases (1.54%): stillbirths - 31 (1.29%), early neonatal mortality - 6 (0.25%). 148 (6.2%) cases of COVID-19(+) were detected in newborns. Conclusion. The incidence of COVID-19 in pregnant women in Siberia and Far East is higher than in general population, but the disease is characterized by lower demand for IMV and lower mortality rate. The rates of preterm delivery and cesarean section in patients with COVID-19 were higher than in the general population. Finding of the SARSCoV-2 RNA in newborns suggested vertical transmission of the infection.

Aim. To study pregnancy course and outcomes in patients with familial Mediterranean fever (FMF). Materials and methods. An observational cohort study compared pregnancy outcomes in 251 women with FMF and in 312 women without FMF. A group of women (4577) of reproductive age (18-49 years) with confirmed diagnosis of FMF was sequentially selected among 32,000persons of Armenian nationality, who were examined for the presence of mutations in MEFV gene and their clinical, laboratory and genetic test results were included in the information register for the period 1998-2018 in the Center for Medical Genetics and Primary Health Care, Yerevan, Armenia. The main group included 211 patients with FMF. Inclusion criteria were: termination of pregnancy or abortion, obstetric complications, perinatal outcomes. The results were processed using the SPSS Statistics 16.0 software package. To study a possible relationship between a certain outcome and risk factor in the compared groups, the data were processed using the GraphPad Prism 4 and GraphPad Prism 5 software packages. Relative risk (RR) with 95% confidence interval (CI) was calculated. Results. Pregnancy complications associated with FMF were found as follows: preterm delivery (PTD<37 weeks) (RR=1.9; 95% CI 1.2-4.4, р=0.036); ectopic pregnancy (eP) (RR=1.5; 95% CI 1.1-2.7, р=0.018). In patients with FMF 149pregnancies (59.3%) without complications resulted in 184 live births (73.3%) (RR=1.0; 95% CI 0.9-1.0, р=0.811). In patients without FMF 190pregnancies (61.0%) resulted in 231 live births (74.0%). There were no significant differences among the groups with early (15.9% vs. 16.3%, p=0.326) and late miscarriages (1.6% vs. 3.2%, p=0.457), сesarean delivery (CD) (12.6% vs. 13.2%, p=0.794), premature detachment of a normally positioned placenta (PDNPP)(0.4% vs. 1.0%, p=0.431), intrauterine growth restriction (IUGR) (1.2% vs. 1.3%, p=0.930), preeclampsia (PE) (3.2% vs. 3.2%, p=0.996), intrauterine fetal hypoxia (2.4% vs.1.9%, p=0.699), antenatal fetal death (AFD) (2.4% vs. 3.5%, p=0.438), fertility treatment (24.7% vs. 23.7%, p=0.823), respectively. Perinatal outcomes in the groups were comparable: low Apgar scores at the 1st minute (<7) (1.6% vs. 2.5%, p=0.497) and and the 5th minute (0.5% vs. 0.4%, p=0.875), congenital malformations (CM) (1.6% vs. 2.6%, p=0.431) and perinatal mortality (PM) (3.2% vs. 4.5%, p=0.438), respectively. In 75.3% of patients with FMF, the average maternal age at delivery was 19-35 years, compared to 47.1% in the control group. Women without FMF were older (>36 years - 51.2%, p<0.0001). The average birth weight in babies (2500-4000 g) was lower in the main group (64.2% vs. 80.2%, p<0.0001). Assessment of pregnancy outcomes in 131 (52.2%)patients who were taking colchicine, and 120 (47,8%) who were not taking colchicine or not taking regularly did not show differences regarding CM, PE, PDNPP, IUGR, AFD, PM, late miscarriage, CD. Controlling FMF attacks in 88,5% of cases and more favourable pregnancy outcomes were due to intake of colchicine: early miscarriages (13.7% vs. 18.3%, p=0.326; respectively), PTD (5,3% vs. 8.3%;p=0.121),<37 weeks (5.3% vs. 8.3%, p=0.121; respectively), EP(4.6% vs. 9.2%, p=0.225), respectively, but the results did not reach statistical significance. Conclusion. Familial Mediterranean fever is associated with an increased risk of preterm delivery, lower birth weight and ectopic pregnancy. Perinatal outcomes in patients with and without FMF are comparable. Colchicine treatment of pregnant women with FMF has a beneficial effect on the clinical course of the disease and does not affect pregnancy outcomes.

Aim. To identify risk factors for developing cesarean uterine scar defect using sonographic and the scar's morphological characteristics. Materials and methods. This retrospective study of164 women with a cesarean uterine scar included 98 (59.7%) women with normal uterine scar thickness (group I) and 66 (40.3%) with thinned uterine scars (group II). We used the data of hospital medical records, antenatal care cards, and the morphology reports of uterine scars after repeat cesarean section. Results. The groups had significant differences in uterine position, active phase of labor, suture technique, infectious complications before or after surgery, intraoperative blood loss, and operating time (all P<0.001). There were also significant differences in uterine scar morphological characteristics (P<0.001). Conclusion. Longer operating time, infectious complications, and uterine retroflection are risk factors for the development of a dehiscent scar. In contrast, intraoperative blood loss < 400 ml and double-row uterine closure technique are factors that reduce the risk of a scar defect.

Purpose. To identify the effectiveness of platelet-rich plasma (PRP) use for preparation of "thin" endometrium for cryopreservation programs. Materials and methods. A prospective study was conducted; the main group included 37 patients with "thin" endometrium, among whom embryo transfer cycles were repeatedly canceled due to insufficient endometrial thickness. Against the background of receiving cyclic hormone therapy (CGT), patients were administered intrauterine PRP on the 8-9, 10-11, and 12-13 days of the menstrual cycle. The control group included 17patients with "thin" endometrium who received only CGT. The thickness of endometrium was assessed by ultrasound examination of pelvic organs. The endometrial thickness over 7 mm was considered optimal for embryo transfer. Results. After the use of PRP, the endometrial thickness of more than 7 mm was in 18 (48.65%) patients, in the control group - in 8 patients (p=0.92). The average endometrial thickness in the main group on the day of embryo transfer was 7.79 mm, in the control group - 6.89 mm (p=0.02). The embryo transfer cycle was cancelled in 6 patients (16.22%) in the main group and in 13 (76.47%) in the control group (p<0.001). Embryo transfer was performed in 32 (86.49%) patients in the main group and in 4 (23.53%) in the control group. Pregnancy occurred in 16 patients (50%) in the main group and in none of the patients in the control group (p=0.58). Among these, 14 (43.75%) patients in the main group had a clinical pregnancy; 4 (28.57%) patients had spontaneous miscarriage, and in 2 (14.29%) patients live births were documented. Conclusion. With intrauterine administration of PRP in addition to CGT, there is a statistically significant increase in the thickness of the endometrium, the frequency of termination of the embryo transfer cycle decreases; nominally, pregnancy rate is higher in the main group, but the difference is not statistically significant.

Aim. To investigate the effectiveness of sucking in preterm newborns during the transition from tube to oral feeding (breast or bottle) and to substantiate the principles of creating computer software for an objective assessment of the sucking reflex. Materials and methods. The development of sucking activity was examined in 105 infants born at 25-31 weeks, divided into three groups categorized by the severity of respiratory disorders. The study included the development of computer software for non-invasive visual analysis of sucking effectiveness in newborns. Results. The analysis involved examining the association between timing of the onset of sucking, discontinuation of tube feeding, and severity of respiratory disorders. The presence of moderate and severe bronchopulmonary dysplasia significantly prolonged the transition from tube to oral feeding. An objective method using sucking pattern recognition software was developed to assess sucking effectiveness. Conclusion. The developed software allows for a quantitative objectified assessment of the movements of various parts of the newborn’s face during sucking. Once verified and validated, the method can objectively assess sucking in neonates of different gestational ages.

Objective. To enhance the efficiency of therapy for chronic endometritis by modulating the local expression of innate immunity factors. Materials and methods. Eighty-three patients with chronic endometritis (a study group) were divided into Subgroup 1 (n=43; 20-day therapy) and Subgroup 2 (n=40; 40-day therapy). The endometrial material was obtained by aspiration biopsy on the 20-24th of the cycle. An immunohistochemical (IHC) assay was used to estimate the number of pinopodia, steroid hormone receptors, virus antigens, and inflammatory markers (CD138, 20, 8, 4, 56, HLA-DRII, and MUC-1). The expression of TLR4, TLR2, HBD-1, TNFa, and HNP1-3 was evaluated by reverse transcription and RT-PCR assays. Results. The best indicators of therapy were achieved after 40 days. The gene expression of innate immunity factors was normalized for TLR2 and TLR4. The expression level of TNFa and HBD-1 was 1.3 times higher than normal, whereas that of HNP1-3 was 1.4 times higher. The number of cells with herpes simplex virus type 2 declined by 1.85 times and that with Epstein-Barr virus decreased by 1.83 times. A quantitative relationship to the duration of therapy was not detected for CD138 and CD20, but was noted for CD8 (a 2.45-fold decrease), CD4 (a 1.86-fold decrease) and CD56 (a 1.44-fold decrease). Conclusion. Exogenous cytokine therapy effectively affects the restored expression of innate immunity factors, which leads to relief of chronic inflammation and normalization of tissue receptivity.

Objective. To evaluate laboratory parameters and to assess the clinical and morphological features of the course of postpartum metroendometritis (PME) in women. Materials and methods. A total of174 postpartum women were followed up. They were divided into a study group that included 124patients with PME and a comparison group that consisted of 50 healthy puerperas. The general clinical and biochemical parameters of serum cytokines (TNF-а, and IL-10), and the microflora of the cervical canal were studied. Results. The puerperas with PME were found to have changes in the blood levels of cytokines, C-reactive protein (CRP), fibrinogen, and white blood cells in relation to the severity of the disease. In cases of its severe course, a positive correlation was established between the levels of IL-10 and C-reactive protein (r = +0.63; p<0.05), IL-10, and leukocytosis (r = +0.26, p>0.05), whereas a negative correlation was found between those and the amount of fibrinogen (r = -0.53; p<0.05). A positive correlation was shown between the levels of CRP and TNF-а (r = +0.64, p<0.05) and those and leukocytosis (r = +0.77; p<0.05). Analyzing the spectrum of the microflora in the puerperas revealed that the most common isolates were Escherichia coli (19.3% (24/124)), Enterococcus faecalis (16.9% (17/124)), Staphylococcus haemoliticus (12.9% (16/124)), Staphylococcus aureus (10.4% (13/124)), Klebsiella pneumoniae (3.2% (4/124)), and associations (66.1% (82/124)). Conclusion. The found cytokine balance changes in PME can be used as an additional method to assess the nature of its course.

Oxidative stress is an imbalance between the prooxidants and components of the antioxidant defense system, which causes changes in metabolism and energy balance in the body: the cells get damaged; pathological changes occur in human tissues and organs. The effect of prooxidants leads to oxidation of nucleic acids and to peroxidation of lipids, cell membrane shells, and protein structures. According to the modern concepts, carbonyl stress plays a major damaging role. The above changes contribute to the development of many diseases, for example, cardiovascular system diseases can affect the normal functioning of the brain and lead to various pregnancy complications, provoke and aggravate the course of different gynecological diseases. Despite the results of studies that indicate the role of various markers of oxidative stress in determining this pathological condition, specific indicators that could be used in routine practice have not been identified today. Antioxidant enzymes play a main role in antioxidant defense. However, to date, there is no clear opinion about the elimination of the consequences of oxidative stress. Numerous studies are being conducted to figure out the methods that might reduce the likelihood of developing this pathological process.

Background. Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with a variety of clinical manifestations that frequently appear as a mask of various diseases. The kidneys are most commonly involved in the pathological process in SLE due to the ability to delay circulating immune complexes. Case report. The paper describes a clinical case of a nephritic mask of SLE in a pregnant woman and the birth of a baby with neonatal lupus. In the multigravida with a compromised history of pregnancy loss and early preeclampsia, who had long been followed up for chronic glomerulonephritis and hypertensive syndrome, there could be an successful outcome of twin pregnancy with the birth of viable newborns due to a thorough examination for SLE as a cause of nephritic syndrome. Conclusion. The establishment of the lupus etiology of glomerulonephritis, the presence of chronic kidney disease in the outcome of lupus nephritis concurrent with APS-associated nephropathy made it possible to optimize drug therapy and to successfully complete this pregnancy.

Background. It is important to develop new methods for correcting the postoperative uterine scar niche after cesarean section. Case report. The paper describes a case of a 27-year-old patient with a history of two previous caesarean sections. Transvaginal ultrasound and MRIrevealed two postcesarean uterine scar defects at different levels: in the isthmus area and at 15 mm above the level of 17.0 and 13.6 mm internal orifices with the residual myometrial thickness above the defect being 2.6 and 2.9 mm, respectively. Laparoscopy was performed. The special feature of the operation was to locate a thinned uterine scar, by using the original technique for transilluminating the scar area with a LED fiber-optic stent. This technique involved transillumination using a fiber-optic catheter connected to a light source in order to locate the area of a thinned uterine scar without the need for preliminary hysteroscopic imaging. Conclusion. A laparoscopic approach can be considered as the procedure of choice for the repair of a large myometrial defect with residual myometrial thinning in the presence of more than one inconsistent uterine scar.