No 10 (2021)

Fetal growth restriction is a key problem of modern obstetrics, which is accompanied by high perinatal mortality and morbidity rates. Selective fetal growth restriction is a monochorionic twin pregnancy complication that occurs in 10-15% of cases and significantly increases the probability of antenatal death of one of the fetuses, as well as the development of severe neurological complications in the newborn. The perinatal risks are significantly higher in twin pregnancies than those in singlet pregnancies. The most problem pregnancy is that with monochorionic placentation, which accounts for up to 60% of all complications, while the risk of death of the other fetus and the development of neurological complications in the newborn is 3 times higher than that with a dichorionic twin pregnancy. The paper searches and analyzes the data available in the world literature on studies of the key determinants of the development of selective fetal growth restriction in monochorionic twin pregnancy. The current fundamental aspects of the pathogenesis of this process are analyzed in detail. The paper presents the possibilities of studying angiogenesis and vasculogenesis of the monochorial placenta and epigenetic factors as a predictor at the preclinical stage of selective fetal growth restriction. Conclusion: Selective fetal growth restriction is a serious complication of monochorionic twin pregnancy, since it is associated not only with the antenatal death of a low-weight fetus, but also with a decrease in the quality of life up to childhood disability of the surviving twin. It is necessary to conduct further investigations to develop optimal management tactics for pregnant women, as well as to predict the fetuses’ condition after birth.

The paper analyzes the results of the Russian and foreign studies published in the international databases, which deal with the problems of alcohol consumption in pregnant women and its impact on their bioelement status. To date, a huge amount of clinical and experimental material has been accumulated on the effects of many macro-and microelements on human physiology and pathology, but there are few studies of the effect of alcohol and its metabolites on the body, the bioelement status of pregnant women in particular. Nevertheless, the study results presented in this article indicate an extremely negative effect of alcohol on a pregnant woman, including on her bioelement status. It is also noted that when pregnant women abuse alcohol, they are found to have impairments in all lineages of hematopoiesis, especially those of erythropoiesis. Conclusion: There are not enough studies on the relationship of the content of bioelements in alcohol consumption to the course of pregnancy, childbirth, fetal development, and neonatal adaptation. In addition, they do not fully cover all aspects of this problem. There is a need for pregravid preparation, that is, to prepare for a favorable pregnancy, and this is primarily to refuse to drink alcohol and to replenish the lack of vital bioelements. The use of drugs that contain various bioelements, the development of diets with an optimized content of micro- and macroelements for pregnant women with an alcoholic history, and the development of special infant formulas will certainly help improve the health of the mother, fetus, and newborns.

Machine learning models are used everywhere to analyze images, signals, and videos. At first glance, this is a well-designed process that involves the stages of data collection, mark-up, and training a model, and, as a result, its application in a particular field (recognition of vehicle plate numbers, smartphone faces, etc.). However, everything is much more complicated in the field of medicine: the use of artificial intelligence models is a serious challenge. Machine learning methods are becoming more and more used in morphological sciences and biomedical studies. The introduction of artificial intelligence for image analysis can lower the burden on an operator (a pathologist, a histologist), eliminate the factor of subjective assessment, and reduce the likelihood of an error. This review provides a brief excursion into the history of machine learning methods, considers the examples of their use in two areas where they are most widespread: morphopathology and assisted reproductive technologies, and also indicates the limitations and difficulties that developers face when training neural networks. Conclusion: The authors also propose solutions to overcome the difficulties associated with the collection and joint marking of data, and model training: creation of a high-quality infrastructure, attraction of highly qualified specialists who mark data, an advanced scientific approach to artificial intelligence technologies; cloud platforms are offered to be used as a basis for the scalable storage and analysis of biomedical data.

Objective: To study the production of reactive oxygen species by polymorphonuclear leukocytes in peripheral blood stimulated with zymosan and lipopolysaccharide, which are recognized by Toll-like receptors in women with miscarriage associated with infection in early pregnancy compared to healthy pregnant women. Materials and methods: 75 women aged 18-42 years were tested. They were stratified into 3 groups: group 1 - healthy nonpregnant women (n=25); group 2 - healthy pregnant women (n=25); group 3 - women with miscarriage associated with infection (n=25). In all women, the term of pregnancy was the first trimester of gestation (5-12 weeks). The functional activity of polymorphonuclear leukocytes in peripheral blood was determined by luminol-dependent chemiluminescence. Results: It was found that the production of reactive oxygen species by polymorphonuclear leukocytes stimulated with zymosan and lipopolysaccharide increased from 5 to 100 ig/mL, and the production of reactive oxygen species by the cells stimulated with lipopolysaccharide decreased from 50 to 100 ig/mL compared to healthy pregnant women. Conclusion: In women with miscarriage associated with infections and in healthy pregnant women on the background of oxidative stress in the first trimester of pregnancy, the production of reactive oxygen species by polymorphonuclear leukocytes in peripheral blood stimulated with zymosan or lipopolysaccharide, which are recognized by Toll-like receptors, may depend on the expression of these receptors on the membrane of cells.

Objective: To investigate blood levels of two adipokines in the first trimester and expression of placental vascular endothelial growth factor (VEGF) in the third trimester in women with a high body mass index (BMI) and without gestational diabetes. Materials and methods: The prospective observational study included 70patients with grade I-III obesity (24, 24, and 22 women, respectively) who gave birth at full term to newborns with an Apgar score of 7-8. The control group consisted of 22 postpartum women with a normal BMI. Blood adiponectin and omentin were determined using an enzyme-linked immunosorbent assay (ELISA) before nine weeks of gestation. The expression of vascular endothelial growth factor (VEGF) was examined in 24 placenta samples. Results: At the gestational age of 8-9 weeks, blood adiponectin level in women with grade I-III obesity was statistically significantly lower than in the controls. Omentin levels in the control group and those with grade I obesity did not differ and exceeded those with grade II and III obesity. There was a moderate negative correlation between the BMI of women of all groups and the blood omentin levels (r=-0.565, p<0.0001). The IHCA showed that the total VEGF expression in terminal villi and capillaries of the fetal placentae in obesity is reduced compared to the control group. In a pairwise comparison of groups with high BMI, the highest VEGF expression was found in obesity grade I relative to grades II and III, which did not differ from each other. Conclusion: In the first trimester of pregnancy, maternalpregravid obesity is associated with decreased adiponectin and omentin concentrations and placental VEGF expression. A high BMI, starting with II grade obesity, can be considered a risk factor for placental insufficiency.

Materials and methods: The study included 466 patients of Outpatient Department of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia. Cytological examination, HPVtesting, colposcopy, cervical biopsy (when indicated), histological examination, and gene- expression analysis in real-time RT-PCR for mRNA expression profile of 11 genes were performed. 90 patients with "minor" forms of cervical intraepithelial neoplasia underwent dynamic observation every 6 months within 24 months. Results: A method for detection of severe dysplasia, cervical cancer and the risk of progression of "minor" forms of HPV-associated diseases was developed. Using regression analysis of MKI67, CDKN2A, CCNB1, MYBL2, EXO, ANLN, UBE2T, PGR, ESR1, BAG1, BCL2 mRNA expression and considering high oncogenic risk of HPV, an algorithm for calculation of the risk index (RI) of cervical lesions was proposed. 88.3% of HSIL and 100% of CC cases were detected using the RI. For "minor" cervical lesions, unfavorable and favorable prognosis were confirmed in 81.5% and in 84.1% of cases, respectively. Conclusion: The developed model can be prospectively applied in clinical practice for screening and prevention of cervical cancer as an additional testfor sorting the samples with "severe" lesions and assessment of the risk of the disease progression, as well as selecting the patients for colposcopy and biopsy according to indications.

Objective: To compare the diagnostic value of body mass index (BMI), body composition, and their relationship with the metabolic profile of patients with polycystic ovary syndrome (RCOS). Materials and methods: A single-center, cross-sectional study included 129 women with PCOS (mean age 26.7 (5.4) years). They underwent a comprehensive clinical and laboratory examination, including BMI calculation, body composition analysis, hormonal and lipid prof iles, glucose metabolism, and pelvic ultrasound. Results: Among patients with PCOS, overweight and obesity were diagnosed only in 48/129 (37.2%) patients, and 95/129 (73.6%) had an excess of total adipose tissue located mainly in the visceral region. Forty-six of 81 (56.8%) patients with normal BMI values had an excess of total adipose tissue, indicating latent obesity. Among them, 18/46 (39.1%) had visceral obesity, which was associated with hyperinsulinemia, insulin resistance (IR), and dyslipidemia in every third case and with impaired glucose tolerance (IGT) in every 5th case. ROC analysis showed that at a threshold value of BMI≥223 kg/m2, an excess of total adipose tissue was detected in 100% of cases, NTG was more than 11 times more common, and hyperinsulinemia and dyslipidemia were three times more common. In patients with PCOS, a BMI≥223 kg/m2 can be considered a factor predisposing to the development of IR with a sensitivity of 74% and a specificity of 70%. Conclusion: It would be appropriate to include body composition analysis in the diagnostic evaluation of patients with PCOS to identify excess adipose tissue associated with metabolic disorders. BMI≥223 kg/m2 can be considered a clinical marker of excess adipose tissue and a high risk of developing metabolic disorders. With their early diagnosis, effective interventions can be selected, including lifestyle modification and pharmacotherapy to reduce the risk of type 2 diabetes and cardiovascular diseases in the long term.

Objective: To evaluate the clinical and morphological characteristics, the expression of cytokines in serum and peritoneal fluid in patients with tubo-ovarian abscesses (TOA). Materials and methods: A total of476 women were enrolled in the study, namely 456patients with TOA (the main group) and 20 healthy women who underwent laparoscopic sterilization with removal of the fallopian tubes (the control group). The study included clinical and anamnestic data, general clinical and biochemical parameters, cytokines (IL-1, IL-4, IL-6, TNF-a, fibronectin) in serum and peritoneal fluid, histological and morphometric parameters. Results: The patients of the main group showed an increase in the level of anti-inflammatory cytokines IL-1P, IL-6, TNF-a, fibronectin, both in serum and peritoneal fluid. The average value of IL-1P in the blood of healthy women was 14.22 (1.33) pg/ml, and it was 381.6 (22.2) in the patients of the main group; TNF-a was 2.79 (0.54) and 56.34 (7.42) pg/ml, respectively; IL-6 was 3.19 (0.27) and 7.69 (0.52) pg/ml, respectively; fibronectin was 324.05 (12.82) and 2729.04 (253.74) pg/ml, respectively. A similar increase in the level of all pro-inflammatory cytokines was noted in the peritoneal fluid in women of the main group. The values of IL-4 in patients with TOA were reduced in all biological media compared to healthy women. Morphometric analysis revealed an increase in the volume density of connective tissue in TOA wall to 51.2 (3.7) %, and a decrease in the muscle tissue volume to 6.09 (0.05) %, which was 8.5 times less than the same indicator in the healthy controls. All the differences were statistically significant. Conclusion: The obtained results indicate that there is an increase in the production of pro-inflammatory cytokines in patients with TOA, along with a decrease in the production of anti-inflammatory ones, both in serum and exudate. Histological and morphometric changes conf irm the loss of function of the uterine appendages.

Objective: To investigate the incidence of neonatal seizures and their transformation into structural epilepsy in children with extremely low birth weight (ELBW) and very low birth weight (VLBW). Materials and Methods: This retrospective analysis of the medical records included 297 patients born at 25-32 weeks' gestation with birth weight less than 1499 g, including 29 children with neonatal seizures. After discharge, patients with neonatal seizures were under outpatient supervision by a neurologist. Electroencephalography (EEG) was performed at the corrected age (CA) of 2, 6, 9, 12, 18, 24, and 36 months. Neurological outcome was assessed at CA of 36 months. Results: Neonatal seizures were diagnosed in 29 patients (9.8%). Amplitude-integrated EEG (aEEG) and multichannel EEG in the neonatal period were performed in 246 patients. Among children with neonatal seizures, epileptiform activity on the aEEG and EEG tracings were observed in 16 (55%) and 20patients (69%), respectively. Among patients with clinical manifestations of neonatal seizures (n=29), antiepileptic therapy was administered to 26 patients (89.7%). At CA of 6 months of treatment, six patients with neonatal seizures showed normalization of EEG data, which was an indication for discontinuation of antiepileptic therapy. According to EEG findings, four children retained epileptiform activity without convulsions; one child developed repeated epileptic seizures. These patients were diagnosed with structural epilepsy. Antiepileptic therapy was continued. All patients with neonatal structural epilepsy had status seizures. Conclusion: Neonatal seizures were diagnosed in 9.8% of patients. Compared to aEEG, EEG is more sensitive in detecting epileptiform activity. Structural epilepsy was diagnosed in children with neonatal seizures, requiring anticonvulsant therapy for more than three years. The study findings show the importance of a comprehensive neurological examination and follow-up of patients with neonatal seizures.

Timely and accurate assessment of the fetal condition during pregnancy and childbirth is the main component of medical care which makes it possible to avoid perinatal complications in obstetrics. Such simple devices as fetal Doppler which can register the fetal heart rate have a significant drawback. During the study the data obtained using a standard fetal Doppler are usually reflected only on a digital display, they are not stored in the device memory and are not recorded on paper or electronic media. Objective: To study the potential use of the analyzer ADMP-02 for an objective identification of the presence of fetal cardiac activity in the second trimester of pregnancy, as well as for rapid documented assessment of the fetal condition in the third trimester when the device is used by paramedical personnel or doctors before cardiotocography or ultrasound examination during the initial contact with the patient. Materials and methods: This was the analysis of 415studies of pregnant women using ADMP- 02performed in the Tula Regional Perinatal Center and other medical institutions of this city. A total of198 studies were conducted at 14-28 weeks gestation and 215 studies were performed at gestation after 28 weeks, all the results were documented on paper. After using the analyzer ADMP-02, all the pregnant women had a standard full examination with the use of ultrasound and CTG; the condition of the fetus in the third trimester was indicated in the clinical report. There was a comparison of the data of the device and subsequent studies which are considered to be the gold standard. Results: The rate of unsuccessful studies in the second trimester of pregnancy was 20.7% (41 cases) and 8.3% (18 cases) in the third trimester. The main reasons for unsuccessful studies were increased subcutaneous fat, severe polyhydramnios, the location of the placenta on the anterior wall of the uterus and the posterior view. A total of 194 studies were referred to normal (97.5%), 3 cases were identified as suspicious and 2 cases were identified as pathological. The comparative analysis of the potential use of the analyzer ADMP-02 and hospital diagnostic systems in our study demonstrated 100% sensitivity and 98% specificity. Conclusion: The analyzer ADMP-02 can be used by various medical personnel to identify fetal cardiac activity starting from 14-16 weeks gestation. In the third trimester, the use of the analyzer ADMP-02 made it possible to identify the normal or pathological condition of the fetus prior to the standard obstetric examination. The timely detection contributed to the rapid and rational development of tactics for further monitoring and management of the pregnant woman to reduce obstetric complications and perinatal mortality.

The relevance of the research topic is due to the severity of the problem of vitamin D deficiency in a woman's body during reproductive age. The purpose of the study is to investigate the issues of the onset and development of adenomyosis in reproductive-aged women due to a lack of vitamin D in their body and to find ways to effectively solve these problems. The leading methods of the investigation are systematic and analytical techniques. Statistical data analysis made it possible to study the spread of adenomyosis among the reproductive-aged women of Kazakhstan, as of2020. The main results obtained in this study should be considered the determination of the role of vitamin D in maintaining the health of reproductive-aged women and the prospects for its use, if necessary, to treat adenomyosis should be considered to be the main results obtained during this investigation. Conclusion: The investigation has defined two ways to solve the problem of vitamin D deficiency: 1) inclusion of foods high in this vitamin into the diet; 2) targeted higher-dose vitamin D supplementation. The prospects for subsequent scientific research in this area are determined by the urgent need to find effective ways to solve the problems of vitamin D deficiency in reproductive-aged women and to create conditions for them to receive it in the required amount.

Background: The relevance of treating patients diagnosed with breast cancer during pregnancy is indisputable. In recent years, the number of patients has become larger due to increases in the age of pregnant women and in the number of IVF procedures. Case report: The paper describes an observation of a 24-year-old patient at diagnosis; the follow-up of the patient and her child lasted 6 years. The patient received combination chemotherapy cycles during pregnancy, which were followed by delivery, continuation of drug therapy involving chemotherapy and targeted therapy cycles and by surgical treatment. The patient having a VRCA1 gene mutation underwent preventive subcutaneous mastectomy with simultaneous reconstruction for mutation carriage; thus, bilateral breast reconstruction surgery that is a method of surgical rehabilitation was performed. Conclusion: An ultrasound study of the breasts is a mandatory diagnostic technique during pregnancy; if any breast nodule is present, its morphological verification is needed.

Background: Torsion of the uterus is defined as its rotation of more than 45° along its vertical axis. This pathology is extremely rare. Most obstetricians are faced with this situation once in a lifetime. Uterine torsion is a potentially dangerous obstetric situation. The main factors predisposing to uterine torsion are uterine leiomyoma or malformations, abnormal fetal positions, polyhydramnios, multiple pregnancies, cesarean section history, but any known cause is absent in 16-30% of cases. The clinical manifestations of uterine torsion are nonspecific and variable. There are often clinical presentations of an acute abdomen, in which a differential diagnosis is made in the presence of premature placental abruption, uterine scar rupture, torsion of the uterine appendages, acute appendicitis, and peritonitis. However, asymptomatic uterine torsion has been described in 11% of cases. The authors have not found any publications related to this problem in the Russian literature. Case report: The article describes a clinical case of asymptomatic uterine torsion with favorable maternal and fetal outcomes. A 29-year-old secundipara underwent cesarean section delivery at 34 weeks and 5 days, as concomitantly indicated. Attention is drawn to the fact that after hysterotomy, there is a large (3-4 cm) thickness of the uterine wall, the edges were separated with difficulty; a live premature girl (weight 2280 g; height 46 cm) with an Apgar score of 7/8 was extracted by the head with technical difficulties, by using a Kiwi vacuum cup after an additional incision in the center. The uterus was removed into the wound and its torsion was found in the lower segment by 180° to the right. Uterine derotation was done. It was found that hysterotomy was performed on the posterior uterine wall. The total blood loss was 750 ml. The postoperative period was uncomplicated. Conclusion: Uterine torsion is an extremely rare complication of pregnancy. Uterine torsion can occur in the absence of known risk factors and be asymptomatic. It should be remembered that during any cesarean section operation, it is necessary to carefully evaluate anatomical landmarks in order to avoid injury to large vessels, ureters, and bladder.