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No 9 (2022)

Articles

Risk factors for birth injury

Kravchenko E.N., Serov V.N., Baev O.R.

Abstract

An analysis of literature reviews over the past 15 years has shown that, being generally a rare childbirth complication, birth trauma does not lose its relevance due to not only medical and social aspects, but also legal ones. The prevalence of birth trauma varies between 0.2 and 6%, and depends on the risk factors of this complication. There are many risk factors that favor the development of fetal damages during childbirth, most of which occur antenatally, particularly those caused by pregnancy complications (macrosomia, postmaturity, premature birth), extragenital disease (diabetes mellitus), infections, and placental pathology (chorioamnionitis). Of vital importance are childbirth complications: difficult delivery (shoulder dystocia), instrumental vaginal delivery (involving the application of forceps, vacuum extraction of the fetus). Conclusion: Birth injuries generally require urgent care in the delivery room, so knowledge of obstetric risk factors and antenatal conditions associated with this complication is an important aspect in their prevention, timely diagnosis and management tactics.
Obstetrics and Gynecology. 2022;(9):5-10
pages 5-10 views

Pathogenesis of pain in endometriosis

Timofeeva Y.S., Marinkin I.O., Kuleshov V.M., Aidagulova S.V.

Abstract

The review analyzes foreign and Russian articles on theoretical issues of the pathogenesis of pain in endometriosis. The current concepts are that inflammation, neuroangiogenesis, and neurogenic inflammation, which underlie peripheral and central sensitization, as well as the advancing interorgan sensitization, are involved in the pathogenesis of pain in endometriosis. The review considers the molecular mechanisms underlying the above pathological phenomena causing deterioration in quality of life in patients with endometriosis in some cases even after surgical excision of heterotopias. By now, it has not been possible to identify endometriosis-specific pain; the disease can take both its asymptomatic course and its course with the only pain symptom of varying intensity, as well as with their combinations. The study of the pathogenesis of endometriosis is still relevant; there are many questions to be answered in order to improve quality of life in patients and to relieve the pain syndrome that is present in almost half of the cases of endometriosis. Conclusion: The pathogenesis of pain in endometriosis includes the following components: a biochemical signal that is converted through activation of nociceptors into a nerve signal that is modulated at the spinal level and sent to the brain neurons with pain f ixation. The nature of the pain syndrome largely depends on the prevalence of endometrioid heterotopias, the duration of the disease and the individual characteristics of the patients. The nature of pain syndrome largely depends on the prevalence of endometrioid heterotopias, the duration of the disease, and the individual characteristics of the patients.
Obstetrics and Gynecology. 2022;(9):12-18
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Predictors of development and progression of cervical dysplastic processes

Levakov S.A., Mushkyurova D.R., Sheshukova N.A., Obukhova E.A.

Abstract

Cervical cancer (CC) ranks fourth in the structure of morbidity and mortality from cancers in women. Early detection of CC and assessment of malignancy prognoses are of critical importance, because women who have early-stage invasive carcinoma have signif icantly higher chances of being cured, which is in turn cost effective. Publications in the PubMed and Cochrane databases; recommendations of international and Russian professional communities, clinical studies published in the public domain to search for modern markers for the progression of cervical precancerous processes have been analyzed. The review presents markers for the progression of cervical precancerous processes and describes the main mechanisms of the pathogenic effect of human papillomavirus (HPV) on epithelial cells. Along with well-known markers, such as p16, Ki-67, proteomics that is a valuable tool for studying the mechanisms involved in the interaction of viral infection and protein dysfunction leading to cervical carcinogenesis is being actively investigated. Metabolomics is widely used to study cancer metabolism. Metabolites, the end products of various biological processes, hold promise as accurate biomarkers that reflect past biological events, such as genetic mutations and environmental changes. Altered metabolites will help to better understand metabolic dysregulation during tumor initiation and progression. Conclusion: An analysis of the data available in the literature has shown that markers for dysplasia progression enhance the possibilities of timely diagnosis and therapy.
Obstetrics and Gynecology. 2022;(9):19-24
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Possibilities for predicting the effectiveness of assisted reproductive technology programs

Martynova A.E.

Abstract

Continuous improvement of assisted reproductive technologies (ART) enhances the effectiveness of infertility treatment; however, its efficiency remains individual in each clinical case. Many factors can influence the successful implementation of ART programs. A competent assessment of the chances before starting treatment allows a couple to more easily accept the possible need for repeated IVF attempts, to correctly plan financial costs, and, in some cases, to choose an alternative solution to the problem. The objective of this review - to generalize the data available in the literature on the possibility of predicting the outcomes of ART programs. The review considers issues, such as the influence of age, ovarian reserve biomarkers, body mass index, hormonal background, lifestyle, and alternative markers on the efficiency of IVF treatment. It reflects complex clinical models and calculators for assessing the chances of a positive treatment outcome. Conclusion: There are a large number of criteria that potentially affect the effectiveness of ART programs; however, each of them has a low predictive value; in this connection it is important to create complex predictive models to improve overall accuracy. The creation of clinically significant models for predicting the efficiency of ART treatment will assist clinicians and patients to fundamentally and thoroughly plan treatment, to optimally use the ovarian reserve, and to promptly recommend fertility preservation programs, thereby increasing the chances of having healthy offspring.
Obstetrics and Gynecology. 2022;(9):26-32
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The role of fetal gender in the pathogenesis of gestational diabetes mellitus and obstetric complications

Botasheva T.L., Andreeva V.O., Rymashevskiy A.N., Tezikov Y.V., Lipatov I.S., Fabrikant A.D., Lebedenko E.Y., Zheleznyakova E.V.

Abstract

Objective: To reveal the mechanisms leading to the development of gestational diabetes mellitus and associated obstetric complications depending on the fetal gender. Materials and methods: The study included 642 women aged from 18 to 28 years with a spontaneous singleton pregnancy. The main group consisted of 328 patients with gestational diabetes mellitus: 152 women carried male fetuses and 176 women carried female fetuses. The control group included 314 patients with normal pregnancy: 158 women carried male fetuses and 156 women carried female fetuses. The levels of hormones were evaluated in the dynamics of gestation. Results: During the first trimester, pregnant women carrying male fetuses were found to have a reduced integration between stress liberating and steroid hormone subsystems, an increase in the production of contra-insular hormones, and thus more predisposed to the development of obstetric complications. Conclusion: The male gender of the fetus is a factor that contributes to the increased incidence of gestational diabetes mellitus, placental insufficiency, and the risk of preterm birth; therefore, it is necessary to develop individual support programs in gestational diabetes.
Obstetrics and Gynecology. 2022;(9):33-41
pages 33-41 views

The role of angiogenic factors in the pathogenesis of placenta accreta spectrum in women with placenta previa

Makukhina T.B., Penzhoyan G.A., Morozova R.V., Zadornaya O.I., Dontsova M.V., Krivonosova N.V., Amirkhanyan A.M.

Abstract

Objective: To investigate the contribution of angiogenic factors to the pathogenesis of placenta accreta spectrum (PAS) in women with placenta previa to identify additional biomarkers of abnormal placental invasion. Materials and methods: Baseline evaluation included measurement of serum concentrations of PlGF, VEGF, sFlt-1, Doppler ultrasound in women with placenta previa (n=42) and with PAS (n=46), immunohistochemistry of local expression of VEGFand Flt-1in placenta previa (n=17), pl. accreta (n=16), pl. increta (n=18), pl. percreta (n = 6) groups. Results: Women with PAS had lower expression of Flt-1 in chorionic villi than those without PAS. This was found both in (p=0.02; <0.001; 0.003for pl. accreta, increta, percreta, respectively) and outside of the invasion zone for invasive forms of PAS (p=0.005; 0.003for pl. increta, percreta, respectively). These changes were associated with a decrease in serum sFlt-1/PlGF in PAS (1.65 vs 3.0, p=0.035). The increase in local VEGF expression in PAS was not in parallel with the changes in serum concentrations of this biomarker. Women with PAS were more likely to have increased subplacental vascularization according to color Doppler; a combination of > 3 US signs (91.3% vs 40.5%; 67.4% vs 11.9%, p<0.001<0.001, respectively). There were no differences in uteroplacental hemodynamics between groups according to spectral Doppler (p=0.323). Ultrasound for the diagnosis of PAS demonstrated sensitivity of 95.7%, specificity of 54.8%, positive predictive value of 69.8%, negative predictive value of 92.0%, and accuracy of 76.1%. Conclusion: The decrease in serum sFlt-1/PlGF in pregnant women with PAS in the third trimester is consistent with a decrease in local Flt-1 expression in the chorionic villi and can be used as an additional biomarker of PAS in women with placenta previa. Assessment of multiple ultrasound signs of PAS may improve the specificity and accuracy of antenatal diagnosis in patients at risk.
Obstetrics and Gynecology. 2022;(9):42-53
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Risk factors for shoulder dystocia during labor in women with diabetes mellitus

Kapustin R.V., Kopteeva E.V., Alekseenkova E.N., Tsybuk E.M., Arzhanova O.N., Kogan I.Y.

Abstract

Objective: Identify risk factors for shoulder dystocia in labor in women with diabetes mellitus (DM) and assess the contribution of the identified determinants of adverse obstetric and perinatal outcomes to this complication. Materials and methods: This retrospective cohort study was conducted at the D. O. Ott Research Institute for OG&P. Pregnant women with different types of DM delivered over 10 years (2008-2017, n=3261) were divided into comparison groups. There were patients with T1DM receiving continuous subcutaneous insulin infusion (CSII) (n=60), patients with T1DM on multiple daily insulin injections (MDII) (n=446), patients with T2DM on diet (n=95), T2DM on insulin therapy (n=134), gestational DM on diet (n=1652), gestational DM on insulin therapy (n=735), and control group (n=139). The odds ratios (OR) were calculated to determine the risk and assess the contribution of determinants to the development of shoulder dystocia. Statistical analysis was performed using SPSS v 23.0 software. Results: One of the most significant risk factors for shoulder dystocia in labor was fetal weight. In the presence of DM, the minimum fetal weight at which the risk of shoulder dystocia was significantly increased was 4250 g; at fetal weight greater than 4750 g, the odds ratio for shoulder dystocia increased 5-fold (OR 4.86; 95% CI 1.32- 14.5). Other significant risk factors were maternal age (>30 years), prepregnancy body mass index (>30 kg/m2), glycated hemoglobin level in the first trimester (>6.5%), and gestational weight gain over 15 kg. At the same time, a history of DM was not found to be a predictor of fetal dystocia in women with DM. Conclusion: Individual evaluation of the identified risk factors will optimize a rational pregnancy management algorithm and the choice of mode and tim ing of delivery, thereby reducing the incidence of shoulder dystocia in patients with DM.
Obstetrics and Gynecology. 2022;(9):54-63
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Informative value of oxidative stress markers in predicting outcomes of infertility treatment using ART methods

Agadzhanyan D.S., Smolnikova V.Y., Krasnyi A.M., Lobanova N.N., Shchipitsyna V.S., Sadekova A.A., Makarova N.P., Kalinina E.A.

Abstract

Objective: To assess the level of reactive oxygen species (ROS) and total antioxidant capacity (TAC) in the peripheral blood and follicular fluid in women with various types of infertility and to identify the informative value of these markers of oxidative stress in predicting the outcomes of assisted reproductive technologies (ART) up to 12 weeks gestation. Materials and methods: A total of 75 patients received ART treatment for infertility. The level of ROS was measured in the peripheral blood and follicular fluid of all patients by means of the FORM 3000 device using the FORT kit. The level of TAC was determined in the peripheral blood and follicular fluid of 45 patients by means of the FORM 3000 device using the FORD kit. Results: The likelihood of implantation was higher in women with higher levels of ROS in the follicular fluid (p=0.024). A positive correlation between the level of ROS in the follicular fluid and body mass index (BMI) was identified. There was a correlation between the level of ROS in the peripheral blood and the follicular fluid of patients, therefore, it was possible to determine the level of oxidative stress only in one biological fluid. The level of ROS in the follicular fluid of patients who had implantation and ongoing pregnancy up to 12 weeks was higher compared to the patients who had implantation failure and pregnancy loss up to 12 weeks, respectively. The level of TAC in these fluids was higher in the groups of patients who had pregnancy loss up to 12 weeks gestation and implantation failure in comparison with the pregnant patients. The measurement of ROS and TAC is not interchangeable. Conclusion: According to the data on the parameters of oxidative stress, the levels of ROS and TAC have an influence on the outcomes of ART treatment. It is necessary to continue studying oxidative stress in patients with various types of infertility in order to develop a mathematical model for predicting the results of ART treatment and improving the preconception care of couples prior to infertility treatment.
Obstetrics and Gynecology. 2022;(9):64-70
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Comparative analysis of clinical and anamnestic data from couples undergoing frozen-thawed embryo transfer in the natural and hormone replacement therapy cycle

Gokhberg Y.A., Fedorov I.S., Timofeeva A.V., Kalinina E.A.

Abstract

Objective: To analyze clinical and anamnestic data of patients undergoing ART and subsequent frozen-thawed embryo transfer in the natural and hormone replacement therapy (HRT) cycle. Materials and methods: The study included 102 infertile couples with women aged from 23 to 43 years. Of these, 42 and 60 underwent embryo transfer in a natural and HRT cycle, respectively. The baseline evaluation consisted of a complete clinical and laboratory examination, assessment of the hormonal profile, and ultrasound examination. The study analyzed the results of in-vitro fertilization (IVF) and frozen-thawed embryo transfer. Results: Patients in the HRT cycle group who achieved and did not achieve pregnancy had statistically significant differences in progesterone level (p<0.001), testosterone level (p=0.02) and endometrial thickness on date of embryo transfer (p<0.001). Positive correlations were also found between endometrial thickness on the day of embryo transfer and baseline progesterone levels (p=0.04, r=0.28). In the natural cycle group, there were statistically signif icant differences between patients who achieved and did not achieve pregnancy in progesterone levels (p<0.001). Conclusion: The natural cycle and HRT cycle groups did not differ statistically significantly in pregnancy rates in frozen-thawed embryo transfer (p=0.70). High baseline progesterone levels before IVF were associated with pregnancy onset in both natural cycle and HR Tgroups, which suggests its possible association with the effectiveness of ARTprograms and requires further study. Therefore, an individualized approach to luteal phase support during cryopreserved embryo transfer in both natural cycle and HRT cycle according to serum progesterone levels may play an important role in increasing the effectiveness of ART programs.
Obstetrics and Gynecology. 2022;(9):72-80
pages 72-80 views

Analysis of the embryonic stage of in vitro fertilization programs in patients with unexplained infertility

Bachurin A.V., Kirakosyan E.V., Nazarenko T.A., Pavlovich S.V.

Abstract

Objective: The purpose of the study was analysis of the embryonic stage of in vitro fertilization programs (IVF and ICSI) in patients with unexplained infertility compared to patients with tubo-peritoneal factor of infertility. Materials and methods: We collected and analyzed information on embryonic stage of IVF programs in women with unexplained infertility (the study group consisting of 80 women), who underwent 113 IVF programs, and in women with tubo-peritoneal factor of infertility (the control group consisting of 30 patients), who underwent 41 IVF programs in the Departments of the Institute of Reproductive Medicine of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia in the period from 2019 to 2021. The comparison groups of patients were representative of the general population in qualitative and quantitative parameters, comparable in age, duration of infertility, ovarian reserve status, stimulation protocols and the number of IVF programs per woman. Results: The blastulation rate was considered to be the endpoint in IVF programs, and it was significantly lower in the group of women with unexplained infertility. In-depth analysis of the embryonic stage of IVF programs showed, that low blastulation rate in unexplained infertility was mainly due to the fact that embryos stopped developing about three days after they were cultured. At the same time the morphological assessment showed that the quality of blastocysts was higher in the group of unexplained infertility compared to the group of tubo-peritoneal factor of infertility. Preimplantation genetic testing for aneuploidy (PGT-A) showed similar frequency of detection of euploid embryos. Conclusion: Given the identified impairments of early embryonic development in unexplained infertility, it is appropriate to recommend the patients to undergo early use of IVF with good quality embryo (>3, AA, AB, BA) transfer on day 5 of culture without long-lasting preliminary examination and empirical treatment.
Obstetrics and Gynecology. 2022;(9):81-86
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Assisted reproductive technology in late reproductive age women with polycystic ovarian syndrome

Mikhailova N.D., Aksenenko A.A., Durinyan E.R., Gavisova A.A.

Abstract

Objective: To compare the efficiency of frozen-thawed embryo transfer after preimplantation genetic testing for aneuploidy (PGT-A) in late reproductive age women with polycystic ovarian syndrome (PCOS) and those with tubal-peritoneal factor infertility. Materials and methods: The study included 63 infertile women of late reproductive age undergoing IVF/ICSI with gonadotropin-releasing hormone (GnRH) antagonists followed by PGT-A. The patients were divided into Group 1 including women with tubal-peritoneal infertility (n=30) and Group 2 including women with PCOS (n=33). Then, all the patients included in this study underwent frozen-thawed embryo transfer, providing the availability of embryos recommended for transfer by genetic testing. The effectiveness of the ART program was evaluated by the rates of achieved pregnancy, biochemical pregnancy rate, ectopic pregnancy rate, spontaneous miscarriage rate, missed miscarriage rate, and live birth rates. Results: There were no differences in IVF/ICSI efficacy between the two study groups. A total of9/27 (33.3%) pregnancies were recorded in the tubal-peritoneal factor group versus 8/25 (32%) in the PCOS group (p=0.919), a difference that was not statistically significant [OR 1.042 (CI0.48; 2.28), p=0.919]. Of them, 5/27 (18.5%) and 4/25 (16%) ended in birth [OR 1.157 (CI 0.35; 3.83), p=0.811] and 6/27(22.2%) and 4/25 (16%) resulted in miscarriage [OR 1.39 (CI 0.44; 4.35), p=0.569]. There was only one miscarriage (3.7%) in the group of patients with tubal-peritoneal infertility factor. Conclusion: In late reproductive age, patients with both PCOS and tubal-peritoneal infertility factor, IVF/ICSI and PGT-A programs followed by frozen-thawed embryo transfer demonstrated similar efficacy. Despite the higher ovarian reserve, the efficacy of ART programs in patients with PCOS also decreases with age, requiring PGT-A in older patients, regardless of the infertility factor. Further studies of this problem on a larger sample of patients are needed.
Obstetrics and Gynecology. 2022;(9):87-93
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The use of androgen priming in infertile women with diminished ovarian reserve undergoing assisted reproductive technology (IVF/ICSI)

Gavisova A.A., Kamaletdinov N.S., Nazarenko T.A., Dolgushina N.V.

Abstract

Objective: To study the effectiveness of androgen priming in infertile women with diminished ovarian reserve (DOR) undergoing assisted reproductive technology (ART) treatment. Materials and methods: A prospective cohort study included infertile women with DOR undergoing in vitro fertilization (IVF) treatment. According to the ESHRE criteria (Bologna Criteria, 2011), the study group included 305 women; among them there were 203 patients who received androgen priming during one month prior to the IVF/ICSI program. The hormonal study including the androgen fractions in the blood serum was carried out using immunochemiluminescent assay (ICMA) in all women. Results: The use of androgen priming in infertile women with DOR led to statistically significant improvements in the parameters of oogenesis and embryogenesis. The use of dehydroepiandrosterone (DHEA) revealed statistically significant differences in the number of oocytes from 2.9 (0.3) to 4.4 (0.3), including mature oocytes from 1.8 (1) to 3.3 (1.05), zygotes from 1.2 (0.6) to 2.1 (0.7), blastocysts from 0.8 (0.4) to 1.4 (0.6), and the frequency of blastula formation from 27.6% to 31.8% (p<0.001). There was an increase in the pregnancy rate from 8.6% to 11.4% (p=0.32). The use of testosterone-containing gel also revealed statistically significant differences in the number of oocytes from 3.0 (0.5) to 4.1 (0.5) and mature oocytes from 1.74 (0.5) to 3.4 (0.6), zygotes from 1.1 (0.4) to 2.2 (0.6), blastocysts from 0.6 (0.3) to 1.5 (0.7), the frequency of blastula formation from 20.0% to 36.6% and pregnancy rate as well (p<0.001); however, pregnancy rate was found to be higher (14%) in this group after receiving therapy compared to the DHEA group. Conclusion: A decrease in the level of androgens in the blood serum is associated with impaired folliculogenesis, oogenesis, embryogenesis and leads to reduced effectiveness of the IVF/ICSI program. The study demonstrated an increase in the number of mature oocytes, the percentage of fertilization and the number of blastocysts of good and excellent quality, which can be the main factors leading to the clinical effectiveness of ART programs; however, there was no statistically significant difference in the pregnancy rate between the groups of patients who received treatment.
Obstetrics and Gynecology. 2022;(9):94-101
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Peripheral blood NK-cells in women with unsuccessful attempts of assisted reproduction: quantity, subpopulation composition and activation markers

Zagaynova V.A., Kogan I.Y., Selkov S.A., Bespalova O.N., Krikheli I.O., Mikhailova V.A., Davydova A.A., Milyutina Y.P., Sokolov D.I.

Abstract

Objective: To study the subpopulation composition of lymphocytes, quantity, subpopulation composition and activation markers of peripheral blood natural killer cells (pbNK cells) in women with unsuccessful attempts of assisted reproductive technologies (ART). Materials and methods: The main group consisted of 60 women with the previous history of one or more unsuccessful ART attempts who were subdivided into groups as patients with primary and secondary infertility. The patients with secondary infertility were divided into those who had a history of miscarriage and those who did not have it. The control group included 15 healthy fertile women. The study was carried out in the 2nd phase of the menstrual cycle (day 19-22). Subpopulation composition of peripheral blood lymphocytes, subpopulation composition of pbNK cells, their activated forms expressing receptors CD107a and NKG2D were determined using flow cytofluorimetric method. Results: The patients of the main group in comparison with the control group demonstrated a decline in the relative number of B-lymphocytes (p<0.05), number of CD16+CD107a+pbNK cells (p<0.01) and lower CD107a receptor expression (MFI) (p<0.01). The patients of the main group showed an inverse correlation between the number of pregnancies and the absolute pbNK cell count (rs=-0.55; p<0.01), as well as a direct correlation with MFI CD16+CD107a+ pbNK cells (rs=0.41; p<0.01). The threshold values associated with the absence of pregnancy were more than 0.312 k/μL for pbNK cells. The patients of the main group with primary infertility in comparison with those with secondary infertility had a decrease in the relative number of T-helpers (p<0.05), an increase in the absolute number of pbNK cells, as well as the number of NKG2D+CD56dimCD16brigh and NKG2D+CD56brighlCD16dim of pbNK cells (p<0.05). The patients who had secondary infertility and a history of miscarriage showed a decrease in the number of CD56dimCD16brighl and CD56brighlCD16dim of pbNK cells (p<0.05) and an increase in the number of CD56dimCD16dim of pbNK cells (p<0.05) compared to the patients who had no history of miscarriage. Conclusion: Depending on primary or secondary infertility as well as the presence of miscarriage in the patient’s history, the changes in pbNK cell parameters of the patients with unsuccessful ART attempts may reflect the immunological characteristics of the impaired mechanisms of implantation or termination of pregnancy in the early stages.
Obstetrics and Gynecology. 2022;(9):102-113
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Experimental technique for the transfer of pronuclear stage genetic material

Sukhikh G.T., Kamaletdinov N.S., Nazarenko T.A., Martirosyan Y.O.

Abstract

Background: An increased proportion of late reproductive age women with aneuploid oocytes suggests the development of novel techniques capable of improving their quality. Some of them are based on the transfer of genetic material from the recipient to the donor cell. The article presents the preliminary results of an experimental study aimed at developing a technique for the transfer of the nucleus from the recipient to the donor cell. Objective: To identify the technical possibility of the transfer of the nuclei at late pronuclear stage. Materials and methods: The technique of nuclear transfer was practiced on abnormally fertilized oocytes (3PN) which were unsuitable for further use in the ART procedures and were to be disposed of. A total of 28 triploid zygotes were used and 14procedures of pronuclear transfer were carried out. Results: The transfer procedure resulted in successful fusion of transferred nuclei with enucleated cytoplast in 57% of cases, degeneration occurred in 43% of cases. Fragmentation with varying degrees (10-70%) was observed in all 8 successfully reconstructed zygotes, however, the percentage of compactification and blastulation was reduced; as a result, we obtained one embryo at the morula stage and one embryo at the blastocyst stage. The key point in the nuclear extraction process is the quality of the cytoplasm. The necessary material support as well as solutions and their concentrations were determined, the effectiveness of virus HVJ-E in the cell membrane fusion was found to be acceptable. Conclusion: This experiment has shown the possibility of transferring pronuclei from one cell to another. It is necessary to continue developing the technique for the transfer of genetic material and modify it; it is worth developing the technique for the transfer of the material at other stages (for example, at metaphase IIspindle stage).
Obstetrics and Gynecology. 2022;(9):114-121
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Complications of laparoscopic hysterectomy: search for risk factors

Volkov O.A., Shramko S.V., Renge L.V., Saltykova P.E., Sabantsev M.A., Shisheya E.Y., Koval E.Y., Vlasenko A.E., Chubar E.A.

Abstract

Objective: To identify risk factors of complications after laparoscopic hysterectomy. Materials and methods: The study enrolled 87 patients who underwent endoscopic total hysterectomy for uterine fibroids and adenomyosis. Of these, vaginal cuff closure was performed by transvaginal sutures (n=54, 62.1%) or intracorporeal sutures (n=33, 37.9%). Results: Total vaginal cuff dehiscence was observed in 11 cases, of which 10 cases manifested by bleeding and one by eventration. Infectious complications were registered in five cases including two surgical site (ICSS) infections, two peritonitis, and one peritonitis concurrent with ICSS. The following risk factors for complications after laparoscopic hysterectomy were established: reproductive age, adenomyosis, obesity, respiratory diseases, transvaginal vaginal cuff suture, subcompensated or decompensated blood flow in the vaginal branch of the uterine artery (IR≥0.8) or its absence on the 2nd day after surgery and leukocyte intoxication index ≥2 on the 3rd day after surgery. Conclusion: Identification of risk factors for complications after laparoscopic hysterectomy will prevent patients from re-hospitalization by optimizing pre-surgical planning of surgical access, choosing method of vaginal cuff closure, and determination of terms of discharge.
Obstetrics and Gynecology. 2022;(9):122-128
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Laparoscopic ovarian cystectomy in newborns

Mokrushina O.G., Chundokova M.A., Shumikhin V.S., Levitskaya M.V., Erokhina N.O., Nagornaya Y.V., Smirnova S.V., Khalafov R.V.

Abstract

Objective: To perform a comparative analysis of treatment of newborn girls with complex and simple ovarian cysts. Materials and methods: A retrospective analysis of treatment of 93 newborn girls with complex ovarian cysts and 32 newborn girls with simple ovarian cysts was performed within 13 years (2009-2021). The diagnosis was based on the results of diagnostic ultrasound examinations in the antenatal and postnatal periods. Analysis of cyst content and size was performed using ultrasound. Preoperative, intraoperative and postoperative evaluation was performed. Results: Emergency laparoscopic surgery was performed in newborns with simple ovarian cysts about 10 cm in diameter in 37% of cases of all simple ovarian cysts, and in 9% of cases of complex ovarian cysts due to the symptoms of intestinal obstruction. The age of newborns in both groups was 6 days (p=0.880). Elective surgeries was performed at the age of 42 days in the group with complex cysts and 48 The operative time was 30 minutes (p=0.164).Adhesions were found more frequently in the group with complex cysts (p=0.049 in emergency surgeries; р=0.153 in elective surgeries). Ovariocystectomy was performed in all cases of complex cysts. In patients with simple cysts, ovarian tissue was preserved. In both groups, smooth postoperative period lasted 2 days (p=0.072). Conclusion: Laparoscopy is a reliable and safe technique for treatment of ovarian cysts in newborns. However, it is necessary to define the best way to prevent torsion of ovarian cyst in utero. Puncture of fetal ovarian cyst can be one of the techniques.
Obstetrics and Gynecology. 2022;(9):129-134
pages 129-134 views

Chemotranscriptome analysis of synergism between D-chiroinositol and myoinositol in the context of postgenomic pharmacology

Torshin I.Y., Gromova O.A., Tetruashvili N.K.

Abstract

Background: The effect of myoinositol (MI) and D-chiroinositol (DCI) on gene transcription is of great importance for assessing the molecular mechanisms of synergism between these micronutrients. Such micronutrients are necessary for the prevention of insulin resistance, manifestations of polycystic ovary syndrome, congenital malformations and fetal macrosomia, especially in pregnant women with insulin resistance, dyslipidemia, and overweight. Materials and methods: The paper presents the results of a chemotranscriptome analysis of the effects of myoinositol (MI) and D-chiroinositol (DCI). The dose-dependent effects of MI and DCI on the transcription of 12716 annotated human genes in human umbilical vein endothelial cells (HUVEC line, stimulation of cells with MI/DCI at 6 different concentrations for 24 h) were evaluated. Results: MI was found to cause significant transcription changes (more than 50% per 10 pmol on average) of 6516 genes: the expression of 4085 genes increased, and the expression of 2431 genes decreased. DCI is an important MI synergist in six functional groups of genes: (1) fat metabolism, (2) carbohydrate metabolism, (3) thyroid function, (4) morphogenesis, cell differentiation and survival, (5) neuroprotection and neurotrophicity, (6) structure and function of blood vessels. MI and DCI changed the expression of genes involved in the human body’s response to 49 drugs. Conclusion: It was possible to establish an individual pattern of DCI and MI action and to identify the molecular mechanisms of synergism between these two forms of inositol at the level of the human transcriptome. The results of the study suggest a higher efficiency of the combined administration of MI and DCI for the correction of disorders of carbohydrate and fat metabolism in pregnant women and for the prevention of abnormal fetal morphogenesis.
Obstetrics and Gynecology. 2022;(9):135-145
pages 135-145 views

The characteristics of the course of pregnancy and surgical management in placenta increta in patients with reproductive tract malformations

Mikheeva A.A., Yarygina T.A., Shmakov R.G., Nizyaeva N.V., Amiraslanov E.Y., Karapetyan T.E., Rogachevskiy O.V., Pyregov A.V.

Abstract

Background: The impact of congenital uterine malformations on reproductive outcomes remains a highly controversial issue in the modern world. In patients with an internal genital malformation, the frequency of spontaneous abortions, premature detachment of a normally located placenta, premature delivery, and fetal death is increased; the risk of placenta increta is also higher in this category of women. In connection with the above, it seems relevant to analyze the course of pregnancies, surgical tactics, and outcomes in case of abnormal placental invasion in patients with a uterine malformation, as well as to compare the authors’ own experience with foreign data on the concurrence of these pathologies. Case report: In the foreign sources, there are 4 cases of placenta increta in uterine malformations, each of which was accompanied by substantial blood loss requiring hysterectomy. A full-term baby was born only in 1 of the presented cases; 2 cases of antenatal fetal death occurred; one baby was born alive at 28 weeks’ gestation. It is important to note that abnormal placental invasion was not diagnosed until the onset of pain or bleeding in 3 of the published cases. The authors describe Russia’s first clinical case of pregnancy resulting from in vitro fertilization in a patient with a reproductive tract malformation and antenatally diagnosed placental ingrowth into the area of a postoperative uterine scar. Conclusion: Due to the timely diagnosis ofabnormal placental invasion, correct patient routing, a multidisciplinary approach to pregnancy management, and a proven technique of organ-sparing surgery for placenta increta, it was possible to bring the pregnancy to full term, to perform organ-sparing surgery using blood-saving technologies.
Obstetrics and Gynecology. 2022;(9):146-154
pages 146-154 views

Vulvovaginal candidiasis treatment with local clotrimazole

Apolikhina I.A., Ramazanova M.O.

Abstract

Vulvovaginal candidiasis is a widespread disease that affects apparently healthy women of childbearing age, which enhances the social significance of this disease. It manifests itself by symptoms, such as itching, burning, pain, redness, and genital discharge, which significantly affects quality of life in patients. According to clinical practice guidelines, azoles should be intravaginally used to treat uncomplicated vulvovaginal candidiasis. The efficiency of therapy for this disease with different azoles is comparable; therefore, the treatment should be chosen on the basis of criteria, such as tolerability, patient convenience, etc. Of all the azoles that can be used to treat vulvovaginal candidiasis, clotrimazole has the best tolerance. There are also topical drugs containing local anesthetics and antiseptics to relieve itching and burning, but many women report discomfort during their use and the absence of the expected effect. A number of authors also emphasize that the use of a combination of clotrimazole with topical corticosteroids unreasonably and frequently enhance the manifestations of the fungal infection. Thus, as compared with clotrimazole monotherapy, combination local therapy with various drugs may apparently have a number of disadvantages. Conclusion: Clotrimazole cream 2% shows high efficiency and safety confirmed in numerous Russian and foreign studies and can be recommended for use in patients with vulvovaginal candidiasis. The paper presents own clinical case of successful clotrimazole monotherapy of a patient with candidiasis vulvovaginitis on the basis of the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia.
Obstetrics and Gynecology. 2022;(9):155-159
pages 155-159 views

Peritoneal inclusion cyst

Ivanova L.B., Valiev R.K., Davydova I.Y., Loginova E.A., Dymova A.V., Chistova E.Y.

Abstract

Background: To preserve the reproductive potential of women diagnosed with pelvic cystic neoplasms, it is important to correctly diagnose and to determine treatment policy. Case report: The paper describes a clinical case of peritoneal inclusion cyst (PIC) timely diagnosed and treated in a reproductive-aged woman. A comprehensive laboratory and instrumental studies were conducted; the results of which could recommend that the patient diagnosed with an ovarian cyst should undergo surgical treatment. Morphological study of surgical material revealed PIC. Conclusion: Given the complexity of diagnosing PIC and commonly its asymptomatic course, there is a need for standardization of diagnostic criteria. The advantage of surgical treatment is to obtain morphological findings in order to verify the diagnosis.
Obstetrics and Gynecology. 2022;(9):160-164
pages 160-164 views

In memory of Vyacheslav S. Baranov

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Obstetrics and Gynecology. 2022;(9):165-165
pages 165-165 views

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