No 5 (2022)

This literature review analyzes the factors that explain failures in the prediction, timely diagnosis, treatment, and prevention of one of the most important obstetric problems, such as miscarriage. It presents an update on neonatal morbidity and mortality, which are due to prematurity as a result of preterm birth. Premature birth is considered as a complex multifactorial problem; the review underlines the importance of identifying risk factors for their development in different populations (body mass index calculation, weight gain during pregnancy, urinary steroid profile analysis, elastography, sociodemographic factors and others), which makes it possible to select appropriate preventive measures. Overproduction of androgens is a potentially significant risk factor for preterm birth. There is a review of modern literature sources, which reflects trend priorities in assessing the relationship between hyperandrogenism and isthmicocervical insufficiency. There is information on main risk factors for maternal hyperandrogenism, its impact on pregnancy complications, and fetal outcomes. Consideration is given to the trigger mechanisms of isthmicocervical insufficiency and the cofactors that determine its therapy; there are diverse opinions about the importance of hyperandrogenism of various geneses in the development of miscarriage and complicated pregnancy. Attention is focused on the direct cause-and-effect relationship between hyperandrogenism and the development of isthmicocervical insufficiency. Conclusion: The effectiveness of medical and surgical correction of isthmicocervical insufficiency is comparatively evaluated. Emphasis is laid on that the treatment policy for isthmicocervical insufficiency concurrent with hyperandrogenism should be differentiated and depends on many factors that today remain insufficiently studied in the world, by maintaining the risks of miscarriage.

There are three methods to overcome infertility in ovarian endometrioid cysts: assisted reproductive technologies through in vitro fertilization, surgical or medical treatment followed by expectant management, and surgical treatment followed by the use of assisted reproductive technologies. In vitro fertilization with cycle segmentation also increases fertility: surgical and medical treatment in a cryoprotocol is performed before embryo transfer. Minimally invasive treatment, such as ultrasound-guided transvaginal puncture and aspiration of a cyst with or without sclerosis, is used as an alternative to laparoscopic cystectomy. The rate of relapses can be reduced, by using 96% ethanol that acts as a sclerosing agent for the cyst bed for 15 minutes, which causes its obliteration. Cryopreservation of oocytes, embryos, or ovarian tissue may be offered to a number of patients in terms of a higher risk for infection of the pelvic organs during material sampling. Repeat surgical treatment is not recommended due to diminished ovarian reserve: it is advisable to use assisted reproductive technologies in case of recurrence. Conclusion: The choice of a fertility-preserving treatment for ovarian endometriosis depends on the patient’s age, her ovarian reserve, medical history, and desire for the time of pregnancy onset.

Literature data on the main areas of treatment for cervical precancers and cancers are analyzed. Human papillomavirus (HPV) is indicated to be the leading etiological agent in the development of squamous intraepithelial lesions and squamous cervical cell cancer of the cervix. Persistent HPV in the cervical epithelium is largely due to the presence of the virus in the vaginal mucosa. Therefore, it is relevant to develop treatments to achieve viral elimination from the mucous membrane of the genital tract, by taking into account the tropism of HPV to the epithelial cells of this area. The promising organ-sparing highly selective treatment for cervical intraepithelial neoplasia is photodynamic therapy (PDT) that is based on the systemic or local administration of special substances, such as photosensitizers, that are affected by laser radiation after their injection into the body. The interaction of photosensitizer molecules and light quanta is accompanied by the formation of reactive oxygen species that damage cells and trigger a cascade of processes leading to the death of tumor cells. At the same time, the tumor cells absorb the photosensitizer more actively than healthy ones, which is responsible for the selective antitumor effect of laser radiation. The requirements for the ideal photosensitizer are considered. These substances during PDT are administered intravenously or topically as a gel or ointment. Conclusion: The analysis of the literature data has demonstrated the clinical efficiency of PDT in the treatment of patients with cervical intraepithelial neoplasia and HPV carriers without adverse effects on fertility. PDT contributes to the successful treatment of pathological foci on the cervical mucous membrane; the efficiency and safety of the technique are ensured by tissue selectivity of the effect. During the treatment, the surrounding intact tissues are not damaged, there is no gross scarring or stenosis of the cervical canal; thus, PDT makes it possible to preserve the normal anatomical and functional characteristics of the cervix.

Objective: To evaluate the dynamics of vaccination against the new coronavirus infection COVID-19 in pregnant women in the Far Eastern and Siberian Federal Districts from October 29, 2021 to December 24, 2021. Materials and methods: A total of 127787 pregnant women were monitored for vaccination from October 29, 2021 to December 24, 2021 in 11 regions of the Far Eastern Federal District and 10 regions of the Siberian Federal District. The findings were presented by the chief obstetricians-gynecologists of the regions. Statistical processing of the obtained data was carried out using the software package Microsoft Excel 2007. The level of null hypothesis testing was considered to be statistically significant atp<0.05. Results: According to the presented data, 126897pregnant women were registered in the regions of the Far East and Siberia as of October 29, 2021, and 127787women as of December 24, 2021. The results of the study showed an extremely low percentage of preconception specific prevention in pregnant women in the Far East and Siberia as of October 29, 2021. This indicator increased within two months by more than 2.26 times, namely from 4.2% to 9.5%. During monitoring, the proportion of vaccinated women before 22 weeks gestation increased by 2.1 times, from 0.7 to 1.5%; after 22 weeks gestation, it increased by 3.7 times, from 1.5 to 5.5%. The proportion of pregnant women who were ill with COVID-19 or vaccinated in the regions of the Far Eastern and Siberian Federal Districts increased from 13.0% to 26.3% during the monitoring period (p<0.001). There were no serious adverse events during COVID-19 vaccination with the Gam-COVID-Vac vaccine (Sputnik V) in 9667pregnant women. Conclusion: Despite the absence of serious adverse events during COVID-19 vaccination with the Gam-COVID-Vac (Sputnik V) vaccine in pregnant women, it is necessary to conduct further detailed studies of the safety of vaccination during pregnancy, and also to develop a set of organizational measures aimed at increasing compliance with vaccination against COVID-19 at the period of pregnancy planning.

HELLP syndrome is associated with maternal mortality of 24.2-75% and perinatal mortality of 79%o and is commonly regarded a severe complication of preeclampsia. Objective: To identify the preconditions for the development and basic laboratory criteria for different forms of HELLP syndrome to improve diagnosis and maternal and perinatal outcomes. Materials and methods: This study retrospectively reviewed antenatal care cards and delivery notes of 22 patients with complete (n=7) and partial (n=15) HELLP syndrome. The analysis included age, medical history, specific characteristics of the course and outcome of pregnancy, and the main clinical and laboratory parameters. Quantitative variables were compared using the Mann-Whitney test; the arithmetic mean (M), standard deviation (SD), and the median difference were calculated. Binary variables are presented as counts and percentages with the effect expressed as odds ratio with 95% CI. Results: The age of14/22 (63.6%)patients rangedfrom 18 to 35years, and 17/22(77.3%) were multipara. HELLP syndrome developed during pregnancy and postpartum in 20/22 (90.9%) and 2/22 (9.1%) patients, respectively. Patients with the complete form of HELLP syndrome had more severe thrombocytopenia, proteinuria, and elevated levels of LDH, AST, ALT, and bilirubin. Patients with a partial form of the HELLP syndrome had more severe hypoproteinemia and higher BP. Only 1/22 (4.5%) patients with the complete form of HELLP syndrome complained of nausea and epigastric pain. Conclusion: Preeclampsia should not be considered as a background for the development of the complete form of HELLP syndrome, because both the Zangemeister triad and the combination of arterial hypertension and proteinuria were detected only in 9/15 (60%) patients with the partial form. Complete form was characterized by a sudden decrease in platelet count with a lightning-fast increase in LDH and bilirubin against a background of patient well-being.

Objective: Analysis of clinical characteristics and embryological parameters in IVF programs for women with infertility of unclear genesis versus the patients with tuboperitoneal infertility. Materials and methods: The clinical characteristics of women with infertility of unclear genesis versus the patients with tuboperitoneal infertility were analyzed retrospectively and prospectively. The study group comprised 93 women, and the control group consisted of 45 patients. Embryological parameters in fertility treatment programs were compared between 108 women with infertility of unclear genesis and 49 women with tuboperitoneal infertility. The ovarian stimulation protocols were comparable between the groups of patients. Severe deviations in spermogram parameters and possible infertility factors in the partners were excluded. Results: Significant differences were found between the groups in anamnestic, clinical, laboratory, and instrumental characteristics including women's age, mean age of their partners, women's body weight and body mass index, hereditary anamnesis, chronic diseases, previous pelvic and cervical surgery, and the infection in the pelvic organs. Statistically significant differences were found between the age at menarche, duration of menstruation and painful periods, and the data of reproductive history: the duration of unprotected sexual activity, time of establishing the diagnosis, duration of treatment before admission to IVF clinic, the use of other infertility treatment options before IVF treatment, the number of intrauterine inseminations and IVF attempts in anamnesis. The blastulation rate was considered to be the endpoint in IVF treatmen, and it was significantly lower in the group of women with infertility of unclear genesis. Conclusion: Clinical characteristics and embryological parameters of IVF treatment programs for women with infertility of unclear genesis were determined. A "clinical portrait" of women with infertility of unclear genesis was described and specific features of infertility were identified versus the women with tuboperitoneal infertility. The low blastulation rate was noted in IVF programs for women with infertility of unclear genesis. This may be an indirect sign of impaired embryonic development at early stages, and, therefore, can be an indication for earlier IVF treatment in order to achieve pregnancy.

Objective: Ta investigate the impact af ejaculate total antiaxidant capacity af the ejaculate an fertilization and embrya develapment in cauples with different types af infertility and determine the value af the tatal antiaxidant capacity as a biomarker far predicting the outcomes af assisted reproductive technology (ART). Materials and methods: The study included 50 infertile cauples wha underwent in vitra fertilizatian using intracytaplasmic sperm injection (ICSI). On the day af transvaginalpunctures, native ejaculate was collected from their spouses ta test far total antiaxidant capacity using the FORM 3000 device using the FORD kit. Results: Embryos obtained with sperm from the ejaculate with higher total antiaxidant capacity reached the late blastocyst stage an day 5. Embryos obtained with sperm from the ejaculate with lower total antiaxidant capacity by day 5 developed ta morulae ar early blastocyst stage (p=0.03). There was a negative correlation between the total antiaxidant capacity af the ejaculate and the percentage af fertilized oocytes. No correlation was found between total antiaxidant capacity and ART outcomes in couples with different types af infertility. Conclusion: Total ejaculate antiaxidant capacity af native ejaculate before in vitro fertilization affects the characteristics af the embryalagical stage af ART. A high level af oxidative stress was significantly associated with a decrease in the fertilization rate. At the same time, the pregnancy rate was not associated with the level af oxidative stress in male germ cells. Careful pre-pregnancy care and conscious parenting are necessary ta improve the effectiveness af ART in men with high levels af oxidative stress in the ejaculate through an increase in the number af zygates.

The article presents the results af the surveillance af severe maternal morbidity (SMM) accarding ta SMM surveillance regulations in the Russian Federation (RF). The study analyzed the SMM Register af the Vertically Integrated Medical Information System af Obstetrics and Gynecalagy and Neonatalagy (VIMIS AKU&NEO) and the results af near-miss audit. The analysis included life-threatening maternal conditions without fatal autcame identified accarding ta categaries af argan dysfunctian using the WHO diagnastic criteria (2011). The study aimed ta identify strategies ta reduce and prevent maternal martality (MM) in Saint Petersburg. The authors analyzed the types af SMM registered in level II (51.0%) and level III (49.0%) maternal care providers (MCP) af Saint Petersburg. They alsa presented characteristics af near-miss cases, af which 12.5% and 83.3% accurred in level II and level III MCPs, respectively. Integral indicatars af medical care quality in near-miss groups included near-miss rate, life-threatening condition rate, survival rate index, and mortality rate index. Obstetric pathalagy, blaad pathalagy, and respiratory pathalagy were the leading causes af SMM in Saint Petersburg in 2021, which is camparable with the data af SMM registered in the Russian Federatian in general. There were na cases af MM in the abstetric pathalagy graup, which was the mast frequently registered category af SMM (39.4% af the tatal number af SMM), including severe pre-eclampsia and eclampsia (83.1% af the group) and uterine rupture (9.6% af the group). The absence af MM in this category af SMM is associated with the implementation af effective and quality medical care in patients at high risk far obstetric and perinatal complications in Saint Petersburg in 2021. Blaad pathalagy was the second mast frequently registered category af SMM (36.8% af all SMM, 95.8% af the graup); ane case af MM was registered in a Level III MCP and ane case autside the MCP befare ambulance arrival. Bath cases were assaciated with massive blaad lass (mare than 1000 ml). In 2021, during a pandemic af a navel coronavirus infection (COVID-19) in St. Petersburg, 41 cases af SMM associated with respiratory pathalagy (9.1% af tatal SMM) were reparted. Of them 39 were identified as near-miss cases (respiratory dysfunction), which accounted far 54, 2% af the tatal number af near-miss cases with 20 deaths in level III MCPs. These deaths were due ta severe ar extremely severe bilateral viral ar viral bacterial pneumonia complicated by acute respiratory distress syndrome ar pulmonary embolism due ta COVID- 19 (O98. 5, U07.1). The main strategy ta prevent and reduce the incidence af near-miss cases and MM based an improving the modern integral madel af internal control af the quality af medical care in maternal care providers, near-miss audit, and the introduction into practice af bath medical and organizational methodological, including telecommunications and other technologies aimed at improving professional competence. Conclusion: SMM surveillance and near-miss audit allows for a detailed assessment of the nature and quality of medical care to improve pregnancy outcomes.

Objective: To enhance the efficiency of treatment for combined types of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with mesh implants and to introduce an ultrasound-based algorithm for examining patients with this disease. Materials and methods: The investigation enrolled 51 female patients aged 55±3.0 years with grades 2 and 3 genital prolapse and SUI who had undergone surgical treatment with mesh implants. POP was corrected with the INGyneous mesh implant in 26 patients and with OPUR in 25 examinees. A control group consisted of 32 healthy women of comparable age without POP and SUI. All the patients underwent pre- and postoperative two- and three-dimensional ultrasound examinations in addition to clinical examination. The main parameters of ultrasound-based evaluation were the presence and structure of the pubovesical fascia, the shape of the bladder, α/β angles, and the shape of the urethral sphincters. So, the resulting complete disappearance or pronounced changes in the structure of the pubovesical fascia at the preoperative stage regulate the mandatory correction of cystocele. Results: Ultrasound performed on days 3-5 after surgery showed that correction of α and β angles, as well as the shape of the bladder to normal values, was achieved in all the patients both in resting and during straining, suggesting that the anatomy of the pelvic organs was properly restored. Assessment of the long-term results indicated that complete and incomplete clinical and ultrasound effects on SUI were achieved in 58.8 and 23.5% of cases, respectively. SUI was relieved completely in 17.6% of the patients. Before surgery, all the patients with preserved SUI were diagnosed to have severe urethral hypermobility, α angle deviation greater more than 40° during the Valsalva maneuver, and funnel-shaped expansion of the proximal urethra, indicating urethral sphincter incompetence. Doppler ultrasound and gray scale imaging could record the reverse flow of urine from the urethra to the bladder due to the inversion of the urethral and vesicular pressure gradient. The combination of similar ultrasound criteria gives a pessimistic prognosis of incontinence. The result of the investigation was to identify the place of ultrasound in the diagnosis of combined forms of POP and SUI. Conclusion: Thus, surgical treatment for POP with mesh implants is a reliably effective treatment method. Preoperative ultrasound allows prognostic assessment of the correction of SUI in POP

Background: Diminished ovarian reserve remains one of the most pressing problems in modern reproduction. The use of donor oocytes is an effective way of coping with infertility in patients with decreased ovarian function despite the serious psychological difficulties of this approach. There are presently different experimental methods approved by local ethics committees, which are aimed at improving ovarian function, one of which is the intraovarian injection of a patient’s own platelet-rich plasma (PRP). Case report: This paper describes a clinical case of a successful delivery in a patient with a diminished ovarian reserve and a double intraovarian PRP injection. A 34-year-old patient with diminished ovarian reserve who came to the B.V. Leonov Department of Assisted Technologies, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, for infertility treatment, where she received two intraovarian PRP injections, followed by assisted reproductive technologies, resulting in pregnancy and spontaneous delivery of a live full-term fetus. Conclusion: According to the data available in the literature and to the Department's own accumulated experience in 61 patients, the intraovarian PRP injection may have a short-term positive effect on the ovarian function of patients with diminished ovarian reserve. It is necessary to continue investigations in this area and to gain clinical experience

Background: The course and prognosis of the novel coronavirus infection (SARS-CoV-2) in pregnant women are unpredictable; at the same time, the clinical presentation can be vague and non-specific; a critical condition can suddenly develop in the presence of the stable course of the disease. In the literature, there are data on survival rates with 100% lung damage caused by SARS-CoV-2 delta variant; however, the experience of managing pregnant women with total lung damage is not presented. Case report: A female patient was admitted to the hospital at 33 weeks of gestation on day 7 of the novel coronavirus infection (SARS-CoV-2). On the 4th day of inpatient treatment, there was a progressive deterioration in the condition of the pregnant woman with a complication as severe bilateral polysegmental interstitial pneumonia. She received combined antibacterial, glucocorticoid, hepatoprotective, infusion, anticoagulant therapy and non-invasive ventilation with the postpartum transition to mechanical ventilation. Taking into consideration the signs of progressive fetal hypoxia, her baby was delivered by cesarean section. The boy was alive premature who had signs of morphofunctional immaturity. After 88 days of inpatient treatment (49 days after 100% lung disease), the female patient was discharged with respiratory support with humidified O2 using a portable concentrator. The patient had been in the intensive care unit for 65 days, of which 46 days on mechanical ventilation. The newborn was discharged home in a satisfactory condition. The clinical case demonstrates favorable gestational and perinatal outcomes with 100% lung involvement, as evidenced by computed tomography. Management of a near-miss pregnant or puerperant woman required an interdisciplinary approach. Specialists used the possibilities of telemedicine for consulting the patients. Conclusion: The accumulation of knowledge and clinical experience in the management of pregnant and puerperant women with SARS- CoV-2 and total lung tissue damage will undoubtedly be able to optimize medical strategies and to prevent maternal and perinatal critical conditions and deaths.