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No 11 (2022)

Articles

Results of the XXIII National Scientific and Educational Forum "Mother and Child - 2022"

Sukhikh G.T., Serov V.N., Baranov I.I., Nesterova L.A.
Obstetrics and Gynecology. 2022;(11):5-13
pages 5-13 views

Functional disorders of the liver in the first trimester of pregnancy

Kryshnia M.A., Mozgovaya E.V.

Abstract

Any abnormal liver function can simultaneously present with the onset of pregnancy. This may be a pre-existing chronic liver disease or liver dysfunction associated with pregnancy. Consultation for liver disease in pregnancy is a challenge for both the hepatologist and gynecologist, since the normal physiological changes during pregnancy can mimic chronic liver disease. Pregnancy-specific liver diseases are the main causes of abnormal tests of the hepatic panel. In this case, as much as 3% of all pregnant women in developed countries suffer from liver diseases to unrelated pregnancy. The main factors determining the prognosis of the course of pregnancy for the mother are the type of liver disease and the degree of synthetic, metabolic, and excretory liver dysfunctions. This paper deals with a systematic approach to diagnosing and treating pregnancy-specific liver diseases in the first trimester, which includes an understanding of normal outcomes during pregnancy, exclusion of liver diseases nonspecific to pregnancy, consideration of the early onset of blood biochemical changes, and use of clinical data for early diagnosis and timely treatment. Conclusion: The studied data on the etiology and pathogenesis, diagnosis and principles of treatment of functional disorders of the liver in the first trimester of pregnancy can serve as a reason for further in-depth studies of hepatopathy in order to expand the understanding of the prevalence and etiopathogenesis, prediction and drug correction of this pathology for the prevention of maternal and perinatal morbidity.
Obstetrics and Gynecology. 2022;(11):14-22
pages 14-22 views

Features of neurogenesis in fetal growth restriction

Kan N.E., Leonova A.A., Tyutyunnik V.L., Khachatryan Z.V.

Abstract

The paper analyzes the current literature data on the role of neurogenesis and fetal programming in fetal growth restriction. It considers the mechanisms and scientific hypotheses that lead to structural changes in the central nervous system and to neuroregulatory disorders even in the intrauterine period with adverse consequences to the development of the nervous system and social cognitive functions. The paper discusses the role of potential proteins as markers for brain damage in fetal growth restriction. A change in fetal programming, in the direction of immunometabolic processes, and in the level of an inflammatory response is a cause of health impairment, vital cardiovascular and neuroendocrine diseases in the postnatal period of life. Therefore, the identification of cellular and molecular mechanisms that cause placental dysfunction, the optimal development of fetal organs, and the disruption of genetic/epigenetic programming, proteins as markers for fetal brain matter damage, the determination of which is necessary for the early diagnosis of hypoxic ischemic encephalopathy, is a serious problem that needs to be further studied. Conclusion: With the introduction of modern studies of epigenetic regulation, there is hope for the development of new methods to predict and diagnose fetal growth restriction, taking into account the findings on etiology and pathogenesis. Increasing information on the fetal programming of certain diseases in adults may be an important trigger to stop the progression of pathology.
Obstetrics and Gynecology. 2022;(11):24-30
pages 24-30 views

Cognitive development and neuropsychic health of children conceived by assisted reproductive technologies

Lokshin V.N., Ilmuratova S.K.

Abstract

Objective: To carry out a systematic analysis of current publications on the assessment of a risk for neuropsychiatric disorders in children conceived by assisted reproductive technologies (ART). Materials and methods: This review includes an analysis of foreign articles found in the online databases Medline, PubMed, and Springer and published in the past 5 years. Results: Despite the encouraging results of studies on the long-term potential consequences of ART on the neuropsychiatric health of children, information is limited due to the presence of independent risk factors for nervous system diseases that are directly unrelated to reproductive technologies, such as multiple pregnancies, preterm birth, and no comparison group of children conceived spontaneously and born to mothers with a history of infertility. Conclusion: Considering the pace of development and introduction of up-to-date technologies in reproductology, it is necessary to further investigate the potential impact of ART on neuropsychiatric health, taking into account amendments for an adequate risk assessment. Neonatal nervous system diseases are probably more associated with multiple pregnancies and abnormal pregnancy and childbirth.
Obstetrics and Gynecology. 2022;(11):31-36
pages 31-36 views

Artificial intelligence in reproductive medicine: ethical and clinical aspects

Drapkina Y.S., Kalinina E.A., Makarova N.P., Milchakov K.S., Frankevich V.E.

Abstract

The introduction of artificial intelligence (AI) systems in medicine is one of the most important current trends in global healthcare. AI technologies can substantially update a diagnostic system and the design of new drugs and improve the quality of healthcare, by simultaneously reducing cost. Despite the obvious advantages of applying AI-based algorithms, there are a number of limitations in the implementation of these programs in healthcare. Among these problems, there is an ethical challenge in AI, as well as responsibility for programmed decisionmaking. Another important issue of the safe use of AI is the black box principle, when determining causal relationships between data, how the system has actually arrived at a derived conclusion cannot be determined exactly. At the moment, the major goal of AI studies should be to improve software accuracy. Conclusion: The review considers the main areas of AI application, different machine learning techniques, ethical restrictions, and prospects for introducing these programs into clinical practice, including those used in assisted reproductive technologies.
Obstetrics and Gynecology. 2022;(11):37-44
pages 37-44 views

Contraception in cancer survivors: Breast and gynecological cancers (Part I)

Yakushevskaya O.V., Yureneva S.V., Ashrafyan L.A., Babaeva N.A.

Abstract

Contraception in cancer survivors has acquired its importance for various reasons. The bulk of cancers occurs in old age, but they are often diagnosed in premenopausal and reproductive-aged women. As the efficiency of antitumor therapy for many kinds of cancer has increased, so has the number of patients who have completed it favorably. Chemotherapy, radiotherapy, and ovarian surgery can negatively affect ovarian reserve. Residual ovarian function depends on age at diagnosis, type of treatment, and baseline ovarian reserve. Over the past decade, there have been significant changes in the management of patients in terms of fertility preservation and ovarian reserve assessment. In any situation, it is important to assess a patient’s need for contraception before, during, and after anticancer treatment. This paper gives the results of the work of the European Society of Contraception Expert Group that has analyzed risks for recurrence of the most common cancers in women using different contraception methods. The results are summarized and formed into recommendations for contraception for various cancer sites. Due to a large amount of information, the results are presented in two parts. Part 1 considers the contraceptives recommended for use after breast and gynecological cancers (cervical, endometrial and ovarian cancer, trophoblastic disease). Part 2 provides advice on contraception for women who have had a history of non-gynecological cancer (skin, gastrointestinal, blood, and endocrine cancers). Conclusion: The myth that the use of hormonal contraceptives is always accompanied by an increase in cancer risks, whereas pregnancy is associated with fewer risks than that of COCs has been now dispelled. Because of the high risk of fetal toxicity and the risk of recurrent cancer, the prevention of pregnancy during the f irst 2 years after chemotherapy can be considered to be a reasonable strategy to preserve and maintain women’s health.
Obstetrics and Gynecology. 2022;(11):45-51
pages 45-51 views

Pathogenic variants in the BRCA 1 and BRCA2 genes: what is important for a practicing gynecologist to know

Yureneva S.V., Averyanova M.V., Ashrafyan L.A., Yakushevskaya O.V., Buyanovskaya O.A.

Abstract

The BRCA1 and BRCA2 genes encode amino acid sequences in the nuclear proteins that are involved in the regulation of DNA damage repair and cell division. Pathogenic variants in the BRCA1 and BRCA2 gene cause chromosomal instability and malignant transformation of cells in the breast, ovaries, and other organs. The lifetime cumulative risk for breast cancer (BC) is as much as 72% and the risk for ovarian cancer (OC) is as much as 64% for female carriers of a pathogenic variant in the BRCA1. The risk for BC and OC for those of this variant in the BRCA2 gene is 69 and 17%, respectively. To a lesser extent, the carriers of pathogenic variants in the BRCA genes are at increased risk for other malignant neoplasms, such as melanoma, endometrial, pancreatic, peritoneal, and prostate and colon cancers. The presence of pathogenic variants in the BRCA1 and BRCA2 genes in a patient largely determines the choice of treatment policy, as well as preventive measures. Studies have shown that population screening for pathogenic variants in the BRCA1 and BRCA2 genes is cost-effective and can be used as an effective strategy to reduce the risk of BC/OC. Conclusion: A clear algorithm of actions should be elaborated to identify pathogenic variants in the BRCA1 and BRCA2 genes in individuals without a history of BC/OC, by taking into account the patient's age and plans for the implementation of reproductive function. There is a need for further investigations on the rehabilitation of patients after preventive surgery, including the safety of hormone replacement therapy, the adjustment of optimal doses, the design of drugs, and the determination of the duration of their use.
Obstetrics and Gynecology. 2022;(11):52-59
pages 52-59 views

Current concepts of HPV as a multifactorial predictor for squamous intraepithelial lesions of the cervix

Andreev A.O., Bairamova G.R., Zaretsky A.R., Rebrikov D.V.

Abstract

Human papillomavirus (HPV)-related cervical diseases are currently one of the urgent global health challenges. Due to its high diagnostic efficiency, HPV testing is one of the cervical cancer screening methods. To date, close attention is paid to the identification of the genotype of HPV. It is generally accepted to classify HPV into high and low carcinogenic genotypes, while it is widely believed in clinical practice that HPV genotypes 16 and 18 have the highest risk for developing and progressing precancerous diseases of the cervix. However, recent observations in many countries have shown that this position needs to be revised, as other HPVgenotypes, such as 31, 33, or 51, occur in more cases than HPV genotype 18, and are more commonly associated with squamous intraepithelial lesions (SIL). Nevertheless, a more detailed study of the factors of HPV infection is a promising direction, since many aspects, such as the determination of a HPV viral load and the geographical distribution of various genotypes, are still little studied. In addition, the international community has not come to a consensus as to the detection of several HPV genotypes in one sample. The results of many recent studies on this issue often lead to diametrically opposite conclusions. The HPV test result has a great influence on the choice of further tactics for the behavior of patients with cervical lesions, as well as the correct interpretation of test results and their subsequent extrapolation to each clinical case are extremely important. Conclusion: Thus, HPV is a multifactorial predictor for cervical lesion; the correct interpretation, and the subsequent extrapolation of HPV test results to each specific clinical case are possible only through a comprehensive assessment of the factors of human papillomavirus infection.
Obstetrics and Gynecology. 2022;(11):60-66
pages 60-66 views

Delivery in premature rupture of membranes at 22 to 28 weeks: management tactics, perinatal outcomes

Kuznetsova N.B., Dybova V.S.

Abstract

Materials and methods: The investigation was prospective. It enrolled 30 female patients with premature rupture of membranes at 22-28 weeks’ gestation. All the pregnant women with amniorrhea underwent a standard examination and a vaginal microbiome study using the special gene technology - I6S rRNA gene sequencing. Results: Wait-and-see tactics with an increase in the gestational period led to the birth of babies with a larger weight and a better Apgar score at one and five minutes. However, the development of an inflammatory reaction in a pregnant woman increased the risk of chorioamnionitis and neonatal sepsis. An analysis of vaginal microbiome in pregnant women showed that the presence of bacteria of the Ureaplasma genus was associated with low birth weight, an increase in the relative abundance (%) of these bacteria was related to low neonatal survival rates in the first 7 days, and the presence of Dialister bacteria was linked to the development of chorioamnionitis. Conclusion: Prolongation of pregnancy when choosing a wait-and-see management tactic, by increasing the duration of the time between membrane rupture and delivery in premature rupture of membranes at 22 and 28 weeks’ gestation and, accordingly, the gestational period at the time of delivery is associated with an improvement in perinatal outcomes. The appearance of signs of a systemic inflammatory response, the presence of Ureaplasma and Dialister bacteria, and an increase in the relative abundance (%) of Ureaplasma bacteria in the vaginal microbiome is a risk factor for adverse perinatal outcomes.
Obstetrics and Gynecology. 2022;(11):67-74
pages 67-74 views

Development and validation of a questionnaire for assessing androgen deficiency in women (FAD - Female Androgen Deficiency) of reproductive age

Chausov A.A., Gavisova A.A., Dolgushina N.V., Nazarenko T.A., Gardanova Z.R.

Abstract

Relevance: The early manifestations of androgen deficiency begin in women after the age of 35, particularly in infertile patients with diminished ovarian reserve (DOR). Their detection can be used in clinical practice to assess the degree of androgen deficiency and to predict possible outcomes of assisted reproductive technology (ART) (IVF/ICSI) programs. Objective: To develop and validate a Female Androgen Deficiency (FAD) questionnaire for assessing androgen def iciency in infertility women for f urther use in clin ical practice. Materials and methods: We developed the FAD questionnaire in accordance with international and Russian standards and tested it with a focus group of women with presumed androgen deficiency including infertile women with diminished ovarian reserve. After that we assessed the results of psychometric testing including reliability, validity and sensitivity of the developed questionnaire. Results: The results of FAD testing with the participation of patients and expert clinical opinion confirmed the acceptability of the FAD questionnaire, its compliance with the environment, and high indicators of content and external validity. The stable structure of the instrument was shown, indicating satisfactory construct validity of the questionnaire. The a-Cronbach's coefficient was equal to 0.837, indicating the internal consistency of the FAD questionnaire. An analysis of the correlations between the total FAD score and the number of symptoms in infertile women with DOR revealed a statistically significant strong negative relationship (r=-0.76; p<0.001), which reflects good criterion validity. The factor analysis showed the adequacy of the questionnaire's factor structure according to the relationships between variables and its stable construct validity. The total quality of life score on the questionnaire was lower in healthy women than in women with DOR [31.7(6.2) vs 18.4 (4.1)], demonstrating satisfactory discriminant validity of the questionnaire. The correlation analysis of the FAD and FSFI showed satisfactory convergent validity of the FAD questionnaire. Conclusion: The study results testify to the reliability, validity, and sensitivity of the FAD questionnaire and its use for both clinical practice and for scientific purposes in obstetrics and gynecology, in particular, gynecological endocrinology and reproductive medicine.
Obstetrics and Gynecology. 2022;(11):75-89
pages 75-89 views

Impact of the novel coronavirus infection (COVID-19) experienced by pregnant women on the health of newborns

Kosolapova Y.A., Boris D.A., Poludenko N.D., Makieva M.I., Nikitina I.V., Inviyaeva E.V., Vtorushina V.V., Krechetova L.V., Mikhanoshina N.V., Zubkov V.V., Degtyarev D.N.

Abstract

Background: Due to the high spread rate of SARS-CoV-2 and to the rapid increase in its incidence, including those among pregnant women, the novel coronavirus infection (COVID-19) has become a challenge in modern healthcare. Objective: To analyze the impact of the novel coronavirus infection experienced by pregnant women on the health of newborns in the early neonatal period. Materials and methods: A retrospective analysis was carried out of the birth records of 400 women who had experienced the novel coronavirus infection during pregnancy and the neonatal records of their newborns (n=500) who received health care in the clinical units of the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia (Center), in July 2020 to July 2021. A comparison group consisted of randomly selected birth records of 495 pregnant women who had not been infected with COVID-19 and the neonatal records of their babies (n=500) born at the same Center at the same time. Results: The vast majority of women who had been infected with COVID-19 during pregnancy were found to have familial obstetric/gynecological and/or somatic histories. Among the factors aggravating pregnancy in the presence of COVID-19, chronic hypertension, hereditary thrombophilia, fat metabolism disorders, urogenital infections, and anemia are more common than those in the control group (p<0.05). This female group also tended to have miscarriage; however, no statistically significant differences could be detected (p=0.06). There were no statistically significant differences in the term and frequency of cesarean delivery in pregnant women in the study and control groups (p>0.05). Neonates born to women who had been infected with COVID-19 in the first trimester had its statistically significantly higher morbidity rates (p<0.05). The frequency of perinatal complications was higher in newborns whose mothers had experienced the novel coronavirus infection in the first trimester. Neonatal infants borns from women who had a new coronavirus infection in the third trimester, rhinitis and otitis media are statistically significantly more common in the early neonatal period. Among the factors leading to disruption of early neonatal adaptation of children whose mothers had a new coronavirus infection during pregnancy, the following were statistically significantly more common: infectious and inflammatory diseases (rhinitis, otitis media), hemorrhagic syndrome, and hypoglycemia (p<0.05). Neonates born to women who had been infected with COVID-19 in the first trimester were observed to have statistically significantly higher morbidity rates (p<0.05). The incidence of perinatal complications was higher in newborns whose mothers had experienced the novel coronavirus infection in the f irst trimester. Neonatal infants born to women who had the novel coronavirus infection in the third trimester were statistically significantly more commonly recorded to have rhinitis and otitis media in the early neonatal period. Among the factors leading to failure of early neonatal adaptation of babies whose mothers had the novel coronavirus infection during pregnancy, there were statistically significantly more often infectious and inflammatory diseases (rhinitis, otitis media), hemorrhagic syndrome, and hypoglycemia (p<0.05). Conclusion: The incidence of perinatal complications in babies born to women who had been infected with COVID- 19 depended on their gestational age and was higher than that in newborns whose mothers had experienced the novel coronavirus infection in the first trimester. At the same time, the incidence of infectious and inflammatory diseases proved to be higher in infants whose mothers had a coronavirus infection in the third trimester. Failure of early neonatal adaptation of babies born to women who had an infection caused by SARS- CoV-2 during pregnancy may be due to both infectious and non-infectious factors that complicate the course of pregnancy and childbirth.
Obstetrics and Gynecology. 2022;(11):90-98
pages 90-98 views

Ultrasound characteristics of fetal brain structures in Arnold-Chiari malformation type II

Chugunova L.A., Shmakov R.G., Gladkova K.A., Kostyukov K.V.

Abstract

Objective: To evaluate the echographic characteristics of brain structures in fetuses with Arnold-Chiari type II malformation. Materials and methods: We analyzed 25 cases of pregnancy with Arnold- Chiari type II malformations diagnosed between 12 and 21 weeks. All patients received clinical consultation at the V.I. Kulakov NMRC for OG&P from January 2019 to February 2022. Fetal evaluation included expert anatomical examination, extended two-dimensional echocardiography, and detailed evaluation of CNS structures. At 23.1-25.5 weeks’ gestation, 20 fetuses underwent successful intrauterine fetal surgery for Spina Bifida. In the remaining 5 cases, the pregnancy was terminated at the place of residence. Results: At 12-14 weeks of gestation, all 5 fetuses had an abnormal amount of cerebrospinal fluid in the lateral ventricles, stenotic or not visible by ultrasound cerebral aqueduct with displacement of its posterior contour toward the occipital bone, and a «banana»-shaped cerebellum. At 19-21 weeks’ gestation, additional cerebral signs were identified, including corpus callosum abnormalities, dorsal cystic enlargement of ventricle III, interhemispheric holoprosencephaly, beak-like appearance of the tectum, sharpened occipital horns of the lateral ventricles, and delayed sulcation. Conclusion: Alterations in supraand infratentorial brain structures are characteristic of Arnold- Chiari malformation type II. Early echographic detection of cerebral signs of Arnold-Chiari type II allows timely decision making on fetal intrauterine surgery for Spina Bifida in the case of prolonged pregnancy.
Obstetrics and Gynecology. 2022;(11):99-108
pages 99-108 views

Clinical and diagnostic features of different forms of genital endometriosis in female adolescents

Khaschenko E.P., Allakhverideva E.Z., Uvarova E.V., Chuprynin V.D., Kylabukhova E.A., Luzhina I.A., Uchevatkina P.V., Mamedova F.S., Asaturova A.V., Tregubova A.V., Magnaeva A.S.

Abstract

Endometriosis is a condition that can be misdiagnosed on average for 8-10 years. This is especially true for adolescent patients, who are waiting for healthcare 2-3 times longer than adult women. Objective: To study clinical and diagnostic features of different forms of genital endometriosis in female adolescents. Materials and methods: The case-control study included adolescents aged 13-18years. The main group included 98 girls with confirmed laparoscopic diagnosis of endometriosis; the comparison group consisted of 44 somatically healthy girls. Results: The patients with endometriosis were characterized by the burden of inherited gynecologic diseases via close relatives compared to healthy girls (32.7% versus 9.1%, p<0.001), earlier menarche (11.8±2.5 versus 12.5±1.2, р<0.001), heavy (32.1% versus 10.4%, р=0.034) and irregular menstrual bleeding at menarche (42.9% versus 15.9%, р=0.002). The patients with endometriosis had lower abdominal pain in the first 3-4 days of menstruation, which scored 8-9 points on the Visual Analog Scale (VAS) (75.3% versus 13.6%, p<.001), higher levels of luteinizing hormone (LH) (8.3±6.7 versus 4.1±1.9, р<0.001), estradiol (335.2±292.3 versus 171.5±73.9, р=0.032), prolactin (481.2±312.4 versus 237.8±126.4, р<0.001), 17-OHP (5.8±3.7 versus 3.9±1.8, р=0.022), total androstenedione (10.8±4.3 versus 8.4±2.5, р=0.014). According to pelvic MRI, the signs of genital endometriosis were detected in 37 (78.7%) patients with external genital endometriosis and in 24 (88.9%) patients with adenomyosis. Conclusion: In 96.9% of cases, in adolescents with persistent dysmenorrhea scoring 8-9 points according to VAS, the diagnosis of genital endometriosis was confirmed laparoscopically. The significant factors for the diagnosis were the burden of inherited endometriosis (x2=82.8, p<0.001), persistent dysmenorrhea at menarche (x2=49.8, p<0.001), suspected genital endometriosis according to MRI results (x2=91.4, p<0.001), high levels of LH (X2=28. 5, p<0.001) and androstenedione (x2=8.0, p<0.005).
Obstetrics and Gynecology. 2022;(11):109-121
pages 109-121 views

Sialidase activity of vaginal bacteria in reproductive-age women

Shipitsyna E.V., Korkina S.A., Krysanova A.A., Kolousova K.A., Shalepo K.V., Budilovskaya O.V., Khusnutdinova T.A., Savicheva A.M., Kogan I.Y.

Abstract

Bacterial sialidase activity catalyzes the degradation of protective mucosal barriers. Objective: To investigate sialidase activity of vaginal bacteria and identify sialidase genotypes and phenotypes of different species of Gardnerella spp. Materials and methods: A semiquantitative sialidase assay was developed and used to test 89 strains of vaginal bacteria, including 19 strains of Gardnerella spp. The Gardnerella spp. species were identified by DNA sequencing. Gardnerella spp. sialidase genes were detected by PCR. Results: Sialidase activity was detected in 8 strains belonging to three genera, including Anaerococcus (n=1), Bif idobacterium (n=1), and Gardnerella (n=6). G. vaginalis represented the majority of the Gardnerella strains (n=16, 84%); the proportion of G. swidsinskii was (n=3, 16%). Nine strains of G. vaginalis had only the nanH1 gene and all of these strains did not exhibit sialidase activity. The remaining seven strains of G. vaginalis simultaneously had the nanH1 and nanH3 genes, and sialidase activity was registered in 6 strains. No sialidase genes were detected in any G. swidsinskii strain. Conclusion: Most cultured species of vaginal bacteria, including lactobacilli, do not produce sialidase activity. The predominant species of the genus Gardnerella is G. vaginalis (84%); the proportion of G. swidsinskii is 16%. Bifidobacterium bifidum, Anaerococcus tetradius strains and most strains of G. vaginalis, whose genome contains both the nanH1 and nanH3 genes, can degrade sialoglicans. G. swidsinskii strains, as well as G. vaginalis strains with only the nanH1 gene, do not exhibit sialidase activity.
Obstetrics and Gynecology. 2022;(11):122-130
pages 122-130 views

Stillbirths in the Russian Federation in 2020 (COVID-19 pandemic year)

Shchegolev A.I., Tumanova U.N., Chausov A.A., Shuvalova M.P.

Abstract

Objective: To compare maternal and placental conditions that caused stillbirths in the Russian Federation in the years 2020 (COVID-19pandemic year) and 2019. Materials and methods: The study analyzed statistical forms А05 of the Federal State Statistics Service (Rosstat) for the years 2019 and 2020 based on medical records of perinatal deaths related to stillbirths. Maternal and placental conditions that caused stillbirths were divided into 4 groups: I, maternal conditions unrelated to the index pregnancy; II, maternal complications of the index pregnancy; III, placental, umbilical cord and sheath complications; and IV, other complications of labor and other maternal conditions. Stillbirth rates were calculated as the ratio of the number of stillbirths to the total number of newborns born alive and dead, multiplied by 1000. Results: According to Rosstat data, in 2020 the absolute number of stillbirths and the stillbirth rate increased by 1.1% and 4.2%, respectively, compared to 2019. At the same time, the stillbirth rate as a result of respiratory disorders and a group of endocrine, metabolic, and other disorders specific to the perinatal period increased by 4.7% and 4.3%, respectively. The stillbirth rate from congenital anomalies, on the contrary, decreased by 15.4%. Among the conditions that contributed to stillbirth in 2020, dominated placental, umbilical cord, and fetal membrane lesions, which were noted in 45.7% of the observations. The stillbirth rate due to placental abnormalities increased by 5.6% compared to 2019. In 2020 compared to 2019, there was an increase in the proportion of parasitic diseases (by 29.5%) and the group of so-called other maternal respiratory and circulatory diseases (by 25.9%), as well as the number of multiple pregnancies (by 17.2%). There were significant differences between the rates of conditions that caused stillbirths in different Federal Districts of the Russian Federation. Conclusion: According to Rosstat data, in 2020 (the year of the COVID-19 pandemic) the absolute number of stillbirths and the stillbirth rate increased by 1.1% and 4.2%, respectively, compared to 2019. Analysis of the incidence of conditions that caused stillbirths showed an increase in the proportion and rate of stillbirths for maternal conditions unrelated to the index pregnancy and placental disorders.
Obstetrics and Gynecology. 2022;(11):131-140
pages 131-140 views

Long-term results of surgical treatment of pelvic organ prolapse using prosthetic mesh

Berg P.A., Musin I.I., Yaschuk A.G., Naftulovich R.A., Battalova G.Y.

Abstract

Objective: To analyze postoperative complications in patients after surgical treatment of apical pelvic organ prolapse using prosthetic mesh. Materials and methods: In this study we analyzed complications after surgical implantation of polypropylene (PP) meshes in women with genital prolapse within 18-36 months after surgery. Retrospectively, 732 women were divided into 2 groups depending on the techniques used for surgical treatment of pelvic organ prolapse. Group 1 consisted of patients who underwent laparoscopic sacrocolpopexy using polypropylene mesh prosthesis (n=348). Group 2 consisted of patients who underwent transvaginal bilateral sacrospinous fixation with implantation of a polypropylene mesh prosthesis (n=394). Statistical processing of the obtained results was performed using software packages STATISTICA 10.0andEviews 12.0. Results: Recurrence of genital prolapse occurred in 28 women (8.0%) in group 1, while this complication was diagnosed in 62 women (15.7%) in group 2, p<0.001. The rate of vaginal wall erosion after prosthetic mesh implantation was 2.0% and 6.3% in group 1 and 2, respectively. The rate was significantly high among women who underwent sacrospinous fixation (group 2), p<0.001. In premenopause, surgical treatment of women with genital prolapse using bilateral sacrospinous fixation increases the risk of vaginal wall erosion (AUC 0.736, p=0.004, 95% CI: 0.535-0.896). Conclusion: Analysis of postoperative complications showed that laparoscopic sacrocolpopexy is more effective versus bilateral sacrospinous fixation.
Obstetrics and Gynecology. 2022;(11):141-147
pages 141-147 views

Methodological approaches to evaluating the efficiency of using assisted reproductive technologies at the regional level

Malyshkina A.I., Dolgushina N.V., Pesikin O.N., Kuligina M.V.

Abstract

Objective: To analyze the frequency and efficiency of assisted reproductive technologies (ART) used to treat infertility in the Central Federal District (CFD) of the Russian Federation in 2017-2021. Materials and methods: The frequency and efficiency of using ART in 16 areas of the Central Federal District (except for Moscow and the Moscow Region) were analyzed from the data provided by health service authorities, including those in the Federal Statistical Monitoring forms (No. 30 “Information on a health facility”, No. 232 (Insert to Form No. 32 “Information on the regionalization of obstetric and perinatal care in maternity hospitals (units) and perinatal centers”, No. 62 “Information on resource provision and on medical care for the population” over 2017-2021, by using the proposed procedure for evaluating the efficiency of organizing medical care in infertility treatment with ART. Results: In the CFD, the efficiency of organizing medical care in infertility treatment with ART remained the same in 2021 as in 2017. There are substantial differences in the activity of the Russian Federation subjects in using ARTs and their efficiency. Conclusion: The proposed methodological approaches to evaluating the efficiency of organizing medical care for infertility using ART provide a comparative analysis in temporal and territorial aspects. The reserve for enhancing the efficiency of control over the organization and quality of medical care using ART for infertility is to improve statistical reporting, to introduce a monitoring system, including a follow-up.
Obstetrics and Gynecology. 2022;(11):148-154
pages 148-154 views

Evaluation of the efficacy of antiviral therapy with Allokin-alpha in the combination treatment of patients with grade II HPV-associated cervical intraepithelial neoplasia

Kononova I.N., Dobrokhotova Y.E., Kareva E.N., Shmakova N.A., Graban I.V., Ogurtsova T.A.

Abstract

Excisional neoplasia treatment performed during subcompensation of local immunity is not effective enough. Preservation of a high HPV (human papillomavirus) viral load after excision and the frequent recurrence of grade II cervical intraepithelial neoplasia (CIN II) have actualized the study of the role of antiviral and immunomodulatory therapy in the combination treatment for the elimination of HPV in order to prevent recurrent cervical neoplasia. Objectives: 1. To study the effect of Allokin-alpha on the elimination of HPV and the incidence of recurrent CIN II, to optimize the treatment of grade II neoplasia. 2. To evaluate the effect of Allokin-alpha on HPV viral load before excision. 3. To assess the feasibility of using Allokin-alpha in the combination treatment of HPV-associated CIN II, by comparing viral loads: before treatment; after therapy with the drug; after excision. Materials and methods: An examination was made in 194 patients with HPV-associated CIN 2 verified morphopathologically and by PCR. Ninety-seven patients received immunomodulatory therapy with Allokin-alpha before excision. A control group consisted of 97 patients who underwent excision only. Results: HPV viral loads were found to decrease by more than 2 orders of magnitude, namely, 141 times, before excision (from 5.7 lg to 3.55 lg) in 70.1% of patients who had received antiviral treatment. The use of Allokin-alpha in the combination treatment of CIN 2 increases the frequency of HPV elimination from 53.6% in the control group to 94.8% on the study one. The recurrence rate after 12 months reduced by 7.4 times in the study group compared to the control one. Conclusion: The findings suggest that it is expedient to incorporate Allokin-alpha into the algorithms of treatment for HPV-associated CIN II at the stage of preparation for excision. Decreased viral load in patients after therapy with Allokin-alpha before excision indicates the independent efficacy of the drug against HPV.
Obstetrics and Gynecology. 2022;(11):155-162
pages 155-162 views

Asymptomatic bacteriuria in pregnancy: a modern approach to therapy

Tyutyunnik V.L., Mikhailova O.I., Kan N.E., Mirzabekova D.D.

Abstract

Objective: To evaluate the efficiency of combination therapy for asymptomatic bacteriuria in pregnant women, its impact on pregnancy outcomes and the course of the perinatal period. Materials and methods: The clinical study involved 44 patients who had experienced an episode of asymptomatic bacteriuria in the first trimester of pregnancy. There were two equal groups: a study group of 22 women who received therapy with antibacterial and immunomodulatory drugs and a comparison group of 22 patients who had monotherapy with an antibacterial drug. The efficiency of different treatment regimens for asymptomatic bacteriuria was evaluated, by analyzing the results of laboratory tests, such as clinical urinalysis and urine microbiological examination; the duration of a relapse and an interval between exacerbations; and the course of labor and perinatal outcomes. Results: The patients treated with a combination of an antibacterial drug and an immunomodulatory agent for asymptomatic bacteriuria in pregnancy had the best therapy results. This was confirmed by a considerable reduction in the growth of pathogenic microorganisms during microbiological examination, a substantially longer interval between relapses, and a decrease in their duration. The study group showed the most favorable obstetric and perinatal outcomes. Conclusion: The immunomodulator Superlymph can be recommended for use in combination with an antibacterial drug in the treatment of asymptomatic bacteriuria in pregnant women. In the authors’ opinion, this combination is effective in achieve a high therapeutic effect.
Obstetrics and Gynecology. 2022;(11):165-170
pages 165-170 views

Vaginitis and vaginosis: diagnostic and treatment approaches in the light of the current clinical practice guidelines

Mikhanoshina N.V., Priputnevich T.V., Grigorian I.E.

Abstract

Vaginal inflammatory diseases of microbial etiology (vaginitis) are one of the most common reasons for women to visit a gynecologist. It is important to know the etiology, pathogenesis, clinical course types, diagnosis, and treatment of aerobic (nonspecific) vaginitis and bacterial vaginosis. Making the correct diagnosis is a key to choose effective treatment means and methods. Bacterial vaginosis (BV) is a polymicrobial dysbiotic disease, in which the numbers of Lactobacillus spp. dramatically decrease, whereas those of facultative and obligate anaerobes and microaerophiles, such as Gardnerella vaginalis, Peptostreptococcus, Clostridium spp., Prevotella spp., Bacteroides, Fusobacterium, Veillonella, Eubacterium, Atopobium vaginae, Mobiluncus spp., and others, increase. At our present level of knowledge, G. vaginalis and A. vaginae are recognized to play a leading role. The Russian Society of Obstetricians and Gynecologists recommendations (2019) state that aerobic vaginitis (AV) is a vaginal mucosal inflammatory disease that occurs when the opportunistic aerobic microorganisms activate and affect the epithelial cells. Since 2011, the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, has been using the medical technology “Integral assessment of the vaginal microbiota. Diagnosis of opportunistic vaginitis”, permitted by FS No. 2011/072 dated April 18, 2011, which was designed by A.S. Ankirskaya and V.V. Muravieva. The diagnosis is based on a combination of gram-stained smear microscopy and vaginal discharge culture. This makes it possible to obtain reliable information on the vaginal microbiota, to diagnose infections caused by opportunistic microorganisms, and to prescribe goal-directed treatment at the lowest economic costs. Conclusion: The main goal of treatment for mixed vaginitis is to affect aerobic microorganisms by topical application of broad-spectrum bactericidal antibiotics, including those in combination with antifungal agents to eliminate yeast fungi, and to prevent the development of resistance in opportunistic pathogens.
Obstetrics and Gynecology. 2022;(11):172-178
pages 172-178 views

Lymphoepithelioma-like carcinoma of the cervix

Rymashevsky A.N., Volkov A.E., Voloshin V.V., Todorov S.S., Berlev I.V., Borshchenko I.N.

Abstract

Background: Lymphoepithelioma-like carcinoma of the cervix is one of the subtypes of squamous cell carcinoma of the cervix (CC). Taking into consideration the lack of information about this malignant lesion, publishing the experience of diagnosing and treating a rare variant of CC based on morphologically confirmed echographic data is of interest for practical gynecological oncology. Case report: A 41-year-old patient having acyclic profuse bloody vaginal discharge for 3 months underwent transvaginal echography revealing that the subepithelial tissue of the cervix showed a hypoechoic, homogeneous nodular structure with clear, even contours, 10*11*14 mm with intense low-velocity blood flow in the center and around the periphery. Extended colposcopy indicated no abnormal changes. MRI confirmed the presence of an endophytic tumor in the cervix without invasion into the vagina, parametria, bladder, rectum, and regional lymph nodes. Radiowave excision of the cervix removed a tumor growing into the endometrium, which was identified as a lymphoepithelial-like carcinoma. Taking into account the malignant nature of the tumor, the investigators performed laparoscopic nerve-sparing radical extirpation of the uterus with fallopian tubes, parametria, and the upper third of the vagina, as well as pelvic lymphadenectomy, and ovarian transposition. The postoperative follow-up is 9 months. The patient’s condition is satisfactory. Conclusion: In the absence of CC manifestations in the exocervix, transvaginal echography is deemed as a diagnostic tool to detect potentially malignant lesions, rare forms of CC in particular.
Obstetrics and Gynecology. 2022;(11):180-186
pages 180-186 views

To the Jubilee of I.A. Salov

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Obstetrics and Gynecology. 2022;(11):187-188
pages 187-188 views

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