No 2 (2022)

This paper reviews current provisions on the features of management of monoamniotic twin pregnancy. It describes diagnostic ultrasound criteria for monoamniotic twins and considers main complications of monoamniotic multiple pregnancy, such as congenital developmental anomalies, including conjoined twin syndrome, umbilical cord entanglement, discordant malformations, as well as specific complications of monochorionic twins, such as twin-to-twin transfusion syndrome, anemia-polycythemia sequence, and twin reversed arterial perfusion syndrome. The paper presents the current principles of antenatal correction by fetal surgical techniques. It considers in detail the debatable problems of antenatal follow-up of monoamniotic twin pregnancy, as well as approaches to management tactics and timing of delivery. Monoamniotic twins are extremely high-risk pregnancies that require careful follow-up in order to diagnose and correct possible complications in a timely manner. At the same time, there is nowadays no optimal approach to the follow-up protocol for monoamniotic twins in the second half of pregnancy, to the organization of its outpatient and/or inpatient follow-up, as well as the choice of the optimal delivery time in the uncomplicated course of this pregnancy, which makes it possible to minimize both antenatal losses and neonatal morbidity and mortality. Conclusion: It is necessary to organize multicenter, preferably randomized trials for establishment of an optimal follow-up protocol in the second half of pregnancy and time of delivery of monoamniotic twins.

The medical community has currently accumulated significant reliable scientific facts about the relationship of physiological and pathological insulin resistance (IR), compensatory and chronic hyperinsulinemia (HI) before conception and during pregnancy to the adaptive mechanisms of the formation of the biological mother-newborn system and to the development of postpartum diseases. Numerous studies have provided evidence that gestational IR and HI can lead to metabolic dysfunction in both the mother and the newborn with impaired lactogenesis, lactopoiesis, the development of infectious and inflammatory diseases, the transformation of gestational diabetes mellitus (DM) to type 2 DM, hypertension, obesity, metabolic syndrome, chronic kidney disease, which requires timely diagnosis. The methodological basis of the analysis was the study of the scientific literature of Russian and foreign databases over the past seven years. The review article presents all known aspects of the role of IR in the processes of postpartum adjustment and in the development of diseases in the puerperal and neonatal periods. Conclusion: Knowledge of the causes and formation of pathological IR and chronic HI and their consequences for the development of female reproductive system diseases in all periods of life necessitates an interdisciplinary approach to developing personalized programs for stratification prediction, primary prevention and rehabilitation aimed at reducing the phenotypic manifestations of hereditary and acquired high risk factors.

Objective: To investigate the role of the complement system in the development and progression of preeclampsia. Materials and methods: A study group comprised 25patients with preeclampsia (13 moderate, 12 severe) and a comparison group of 22 relatively healthy women with uncomplicated pregnancies. Serum levels of complement factors (C1q, C3, C5a, Factor B, Factor H, Factor I, Factor D) were determined before treatment and in the neonatal cord blood immediately after delivery using the Multiplex method (Merck complement panels, Germany). Results: Patients with moderate preeclampsia had significantly elevated levels of C1q, C3, FB, FH, and a less marked increase in FI and FD. A paradoxical reduction in all these factors was seen in patients with severe preeclampsia. C5a levels increased with the progression of preeclampsia, culminating in severe preeclampsia. The changes of neonatal cord blood complement factors overlapped with maternal ones but were less pronounced, with a signif icant increase in C5a in the severe preeclampsia subgroup. Conclusion: The high concentrations of C1q, C3, C5a, FB, FD in pregnant women with preeclampsia suggest complement activation through the classical and alternative pathways, accompanied by a compensatory increase in regulatory FH and FI to limit excessive complement activation. In severe preeclampsia, continuing complement activation is associated with consumption hypocomplementemia.

Objective: To investigate the feasibility and efficacy of multiple intrauterine blood transfusions (IUT) in severe Rh hemolytic disease of the fetus and newborn (HDFN). Materials and methods: The study comprised 99 pregnant women with Rh alloimmunization, including 4 (4%) patients with severe HDFN (group I), 74 (74.7%) with very severe HDFN (group II), and 21 (21.2%) with hydrops fetalis (group III). All patients received multiple (from 3 to 7) IUTs. Exchange transfusions were performed in 65 (68.4%) neonates on the 1st day of life, and 17 (17.9%) received regular blood transfusions on days 3-5. The perinatal outcomes were evaluated. Results: Multiple IUTs for severe HDFN in 72.7% of patients resulted in prolonging gestation to 32-36 weeks, 96% fetal survival, including 80.9% for hydrops fetalis. A hematocrit level <25th percentile indicates the adverse course of severe HDFN. Earlier intrauterine treatment for hydrops fetalis (at 19-23 weeks) and 4 to 6 IUTs performed resulted in fewer exchange transfusions (72.7%) and regular transfusions (18.2%) compared with intrauterine treatment started later (at 24-27weeks) and only 3 IUTs performed (87.5% and 37.5%, respectively). Conclusion: IUT is the best available treatment for HDFN, allowing for improved perinatal outcomes in severe disease.

Aim: To make a comparative analysis of causes and rates of early neonatal mortality in the Russian Federation in 2019 and 2020. Materials and methods: This study was based on the analysis of statistical forms A-05 of the Federal State Statistics Service (Rosstat) for the years 2019-2020. These forms included medical records of perinatal deaths related to stillbirths. Stillbirth rates were calculated as the ratio of stillbirths to the total number of babies born alive and dead multiplied by 1000. Results: In 2020, the number of babies born alive decreased by 7.6%, and the number of babies born dead increased by 1.12% versus the data reported in 2019. In 2020, the rate of stillbirth (5.67%o) increased by 4.2% versus the rate in 2019 (5.44%). Most of all, the increase in stillbirths was noted in the South and Siberian Federal Districts. In general, the most common causes of stillbirths in the Russian Federation were respiratory disorders: the number of antenatal hypoxia was 78.2 (80.5%) and fetal intrapartum hypoxia was 6.7 (5.0%) of total number of stillbirths in 2019 and 2020, respectively. The proportion of congenital anomalies as the main disease was 6.7 (5.4%) of total number of stillbirths in 2019 and 2020, respectively. It was noted, that the number of stillborn babies with unknown causes of death increased by 52.2% in 2020 (4.7% of total number of stillborn babies) versus 2019 (3.1% of total number of stillborn babies)). Significant differences between the rates of major diseases that caused stillbirths were registered in different Federal Districts of the Russian Federation. Conclusion: According to Rosstat data, in 2020 (due to COVID-19 pandemic), the absolute number of babies born dead increased by 1.1% and the rate of stillbirths increased by 4.2% compared to 2019. Increased proportion of respiratory diseases, in particular, antenatal hypoxia and congenital pneumonia, reflects the direct and indirect effects of SARS- CoV-2 infection.

Background: The therapy of vulvovaginal candidiasis (V VC) still remains an unsolved issue. The development of the pharmaceutical industry and clinical studies conducted with the use of various antimycotic drugs have not provided the clear answers to the questions about the treatment of VVC. Research work in this sphere is relevant. Among other antimycotic drugs in the pharmacological market, sertaconazole appears to be promising. It has high eff iciency and safety indicators which are conf irmed by a number of studies; the data of the studies are presented in the article. Sertaconazole is a drug that has a triple effect on fungal pathogens: fungicidal and fungistatic action, as well as inhibition of dimorphic transformation (it blocks the transition of the fungus from a non-pathogenic to a pathogenic one which significantly increases the inter-relapse interval of VVC. Results: The therapeutic efficacy of sertaconazole was evaluated in 25 patients with chronic recurrent VVC. In all cases, the diagnosis of VVC was confirmed by clinical and laboratory methods, C. albicans was mainly identified in women. The patients received Zalain at a dose of300 mg once in the form of a vaginal suppository. No patients reported side effects after taking the drug. A day after the introduction of the suppository, 13 patients noted a significant improvement in their condition due to a decrease in itching and burning and 12patients noted the complete disappearance of symptoms of the disease. A week after the treatment, all patients’ symptoms of VVC were relieved; the results of the repeated cultural studies confirmed it. Conclusion: The treatment of VVC with a drug containing sertaconazole determines a successful outcome in the fight against the disease. It is important to use an integrated approach in its treatment and include adjuvant therapy which significantly accelerates recovery. Such therapy can also be used for the prevention aimed at reducing the likelihood of recurrent VVC and/or concomitant diseases of the genital tract.

Background: Splenic rupture during pregnancy is a rare and potentially fatal condition. Data from multiple reviews demonstrate the rarer occurrence of spontaneous splenic rupture. The definition of spontaneous rupture is conditional, because during the latter it is often possible to establish a minor injury that in the presence of the intact splenic parenchyma could not lead to disintegration of the organ. The paper describes cases of spontaneous splenic rupture in pregnant women with liver cancer, pancreatic cancer, or Gaucher’s disease. The number of publications on the problem of spontaneous splenic rupture in pregnant women is limited in both Russian and foreign literature. In connection with the above, this case is of particular interest. Case report: The paper presents the authors’ own case of splenic rupture in a puerpera on the first day after timely delivery. The patient was admitted to the maternity hospital for regular labor activity. Delivery per vias naturalis occurred. By the end of the first day of the postpartum period there were clinical signs of massive intra-abdominal bleeding. Revising the abdominal organs detected splenic rupture; splenectomy was performed. Conclusion: This clinical observation belongs to a near miss case and only a multidisciplinary approach and careful monitoring of the patient have allowed fatal consequences to be avoided.