No 5 (2023)

The pathophysiology of premature birth remains insufficiently studied. One of the mechanisms of is development is considered to be mitochondrial dysfunction and an imbalance between increased oxidative stress and impaired antioxidant protection. At the molecular level, the changed and impaired mitochondrial function is caused by a reduction in the metachondrial transfer of major metabolites; by a change or a loss in maintaining the electric and chemical transmembrane potential of the inner mitochondrial membrane. In consequence of these modifications, oxidative phosphorylation becomes less effective, accordingly causes a reduction in ATP production. The division and creation of new mitochondria, митохондрий, the removal and complete degradation of dysfunctional mitochondria (mitophagia) can affect the function of the placenta, including its development, nutrient exchange and hormonal release. The modifications of mitochondrial function may be mediated or may lower the impact of poor gestational conditions on placental function, therefore the risk of pregnancy complications, including premature birth.

Conclusion: Identification of molecular pathways responsible for the elimination of dysfunctional mitochondrial may play a key role and be one of the components of the pathogenesis of premature birth.

Today it is known that approximately half of all women during their lifetime will have at least one episode during their lifetime, and 27% to 48% among them will experience recurrent infection episodes in the future. The recent guidelines of international urology associations, as well as the summarized results of researches in the past years emphasize the advisability of the limited use of antibiotics in urinary tract infections, which is due to the constant increase in antibiotic resistance of uropathogens. Under these conditions, the promising area in the prevention and treatment is to use D-mannose, a monosaccharide that is excreted unchanged from the body with urine, where it competitively inhibits bacterial cell adhesion to the urothelium, by creating a biomechanical barrier.

This review gives new scientific data concerning the mechanisms of adhesion of E. coli to the umbrella cells of the urothelium; describes the key features of the pharmacokinetics of D-mannose in the human body, its role in countering E. coli adhesion to the mucous membrane of the urinary tract. The paper presents the results of experimental studies establishing that it is advisable to use D-mannose in urinary tract infection. It analyzes the clinical trials, the results of which demonstrate that the prevention of urinary tract infections in women with D-mannose is highly competitive with the prophylactic use of antibiotics. The today’s concept of the pathogenesis of urinary tract infection in women presumes that urobioma damage precedes symptomatic infection. In this connection, the paper analyzes the intermediate results of combined prophylactic use of D-mannose in women and some Lactobacillus species.

Conclusion: The use of D-mannose may become a promising area in the prevention and treatment of urinary tract infection in women who have no contraindications or apparently side effects.

Fetal macrosomia is a risk factor for adverse obstetric outcomes, such as operative vaginal delivery, cesarean section and shoulder dystocia. With fetal macrosomia, the effectiveness of reducing the frequency of operative delivery is still a matter of debate. More promising is to study a possibility of early-term delivery in women with large-for gestational-age (LGA) fetuses, who have not yet reached the criteria for defining macrosomia.

Objective: To evaluate the frequency of operative delivery in pregnant women with LGA fetuses, depending on management strategy (pre-induction/ induction of labor or expectant management) and gestational age.

Materials and methods: A retrospective cohort study included 478 healthy primiparous women with delivery of large-for-gestational age fetuses according to ultrasound data. The women were divided into two groups. The comparison group was expectant management (n=195) and the main group was induction of labor (n=283). Both groups were divided into three subgroups depending on gestational age: subgroup 1 included women who were 38 weeks pregnant, subgroup 2 – 39 weeks, subgroup 3 – 40 weeks.

Results: The frequency of cesarean section in the group of women with spontaneous onset of labor at 38 and 39 weeks was 33.3% and 20.5% versus 22.2% and 17.1% in the induction group (p>0.05). At the same time, the frequency of cesarean section at 40 weeks was significantly lower in the expectant management group, 21.8% versus 36.9%, p=0.02. There were no differences between the rates of vaginal delivery, fetal shoulder dystocia, and perinatal outcomes. However, in the expectant management group at 39 weeks, there were significantly more newborns with Apgar score of 7 or less, 12.8% versus 4.04% in the induction group, p=0.04.

Conclusion: In most cases, the formation of macrosomia was between 39–40 weeks, and induction of labor as a method for preventing complications associated with macrosomia was ineffective. It is apparent that, the optimal gestational age for delivery was 39 weeks for ultrasound-estimated fetal weight equal to the 90th percentile, 38 weeks for the 95th percentile, and 37–38 weeks for the 97th percentile.

Objective: To compare the quality of life (QoL) between patients with premature ovarian insufficiency (POI) treated with hormone replacement therapy (HRT) and women with preserved ovarian function.

Materials and methods: This cross-sectional study of 374 patients was conducted at V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia. Group 1 included 223 patients with POI who received HRT, and group 2 included 151 patients with preserved ovarian function. Quality of life was assessed using the Health Status Survey (SF-36), which was validated for use in Russia.

Results: Patients in group 1 had statistically significant differences in all eight domains of the SF-36 questionnaire compared with those in group 2 (p<0.0007, p<0.0001). The lowest scores in group 1 were on the VT (Vitality) scale at 43.3 (18.3), GH (General Health) at 40.1 (18.0), and RP (Role Physical) at 46.6 (34.8). POI was associated with an 18% (1.21 times) decrease in the mean score of the integral measures of the physical and mental health components of the patients compared to the control group. Patients in group 1 were 3.06 times less likely (95% CI 2.39–3.92) to have a score above the normal 50-point threshold for the physical component of health, and 4.43 times less likely (95% CI 2.96–6.63) to have a score above the mental component of health than those in group 2. The QoL of POI patients was directly related to the estradiol (E2) dose in HRT; an increase in the E2 dose was associated with higher scores on most SF-36 measures.

Conclusion: POI has long-term adverse effects on all components of health and reduces QoL. HRT with standard doses of E2 in POI patients often fails to provide a QoL comparable to that of women of the same age with preserved ovarian function. Prescribing adequate doses of HRT, using an individualized approach and a multidisciplinary team to manage patients with POI, can significantly improve quality of life and outcomes.

Objective: To investigate the phenotypic profile of mononuclear cells in the peripheral blood of pregnant women with preeclampsia.

Materials and methods: This study included 38 pregnant women. The study group included 20 women (10 with mild preeclampsia and 10 with severe preeclampsia). The control group comprised 18 women with healthy pregnancies. Flow cytometry was used to determine the expression by monocytes and lymphocytes of costimulatory inflammatory factors CD40, CD80, CD86, surface signaling molecules of the "don't eat me" pathway CD24 and CD47, surface costimulatory receptors CD28 and CD152, and Fc receptor CD16.

Results: Lymphocytes in the blood of pregnant women in the study group had increased expression of CD28 and CD16, monocytes had increased expression of CD152 and CD86, and there was a higher content of monocytes expressing CD16 in this group. Correlation analysis showed a relationship between the level of expression of CD152 and CD86 in monocytes and the content of monocytes expressing CD16 in women in both groups.

Conclusion: The relationship between the expression levels of CD16, CD152, and CD86 indicates the possibility of their involvement in the same CD86-mediated signaling pathway leading to the activation of the CD152 receptor, followed by the expression of the CD16 Fc receptor. These findings suggest that these factors may be potential markers for PE.

Currently, there has been an increased incidence of macrosomia, that negatively affects newborn’s future life and health. There is no data in literature on the effect of serum fatty acid synthase (FAS) on threatened miscarriage in women with gestational diabetes mellitus (GDM). Serum FAS concentrations have not been previously assessed to predict macrosomia.

Objective: To compare serum FAS concentrations between women with GDM and threatened miscarriage that was diagnosed in the second trimester of pregnancy and women without GDM and with threatened miscarriage that was diagnosed in the second trimester.

Materials and methods: The main group included 25 patients with GDM and miscarriage, diagnosed in the second trimester of pregnancy. The comparison group consisted of 30 women with miscarriage diagnosed in the second trimester of pregnancy.

Results: The number of microsomic babies was higher in the main group versus the comparison group (15/25 (60.0%), 4/30 (13.33%), p=0.002). Serum concentrations in women in the main group was higher (1.64 ng/ml (1.13; 1.98); 0.8 ng/ml (0.3075; 1.55); p<0.001). The comparison between pregnant women with fetal macrosomia and women without fetal macrosomia showed high diagnostic ROC AUC value=0.867 (95% CI 0.67–0.96). Sensitivity was 87.5% (95% CI 70.3–93.4), specificity was 88.9% (95% CI 58.3–99.4), the prognostic value of positive results was 93.3% (95% CI 75.0–99.6), and the prognostic value of negative results was 80.0% (95% CI 52.5–89.5).

Conclusion: It is probable that detection of serum FAS concentration can be considered as a promising method for prediction of macrosomia. However further studies are necessary in this area.

Objective: To make a structural analysis of psychoemotional disorders in pregnant women with COVID-19 pneumonia. Hamilton Anxiety Rating Scale

Materials and methods: The prospective investigation enrolled 3080 pregnant women infected with SARS-CoV-2; of them 889 were in the first trimester; 1056 and 1135 were in the second and third trimesters, respectively. The vast majority (64.3%; 1980/3080) of cases were diagnosed with moderate COVID-19 pneumonia. Psychoemotional disorders were identified and its severities were assessed using. The Hamilton Anxiety Rating Scale-7 was used to identify psychoemotional disorders and to assess their severity; posttraumatic stress disorders (PTSDs) were detected using the IES-6 and depressive syndrome was identified using the PHQ-9.

Results: A considerable part (80.1%; 2467/3080) of pregnant women during COVID-19 infection was noted to have psychoemotional disorders; with 100% (n=1056) in the second trimester of pregnancy. Depressive syndrome was evident in the first trimester, while anxiety states and PTSDs were more characteristic for the second trimester. There was a higher incidence of mixed mental disorders with the higher pregnancy status. The most of pregnant women with psychoemotional disorders (51.5%; 1585/3080) was assigned to a cohort of patients with moderate COVID-19; in the same pattern of moderate COVID-19 pneumonia, there was a preponderance of cases of PTSDs (59.5%; 1178/1980).

PTSDs showed a practically equal incidence among pregnant women with severe and very severe COVID-19 (54.3 and 52.7%, respectively), as well as anxiety (28.6 and 28.4%, respectively) and depressive (17.1 and 18.9, respectively) states. The high incidence of mixed psychoemotional disorders was characteristic for pregnant women with severe and very severe COVID-19 pneumonia (46.7 and 52.7%, respectively, which indicates the aggravation of the clinical presentations of psychoemotonal disorders during COVID-19 pneumonia progression.

Conclusion: Psychoсихоemotional disorders during COVID-19 infection are characteristic for a considerable part of pregnant women. Moreover, their early detection using specialized questionnaire scales (HARS-7, IES-6, and PHQ-9) can be favorable to the timely inclusion of a psychological component of treatment policy and prevent poor perinatal and social consequences.

Elective operative care in gynecological practice deserves no less attention than emergency interventions. Potential risks of postoperative pyoseptic complications can be reduced by the prophylactic sanitation of the vaginal tract.

Objective: To evaluate the efficiency of preoperative sanitation of the vaginal tract with the combined drug Targifort in female patients with different forms of a gynecological disease who were elected to receive operative treatment.

Materials and methods: A clinical and laboratory examination and preoperative preparation of the vaginal tract were made in 96 patients aged 28 to 62 years with a number of gynecological diseases who were assumed to receive surgical treatment. During their preoperative preparation, the women were diagnosed with nonspecific vaginitis and vulvovaginitides of various etiologies. For prophylaxis, prior to surgery and to reduce postoperative complications, all the patients underwent local sanitation with the combined drug Targifort (metronidazole 500 mg, chloramphenicol 200 mg, natamycin 150 mg, hydrocortisone acetate 15 mg) as one suppository overnight for 10 days. The standard routine diagnosis spectrum was used. During the therapy, changes in clinical manifestations were assessed before surgical treatment and in the postoperative period.

Results: The decreased volume of vaginal discharge was found in 92.4% of the patients. Complaints of itching, burning, and discomfort in the vulvar area were noted to disappear in 78.2 and 66.4% of the women. “Amine” odor was gone in the all women receiving the therapy. The vaginal microflora spectrum was assessed immediately after therapy (before surgical treatment) and at 3–4 weeks after surgery. Normocenosis was obtained in 91.4% of the patients. This condition was retained in 88.2% of the women following surgery. The spectrum of the opportunistic vaginal flora was diverse prior to therapy. After vaginal sanitation, there was a reduction in the obligate anaerobic, facultative anaerobic flora, and fungal one. факультативно-анаэробной флоры и грибковой флоры.

Conclusion: Targifort confirmed its clinical efficacy and therapeutic safety and it can be recommended for the therapy of mixed vaginitis, vulvovaginal candidiasis and bacterial vaginosis in the perioperative period to prevent postoperative complications.

From the modern perspective, endometriosis is a chronic hormone-dependent disease tending to progress and recur, including after earlier surgical treatment. лечения. In view of this, a search for the optimal drug therapy that prevents relapses and that is effective and safe in its prolonged use is relevant. The paper reviews the Russian and foreign sources demonstrating the expendiency of using dienogest as a first-line therapy for endometriosis. One of the advantages of this progestagen is its pleiotropic mechanism of action, which directly or indirectly contributing to a decrease in the activity of endometrioid foci. Furthermore, the paper presents the data demonstrating the advantages of using dienogest both from the standpoint of prolonged therapy for different forms of endometriosis and in comparison with other drug treatments with gonadotropin-releasing hormone agonists, combined oral contraceptives, the levonorgestrel-containing intrauterine system, and other agents.

Conclusion: As of now, surgical and medical treatments for endometriosis are not contrasted, but complement each other. It is extremely important in the context of a decline in the rate of postoperative relapses, an improvement in life quality in the women, and a reduction in the risk of polycystic ovary syndrome. To date, dienogest is the drug of choice for good reason for prolonged therapy for endometriosis in view of not only the high activity of the drug against different forms of endometriosis, but also its safety during prolonged use.

Background: Takayasu’s arteritis (TA) is assigned to systemic vasculitides and is an autoimmune lesion of large vessels, which affects the aorta and its branches; occurs manly in reproductive-aged females. Hypertensive events, premature termination of pregnancy, placental insufficiency, and fetal growth restriction are more commonly observed in pregnant women with TA than in the population. To improve maternal and perinatal outcomes, there is a need to carefully monitor the activity of TA during pregnancy and at the pregravid stage.

Case report: A thirty-year old female patient was delivered to a hospital at 29 weeks’ gestation with complaints of pressing pains behind the sternum, which irradiate to the left arm. Three years before, AT affecting the brachiocephalic arteries and thoracic aorta was diagnosed. During admission examination, pulsation of radial and temporal arteries on the left was not detected; it on the right was weakened. Left blood pressure was not recorded; right one was 128/85 mm Hg. Electrocardiography could not reveal focal coronary symptoms. The troponin test was negative. C-reactive protein was 140.4 mg/ml. Duplex vascular scanning established stenosis of brachiocephalic and renal arteries. Uterine echographic examination revealed fetal growth restriction and bilateral impairments of uterine artery blood flow. Specific therapy for TA was resumed in the patient and early delivery was performed.

Conclusion: In this clinical case, acute myocardial damage was excluded in the patient who developed symptoms of the acute coronary syndrome; however, she was found to have a prognostically unfavorable impairment of uterine-placental blood flow with the development of fetal growth restriction, as well as renal dysfunction. Pregnancy in the presence of TA is a high-risk pregnancy and requires close collaboration and succession of specialists of different profile.