No 9 (2023)

The non-hemostatic function of platelets has been confirmed by numerous studies. Besides their participation in pathological processes, these cells play an important role in the menstrual cycle, embryo implantation and maintaining the pregnancy. Megakaryocyte derivatives contribute to leukocyte differentiation, polarization of the immune response and the induction of immunological tolerance through the secretion of soluble mediators and through direct intercellular interactions in the activation process. The activation occurs both in response to changes in hemodynamics and due to the action of factors found in the platelet microenvironment on a wide spectrum of receptors on their surface. The thorough analysis of the composition of seminal plasma revealed a wide range of components that can modulate the functional activity of platelets, namely, induction of migration, aggregation, secretion of granule contents, expression of activation markers, apoptosis. A local short-term inflammation that develops after semen plasma enters the female reproductive tract is able to determine the nature of platelet-leukocyte interactions followed by the recruitment of neutrophil granulocytes in this area, their timely elimination and migration of T-regulatory lymphocytes. Incorrect platelet activation by seminal plasma components can lead to an increase in their procoagulant potential which is associated with impaired vascularization processes, the development of microthrombi in uterine vessels and the progression of placenta-associated pregnancy complications.

Conclusion: Seminal plasma components provide regulation of molecular and cellular interactions including platelet activation involved in the preparation of the female reproductive tract for embryo implantation and the creation of a microenvironment favorable for maintaining the pregnancy.

This article reviews essential information for clinical specialists regarding the ductus venosus, a functionally significant component of the unique fetal circulation system. It outlines the main stages of formation and the normal anatomical structure of the venous system, which plays a crucial role in providing the oxygenation required for the physiological development of the fetus. The article also describes a technique for obtaining ultrasound images of all components of the afferent-venous complex of the placenta, with a focus on the venous duct. It discusses various types of umbilical-portal-systemic venous shunts that can be detected during the prenatal stage and their association with high risks of syndromic pathology and functional disorders in the fetus. These cases necessitate an individualized approach for the examination and management of each clinical scenario. Additionally, this article covers the guidelines and indications for Doppler assessment of blood flow velocity curves in the venous duct for various complications in both singleton and multiple pregnancies. The authors present data on the normal postnatal closure of the ductus venosus and potential manifestations of a persistent open ductus venosus in children, a rare pathology that significantly affects newborns.

Conclusion: Raising awareness among practitioners regarding the importance of perinatal ultrasound diagnosis for ductus venosus pathologies and hemodynamic disorders will enhance the efficiency of medical care, ultimately reducing perinatal and childhood morbidity and mortality.

Laparoscopy is considered the gold standard for the surgical treatment of most pelvic diseases. Along with this, laparoscopic interventions are accompanied by the appearance of a specific postlaparoscopic shoulder pain (PLSP). During the first two days after surgery some patients can experience a severe pain which limits their mobilization. There is a global trend towards the introduction of protocols for enhanced recovery after surgery (ERAS) aimed at reducing the stress associated with the surgical intervention and the rapid return of patients to normal life. This article describes the epidemiology of postlaparoscopic shoulder pain. Its pathogenesis and the most common theories of its origin are reviewed. The results of the studies devoted to the methods of reducing postoperative pain syndrome in accordance with the suggested theories are presented in the article. There is a description of the effect of changing the gas for the pneumoperitoneum and reducing its pressure level, instillation of saline solution into the abdominal cavity, forced gas removal, as well as local use of anesthetics.

Conclusion: To date, this issue has not been sufficiently covered in the national literature, and the available data from foreign studies are contradictory. It is necessary to conduct the research on the frequency of postlaparoscopic pain syndrome and factors affecting its severity, as well as the search for effective and safe methods for its reduction.

Objective: To demonstrate the effectiveness of a two-step approach for the prevention of pre-eclampsia in high-risk women, consisting of pregestational use of the insulin sensitizer metformin (ISM) followed by low-dose acetylsalicylic acid (LDAA) during pregnancy.

Materials and methods: At the preconception stage, women at high risk of preeclampsia were divided into groups according to the prevention method: group 1, 77 patients who received two-stage prophylaxis (ISM at the preconception stage and LDAA during pregnancy); group 2, 75 patients who received LDAA monotherapy at the gestational stage; group 3, 72 patients who received metformin only preconceptionally; and group 4, 73 patients who refused prevention. Thirty women with physiological gestation served as the controls. At 11–14, 18–21, and 30–34 weeks, hormonal-metabolic, pro-inflammatory, and endothelial-hemostasiological patterns were assessed. Based on the primary outcome, the incidence of pre-eclampsia, the size of the effect of the preventive intervention was calculated.

Results: Clinical and laboratory parallels proved the advantage of a two-stage approach to the prevention of preeclampsia: the incidence of preeclampsia in group 1 was 3.8 times lower (RR 0.26 [0.14; 0.49], RRR 73.7% [50.9; 85.9], ARR 36.3% [22.6; 50.1], NNT 3 [2; 4], χ²=21.58, p<0.001), compared with the group without prevention, and with ISM or LDAA alone, only 2.7 (RR 0.37 [0.21; 0.63], RRR 63.4% [36.9; 78.8], ARR 31.3% [16, 8; 45.8], NNT 4 [2; 6], χ²=14.47, p<0.001) and 1.6 times (RR 0.62 [0.41; 0.94], RRR 37.8 % [6.0; 58.8], ARR 18.7% [3.1; 34.2], NNT 6 [3; 32], χ²=4.62, p=0.03), respectively. In group 1, the incidence of severe preeclampsia was reduced by 3.1 and 3.6 times, early preeclampsia by 1.6 and 1.6 times, relative to groups 2 and 3. The effectiveness of the staged approach was confirmed by the influence of preeclampsia prevention methods on the intensity of compensation for insulin resistance and the associated proinflammatory and prothrombogenic patterns, markers of alteration, and remodeling of the vascular endothelium. The lack of effectiveness of the standard use of LDAA is associated with the lack of a periconceptual influence on key events in early pregnancy.

Conclusion: A new strategy for the prevention of preeclampsia is represented by a staged approach that provides a reduction in cardiovascular risk by developing metabolic resistance in women at high risk of preeclampsia from the stage of pregnancy planning and is implemented as a promising, highly effective, pathogenetically substantiated method of prevention aimed at improving obstetric outcomes and stabilizing cardiovascular disease. the vascular continuum later in life.

Objective: To develop a model for predicting and diagnosing fetal growth restriction based on clinical and anamnestic factors and examination data during pregnancy.

Materials and methods: Postnatally, the weight and growth parameters of 473 newborns were assessed according to the INTERGROWTH-21 centile curves, which made it possible to form a study group that included 202 pregnant women with fetal growth restriction. The comparison group included 206 women without fetal growth restriction who delivered at terms corresponding to the terms in the study group. Risk factors, parameters of somatic and gynecological anamnesis, features of the course of pregnancy and delivery, ultrasound and Doppler data, and a comprehensive assessment of the health status of newborns were analyzed. After statistical processing of the parameters, binary logistic regression was used to develop a mathematical model for predicting fetal growth restriction.

Results: The prognostic model based on binary logistic regression, including somatic and gynecological diseases and medical history, had a sensitivity of 55.6% and specificity of 82.3%. When physical examination data during pregnancy, including fetal abdominal circumference as measured by ultrasound, were added, the model had a sensitivity of 96.7% and a specificity of 76.8%.

Conclusion: The models developed using the binary logistic regression method can be proposed for use in practical healthcare to identify risk groups and predict and diagnose fetal growth retardation, which will allow for timely prevention to reduce the incidence of perinatal complications.

Objective: To analyze the restoration of reproductive function in endocrine infertility in women living in Altai Krai.

Materials and methods: The study included 1610 women with ovulation disorders out of 9325 who had sought counseling for infertility from April 27, 2001, to December 31, 2020. According to the classifications relevant during the study period, WHO (1973), and NICE (2013), all women were divided into three groups according to the nature of ovulatory dysfunction. The study analyzed gynecological and extragenital pathology among the groups and the influence of the type of ovulatory dysfunction on the choice of treatment strategy. The results of overcoming infertility in patients are presented.

Results: The anovulatory infertility rate in the entire cohort was 19.6%. The clinical differences among the three study groups were clarified. Information is presented on the restoration of the reproductive function of women with impaired ovulation in real clinical practice. The advantages and disadvantages of various management strategies, from expectant to ART, are presented. Algorithms have been developed to improve the efficiency of reproductive function in anovulatory infertility.

Conclusion: The success in the fulfillment of reproductive potential depends on the correct diagnosis of the causes of ovulation disorders and the choice of a rational way to overcome infertility, considering its clinical and pathogenetic forms. It is advisable to use assisted reproductive technologies when other treatments are ineffective or when multiple factors contribute to infertility. In a hypergonadotropic state, ART using donor oocytes is a rational way to overcome infertility.

Objective: To evaluate the effectiveness of infertility treatment in the programs of cryo-embryo transfer, when embryos were obtained after autologous co-culture with cumulus cells in assisted reproductive technology (ART) programs.

Materials and methods: 198 married couples with repeated implantation failure (at least 2 attempts) were examined during the period of the study. The couples underwent IVF treatment with frozen-thawed embryo transfer into the uterine cavity. 114 couples underwent the program of autologous embryo-cumulus cells co-culture, and 84 couples underwent IVF treatment with frozen-thawed embryo transfer without using this program. Preparation of all women for cryo-transfer included cyclic hormonal treatment. Only one embryo was thawed and transferred into the uterine cavity. Pregnancy and birth rates were assessed.

Results: The study showed that autologous embryo-cumulus cells co-culture increased pregnancy rate in the group of women aged ≤35 years from 26.3% to 48.2% (OR 1.83; 95% CI 1.00–3.32) and significantly dicreases pregnancy rate in women of later reproductive age from 41.3% to 20.6% (OR 0.37; 95% CI 0.15–0.88). There was no significant difference in birth rates between the groups.

Conclusion: The results obtained in the study make it possible to recommend using autologous embryo-cumulus cells co-culture in women aged ≤35 years, who had repeated failed attempts of ART in history, to improve the effectiveness of infertility treatment.

Objective: To investigate the association between hyperthermia during labor and the use of epidural analgesia (EA), identify the risk factors for its occurrence, and analyze the impact of EA on labor progression and delivery methods.

Materials and methods: This study included 1874 delivery records from January 1 to June 31, 2021, at D.D. Pletnev City Clinical Hospital in Moscow. Among these, 956 involved EA, whereas 918 did not use neuraxial anesthesia. The study categorized cases based on temperature elevation (temperature ≥37°C and <37.5°C, indicative of hyperthermia tendency; temperature ≥37.5°C, hyperthermia) and delivery type (vaginal delivery (VD) and cesarean section (CS)). Patients who gave birth with EA and a temperature <37.5°C (877/956) constituted subgroup A, whereas those with a temperature ≥37.5°C (79/956) belonged to subgroup B. A comparative analysis of patient history, one-way correlation analysis, and analysis of variance were conducted to identify factors predisposing patients to hyperthermia.

Results: The analysis revealed a statistically significant association between the use of EA for pain relief during labor and the occurrence of hyperthermia. Specifically, 97.53% (79/81) of hyperthermia cases were recorded in patients who received EA (95% CI:93.31–99.23, p<0.001). Predisposing factors included the duration of labor, interval between anesthetic administration, number of vaginal examinations (all p<0.001), amniotic fluid characteristics (p=0.001), and cervical dilation at the time of analgesia (p=0.002). Hyperthermia in the presence of EA was associated with a higher risk of operative delivery, with emergency CS performed 2.5 times more frequently (30.4% (24/79) vs. 12.2% (107/877), p<0.001) and vacuum-assisted fetal extraction performed 2.9 times more frequently (10.1% (8/79) vs. 3.5% (31/877), p=0.003) in subgroup B than in subgroup A. The most common indication for surgery was fetal distress, (patients with EA and a body temperature of 37.5°C or higher were 2.6 times more likely to have fetal distress than in those without hyperthermia (29.1% (23/79) and 11.4% (100/877), p <0.001).

Conclusion: Early and prolonged EA is associated with an increased risk of hyperthermia, operative delivery, and adverse perinatal outcomes. Optimizing the application of this form of labor pain relief can enhance the quality of obstetric care.

Relevance: The issue of staff complement for doctors in medical faciltites is of high relevance in terms of availability and timeliness of health care delivery. It is extremely important to deliver timely care, including preventive care in obstetrics and gynecology to preserve reproductive health in female population. he timeliness directly influences staff complement for obstetricians and gynecologists in medical facilities.

Objective: To investigate the level of staff complement for obstetricians and gynecologists in medical facilities in the Far Eastern Federal District.

Materials and methods: The analysis of the staffing levels for obstetricians and gynecologists in medical facilities in the Far Eastern Federal District was carried out according to the Federal statistical monitoring data for the period 2017–2021. Descriptive statistics and analytical research methods were used in the study.

Results: Staffing levels for obstetricians and gynecologists in medical facilities in Russia per the number of occupied positions over the past five years generally decreased from 90.2% to 86.2%; in the Far Eastern Federal District from 90.8% to 83.0%, and in the Khabarovsk Territory from 84.5% to 80.0%. This trend is also typical for other Federal Districts, with the exception of the North-Caucasian Federal District, where it increased from 91.4% to 92.5%. Calculations of the number of individuals showed widespread reduction of this indicator both throughout the country and in the Federal Districts was based on calculation of the total number of individuals. At the same time, opposite trends were observed in the territorial subjects of the Far Eastern Federal District.

Conclusion: Over the past five years, staffing levels for obstetricians and gynecologists tended to decrease in all Federal Districts, while in the most territorial subjects of the Far Eastern Federal District, staffing levels for specialists that was calculated per the number of individuals, increased.

Objective: To present a comprehensive medical and social profile of health care professionals working in the field of obstetrics and gynecology in outpatient settings.

Materials and methods: To conduct this study, we developed a comprehensive toolkit comprising both closed- and open-ended questions, addressing various aspects of the daily lives of medical practitioners. A sociological survey was administered to 250 medical professionals specializing in obstetrics and gynecology, delivering outpatient care across nine antenatal clinics affiliated with the S.I. Spasokukotsky City Clinical Hospital. Data analysis, including calculation of extensive indicators, was performed using MS Excel 2016.

Results: Contemporary medical professionals providing outpatient obstetrics and gynecology care were primarily women of working age, residing in separate accommodations, married with children, earning an average income, leading healthy lifestyles, and driven by a genuine vocation for medicine. They demonstrated a patient-centered approach, expressed satisfaction with their professional roles, and recognized the importance of continually enhancing their legal knowledge.

Conclusion: Despite the challenges inherent in the current healthcare system models, particularly within maternal and child health, contemporary medical practitioners harness the advancements and opportunities of their era. Elevating their status within modern society, enhancing the prestige of their profession through media exposure, and cultivating positive public perception are vital incentives for bolstering their professional motivation.

There is currently no evidence for the clinical benefits of using bioequivalent micronized progesterone preparation produced in Russia compared to the original preparation for post-transfer support after the frozen-thawed embryo transfer. Therefore, it is important to confirm the therapeutic equivalence of the Russian preparation in the programs of assisted reproductive technologies (ART).

Objective: To perform a comparative analysis of the effectiveness of frozen-thawed embryo transfer programs and pregnancy outcomes in women who took bioequivalent and original micronized vaginal progesterone preparations for the secretory transformation of the endometrium and post-transfer support.

Materials and methods: The study included 93 infertile women who had frozen-thawed own embryo transfer with hormone replacement therapy cycle in the Assisted Reproduction Department, Urals Scientific Research Institute for Maternal and Child Care. The first group consisted of 45 patients who took Russian bioequivalent micronized progesterone preparation “DlyJens pro” (600 mg/day intravaginally) for full secretory transformation of the endometrium, the second group included 48 patients who were prescribed original micronized vaginal progesterone preparation (600 mg/day intravaginally).

Results: The implantation rate was 22/45 (48.89%) patients in group 1, it was 21/48 (43.75%) in group 2. The clinical pregnancy rate was higher in group of patients who took the bioequivalent micronized progesterone preparation than in group 2 and it was 19/45 (42.22%), however, no statistical differences were found (p=0.796). There was no statistical difference in the rate of multiple pregnancies in both groups (p=0.462). Multiple pregnancies were detected in 4/19 (21%) patients in group 1 and in 6/19 (31.6%) patients in group 2.

Conclusion: The data obtained in the study on the outcomes of frozen-thawed embryo transfer programs showed comparable effectiveness of the bioequivalent and original micronized progesterone preparations. The study demonstrated the possibility of using both original and bioequivalent micronized vaginal progesterone preparations in hormone replacement therapy cycles in assisted reproduction.

Group B streptococcus (GBS) is a significant cause of neonatal infections, particularly early-onset neonatal sepsis (EONS). This article presents a clinical case of an atypical course of systemic early neonatal infection caused by GBS in a preterm baby born at 36 weeks of gestation. The initial clinical manifestations, including pronounced hyperbilirubinemia and anemia, were more commonly associated with hemolytic disease of the newborn rather than GBS infection. A comprehensive analysis of the patient's course, clinical and laboratory data is provided, along with a comparison to current global findings. The publication also reviews the epidemiology, etiology, and diagnosis of GBS infections in pregnant women and newborns, with a specific focus on screening and timely diagnosis to reduce the severe outcomes associated with GBS infections in newborns.

Conclusion: Implementing prenatal screening measures, in conjunction with rapid microbiology and molecular genetic research methods, enables the prompt verification of premature newborn diagnoses. This approach facilitates the timely initiation of etiopathogenetic therapy and helps prevent the development of disabling complications.

Background: The pregnancy rate in patients with incompetent uterine scar (isthmocele) ranges between 1/1800 and 1/2216, which makes up 6.1% of all pregnancies with a history of cesarean section. Isthmocele occurs in 70% of pregnant women who previously underwent uterine surgery and presents a high risk of uterine rupture. Metroplasty during pregnancy is a rare type of medical care that requires profound knowledge and experience in this area.

Case report: The article presents a clinical observation of a 33-year-old patient with a uterine scar in her second pregnancy after having a cesarean section 6 years before. The routine ultrasound examination revealed a 28.0×16.0×40.0 mm isthmocele at 19–20 weeks’ gestation, clinical symptoms were absent. After the patient was hospitalized, metroplasty was performed. The pregnancy was prolonged to 34 weeks due to the administered medications for the prevention of preterm birth. The thickness of the myometrium in the area of the scar was 2.0 mm. When there were complaints indicating the threat of the uterine rupture (pain in the lower abdomen, a decrease in the thickness of the myometrium to 1.8 mm), a cesarean section was performed. A live premature female infant was born weighing 1922 g, 47 cm long, with an Apgar score of 7–8 points. The wound on the uterus was closed with a double-row continuous polyglycolide suture, peritonization was not performed. The postoperative period was uneventful. The patient was discharged on the 3rd day after the operation. After 6 months, the ultrasound examination showed that the endometrium corresponded to the first phase of the cycle, the uterine scar along the anterior wall had no signs of incompetence and was more than 10 mm thick. The child’s development was age-appropriate.

Conclusion: Metroplasty for the incompetent uterine scar is a method of choice that makes possible to prolong a pregnancy and deliver a viable child at the time close to full-term.