No 10 (2023)

The paper presents a study of scientific publications written by the Russian and foreign authors in research databases such as Pubmed, Cochrane, Web of Science, MedLine, Google Scholar, Embase, Maternity and Infant Care. It covers epidemiological aspects of coronavirus infection, experience of previous epidemics of respiratory viruses, data on the impact of novel coronavirus infection on the course of pregnancy and perinatal outcomes. At the first stages of the pandemic some publications provided the information that the SARS-CoV-2 virus is not dangerous for pregnant women. Later the incidence in pregnant women was found to be higher than in the population. The following risk factors for SARS-CoV-2 infection have been identified: concomitant pathology, late reproductive age. The clinical course of COVID-19 in pregnant women may vary from asymptomatic forms to the development of acute respiratory and multiple organ failure. Novel coronavirus infection has been proven to play a role in the development of hypertensive disorders during pregnancy, preterm birth, spontaneous miscarriage and placental pathology. To date, the available literature contains few data on the analysis of pregnancy outcomes depending on the gestational age at the time of infection. It remains unclear how coronavirus infection in pregnancy affects the development of congenital malformations in the fetus, short-term and long-term consequences for the child’s health.

Conclusion: It is necessary to conduct further studies to identify the effect of the novel coronavirus infection on the course of pregnancy and perinatal outcomes. The experience obtained by the clinicians will help the society to be ready for the next challenges of the time.

Preterm birth is one of the great obstetrical syndromes that poses an enormous problem for obstetricians nowadays. Being the leading cause of infant mortality in the world, it accounts for 80% of all cases of neonatal morbidity and leads to serious financial and emotional losses for families and society. One of the most severe complications leading to preterm birth is premature rupture of membranes (PROM). The article covers the etiological and pathogenetic aspects of PROM including inflammation as a key factor. Aseptic inflammation associated with biological aging and maturation of the membranes is considered as a variant of the PROM pathogenesis. Collagen remodeling, development of microcracks in the membranes, and enhanced angiogenesis are considered as factors contributing to the destruction of the extracellular matrix. To date, the study of rupture of the membranes has been carried out in terms of cell biology and histology, as well as inflammation. This review examines various pathogenetic variants of PROM which may occur independently or in combination. Despite the large number of studies on the subject, there is currently a great interest in new approaches to the prevention of PROM, the search for prognostic markers and risk factors for the development of effective therapeutic tactics.

Conclusion: The introduction of new research methods that can reveal or clarify the mechanisms of aseptic and infectious pathogenesis using mass spectrometry in PROM will help to identify differential patterns of protein expression associated with oxidative stress and bacterial invasion in the amniotic fluid and membranes. The introduction of non-invasive markers into clinical practice will provide the clinicians with the possibility of taking timely preventive measures, prescribing therapy and determining the tactics of management of pregnant women in order to improve the perinatal outcomes.

This review presents the data of the recent studies on the structure and role of the vaginal microbiota in providing colonization resistance and maintaining female reproductive health. New therapeutic options in the treatment of infectious diseases in gynecology are covered. The review shows the significance of preserving the specific functioning of the vaginal microecosystem, searching for new effective therapeutic opportunities in the treatment of infectious and inflammatory diseases and correction of dysbiotic disorders of the vaginal microbiota, its ability to resist pathogenic microorganisms. The unique local immune status directly correlates with the specific microbial composition of the vagina. Recent studies have shown the high efficiency of intestinal microbiota transplantation in gastroenterology. To date, there is a promising concept of introducing selective microbiota transplantation into clinical practice. According to this concept, it is possible to obtain autoprobiotics that can simultaneously solve the problem of safety during transplantation and provide personalized treatment. It is necessary to carry out further studies on the characteristics of pharmacological properties, on degree of stability and safety, on the ability of microorganisms to multiply in the vagina, and on the determination of dosage and frequency of use. The effectiveness of vaginal microbiota transplantation should be determined and proven in subsequent randomized placebo-controlled clinical trials.

Conclusion: Autoprobiotics originating from the vagina can become the basis for the development of personalized medicines using a person’s own microbiota as it is safe and accessible and can help in the treatment of diseases with complex etiology and pathogenesis. Preliminary clinical results in a number of experimental studies have demonstrated a good therapeutic effect and great prospects for vaginal microbiota transplantation in comparison with other methods of treatment.

The risk of thrombotic complications is known to increase several times in cancer patients. The malignant process causes changes in the blood coagulation and fibrinolytic systems which negatively affect the prognosis of the patient’s complications. The tumors of the female reproductive system, especially ovarian cancer, are among the most thrombogenic solid tumors. The level of specific markers increases particularly in patients with ovarian cancer. These markers can help to identify patient’s predisposition to the rapid development of venous thromboembolism. There are certain risk factors that increase the likelihood of thrombosis in ovarian cancer: age over 60 years, excess body weight, tumor diameter of more than 100 mm, and the presence of ascites and chronic diseases. Medications used for ovarian cancer are also worth noting. The use of antitumor drugs is known to contribute to thrombotic complications.

Conclusion: There is an active discussion about the increased risk of venous thromboembolism in patients who received tranexamic acid and other antifibrinolytic agents to reduce intraoperative blood loss. Although some studies have confirmed the effectiveness of tranexamic acid, there are currently not enough randomized trials to guarantee the absence of a link between the use of antifibrinolytic agents and venous thromboembolism in patients with ovarian cancer. The reasonable use of this group of drugs with obligatory thromboprophylaxis is recommended.

Objective: This study aimed to identify the risk factors associated with vaginal delivery in women who had previously undergone cesarean section. The analysis focused on clinical data and medical history as well as the course of pregnancy and labor.

Materials and methods: Forty pregnant women with a uterine scar from a prior cesarean section who attempted vaginal delivery were included in this study. Based on the labor outcomes, they were divided into two groups. Group 1 comprised 26 women who underwent vaginal delivery, while group 2 consisted of 14 women who required repeat cesarean section during labor. A comparative analysis was conducted, taking into account clinical data, medical history, and the progression of index pregnancy and labor.

Results: Patients in group 2 exhibited higher weight gain during pregnancy than those in group 1, with values of 12.5 [11, 16] and 10 kg [9; 14], respectively (p=0.045). Additionally, 30.8% of the women in group 1 had a history of previous vaginal deliveries, whereas no patients in group 2 had such a history (p<0.05). The placenta was more frequently located along the anterior uterine wall in group 1 (80.8%) than in group 2 (28.6%) (p=0.002). On admission to the maternity hospital, the minimum thickness of the lower uterine segment in the scar area, as determined by ultrasound, was greater in group 1 than in group 2, measuring 2.35 mm [2; 2.8] and 2.1 mm [1.95; 2.23], respectively (p=0.015). Moreover, women in group 1 were significantly more likely to be admitted with a mature cervix according to the Bishop scale than those in group 2 (p=0.007). The dilation of the internal os was twice as wide in group 1 versus group 2 (p=0.002). Rupture of membranes occurred at term more frequently in group 1 than in group 2 (p=0.03).

Conclusions: Based on our findings, risk factors associated with an unsuccessful attempt at vaginal delivery after cesarean section include a lower uterine segment thickness ≤2.1 mm upon admission, cervical maturity score ≤5 points according to the Bishop scale, dilation of the internal os ≤2 cm upon admission, and early rupture of membranes.

Background: Preeclampsia (PE) is a life-threatening and difficult-to-predict complication of pregnancy, characterized by multi-organ dysfunction. PE affects 2–8% of all pregnancies and is one of the leading causes of perinatal and maternal mortality, especially in cases of early onset PE.

Objective: To develop models for predicting total and early onset PE in the first trimester of pregnancy using machine learning (ML) technologies based on real-world clinical data.

Materials and methods: We analyzed 21,092 records obtained from electronic medical records through the Webiomed platform, corresponding to 12,434 unique pregnancies of 12,283 women aged 11 to 60 years, up to 16 weeks. Anamnestic, constitutional, clinical, instrumental, and laboratory data, commonly used in routine medical practice, were selected as potential factors for predicting PE, totaling 53 variables. To create the models, we employed logistic regression (LR), gradient boosting methods (LightGBM, XGBoost, CatBoost), and methods based on decision trees (RandomForest and ExtraTrees).

Results: The ExtraTrees model demonstrated the highest accuracy in predicting PE, with an area under the curve (AUC) of 0.858 (95% CI 0.827–0.890). The model's overall accuracy was 0.634 (95% CI 0.616–0.652), sensitivity was 0.897 (95% CI 0.837–0.953), and specificity was 0.624 (95% CI 0.605–0.643). Among the models for assessing the risk of early onset PE, the RandomForest algorithm yielded the most promising results. The AUC after validation was 0.848 (95% CI 0.785–0.904), with an accuracy of 0.813 (95% CI 0.798–0.828), sensitivity of 0.733 (95% CI 0.565–0.885), and specificity of 0.814 (95% CI 0.799–0.828).

Conclusion: The metrics of the final models align with previously published models. External validation results demonstrate the relative stability of the models with new data, indicating their potential applicability in real clinical practice. This is our first experience in predicting complex pregnancy complications based on real-world clinical data. The quality of the predictive model depends directly on the data and the statistical algorithms used, aspects that we intend to refine in future studies.

Objective: To assess the clinical significance of interleukin (IL-6 and IL-8, and matrix metalloproteinase-8 (MMP-8) in predicting pregnancy outcomes in patients with cervical insufficiency (CI) undergoing cervical cerclage.

Materials and methods: This prospective cohort study included 67 pregnant women with CI. Women were divided into two groups based on the timing of their subsequent deliveries. Group 1 comprised 30 (44.8%) pregnant women who gave birth before 32 weeks, whereas Group 2 included 37 (55.2%) women who gave birth after 32 weeks. During the vaginal speculum examination, cervical mucus was collected from the cervical canal before the cerclage procedure to determine the concentrations of IL-6, IL-8, and MMP-8.

Results: In Group 1, the concentrations of IL-6, IL-8, and MMP-8 were 12.3 pg/ml, 261.0 pg/ml, and 28.5 ng/ml, respectively. In Group 2, the concentrations were 6.4 pg/ml, 102.3 pg/ml, and 12.3 ng/ml for IL-6, IL-8, and MMP-8, respectively. The threshold values for each marker were determined by ROC analysis. The threshold concentrations at the cut-off point were 11.3 pg/ml, 202.6 pg/ml, and 22.3 ng/ml for IL-6, IL-8, and MMP-8, respectively.

Conclusion: Our study revealed that in patients with CI who delivered after 32 weeks, the levels of immunological markers were significantly higher than those in patients who delivered later. Unfavorable pregnancy outcomes with delivery before 32 weeks of gestation were predicted at levels of IL-6, IL-8, and MMP-8 ≥ 11.3 pg/ml, ≥ 202.6 pg/ml, and ≥ 22.3 ng/ml, respectively. Cervical cerclage is considered ineffective in these patients.

Objective: To suggest a variant of surgical treatment of vestibulovaginal hypospadias in girls.

Materials and methods: A total of 201 girls were diagnosed with vestibular hypospadias, 16 girls with vestibulovaginal hypospadias, and 3 girls with vaginal hypospadias. Five girls with vestibulovaginal hypospadias underwent surgery, namely, isolation of the urethra from the external orifice to the bladder neck and moving it below the clitoris.

Results: The conservative treatment was prescribed to all children with hypospadias. It was effective only for the patients with the vestibular form of hypospadias. All children experienced vulvitis, vaginitis, chronic cystitis and pyelonephritis. Dystopia of the external urethral orifice was a manifestation of the vulvovaginal form of hypospadias. The X-ray examination revealed vesicoureteral reflux in six children and ureterohydronephrosis in two children. The girls with vestibulovaginal hypospadias (11 out of 16) continued to be treated conservatively. Five girls underwent surgical treatment with a good long-term result.

Conclusion: Ineffective long-term therapy of vulvitis, vaginitis, cystitis, chronic pyelonephritis is an indication for surgical treatment of vestibulovaginal hypospadias. The lower wall of the urethra and the anterior wall of the vagina are a single formation in girls. Only the complete separation of the urethra from the vagina leads the operative manipulation to success. The presence of ectopia of the external urethral orifice, its permanent trauma during coitus may be a substrate of urinary tract infection in sexually mature women. Operative treatment serves as the prevention of postcoital complications in the future.

Since gonadotropin releasing hormone (GnRH) agonists significantly suppress steroidogenesis, they contribute to the regression of endometrioid lesions and the decrease in clinical symptoms of the disease. However, hypoestrogenism caused by the prolonged use of GnRH agonists is complicated by the appearance of side effects. It is important to find the ways to reduce side effects while maintaining the effectiveness of GnRH agonists.

Objective: To assess the clinical and hormonal status of patients with extragenital endometriosis after taking 3.75 mg of Buserelin-depo with 6-week and 4-week intervals between the administration of the drug in the postoperative period.

Materials and methods: The patients of group I (n=10) were administered Buserelin-depo at a standard dose of 3.75 mg with an interval of 6 weeks; the patients of group II (n=10) who had ASRM stage I and II verified endometriosis were administered the drug according to the usual scheme with a 4-week interval. The study included the comparison of the dynamics of estradiol, LH, FSH, the rate of appearance and the profile of side effects associated with induced hypoestrogenism, the clinical efficacy of drug administration in both groups.

Results: The levels of FSH, LH and E2 in patients of both groups showed similar results of hormonal suppression. A decrease in pain syndrome was also observed after the administration of Buserelin-depo: 3.3 scores using the VAS system in group I and 2.4 scores in group II (compared to 9.9 points initially). Menstruation started again in 78 days after the fourth injection in group I and in 82 days after the sixth injection in group II. In both groups, adverse events were noted which were mild according to the Kupperman index (in 6/10 in group I, in 10/10 in group II). Neither endometrial growth nor signs of folliculogenesis were observed in any case in groups I and II.

Conclusion: The effectiveness of the administration of Buserelin-depo with an increased interval between injections for up to 6 weeks is equal to the effectiveness of its administration in the standard mode (every 4 weeks). However, the side effects were less severe. It is necessary to conduct a comprehensive study in order to clarify the effectiveness of the prolonged interval between injections using statistical analysis.

The article presents the protocols for high-intensity pulsed electromagnetic field therapy in the treatment of neurogenic pelvic pain including the use of perineal extracorporeal, translumbosacral and transcranial magnetic therapy. The protocols were developed at the Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia.

Objective: To evaluate the opinion of experts and develop a consensus document on the use of protocols for high-intensity pulsed electromagnetic field therapy in the treatment of patients with chronic neurogenic pelvic pain.

Materials and methods: A total of 55 people were invited to participate in the survey; 55 patients or 100% took part in the survey. All the responses as well as comments and recommendations were analyzed and grouped.

Results: The present work evaluated the respondents’ opinions on the options for the use of high-intensity pulsed electromagnetic field therapy in the treatment of chronic neurogenic pelvic pain. The interdisciplinary consensus on the use of this treatment in Russia was reached. Experts’ opinions on the necessity of using the developed treatment algorithm were highly consistent: more than 80% of the experts agreed on all issues during the first round of decision-making process, therefore there was no need to hold the second round of voting. It was possible to improve the therapeutic algorithm taking into consideration the suggestions made by the specialists and experts.

Conclusion: The protocol for using high-intensity pulsed electromagnetic field therapy in the treatment of patients with chronic neurogenic pelvic pain was approved by the multidisciplinary consensus of specialists. The presented consensus protocol needs to be studied and tested in a controlled clinical trial.

Relevance: The incidence of preterm birth associated with premature rupture of the membranes remains at a stable level in the world despite the development of new approaches to therapy and their standardization. The rupture of the membranes during pregnancy is known to be directly associated with anaerobic vaginal dysbiosis. Multiple pregnancy in women with vaginal dysbiosis almost always ends in preterm delivery of infants with extremely and very low birth weight. The existing approaches to the treatment of vaginal dysbiosis during pregnancy do not always show a 100% effectiveness; therefore, it is necessary to find new alternative ways to normalize the vaginal microbiota.

Case report: We present a clinical case of recurrent anaerobic vaginal dysbiosis in a pregnant woman with spontaneous triplet pregnancy who was prescribed vaginal autoprobiotics. The woman was examined and treated at Professor Bushtyreva Clinic, Rostov-on-Don, Russia. The prescription of vaginal autoprobiotics made it possible to normalize the state of the vaginal microbiota of the pregnant woman, obtain absolute normocenosis, avoid premature rupture of the membranes and deliver full-term infants in high-risk pregnancy.

Conclusion: The prescription of vaginal autoprobiotics as therapy for anaerobic dysbiosis is a personalized and safe method of treatment, since autoprobiotics represent a woman’s own beneficial lactobacillus vaginal microflora that is genetically close and that does not cause rejection reactions. It is necessary to carry out further extensive studies on the effectiveness of vaginal autoprobiotics in pregnancy for the possible popularization of this technique.

Background: Breast cancer (BC) is the most common breast form diagnosed during pregnancy (from 1:3,000 to 1:10,000 cases) and is about 3% of all forms of BC. Physiological changes during pregnancy can hide the early signs of BC and, thereby, delay the diagnosis. When planning treatment during pregnancy, in each case, it is inevitable to discuss the gestation period, stage and form of BC.

Case report: The paper describes a clinical case of a 28-year-old pregnant woman with malignant breast neoplasm diagnosed at 9.1 weeks’ gestation, with a family history, BRCA1 gene mutation, and HER2neи amplification. Due to the patient's refusal to terminate the pregnancy, resection of the left breast with a nodular mass and biopsy of the sentinel lymph node biopsy were performed. A postoperative histological examination confirmed high-grade invasive ductal carcinoma; no metastases were found in the distant lymph nodes. A consultation of doctors recommended adjuvant chemotherapy according to the AS regimen with an inter-cycle drug administration period of 21 days and subsequent targeted therapy with trastuzumab after delivery.

Conclusion: The discussed case reflects the complexities of diagnosis and combination treatment in pregnant patients with BC.