Journal of obstetrics and women's diseases

BACKGROUND: Being strongly affected by maternal and fetal genetic factors, intrauterine environment plays a critical role in fetal growth. Intrauterine conditions, in turn, are largely determined by the genetic factors.

AIM: The aim of this study was to evaluate the effect of the IGF1R rs907806 and GHSR rs572169 genetic variants on the weight of newborns.

MATERIALS AND METHODS: This prospective study included 221 mother-newborn pairs. The inclusion criteria were singleton pregnancy and informed consent to participate in the study. The exclusion criteria were severe somatic, oncological and acute illnesses three months prior or during pregnancy, gestational diabetes mellitus, refusal to participate in the study at any stage, and insufficient data. The study groups included patients with type 1 diabetes mellitus (group I), type 2 diabetes mellitus (group II), and no carbohydrate metabolism disorders (group III). Cord blood samples were obtained after delivery. The IGF1R rs907806 and GHSR rs572169 genotypes were determined by polymerase chain reaction with restriction fragment length polymorphism analysis. The main outcomes were delivery of a large for gestational age fetus (weight of more than the 90th percentile INTERGROWTH-21^st). The secondary outcomes were diabetic fetopathy, diabetic cardiomyopathy, and neonatal hypoglycemia.

RESULTS: In group III, the minor G allele of the IGF1R rs907806 variant was more frequent in large-for-gestational-age newborns (p = 0.017; odds ratio 3.039; 95% confidence interval 1.244–7.424) than in those with a weight of less than 90th percentile. For the GHSR rs572169 variant, no similar trend was observed. This pattern was pronounced in the male newborns only (rs907806 AA vs. AG+GG; p = 0.046; odds ratio 4.229, 95% confidence interval 1.181–15.139). In newborns with hypoglycemia, a higher frequency of the GG genotype of the GHSR rs572169 (G>A) variant was observed in the total sample (p = 0.004) and the type 1 diabetes mellitus group (p = 0.0496).

CONCLUSIONS: The IGF1R rs907806 variant may affect birthweight in the male newborns of mothers without carbohydrate metabolism disorders. The observed association of neonatal hypoglycemia with the GG genotype of the GHSR rs572169 variant requires further investigation. Genetic factors can contribute to prognostic models of perinatal complications, while improving their early diagnosis opportunities.

BACKGROUND: A microbial imbalance in the vaginal biotope leads to the development of vaginal infections and is associated with urinary tract infections. The ineffectiveness of the therapy and the frequent recurrence of these infections are important reasons for searching for alternative treatment strategies. A progressive solution to this issue has been the use of oral probiotics with a targeted effect on the intestinal and vaginal microflora.

AIM: The aim of this study was to evaluate the antagonistic and antibacterial activity of the probiotic strains Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14, which are the components of the oral probiotic, against opportunistic microorganisms of intestinal origin, while assessing the sensitivity of these strains to antimicrobial drugs.

MATERIALS AND METHODS: The probiotic strains Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14 included in the oral probiotic Duogynal® were cultivated and the grown colonies were identified using the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry method (Bruker Daltonics GmbH & Co., Germany). To study the antagonism of the probiotic strains of lactobacilli and opportunistic pathogenic microorganisms, the following 11 clinical isolates were collected: Escherichia coli (two isolates), Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter asburiae, Proteus mirabilis, Citrobacter freundii, Staphylococcus aureus, Enterococcus faecalis, Streptococcus agalactiae, and Candida albicans. To assess the sensitivity of the probiotic strains to antimicrobial drugs, the Gram Positive AST panel (Autobio Diagnostics Co., Ltd, China) was used.

RESULTS: When the microorganisms were co-cultivated with the probiotic lactobacilli (Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14), we noted a decrease in pH and the death of opportunistic microorganisms such as Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter asburiae, Proteus mirabilis, Citrobacter freundii, Staphylococcus aureus, Enterococcus faecalis, and Streptococcus agalactiae, as well as yeast-like fungi Candida albicans. When studying antibiotic resistance, it was found that the both strains of lactobacilli were resistant to ampicillin, vancomycin, daptomycin, clindamycin, linezolid, moxifloxacin, nitrofurantoin, oxacillin, oritavancin, penicillin, rifampin, teicoplanin, tigecycline, trimethoprim/sulfamethoxazole, cefoxitin, ceftarolin, and ciprofloxacin.

CONCLUSIONS: The oral probiotic, which contains a combination of two lactobacilli (Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14), has pronounced antagonistic activity against opportunistic microorganisms. These strains are resistant to most antibacterial drugs used in widespread clinical practice, which may be the basis for recommending the use of this probiotic drug together with prescribed antibiotics for prevention of vaginal or intestinal dysbiosis.

BACKGROUND: Despite the availability of visual examination of the cervix, cervical screening in Russia has not been widespread enough, and therefore the incidence of cervical cancer remains consistently high. In recent years, the vaginal microbiota is given special attention as a risk factor for the development of precancerous diseases of the cervix.

AIM: The aim of this study was to compare the cervicovaginal microbiota in patients with high-grade squamous intraepithelial lesions (HSIL) or negative for intraepithelial lesions or malignancy (NILM).

MATERIALS AND METHODS: Microorganisms isolated from the cervicovaginal microbiota were identified in 40 patients using the mass spectrometry method. 20 women had severe cervical dysplasia, and the other 20 were healthy women without precancerous cervical lesions.

RESULTS: Corynebacterium spp. and Streptococcus spp. were found more often in the cervicovaginal microbiome in patients with high-grade squamous intraepithelial lesions than in women negative for intraepithelial lesions or malignancy.

CONCLUSIONS: The data obtained suggest that the presence of Corynebacterium spp. and Streptococcus spp. in the cervicovaginal microbiota is associated with the presence of severe cervical intraepithelial changes.

BACKGROUND: The effectiveness of in vitro fertilization cycles / frozen-thawed embryo transfer cycles depends on a number of factors, the endometrial one being of great importance. Adequate endometrial and subendometrial blood supply is considered necessary for successful implantation. Currently, the possibilities of non-invasive assessment of the implantation properties of the endometrium are limited to the use of ultrasound.

AIM: The aim of this study was to assess the performance of endometrial and subendometrial three-dimensional power Doppler angiography combined with the Virtual Organ Computer-aided Analysis (VOCAL) method in frozen-thawed embryo transfer cycles on hormone replacement therapy and compare the obtained data among the women examined.

MATERIALS AND METHODS: This prospective study included 20 women. Doppler measurements were carried out three times — on the day of progesterone initiation, the day before embryo transfer and on the day of embryo transfer. The VOCAL software assessed the endometrial and subendometrial volume and blood flow indices such as vascularization index, flow index, and vascularization flow index. Patients were divided into two study groups depending on the onset of clinical pregnancy.

RESULTS: On the day of progesterone initiation among patients who got pregnant, we observed higher vascularization (3.52 ± 1.99 vs. 1.05 ± 1.36; p = 0.03) and vascularization flow (1.54 ± 0.98 vs. 0.63 ± 0.55; p = 0.03) indices compared to women with a negative result. Moreover, endometrial vascularization index on the day of progesterone initiation was positively correlated with the estrogen dose among both pregnant (r = 0.61; p = 0.04) and non-pregnant (r = 0.9; p = 0.0008) women. No differences in subendometrial blood flow indices depending on the onset of pregnancy were obtained, just as endometrial blood flow indices the day before embryo transfer and on the day of embryo transfer were comparable between women in the both study groups.

CONCLUSIONS: Three-dimensional power Doppler angiography evaluated by the Virtual Organ Computer-aided Analysis (VOCAL) method is a promising tool for non-invasive assessment of endometrial receptivity in frozen-thawed embryo transfer programs. However, further studies are required on a larger patient sample to form conclusions that are more accurate.

BACKGROUND: During pregnancy complicated by diabetes mellitus, the risks of developing fetal macrosomia and other perinatal complications increase. Redistribution of blood flow in the fetal umbilical-portal venous system may be an important but poorly understood compensatory mechanism that affects macrosomic fetal growth.

AIM: The aim of this study was to determine the features of the fetal umbilical-portal venous hemodynamics in pregnant women with various types of diabetes mellitus and the absence of carbohydrate metabolism disorders, taking into account the gestational age and the macrosomic fetal growth.

MATERIALS AND METHODS: In this prospective cohort study, 86 pregnant women with pregestational diabetes mellitus, 44 pregnant women with gestational diabetes mellitus and 58 patients without carbohydrate metabolism disorders underwent ultrasound examinations from 30⁺⁰ to 41⁺³ weeks of gestation. During ultrasound, we performed Doppler assessment of venous hemodynamic parameters in the vessels of the umbilical-portal venous system, with volumetric blood flow calculated for each vessel. Additionally, the total liver volumetric blood flow and ductus venosus shunt fraction were calculated.

RESULTS: The presence of fetal macrosomia in patients from the pregestational diabetes mellitus group is associated with an increase in the volumetric blood flow of the umbilical vein by 89.5 ml/min (p = 0.003) and the left portal vein by 33.3 ml/min (p = 0.008), as well as the total volumetric blood flow of the fetal liver by 95.7 ml/min (p = 0.001) compared with normal-weight fetuses. At the same time, the ductus venosus shunt fraction decreased in macrosomic fetuses by 3.83% (p = 0.001). In the gestational diabetes mellitus and control groups, despite the tendency for these parameters to increase in fetuses with macrosomia, the differences did not reach statistical significance. With a left portal vein volume flow threshold of 94.51 ml/min, the sensitivity and specificity for predicting large births were 84.46 and 72.09%, respectively.

CONCLUSIONS: Pregestational diabetes mellitus in the mother is associated with a priority redistribution of blood flow to the fetal liver and is accompanied by a decrease in the ductus venosus shunt fraction. The severity of these hemodynamic changes increases in the presence of fetal macrosomia, which confirms the role of liver perfusion in the regulation of fetal growth in uncomplicated pregnancy and maternal diabetes mellitus.

This analytical review article compares elective induction of labor with expectant management for a tendency to post-term pregnancy and examines its impact on maternal and neonatal outcomes and caesarean section rates. Currently, the issue of management tactics during pregnancy beyond 41 weeks remains hotly debated and requires further research.

BACKGROUND: Women with gestational diabetes mellitus are at high risk of operative delivery. Meanwhile, hyperglycemia affects the metabolism of narcotic analgesics, while increasing their need. Thus, the anesthesiologist is faced with the question of what method of anesthesia to choose for a particular cesarean section.

AIM: The aim of this study was to estimate the features of the perioperative period of cesarean section in patients with gestational diabetes mellitus.

MATERIALS AND METHODS: This prospective, controlled, single-center study enrolled 101 patients who were delivered by planned cesarean sections from April to November 2023. Group 1 included patients with gestational diabetes mellitus on diet therapy (n = 28), group 2 comprised patients with gestational diabetes mellitus on insulin therapy (n = 29), and group 3 (control) included women with a normal pregnancy without carbohydrate metabolism disturbances (n = 44).

RESULTS: The highest initial values of mean arterial pressure were in group 2 and amounted to 91.8 ± 7.0 mmHg. In group 1, the mean arterial pressure was within 89.1 ± 6.4 mmHg, and in group 3, that was 85.9 ± 9.1 mmHg, which was significant (p < 0.05). The sympathetic block developed longer in patients of group 2. In group 1, the sensory block was recorded at the Th_IV–Th_V level after 10.1 minutes and the motor block (Bromage score 3) after 12.2 minutes compared to 7.8 and 8.6 minutes, respectively, in group 2, and 4.5 and 5.1 minutes, respectively, in group 3. In group 2, authors observed the most rapid regression of the block (79.4 minutes after the injection of local anesthetic), which required an earlier start of the transversus abdominis plane block (after 65.3 minutes). The sympathetic block regressed after 86.2 and 138.1 minutes in patients of groups 1 and 3, respectively (p < 0.05), when the transversus abdominis plane block was performed. Thus, immediately after cesarean section, women with gestational diabetes mellitus (especially on insulin therapy) had a higher need for analgesics than those without gestational diabetes mellitus.

CONCLUSIONS: During cesarean section under spinal anesthesia in patients with gestational diabetes mellitus, the rate of development of the sympathetic block is reduced (especially in women who received insulin therapy). At the same time, block regression in these patients occurs much faster, which requires an earlier start of postoperative anesthesia. An increased need for systemic analgesics has been demonstrated during the postoperative period in women with gestational diabetes mellitus, mainly with insulin therapy.

This article sheds light on the personal and professional paths of Professor Viktor Baskakov, who was an outstanding obstetrician-gynecologist, an endometriosis specialist, and the author of the first fundamental scientific works on endometriosis in Russia. The paper explores the milestones of the professor’s scientific career and discusses the peculiarities of clinical work and surgical techniques in the treatment of deep infiltrative endometriosis, in particular. In addition, new methods of management of the early postoperative period, as well as prevention and rehabilitation of gynecological patients are described. Viktor Baskakov was a talented teacher and mentor, a skilled surgeon, a competent scientific and clinical supervisor who had an innovative and bold view of the problems of treatment and diagnosis of endometriosis, which at that time were especially relevant and under-investigated. Special attention is paid to the many memories of colleagues and grateful patients of Professor Viktor Baskakov.