Vol 69, No 1 (2020)

Actual Health Care Problems
Cognitive function of pregnant women: the problem of postoperative cognitive dysfunction in women after labor
Shchegolev A.V., Shirokov D.M., Chernykh O.A., Vartanova I.V., Khrabrova M.V.

The problem of postoperative cognitive dysfunction is relevant in obstetrics due to the initial psychophysiological state of a pregnant woman and the high frequency of abdominal delivery everywhere. When choosing the optimal method of anesthesia for a cesarean section, which would minimally affect cognitive functions, it is necessary to consider the impact of anesthesia on the memory and attention of puerperas, as well as their initial cognitive status. To assess memory and attention in women of reproductive age, in our opinion, the most appropriate tests are the MoCA-test, Benton test, Wechsler test, hospital anxiety and depression scale, and a self-assessment questionnaire. These tests are recommended by psychophysiologists and have proven themselves to be well applied in daily clinical practice. Standard test kits with a formalized (quantitative) evaluation of the results allow a rapid assessment of several cognitive functions in a limited time. This review article presents the problem of the cognitive function of pregnant women and postoperative cognitive dysfunction during pregnancy.

Journal of obstetrics and women's diseases. 2020;69(1):7-16
Original Research
Preterm birth in women with diabetes mellitus
Kapustin R.V., Alekseyenkova E.N., Arzhanova O.N., Petyaeva A.V., Atayeva M.G., Yusenko S.R.

Hypothesis/aims of study. Diabetes mellitus (DM) is associated with an increased risk of obstetric complications, including preterm birth (PB). The incidence rate of PB in women with DM is higher than in the general population and amounts to 30–40%. Nevertheless, there are still open questions on the structure of PB, pharmacological approaches to its prevention and treatment, as well as the feasibility of prolonging the timing of glucocorticoid therapy to reduce perinatal morbidity and mortality. The objective of this study was to research the features of structure and clinical approaches in the case of PB in women with different types of DM, based on a literature review.

Study design, materials and methods. The study was performed using literature search, screening, data extraction, and analysis of publications collected in world databases such as MEDLINE, EMBASE, CNKI, and Cochrane.

Results. The rate of PB is the highest in women with pregestational DM: 21–30% in type 1 DM and 19–40% in type 2 DM. The incidence of PB in gestational DM (7–10%) is almost equal to the general population level (7–9%) and depends on the type of diabetes therapy: insulin — 16%, diet — 7%. Risk factors for PB in women with DM are poor glycaemic control, microvascular complications of DM, hypertension, obesity, infection, age, fetal macrosomia, polyhydramnios, and congenital malformations. Adequate glycemic control from early gestation is an important condition for PB prevention. The structure of PB in patients with pregestational DM changes due to an increase in both spontaneous and induced PB proportions. The most common indications for early delivery in DM are preeclampsia, premature placental abruption, impaired renal function in diabetic nephropathy, severe forms of carbohydrate metabolism disorders, diabetic fetopathy, and fetal distress. The risk of fetal respiratory distress syndrome in newborns of mothers with DM is higher than in the general population. The maturity of the lungs of a newborn may be insufficient, even in the case of term delivery. The use of antenatal corticosteroids is effective prophylaxis of respiratory disorders. However, these corticosteroids can increase the risk of neonatal hypoglycemia.

Conclusion. Despite the “term” weight and height, the newborn of a mother with DM may remain immature, therefore, delivery at term is recommended. The gestational age, until which it is advisable to prescribe corticosteroids for pregnant women with DM, and the mode of delivery in the case of PB, remain a matter of debate.

Journal of obstetrics and women's diseases. 2020;69(1):17-26
Hormonal and metabolic features of the androgenic phenotypes of polycystic ovary syndrome and non-classic adrenal hyperplasia with various polymorphic variants in the CYP17A1 gene
Komarov E.K., Mikhnina E.A., Osinovskaya N.S.

The CYP17A1 gene encodes the most important stages of sex steroid biosynthesis by the adrenal glands and ovaries. The objective of this study was to evaluate the hormonal and metabolic status of patients with hyperandrogenia and the CYP17A1 rs743572 gene polymorphism. We examined 106 women with polycystic ovary syndrome androgen phenotypes A, B, and C and 28 women with latent non-classic congenital adrenal hyperplasia. It was found that there were no significant differences in the frequency of CYP17A1 alleles and genotypes between the three phenotype groups of patients with polycystic ovary syndrome. Body mass index and insulin resistance after glucose loading were comparable in individuals with these phenotypes of polycystic ovary syndrome. The CYP17A1 gene polymorphism in patients with different polycystic ovary syndrome phenotypes and in individuals with latent non-classic congenital adrenal hyperplasia did not associate with the concentration of estradiol and androgens in the blood. Neither did LH / FSH ratio differ between groups with different allelic variants of the CYP17A1 gene. These results show that patients with different polycystic ovary syndrome phenotypes do not require differentiated therapy. Serum levels of DHEA-S and cortisol were elevated in 38.7% of women with polycystic ovary syndrome without non-classic congenital adrenal hyperplasia, which indicates an adrenal cause of hyperandrogenia. We suppose that in the diagnosis of polycystic ovary syndrome, it is necessary to define not only phenotypes, but also a suprarenal source of androgens. The therapy of these patients may require application of corticosteroids besides the usual methods in planning of pregnancy.

Journal of obstetrics and women's diseases. 2020;69(1):27-36
Efficiency of the combination of transdermal estrogens and a hormone-releasing intrauterine system for the correction of menopausal symptoms
Medvedevа I.N., Svyatchenko K.S.

Hypothesis/aims of study. The aim of this study was to assess the efficiency of Mirena (levonorgestrel-releasing intrauterine system) combined with EstroGel (17β-estradiol transdermal gel) being applied in the test group of peri- and postmenopausal women as menopausal hormonal therapy.

Study design, materials and methods. The study involved 62 patients aged 42 to 55 years. The main group included 33 women who were prescribed Mirena in combination with EstroGel. The control group consisted of 29 women who were prescribed a combined two-phase tablet preparation containing micronized 17β-estradiol as an estrogen component and dydrogesterone as a gestagen component. The condition of the patients was evaluated at the beginning of therapy and after 3, 6 and 12 months.

Results. During therapy, patients in the main group decreased climacteric symptoms and improved lipid profile and blood biochemical parameters characterizing the hepatobiliary system. Patients in the control group had a comparable decrease in menopausal symptoms; however, there were changes in biochemical parameters, such as hypertriglyceridemia and a significant increase in bilirubin and transaminases, which required discontinuation of therapy. All the patients using Mirena in combination with EstroGel demonstrated good tolerability, efficiency of the therapy and no significant symptoms requiring its withdrawal. During the menopausal hormonal therapy, there were no cases of relapse of endometrial hyperplasia, growth of myomatous nodes and an increase in endometriosis prevalence. Patients in the control group during the first three months of therapy noted acyclic spotting, breast engorgement and tenderness, headaches, and exacerbation of cholelithiasis, which resulted in decreased adherence to therapy.

Conclusion. The use of estrogen transdermally in combination with the intrauterine administration of levonorgestrel is an effective and safe method that helps to relieve menopausal symptoms and to improve the health and quality of life of women with extragenital pathology, endometrial and mammary gland hyperplastic processes, endometriosis, and menometrorrhagia.

Journal of obstetrics and women's diseases. 2020;69(1):37-44
Current trends in the treatment of chronic placental insufficiency
Novitskaya E.V., Bolotskikh V.M., Polyakova V.O., Kvetnoy I.M.

According to literature, intrauterine growth retardation complicates about 5% of pregnancies and is usually caused by chronic placental insufficiency. This article reviews literature data on modern views on the issue. Special attention is paid to the role of melatonin in chronic placental insufficiency and intrauterine growth. Examples of experimental studies demonstrate successful pregnancy course and functional fetal development in animals with melatonin treatment. The data obtained by other researchers on the effect of melatonin on pregnancy, in particular, on chronic placental insufficiency in women, are analyzed. Also in this review, we suggest that melatonin, which is a powerful antioxidant, can reduce morbidity and mortality associated with intrauterine growth retardation.

Journal of obstetrics and women's diseases. 2020;69(1):45-52
The niche in the uterine cesarean scar: a new problem of women’s reproductive health
Nozhnitseva O.N., Bezhenar V.F.

Hypothesis/aims of study. In the recent decades, the quality of uterine suture repair after a cesarean section is widely discussed, as local thinning of the myometrium forming uterine scar defects, or the so-called scar niche, are relatively common after the operation. The aim of this study was to identify the causes of local thinning of the uterine scar after cesarean section, to determine the effectiveness of existing methods for assessing the uterine scar in non-pregnant women, and to develop a method for surgical correction of this pathology.

Study design, materials and methods. Over 4 years, 175 non-pregnant women with a uterine scar were examined. The 50 of them were diagnosed with the uterine scar niche, with a laparoscopic metroplasty performed in these patients. The effectiveness of the operation was evaluated in the long-term postoperative period.

Results. Performing cesarean section because of weakness of labor activity and a complicated course of the postpartum period are significant factors in the formation of a uterine scar niche (p < 0.05). Ultrasound examination and magnetic resonance imaging of the pelvic organs can be used to detect local thinning of the myometrium with a sensitivity of 82% and 96%, and a specificity of 85% and 90%, respectively.

Conclusion. Metroplasty for patients with a diagnosed scar niche can significantly increase the thickness of the myometrium (p < 0.05) and reduce the frequency of complaints of such menstrual irregularities as postmenstrual vaginal bleeding, dysmenorrhea, and hypermenorrhea (p < 0.05).

Journal of obstetrics and women's diseases. 2020;69(1):53-62
Role of doppler in the middle cerebral artery in prediction of fetal distress during labor in uncomplicated pregnancies at 40 weeks and beyond
Rukhlyada N.N., Bolotskikh V.M., Semyonova E.R., Klitsenko O.A.

The aim of this study was to reveal correlation between Doppler in the fetal middle cerebral artery and fetal decompensation during labor in uncomplicated pregnancies at 40 weeks and beyond. We by means of ultrasound Doppler examined 260 women at 40 to 42 weeks of uncomplicated pregnancy 48 hours before delivery, with fetal condition assessed subsequently during labor and immediately after delivery. We found out that in the group of women with caesarean section caused by fetal distress during labor, pulsatility indices in the middle cerebral artery evaluated just before labor were significantly lower than in the group of women whose fetus had better condition during labor. The same trend was observed when comparing Doppler velocimetry using the fetal cerebroplacental ratio. Moreover, we identified that in the group of women with newborns having Apgar 7 and less, middle cerebral artery measured less than 48 hours before delivery were lower than in the group of women having babies in better conditions. Furthermore, as result of this study, the trigger threshold for PI was found to be 0.835, below which fetuses have adverse perinatal outcome during labor. Thus, it was shown that Doppler in the fetal middle cerebral artery in uncomplicated pregnancies at 40 weeks and beyond could predict fetal distress and avoid hypoxic brain damage to the fetus during labor.

Journal of obstetrics and women's diseases. 2020;69(1):63-72
Modern possibilities for the diagnosis of adenomyosis
Shalina M.A., Yarmolinskaya M.I., Abashova E.I.

This review article presents modern data on the diagnosis and pathogenesis of adenomyosis, various classifications of the disease being highlighted. The role of genetic and immunological factors in the development of internal endometriosis is discussed. The results of domestic and foreign studies are presented, with the most informative non-invasive markers for the diagnosis of adenomyosis described.

Journal of obstetrics and women's diseases. 2020;69(1):73-80
Placental microbiota and its role in the development of intra-amniotic infection
Dadayeva D.G.

Microbial invasion of the amniotic cavity and subsequent infection process are the leading cause of adverse pregnancy and postpartum outcomes. Intra-amniotic infection can be caused by both pathogenic and opportunistic microorganisms and viruses, but in the vast majority of cases, intra-amniotic infection is associated with the normal microflora of different body sites. In this review article, the current literature data on the role of the placental microbiota in the adverse pregnancy outcomes and on the sources and mechanisms of intra-amniotic infection are summarized.

Journal of obstetrics and women's diseases. 2020;69(1):81-86
Role of the maternal melatonin circadian rhythm absence in early catch-up growth in children
Evsyukova I.I., Ailamazyan E.K.

The review presents the results of experimental and clinical studies, according to which the absence of circadian melatonin production in pregnant women associated with the pathologies they have (obesity, diabetes mellitus, metabolic syndrome, pregnancy complicated by gestosis and chronic placental insufficiency, etc.) disrupts the genetic process of organizing the rhythmic activity of genes of the suprachiasmatic nuclei of the hypothalamus and melatonin production in the pineal gland of the fetus, leading to dysregulation of metabolic processes in the child’s body after birth and programming pathology in following life. The significance of this factor in the pathophysiological mechanisms of catch-up growth during the first months of life determines a new approach to assessing the risk of obesity and necessitates learning the consequences of impaired development of the brain and other functional systems in fetuses that are born earlier than the 26th week of pregnancy and are thereby deprived of maternal melatonin, a key signaling molecule that directs and coordinates the genetic development process, during the most critical period of early ontogenesis.

Journal of obstetrics and women's diseases. 2020;69(1):87-94
Importance of neurotransmitters in the regulation of the reproductive system
Ivanova A.O., Yarmolinskaya M.I., Tkachenko N.N., Kondratyeva E.A.

Hypothesis/aims of study. Recently, due to empowering the improvement of care for patients with traumatic brain injury and creating effective methods of intensive therapy for severe brain lesions of various genesis, there has been a tendency towards an increased number of patients who have gone out of a coma into an unconscious state — a vegetative state or an unresponsive wakefulness syndrome (BS / UWS). The functions of the brain stem and hypothalamus in patients in a BS / UWS are preserved. The aim of this study was to evaluate the significance of the relationship between the regulation of sex steroid hormones and the secretion of neurotransmitters.

Study design, materials and methods. The study was performed using systematic analysis and compilation of literature data obtained by foreign and domestic authors over the period from 1931 to 2018.

Results. This article reviews publications covering the relationship between the regulation of sex steroid hormones and the secretion of neurotransmitters, as well as their effect on the reproductive system. The theory of neurosecretion depicting the mechanisms of positive and negative feedback of the synthesis of neurotransmitters and sex steroid hormones, and the characteristics of the secretion machineries for sex hormones with normogonadotropic and hypogonadotropic pituitary insufficiency, and nonendocrine manifestations of the pathology of the hypothalamus is highlighted in this review.

Conclusion. The hormonal profile of patients with chronic disorders of consciousness remains almost unstudied. A further study of the hormonal profile in this patient category will create the prerequisites for the development of pathogenetically substantiated hormone-modifying replacement therapy, which may have a positive effect on the dynamics of recovery of consciousness and improve treatment outcomes.

Journal of obstetrics and women's diseases. 2020;69(1):95-108
Quality of birth — a lifetime resource: pre-perinatal aspects in the discussion on personality formation
Brekhman G.I., Brekhman E.A.

Having entered into a long-standing discussion about what is leading in the formation of an individual — genes or parenting — the authors point out the role of the quality of birth as the third equal component of this process. The authors introduced the notion of emergentness in relation to the psychosomatic qualities of a conceived child, distinguishing him from each of the parents and underlying his uniqueness, security and individuality of reactions in the conditions of ambiguity, multifactorial effects (psychological, social, environmental) before and after birth during lifetime.

Journal of obstetrics and women's diseases. 2020;69(1):109-114

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