Vol 69, No 1 (2020)

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.

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.

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.

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).

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.

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.

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.

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.