Vol 69, No 4 (2020)

Hypothesis/aims of study. To date, intranatal injuries of the genital tract and their adverse effects on the woman’s body remain one of the most important issues in obstetrics and gynecology. Despite the improved management of childbirth, the frequency of the birth canal tissue injuries has no tendency to decrease and amounts to 10.2–39.0%. The aim of this study was to assess the possibility for predicting intranatal perineal injuries.

Study design, materials and methods. The study included a prospective analysis of 90 cases of labor through the natural birth canal based on data obtained from Ufa and Chita perinatal centers in the years 2017–2019. To determine the elasticity of perineal tissues, a perineoelastomer has been developed, which allows expressing the elasticity of the vulvar ring tissues by a special conditional coefficient. Data was processed using the IBM SPSS Statistics V25.0 software package.

Results. Based on the assessment of the obtained data, a probability coefficient of perineal injuries was developed. Its calculation is based on a nonlinear regression analysis and is expressed by the formula: T = (100 ∙ CFH) / (PAA ∙ FBD ∙ ε ∙ π), where CFH is the circumference of the fetal head at the level of visual tubercles (mm), PAA is the pubic arch angle (degrees), FBD is the distance from the front to the back of the adhesion of the vulvar ring (cm), ε is the coefficient of elastic deformation of the perineum. When the coefficient T is more than 1, perineal rupture in labor is predicted.

Conclusion. In the development of obstetric injuries of the perineum, a major role is played by the ratio of the circumference of the fetal head and the maximum perimeter of the extension of a vulvar ring, which, together with the value of the pubic arch angle and the coefficient of elastic deformation of the perineum, may be a criterion in favor of performing surgical protection of the perineum in case of a threatening rupture.

Hypothesis/aims of study. Poor placental vascularization can lead to placental insufficiency, due to which the metabolism of nutrients and microelements between the maternal and fetal blood circulations subsequently decreases. Due to poor perfusion of placental vessels, placental dysfunction occurs. Chronic fetal hypoxia causes fetal growth retardation. The aim of this study was to assess the frequency of placental insufficiency in women with different somatotypes and to develop a model for predicting the risk of this pathology.

Study design, materials and methods. A total of 390 women were examined, of whom 110 were macrosomatic, 173 mesosomatic, and 107 microsomatic. Somatometry was performed according to R.N. Dorokhov for women in the early stages of pregnancy (up to 9-10 weeks). Placental insufficiency markers (VEGF, PlGF, IL-6, and endocan-1) were determined spectrophotometrically in blood serum at the gestational age of 12–13 and 22–23 weeks using ELISA methods.

Results. Placental insufficiency was significantly more prevalent among the women of the macro- and microsomatic body type compared with those of mesosomatotypes (p < 0.05). In pregnant women with subsequent placental insufficiency, VEGF and PlGF serum levels at 12–13 weeks were lower, when compared to those in patients who did not develop pathology (p < 0.05), and the levels of serum endocan-1 and IL-6 were higher in comparison with those in individuals who did not develop pathology (p < 0.05). Using multiple regression analysis, we obtained the regression equation (formula), which predicts the development of placental insufficiency in women of different somatotypes.

Conclusion. The resulting formula allows us to accurately predict the development of placental insufficiency and to form high-risk groups among women for the development of this disease. This will contribute to the effective implementation of therapeutic and preventive measures to avert the development of this pathology.

Thrombotic microangiopathies during pregnancy and puerperium are rare and, if undiagnosed, can be life-threating conditions for both the mother and the baby. The aim of this review article is to briefly describe clinical profile and highlight the clues for a correct diagnosis of pregnancy-related thrombotic microangiopathies. Of particular interest and important practical significance are the presented data on changes in the hemostatic system in patients with a new coronavirus infection COVID-19 through the prism of thrombotic microangiopathies.

This article reviews the literature data on the mechanisms of the obesity effect on the in vitro fertilization (IVF) clinical efficacy and discusses the main directions of improving assisted reproductive technology data for overweight women. It was noted that the multi-level effect of obesity is manifested by a decrease in the frequency of clinical pregnancy with IVF, these women having a higher frequency of pregnancy complications, with, in particular, the risk of spontaneous miscarriages increased. It is believed that such disorders are associated with changes in the morphology of oocytes and embryos in this category of patients, as well as with impaired endometrial receptivity. A number of studies have shown that achieving normal body weight through lifestyle modifications that include healthy eating and exercise for several months before and during the IVF program and contribute to gradual and sustained weight loss can significantly improve the assisted reproductive technology outcomes.

Adenomyosis is a common benign condition, often diagnosed in women of reproductive age with dysmenorrhea and polymenorrhea, miscarriage and infertility. Previously, it was believed that the pathological process was associated with intrauterine interventions, parturition or endometriosis diagnosed by histological examination as the gold standard. Currently, adenomyosis is perceived as an independent disease, the etiology and pathogenesis of which are based on complex molecular, genomic and immune processes, also occurring in women without a burdened maternal obstetric and gynecological history. Modern non-invasive diagnostic methods, such as ultrasonography and magnetic resonance imaging, have high sensitivity and specificity and are successfully used for diagnosis of adenomyosis. One of the main initial morphological and functional signs of the disease is a change in the so-called J-zone (junctional zone, JZ), which is the transitional part of the myometrium. Its subendometrial layer has unique structural organization, immunohistochemical structure and functional activity, which remains not fully understood. Data on the effect of adenomyosis on the course and outcome of pregnancy are mixed. This article presents a literature review of world studies on the etiology, pathogenesis and diagnosis of adenomyosis and its effect on fertility.

Polycystic ovary syndrome (PCOS) is a common endocrine pathology that affects 8–14% of women of reproductive age. The leading signs of the disease are hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Over the past decades, a variety of animal models have been developed to study the etiology and pathogenesis of PCOS, including chemical, hormonal, and genetic interventions. However, a large number of experimental techniques differ even in the framework of a single model. In this review article, we summarized PCOS animal models using both direct hormonal effects and indirect methods.

A clinical observation of endometrioid infiltrate of a postoperative scar formed as a result of surgical delivery by cesarean section is presented in this article.