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Vol 69, No 6 (2020)

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Original Research

Lipid profile in women of reproductive age with various polycystic ovary syndrome phenotypes

Abashova E.I., Yarmolinskaya M.I., Bulgakova O.L., Misharina E.V.


Hypothesis/Aims of study. Dyslipidemia is a common metabolic disorder and is an atherogenic factor in the development of cardiovascular disease in women with polycystic ovary syndrome. Currently, four phenotypes of polycystic ovary syndrome are distinguished, associated in varying degrees of severity with dyslipidemia, insulin resistance, impaired glucose tolerance, and diabetes mellitus on one hand and chronic inflammation and oxidative stress on the other. Hyperandrogenic phenotypes (A, B, C) in polycystic ovary syndrome are associated with the development of adverse metabolic disorders and associated complications. The aim of this study was to evaluate the lipid profile in the serum of women of reproductive age with various polycystic ovary syndrome phenotypes.

Study design, materials and methods. The study included 86 women of reproductive age from 22 to 37 years old (average age was 26.6 ± 4.3 years), who, in accordance with polycystic ovary syndrome phenotypes (A, B, C, D), were divided into four groups. We studied the levels of anti-Müllerian hormone, follicle-stimulating and luteinizing hormones, prolactin, estradiol, and androgens from days 2 to 5 of the menstrual cycle. The levels of progesterone in the blood serum were determined by the enzyme immunoassay on days 20 to 23 of the menstrual cycle for three consecutive cycles. We also used echographic methods for diagnosing polycystic ovaries. All women underwent a biochemical blood test with an assessment of the lipid profile parameters (total cholesterol, triglycerides, high-density lipoproteins (HDL), and low-density lipoproteins, LDL). Besides, an oral glucose tolerance test was assessed with the study of plasma glucose and insulin levels on an empty stomach and two hours after ingestion of 75 g of glucose, the HOMA-IR index being used to assess insulin resistance.

Results. Phenotype A was found in 40 (46.5%) women with polycystic ovary syndrome, phenotype B in 22 (25.6%), phenotype C in 10 (11.6%), and phenotype D (non-androgenic) in 14 (16.3%) patients with PCOS. Of those 42 (48.8%) individuals had changes in carbohydrate metabolism (impaired glucose tolerance), of whom 39 (92.8%) women had androgenic polycystic ovary syndrome phenotypes (A, B, C). Both non-androgenic phenotype D and impaired glucose tolerance were found in 7.2% of cases. In women with hyperandrogenic polycystic ovary syndrome phenotypes, both the fasting and stimulated insulin levels were increased significantly comparing to the non-androgenic anovulatory phenotype (p < 0.05). The HOMA-IR index in women with phenotypes A, B and C was significantly (p < 0.05) higher than in patients with non-androgenic phenotype D. When evaluating the lipid profile parameters, no significant differences in cholesterol level and atherogenic coefficient in women with various polycystic ovary syndrome phenotypes were found. The levels of triglycerides and LDL were significantly (p < 0.05) higher in women with androgenic phenotype B compared to those in patients with non-androgenic phenotype D and they correlated significantly (p < 0.05) with the serum levels of androgens and sex hormone-binding globulin (SHBG). Patients with androgenic polycystic ovary syndrome phenotypes (A and B) had significantly (p < 0.05) decreased HDL levels that correlated negatively (r = –0.29; p < 0.05) with the levels of free testosterone and SHBG, when compared to the same parameters in women with non-androgenic phenotype D. In women with androgenic polycystic ovary syndrome phenotypes (A, B, C), a significant correlation (r = 0.27; p < 0.05) between the levels of stimulated insulin and SHBG were found, and a direct relation (r = 0.32; p < 0.05) between those parameters and increased levels of triglycerides and LDL was also revealed.

Conclusion. In women with hyperandrogenic and anovulatory polycystic ovary syndrome phenotypes A and B, atherogenic dyslipidemia and impaired carbohydrate metabolism were significantly more pronounced, when compared with patients with non-androgenic phenotype D. A differential and personalized approach to the examination of patients with various polycystic ovary syndrome phenotypes is an important step in the prevention of the risks of developing cardiovascular diseases in women of reproductive age.

Journal of obstetrics and women's diseases. 2020;69(6):7-16
pages 7-16 views

Informative application of the instrumental diagnosis of scar integrity in the experimental model of the uterine cavity

Alekseeva A.Y., Mochalova M.N.


Currently, the frequency of deliveries by cesarean section is steadily increasing. Independent childbirth in women with a uterine scar is one of the mechanisms of its reduction. Meanwhile, the delivery of this category of patients through the natural birth canal requires the development of a safe and effective method for assessing scar integrity in the early postpartum period. For this purpose, a new instrumental diagnostics method has been developed, with its information content compared to manual examination data in an experimental model of the uterus. Each model was made of a bovine heart and had three defects with diameters less than 0.5 cm, 0.5-0.8 cm and 0.8-1.2 cm. Defects with diameters less than 0.5 cm were not detected by any of the methods studied. Defects with a diameter of 0.5-0.8 cm were detected using the developed device in 90 % (45/50) of cases and using manual examination in 44 % (22/50) of cases (χ2 = 23.93, p < 0.001), defects with a diameter of 0.8-1.2 cm being detected in 100% (50/50) and 98% (49/50) of cases, respectively (χ2 = 1.01, p = 0.32). The information content of the instrumental model exceeds that of the manual study by 1.34 times (RR = 1.34, 95 % CI 1.09-1.65, p < 0.05). Therefore, the possibility of testing this device in clinical trials needs to be considered.

Journal of obstetrics and women's diseases. 2020;69(6):17-22
pages 17-22 views

Clinical features and etiology of postpartum endometritis in women with a high risk of purulent-septic complications

Batrakova T.V., Zazerskaya I.E., Dolgo-Saburova Y.V., Vasilyeva E.Y., Saprykina D.O.


Hypothesis/Aims of study. Postpartum purulent-septic complications continue to rank third in the structure of maternal mortality. In the etiology of postpartum endometritis, the key role is played by opportunistic microflora, including associations of microorganisms, as well as a history of chronic urogenital infection, bacterial vaginosis, and sexually transmitted infections. Despite numerous studies, the question of which microorganisms colonizing the birth canal are potentially dangerous in relation to the development of infectious and inflammatory pathology of the postpartum period is still a subject of discussion. The aim of this research was to study the etiology and identify the clinical features of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications.

Study design, materials and methods. This retrospective comparative study included 199 puerperas, who were divided into two groups: the main group consisted of women who developed postpartum endometritis (n = 72), and the comparison group comprised women with the physiological course of the postpartum period (n = 127). Bacteriological examination of lochia was performed on the third day of the postpartum period, as well as with the development of postpartum endometritis before empirical antibiotic therapy was started.

Results. During the bacteriological study of lochia in the main group of patients, potentially pathogenic microorganisms were observed in 68 % of puerperas, with the pathogen of endometritis not detected with repeated crops of lochia in 32 % of postpartum women. In the comparison group, this proportion was only 15 % (p < 0.005). During pregnancy, the release of microorganisms from the cervical canal was observed in 26.4 % of cases in the main group and in 7 % of cases in the comparison group of puerperas (p < 0.005). Despite the absence of clinical symptoms, all patients received systemic antibacterial therapy. Subsequently, 90 % of maternity patients in the main group revealed the ineffectiveness of empirical therapy due to antibiotic resistance of the identified microflora. When analyzing the species composition of microorganisms, intestinal microflora in monoculture was more often isolated in the patients of the main group: Escherichia coli (40 % vs. 2.4 % in the comparison group) and Enterococcus faecalis (25 % vs. 4.7 % in the comparison group). In 10 % of postpartum women with severe purulent-septic complications (sepsis, parametritis, pelvioperitonitis), the composition of the released microflora in lochiae did not differ from that of maternity women with endometritis without severe purulent-septic complications, and microbial associations were only detected in two cases.

Conclusion. The etiological cause of postpartum endometritis in puerperas with risk factors for the development of purulent-septic complications is intestinal bacteria (Escherichia coli, Enterococcus faecalis) more often detected as a monoculture. The species composition of microorganisms that cause severe forms of postpartum purulent-septic complications does not differ in principle from the pathogens of uncomplicated forms of postpartum infection. Unreasonable antibacterial therapy during pregnancy is associated with antibiotic resistance of microorganisms that cause postpartum endometritis, which poses significant difficulties in the selection of antibacterial drugs for its treatment.

Journal of obstetrics and women's diseases. 2020;69(6):23-30
pages 23-30 views

Case reports of patients with chronic disorders of consciousness in obstetric and gynecological practice

Ivanova A.O., Kondratyeva E.A., Yarmolinskaya M.I., Misharina E.V., Florova M.S., Kondratyev A.N.


According to the modern classification system, chronic disorders of consciousness are defined as an altered state of consciousness that develops after coma and is accompanied by the restoration of wakefulness without the complete recovery of conscious activity for more than 28 days after traumatic brain injury. Clinical cases of chronic chronic disorders of consciousness development in women after surgical interventions related to various obstetrical and gynecological pathologies, as well as after routine surgical interventions for comorbid somatic pathology, are of particular interest to obstetricians and gynecologists. In the presented chronic chronic disorders of consciousness related clinical cases of operations for ectopic pregnancy, as well as consequences of elective surgery for gallstone disease, the development of hypo- and normogonadotropic ovarian insufficiency associated with chronic disorders of consciousness is described. The characteristics of the thyroid status, adrenocorticotropic function, and vitamin D levels are given. Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to determine informative markers for prognostication of outcomes, as well as to develop new effective approaches to consciousness rehabilitation in this category of patients.

Journal of obstetrics and women's diseases. 2020;69(6):31-42
pages 31-42 views

Urethrovesical segment ultrasound for the efficacy evaluation of surgical treatment of stress urinary incontinence

Kira K.E., Bezhenar V.F., Prokhorova V.S.


Hypothesis/Aims of study. At present, there is no doubt about the importance of the problem of female stress urinary incontinence (SUI) and the search for the best way to eliminate it. Sling operations in SUI treatment are the most popular in world and domestic practice. However, they are not without certain complications. In this regard, it becomes relevant to determine the factors for predicting their effectiveness and safety. The aim of this study was to conduct a comparative study of the effectiveness of two anti-stress operations: TVT-Obturator® and urethrovesicopexy with vaginal flap, by using echography of the urethrovesical segment.

Study design, materials and methods. During the period from 2011 to 2018, 105 incontinent patients were examined and operated on. Two groups were formed: Group 1 consisted of 52 patients who underwent TVT-Obturator® surgery, Group 2 included 52 patients who underwent urethrovesicopexy with vaginal flap. In all patients, the anatomical topographic position of the bladder and urethrovesical segment, the internal urethral sphincter status, as well as the angles α and β were determined, based on which the conclusion about the type of SUI was made and, accordingly, the adequate method of surgical intervention was determined.

Results. Before the operation, the angle α averaged 37.2 ± 10.11, with 24.7 ± 4.64 a year after the operation and 26.8 ± 3.72 five years after the operation. Rotation of the angle α in the study groups >20° before surgery did not significantly affect the presence of long-term complications, urinary retention after a year and five years, and recurrence of urinary incontinence. After the operation, there was an increase in the angle β after a year (p = 0.0032) and five years (p = 0.0035) and in the total urethral length after a year (p = 0.0022), but after five years, this parameter did not differ significantly from that before surgery (p = 0.29).

Conclusion. TVT-Obturator® and urethrovesicopexy with vaginal flap are equally effective (p > 0.05) in the surgical treatment of female SUI in both the nearest postoperative period (96.2% and 94.3%, respectively) and the distant period (90.4% and 88.7%, respectively).

Journal of obstetrics and women's diseases. 2020;69(6):43-48
pages 43-48 views

Integral assessment of markers of the local infectious and inflammatory process in women with preterm birth in multiple pregnancies

Kosyakova O.V., Bespalova O.N., Budilovskaya O.V., Savicheva A.M.


Hypothesis/Aims of study. Premature birth in multiple pregnancies remains an important object of research, since it is the main factor in poor perinatal outcomes, and their heterogeneous mechanisms determine the ineffectiveness of prediction and prevention methods. In the pathogenesis of premature birth, as is known, one of the leading links is inflammation caused by infections of the lower genital tract (40%). In multiple pregnancies, which in most cases occur as a result of assisted reproductive technology treatment (70%) and are mainly accompanied by complications, pregravid preparation and antenatal observation include more careful control and correction of local infectious and inflammatory processes. In this regard, the persisting high rate of premature birth in multiple pregnancies (about 54%) demonstrates the ambiguity of the opinion about the suppressive role of the infectious factor in the induction of premature birth and determines the need for studying its contribution to multifactorial genesis. The aim of this study was to conduct an integral assessment of markers of the local infectious and inflammatory process in women with PB in multiple pregnancies.

Study design, materials and methods. We performed a comprehensive study of the bacteriological composition of the lower genital tract discharge using microscopic, bacteriological, and molecular biological methods (Femoflor 16 test) and assessed the local inflammatory status (ImmunoQuantex test) in 30 pregnant women with dichorionic diamniotic twins. The main group consisted of women with premature birth (n = 13), the control group comprising those with term birth (n = 16), while patients with induced premature birth (n = 2) were not included in the comparative analysis.

Results. This study was the first to determine the features of vaginal microbiocenosis and the local immune status in women with premature birth in multiple pregnancies. In general, the study cohort had a low inflammatory status and normal or intermediate types of vaginal biotope. The most common disruptions (24.1%) were vaginal dysbiosis, expressed in a small amount of Lactobacillius spp., and non-specific vaginitis associated with Mycoplasma hominis. The local immune status of women with premature birth was characterized by a relative decrease in the mRNA expression of such innate immunity genes as IL1B, TNFα, TLR4, and GATA3. An integrated assessment of the studied parameters based on the data obtained allowed us to build a mathematical model for predicting premature birth with the probability of 87.6%.

Conclusion. The integral assessment of infectious and inflammatory markers is important from the standpoint of not only their possible identification as predictors, but also a general understanding of the genesis of premature birth.

Journal of obstetrics and women's diseases. 2020;69(6):49-60
pages 49-60 views

Suboptimal response to controlled ovarian stimulation in IVF / ICSI cycles

Nguyen C., Niauri D.A., Dzhemlikhanova L.K., Kogan I.Y., Krikheli I.O., Mekina I.D., Lesik E.A., Komarova E.M., Ishchuk M.A., Gzgzyan A.M.


Hypothesis/Aims of study. Currently, the frequency of suboptimal response (4-9 retrieved oocytes) to controlled ovarian stimulation (COS) in woman is quite high; however, its efficacy is poorly studied. The aim of this study was to evaluate the main characteristics of IVF / ICSI programs in patients with a suboptimal response to COS.

Study design, materials and methods. We performed a retrospective study of 412 IVF / ICSI cycles in women with a suboptimal response to COS, including a comparative analysis of clinical and embryological parameters, ovarian reserve and the efficacy of IVF / ICSI protocols.

Results. Clinical pregnancy rate in ovarian stimulation cycles with a suboptimal response to COS was 27.9%. The efficacy of assisted reproductive technology (ART) programs in women with uterine fibroids was significantly lower than in patients without fibroids (19.1% vs. 30.5%, p = 0.03; OR = 0.54; 95% CI: 0.31-0.95). Clinical pregnancy rate in patients with male factor infertility was significantly higher than in women with anovulation (37.1% vs. 20.9%, р = 0.005; OR = 2.24; 95% CI: 1.27-3.94) or tubal factor infertility (37.1% vs. 24.8%, р = 0.02; OR = 1.79; 95% CI: 1.09-2.94). There were significant correlations between the number of retrieved oocytes with serum anti-Müllerian hormone (AMH) concentration (r = 0.32, p < 0.001) and antral follicle count (AFC) (r = 0.38, p < 0.001). In addition, the need for follicle-stimulating hormone (FSH) preparations during COS correlated significantly with ovarian reserve parameters (AMH and AFC) (r = –0.45 and –0.44, both p < 0.001, respectively) and the age of patients (r = 0.47; p < 0.001).

Conclusion. The clinical pregnancy rate in women with a suboptimal response to COS was low. Concomitant uterine fibroids represented an additional factor of negative influence on IVF / ICSI outcomes in women with a suboptimal response to COS. The male factor of infertility in patients with a suboptimal response did not reduce the efficacy of ART programs. Ovarian reserve parameters in women with a suboptimal response correlated with the need for FSH preparations during COS and the number of retrieved oocytes.

Journal of obstetrics and women's diseases. 2020;69(6):61-70
pages 61-70 views

New coronavirus infection and pregnancy

Oganyan K.A., Shalepo K.V., Savicheva A.M., Bespalova O.N., Kogan I.Y.


The novel coronavirus infection (COVID-19), first reported in Wuhan, China in December 2019, is dangerous for pregnant women, and the probability of infection is the same as in the general population. COVID-19 may be transmitted from person to person through two different routes: airborne and direct contact. Diagnosis of COVID-19 requires the detection of SARS-CoV-2 RNA by reverse transcription polymerase chain reaction. The main biomaterial for laboratory research is discharge from the nasopharynx and (or) oropharynx. The incubation period for COVID-19 is thought to last from 2 to 14 days, with a median time of 4–5 days. The causative agent of COVID-19 can be detected in the upper respiratory tract 1–2 days before and within 7–14 days after the onset of symptoms. The disease can occur with mild-to-moderate severity, and manifests itself as a respiratory infection (runny nose, sore throat, low-grade fever, with no viral pneumonia and hypoxia). Severe COVID-19 may develop pneumonia, respiratory distress syndrome, sepsis, septic shock, cardiomyopathy, arrhythmia, renal failure, and other complications up to multiple organ failure. Pregnant women with COVID-19 may have complications of pregnancy, such as miscarriage, premature discharge of amniotic fluid, and premature birth. There are no reports of vertical transmission, but some newborns develop intrauterine growth retardation and life-threatening gastrointestinal complications. Thus, pregnant women with a confirmed diagnosis or suspicion of COVID-19 are at high risk for developing pregnancy complications and adverse perinatal outcomes. Currently, information is being collected on COVID-19 cases in pregnant women, the course of infection, and perinatal outcomes.

Journal of obstetrics and women's diseases. 2020;69(6):71-80
pages 71-80 views

Pathomorphological features of the endometrium in patients with abnormal uterine bleeding in the presence of uterine leiomyoma

Rumyantseva Z.S., Sulima A.N., Volotskaya N.I., Zyablitskaya E.Y., Anikin S.S., Glazkov I.S., Keshvedinova A.A.


Hypothesis/Aims of study. One of the problems discussed in the field of obstetrics and gynecology is the combined pathology of the reproductive system. Among the female reproductive system disorders associated with uterine leiomyoma, endometrial pathology prevails in the form of local inflammatory, receptor and hormonal changes. The aim of this study was to evaluate the structural features of the endometrium and its receptivity in patients with uterine leiomyoma, depending on its histological type and localization.

Study design, materials and methods. We examined 128 women with leiomyoma manifesting abnormal uterine bleeding, using clinical, instrumental and morphological methods.

Results. Combined pathological changes in the endometrium are more characteristic of submucous leiomyoma compared to intramural and subserous leiomyomas. The proliferative activity of endometrial cells in submucous leiomyoma is two or more times higher than in intramural and subserous leiomyoma. In submucous leiomyoma, cell proliferation occurs significantly more often than in other locations of myomatous nodes.

Journal of obstetrics and women's diseases. 2020;69(6):81-89
pages 81-89 views

Morphological features of the placenta in obese women

Seryogina D.S., Sosnina A.K., Tral T.G., Tolibova G.K., Mozgovaya E.V.


Hypothesis/Aims of study. Obesity and severe chronic somatic pathology in a woman leads to a rapid depletion of compensatory and adaptive reserves of the placenta and to the progression of circulatory and dystrophic changes, which causes intrauterine growth retardation and reduces the likelihood of a favorable course of pregnancy and childbirth. The aim of this study was to assess the morphological features of the vascular component of placental villi in obese women.

Study design, materials and methods. Histological and immunohistochemical studies were conducted on 41 placentas from obese patients with and without gestational diabetes mellitus and from healthy patients, endothelial marker CD34+ expression being assessed in chorionic villi.

Results. In obese patients, chronic placental insufficiency is presented in most cases as a dissociated form with persistence of not only mature but also immature villi, which indicates early structural pathology of the placenta.

Conclusion. Obesity in women contributes to more frequent chronic placental insufficiency with severe circulatory disorders and varying degrees of severity of compensatory and adaptive changes.

Journal of obstetrics and women's diseases. 2020;69(6):91-98
pages 91-98 views


Role of maternal melatonin in the development of the microbiome in children

Evsyukova I.I., Ailamazyan E.K.


This review presents literature data on the role of melatonin in regulating the composition of the microbiota and on the variety of functions it performs that are synchronized with the circadian rhythm of vital activity of the body. During pregnancy, the restructuring of the intestinal, vaginal and placental microbiota is provided by a significant increase in the production of epiphyseal melatonin, which contributes to the creation of optimal conditions for the development of microflora in early ontogenesis. In the absence of circadian production of melatonin, a pregnant woman retains dysbiosis, which determines the transmission of altered intestinal microflora to the fetus and subsequent metabolic dysregulation in the child’s body.

Journal of obstetrics and women's diseases. 2020;69(6):99-105
pages 99-105 views

Prevention of mother-to-child HIV transmission: from the first stages to the possibility of elimination

Mozalyova O.L., Samarina A.V.


Despite the success in reducing mother-to-child HIV transmission rate worldwide, the problem of perinatal HIV transmission is still relevant. Sexual activity nowadays is the predominant way of transmission, therefore the number of HIV cases among women growths. This leads to an increased number of pregnancies and childbirth in HIV-infected women. Better preventive treatment has decreased the transmission risk to 1% or less. Despite this, the Russian Federation is still not among the countries where the elimination of mother-to-child transmission has been recorded. This review article focuses on the main stages of mother-to-child transmission prevention from the time that no antiretroviral therapy was available to the current stage, when highly active antiretroviral therapy is used during pregnancy, childbirth and for the treatment of newborns. The research provides a comparative analysis of modern national and international clinical recommendations for the prevention of mother-to-child HIV transmission.

Journal of obstetrics and women's diseases. 2020;69(6):107-116
pages 107-116 views

Possibilities of intrapartum fetal monitoring at the present stage

Mochalova M.N., Mudrov V.A.


The intrapartum period is one of the most crucial stages for both the mother and the fetus. During the delivery process, complications can develop that lead to a deterioration in the condition of the fetus and threaten his life. Therefore, the outcome of labor depends on the effectiveness of fetal monitoring. The aim of this study was to define the possibilities of intrapartum fetal monitoring at the present stage of research. We systematically analyzed and summarized the literature data of foreign and domestic authors for the period from 1997 to 2020. An integrated approach to assessing intrapartum fetal status will optimize the management of labor, which will improve perinatal outcomes in the future.

Journal of obstetrics and women's diseases. 2020;69(6):117-130
pages 117-130 views

Discussion issues of management of pregnant women with thrombocytopenia

Mysik O.L.


The study of the pathogenesis of thrombocytopenia during pregnancy remains a very important problem, since hemostatic abnormalities continue to occupy one of the leading places among the causes of infertility, miscarriage and a large number of perinatal complications. Pregnant women with thrombocytopenia constitute a risk group for the development of bleeding events and thrombotic complications during pregnancy, in childbirth, and in the postpartum period. This article reviews literature data on the pathogenic causes of thrombocytopenia during pregnancy and on the main methods of treatment of the disease.

Journal of obstetrics and women's diseases. 2020;69(6):131-139
pages 131-139 views

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