Vol 70, No 2 (2021)

BACKGROUND: Uterine developmental anomalies have a negative impact on the implementation of female reproductive function, leading to a high risk of reproductive failures, premature birth, placental insufficiency, intrauterine growth retardation syndrome, labor anomalies and postpartum bleeding. The presence of both structural anomalies themselves and the high frequency of reproductive failures leads to repeated intrauterine interventions, which are considered as a premorbid background for the endometrial pathology development. Despite the combined causes of reproductive failure, morphological studies of the endometrium in women with various uterine anomalies are scarce.

AIM: The aim of this study was to evaluate the clinical and anamnestic data and morphological characteristics of the endometrium in women with uterine anomalies and reproductive failures in the anamnesis.

MATERIALS AND METHODS: We examined 123 women with uterine developmental anomalies (49 patients with an arcuate uterus, 38 patients with a uterine septum, 16 patients with a bicornuate uterus, 10 patients with an unicornuate uterus, 10 patients with dimetria). Standard clinical and laboratory work-up, hysteroscopy with endometrial biopsy and laparoscopy were performed in all patients. Histological and immunohistochemical examination of the endometrium was carried out according to the standard technique with assessment of the relevant receptor profile (estrogen and progesterone receptors) and pro-inflammatory markers (CD8⁺, CD20⁺, CD4⁺, and CD138⁺).

RESULTS: Clinical and anamnestic data evaluation in patients with uterine anomalies revealed menstrual abnormalities, commonly, dysmenorrhea. Regardless of the type of uterine anomaly, a high incidence of pelvic inflammatory disease, endometriosis and a high frequency of reproductive failures were found. The morphological structure of the endometrium with uterine anomalies was characterized by a higher frequency of endometrial hyperplasia, impaired secretory transformation and the presence of chronic endometritis.

CONCLUSIONS: Patients with a variety of uterine developmental anomalies are characterized by menstrual irregularities, a high incidence of gynecological pathology and reproductive failures. There is no association between pathognomonic signs of endometrial morphofunctional abnormalities and the type of uterine anomaly; however, they are similar to those seen in recurrent miscarriages and infertility of various origins.

BACKGROUND: Despite numerous studies, the etiopathogenesis of preterm birth in multiple pregnancy remains unclear, which determines the low effectiveness of measures for the prevention of preterm birth. This fact makes it necessary to study possible ways of implementing preterm birth in multiple pregnancies and to search for new biomarkers of their pathogenetic links. Experimental and clinical studies have demonstrated the contribution of the pleiotropic hormone relaxin to the regulation of a wide range of physiological processes and its role in the implementation of the pathogenetic mechanisms of pregnancy complications, primarily premature birth. The proven autocrine / paracrine mechanism of placental relaxin action, which implements important local effects, determines the prospects for studying the contribution of its dysregulation to the implementation of spontaneous preterm labor in multiple pregnancies.

MATERIALS AND METHODS: A morphological examination of 92 placentas from 46 deliveries of dichorionic diamniotic twins was performed: 24 of them were spontaneous premature births and 22 spontaneous term births. Histological examination of placentas along with immunohistochemical verification of relaxin 2 expression in the chorionic villus of the dichorial twins’ placentas were carried out.

RESULTS: Histological examination of the dichorionic twins’ placentas revealed that those from spontaneous preterm birth were characterized by a higher frequency of chronic placental insufficiency with reduced compensatory and adaptive mechanisms and more pronounced circulatory disorders in the circulatory bed of the villous tree, when compared to placentas from spontaneous term labor. The first verification of relaxin 2 expression in the chorionic villi of the dichorionic twins’ placenta showed the role of the peptide in the initiation of spontaneous preterm birth. The relative area of relaxin 2 expression in spontaneous preterm labor was significantly higher (p < 0.05) compared to that in spontaneous term labor.

CONCLUSIONS: The data obtained confirm the hypothesis put forward about the involvement of placental relaxin in the pathogenesis of spontaneous preterm labor in multiple pregnancies. The authors were the first to propose the definition of a “relaxin-dependent” way of implementing spontaneous preterm labor. To help define new preventive strategies, the prospects for further studies of the role and significance of relaxin in the implementation of pathogenic processes involved in spontaneous preterm birth in multiple pregnancies have been outlined.

AIM: The aim of this study was to investigate the morphometric features of tissues after exposure to bipolar energy of various electrosurgical generators and surgical hemostatic instruments used in vaginal hysterectomy.

MATERIALS AND METHODS: The study included 48 individuals who underwent a vaginal hysterectomy. The patients were divided in three groups based on the instrument used for sealing blood vessels: a BiClamp^® was applied in Group 1 (n = 16), a TissueSeal PLUS COMFORT^® in Group 2 (n = 16), and a Thunderbeat^® in Group 3 (n = 16). The maximum temperature of tissue measured using a Fluke FLK TIS 40 9HZ thermal imaging infrared camera was compared within the groups.

RESULTS: The maximum tissue temperature between the branches on electroligation, the minimum tissue temperature, and the tissue temperature at the coagulation boundary were significantly lower when using a TissueSeal PLUS COMFORT^® clamp than when using BiClamp^® and Thunderbeat^® clamps (H value = 41.8, p ≤ 0.01). Morphometric parameters (prevalence, coagulation depth and area) were the smallest with a TissueSeal PLUS COMFORT^® clamp compared to other clamps.

CONCLUSIONS: Using a TissueSeal PLUS COMFORT^® clamp during vaginal hysterectomy is effective and safe and has the best thermometric and morphometric characteristics when applied to the tissue, thereby reducing the risk of lateral thermal damage. The possibility of perifocal heat transfer varies with the type of tool and with the temperature at the coagulation boundary.

AIM: The aim of this study was to assess the actual nutrition of pregnant women in the first trimester as the basis for a personalized approach to pregnancy management.

MATERIALS AND METHODS: The actual nutrition during pregnancy was studied by analyzing the frequency of food consumption using the food weighing method, and the average daily indicators were calculated based on data for a period of one week. In total, 417 women were surveyed. The diet was characterized to identify deficiencies of the vitamins and minerals most significant for the reproductive system using the Individual Diet (My Body 3.0 version) software. Descriptive statistics methods were used to quantify the results. In the course of the work carried out, descriptive statistics methods were used.

RESULTS: The energy value of the daily diet of pregnant women averaged 2294.3 ± 487.21 kcal, which is within normal values (2070.0–3507.5 kcal / day), a surplus being observed in almost a third of the respondents (n = 118, 28.3%). The analysis of the diet showed that most of the patients had a deficiency in vitamins, macro- and microelements most significant for the reproductive system. On average, pregnant women consumed 155.0 ± 0.52 μg / day of folic acid with food, no woman receiving enough folic acid to prevent congenital malformations of the fetus. The average dietary intake of iodine was 70 μg / day. Thus, focusing on the recommendations for pregnant women, a diet deficient in iodine was observed in 90% of the respondents, and only five women (1.2%) consumed a sufficient amount of iodine-containing products. It was found that pregnant women consumed 5.9 ± 2.10 mg / day of zinc, with the recommended intake level of more than 12.5 mg / day not recorded in any woman. Iron deficiency was found in 289 respondents (69%). According to the survey results, more than half of the respondents (n = 269, 64.5%) had insufficient selenium intake. Calcium deficiency was registered in half of pregnant women (n = 210, 50.0%). Only every tenth woman (n = 48, 10.0%) consumed a sufficient amount of calcium containing food. Poor magnesium consumption was rarer and was found in only one third of the respondents (n = 135, 32.0%).

CONCLUSIONS: The data obtained indicate the need to study the individual level of actually consumed vitamins and nutrients, which may be the basis for personalized selection of drugs and efficient microelement dosing strategy.

BACKGROUND: Anemia during pregnancy, undiagnosed and untreated promptly, is the cause of various obstetric complications: spontaneous miscarriages, premature birth, placental insufficiency, obstetric bleeding, ante- and intrapartum fetal death.

AIM: The aim of this study was to evaluate the incidence of iron deficiency anemia in pregnant women with different somatotypes and to develop a prognostic model for the pathology onset.

MATERIALS AND METHODS: We examined 390 pregnant women. Somatometry was performed according to the method of R.N. Dorokhov in terms of pregnancy not exceeding 9-10 weeks. Of the examined pregnant women, 110 were of the macrosomatotype, 173 of the meso- and 107 of the microsomatotype. In a clinical blood test, the levels of hemoglobin and red blood cells were determined using well-known methods. Blood iron levels were evaluated by the colorimetric method with ferrozine using a Parma Iron Reagents Kit (Parma Diagnostics Ltd., Russia). Serum hepcidin levels were determined spectrophotometrically using ELISA methods.

RESULTS: Iron deficiency anemia was most commonly detected in pregnant women of the macro- and microsomatotype, when compared to those of the mesosomatotype (p < 0.05). There was no severe anemia in the study groups. The levels of hematological parameters (serum iron and serum hepcidin) were significantly higher in the group of pregnant women with latent anemia, compared to the study group without signs of anemia (p < 0.05). In the second trimester, iron deficiency anemia occurred in the group of patients with latent anemia. Using multiple regression analysis, a formula was obtained for predicting the onset of iron deficiency anemia in pregnant women of different somatotypes.

CONCLUSIONS: Hematological parameters (serum iron and serum hepcidin) should be attributed to markers of iron deficiency anemia and timely predict the onset of pathology. The mathematical formula obtained allows predicting with high accuracy the onset of iron deficiency anemia in pregnant women, taking into account the somatotype in the first trimester of pregnancy, and timely preventing the onset of pathology.

The incidence of type 1 diabetes mellitus is increasing worldwide, and the number of people with vitamin D deficiency in all age groups, including children and adolescents, is simultaneously growing in the world. Over the past decades, it has been found that vitamin D, in addition to participating in the regulation of calcium homeostasis and bone metabolism, has an anti-inflammatory and immunomodulatory effect. Epidemiological evidence suggests the involvement of vitamin D deficiency in the pathogenesis of type 1 diabetes mellitus. Polymorphisms in genes important for vitamin D metabolism also modulate the risk of type 1 diabetes mellitus. Several studies have evaluated the role of vitamin D as adjuvant immunomodulating therapy in patients with newly diagnosed type 1 diabetes mellitus. The purpose of this review is to present current data on the involvement of vitamin D in the pathogenesis of type 1 diabetes mellitus and to evaluate its role as a drug for the prevention of the disease and its use in treatment in addition to insulin therapy.

Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic glycoprotein that promotes proliferation, differentiation and activation of myeloid lineage cells. The abundant presence of G-CSF receptors in the female reproductive system highlights its possible importance in oogenesis, ovulation, implantation, and pregnancy development. This literature review describes the main aspects of G-CSF use in reproductive medicine, such as ovulation induction in women with the luteinized unruptured follicle syndrome, the improvement of folliculogenesis, overcoming repeated implantation failures, therapy of thin endometrium and recurrent pregnancy loss.

This article analyzes a clinical case of feto-fetal transfusion syndrome development in dichorionic diamniotic twin pregnancies with fused placentas. Feto-fetal transfusion syndrome is a typical complication of the monochorionic type of placentation, but it is quite rare in the dichorionic type of placentation. In this case, the syndrome development became possible due to the close anatomical location of the placentas, which probably led to their fusion and the development of unbalanced interplacental anastomoses. During the observation of the patient in an antenatal clinic, no ultrasound signs of feto-fetal transfusion syndrome were detected. At a 25⁺⁵-week gestation period, the patient complained of cramping pains in the lower abdomen and liquid discharge from the genital tract. The patient was hospitalized at the second stage of labor and gave birth through the natural birth canal. The first fetus had polyhydramnios, the second one having extremely low water. The first was a premature boy in the occiput posterior position weighing 980 g and 32 cm in height in a state of severe asphyxia with an Apgar score of 1, 4 and 6 points. The second was a premature boy in breech position weighing 490 g and 32 cm in height, also in a state of severe asphyxia with an Apgar score of 1, 4 and 6 points. The first child developed severe multiple organ failure, which caused death on the twelfth day. The second newborn developed respiratory distress followed by death on the second day of the neonatal period.