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Vol 70, No 5 (2021)

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Current public health problems

Maternal mortality: structure and solutions to the problem

Ziganshin A.M., Nagimova E.M., Marakanov R.M., Mudrov V.A.

Abstract

Maternal mortality is the most important indicator of women’s health, but its level is still high. In 2018, 146 cases of maternal death were registered in the Russian Federation. Its main causes were extragenital diseases, bleeding, preeclampsia and eclampsia, amniotic fluid embolism, clinical narrow pelvis, and unsafe abortion. The aim of this study was to assess the structure of maternal mortality in recent years and to evaluate possible ways to reduce it. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on the maternal mortality issue. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the creation until July 2021. The measures adopted so far do not allow for counting on a further decrease in maternal mortality rate, therefore the coming decade requires the introduction of artificial intelligence technologies.

Journal of obstetrics and women's diseases. 2021;70(5):5-14
pages 5-14 views

Original Research

Virulence and pathogenicity factors of S. agalactiae strains isolated from pregnant women and newborns

Kolousova K.A., Shipitsyna E.V., Shalepo K.V., Savicheva A.M.

Abstract

BACKGROUND: Obstetric and neonatal infections caused by Steptococcus agalactiae are among the most significant perinatal infections. To date, intrapartum antibiotic prophylaxis is used to prevent the transmission of the pathogen to the child, however, the growth of antibiotic resistance and ineffectiveness of therapy against late-onset neonatal infection are its limitations. Vaccination is considered to be the most effective method for preventing diseases caused by S. agalactiae in both pregnant women and newborn babies. To identify promising vaccine targets and to develop alternative prevention approaches, it is necessary to study the virulence factors of S. agalactiae strains and their variability in the population.

AIM: The aim of this study was to evaluate the variability of virulence and pathogenicity factors (capsular polysaccharides, pili, hypervirulent sequence type ST-17, biofilm-forming ability, antibiotic resistance) of S. agalactiae isolated from pregnant women and newborn infants in St. Petersburg, Russia.

MATERIALS AND METHODS: We studied isolates of S. agalactiae out of clinical material samples obtained from pregnant women and newborns at the D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology in 2018-2020. The PCR method was used to determine the types of capsular polysaccharides, pili, and strain affiliation with the hypervirulent sequencing type ST-17. Biofilm-forming ability was determined by the Christensen method. The antibiotic sensitivity was determined by disc diffusion.

RESULTS: We examined 60 clinical isolates of S. agalactiae. The most common S. agalactiae serotypes were Ia, Ib, II, III, IV, and V; in total, these six serotypes accounted for 95.1% of all strains. The most common pili genotype was PI-1 + PI-2a (60%). Resistance to erythromycin was found in 36.7% of the strains, and a similar number of the strains were resistant to clindamycin. The ability to form biofilms was detected in 68% of the strains, and the increased ability was associated with the PI-2b pili allele.

CONCLUSIONS: A hexavalent vaccine based on capsular polysaccharides of types Ia, Ib, II, III, IV, and V would have a 95% efficacy in this region. Stable distribution of different pili types is an important factor when using pili as vaccine targets. The high level of resistance of S. agalactiae strains to erythromycin and clindamycin indicates that isolates should be tested for sensitivity to these antibiotics before their use, and regular regional monitoring of antibiotic resistance of the pathogen to update clinical guidelines should be performed.

Journal of obstetrics and women's diseases. 2021;70(5):15-22
pages 15-22 views

Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

Kondratyeva E.A., Ivanova A.O., Yarmolinskaya M.I., Potyomkina E.G., Dryagina N.V., Zybina N.N., Andreeva N.Y., Kondratyev A.N.

Abstract

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation.

AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness.

MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid.

RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state.

CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

Journal of obstetrics and women's diseases. 2021;70(5):23-36
pages 23-36 views

Clinical significance of predictive and diagnostic indices of fetal pathology associated with placental insufficiency in women with endometriosis

Lipatov I.S., Tezikov Y.V., Amosov M.S.

Abstract

BACKGROUND: Modern achievements of pharmacology, surgery and reproductive medicine have determined an increase in the implementation of reproductive function in endometriosis of various localization. The onset of pregnancy in presence of impaired endometrial receptivity and progesterone resistance, pro-inflammatory and pro-thrombotic status, abnormal functioning of the immune system, structural changes in the reproductive organs leads to impaired formation of the embryo (feto) placental system, early reproductive losses, complicated pregnancy and adverse perinatal outcomes. In this regard, the “endometriosis and pregnancy” issue requires close study and specific proposals to optimize pregnancy management.

AIM: The aim of this study was to develop predictive (PIs) and diagnostic (DIs) indices of placenta-associated fetal pathology in pregnant women with endometriosis, to determine their prognostically and diagnostically significant parameters.

MATERIALS AND METHODS: This prospective study in the dynamics of gestation included a comprehensive clinical and laboratory examination of 175 pregnant women with endometriosis (100 subjects with adenomyosis and 75 subjects with ovarian endometriosis). To develop PIs and DIs, two comparison groups with fetal pathology due to placental insufficiency were retrospectively identified, depending on the location of endometriosis. Group I consisted of 49 pregnant women with adenomyosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia; Group II comprised 29 pregnant women with ovarian endometriosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia. The control group (Group III) included 30 healthy pregnant women with a normal course of gestation. The examination was performed at 10-14 weeks, 20-24 weeks, and 28-34 weeks of gestation and included an assessment of placental insufficiency markers such as placental growth factor (PlGF), placental α-1-microglobulin (PAMG-1), tumor necrosis factor (TNFα), lymphocytes with membrane receptor FasR (L CD95+), C-reactive protein, placental alkaline phosphatase (PAPh), and fetal hemoglobin (HbF). The information value of individual parameters and indices was determined by ROC analysis, odds ratio, and clinical epidemiology tests.

RESULTS: Pregnancy in presence of endometriosis in 100% of cases was complicated by placental insufficiency of varying severity (with fetal pathology in 81.5% of cases), the frequency of which had statistically significant differences between the groups of pregnant women with adenomyosis and ovarian endometriosis (χ2 = 4.06, p = 0.04). To predict growth retardation and / or chronic fetal hypoxia, we have developed PI I (PlGF / TNFα × 100) and PI II (PAMG-1 / PlGF × 100), which characterize the state of placental angio-and vasculogenesis depending on systemic inflammatory response level. For early diagnosis of fetal pathology, we have proposed DI I (CRP / PAPh × 100), DI II (HbF / PlGF × 100) and DI III (L CD95+ / PAPh × 100), which allow for diagnosing placental alterations with impaired placental energy supply due to an increase in inflammatory status. Evaluation of prognostic and diagnostic significance of PIs and DIs showed that the most informative tools are PI I (Se = 86.1%, Sp = 80.5%) and DI I (Se = 88.3%, Sp = 83.7%).

CONCLUSIONS: The use of PIs allows for risk stratification of pregnant women from the 1st trimester of gestation to address the issue of the prevention method. The clinical capabilities of DIs optimize obstetric tactics for the timely prescription of therapy for placental insufficiency and targeted diagnosis of fetal pathology. Pregnant women with endometriosis should be classified as a high perinatal risk group, and therefore the proposed PIs and DIs should be included in the dynamic examination complex.

Journal of obstetrics and women's diseases. 2021;70(5):37-48
pages 37-48 views

Psychological analysis of women’s experiences of late pregnancy termination for fetal anomaly

Mikhaylov A.V., Zamanayeva Y.V.

Abstract

AIM: The aim of this study was to conduct a psychological analysis and summarize information on women’s experiences of late pregnancy termination for fetal anomaly.

MATERIALS AND METHODS: The study included 105 patients aged 19 to 43 years who experienced late pregnancy termination for fetal anomaly after 22 weeks of gestation and who received psychological support during their stay in the maternity hospital. The method of data collection involved structured clinical interview with subsequent analysis and summarizing the information received. The data obtained were compared with the literature, thus leading to a conclusion about long-term psychological consequences after late pregnancy termination.

RESULTS: The general psychological patterns of women’s experiencing of several consequential steps of late pregnancy termination were revealed: during the primary diagnosis, in the decision-making process, during the feticide procedure, during delivery, and in the postpartum period. The tasks of psychological support were formulated; the types of reasons for termination decision were described; the key influence of the psychological status of the fetus on the subjective character of experience was determined. The analysis of foreign issues was made and faraway traumatic consequences of late pregnancy termination for the woman and her family were depicted.

CONCLUSIONS: Late pregnancy termination is a traumatic choice for a woman and her family and it has medical, psychological, ethical and legal contexts. Psychological maintenance can optimize the patient’s contact with the medical staff during her stay in the maternity hospital. Psychologically conceived experience ensure a constructive attitude towards the future pregnancy and its positive conditions.

Journal of obstetrics and women's diseases. 2021;70(5):49-62
pages 49-62 views

Technology for predicting abnormal labor

Mudrov V.A., Yakimova A.V.

Abstract

BACKGROUND: Abnormal labor is the most common complication of labor. It occurs in 10-15% cases of labor and is an indication for operative delivery in a third of all cases. Until now, there are no effective ways to predict abnormal labor. Meanwhile, the use of high-tech forecasting methods is not available for a wide range of obstetric institutions in the Russian Federation.

AIM: The aim of this study was to create a technology for predicting abnormal labor, based on generally available methods of laboratory and instrumental research.

MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 200 cases of labor was carried out. The total sample was divided into four study groups: 100 women with normal labor activity (group 1), 30 women with uterine inertia (group 2), 30 women with incoordinate uterine activity (group 3), and 50 women with excessive uterine activity (group 4). The groups were comparable in terms of age, anthropometric parameters and extragenital pathology. All women on the eve of labor (1-2 days) underwent general clinical and ultrasound examination. Statistical processing of the results was carried out using the IBM SPSS Statistics version 25.0 software.

RESULTS: The technology for predicting abnormal labor is implemented based on a multilayer perceptron, with the percentage of incorrect predictions being 21.3%. The structure of the trained neural network included nine input neurons: labor parity, gestational age, leukocyte count, erythrocyte sedimentation rate, total protein concentration, amniotic fluid index, biparietal size, as well as fetal head and abdomen circumference.

CONCLUSIONS: An integrated approach based on generally available laboratory and instrumental research methods, such as complete blood count and biochemical blood test, as well as ultrasound examination, on the eve of labor allows for predicting the abnormal labor development with an accuracy of up to 70%. The use of this technology in clinical practice will help, in the future, not only to prevent abnormal labor, but also to reduce the incidence of adverse obstetric and perinatal outcomes.

Journal of obstetrics and women's diseases. 2021;70(5):63-72
pages 63-72 views

Stigmatization of people living with HIV among obstetricians and gynecologists: a pilot study

Suturina L.V., Kuzmin M.Y., Markova D.P., Atalyan A.V., Maryanian A.Y., Protopopova N.V., Dudakova V.N., Sharifulin E.M., Vygovsky E.L., Slautina T.I., Kokunova E.G., Tokunova O.V., Dudik E.A., Ionushene S.V., Semyonova G.I., Molchanova I.A.

Abstract

BACKGROUND: The stigma of people living with HIV (PLHIV) remains an urgent problem of modern science. Meanwhile, it can be stated that there is a lack of methods used to study stigmatization.

AIM: The aim of this study was to evaluate the stigmatization of PLHIV among healthcare workers of the obstetric and gynecological service.

MATERIALS AND METHODS: The study included 232 doctors and nurses of the obstetric and gynecological service and was conducted from April to November 2018. We adapted the Questionnaire for Doctors and Nurses’ Views on People Living with HIV/AIDS and the Comprehensive Health Staff Questionnaire (for sentinel surveillance) for this study.

RESULTS: We have studied the current level of awareness of healthcare workers of the obstetric and gynecological service regarding the ways of HIV transmission and methods of treatment. The contradictory attitudes of medical workers towards PLHIV were considered. On the one hand, medical professionals believe that, regardless of their status, the patient deserves qualified assistance. On the other hand, they find it difficult to assess the moral aspect of HIV infection. Dependences of the level of awareness and the peculiarities of attitudes towards PLHIV on sociodemographic characteristics were established.

CONCLUSIONS: This article analyzes the results of the pilot study of stigmatization of PLHIV among healthcare workers of the obstetric and gynecological service. We compared our own results with the data obtained by domestic and foreign authors and discussed the similarities and differences in the conclusions. The limitations of this pilot study were analyzed, with the probable ways of further work proposed and outlined.

Journal of obstetrics and women's diseases. 2021;70(5):83-94
pages 83-94 views

Myomectomy or conservative management of uterine fibroids: effects on reproductive potential

Shapovalova A.I., Popov E.N., Mozgovaya E.V.

Abstract

AIM: The aim of this study was to analyze reproductive function, pregnancy and labor in women after laparoscopic myomectomy and in women with unoperated myoma.

MATERIALS AND METHODS: The main group consisted of 60 patients aged 25-46 years with a scar on the uterus who had laparoscopic myomectomy. Inclusion criteria were full-term pregnancy, uterine scar after laparoscopic myomectomy for subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). The comparison group included 30 women aged 25-46 years who were not surgically treated. Inclusion criteria were full-term pregnancy, subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). All patients in the main group underwent laparoscopic myomectomy. In all cases, the myomatous nodule was removed intracapsularly, leaving the leiomyoma pseudocapsule, which, with a deep arrangement of the transmural myomatous nodules, avoided opening the uterine cavity; myomatous nodule morcellation being used. With a deep intramural arrangement of the leiomyoma, the myometrial defect was sutured layer by layer with the application of several rows of endosutures.

RESULTS: Six months after myomectomy, the patients underwent MRI of their pelvic organs with contrast. In 95% of cases, the uterine scar had no anatomical insolvency. In assessing the anamnesis, gynecological diseases occurred two times more often in women in the main group: 22 (36.7%) patients resorted to the use of the in vitro fertilization method for pregnancy, while among the patients in the comparison group, there were only two (6.7%) of them (χ2 = 12.8; р < 0.001). In the main group, moderate preeclampsia and gestational diabetes mellitus were twice as common. In the main group, all patients were delivered by caesarean section, of which 83.3% were planned and 16.7% were emergency. In the comparison group, 73.3% of patients were delivered through the natural birth canal and 26.7% by caesarean section (χ2 = 149, p < 0.0001). The most unfavorable signs predisposing to obstetric complications and operative delivery were the presence of multiple nodules (OR = 5.96 (1.09-32.72), p < 0.05), the location of the nodule or scar in the uterine bottom (OR = 2.52 (1.00-6.33), p < 0.05), and their combination with IVF (OR = 9.09 (2.42-34.07), р < 0.01).

CONCLUSIONS: In 95% of women, the scar on the uterus after myomectomy was consistent, but all these pregnant women were delivered by cesarean section, mainly for combined indications. However, they carried out the pregnancy safely, with a good outcome for the fetus. In women with uterine myoma and its conservative management, there was a lower rate of aggravated gynecological history and obstetric complications, and 73.3% of them were delivered through the natural birth canal. Despite the increased risk of caesarean section, the presence of uterine fibroids, even of a large size (more than 4 cm), should not be considered as a contraindication to vaginal delivery.

Journal of obstetrics and women's diseases. 2021;70(5):95-104
pages 95-104 views

Clinical features of labor and morphological aspects of the myometrium receptor profile in obese women

Seryogina D.S., Mozgovaya E.V., Tral T.G., Tolibova G.K., Sotnikova L.K.

Abstract

BACKGROUND: Obesity is currently considered as one of the most significant social chronic diseases. It has been proven that obese pregnant women are more likely than women with normal body weight to experience complications of pregnancy and labor. The most frequent complications of labor in obese women are weakness and discoordination, which are probably associated with a decrease in the sensitivity of the myometrium to oxytocin, due to suppression of oxytocin receptor expression.

AIM: The aim of this study was to explore the clinical features of labor and morphological aspects of the myometrium receptor apparatus in obese women.

MATERIALS AND METHODS: We performed a prospective assessment of labor activity in women with obesity, with a combination of obesity and gestational diabetes mellitus and in healthy women. We also conducted a morphological study of myometrium biopsies obtained during cesarean section.

RESULTS: Obese patients are more likely to experience various complications of pregnancy and labor, which is the reason for the higher frequency of operative delivery. Patients with obesity showed lower expression of oxytocin receptors in the lower segment of the uterus, which, apparently, is the cause of abnormal contractility of the myometrium during labor and the lack of effect from drug correction of this condition.

CONCLUSIONS: The presence of obesity in women before pregnancy contributes to frequent complications of pregnancy and labor, abnormal uterine contractility related to the decreased oxytocin receptor expression, and a high incidence of surgical delivery.

 
Journal of obstetrics and women's diseases. 2021;70(5):73-82
pages 73-82 views

Reviews

Modern concepts of etiology, pathogenesis and risk factors for preeclampsia

Abramova M.Y., Churnosov M.I.

Abstract

Preeclampsia is a serious complication of pregnancy and complicates its course in 2-8% of all cases. According to the literature, the disease is associated with an increase in maternal and perinatal morbidity and mortality, and is a predictor of the development of chronic diseases in the distant future, which is an important medical and social issue. Of particular interest is the study of the molecular mechanisms of etiopathogenesis and risk factors for preeclampsia, which, unfortunately, are currently poorly studied and understood, thus dictating the need for further study of this complication of pregnancy. This article discusses the current understanding of the etiology, pathogenesis and risk factors for preeclampsia.

Journal of obstetrics and women's diseases. 2021;70(5):105-116
pages 105-116 views

Abnormal labor as a medical and social issue

Mudrov V.A.

Abstract

Abnormal labor is a main cause of obstetric and perinatal complications. Impaired uterine contraction during childbirth is accompanied by an increase in the risk of fetal asphyxia, obstetric bleeding and postpartum inflammatory diseases. The frequency of diagnosed abnormal uterine contractile activity is 10-25%, which, along with the high need for operative delivery, allows for considering abnormal labor as one of the main medical and social issues of the present time. The aim of this study was to consider abnormal labor as a medical and social problem. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on abnormal labor. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the creation until July 2021. Abnormal labor is an important medical and social issue that requires the active development of methods to predict and prevent not only violations of uterine contractility, but also their complications.

Journal of obstetrics and women's diseases. 2021;70(5):117-130
pages 117-130 views

Stress urinary incontinence in women. Possibilities of conservative therapy

Rusina E.I., Zhevlakova M.M., Yarmolinskaya M.I.

Abstract

The relevance of this study is due to the high prevalence of stress urinary incontinence in women of different age groups and the search for effective conservative treatment methods.

The aim of this study was to present scientific data based on modern evidence on the effectiveness of conservative treatment methods and their safety in the treatment of stress urinary incontinence in women.

A review of the literature (original articles, systematic reviews) on the use of conservative therapy for the treatment of stress urinary incontinence in women was carried out.

Depending on the severity of stress urinary incontinence in women, their age and concomitant diseases, the options for the proposed treatment may vary. For the conservative treatment of the disease, along with lifestyle modification and the use of hygiene products, it is possible to use training and electromyostimulation of the pelvic floor muscles, innovative laser technologies, and drug therapy. The first line therapy is to train one’s pelvic floor muscles. The best effect of the training is observed in younger patients with mild to moderate severity of the disease using stationary biofeedback simulators under the supervision of medical staff. An alternative to this type of treatment is to conduct training of the pelvic floor muscles in the biofeedback mode with portable simulators remotely under the supervision of specially trained personnel. In connection with the coronavirus pandemic, this therapy is gaining wide popularity, as every patient should be offered acceptable and effective treatment options.

Journal of obstetrics and women's diseases. 2021;70(5):131-140
pages 131-140 views

Theory and Practice

A clinical case of the uterine complete rupture along with the previous scar during pregnancy with atypical clinical features

Mochalova M.N., Mudrov V.A., Alexeyeva A.Y., Kuzmina L.A.

Abstract

This article presents an unusual case of rupture of the scarred uterus at 36-37 weeks of gestation. The patient presented with pain in the pubic and hip joint area, growing stronger while her walking, seated and changing position. No clinical manifestations of hemorrhagic shock were observed. External obstetric examination revealed a normotonic uterus and satisfactory fetus condition. Provocation tests were conducted to exclude subluxation of the pubic joint. Pubic symphysis diastasis palpation, long dorsal sacroiliac ligament palpation, P4 test, Patrick’s test, and the modified Trendelenburg test were negative. Pelvic examination revealed sharp pain in lower uterus segment. Ultrasound scan revealed deformation and thinning of the scar up to 1 mm, and no abnormalities in pubic symphysis. A threatening uterine rupture was diagnosed, and emergency cesarean section was performed. Intraoperative examination showed that the scar located in the lower segment consisted of connective tissue. In addition, there was a 4 × 5 cm scar defect with the overlying amniotic sac, no hemorrhage being noted. After removing the fetus, scar excision was performed. The uterine defect was repaired with a double layer running-locking suture. The patient was discharged from hospital on day 5 of postpartum period. The infant was exposed in the neonatal intensive care unit to provide an early developmental care.

Journal of obstetrics and women's diseases. 2021;70(5):141-146
pages 141-146 views

Urological complications in obstetrics

Musin I.I., Berg E.A., Safiullin R.I., Urmantsev M.F., Absalyamova D.F., Fatkullina Y.N., Yashchuk K.N.

Abstract

Urinary tract injury is a rare but severe complication during abdominal delivery. Over the past quarter of the last century, the frequency of abdominal delivery in Russia has more than tripled due to the increase in the number of pregnant women at high risk for the development of maternal and perinatal complications. Intraoperative diagnosis of urinary tract injuries allows timely treatment with better postoperative outcomes. Given the high percentage of caesarean sections in many countries, the risk of the above complications remains high. Risk factors for urinary tract injury during cesarean section are an increase in women’s average age and body mass index, high parity, the presence of adhesions, prior cesarean section, emergency cesarean section, and cesarean section in the second stage of labor. This article discusses several clinical cases on the development of urological complications in obstetrics and gynecology. Due to modern progress in the field of operative obstetrics, vesicouterine fistulas caused by obstetric causes may not occur as often as in the last century. Nevertheless, even despite this, one should not forget about elementary preventive measures in operative delivery, especially in such obstetric situations as placental ingrowth, bleeding, hematoma, and parametria.

Journal of obstetrics and women's diseases. 2021;70(5):147-155
pages 147-155 views

Viewpoint

On dissection of the uterine wall during laparoscopic myomectomy

Plekhanov A.N., Bezhenar V.F., Shishkina Y.S., Linde V.A.

Abstract

BACKGROUND: Laparoscopic myomectomy is becoming the leading method of surgical treatment of uterine fibroids while preserving reproductive and menstrual functions. Increasingly, ultrasound energy is used to dissect the myometrium. Meanwhile, the mode and direction of the ultrasound energy supply to minimize damage to the underlying tissues have not been specified.

AIM: The aim of this study was to perform a comparative analysis of the myometrium and the fibroid pseudocapsule in the projection of the myoma nodule after dissection using ultrasound energy with different initial characteristics of the surgical instrument.

MATERIALS AND METHODS: For comparison, we selected two instruments with a longitudinal ultrasound energy supply with an output frequency of 80 MHz ... 2.5 GHz and 47 kHz at intermittent operating mode of 5/10 sec and one torsion instrument with a transverse ultrasound energy supply with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec.

RESULTS: Our study has shown that the smallest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed at 90 degrees to the blade, and the largest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 47 kHz at intermittent operating mode of 5/10 sec with its longitudinal feed.

CONCLUSIONS: Morphometric studies with an analysis of the depth of necrotic and necrobiotic changes in the myometrial tissue showed that from the standpoint of reproductive surgery, it is preferable to use USE with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed.

Journal of obstetrics and women's diseases. 2021;70(5):157-162
pages 157-162 views


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