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Vol 70, No 6 (2021)

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Markers of brain damage in full-term newborns with intrauterine growth retardation

Evsyukova I.I.


The increase in the number of newborns with intrauterine growth retardation, who are characterized not only by high perinatal morbidity and mortality, but also by neurodevelopmental disorders in later life, has determined a wide search for diagnostic markers of prenatal hypoxia for a timely objective assessment of brain damage and a justification of neuroprotection methods. This article presents literature data on biomarkers and methods of instrumental diagnosis of brain damage that have received evidence of the effectiveness of their use in early neonatal life of newborns with intrauterine growth retardation. It is emphasized that such biomarkers as S100B, NSE, and BDNF proteins are the most reliable and easy to determine non-invasively. However, for their wide application in clinical practice, it is necessary to establish reference values in umbilical cord blood and urine, while taking into account the gestational age, sex, and method of giving birth, and to unify the use of laboratory analysis systems and diagnostic tests for this purpose. The comparison of biomarker indicators with cerebral oximetry, electroencephalogram and magnetic resonance imaging data will allow for developing new approaches to the treatment of perinatal pathology and, largely, preventing adverse consequences in those born with intrauterine growth retardation.

Journal of obstetrics and women's diseases. 2021;70(6):83-90
pages 83-90 views

The potential of micronutrient support with omega-3 and omega-6 fatty acids in the prevention of human reproductive disorders

Zhernakova T.S., Bespalova O.N.


Omega-3 and omega-6 polyunsaturated fatty acids are among the nutrients essential for the vital functions of the human body. Fundamental cellular functions of omega-3 and omega-6 polyunsaturated fatty acids affect both physical and reproductive health. Based on the principles of personalized medicine, early detection of polyunsaturated fatty acid deficiency is necessary for its prompt correction and prevention of further diseases. We present a literature review on the effects of polyunsaturated fatty acids on female and male fertility. The brief information on biochemical aspects, current data on diagnosis, and possible methods for correction of polyunsaturated fatty acid deficiency are described in this article.

Journal of obstetrics and women's diseases. 2021;70(6):91-104
pages 91-104 views

Biochemical factors of hypoxia and their role in assessing the functional state of the fetus

Rozhdestvenskaya O.V., Kokaya A.A., Bezhenar V.F.


The constant frequent incidents of fetal hypoxia during pregnancy and childbirth remain the leading unsolved problem in modern practical obstetrics. In some cases, the onset of a pathological process can be diagnosed earlier due to the on-time monitoring of functional disorders of the fetus. However, the existing diagnostic methods do not show the compensatory and adaptive capabilities of the fetus; do not lead to an in-depth understanding of the pathophysiology of this condition and do not contribute to the implementation of evidence-based therapy. This review summarizes current knowledge about the diagnosis of functional disorders of the fetus and discusses possible ways of assessing adaptive mechanisms in response to stress during pregnancy and childbirth. The article shows the development of biochemical methods for diagnosing functional disorders of the fetus. The putative biochemical markers for assessing the compensatory capabilities of the fetus during pregnancy and childbirth are presented.

Journal of obstetrics and women's diseases. 2021;70(6):117-126
pages 117-126 views

Oxytocin: physiological and pathophysiological determinants. A review

Prokhorova O.V., Olina A.A., Tolibova G.K., Tral T.G.


Oxytocin is a pleiotropic peptide hormone that plays a leading role in the implementation of the tonomotor activity of the myometrium during labor. Over the past decade, significant progress has been made in understanding the complex neurobiology of the oxytocin system, including oxytocinergic pathways, local release patterns and distribution of oxytocin receptors in the brain, and intra-neuronal oxytocin receptor signaling. This article presents the view of modern researchers on the biological functions of the hormone, including its participation in onco- and immunogenesis, as well as in the implementation of adaptation, reproduction and social behavior in humans.

Journal of obstetrics and women's diseases. 2021;70(6):105-116
pages 105-116 views

Vitamin A and pregnancy: myths and reality; prospects for the use in patients with endometriosis. A review

Seyidova C.I., Yarmolinskaya M.I.


BACKGROUND: Retinol in its various forms, being a powerful antioxidant, has a multifaceted effect on the functioning of body systems. Replenishment of the daily requirement for the vitamin is possible only when it is supplied from outside sources. Both excess intake and deficiency of retinol are associated with adverse effects.

AIM: The aim of this study was to assess the role of vitamin A in the functioning of the female reproductive system, its effect on pregnancy, and the prospects of using it as a pathogenically justified therapy for endometriosis.

MATERIALS AND METHODS: We performed this review, analyzing articles from such electronic databases as PubMed, ScienceDirect, and Cyberleninka, published in the period from 2000 to 2020.

RESULTS AND CONCLUSIONS: Vitamin A plays an important role in pregnancy; its deficiency is associated with a number of malformations, the risk of respiratory distress syndrome and disorders of the immune system development in the fetus. Despite the alleged risk of using vitamin A in pregnant women, it can be prescribed both at the planning stage and during pregnancy in safe therapeutic doses, up to 10,000 IU / day, in order to reduce the number of congenital malformations, to give birth to children with higher Apgar scores, and to prevent anemia. Retinol has antiproliferative and antitumor effects and affects the biosynthesis of estrogens, which justifies the possibility of its involvement in the pathogenesis of genital endometriosis. Given the ability of vitamin A to inhibit the proliferation of endometrioid ovarian cysts, to reduce the size of endometrioid heterotopias, and to modulate the synthesis of proinflammatory cytokines, it can be considered as a perspective therapy in the combined treatment of genital endometriosis.

Journal of obstetrics and women's diseases. 2021;70(6):139-146
pages 139-146 views

Vulvar dystrophies: a modern view of the problem

Tsygankova O.Y., Kravchenko E.N., Tsygankova M.V.


This article overviews modern literature data on vulvar dystrophies. The increase in the number of patients with dystrophic diseases of the vulva, a pronounced tendency towards rejuvenation, the complexity of diagnosis, frequent recurrence of the disease and low effectiveness of therapy make this issue extremely urgent. Until now, morphologists have not developed a single classification, and among clinicians, a specific etiopathogenetic concept of development of vulvar dystrophies has not been determined. There are many theories of the disease development. The process starts asymptomatically and is not diagnosed in a timely manner, and due to the localization in the intimate area, it is characterized by low circulation and an increase in the number of neglected cases. Only a comprehensive, timely started treatment with the right choice of drugs and methods of activating reparative processes will prevent development of the disease and reduce the duration of the main symptoms and the likelihood of relapses, exacerbations, and complications.

Journal of obstetrics and women's diseases. 2021;70(6):147-156
pages 147-156 views

Application of enhanced recovery after cesarean delivery. A review

Ryazanova O.V., Shifman E.M., Olina A.A., Alexandrovich Y.S., Medzhidova D.R., Ezhova V.O., Kogan I.Y.


Caesarean section is the most common surgical intervention over the world, so the development of the enhanced recovery after cesarean delivery is turning out to be a vital problem. The practical application of the enhanced recovery after cesarean requires multidisciplinary collaboration and well-coordinated teamwork of an anesthesiologist, an obstetrician-gynecologist, nursing staff and other specialists. In this review, we have studied recent domestic and foreign articles dedicated to the enhanced recovery after cesarean. Particular attention was paid to the case management at all stages of the perioperative period, especially preoperative preparation, postoperative care and women’s awareness raising. The presented studies included such program criteria as avoidance of prolonged preoperative fasting accompanied by early postoperative feeding, early breastfeeding attachment of the newborn, the use of multimodal analgesia in the postoperative period, the early activation of the postoperative patient, and the minimization of the detention period of hospital stay. The reviewed articles indicated the positive impact of this program on maternal and newborn outcomes and demonstrated the need for detailed further study of several issues and standardization of the enhanced recovery after cesarean methods.

Journal of obstetrics and women's diseases. 2021;70(6):127-138
pages 127-138 views

Original Research

Intestinal dysbiosis during pregnancy: the norm or pathology?

Bezmenko A.A., Sadovaya N.D.


BACKGROUND: An interest in the study of intestinal microflora has grown among scientists in recent years. This is due to the active development of molecular genetic techniques. The obvious importance of gut microbiota for pregnancy has been established in some scientific works; however, the number of studies devoted to this issue is small.

AIM: This study was aimed to assess the qualitative and quantitative composition of the intestinal microflora in pregnant women.

MATERIALS AND METHODS: The study involved 200 women aged 18 to 43 years in pregnancy from six to 22 weeks. A qualitative and quantitative analysis of the intestinal and vaginal microbiota was performed by real-time PCR.

RESULTS: Intestinal dysbacteriosis was detected in 100% of the examined pregnant women. Grade I was detected in 64.5% (n = 129), grade II in 26.5% (n = 53), and grade III in 9% (n = 18) of cases. A decrease in the concentrations of resident bacteria was noted in all pregnant women; in addition, in women with moderate and severe dysbacteriosis, opportunistic microorganisms (Clostridium difficile, Enterobacter spp., Streptococcus spp., and Campylobacter spp.) were detected in quantities exceeding the formally permissible values. The analysis of the course of pregnancies showed that grade I and grade II intestinal dysbacteriosis is a risk factor for early pregnancy complications (OR = 0.2, p = 0.00), thus confirming the role of intestinal microbiocenosis in miscarriage.

CONCLUSIONS: Pregnancy is a predisposing factor for changes in the intestinal microflora, as evidenced by the detection of intestinal dysbiosis in 100% of pregnant women in the main and control study groups. Considering that the majority of women with a normal pregnancy were diagnosed with grade I intestinal dysbiosis, it can be assumed that this degree of dysbiosis is the norm of pregnancy. Thus, the identification of moderate or severe intestinal dysbiosis should be associated with complications of early pregnancy.

Journal of obstetrics and women's diseases. 2021;70(6):5-12
pages 5-12 views

Comparative assessment of the parietal microflora of the vagina in healthy girls and girls with vulvovaginitis in the neutral period of sexual development

Bezrukova A.A., Yarmolinskaya M.I., Sazonova O.V., Spiridonova N.V.


BACKGROUND: Vulvovaginitis is a common gynecological problem in prepubertal girls and is most likely caused by an imbalance in the vaginal microbiota. A number of studies have been carried out to determine the vaginal microflora of healthy prepubertal girls and girls with vulvovaginitis using traditional bacteriological methods. However, until now, a comparative study of the composition of the vaginal microflora in prepubertal girls using molecular methods has not been performed.

AIM: The aim of this study was to conduct a comparative assessment of the composition of the parietal microflora of the vagina in healthy girls and girls with vulvovaginitis in the neutral period of sexual development.

MATERIALS AND METHODS: This study included 168 prepubertal girls aged 3–6 years, of which 70 girls with vulvovaginitis made up the main group and 98 girls without symptoms or signs of vulvovaginitis comprised the comparison group. All girls were assessed for the parietal microflora of the vagina by real-time PCR (Lactobacillus spp, Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp., Eubacterium spp., Sneathia spp. / Leptotrihia spp. / Fusobacterium spp., Megasphaera spp. / Veillonella spp. / Dialister spp., Lachnobacterium spp. / Clostridium spp., Mobiluncus spp. / Corynebacterium spp., Peptostreptococcus spp., Atopobium vaginae, Mycoplasma hominis, Ureaplasma (urealyticum + parvum), Candida spp., and Mycoplasma genitalium) using the Femoflor 16 REAL-TIME PCR Detection Kit (DNA-Technology Research & Production, Moscow, Russia).

RESULTS AND CONCLUSIONS: In healthy prepubertal girls, the vaginal microflora is mainly composed of obligate anaerobes. With vulvovaginitis in the vaginal biotope of girls, the total bacterial mass of microorganisms (p = 0.005) decreased, both the biodiversity (the Shannon’s index, p = 0.001; the Simpson’s index, p = 0.004) and the number of obligate anaerobes (p = 0.006) decreased, while the number of facultative anaerobes increased (p = 0.043). The frequency of obligate anaerobes in vulvovaginitis, despite their prevalence in general, was significantly lesser: Peptostreptococcus spp. (p = 0.002), Mobiluncus spp. + Corynebacterium spp. (p = 0.048), Megasphaera spp. + Veillonella spp. + Dialister spp. (p = 0.004); while the frequency of Atopobium vaginae increased (p = 0.002). The concentrations of Peptostreptococcus spp. (p = 0.002); Megasphaera spp. + Veillonella spp. + Dialister spp. (p = 0.002), Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp. (p = 0.006), and Eubacterium spp. (p =0.006) significantly decreased; while the absolute concentration of Sneathia spp. + Leptotrichia spp. + Fusobacterium spp. (p = 0.042), and Mobiluncus spp. + Corynebacterium spp. (p = 0.012) increased. The frequency of facultative anaerobes remained unchanged (p = 0.067) against an increase in the concentration of the family Enterobacteriaceae (p = 0.026). The concentrations of Streptococcus spp. and Staphylococcus spp. remained unchanged, with Lactobacillus spp. not detected in any girl in both study groups.

Journal of obstetrics and women's diseases. 2021;70(6):13-24
pages 13-24 views

Stress in pregnant women and childbirth amid the COVID-19 pandemic

Blokh M.E., Anikina V.O., Savenysheva S.S.


BACKGROUND: During the pandemic pregnant women experience a wide range of negative feelings that can have short- and long-term impact on both the woman and her child.

AIM: The aim of this study was to analyze the impact of stress associated with the coronavirus pandemic on the emotional state of pregnant women and their childbirth.

MATERIALS AND METHODS: State-Trait Anxiety Inventory, Impact of Events Scale-Revised, telephone interview about delivery process and outcome, socio-demographic data. Research is done online, data is being gathered.

RESULTS AND CONCLUSIONS: Majority of women experience high (36%) and moderate (48%) anxiety. Changes in the national healthcare system, the financial situation in the family and the political situation in this country are having a greater negative impact on pregnant women than their fear for the child’s and their own health. Remote preparation, refusal of their partner’s delivery, forced change of plans for childbirth have become significant factors for a negative assessment of labor and delivery. 69% evaluate delivery process as difficult, 42% report on obstetric aggression.

Journal of obstetrics and women's diseases. 2021;70(6):25-32
pages 25-32 views

Expression of the anti-Müllerian hormone receptor (AMHR2) in the endometrium of patients with uterine anomalies

Kazantseva E.V., Tolibova G.K., Tral T.G., Kogan I.Y.


BACKGROUND: Uterine anomalies are a cause of female reproductive failure. Originally, malformations of the Müllerian ducts are believed to be the main reason for uterus abnormalities. There is an assumption that anti-Müllerian hormone (AMH) or AMH receptor (AMHR2) gene mutation may lead to alterations in the formation of the Müllerian ducts in female fetuses resulting in uterine anomalies.

AIM: The aim of this study was to assess the AMHR2 expression in the endometrium of patients with uterine anomalies and a history of reproductive failure.

MATERIALS AND METHODS: The present study included 112 women, of whom 92 patients were diagnosed with uterine anomalies (main groups): arcuate uterus (n = 30), septated uterus (n = 30), bicornuate uterus (n = 12), unicornuate uterus (n = 10), didelphys uterus (n = 10); and 20 patients had normal uterine anatomy (control group), with the secretory phase (n = 10) and the proliferative phase (n = 10) of menstrual cycle evaluated. Histological and immunohistochemical studies of the endometrium were carried out according to the standard technique with an assessment of AMHR2 marker expression in the biopsy samples.

RESULTS: The AMHR2 area expression in the endometrial stroma was significantly lower in patients with septated uterus compared to those with arcuate uterus (р < 0.001). The same tendency was noted when compared to other uterine anomalies and healthy controls. AMHR2 expression in the endometrial stroma of patients with arcuate uterus was significantly higher compared to unicornuate uterus (p < 0.05).

CONCLUSIONS: The data obtained suggest that morphofunctional characteristics of the endometrium in patients with uterine anomalies have no specific pathognomonic features. The decline in AMHR2 expression in the endometrial stroma seems to be related to chronic endometritis, as an inverse correlation exists between the AMHR2 area expression and chronic endometritis, compromising pregnancy occurrence.

Journal of obstetrics and women's diseases. 2021;70(6):33-40
pages 33-40 views

The course and outcomes of pregnancy after surgical correction of uterine cervical incompetence. Risk rating

Mamedova M.A., Ilyin A.B., Stolitsa A.A., Sheyerman E.A.


BACKGROUND: Uterine cervical incompetence is a leading cause of miscarriage. There are surgical and conservative methods of treatment to correct cervical insufficiency during pregnancy. Surgical methods of correction include suture on the cervix (cervical cerclage), which could be categorized as preventive, therapeutic or emergency suture.

AIM: The aim of this study was to compare the clinical effects of preventive and therapeutic cerclages on the course and outcomes of pregnancy in women with uterine cervical incompetence.

MATERIALS AND METHODS: This prospective study included 106 pregnant women aged 20-45 years, who were diagnosed with uterine cervical incompetence and underwent surgical correction at gestation period of 14 to 24 weeks in combination with intravaginal micronized progesterone. The women were divided into two groups. Group 1 (n = 30) included patients without structural abnormalities of the cervix, who underwent prophylactic cerclage. Group 2 (n = 76) consisted of pregnant women who underwent therapeutic cerclage. Examination of the hormonal status included study of anamnesis related to the menstrual and reproductive function and determination of the presence and type of obesity and the severity of secondary sexual characteristics. The anatomical causes of miscarriage were assessed while examining the cervix in the mirrors and using ultrasonography. Dynamic transvaginal ultrasonography was also performed. The markers of the inflammatory response were assessed (complete blood count parameters and C-reactive protein level). In addition, the biochemical blood test and the coagulogram were performed, with a smear study carried out for microbiocenosis and sowing from the cervical canal. The pH balance of the vagina was also determined.

RESULTS: The ratio of patients without structural changes of the cervix with prophylactic cerclage and pregnant women with therapeutic cerclage is 28% and 72%. This means that only 28% of patients with uterine cervical incompetence come to the specialized hospital with medical examination and pregraving preparation. The remaining 72% of women came with the first examination and already had complications of pregnancy.

CONCLUSIONS: Surgical correction is an effective prevention method of late pregnancy loss. Preventive cerclage has advantages – time of manipulation, the number of complications and the stay of pregnant in the hospital are reduced. The use of surgical correction of uterine cervical incompetence has prolonged the pregnancy of all women before the birth of a viable child. This is a good reserve to reduce perinatal morbidity and mortality. The problem of early diagnostics and surgical correction of uterine cervical incompetence remains relevant.

Journal of obstetrics and women's diseases. 2021;70(6):41-48
pages 41-48 views

Comprehensive assessment of risk factors as a method for predicting prelabour rupture of membranes

Mudrov V.A., Yakimova A.V.


BACKGROUND: Prelabour rupture of the membranes (PROM) is a common obstetric pathology, the incidence of which reaches 20%. There is evidence that PROM is the main risk factor not only for abnormal labor, but also for postpartum hypotonic bleeding. Meanwhile, the etiology and pathogenesis of this complication have not been finally determined until now.

AIM: The aim of this study was to create a model that allows for predicting PROM, based on a comprehensive assessment of risk factors.

MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the prospective analysis of 213 cases of labor was carried out. The total sample was divided into two study groups: group 1 included 142 cases of labor with timely rupture of membranes; group 2 included 71 cases of labor, complicated by PROM. The groups were comparable in terms of nationality, age, material and social living conditions of women, frequency of genital pathology, gestational age and gender distribution of newborns. On the eve of labor (1-2 days), all patients underwent a general clinical examination and clarification of the anamnesis. Ultrasound examination was carried out both the day before and during labor in order to clarify fetal position. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 program.

RESULTS: Risk factors for PROM are: the presence of posterior view of the occipital presentation (RR = 2.67 (95 % CI 1.13-6.31), p = 0.02) and varicose veins (RR = 3.2 (95 % CI 1.09-9.43), p = 0.04), distantia cristarum more than 28.5 cm (RR = 1.99 (95 % CI 1.12-3.54), p = 0.02), distantia trochanterica more than 30.5 cm (RR = 2.15 (95 % CI 1.09-4.23), p = 0.03), and conjugata externa more than 20.5 cm (RR = 1.84 (95 % CI 1.01-3.37), p = 0.046). Oligohydroamnion is a protective factor in relation to PROM (RR = 0.31 (95 % CI 0.11-0.85), p = 0.02). This predictive model, which takes into account such factors as the type of fetal head presentation, the presence of oligohydramnios and varicose veins, and the size of distantia cristarum, allows for predicting PROM with much effect.

CONCLUSIONS: The comprehensive assessment of risk factors, despite its simplicity and availability, allows for predicting the timeliness of rupture of the membranes with an accuracy of 71.0%. Application of the developed model makes it possible to identify a risk group subject to preventive preinduction, which in the future will help to reduce the frequency of abnormal labor and associated complications.

Journal of obstetrics and women's diseases. 2021;70(6):63-72
pages 63-72 views

The psychological portrait of pregnant women with several complications of multiple pregnancy

Mikhaylov A.V., Zamanayeva Y.V.


BACKGROUND: Multiple pregnancies are high-risk pregnancies from both an obstetric and a psychological point of view.

AIM: The aim of this study was to identify the features of prenatal experiences of women carrying multiple pregnancies and to determine the influence of several complications of multiple pregnancy on prenatal experience.

MATERIALS AND METHODS: The study involved 80 individuals aged 19 to 43 years, at a gestational age of 21 to 39 weeks, carrying twins. The patients were divided into five groups by clinical diagnosis and were asked to complete psychodiagnostic questionnaire. The answers to the questions suggested both a quantitative assessment and a qualitative description of their experiences.

RESULTS: We revealed some differences between the study groups in the frequency of manifestations of different psychological elements of the mother’s gestational dominant. Some trends were also found for differences between the groups in terms of prenatal attachment rates. An analysis of pregnant women’s descriptions of their ideas about the unborn children and communication with them showed that there were qualitative differences between the groups in the following: ideas about the characters of the unborn children, actual thoughts about them and thoughts about them after delivery, and features of the mother’s communication with them in several emotional conditions. The data obtained allowed for describing the psychological portrait of pregnant women with several complications of multiple pregnancy.

CONCLUSIONS: Depending on the type of multiple pregnancy complications, there are specific psychological experiences associated with pregnancy, future maternity and an emotional bond with the unborn children. Moreover, these experiences influence the behavior of pregnant women and their communication with other people and medical staff.

Journal of obstetrics and women's diseases. 2021;70(6):49-62
pages 49-62 views

Comprehensive method of ultrasound diagnosis of adenomyosis

Nagorneva S.V., Shalina M.A., Yarmolinskaya M.I., Netreba E.A.


BACKGROUND: There are currently no uniform standards for adenomyosis diagnosis, so the search for the most informative methods is an urgent task. This article presents modern views on the diagnosis of adenomyosis and the role of ultrasound in its diagnostics.

AIM: The aim of this study was to determine the diagnostic capabilities of ultrasound in the diffuse form of adenomyosis.

MATERIALS AND METHODS: This study included 164 patients aged 22 to 43 years old, who had a comprehensive ultrasound examination done. The points were calculated and the presence or absence of adenomyosis, as well as its severity, were determined using the developed scale. The sequential implementation of six ultrasound techniques were used for a comprehensive ultrasound assessment of adenomyosis: assessment of the myometrium echostructure homogeneity; assessment of the ratio of the anterior and posterior uterine wall thicknesses; compression elastography; assessment of the junctional zone in the 3D mode; assessment of the uniformity of the junctional zone thickness along uterine walls; vascularization of the myometrium in the Power Doppler 3D Glass Body mode.

RESULTS: We have developed the comprehensive ultrasound method of adenomyosis diagnostics. The sensitivity of the method was 95%, and the specificity was 100%. The positive predictive value was 100%, and the negative predictive value was 90%. The accuracy of the method was 97%.

CONCLUSIONS: The developed scoring system for the comprehensive assessment of adenomyosis allows for an independent assessment of the myometrium for each criterion, summarizing the scores and, therefore, assessing the presence and severity of adenomyosis more objectively and reliably. The high sensitivity and specificity of this technique allows recommending it for use by ultrasound specialists.

Journal of obstetrics and women's diseases. 2021;70(6):73-82
pages 73-82 views

Theory and Practice

Features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and assessment of perinatal outcomes

Yatsenko D.S., Gabelova K.A., Bezhenar V.F.


AIM: The aim of this study was to investigate the features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and to assess the choice of the optimal method of delivery and perinatal outcomes.

MATERIALS AND METHODS: This study assessed ten cases of pregnancy and delivery in women with cerebrovascular pathology (arteriovenous malformation (50%), cavernous malformation (30%), and arterial aneurysms (20%)). All women were followed up, treated and delivered at the Obstetrics and Gynecology Clinic (Academician I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia) between 2018 and 2019.

RESULTS: In eight out of ten women with cerebrovascular pathology, the course of pregnancy was complicated by the threat of premature birth, chronic placental insufficiency, and severe preeclampsia. In one case, the pathology of the cerebral blood vessels (cavernous malformation) manifested itself as a general hemorrhagic disturbance of the cerebral blood circulation during this pregnancy; in all other cases, cerebrovascular pathology was diagnosed before pregnancy. When analyzing the timing of delivery, it should be noted that only in one case with severe preeclampsia, the pregnancy was completed at 34 weeks and 1 day (emergency childbirth). The average delivery time for the remaining patients was 38 weeks ± 3 days (planned childbirth). The analysis of delivery methods showed that in 90% of cases (n = 9), pregnant women were delivered by caesarean section. Vaginal delivery occurred in one patient with a history of arteriovenous malformation of the left frontal lobe after subtotal embolization. The course of the postpartum period in all the patients was uneventful. During the next year, a planned consultation with a neurologist took place in three cases.

CONCLUSIONS: It is required that a multidisciplinary team should develop tactics for pregravid preparation, pregnancy and postpartum management, with an assessment of long-term consequences in pregnant women with cerebrovascular disease, which will improve the efficiency of medical care and will contribute to the further implementation of reproductive functions in such patients. It is necessary to develop rehabilitation plans with the selection of personalized rehabilitation methods aimed at reducing complications associated with pregnancy and childbirth.

Journal of obstetrics and women's diseases. 2021;70(6):157-164
pages 157-164 views

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