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Vol 71, No 5 (2022)

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Patterns of development and formation of the fetal central nervous system integrative function in the antenatal period

Yusenko S.R., Nagorneva S.V., Kogan I.Y.


The development of the fetal central nervous system and the formation of its integrative functions have been studied for a long time. In the middle of the 20th century, researchers paid attention to structural changes and in the 1980s to the sequence of formation of functional relationships in the fetal body and the possibilities of their assessment. Further development of technology (accumulation of knowledge in the field of embryology, better resolution of ultrasound diagnostic devices, introduction and improvement of magnetic resonance imaging methods) allowed for not only receiving more detailed data on structural patterns in the fetal brain during pregnancy, but also presenting new opportunities for expanding knowledge about its functional condition. The review is devoted to the generalization of knowledge about the development of the fetal central nervous system, the brain vascular network formation and the brain circulation, as well as possibilities of assessing the formation of the fetal central nervous system integrative function during the entire period of pregnancy.

Journal of obstetrics and women's diseases. 2022;71(5):97-110
pages 97-110 views

Morphological changes in fetal organs and tissues in intrauterine death

Ziganshin A.M., Mulyukov A.R., Mudrov V.A., Nurgaliyeva R.R., Zaynullina Y.S.


This article presents a literature review of post-mortem changes in the organs and tissues of the fetus in intrauterine death. The visual and morphological changes that can serve to determine the time of post-mortem changes in organs and tissues at various stages of pregnancy are covered. A detailed study of post-mortem changes in the fetus will help avoid medical errors and unjustified criminal prosecutions, provide an opportunity for an objective assessment of the consequences and causes of intrauterine fetal death, eliminate discrepancies in clinical and pathoanatomic diagnoses, and increase the accuracy of diagnosis and the quality of knowledge. Сomprehension of the key principles for assessing morphological changes in fetal organs and tissues in intrauterine death will allow for developing screening programs to identify relevant risk factors, which, in the future, will reduce perinatal mortality rates.


Journal of obstetrics and women's diseases. 2022;71(5):111-119
pages 111-119 views

Modern methods of treatment of benign diseases of the cervix

Politova A.K., Kolokoltseva I.N., Dudorova S.V.


This review article presents a comparative assessment of various types of energies used in the surgical treatment of cervical pathology, with their positive and negative sides. The mechanisms of action of the damaging agent, indications and contraindications, as well as results of treatment of cervical diseases and follow-up complications are presented. Attention is drawn to current promising areas in the treatment of cervix disorders. In particular, the article reviews the modern method of treatment using ultrasonic ablation, presents an idea of the methodology for conducting high-intensity focused ultrasound therapy, and discusses the possibility of conducting non-invasive this therapy. The article displays the world and domestic literature data.

Journal of obstetrics and women's diseases. 2022;71(5):121-131
pages 121-131 views

Original Research

Effect of electrosurgical energy on suture material. An experimental study

Bezhenar V.F., Kuzmina N.S., Palastin P.M., Ivanov O.A.


BACKGROUND: The instructions for use of the suture material or coagulation tool do not describe the changes that may occur when they interact. A review of the literature found a small number of publications on changes in the physical properties of the suture material when exposed to chemical and mechanical factors. However, this is not enough to predict the effects of energy on the suture material and, as a result, on wound healing or the quality of the postoperative scar.

AIM: To determine and measure the effect of the energy used for coagulation on the strength of the suture material.

MATERIALS AND METHODS: In the experimental research, data on changes in the strength of 20 different filaments after exposure to the energy used for coagulation were analyzed in comparison with control samples.

RESULTS: Research resulted in obtaining both expected or predicted indicators of changes in the strength of threads, and vice versa, absolutely unexpected results, which only confirms the significance of the research. Most of the filaments have lost their original strength after exposure to energy. However, some threads have become, on the contrary, stronger, despite the apparent destructive effect.

CONCLUSIONS: The coagulation energy used in the ligature field changes the physical properties of the filaments. Therefore, in some cases it is worth abandoning the use of a certain type of energy and using another well-known method of hemostasis.

Journal of obstetrics and women's diseases. 2022;71(5):5-12
pages 5-12 views

Anatomical and functional conditions of the pelvic floor muscles after assisted vaginal delivery

Bezhenar V.F., Frederiks E.V., Leonova M.D., Zharuk A.D.


BACKGROUND: The main function of the muscles of the perineum is to preserve the syntopy and topography of the organs of the abdominal cavity and small pelvis. Clinically, various groups of complaints that significantly worsen the patient’s quality of life manifest pelvic floor muscle failure. Currently, one of the most commonly discussed causes of pelvic organ prolapse is still considered obstetric trauma.

AIM: The aim of this study was to assess the anatomical and functional conditions of the pelvic floor muscles after normal physiologic childbirth and childbirth with the use of obstetric forceps.

MATERIALS AND METHODS: The study was conducted in Maternity Hospital No. 13 (Saint Petersburg, Russia) in 2020–2021, which involved 137 patients who delivered through the natural birth canal with the use of obstetric forceps (main group, n = 47) or without the use of delivery instruments (control group, n = 90) six months after delivery. A comprehensive assessment of the condition of the pelvic floor muscles was carried out using the validated PFDI-20 questionnaire and ultrasound examination of the pelvic floor structures at rest. A functional assessment of the condition was carried out using the Pneumatic Pelvic Muscle Trainer XFT-0010.

RESULTS: Evaluating complaints using the PFDI-20 scale revealed that the median was 6.00 ± 1.77 points in the main group and 5.50 ± 1.29 points in the control group, the differences being not significant (p = 0.8). The ultrasound examination showed no significant difference in decreases in the thickness of the tendon center of the perineum and m. bulbocavernosus between the study groups; m. puborectalis thickness in the main group did not differ significantly from the norm either. The assessment of the functional condition of the pelvic floor muscles revealed no significant differences between the patients of the study groups.

CONCLUSIONS: The data obtained demonstrate the safety of the use of obstetric forceps for the anatomical and functional viabilities of the pelvic floor muscles and do not have significant differences compared to childbirth performed without the use of delivery instruments. However, the use of obstetric forceps in the practice of obstetricians and gynecologists can be a reliable tool that does not affect the quality of life of patients in the long term.

Journal of obstetrics and women's diseases. 2022;71(5):13-19
pages 13-19 views

Efficiency of intravenous therapy with Intralipid fat emulsion in patients with early reproductive loss

Bespalova O.N., Zhernakova T.S., Selkov S.A., Chepanov S.V.


BACKGROUND: Immune mechanisms play a leading role in the pathogenesis of early reproductive loss. Modern methods of regulating disorders of immune homeostasis to overcome infertility and recurrent miscarriage include immune-efferent therapies such as immunocytotherapy, plasmapheresis, and intravenous administration of immunoglobulins and fat emulsions. Intralipid is the gold standard of the first generation parenteral fat emulsion that reduces the cytotoxicity of NK cells. In the literature, there are opposite data on the effectiveness of Intralipid fat emulsion in repeated implantation failure. This may be due to indications for its appointment and the choice of criteria for evaluating the effectiveness of this therapy.

AIM: The aim of this study was to evaluate the effect of Intralipid therapy on the onset of pregnancy in patients with a history of early reproductive loss.

MATERIALS AND METHODS: This prospective cohort study was conducted in Saint Petersburg, Russia in 2018–2021 and included 97 patients with a history of early reproductive loss (recurrent pregnancy loss or repeated In Vitro Fertilization failures). Patients were randomized into two study groups. The first group consisted of 41 women with Intralipid therapy, and the second group comprised 56 women without this therapy. Patients of the first group received 200 ml of Intralipid 20% (intravenous fat emulsion) once a month for three consecutive months before pregnancy. Inclusion criteria were ages 18 to 40 years, two cases of reproductive failure (pregnancy loss up to 12 weeks and / or unsuccessful In Vitro Fertilization attempts), and normal spouse karyotypes. Exclusion criteria were miscarriage due to fetal chromosomal abnormalities diagnosed by curettage and histopathological examination of products of conception from miscarriages, anatomical anomalies in the development of the genital apparatus, abnormal spouse karyotypes, and soy protein allergy. We evaluated anamnesis data and immunological parameters (functional activity of NK cells in peripheral blood before and after treatment). The efficacy of therapy was judged by the onset of pregnancy.

RESULTS: The Mann – Whitney U-test showed the difference in the levels of NKT cells before and after treatment with fat emulsions (p = 0.0076), this parameter decreasing 1.846 times compared to control. Clinical pregnancy in patients treated with Intralipid occurred twice as often compared to patients who did not receive fat emulsion therapy: 59.3% (n = 19) vs. 27.6% (n = 13), respectively (p = 0.0048).

CONCLUSIONS: Intralipid fat emulsion increases pregnancy rates by decreasing NKT cells in women with early reproductive loss.

Journal of obstetrics and women's diseases. 2022;71(5):21-28
pages 21-28 views

Morphological and molecular features of recurrent endometrioid ovarian cysts

Petrovskaia N.N., Pechenikova V.A., Chashchina D.M.


BACKGROUND: One of the clinical course features of ovarian endometriosis is its recurrent nature, which leads to repeated operations and increased damage to the ovarian follicular apparatus.

AIM: The aim of this study was to evaluate morphological and molecular features of recurrent endometrioid ovarian cysts in patients of reproductive age.

MATERIALS AND METHODS: Morphological and immunohistochemical studies of the surgical material of 196 observations of endometrioid ovarian cysts were performed — 23 observations of the first surgical intervention with further diagnosed relapse, 22 observations of repeated surgery and 151 observations of a relapse-free course of endometriosis. Monoclonal mouse antibodies to CD68, transforming growth factor β-1, CD34, and α-smooth muscle actin were used.

RESULTS: CD68 (macrophage) expression was detected in lympho-macrophage infiltrates of the cytogenic stroma and endometrioid cyst capsule. Significantly greater values of the expression were obtained in recurrent endometrioid cysts in the surgical material of both the first (cytogenic stroma — 31 [8; 53]%, capsule — 23 [3; 42]%) and second operation (23 [12; 36] and 9 [5; 20]%, respectively) compared to the relapse-free course of the disease (8 [6; 9] and 2 [0; 4]%, respectively). The transforming growth factor β-1 expression area in the endometrioid cyst capsule was significantly higher in the surgical material of both the first (22.8 [21.6; 24.8]%) and second operation (31.2 [30.5; 32.2]%) with recurrent endometriosis compared to cases with no relapse (12.7 [11.2; 13.9]%). But in the cytogenic stroma was it only detected in cases of repeated surgical endometrioid cyst treatment (18.7 [18.0; 19.7]%). The positive α-smooth muscle actin expression area was higher in the surgical material of the second operation with recurrent endometriosis in both the cytogenic stroma (68.3 [66.3; 69.6]%) and endometrioma capsule (82.5 [80.5; 83.8]%). A large area of CD34 expression was also detected in the recurrent course of ovarian endometriosis in the surgical material of both the first (cytogenic stroma — 34.8 [33.4; 35.8]%, capsule — 52.6 [50.4; 55.0]%) and second operation (51.3 [49.0; 53.3] and 48.7 [46.7; 49.8]%, respectively).

CONCLUSIONS: The recurrent course of ovarian endometriosis is characterized by more pronounced inflammation, angiogenesis, myofibroblast proliferation, and fibrogenesis, which indicates the importance of these pathological processes in the chronicity of the disease. Further study of the role of macrophages and the cascade of regenerative and reparative processes that they trigger is important for understanding the pathogenesis of endometriosis and searching for diagnostic markers of its recurrent course.

Journal of obstetrics and women's diseases. 2022;71(5):29-39
pages 29-39 views

Risk factors for recurrence of endometrioid ovarian cysts after combined treatment

Petrovskaia N.N., Pechenikova V.A.


BACKGROUND: The main method of endometrioid ovarian cyst treatment is considered surgery with further hormone therapy. However, the recurrence rate of endometriomas, even 5–7 years after combined treatment, can reach 50%.

AIM: The aim of this study was to identify risk factors for recurrence of endometrioid ovarian cysts among women of reproductive age after combined treatment.

MATERIALS AND METHODS: This study included 196 women operated on for ovarian endometriosis. We carried out a comparative analysis of the data between the study groups: the main group comprised 45 patients with a relapse of the disease; the comparison group consisted of 151 women without a relapse. Hematoxylin-eosin staining was used for morphological examination of the surgical material, and monoclonal mouse antibodies to Ki-67 and bcl-2 (DAKO, Denmark) were used for immunohistochemical examination. The construction of a statistical model for predicting the recurrence of ovarian endometriosis among women of reproductive age was carried out using multivariate binary logistic regression analysis in reverse stepwise mode. The influence of the independent variable on the likelihood of recurrence was determined using the odds ratio and its 95% confidence interval, with the sensitivity, specificity and diagnostic accuracy evaluated.

RESULTS: A set of predictors has been identified that provides the greatest contribution to recurrence of ovarian endometriosis. Immunohistochemistry study showed that the level of Ki-67 protein was higher in the group with relapsed endometriomas compared to the non-recurrent course: in the epithelial lining of the cyst, 9.08 ± 2.60 and 2.06 ± 1.16%, respectively (p = 0.043); in the cytogenic stroma, 11.67 ± 4.10 and 9.81 ± 3.40%, respectively (p = 0.48). Bcl-2 expression was reduced in the epithelial lining of the cyst capsule in the main group in comparison with the material where there was no recurrence: 0.653 ± 0.043 and 0.961 ± 0.056%, respectively (p = 0.31).

CONCLUSIONS: Of significance in predicting the risk of recurrence of ovarian endometriosis is a combination of four signs in one patient: primary infertility; pelvic organ surgery in history, unrelated to endometriosis; elevated levels of CA-125 oncoprotein and proliferative changes in cytogenic stroma cells, as well as increased expression of the Ki-67 antigen in the epithelial lining of the endometrioid cyst.

Journal of obstetrics and women's diseases. 2022;71(5):41-50
pages 41-50 views

Immune interface of patients with reproductive loss in the North-West region of the Russian Federation

Shengeliia M.O., Bespalova O.N., Zhernakova T.S., Zagaynova V.A., Agnayeva A.O., Pachuliia O.V., Chepanov S.V., Domanskaya M.A., Selkov S.A., Kogan I.Y.


BACKGROUND: Currently, more than a hundred immunological biomarkers are known that are important for fertilization, implantation and placentation.

AIM: The aim of this study was to assess the immunological profile for the main allo- and autoantibodies in women with reproductive loss and infertility in the North-West region of the Russian Federation.

MATERIALS AND METHODS: This prospective cohort study was conducted at the stage of pregnancy planning in 325 women with reproductive disorders (spontaneous miscarriages, missed abortions, infertility, IVF failures) on the premises of the D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine (St. Petersburg, Russia) from 2015 to 2022. The study assessed the immune interface of women with a history of reproductive disorders and matching loci of the HLA class II system (DQA1, DQB1, DRB1) among 100 married couples.

RESULTS: In couples with reproductive disorders, coincidences of HLA class II allele (DQA1, DQB1, DRB1) loci were diagnosed in 14% (at 2 loci), 31% (at 3 loci), 14% (at 4 loci), 3% (at 5 loci) and 10% (at 6 loci) of couples. In 34.4% of women, we found an elevated number of spontaneously activated NK cells (CD107a). As many as 31.15% of women had a high level of antibodies to human chorionic gonadotropin. We found that 22.34% of women were carriers of at least one criteria antiphospholipid antibody, and 3.16% of women of two antiphospholipid antibodies. The diagnosis of antiphospholipid syndrome was not established in any patient. Non-criteria antiphospholipid antibodies were found in 6.15% of women. In 12.2% of women, we diagnosed a high level of antibodies to thyroperoxidase, while the average antibody value was 30.76 IU/ml. Only one patient had a high level of antisperm antibodies in the blood serum.

CONCLUSIONS: In 59% of patients with a history of reproductive disorders, we identified some features of the immunological profile, which can lead to this pathology. Thus, 32% of women had a deviation in one immunological parameter, while 20% of patients had it in two parameters, and 7% in three or more parameters.

Journal of obstetrics and women's diseases. 2022;71(5):51-63
pages 51-63 views

Microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix

Sargsyan G.S., Bespalova O.N., Savicheva A.M., Khusnutdinova T.A., Budilovskaya O.V., Krysanova A.A., Shalepo K.V.


BACKGROUND: The insertion of a cervical pessary is a method for treating short cervix and preventing preterm birth. The study of the vaginal microbiota composition and the need for its routine correction after the pessary insertion remain to be investigated. To date, there are no works devoted to the assessment of changes in vaginal microbiocenosis after the cervical pessary insertion.

AIM: The aim of this study was to assess the microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix.

MATERIALS AND METHODS: This prospective study included 22 pregnant women with singleton or multiple pregnancies with short cervix (<25‰ L.J. Salomon scale) and threatened miscarriage in the second and third trimesters who received the Dr. Arabin cervical pessary. The obtained clinical materials included the secretion of the posterolateral vaginal fornix. We used the Femoflor 16 test (NPO DNA-Technology Ltd., Moscow, Russia) as a method of molecular biological analysis. In addition, the patients independently controlled the pH of the vaginal contents using the pH-balance express test. Vaginal microbiocenosis was assessed in a dynamic manner: before the cervical pessary insertion, then every two to four weeks after it, and on the day the pessary was removed. In all 22 pregnant women, clinical material was obtained twice: before the cervical pessary was inserted and when it was removed; in 15 women (68.18%) three times, and in nine pregnant women (40.91%) four times.

RESULTS: The analysis of vaginal microbiocenosis showed no significant changes in vaginal microbiocenosis in the examined pregnant women before and after the insertion of the cervical pessary (p > 0.05). The concentration of lactobacilli remained high (in the range of 107 lg DNA copies/ml) during the entire observation period. The numbers of facultative and obligate anaerobic bacteria, as well as yeast-like fungi of the Candida genus, Ureaplasma spp., and Mycoplasma hominis were within the physiological levels. No pathogenic microorganisms such as Mycoplasma genitalium were detected in any patient. After the cervical pessary insertion against the background of normocenosis, 72.73% of pregnant women noted an increase in the amount of light and odorless discharge from their genital tract. However, we found no changes in the vaginal microbiota composition.

CONCLUSIONS: The insertion of the Dr. Arabin cervical pessary under conditions of vaginal normocenosis is a microbiologically safe way to correct short cervix and prevent preterm birth, and does not disrupt the vaginal microflora in pregnant women before delivery.

Journal of obstetrics and women's diseases. 2022;71(5):65-74
pages 65-74 views

New possibilities of differential diagnosis of uterine fibroids and adenomyosis nodes based on a complex ultrasound assessment

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


BACKGROUND: Ultrasound is widely used in routine practice to diagnose various forms of adenomyosis and uterine fibroids. However, due to the lack of unified criteria, hypo- or overdiagnosis of internal endometriosis is possible. Moreover, there are a number of difficulties in the differential diagnosis of nodular adenomyosis and uterine fibroids.

AIM: The aim of this study was to develop a complex technique for the differential diagnosis of uterine fibroids and adenomyosis nodes.

MATERIALS AND METHODS: We applied a complex ultrasound technique with a detailed and consistent application of the following tools — 3D reconstruction, elastography, color Doppler, 3D power Doppler (glass body mode). The study was conducted in 124 patients of reproductive age with subsequent intraoperative and histological confirmation of the diagnosis.

RESULTS: After the proposed ultrasound technique, uterine fibroids were diagnosed in 112 (90.3%) patients, of whom 85 (75.9%) patients had uterine fibroids combined with a diffuse form of internal endometriosis. Nodular adenomyosis was diagnosed in 12 (9.7%) patients. The additional examination and surgical treatment showed that the preliminary diagnosis of uterine fibroids was confirmed in 110 out of 112 women, and in two other cases, nodular adenomyosis was diagnosed. Eleven (91.7%) out of 12 patients were diagnosed correctly with nodular adenomyosis by the complex ultrasound examination, while in one case the preliminary diagnosis proved to be incorrect, with a conglomerate of three myomatous nodes detected as a result of surgical treatment. Thus, based on the technique we developed, the correct diagnosis was made in 121 (97.6%) patients. Misdiagnosis in three cases was associated with a history of a long-term medical treatment of adenomyosis and therefore Doppler and elastography results had lower sensitivity.

CONCLUSIONS: The development of the described complex ultrasound technique allows for accurately diagnosing the form of adenomyosis, identifying early forms of the disease and differentiating adenomyosis nodes from myomatous nodes, which is necessary for the correct diagnosis, the right choice of the management tactics and the necessary treatment.

Journal of obstetrics and women's diseases. 2022;71(5):75-84
pages 75-84 views

Issues in reproductive health in chromosome translocation carriers

Shilenkova Y.V., Pendina A.A., Fedorova E.M., Efimova O.A., Chiryaeva O.G., Petrova L.I., Dudkina V.S., Tikhonov A.V., Gzgzyan A.M., Bespalova O.N., Kogan I.Y.


BACKGROUND: It is common a wide range of reproductive disorders in couples with structural chromosome aberration in one of the partners, such as infertility, miscarriage, unsuccessful assisted reproductive technologies attempts. In this regard, predicting the reproductive outcome in a particular couple is an extremely difficult task. To solve it, it is necessary to consider the influence of many factors, including the type of chromosome translocation and the carrier’s sex.

AIM: To evaluate the structure of reproductive disorders in couples where one of the partners was a chromosome translocation carrier, depending on its type: Robertsonian or reciprocal, and carrier’s sex.

MATERIALS AND METHODS: In this retrospective cohort study, we analyzed the clinical and anamnestic data of 100 couples where one of the partners was a chromosome translocation carrier. Couples applied to fertility centers between March 2009 and May 2019. To assess the effect of the type of chromosomal translocation and carrier’s sex, we provided intergroup comparisons.

RESULTS: Comparative analysis of somatic pathology and chronic gynecological diseases didn’t reveal significant differences between groups of female patients (Fischer’s exact test, p > 0,05). An intergroup comparison of reproductive outcomes in couples divided by the type of chromosome translocation: reciprocal or Robertsonian, and the carrier’s sex, detected significant differences. Primary infertility was significantly more often detected in couples with a male translocation carrier, secondary — with a female carrier (Fisher’s exact test, p = 0,01). Pregnancy significantly more frequent occurred and, it was also significantly more often spontaneously interrupted in couples with a female carrying of reciprocal or Robertson translocation (χ2 = 13,29, df = 3, p = 0,004). Thus, a female carrying a chromosomal translocation is characterized by a greater risk of miscarriage.

CONCLUSIONS: The chromosome translocation type and the carrier’s sex have a differential effect on the nature of reproductive disorders. Female carrying a chromosomal translocation increases the likelihood of both pregnancy and its spontaneous termination. In contrast, in couples with a male translocation carrier, the probability of both pregnancy and miscarriage is lower. Thus, the type of translocation and the carrier’s sex determine the individual risks of reproductive disorders, including infertility and miscarriage, which should be considered in the planning, choosing the method of onset and management of pregnancy.

Journal of obstetrics and women's diseases. 2022;71(5):85-96
pages 85-96 views

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