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Vol 71, No 6 (2022)

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Features of the prognosis and outcomes of pregnancy with massive subchorionic thrombosis. A literature review

Kuznetsova A.A., Shelepova E.S., Osipova N.A., Roschina T.Y., Zazerskaya I.E.


Massive subchorionic thrombohematoma, also termed in the literature as Breus’ mole, is a rare condition in which a large maternal blood clot separates the chorionic plate from the chorionic villi. The etiology and pathogenesis of this condition are yet unclear, and the very concept of massive subchorionic thrombohematoma remains vague due to the singularity of clinical cases and the necessity to distinguish it from other types of hematomas. The lack of a unified view on the pathology and clear-cut clinical, laboratory and ultrasound criteria can lead to insufficient attention of doctors and untimely or even incorrect establishing diagnosis, which significantly worsens the prognosis of pregnancy and increases the risk of potential complications. Patients with massive subchorionic thrombohematoma require increased attention due to the high rate of such manifestations as antenatal death, fetal growth retardation, late miscarriage, and preeclampsia. Each case should be carefully analyzed in order to find predictors of thrombohematomas and methods of their prevention.

Journal of obstetrics and women's diseases. 2022;71(6):49-61
pages 49-61 views

The use of a lactic acid gel in the treatment and prevention of bacterial vaginosis and urinary tract infections as a challenge to antibacterial therapy. A literature review

Minakova A.D., Dzhibladze T.A., Zuev V.M., Khokhlova I.D.


Bacterial vaginosis and urinary tract infections are common conditions that lead to a decrease in the quality of life and significant economic costs. The review provides up-to-date information on the role of lactic acid in the microbiota of the vagina and urinary tract, as well as on the use of a lactic acid gel in these conditions. Bacterial vaginosis is associated with an increased risk of urinary tract infections. Antibacterial therapy demonstrates statistically significant results in treating exacerbation, but not preventing further relapses, which is due to the possible high ability of bacteria to form biofilms. Lactic acid, unlike hydrogen peroxide, is involved in maintaining the vaginal microbiota and enhancing its protective function against sexually transmitted infections, and indirectly affects the urinary microbiota. This may allow the use of lactic acid for the treatment and prevention of relapses in both bacterial vaginosis and urinary tract infections.

Journal of obstetrics and women's diseases. 2022;71(6):63-70
pages 63-70 views

Predictors of late complications in pregnant women with arterial hypertension

Khalenko V.V., Arzhanova O.N., Mozgovaya E.V.


Arterial hypertension occurs in 8–29% of pregnant women and is a common form of endothelial dysfunction during gestation. In recent decades, the prevalence of arterial hypertension has increased several times largely due to the increasing maternal age of primiparous women and the increased incidence of obesity, diabetes mellitus, and carbohydrate metabolism disorders.

The aim of this study was to formulate the management tactics for pregnant patients with high blood pressure, based on the current understanding of the causes and mechanisms of the disease and the ability to influence the molecular links of pathogenesis, and to identify possible markers for predicting the progression of endothelial dysfunction in pregnant women with arterial hypertension. This review, based on the literature, raises the problem of modern diagnosis of arterial hypertension in pregnancy. We discuss the consequences of late initiation of the therapy and evaluate possible complications.

The severity of arterial hypertension is assessed differently in pregnant and non-pregnant women, according to current clinical guidelines. Thus, chronic arterial hypertension in pregnant women corresponds to grade II arterial hypertension in non-pregnant women, according to the American Heart Association and American College of Cardiology classification. Both untimely diagnosis and delayed or inadequate treatment result in adverse obstetric outcomes. Recent studies indicate the ability of earlier antihypertensive therapy (already at stage I according to the American Heart Association and American College of Cardiology classification) to reduce maternal and fetal adverse effects and prolong pregnancy. The CHAP 2022 study showed that using a blood pressure treatment threshold of 140/90 mmHg for pregnant women with chronic arterial hypertension provides better outcomes compared to treatment at higher numbers. Despite early initiation of therapy, some patients with elevated blood pressure subsequently develop thrombotic and gestational complications associated with endothelial dysfunction. There is an obvious need to introduce early preclinical diagnostic methods that would narrow the risk group and prevent late complications. The authors’ consensus on personalization of acetylsalicylic acid intake has emerged. The review analyzes the potential mechanisms of aspirin resistance, as well as the influence of genetic (the PTGS1, PTGS2, ITGB3, ITGA2, GP6, GP1BA, P2RY1, P2RY12 genes, other genes, and associated microRNA) and biochemical markers (11-dehydrotromboxane B2), which presumably may have prognostic value and applicability in clinical practice.

Our current understanding of the problem of diagnosis and early treatment of arterial hypertension in pregnancy can reduce the number of complications. The problem of predicting the development of endothelial dysfunction remains unresolved to the end. Active implementation of the studied markers into practice requires a further more detailed study of this area and the optimization of research design.

Journal of obstetrics and women's diseases. 2022;71(6):71-82
pages 71-82 views

Fetal growth restriction: ways to the solution of the problem. A literature review

Shcherbakova E.A., Baranov A.N., Revako P.P., Istomina N.G., Burenkov G.M.


Fetal growth restriction is a condition that is defined as the inability of a fetus to reach its full genetically determined growth potential. The mechanism underlying the pathogenesis is a placental dysfunction in the form of inadequate supply of oxygen and nutrients to the fetus. Clinically, this is reflected by a drop in fetal size percentiles over the course of gestation. Worldwide, fetal growth restriction is a leading cause of stillbirth, neonatal mortality and morbidity in postnatal period. Prenatal identification of fetuses with this pathology significantly reduces the incidence of adverse perinatal outcomes. However, recognizing this pathology is often a hard challenge because fetal growth cannot be assessed using only a few biometric parameters of fetal size and the fetal growth potential is hypothetical. It is also necessary to distinguish between fetal growth restriction and a fetus small for gestational age to determine the correct the management of pregnancy and the timing of delivery. In this article, we present the approaches to the management of pregnancies and deliveries in fetal growth restriction, and we identify directions for further research in this area.

Journal of obstetrics and women's diseases. 2022;71(6):83-95
pages 83-95 views

Original Research

Serotonin and cyclic sleep organization in full-term newborn infants with intrauterine growth retardation

Zvereva N.A., Milyutina Y.P., Arutjunyan A.V., Evsyukova I.I.


BACKGROUND: The high frequency of neurological and mental diseases in children who had intrauterine retardatiojn development indicates the need to study specific markers of disorders of fetal brain functional development, in particular, the state of the serotonergic system, which plays a key role in the morpho-functional development of the brain in early ontogenesis.

AIM: To study the content of serotonin in full-term newborns with intrauterine development delay in comparison with quantitative and qualitative characteristics of sleep.

MATERIALS AND MЕTHODS: The main group consisted of 26 newborns, whose intrauterine development took place in conditions of chronic placental insufficiency, which led to the formation of an asymmetric form of intrauterine retardatiojn development. The control group consisted of 72 healthy newborns from healthy mothers without pregnancy complications. Children of each group are divided into three subgroups depending on gestational age: I — 37, II — 38, III — 39–40 weeks. In all children, 7–12 hours after birth, an electropoligram of sleep was recorded (an electroencephalograph of the company “Mizar”, Russia) and its quantitative and qualitative analyses were carried out, highlighting the orthodox, paradoxical phase and undifferentiated state. The serotonin content was determined in platelet-rich plasma of blood from the umbilical cord vein after birth, as well as in a platelet suspension prepared from venous blood taken on the first day of life. The content of serotonin in platelets was judged by the indicator obtained by dividing the amount of serotonin in the platelet suspension by the platelet level. The amount of serotonin was determined by high-performance liquid chromatography with electrochemical detection. Statistical analysis was performed using the Statistica 6 program (Statsoft Inc, USA).

RESULTS: We report here a low content of serotonin in platelet-rich plasma and platelets of newborns with intrauterine growth retardation and the absence of its normal increase in weeks 37–39 of intrauterine development, as well as a violation of the genetic programming for the sleep-wake cycle organization.

CONCLUSIONS: Assessment of the serotonin-producing system of the brain in comparison with the newborn sleep pattern can serve as a diagnostic marker of brain damage and substantiate the need for timely application of neuroprotection.

Journal of obstetrics and women's diseases. 2022;71(6):5-14
pages 5-14 views

Fetal growth restriction in diabetic pregnancy: a retrospective single-center study

Kopteyeva E.V., Shelayeva E.V., Alekseenkova E.N., Nagorneva S.V., Kapustin R.V., Kogan I.Y.


BACKGROUND: The high risk of adverse maternal and perinatal complications in patients with fetal growth restriction and diabetes mellitus requires a detailed assessment of the major risk factors and outcomes.

AIM: The aim of this study was to determine the main risk factors for fetal growth retardation in pregnant women with pregestational and gestational diabetes mellitus, and to assess obstetric and perinatal outcomes in these patients.

MATERIALS AND METHODS: We conducted a retrospective single-center cohort study at the premises of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The study included 103 patients with type 1 diabetes mellitus, type 2 diabetes mellitus, or gestational diabetes mellitus with fetal growth retardation who delivered a singleton neonate from January 2017 to December 2021. Based on the antenatal diagnosis, the patients were divided into the following comparison groups: group I — early fetal growth retardation (n = 29), group II — late fetal growth retardation (n = 27), group III — small for gestational age (n = 47). Relative risk calculations were used to assess the contribution of risk factors and the risk of developing secondary outcomes.

RESULTS: Pregestational diabetes mellitus was the major risk factor for early fetal growth retardation development (relative risk 1.91; 95% confidence interval 1.04–3.50); especially type 1 diabetes mellitus (relative risk 1.64; 95% confidence interval 1.02–2.74) and more than 10 years of pregestational diabetes mellitus duration (relative risk 2.62; 95% confidence interval 1.12–6.17). Chronic hypertension increases the risk of early fetal growth retardation (relative risk 2.11; 95% confidence interval 2.21–3.68), while gestational hypertension was a significant risk factor for late fetal growth retardation development (relative risk 1.81; 95% confidence interval 1.01–3.70). Preeclampsia is associated with both early and late forms of fetal growth retardation. Maternal characteristics, such as age over 35 years, obesity, and in vitro fertilization pregnancy, increased the risk of early fetal growth retardation development. In turn, the presence of fetal growth retardation in patients with diabetes mellitus is associated with increased risk of cesarean section, prolonged stay of the newborn in the neonatal intensive care unit (≥5 days), low Apgar scores (<7 at the 5th minute), and neonatal hypoglycemia. Early fetal growth retardation is a significant risk factor for preterm birth (relative risk 6.23; 95% confidence interval 2.87–13.42) and fetal distress (relative risk 5.51; 95% confidence interval 2.28–13.33).

CONCLUSIONS: Being associated with a highly increased risk of adverse obstetric and perinatal outcomes, early fetal growth retardation in diabetic pregnancy is related to pregestational diabetes mellitus, especially type 1 diabetes mellitus, with a long history, as well as with hypertension in pregnancy.

Journal of obstetrics and women's diseases. 2022;71(6):15-27
pages 15-27 views

Epithelial-mesenchymal transition as a pathogenetic mechanism of development and progression of adenomyosis

Pechenikova V.A., Gaidarova A.A., Churkin K.S., Pertovskaia N.N.


BACKGROUND: In recent years, an important role in the pathogenesis of adenomyosis has been assigned to invasive properties of the cells of the basal layer of the endometrium, which provide them with the capacity to grow into the underlying layers of the myometrium.

AIM: The aim of this study was to evaluate the invasive and migratory properties of the ectopic and heterotopic endometrium in patients with adenomyosis.

MATERIALS AND METHODS: We performed clinical, morphological and immunohistochemical analyses of the surgical material of 98 patients with adenomyosis. Immunohistochemical study was carried out according to the standard avidin-biotin method, using mouse monoclonal antibodies to estrogen receptors, matrix metalloproteinase type 9, vimentin, and fibronectin (DAKO, Denmark) as primary immune sera.

RESULTS: The maximum number of estrogen receptors in both the proliferation and secretion phases was found in the endometrial glands and superficially located endometrioid heterotopias. A weaker expression of this marker was also found in the cells of the cytogenic stroma. In the foci of adenomyosis, located in the deep layers of the myometrium, the expression of estrogen receptors in the epithelial and stromal components of heterotopias varied in a wide range from 0 to 100%. The most pronounced expression of matrix metalloproteinase type 9 was characteristic of the epithelial component of superficial endometrioid heterotopias. In the foci of adenomyosis, located in the deep parts of the myometrium, a pronounced expression of matrix metalloproteinase type 9 was preserved in the proliferation phase, and its significant decrease was found in the secretion phase. The glands of the eutopic endometrium were also characterized by a more significant level of matrix metalloproteinase type 9 expression in the proliferation phase in comparison with the secretion phase. A pronounced expression of vimentin was detected in the epithelium of the glands of both superficial and deep foci of adenomyosis, as well as in the eutopic endometrium (100%). In the cytogenic stroma, the largest area of vimentin expression was found in the eutopic endometrium and superficially located endometrioid heterotopias. However, its value significantly decreased in the foci of adenomyosis located in the deep parts of the myometrium. The largest area of fibronectin expression was characteristic of the cytogenic stroma of superficial adenomyosis foci.

CONCLUSIONS: The displacement of elements of the eutopic endometrium into the thickness of the myometrium and further progression of adenomyosis is provided by two parallel pathogenetic mechanisms, namely, invasive growth due to matrix metalloproteinase type 9 activation and epithelial cell migration due to the epithelial-mesenchymal transition.

Journal of obstetrics and women's diseases. 2022;71(6):29-38
pages 29-38 views

The relationship between the two endocrine pathologies: subclinical gestational hypothyroidism and gestational diabetes mellitus

Uchamprina V.A., Bobrova E.I., Startseva N.M., Anikeev A.S., Sviridova M.I.


BACKGROUND: Over the past decade, gestational diabetes mellitus has become of increasing medical and social importance. It happens due to its increased prevalence and due to its negative impact on pregnancy and long-term metabolic disorders in the mother and fetus.

AIM: The aim of this study was to assess the relationship between subclinical gestational hypothyroidism and gestational diabetes mellitus, the two most common endocrine pathologies in pregnancy.

MATERIALS AND METHODS: We studied 200 medical records of pregnant women. The main group included 133 patients with subclinical gestational hypothyroidism, and the control group consisted of 67 women without endocrine pathology. The diagnosis of gestational diabetes mellitus was made based on the Ministry of Health of the Russian Federation clinical guidelines criteria. The diagnosis of subclinical hypothyroidism was made based on the thyroid-stimulating hormone level above 2.5 μIU/ml in combination with an increased titer of antithyroid antibodies or above 4.0 μIU/ml in the absence of any thyroid disorder. Statistical analysis was carried out using the StatTech v.2.1.0 program (Stattech Ltd, Russia).

RESULTS: The prevalence of hypothyroidism was higher among women with family history of diabetes mellitus. The chances of developing gestational diabetes mellitus increased by 9.706 times in the presence of hypothyroidism, by 1.077 times with an increase in age by one full year at the time of seeing the doctor, and by 1.023 times with an increase in weight before pregnancy by one kilogram. The thyroid-stimulating hormone level of more than 2.7 μIU/ml predicted the development of gestational diabetes mellitus with a sensitivity of 71.4% and a specificity of 63.1%.

CONCLUSIONS: Subclinical gestational hypothyroidism and gestational diabetes mellitus are interrelated endocrine disorders with common pathophysiological predictors. Among women with a normal body mass index, subclinical gestational hypothyroidism is a more significant risk factor for gestational diabetes mellitus than an increase in age or body weight. A certain threshold level of thyroid-stimulating hormone (more than 2.7 μIU/ml) in the first trimester increases the chances of developing gestational diabetes mellitus and should be considered as a signal for timely prevention and detection of gestational diabetes mellitus.

Journal of obstetrics and women's diseases. 2022;71(6):39-47
pages 39-47 views

History of medicine

From the history of the evolution of laparoscopic surgery in the Northern Scientific Medical School of Obstetricians and Gynecologists

Andreyeva A.V., Samburov G.O., Baranov A.N., Dyachkov S.K., Burenkov G.M.


This article provides information on the history of the evolution of laparoscopy in the Northern Scientific Medical School of Obstetricians and Gynecologists. D.O. Ott discovered a way of visualising the organs of abdominal cavity (ventroscopy) and became the first surgeon in the world who performed the endoscopic interventions of the organs in abdomial cavity. Foreign and Russian scientists, including those from Arkhangelsk, as well as practitioners, who are presented in this article, have contributed a lot to the development of laparoscopy in gynecology. Laparoscopy in gynecology of today is an endovideosurgery, which has become a part of the routine practice of gynecologists. Laparoscopic surgery has become one of the most promising areas in gynecology for residents of the European North of Russia, focused on minimizing surgical trauma and improving the quality of patient care.

Journal of obstetrics and women's diseases. 2022;71(6):125-133
pages 125-133 views

Theory and Practice

Evolution of views on operative delivery

Ailamazyan E.K., Kuzminykh T.U.


This article traces the historical path of operative obstetrics up to the present time. The issues of the high frequency of cesarean section, its impact on perinatal mortality, reproductive health of the female population, mental health of the future generation (children by operation), and qualification of obstetricians and gynecologists are raised. The authors point out that there is no direct correlation between the frequency of cesarean section and perinatal mortality rates, since antenatal fetal death dominates its structure, which does not depend on the method of delivery.

Journal of obstetrics and women's diseases. 2022;71(6):97-105
pages 97-105 views

Small intestine prolapse after vaginal hysterectomy with vaginal dome rupture. A clinical case

Ziganshin A.M., Mukhametdinova I.G., Allayarova V.F., Shayhieva E.A.


The relevance of surgical treatment of pelvic organ prolapse is beyond doubt, due to the high prevalence and risk of surgical intervention during life. Surgical treatment of prolapse today remains the only effective method, however, despite more than 400 methods of surgical correction, the number of complications and relapses does not tend to decrease.

This article presents a clinical case of ineffective choice of surgical treatment of genital prolapse with own tissues and vaginal hysterectomy, which subsequently led to the development of enterocele. In the future, the lack of postoperative follow-up and the preservation of a lifestyle that included the performance of hard physical labor led to a rupture of the dome of the vagina and prolapse of the loops of the small intestine.

Today, for the prevention of complications and recurrence of genital prolapse, it is mandatory for patients to go through a careful selection for surgical treatment, which should include a clinical study and study of risk factors. When choosing an operative approach, complex treatment is necessary, including the use of the patient’s own tissues and modern materials that allow creating a reliable physiological framework to strengthen the pelvic organs. When performing this surgery, it is necessary not only to replace the damaged defective pelvic fascia with a new one, but also to create a neofascia that ensures the preservation of the normal function of the pelvic organs.

Journal of obstetrics and women's diseases. 2022;71(6):107-112
pages 107-112 views

Surgical treatment for colorectal endometriosis. A clinical case

Politova A.K., Maksimenkov A.V., Vershinina Y.A., Alexandrova A.D., Dudorova S.V.


The article describes a clinical case of successful surgical treatment of a patient with deep endometriosis involving the rectum using the Da Vinci Surgical System. The use of the Da Vinci robotic complex allows for increasing the radicalism of the operation by improving visualization and expanding the surgeon’s manual capabilities. This starts to be possible thanks to the technical advantages of this technology, specifically 3D imaging and the use of EndoWrist instruments with artificial wrists and seven degrees of freedom that provide greater precision when manipulating in a minimally invasive environment. Surgical treatment of colorectal endometriosis includes three types of operations — focus shaving, discoid and circular bowel resections with anastomosis. When choosing a treatment strategy, one needs to take into account the clinical course of the disease, the results of conservative treatment and instrumental methods of research (ultrasound, MRI), and the woman’s reproductive plans. The excision of the infiltrate is an effective method of treating patients with colorectal endometriosis in terms of pain relief, improving the quality of life and restoring reproductive function. Performing such operations is optimal in medical institutions with a multidisciplinary approach.

Journal of obstetrics and women's diseases. 2022;71(6):113-124
pages 113-124 views

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