Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

Vol 72, No 1 (2023)

Cover Page

Full Issue

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Original Research

Expression of the serotonergic system components in the placenta in various types of preeclampsia

Bettikher O.A., Belyaeva O.A., Dukovich A.I., Vorobeva O.M., Tral T.G., Tolibova G.K., Bart V.A., Kogan I.Y., Zazerskaya I.E.

Abstract

BACKGROUND: The serotonergic system plays an important role in the formation and development of the feto-placental complex. The study of the expression of the serotonin system components, including placental 5-HT2A (serotonin receptor) and SERT (serotonin transporter), in preeclampsia will create prerequisites for discovering new ways to correct hypertensive pregnancy complications and methods of influencing pregnancy outcomes.

AIM: The aim of this study was to compare the expressions of 5-HT2A and SERT in placental tissue in pure preeclampsia and its combinations with other complications of pregnancy.

MATERIALS AND METHODS: A comparative cohort study was conducted among patients with different preeclampsia phenotypes: preeclampsia (n = 6), preeclampsia and gestational diabetes mellitus (n = 6), gestational diabetes mellitus and superimposed preeclampsia (preeclampsia + chronic arterial hypertension) (n = 6), and normal pregnancy without pregnancy complications (n = 6). The expression of 5-HT2A (Abcam, USA) and SERT (BiossAntibodies, USA) was studied in placenta samples from all study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia). The database was constructed and statistical processing was performed using Microsoft Excel 2007 (Microsoft Corporation, USA) and the StatTech program v. 2.6.4 (Stattech Ltd., Russia).

RESULTS: The expression of SERT and 5-HT2A is higher in the studied pregnancy complications when compared to the normal one. The relative 5-HT2A expression area in the placenta among the studied nosologies is higher in preeclampsia without gestational diabetes mellitus or in superimposed preeclampsia in combination with chronic arterial hypertension compared to expression in placentas in preeclampsia in combination with gestational diabetes mellitus or in preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.02 and p = 0.017, respectively). The relative area of SERT expression is higher in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension and in preeclampsia in combination with gestational diabetes mellitus compared to preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.002 and p = 0.012, respectively).

CONCLUSIONS: The highest expressions of 5-HT2A and SERT among the studied preeclampsia phenotypes were found in placentas in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension.

Journal of obstetrics and women's diseases. 2023;72(1):5-16
pages 5-16 views

The dynamics of mental health measures of pre- and postpartum women undergoing assisted reproductive technology

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

Abstract

BACKGROUND: The number of infertile women has been increasing since 2015, with a 10–15% increase in IVF cycles every year. The data on mental health of women using assisted reproductive technology are contradictory; there is little research on the dynamics of mental health outcomes from pregnancy to postpartum.

AIM: The aim of this study was to evaluate the dynamics of mental health measures in the groups of pre- and postpartum women using assisted reproductive technology and to compare these groups with women who conceived spontaneously.

MATERIALS AND METHODS: This study had three stages: during pregnancy, within one month after delivery, and in four to nine months after childbirth, and included 59 women who used assisted reproductive technology (34.0 ± 4.60 years old) and 85 women with natural pregnancy (30.6 ± 4.39 years old). All the women had singleton, planned pregnancy, with the most of them at more than 20 weeks pregnant. Drop out within research stages was approximately 20–30%. We used the Achenbach System of Empirically Based Assessment, socio-demographic and obstetric data gathering, as well as a postpartum telephone interview.

RESULTS: Women in the assisted reproductive technology group were less likely (р = 0.000) to attend or plan to attend childbirth preparation courses. In this study group, emergency (40%) and planned (26%) caesarean sections were used more often (p = 0.001); in 17% of cases, they gave birth before 37 weeks of gestation (vs. 1.9% in the group of women with natural pregnancy); and only 51% of women undergoing assisted reproductive technology used breast feeding (vs. 78% in the group of women with natural pregnancy). No significant differences in Apgar scores and the number of problems in child’s health straight after the delivery were shown. In 4–9 months after the child’s birth in the group of women using assisted reproductive technology, the number of somatic disorders was significantly higher (р = 0.046) compared to the group of women with natural pregnancy. The analysis of the dynamics of mental health measures revealed an increase of withdrawal (p = 0.010) and thought problems (p = 0.001) in the group of women using assisted reproductive technology. In the group of women with natural pregnancy, the analysis revealed a decrease in the number of mental health problems such as anxiety / depression, somatic problems, delinquent behavior, as well as DSM-associated anxiety disorder and avoidance (р < 0.05).

CONCLUSIONS: Mental health measures of women undergoing assisted reproductive technology, their dynamics after childbirth, the number of preterm births and cesarean sections, as well as feeding type altogether may be a risk factor for the mental health and development of the children. These women may require additional support.

Journal of obstetrics and women's diseases. 2023;72(1):17-25
pages 17-25 views

The role of WNT and HOXA signaling cascades in the pathogenesis of adenomyosis

Malysheva O.V., Beganova A.K., Vashukova E.S., Shalina M.A., Yarmolinskaya M.I., Glotov A.S.

Abstract

BACKGROUND: Adenomyosis is a common gynecological disease with unknown pathogenesis. The HOXA10, HOXA11 and WNT4 genes may play an important role in the pathogenesis of adenomyosis both at the stage of embryonic development and in the postnatal period. The study of their expression in the endometrium of patients with adenomyosis can expand the understanding of the pathogenesis of this disease.

AIM: The aim of this work was to study the peculiarity of the WNT4, HOXA10 and HOXA11 gene expression in the eutopic endometrium of patients with isolated adenomyosis.

MATERIALS AND METHODS: The study included 38 women: the main group involved patients with isolated adenomyosis established by ultrasound / magnetic resonance imaging (n = 20) and the control group consisted of healthy patients (n = 18). Endometrial sampling was obtained during surgery or by aspiration biopsy at 5–12 day of the menstrual cycle (proliferative phase) or 20–24 day of the menstrual cycle (secretory phase). The expression of the WNT4, HOXA10 and HOXA11 genes in endometrial samples was assessed by a real-time reverse transcription polymerase chain reaction.

RESULTS: In the proliferative phase endometrial samples of patients with adenomyosis, a significant increase in the WNT4 (of almost two times), HOXA10 and HOXA11 (of one and a half to two times) gene expression levels was shown compared to the control group. In 88% of patients with adenomyosis, there is a significant increase (up to the level of fourth quartile) in the expression of at least one of these genes, such changes being not typical for the endometrium of women in the control group. In the secretory phase endometrial samples, the expression of the studied genes did not differ from the level characteristic of the corresponding groups in the proliferative phase of the cycle.

CONCLUSIONS: The aberrant expression of the WNT4, HOXA10 and HOXA11 genes in the endometrium of patients with adenomyosis indicates a significant role of these genes in the development of the disease and infertility associated with adenomyosis.

Journal of obstetrics and women's diseases. 2023;72(1):27-37
pages 27-37 views

The influence of reproductively significant autoantibodies determined in the follicular fluid on the quality of the obtained oocytes and embryos, as well as on the implantation rate in assisted reproductive technology cycles

Safarian G.K., Dzhemlikhanova L.K., Kogan I.Y., Niauri D.A., Bespalova O.N., Krikheli I.O., Ob’edkova K.V., Lesik E.A., Komarova E.M., Gzgzyan A.M.

Abstract

BACKGROUND: According to reports, the efficiency of in vitro fertilization and intra cytoplasmic sperm injection protocols is decreased in patients positive for various autoantibodies, as opposed to autoantibody negative patients. However, there are contradictory data indicating no autoantibody effect on the outcome of infertility treatment using assisted reproductive technology.

AIM: The aim of this study was to evaluate the embryological outcome and clinical efficiency of infertility treatment in in vitro fertilization and intra cytoplasmic sperm injection protocols in women in the presence of reproductively significant autoantibodies.

MATERIALS AND METHODS: This prospective study enrolled 90 infertile patients undergoing assisted reproductive technology treatment. The follicular fluid obtained on the day of oocyte retrieval was evaluated for a wide autoantibody panel using commercial ELISA kits. The main group (n = 52) included women with autoantibody levels determined in the follicular fluid of more than three standard deviations from the mean values determined among all patients. The comparison group consisted of 38 women with autoantibody levels of less than three standard deviations from all subjects. The intergroup comparative analysis included clinical and anamnestic data, hormonal parameters, ovarian reserve, embryological data, and in vitro fertilization and intra cytoplasmic sperm injection efficiency.

RESULTS: Reliably lower ovarian reserve parameters (anti-Mullerian hormone levels 1.9 (1.4; 4.0) vs. 3.3 (2.2; 6.5) ng/ml; p = 0.005; number of antral follicles 8.5 (6.0; 12.0) vs. 11.0 (9.0; 17.0); p = 0.003) have been noted in the main group relatively to the comparison group. The autoantibodies to thyroid peroxidase and cardiolipin content in the follicular fluid has been shown to be negatively associated with the number of two-pronuclear zygotes, the presence of autoantibodies to aromatase correlating negatively with the fertilization rate. Furthermore, the follicular fluid levels of autoantibodies to thyroid peroxidase (≥105 IU/ml) and cardiolipin (≥5.1 IU/ml) are reliably associated with a higher frequency of a suboptimal response to previous controlled ovarian stimulation, a lower incidence of high quality embryos on days 3 and 4 of in vitro cultivation, a decreased number of top-quality blastocysts, and the clinical efficiency of in vitro fertilization and intra cytoplasmic sperm injection programs.

CONCLUSIONS: The presence of reproductively significant autoantibodies is an independent risk factor for reducing the total efficiency of assisted reproductive technology treatment.

Journal of obstetrics and women's diseases. 2023;72(1):39-52
pages 39-52 views

Antibiotic resistance of pathogens causing community-acquired urinary tract infections in pregnant women with diabetes mellitus

Khusnutdinova T.A., Shipitsyna E.V., Krysanova A.A., Savicheva A.M., Kapustin R.V.

Abstract

BACKGROUND: Urinary tract infections are among the most common infectious diseases in women and are the most frequent cause of infectious complications of pregnancy, especially in pregnant women with type 1 diabetes mellitus. For adequate treatment of urinary tract infections in pregnant women with type 1 diabetes mellitus, it is requisite to regularly monitor antimicrobial resistance of uropathogens in order to update empirical schemes of antibacterial therapy.

AIM: The aim of this study was to determine the spectrum of uropathogens and the activity of antibacterial drugs against pathogens of community-acquired urinary tract infections in pregnant women with type 1 diabetes mellitus or without diabetes mellitus.

MATERIALS AND METHODS: We analyzed 91 strains obtained from pregnant women with or without type 1 diabetes mellitus. The sensitivity of microorganisms to all antibacterial drugs was evaluated by the disk diffusion method.

RESULTS: In the group of pregnant women with type 1 diabetes mellitus in the etiological structure of uropathogens, enterobacteria accounted for 84.8%, Escherichia coli (71.7%) and Klebsiella spp. (13.0%) being the most common. In the group of pregnant women without diabetes mellitus in the structure of uropathogens, enterobacteria accounted for 75.6%, while E. coli was the causative agent of urinary tract infections in 62.2% of women and Klebsiella spp. in 11.1%. Gram-positive uropathogens were isolated much less frequently. In the group of pregnant women with type 1 diabetes mellitus, piperacillin/tazobactam, carbapenems, nitrofurantoin, and amikacin (100%), as well as fosfomycin and gentamicin (97%), had the maximum antibacterial activity against E. coli. The sensitivity of E. coli to various cephalosporins varied in the range of 84.9–90.9%. In the group of pregnant women without diabetes mellitus and with urinary tract infections, the highest E. coli sensitivity rates were observed for piperacillin/tazobactam, carbapenems, fosfomycin, nitrofurantoin, gentamicin, and amikacin (100%). E. coli sensitivity to second and third generation cephalosporins varied in the range of 75.0–82.1%, and it was 96.4% to cefepime. Ampicillin and amoxicillin/clavulanate demonstrated the least activity against E. coli in the two study groups. The rate of extended spectrum beta-lactamase production by uropathogenic enterobacteria in pregnant women with type 1 diabetes mellitus was 15.8% of the strains, and in pregnant women without diabetes mellitus, it was 18.1%.

CONCLUSIONS: There were no significant differences in the activity of antibacterial drugs against the pathogens of community-acquired urinary tract infections in pregnant women with or without diabetes mellitus.

Journal of obstetrics and women's diseases. 2023;72(1):53-62
pages 53-62 views

The technique of intraoperative bladder filling to prevent surgical injuries of the urinary system during delivery in patients with placenta accrete

Kuznetzova N.B., Barinova V.V., Bushtyreva I.O., Zavarzin P.Z.

Abstract

BACKGROUND: The annual increase in operative deliveries in obstetrics is steadily leading to an increase in the number of women with placenta accreta spectrum disorders. Cesarean section in patients with placenta accreta spectrum can be done only by surgeons of the highest qualification in operating rooms with the best technical equipment. Every year, the surgical delivery techniques for such patients get better and better, pursuing the goal of preserving the uterus and minimizing intraoperative complications and blood loss.

AIM: The aim of this study was to assess the effectiveness of the intraoperative bladder filling technique during delivery in patients with placenta accreta spectrum.

MATERIALS AND METHODS: All patients were randomly divided into two groups: 22 pregnant women (Group 1) who underwent caesarean section with metroplasty using intraoperative bladder filling technique and 19 pregnant women (Group 2) who underwent caesarean section with metroplasty without bladder filling. We analyzed the course of the operation, the measures taken to prevent blood loss, the time and scope of surgery, as well as surgical complications. Statistical analysis was performed using the non-parametric Mann-Whitney U-test and Fisher’s exact test.

RESULTS: Patients of the both study groups were comparable in age, number of pregnancies in history, number of medical abortions, spontaneous abortions and non-developing pregnancies, as well as in the number of uterine scars in history. The total blood loss was 2177.8 ± 114.9 ml in Group 1 and 2545.7 ± 158.8 ml in Group 2 (p < 0.05). Duration of surgery was 2 hours 45 ± 7.1 minutes in Group 1 and 3 hours 31 ± 4.1 minutes in Group 2. The bladder injury occurred in one patient in Group 1 in three patients in Group 2 (p < 0.05).

CONCLUSIONS: In patients with placenta accreta spectrum, the use of the bladder filling technique and mobilization of the bladder during cesarean section with metroplasty can reduce the percentage of intraoperative complications (incidence of bladder injury), intraoperative blood loss and the duration of surgery.

Journal of obstetrics and women's diseases. 2023;72(1):63-70
pages 63-70 views

Reviews

Chronic kidney disease and pregnancy: an interdisciplinary assessment of gestational risks and complications. A literature review

Grigoryeva O.A., Bezhenar V.F.

Abstract

Chronic kidney disease represents a heterogeneous group of diseases characterized by changes in the kidneys’ structure and functions. It significantly increases the risks of adverse maternal and perinatal outcomes. These risks increase with worsening renal dysfunction corresponding to an increase in the degree of proteinuria and arterial hypertension. Anatomical and physiological changes in the kidneys during pregnancy are characterized by dilatation of the pelvicalyceal system, a decrease in systemic and renal vascular resistance, and an increase in the glomerular filtration rate. These clinically significant changes can complicate the diagnosis of the renal dysfunction, as well as its progression. Pregnancy can affect the kidney as it can manifest as declining kidney function, especially in the context of concomitant arterial hypertension and proteinuria, while chronic kidney disease, regardless of the stage, contributes to a higher risk of adverse pregnancy outcomes including preeclampsia, premature birth and fetal growth restriction.

Optimization strategies of pregnancy outcomes include strict control of blood pressure, treatment of hypertension and proteinuria, and prevention of preeclampsia. The latter is difficult to diagnose in pregnant women with chronic kidney disease. Serum markers such as soluble fms-like tyrosine kinase 1 and placental growth factor may aid in definitive diagnosis. The choice of delivery mode in women with chronic kidney disease should be based on common obstetric indications. A multidisciplinary team, including an obstetrician-gynecologist, a nephrologist, an anaesthesiologist and a neonatologist, must focus on preconception medical care, antenatal care and treatment of pregnant women with chronic kidney disease for a successful pregnancy outcome.

Journal of obstetrics and women's diseases. 2023;72(1):71-80
pages 71-80 views

Biomechanisms of cervical remodeling and current approaches to maturity assessment

Pachuliia O.V., Khalenko V.V., Shengeliia M.O., Bespalova O.N.

Abstract

The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, and repair to the original state, which is a dense long tubular structure. In this review, the problem of impaired cervical remodeling is discussed in both preterm birth and delayed transformation, which leads to the unpreparedness of the cervix for childbirth and prolongation of pregnancy. Histological, immunological and structural dynamic changes in the cervix begin long before delivery and are noted as early as the first trimester of gestation. There are a few ways to assess the maturity of the cervix. In the second and third trimester, in order to predict preterm birth, these are ultrasound cervicometry and a cervical phosphorylated insulin-like growth factor binding protein-1 test. At full term, in order to determine its readiness for delivery, this is a palpation assessment. Inadequate assessment of the cervical characteristics is one of the factors of untimely prevention of preterm birth, and at full term leads to inappropriate choice of method of preparation for labor. It is necessary to develop new approaches to the comprehensive assessment of the cervix, using existing methods, and to discover new ways to assess its maturity.

In this review, the problem of cervical maturation diagnosis is considered based on literature data from such databases as PubMed, ResearchGate, and Google Scholar, as well as from electronic resources of the M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes data on molecular, biochemical and histophysiological processes occurring during cervical maturation at all stages of gestation.

It is generally accepted that the main role in cervical changes at all stages of gestation is played by: collagen fiber restructuring / desorganization, decreased concentrations of collagen and elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level and tissue hydrophilicity, increased cervical vascularization, as well as changes in glycosaminoglycan and matrix metalloproteinase content. Palpatory technique and ultrasound cervicometry are the most common methods of determining the cervical length, which have insufficient sensitivity, probably because they do not cover all pathogenetic pathways of remodeling and cannot assess all cervical characteristics. Improvement of efficiency is possible through the introduction of combined techniques and the use of promising methods such as elastography, ultrasound diagnosis of the cervix with Doppler assessment of its vessels, determination of a disintegrin and metalloprotease with thrombospondin-like repeats-1 and placental α1-microglobulin in cervical secretion, and relaxin in maternal blood.

Understanding the molecular, biochemical and histophysiological processes that occur during cervical remodeling is crucial for predicting preterm birth, diagnosing isthmic-cervical insufficiency, understanding the lack of timely cervical readiness, and choosing tactics – the method of preinduction and induction of labor if necessary. The lack of clinical methods and their lack of objectivity require a combined approach and the search for new prognostic markers of cervical maturation.

Journal of obstetrics and women's diseases. 2023;72(1):81-95
pages 81-95 views

Modern approaches to classification of adenomyosis

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

Abstract

This article presents a modern review of the main classifications of adenomyosis based on the clinical course, the prevalence of the pathological process, the results of ultrasound and magnetic resonance imaging, and histological verification. The analysis is based on domestic and foreign literature, federal clinical recommendations, and results of our own research. Despite the large number of different classifications of the disease, there are still shortcomings noted in this review. Based on the available rubricators, we emphasized the need to create a classification of adenomyosis with an assessment of the clinical picture, genetic and molecular profiles, the results of non-invasive assessment methods, and a correlation with the histological conclusion. A unified classification would solve many problems in scientific and practical activities for accurate and early diagnosis of adenomyosis, identification of risk groups for patients with an aggressive course of the pathological process, selection of reasonable recommendations, and timely appointment of pathogenetic therapy.

Journal of obstetrics and women's diseases. 2023;72(1):97-108
pages 97-108 views

Theory and Practice

Repeated clinical case of fetal congenital malformation in a family with hereditary short-rib thoracic dysplasia type 3

Shengelia M.O., Bespalova O.N., Pachuliia O.V., Shengeliia N.D., Baldin A.V., Nasykhova Y.A., Glotov A.S.

Abstract

The article shows the genetic causes of recurrent fetal malformations on the example of a clinical case of hereditary short-rib thoracic dysplasia type 3.

Congenital malformations of the fetus are most often sporadic; however, in rare cases, this pathology can recur in one married couple, and the formation of congenital anomalies during subsequent pregnancy can both have general syndromes and affect various systems and organs.

Short-rib thoracic dysplasia type 3 is a rare genetic disorder with autosomal recessive inheritance. Patients for whom the carriage of pathogenic alleles in genes associated with congenital skeletal anomalies has been confirmed require a detailed clinical examination. Such married couples want expert-level medical genetic counseling with performing additional genetic tests, if necessary. This may clarify the diagnosis, which will determine further tactics for preparing the couple for the next pregnancy on their own or using assisted reproductive technology programs and / or surrogate motherhood.

Journal of obstetrics and women's diseases. 2023;72(1):109-118
pages 109-118 views

jubilee

To the 90th anniversary of Professor Leonid Andreyevich Susloparov

Tatarova N.A., Darmogray N.V., Dudnichenko T.A.

Abstract

The article presents the life path of Doctor of Medical Sciences, Professor Susloparov Leonid Andreyevich, his scientific achievements, pedagogical and clinical work.

Journal of obstetrics and women's diseases. 2023;72(1):119-121
pages 119-121 views


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies