Vol 72, No 5 (2023)

BACKGROUND: There is a need to search for early prognostic markers of macrosomia development due to the increase in the incidence of fetal macrosomia, the high risk of maternal and neonatal complications, and the lack of an algorithm for prenatal monitoring. It can improve the accuracy of diagnosis, optimize obstetric management of pregnancy and childbirth, and prevent fetal macrosomia.

AIM: The aim of this study was to develop a scale for predicting macrosomia based on the study of the prognostic value of its risk factors and antifactors.

MATERIALS AND METHODS: The authors conducted a single-center prospective cohort study at the Orenburg Clinical Perinatal Center, Orenburg, Russia, and studied 676 pregnant women with large fetuses (main group) and 600 pregnant women with medium-weight fetuses (control group), as well as their newborns. The observation and study was performed from January 1, 2015 to January 1, 2020.

RESULTS: The large size of the fetus in women without pre-existing and manifest forms of diabetes mellitus is determined to varying degrees by both non-modifiable risk factors and modifiable ones, including obesity, pathological weight gain during pregnancy, especially in the third trimester, excessive consumption of carbohydrates, and low physical activity.

CONCLUSIONS: Calculation of the integrated influence of various factors on the development of a large fetus revealed a number of factors and antifactors in predicting fetal macrosomia. In practical obstetrics, it is advisable to use formalized tables of risk factors for the development of a large fetus, according to the identified prognostic coefficients.

BACKGROUND: Premature rupture of the membranes in the very early stages of pregnancy is an irreversible complication of pregnancy, leading in 100% of cases to premature delivery and the birth of children with extremely low (up to 1000 g) and low (up to 1500 g) birth weight. The course of pregnancy depends on the consequential outcomes of the genetically determined inflammatory response in the female body.

AIM: The aim of this study was to determine the characteristics of pro- and anti-inflammatory cytokine gene polymorphism, as well as local and systemic cytokine profiles in pregnant women with preterm premature rupture of membranes at 22–27 weeks 6 days of gestation.

MATERIALS AND METHODS: This prospective case-control study enrolled 120 pregnant women with a gestation period of 22–28 weeks. Group 1 consisted of 80 pregnant women with preterm premature rupture of membranes, and group 2 included 40 women with normal pregnancy. All pregnant women were analyzed for gene polymorphism of pro- and anti-inflammatory cytokines (IFNG: 874Т>А, IL10: −1082G>A, IL10: −592A>C, IL10: 819C>T, IL12B: −1188C>A, IL18: 137G>С, IL18: −607G>T, IL18: −656А>С, IL1β: −31T>C, IL1β: 3953C>T, IL1β: −511C>T, IL6: −174G>C, IL8: −251А>T, TNF: −238G>A, TNF: −308G>A), as well as local (in the lower reproductive tract: inflammation index level; IL1β, IL10, IL18, TNFα, TLR4, B2M messenger RNA expression levels) and systemic (blood interleukin-1β, -2, -6, -8, -10, -12β, -18, interferon gamma, tumor necrosis factor alpha levels) cytokine profiles.

RESULTS: In women with preterm premature rupture of membranes, the CC genotype is more often registered for the −137G>С polymorphism of the IL18 gene (χ² = 37.4, р < 0.0001). In the blood of women in this group, interleukin-18, interferon gamma, and tumor necrosis factor alpha levels were higher [interleukin-18: 334 (267–384) pg/ml in group 1 and 209 (143–304) pg/ml in group 2 (р = 0.001); interferon gamma: 5.85 (4.8–7.0) pg/ml in group 1 and 3.4 (2.0–6,9) pg/ml in group 2 (р = 0.005); tumor necrosis factor alpha: 15.4 (13.5–23.7) pg/ml in group 1 and 12.6 (10.6–16.0) pg/ml in group 2 (р = 0.001)], while interleukin-10 levels were lower (6.8 (4.7–9.7) pg/ml in group 1 and 9.0 (6.6–13.6) pg/ml in group 2 (р = 0.016) compared to the control group. In the lower reproductive tract, pregnant women with preterm premature rupture of membranes had higher messenger RNA expression levels of pro-inflammatory cytokine genes (IL1β, TNFα), as well as TLR4 and B2M as compared to apparently healthy pregnant women. IL1β level was 5.83 (5.0–6.1) in group 1 and 4.69 (4.0–5.1) in group 2 (р = 0.034). TNFα level was 4.28 (3.8–4.9) in group 1 and 2.17 (1.9–3.2) in group 2 (р = 0.001). TLR4 level was 3.36 (2.6–4.3) in group 1 and 1.9 (1.4–2.2) in group 2 (р = 0.042). B2M level was 5.7 (5.0–6.3) in group 1 and 3.77 (2.9–4.3) in group 2 (р = 0.002).

CONCLUSIONS: Molecular genetic determination of preterm labor associated with very early preterm premature rupture of membranes was established, expressed in a selective potentiation increase in the production of a number of pro-inflammatory cytokines in the second trimester of pregnancy, which creates conditions that ensure the formation of morphofunctional disorders in the membranes with their subsequent failure.

BACKGROUND: Numerous studies indicate that pregnant women are at risk for severe morbidity, adverse gestational outcomes, and mortality following COVID-19. These patients have a higher frequency of miscarriage at various stages of gestation, premature birth, preeclampsia, cesarean section, and birth of children with low body weight. Other publications have suggested that the clinical characteristics of the disease detected in pregnant women with confirmed COVID-19 are similar to those in the general population.

AIM: The aim of this study was to determine obstetric and perinatal risks in women who have had COVID-19 during pregnancy.

MATERIALS AND METHODS: We conducted an open prospective continuous cross-sectional study in which 114 patients were examined after suffering from COVID-19. Depending on the severity of the new coronavirus infection, they were divided into groups: group I (n = 36) included patients with mild disease, group II (n = 56) – with moderate disease, group III (n = 22) – with heavy. The control group consisted of 93 pregnant women who were hospitalized during the specified period without COVID-19 and signs of acute respiratory viral infection.

RESULTS: Gestational diabetes mellitus is associated with a risk of the moderate and severe new coronavirus infections during pregnancy. Placental deficiency is significantly more often recorded in moderate and severe COVID-19 cases. Severe COVID-19 in pregnant women determines a high probability of fetal growth restriction. Preeclampsia complicates pregnancy in all patients with either mild, moderate, or severe COVID-19. The risk of premature birth with a high probability is determined by the moderate and severe courses of the disease. Only moderate COVID-19 during pregnancy is associated with the risk of induced labor. The risk of operative delivery by cesarean section is significantly increased in moderate and severe COVID-19. Moderate and severe courses of the underlying disease during pregnancy determine a high probability of low body weight of children at birth. The risk of hospitalization in the resuscitation unit is associated with moderate and severe COVID-19 during pregnancy.

CONCLUSIONS: Maternal mortality among women with COVID-19 who were hospitalized in an obstetric hospital was 3,636 per 100,000 live births. Perinatal mortality in patients who suffered a new coronavirus infection during pregnancy was 52.6‰.

BACKGROUND: Stress urinary incontinence in women is a widespread disease. It can occur in women of reproductive age, while progressing and disrupting the quality of life. Ultrasound elastography allows for evaluating the stiffness of the urethral supporting structures and can help in studying the pathophysiology of stress urinary incontinence and in diagnosing its mild forms for timely initiation of therapy and preventing the development of severe forms of the disease.

AIM: The aim of this study was to improve the diagnosis of mild stress urinary incontinence in women using ultrasound compression elastography of the ureterovesical junction.

MATERIALS AND METHODS: We examined 25 women with mild stress urinary incontinence (main group) and 15 patients without urinary incontinence (control group) of reproductive and perimenopausal age. The diagnosis of stress urinary incontinence was confirmed during a comprehensive urodynamic study. To assess the urethral mobility and determine the stiffness of the supporting structures, a 2D ultrasound examination was performed with compression elastography of the ureterovesical junction using Voluson E6 and E10 ultrasound systems equipped with a transvaginal probe (GE Healthcare, USA). Four areas of interest in the paraurethral region of the proximal and middle urethra were examined. The obtained elastograms were used to evaluate the color characteristics and strain ratio of the areas of interest in three dimensions, the average values being calculated.

RESULTS: The strain ratios in all studied areas of the paraurethral region had no significant relationship with age and were lower in patients with stress urinary incontinence compared to control values (p < 0.01). Urethral hypermobility (mobility: mean urethral α angle rotation of 40 degrees) was identified in 84% of women with stress urinary incontinence. According to the results of correlation analysis, the strain ratios in the three areas of interest had a significant negative relationship with changes in the urethral α angle rotation. The ROC analysis showed that the stiffness values of the paraurethral region of the proximal posterior wall of the urethra are the most significant parameters for the diagnosis of stress urinary incontinence. The threshold value of the strain ratio for diagnosing stress urinary incontinence was determined to be less than or equal to 0.85 (sensitivity 96.0%; specificity 86.7%; p < 0.001).

CONCLUSIONS: Ultrasound compression elastography of the ureterovesical junction is a new non-invasive technique that can improve the accuracy of diagnosing stress urinary incontinence in women. It is advisable to use the technique in women with mild stress urinary incontinence who are planned for conservative treatment to confirm the diagnosis and monitor therapy.

To date, the methods based on the detection of isolated biomarkers have been ineffective in predicting preterm birth. Probably, a reason for this is that these predictors are associated with any one link in pathogenesis and do not take into account another “scenario” for the pathological events. It is becoming increasingly clear that in order to improve the prediction of preterm birth, it is necessary to apply an approach that shall combine the acquisition of data on different biological levels of regulation.

Thus, the rapidly developing areas of genomics, transcriptomics, and metabolomics open up broad prospects for predicting preterm birth. These methods allow for not only measuring thousands of biomarkers in biological samples during pathology, but also evaluating biological changes that precede clinical manifestations. Meanwhile, a number of studies have demonstrated the leading role of proteins in all cellular reactions of the body, which has determined proteome-wide evaluation as one of the most promising areas of omic research. Proteomics can provide additional information about complex biochemical processes at the molecular level, the understanding of which is critical for predicting the various clinical phenotypes of preterm birth.

The studies presented in this literature review have shown promise in examining the maternal blood proteome to identify potentially effective predictors of preterm birth.

This article presents a clinical case of hereditary thrombophilia associated with the heterozygous FV Leiden mutation in a pregnant woman with a burdened obstetric history. The patient was admitted to the third group hospital with a diagnosis of pregnancy 27 weeks 6 days; burdened obstetric history; uterine scar; hereditary thrombophilia associated with heterozygous factor V mutation; stage 1 grade 1 risk 1 hypertension, controlled; grade 1 alimentary obesity; grade 1 diffuse (endemic) goiter, euthyroidism; and chronic gastritis, remission. Upon admission, the patient received Sol. Enoxaparini natrii at a dosage of 0.4 ml subcutaneously twice a day, but according to the thrombodynamics test, thrombotic readiness remained. The purpose of hospitalization was to select anticoagulant therapy in a patient at high risk of perinatal loss. We found from the anamnesis that the woman’s first pregnancy ended in operative delivery on time due to progressive severe premature detachment of a normally located placenta and intrapartum fetal death.

Together with hematologists, we selected the optimal anticoagulant therapy for this patient as follows: Sol. Enoxaparini natrii at a dosage of 0.8 ml subcutaneously in the morning, then Sol. Enoxaparini natrii 0.4 ml subcutaneously in the evening, and Tab. Acidi acetylsalicylici 0.15. During this therapy, positive dynamics was noted, with normal coagulation observed during a thrombodynamic study. After selecting anticoagulant therapy, the woman was discharged from the hospital under the supervision of an obstetrician-gynecologist at the antenatal clinic and a hematologist at the Clinical Medical Center, Chita, Russia. Antenatal hospitalization was planned at 37 weeks of pregnancy. The patient was delivered by urgent caesarean section due to premature rupture of membranes at 35 weeks 1 day, given the aggravated anamnesis in this patient with the uterine scar. A live premature girl was born weighing 2410 g, 44 cm tall with an Apgar score of 8 / 8 points. In the postpartum period, given the high risk of thromboembolic complications (3 points), the patient was prescribed Sol. Enoxaparinum natrium at a dosage of 0.4 ml subcutaneously once per day for six weeks after delivery.

The presented clinical case of pregnancy and childbirth demonstrates the importance of personalization in modern medicine.

BACKGROUND: The optimal surgical technique for the treatment of Bartholin duct cysts has not been finally chosen. Currently, the following methods are used: needle aspiration, with or without alcohol sclerotherapy; silver nitrate cyst ablation; use of laser techniques; cyst fistulization using a Word catheter, a Foley catheter, or a Jacobi ring; cyst incision and drainage followed by primary suture closure; cyst marsupialization; and cyst excision. However, the relapse rate of the disease is high and averages about 20%. This article presents an original technique for suturing when performing marsupialization of Bartholin duct cysts and an analysis of the results of treating patients using this technique.

AIM: The aim of this study was to evaluate the results of surgical treatment of Bartholin duct cysts using an original technique to create a new ostium of the duct during marsupialization.

MATERIALS AND METHODS: From 2018 to 2023, 14 patients aged 23 to 39 years were operated on for Bartholin duct cysts. Marsupialization was chosen as a method of surgical treatment. Operations were performed in the outpatient department using local anesthesia by lidocaine. After emptying, the cyst cavity was washed with an antiseptic. The external ostium of the Bartholin duct was formed by circular suturing of the cyst into the mucous membrane tissues of the vaginal vestibule according to the original method.

RESULTS: The maximum size of Bartholin duct cysts in the patients we treated was up to 5.0 cm and averaged 4.4 ± 0.2 cm. The patients complained mainly of the presence of a unilateral tumor-like lesion at the entrance to the vagina and moderate-intensity pain in its projection. The duration of the operation was from 10 to 15 min, the blood loss volume being from 3.0 to 5.0 ml. There were no complications during the operation or in the postoperative period. Complete fusion of the mucous membrane tissues of the vaginal vestibule and the Bartholin duct occurred within a week. The duration of observation of patients after surgical treatment ranged from five years to six months. There were no relapses of the disease during the observation period.

CONCLUSIONS: The proposed original method for performing marsupialization of Bartholin duct cysts is an effective and promising technique aimed at preventing recurrence of the disease.

The year 2023 marks the 160th anniversary of the establishment of the Society of Arkhangelsk Doctors, through whose efforts the first free hospital for northerners was opened in the city of Arkhangelsk, Russia in the pre-revolutionary period. Exactly a century ago, the first obstetric institution was created in the nationalized building of this hospital. At the beginning of the 21st century, the maternity hospital named from that time on after Concordia Samoylova became part of the Perinatal Center formed by merging previously existing obstetric institutions in Arkhangelsk.