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

Vol 70, No 4 (2021)

Cover Page

Full Issue

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

Original Research

Combined method of preparing the cervix uteri for labor in pregnant women with a lack of birth preparedness and a tendency to post-term pregnancy

Burkitova A.M., Bolotskikh V.M.

Abstract

Objective. Development of an effective method for preparing the cervix in pregnant women with a tendency to overmaturity against the background of a lack of biological readiness for childbirth, as well as reducing the time for preparing the soft birth canal for childbirth in order to conduct subsequent labor excitation.

Material and methods. The patients were divided into 3 groups depending on the method of preparing the cervix for childbirth: in the 1st group (n = 50) only laminaria was used; in group 2 (n = 50), a Foley catheter was used in combination with mifepristone; in group 3 (n = 50), only mifepristone was used. Inclusion criteria: gestational period 41 weeks – 41 weeks and 4 days inclusive, immature cervix (baseline score on the Bishop scale 0-2 points), singleton pregnancy, cephalic presentation, whole fetal bladder, vaginal cleanliness I-II, satisfactory fetal condition (normal type of curve according to CTG and the absence of fetal hemodynamic disorders according to Doppler data). Statistical processing of the obtained data was carried out using the STATISTICA 10.0 program.

Research results. The patients of the three groups were comparable in age, gestational age, and did not differ in the parity of childbirth and body mass index. With the combined preparation of the cervix for childbirth with mifepristone and a Foley catheter, the dynamics of the assessment of the cervix on the Bishop scale is higher and achieved faster than when preparing for childbirth only with laminaria or only antigestagens. When combining mifepristone with a catheter Foley, it is possible to reduce the time interval from the onset of pre-induction to the development of labor in comparison with pre-induction of labor only with mifepristone or only with the help of laminaria, as well as reduce the frequency of caesarean section due to the lack of effect from induction of labor compared with pre-induction of labor only with mifepristone or only with the help of laminaria. The undoubted advantage of this combined method of preparing the cervix for childbirth is its effectiveness, low risk of uterine hyperstimulation, fetal distress syndrome, as well as the absence of a high risk of developing infectious complications.

Conclusion. The combined method of preparing the body for childbirth with a tendency to post-term pregnancy is effective, safe and allows you to reduce the preparation time of the soft birth canal for childbirth against the background of a lack of biological readiness for childbirth with a tendency to post-term pregnancy.

Journal of obstetrics and women's diseases. 2021;70(4):5-13
pages 5-13 views

The value of vaginal lactobacilli in the restoration of vaginal microbiocenosis in women in the early postpartum period, depending on the method of delivery

Dadayeva D.G., Budilovskaya O.V., Krysanova A.A., Khusnutdinova T.A., Savicheva A.M., Kogan I.Y.

Abstract

BACKGROUND: Despite numerous studies of the vaginal microbiota, there is still a lack of knowledge regarding its restoring dynamics in the early postpartum period. The condition of the vaginal microflora during pregnancy plays a key role in maintaining the physiological microbiocenosis of the birth canal and creating conditions for the normal course of pregnancy, the establishment of an infant’s intestinal microbiota, and the further development of the child.

AIM: The aim of this study was to estimate the role of certain types of lactobacilli in restoring the vaginal microbiota in women in the early postpartum period, depending on the method of delivery.

MATERIALS AND METHODS: We examined 150 women at 38-41 weeks of gestation. The clinical material for the study was vaginal discharge before and after delivery. To determine the species of lactobacilli and other microorganisms in the clinical material, we used quantitative real-time PCR.

RESULTS: Before delivery, lactobacilli were found in vaginal discharge in 144 out of 150 women (96.0%), their number in the majority being more than 106 GE. In the postpartum period, lactobacilli were found in 66/128 (51.5%) cases, while prevailing in women after vaginal delivery in 50/65 (76.9%) cases (4.6±1.6, p = 0.000000). Among the dominant species of lactobacilli was L. crispatus, found in vaginal discharge before delivery, which most often affects the recovery of the vaginal microbiota in the postpartum period (29 out of 61 women, 47.5%). L. iners detected in the lochia predisposes to the violation of uterine involution in the early postpartum period (p = 0.03).

CONCLUSIONS: Normal vaginal microbiota in the postpartum period is restored more quickly in women after vaginal delivery. Our study confirms that L. crispatus and L. iners play a major role in restoring the vaginal microbiota in the postpartum period.

Journal of obstetrics and women's diseases. 2021;70(4):15-23
pages 15-23 views

Vitamin D receptor gene polymorphism in women with genital endometriosis, type 1 diabetes mellitus, and in the population

Denisova A., Ivaschenko T.E., Yarmolinskaya M.I., Shagina A.A., Misharina E.V.

Abstract

AIM: The aim of this study was to analyze the association between the vitamin D receptor gene polymorphism and the risk of developing genital endometriosis and type 1 diabetes mellitus.

MATERIALS AND METHODS: The frequency of allelic variants of the VDR gene was studied by PCR-RFLP analysis in 282 women, including 129 patients with genital endometriosis (stages I–IV), 71 patients with type 1 diabetes mellitus, and 82 women of the control group represented by the population sample.

RESULTS: It was found that the frequency of the allele G polymorphic variant of rs1544410 (BsmI) in the VDR gene was significantly higher in the group of patients with genital endometriosis compared to the population sample (p = 0.048). Significant differences for the G / G genotype in patients with genital endometriosis relative to the control group (p < 0.05) and the group of patients with type 1 diabetes mellitus (p < 0.05) were revealed. According to the odds ratio, the risk of developing genital endometriosis was 1.9 times higher for this genotype (OR = 1.93 CI = 1.082–3.450; OR = 1.892 CI = 1.022–3.430). The combination of the A / A and G / A genotypes was significantly more common in patients with type 1 diabetes mellitus (p = 0.040) and in the population (p = 0.025), when compared to the patients with genital endometriosis. A significant increase in the t allele of the rs731236 polymorphism (TaqI) of the VDR gene was found in the group of patients with type 1 diabetes mellitus (p < 0.05). The combination of the T / t and t / t genotypes of the rs731236 polymorphism (TaqI) of the VDR gene in patients with type 1 diabetes mellitus were significantly more common than in the group of patients with genital endometriosis (p = 0.017).

CONCLUSIONS: The data obtained may be important for risk assessment of genital endometriosis and type 1 diabetes mellitus development and for developing new strategies for the prevention and treatment of these diseases.

Journal of obstetrics and women's diseases. 2021;70(4):25-33
pages 25-33 views

NAT2 and CYP1B1 genetic polymorphisms in patients with genital endometriosis depending on tolerability of melatonin

Ivashchenko T.E., Yarmolinskaya M.I., Tkhazaplizheva S.S.

Abstract

BACKGROUND: Genital endometriosis is one of the most pressing problems of modern gynecology. Melatonin is a promising drug with a potentially curative effect on endometriosis.

AIM: The aim of this study was to conduct a comparative analysis of the genetic polymorphism of some genes encoding enzymes involved in melatonin metabolism.

MATERIALS AND METHODS: The genetic polymorphism in the NAT2 and CYP1B1 genes encoding enzymes involved in melatonin metabolism in patients with different tolerance to this drug was analyzed by PCR-RFLP analysis.

RESULTS: In patients with genital endometriosis, the presence of a wild-type allele (N) of the NAT2 gene was associated with poor tolerance of melatonin. The NAT2 (N / N) rapid acetylator phenotype combined with the low catalytic activity of CYP1B1 (C / C) occurred more frequently in endometriosis patients having poor melatonin tolerability compared to the group of patients who tolerated the therapy well.

CONCLUSIONS: For patients with genital endometriosis with the wild-type (N) allele of the NAT2 gene, melatonin administration is inappropriate due to numerous side effects during the drug use.

Journal of obstetrics and women's diseases. 2021;70(4):35-42
pages 35-42 views

Evaluation of sFlt-1 and PlGF for predicting preeclampsia in pregnant women with diabetes mellitus

Kapustin R.V., Tcybuk E.M., Chepanov S.V., Alekseenkova E.N., Kopteeva E.V., Arzhanova O.N.

Abstract

AIM: The aim of this study was to evaluate soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels in the blood of women with various types of diabetes mellitus, depending on the correction method applied, and to determine the prognostic significance of the sFlt-1 / PlGF ratio for predicting the development of preeclampsia in this patient population.

MATERIALS AND METHODS: We examined 140 pregnant women who were included in six main study groups: type 1 diabetes mellitus (with or without pregravid preparation), type 2 diabetes mellitus (diet therapy or insulin therapy), and gestational diabetes mellitus (diet therapy or insulin therapy). The comparison groups consisted of pregnant women with preeclampsia and patients without complications of pregnancy. Using electrochemiluminescence analysis, PlGF and sFlt-1 levels in the blood serum were determined twice, at 11+0–13+6 and 30+0–33+6 weeks of gestation. Statistical data processing was performed using the IBM SPSS Statistics version 23 and GraphPad Prism version 8.0 software packages.

RESULTS: In the blood serum of pregnant women with diabetes mellitus in the first and third trimesters of pregnancy, we found an increase in sFlt-1 level and a decrease in PlGF level, as well as an increase in the sFlt-1 / PlGF ratio. These changes were most pronounced in individuals with type 1 diabetes mellitus without pregravid preparation and with type 2 diabetes mellitus on insulin therapy. In patients with pregestational types of diabetes mellitus, the sFlt-1 / PlGF ratio was a predictor of preeclampsia already in the early stages of pregnancy. Analysis of the ROC curve showed that the threshold sFlt-1 / PlGF ratio for predicting preeclampsia in pregnant women with diabetes mellitus in the first trimester was 32.5 (sensitivity 92.9%, specificity 50.0%) and in the third trimester 71.8 (sensitivity 85.7%, specificity 82.3%) with AUC 0.78 (95% CI 0.68–0.88) and 0.89 (95% CI 0.83–0.95), respectively. In the first trimester, the positive and negative predictive values of the sFlt-1 / PlGF ratio as a predictor of preeclampsia in pregnant women with diabetes mellitus were 63.3% and 97.6%, respectively; in the third trimester, 38.9% and 93.6%, respectively.

CONCLUSIONS: Blood level alterations of PlGF and sFlt-1 are characteristic of patients with diabetes mellitus in the first and third trimesters of pregnancy. An increase in the sFlt-1 / PlGF ratio is associated with a higher incidence of unfavorable perinatal outcomes in women with impaired carbohydrate metabolism. Determination of the sFlt-1 / PlGF ratio is a valid method for predicting the development or absence of preeclampsia in women with diabetes mellitus.

Journal of obstetrics and women's diseases. 2021;70(4):43-56
pages 43-56 views

The course of labor in term patients with concomitant acute intestinal infections

Kovalchuk A.S., Popov E.N., Lioznov D.A., Sudakov D.S.

Abstract

BACKGROUND: Literature data on the course of labor in women with concomitant acute intestinal infections are very scarce. Individual works and articles are devoted to the coverage of this most important final stage of pregnancy. There are no developed specific tactics of labor management in patients with acute intestinal infections, therefore obstetricians and gynecologists have to use generally accepted standards of labor management in this group of patients, without having a clear idea of the frequency and nature of clinically relevant complications in childbirth.

AIM: The aim of this study was to evaluate the course of labor in women with concomitant AIIs at full-term pregnancy.

MATERIALS AND METHODS: We examined 120 patients aged 19 to 39 years, delivered in Clinical Infectious Disease Hospital named after S.P. Botkin, St. Petersburg in 2017-2019. The main group consisted of 60 women with concomitant acute intestinal infections who gave birth, and the comparison group comprised 60 conditionally healthy women. The spectrum of acute intestinal infection pathogens in pregnant women, the course of labor, complications during labor and the condition of newborns were evaluated.

RESULTS: Women of the both study groups did not differ in the duration of labor and the anhydrous interval, the frequency of birth abnormalities, the volume of blood loss, and the frequency of maternal injury and complications in the postpartum period. The frequency of premature rupture of membranes, acute and chronic fetal hypoxia, and episiotomy was higher in patients of the main group. Asphyxia in the first minute after birth was also more common in newborns from women with concomitant acute intestinal infections.

CONCLUSIONS: Acute intestinal infections may complicate the course of labor. Labor management in women with concomitant acute intestinal infections requires continuous monitoring of the condition of the fetus during labor and the provision of timely medical care to the newborn.

Journal of obstetrics and women's diseases. 2021;70(4):57-63
pages 57-63 views

Russian strains of group B streptococci are different in the content and organization of the PAI-A and PAI-A1 pathogenicity islands

Kuleshevich E.V., Ilyasov Y.Y., Linnik D.S., Malchenkova A.A., Arzhanova O.N., Briko N.I., Glushkova E.V., Priputnevich T.V., Suvorov A.N.

Abstract

Group B streptococci, or Streptococcus agalactiae, are the major cause of severe diseases in newborns and adults. The PAI-A and PAI-A1 pathogenicity islands containing the sspB1 and sspB1a genes, respectively, were found among group B streptococci mobile genetic elements. The presence of sspB genes correlates with urogenital tract infections. The aim of this study was to determine the frequency of group B streptococci strains with the PAI-A and PAI-A1 pathogenicity islands, circulating in Moscow, in comparison with strains from St. Petersburg. The sspB1 gene, and hence the PAI-A pathogenicity island, was not found in the genomes of strains from Moscow. The frequency of the sspB1a gene and the PAI-A1 pathogenicity island in the genomes of clinical strains was three times higher than in the genomes of colonizing strains. Thus, it can be assumed that the genes of the sspB family are more specific of group B streptococci colonizing pregnant women and newborns.

Journal of obstetrics and women's diseases. 2021;70(4):65-72
pages 65-72 views

Regulation of the functional activity of peripheral B lymphocytes in pregnant women with a history of recurrent miscarriage

Malyshkina A.I., Sotnikova N.Y., Voronin D.N., Kust A.V.

Abstract

BACKGROUND: The frequency of recurrent miscarriage is up to 5 % of all desired pregnancies and is mainly due to immunological disorders. Dysfunction in the regulation of the functional activity of B lymphocytes is the pathogenetic link in multiple obstetric complications, including habitual miscarriage.

AIM: The aim of this study was to characterize the regulation of the functional activity of peripheral B lymphocytes in pregnant women with threatened spontaneous miscarriage and a history of habitual miscarriage.

MATERIALS AND METHODS: We examined 88 women aged 18-40 years at a gestation period of 5-12 weeks. The main group consisted of 36 patients with threatened spontaneous miscarriage at the time of examination and a history of habitual miscarriage. The control group included 28 women with uncomplicated pregnancy. The comparison group consisted of 24 primary pregnant patients with threatened spontaneous abortion at the time of examination. BAFF and APRIL levels in the blood serum were determined by enzyme immunoassay. The content of CD19+BAFFR+ B lymphocytes in the lymphocyte gate was evaluated in the peripheral blood by flow cytometry using monoclonal antibodies. Akt mRNA expression was assessed using real-time reverse-transcription quantitative polymerase chain reaction. CD19+ В lymphocytes were isolated by direct magnetic separation.

RESULTS: In the main group, there was an increase in expression of BAFF receptors on peripheral CD19+ B lymphocytes and a decrease in the serum BAFF concentration compared to the parameters in the other study groups. We also found a pronounced trend towards a decrease in the serum APRIL level in the main and comparison groups of patients compared to healthy pregnant women. Besides, Akt mRNA expression in peripheral CD19+ B lymphocytes was increased in the main group.

CONCLUSIONS: Threatened habitual abortion is associated with the deficit of the regulatory influence of BAFF and APRIL, which is expressed in the disruption of B cell homeostasis and the weakening of humoral effector mechanisms.

Journal of obstetrics and women's diseases. 2021;70(4):73-79
pages 73-79 views

IVF efficiency in different phenotypes of polycystic ovary syndrome

Nikolayenkov I.P., Kazymova O.E., Sudakov D.S., Dymarskaya Y.R.

Abstract

Polycystic ovary syndrome occupies a leading place in the structure of endocrine infertility. This article presents the endocrine and metabolic features of the polycystic ovary syndrome phenotypes, as well as modern concepts of efficiency and complications of the use of assisted reproductive technologies, depending on the specific phenotype. The issues of polycystic ovary syndrome influence on selecting the method of assisted reproductive technologies, as well as possible complications that occur during in vitro fertilization and the features of the pregnancy course remain unresolved. The individualization of the approach seems to be promising when taking into account the differences in the hormonal profile and the features of metabolic disorders in each polycystic ovary syndrome phenotype. That may allow us to take one more step towards improving the effectiveness of in vitro fertilization and reducing the frequency of complications in patients with polycystic ovary syndrome.

Journal of obstetrics and women's diseases. 2021;70(4):81-90
pages 81-90 views

Modern sonographic markers for the prognosis of preterm birth in women with different somatotypes

Tomaeva K.G., Gaidukov S.N., Komissarova E.N., Tomaev G.G.

Abstract

BACKGROUND: Preterm birth is one of the causes of perinatal morbidity and mortality. Premature infants have an increased risk of death and the development of neurological and other disorders.

AIM: The aim of this study was to evaluate the modern sonographic parameters of the cervix in pregnant women with different somatotypes and to develop a mathematical model for predicting preterm birth.

MATERIALS AND METHODS: The study included 390 women, among whom 110 were classified with macrosomatic, 173 with mesosomatic, and 107 with microsomatic types. Somatotype was determined in women in early stages of pregnancy (before 9-10 weeks of gestation) using the R.N. Dorokhov anthropometric test method. The utero-cervical angle was measured, shear wave elastography was performed, and the average shear wave speed in the area of the internal cervical os was determined. All measurements were performed on a Philips EPIQ 5 ultrasound machine.

RESULTS: Preterm birth was more often identified in women with macro- and microsomatic types in comparison with women with mesosomatic type (p < 0.05). In pregnant women with subsequent preterm birth at 22-23 weeks, the average SWS in the area of the internal cervical os was reduced (p < 0.05) and the utero-cervical angle was higher in comparison with those women who did not have preterm birth (p < 0.05). Using multiple regression analysis, we obtained the regression equation (formula), which predicts the development of preterm birth in women with different somatotypes.

CONCLUSIONS: Such parameters as the average shear wave speed in the area of the internal cervical os and the utero-cervical angle may be regarded as markers of preterm birth. The mathematical formula obtained allows for predicting the development of preterm birth in women with different somatotypes and for timely prevention of pathology.

Journal of obstetrics and women's diseases. 2021;70(4):91-98
pages 91-98 views

Reviews

Role of genes involved in the regulation of apoptosis in the pathogenesis of genital endometriosis. A literature review

Andreyeva N.Y., Yarmolinskaya M.I., Ivashchenko T.E.

Abstract

BACKGROUND: The high prevalence, the lack of reliable data on the etiology, as well as the complexity of diagnosis and treatment of genital endometriosis indicate the urgency of the problem.

AIM: The aim of this study was to analyze and summarize scientific publications devoted to the study of single-nucleotide polymorphisms involved in apoptosis and their association with endometriosis.

MATERIALS AND METHODS: Based on keyword searches for “gene,” “SNP,” “apoptosis,” and “endometriosis,” a selection of papers published in open sources (PubMed and Google Scholar) in the period from 2010 to 2020 was performed.

RESULTS AND CONCLUSIONS: An analysis of the main and auxiliary apoptotic pathways was performed, with the protein regulators and their genes detailed in accordance with the implementation of the programmed cell death cascade in genital endometriosis. The review identified the significance of a number of proteins (TNF-á, FADD, CASP3, CASP7, CASP10) in the pathogenesis of hyperproliferative diseases. However, many apoptotic regulators (BCL2, BIK, BMF, HRK, BAD, Survivin) in genital endometriosis were found to have been understudied, which makes future research in this direction promising.

Journal of obstetrics and women's diseases. 2021;70(4):99-113
pages 99-113 views

Bulking agents for minimally invasive correction of stress urinary incontinence in women

Rusina E.I., Zhevlakova M.M.

Abstract

BACKGROUND: The study is relevant due to the widespread prevalence of stress urinary incontinence in women and the search for minimally invasive and safe treatment methods.

AIM: The aim of this study was to present data based on modern evidence-based information on the effectiveness of urethral bulking agents and their safety in stress urinary incontinence treatment in women.

MATERIALS AND METHODS: A review of the literature (original articles, systematic reviews) on the use of urethral bulking agents for stress urinary incontinence treatment in women was carried out.

RESULTS: Urethral bulking agents for stress urinary incontinence treatment are effective due to the creation of additional bulk in the paraurethral area without fibrosis or because of inflammation followed by fibrous tissue formation. The efficacy and complications depend on the properties of the used urethral bulking agents. Since the performed studies are heterogeneous and the methods for evaluating the use of bulking fillers in stress urinary incontinence treatment vary, it is difficult to comparatively characterize urethral bulking agents to determine the most effective one. The search is being conducted for an ideal proper filler, which should be biocompatible and non-immunogenic and maintain a long-term therapeutic effect.

CONCLUSIONS: Urethral bulking injections are an alternative therapy for women with stress urinary incontinence who are informed about its short-term effect and are expecting to avoid the risk of possible complications after surgery. Promising is to be regarded as the use of new urethral bulking agents based on hyaluronic acid with an optimal choice of concentration, degree of crosslinking and type of crosslinking agent to ensure maximum duration of action and minimum side effects.

Journal of obstetrics and women's diseases. 2021;70(4):115-124
pages 115-124 views

Theory and Practice

Assessment of 25(OH)D status in patients with genital endometriosis and clinical efficacy of cholecalciferol in the treatment of the disease

Denisova A.S., Yarmolinskaya M.I., Tkachenko N.N.

Abstract

AIM: The aim of this study was to determine the 25(OH)D status in patients with genital endometriosis compared to the control group and to analyze the clinical efficacy of cholecalciferol implication as a combined targeted therapy of the disease.

MATERIALS AND METHODS: The main group included 440 patients with genital endometriosis (mean age 33.7±5.8 years) with various degrees of disease prevalence. The control group consisted of 30 women with the normal ovulatory menstrual cycle (mean age 26.3±3.1 years) in whom gynecological pathology was not revealed. Peripheral blood (PB) 25(OH)D level was assessed in all the participants included into the study. In 49 women from the main group, the level of 25(OH)D in the peritoneal fluid (PF) was determined. Comparative evaluation of the clinical efficacy of cholecalciferol intake in combination with gonadotropin-releasing hormone agonist (aGnRH) 3.75 mg injections or with dienogest 2 mg oral administration, as well as monotherapy in comparison with standard hormone-modulating treatment was carried out. Prior to the start of treatment, the patients had pain syndrome of varying severity, which was evaluated using the McGill Pain Questionnaire with the Visual Analogue Scale for pain. The psycho-emotional status was assessed using the Hospital Anxiety and Depression Scale. The Excel, Statistica 10, and Jamovi software programs were used to process the obtained data.

RESULTS: The level of 25(OH)D in PB of patients with endometriosis was significantly lower compared to the control group (p < 0.001). Women with Grades III and IV genital endometriosis were characterized by lower PB 25(OH)D levels compared to the patients with Grades I and II of the disease, but the difference was not statistically significant. Relationships were revealed between 25(OH)D levels in the PB and PF (p < 0.001), as well as PF 25(OH)D level and the disease prevalence (p = 0.004). Significantly more pronounced pain reduction and stabilization of the psycho-emotional status were observed in patients receiving combined therapy with cholecalciferol.

CONCLUSIONS: Insufficient level of vitamin D and vitamin D deficiency can be considered as factors that play a role in the progression of genital endometriosis. The use of cholecalciferol in combination with aGnRH 3.75 mg or dienogest 2 mg may more effectively reduce the severity of pain and stabilize the psycho-emotional status in patients with genital endometriosis compared to standard hormone-modulating therapy.

Journal of obstetrics and women's diseases. 2021;70(4):125-133
pages 125-133 views

Endometriosis and SARS-CoV-2. A case report

Plekhanov A.N., Bezhenar V.F., Bezhenar F.V., Epifanova T.A.

Abstract

Despite the lack of information in the medical literature on endometrioid disease complicated by infectious and inflammatory diseases, past community-acquired pneumonia caused by the new coronavirus infection may cause purulent-septic complications of endometriosis. The effect of the virus on endometrioid cysts was hematogenous in this clinical case. The information presented in this report can help clinicians in conducting differential diagnostics in patients with a history of endometriosis and previous SARS-CoV-2, establishing a diagnosis, as well as determining the tactics of examination and treatment.

Journal of obstetrics and women's diseases. 2021;70(4):135-140
pages 135-140 views

Pregnancy in a woman with secondary osteoporosis. A case report

Sokolova A.A., Kuznetsova L.V., Khadzhieva E.D.

Abstract

BACKGROUND: Glucocorticoid-induced osteoporosis is one of the most serious complications of prolonged (more than three months) systemic glucocorticoid therapy. Rapid bone loss occurs in the first months of treatment, which is a significant risk factor, especially during pregnancy and lactation. When taking systemic glucocorticoid therapy in a daily dose of 5 mg or more (in prednisone equivalent), the relative risk of vertebral fractures increases by 2.9 times.

RESULTS: This article examines a clinical case of pregnancy and childbirth of 32-year-old woman diagnosed with secondary complicated osteoporosis during treatment with systemic glucocorticosteroids, who has a history of spine compression fractures during lactation after a previous pregnancy. Vitamin D deficiency was diagnosed and corrected during this pregnancy, which minimized the risk of fractures. A baby was delivered through the birth canal. Bisphosphonate therapy was started six months after birth. No new fractures were diagnosed within two years of observation.

CONCLUSIONS: The approach to the management, diagnosis and delivery of pregnant patients with secondary osteoporosis treated long-term with glucocorticosteroids should be multidisciplinary. It is imperative to prescribe vitamin D and calcium preparations throughout pregnancy and lactation.

Journal of obstetrics and women's diseases. 2021;70(4):141-146
pages 141-146 views


This website uses cookies

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

About Cookies