Vol 70, No 6 (2021)

The increase in the number of newborns with intrauterine growth retardation, who are characterized not only by high perinatal morbidity and mortality, but also by neurodevelopmental disorders in later life, has determined a wide search for diagnostic markers of prenatal hypoxia for a timely objective assessment of brain damage and a justification of neuroprotection methods. This article presents literature data on biomarkers and methods of instrumental diagnosis of brain damage that have received evidence of the effectiveness of their use in early neonatal life of newborns with intrauterine growth retardation. It is emphasized that such biomarkers as S100B, NSE, and BDNF proteins are the most reliable and easy to determine non-invasively. However, for their wide application in clinical practice, it is necessary to establish reference values in umbilical cord blood and urine, while taking into account the gestational age, sex, and method of giving birth, and to unify the use of laboratory analysis systems and diagnostic tests for this purpose. The comparison of biomarker indicators with cerebral oximetry, electroencephalogram and magnetic resonance imaging data will allow for developing new approaches to the treatment of perinatal pathology and, largely, preventing adverse consequences in those born with intrauterine growth retardation.

The constant frequent incidents of fetal hypoxia during pregnancy and childbirth remain the leading unsolved problem in modern practical obstetrics. In some cases, the onset of a pathological process can be diagnosed earlier due to the on-time monitoring of functional disorders of the fetus. However, the existing diagnostic methods do not show the compensatory and adaptive capabilities of the fetus; do not lead to an in-depth understanding of the pathophysiology of this condition and do not contribute to the implementation of evidence-based therapy. This review summarizes current knowledge about the diagnosis of functional disorders of the fetus and discusses possible ways of assessing adaptive mechanisms in response to stress during pregnancy and childbirth. The article shows the development of biochemical methods for diagnosing functional disorders of the fetus. The putative biochemical markers for assessing the compensatory capabilities of the fetus during pregnancy and childbirth are presented.

BACKGROUND: Retinol in its various forms, being a powerful antioxidant, has a multifaceted effect on the functioning of body systems. Replenishment of the daily requirement for the vitamin is possible only when it is supplied from outside sources. Both excess intake and deficiency of retinol are associated with adverse effects.

AIM: The aim of this study was to assess the role of vitamin A in the functioning of the female reproductive system, its effect on pregnancy, and the prospects of using it as a pathogenically justified therapy for endometriosis.

MATERIALS AND METHODS: We performed this review, analyzing articles from such electronic databases as PubMed, ScienceDirect, and Cyberleninka, published in the period from 2000 to 2020.

RESULTS AND CONCLUSIONS: Vitamin A plays an important role in pregnancy; its deficiency is associated with a number of malformations, the risk of respiratory distress syndrome and disorders of the immune system development in the fetus. Despite the alleged risk of using vitamin A in pregnant women, it can be prescribed both at the planning stage and during pregnancy in safe therapeutic doses, up to 10,000 IU / day, in order to reduce the number of congenital malformations, to give birth to children with higher Apgar scores, and to prevent anemia. Retinol has antiproliferative and antitumor effects and affects the biosynthesis of estrogens, which justifies the possibility of its involvement in the pathogenesis of genital endometriosis. Given the ability of vitamin A to inhibit the proliferation of endometrioid ovarian cysts, to reduce the size of endometrioid heterotopias, and to modulate the synthesis of proinflammatory cytokines, it can be considered as a perspective therapy in the combined treatment of genital endometriosis.

Caesarean section is the most common surgical intervention over the world, so the development of the enhanced recovery after cesarean delivery is turning out to be a vital problem. The practical application of the enhanced recovery after cesarean requires multidisciplinary collaboration and well-coordinated teamwork of an anesthesiologist, an obstetrician-gynecologist, nursing staff and other specialists. In this review, we have studied recent domestic and foreign articles dedicated to the enhanced recovery after cesarean. Particular attention was paid to the case management at all stages of the perioperative period, especially preoperative preparation, postoperative care and women’s awareness raising. The presented studies included such program criteria as avoidance of prolonged preoperative fasting accompanied by early postoperative feeding, early breastfeeding attachment of the newborn, the use of multimodal analgesia in the postoperative period, the early activation of the postoperative patient, and the minimization of the detention period of hospital stay. The reviewed articles indicated the positive impact of this program on maternal and newborn outcomes and demonstrated the need for detailed further study of several issues and standardization of the enhanced recovery after cesarean methods.

BACKGROUND: An interest in the study of intestinal microflora has grown among scientists in recent years. This is due to the active development of molecular genetic techniques. The obvious importance of gut microbiota for pregnancy has been established in some scientific works; however, the number of studies devoted to this issue is small.

AIM: This study was aimed to assess the qualitative and quantitative composition of the intestinal microflora in pregnant women.

MATERIALS AND METHODS: The study involved 200 women aged 18 to 43 years in pregnancy from six to 22 weeks. A qualitative and quantitative analysis of the intestinal and vaginal microbiota was performed by real-time PCR.

RESULTS: Intestinal dysbacteriosis was detected in 100% of the examined pregnant women. Grade I was detected in 64.5% (n = 129), grade II in 26.5% (n = 53), and grade III in 9% (n = 18) of cases. A decrease in the concentrations of resident bacteria was noted in all pregnant women; in addition, in women with moderate and severe dysbacteriosis, opportunistic microorganisms (Clostridium difficile, Enterobacter spp., Streptococcus spp., and Campylobacter spp.) were detected in quantities exceeding the formally permissible values. The analysis of the course of pregnancies showed that grade I and grade II intestinal dysbacteriosis is a risk factor for early pregnancy complications (OR = 0.2, p = 0.00), thus confirming the role of intestinal microbiocenosis in miscarriage.

CONCLUSIONS: Pregnancy is a predisposing factor for changes in the intestinal microflora, as evidenced by the detection of intestinal dysbiosis in 100% of pregnant women in the main and control study groups. Considering that the majority of women with a normal pregnancy were diagnosed with grade I intestinal dysbiosis, it can be assumed that this degree of dysbiosis is the norm of pregnancy. Thus, the identification of moderate or severe intestinal dysbiosis should be associated with complications of early pregnancy.

BACKGROUND: During the pandemic pregnant women experience a wide range of negative feelings that can have short- and long-term impact on both the woman and her child.

AIM: The aim of this study was to analyze the impact of stress associated with the coronavirus pandemic on the emotional state of pregnant women and their childbirth.

MATERIALS AND METHODS: State-Trait Anxiety Inventory, Impact of Events Scale-Revised, telephone interview about delivery process and outcome, socio-demographic data. Research is done online, data is being gathered.

RESULTS AND CONCLUSIONS: Majority of women experience high (36%) and moderate (48%) anxiety. Changes in the national healthcare system, the financial situation in the family and the political situation in this country are having a greater negative impact on pregnant women than their fear for the child’s and their own health. Remote preparation, refusal of their partner’s delivery, forced change of plans for childbirth have become significant factors for a negative assessment of labor and delivery. 69% evaluate delivery process as difficult, 42% report on obstetric aggression.

BACKGROUND: Uterine cervical incompetence is a leading cause of miscarriage. There are surgical and conservative methods of treatment to correct cervical insufficiency during pregnancy. Surgical methods of correction include suture on the cervix (cervical cerclage), which could be categorized as preventive, therapeutic or emergency suture.

AIM: The aim of this study was to compare the clinical effects of preventive and therapeutic cerclages on the course and outcomes of pregnancy in women with uterine cervical incompetence.

MATERIALS AND METHODS: This prospective study included 106 pregnant women aged 20-45 years, who were diagnosed with uterine cervical incompetence and underwent surgical correction at gestation period of 14 to 24 weeks in combination with intravaginal micronized progesterone. The women were divided into two groups. Group 1 (n = 30) included patients without structural abnormalities of the cervix, who underwent prophylactic cerclage. Group 2 (n = 76) consisted of pregnant women who underwent therapeutic cerclage. Examination of the hormonal status included study of anamnesis related to the menstrual and reproductive function and determination of the presence and type of obesity and the severity of secondary sexual characteristics. The anatomical causes of miscarriage were assessed while examining the cervix in the mirrors and using ultrasonography. Dynamic transvaginal ultrasonography was also performed. The markers of the inflammatory response were assessed (complete blood count parameters and C-reactive protein level). In addition, the biochemical blood test and the coagulogram were performed, with a smear study carried out for microbiocenosis and sowing from the cervical canal. The pH balance of the vagina was also determined.

RESULTS: The ratio of patients without structural changes of the cervix with prophylactic cerclage and pregnant women with therapeutic cerclage is 28% and 72%. This means that only 28% of patients with uterine cervical incompetence come to the specialized hospital with medical examination and pregraving preparation. The remaining 72% of women came with the first examination and already had complications of pregnancy.

CONCLUSIONS: Surgical correction is an effective prevention method of late pregnancy loss. Preventive cerclage has advantages – time of manipulation, the number of complications and the stay of pregnant in the hospital are reduced. The use of surgical correction of uterine cervical incompetence has prolonged the pregnancy of all women before the birth of a viable child. This is a good reserve to reduce perinatal morbidity and mortality. The problem of early diagnostics and surgical correction of uterine cervical incompetence remains relevant.

BACKGROUND: Multiple pregnancies are high-risk pregnancies from both an obstetric and a psychological point of view.

AIM: The aim of this study was to identify the features of prenatal experiences of women carrying multiple pregnancies and to determine the influence of several complications of multiple pregnancy on prenatal experience.

MATERIALS AND METHODS: The study involved 80 individuals aged 19 to 43 years, at a gestational age of 21 to 39 weeks, carrying twins. The patients were divided into five groups by clinical diagnosis and were asked to complete psychodiagnostic questionnaire. The answers to the questions suggested both a quantitative assessment and a qualitative description of their experiences.

RESULTS: We revealed some differences between the study groups in the frequency of manifestations of different psychological elements of the mother’s gestational dominant. Some trends were also found for differences between the groups in terms of prenatal attachment rates. An analysis of pregnant women’s descriptions of their ideas about the unborn children and communication with them showed that there were qualitative differences between the groups in the following: ideas about the characters of the unborn children, actual thoughts about them and thoughts about them after delivery, and features of the mother’s communication with them in several emotional conditions. The data obtained allowed for describing the psychological portrait of pregnant women with several complications of multiple pregnancy.

CONCLUSIONS: Depending on the type of multiple pregnancy complications, there are specific psychological experiences associated with pregnancy, future maternity and an emotional bond with the unborn children. Moreover, these experiences influence the behavior of pregnant women and their communication with other people and medical staff.

AIM: The aim of this study was to investigate the features of the course of pregnancy, childbirth and the postpartum period in women with cerebrovascular pathology and to assess the choice of the optimal method of delivery and perinatal outcomes.

MATERIALS AND METHODS: This study assessed ten cases of pregnancy and delivery in women with cerebrovascular pathology (arteriovenous malformation (50%), cavernous malformation (30%), and arterial aneurysms (20%)). All women were followed up, treated and delivered at the Obstetrics and Gynecology Clinic (Academician I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia) between 2018 and 2019.

RESULTS: In eight out of ten women with cerebrovascular pathology, the course of pregnancy was complicated by the threat of premature birth, chronic placental insufficiency, and severe preeclampsia. In one case, the pathology of the cerebral blood vessels (cavernous malformation) manifested itself as a general hemorrhagic disturbance of the cerebral blood circulation during this pregnancy; in all other cases, cerebrovascular pathology was diagnosed before pregnancy. When analyzing the timing of delivery, it should be noted that only in one case with severe preeclampsia, the pregnancy was completed at 34 weeks and 1 day (emergency childbirth). The average delivery time for the remaining patients was 38 weeks ± 3 days (planned childbirth). The analysis of delivery methods showed that in 90% of cases (n = 9), pregnant women were delivered by caesarean section. Vaginal delivery occurred in one patient with a history of arteriovenous malformation of the left frontal lobe after subtotal embolization. The course of the postpartum period in all the patients was uneventful. During the next year, a planned consultation with a neurologist took place in three cases.

CONCLUSIONS: It is required that a multidisciplinary team should develop tactics for pregravid preparation, pregnancy and postpartum management, with an assessment of long-term consequences in pregnant women with cerebrovascular disease, which will improve the efficiency of medical care and will contribute to the further implementation of reproductive functions in such patients. It is necessary to develop rehabilitation plans with the selection of personalized rehabilitation methods aimed at reducing complications associated with pregnancy and childbirth.