Vol 71, No 1 (2022)

This literature review is based on resources from the following databases: CyberLeninka, PubMed, MedArt, and the Central Scientific Medical Library (I.M. Sechenov First Moscow State Medical University, Moscow, Russia). Adenomyosis is a common non-infectious uterine pathology associated with the risk of infertility and obstetric problems. The local inflammation that develops in adenomyosis reduces the probability of blastocyst implantation and creates an unfavorable environment for the development of the embryo. Adenomyosis reduces the effectiveness of assisted reproductive technology. During the pregnancy in adenomyosis, the risk of incomplete and prolonged pregnancy increases at almost all stages. Besides, the risk of massive hemorrhage increases during pregnancy, childbirth and the early postpartum period. The presented review helps to assess the pathogenetic mechanisms underlying the negative effect of adenomyosis on women’s fertility based on data obtained over the past ten years.

BACKGROUND: Due to the widespread prevalence, steady growth and insufficient effectiveness of existing treatment regimens for external genital endometriosis, further study of the etiology and pathogenesis of the disease remains relevant. Inflammation is known to be one of the links in the pathogenesis of endometriosis; therefore, there is reason to believe that microorganisms are involved in the pathogenesis of this disease.

AIM: The aim of this study was to analyze the role of the reproductive tract microbiota in patients with endometriosis.

MATERIALS AND METHODS: This literature review was performed using systematic reviews, meta-analyses and experimental studies from such electronic databases as PubMed, CyberLeninka, and ScienceDirect published in the period from 1992 to 2021.

RESULTS AND CONCLUSIONS: In the review, we present the pathogenetic relationship between pelvic inflammatory diseases and endometriosis. The quantitatively and qualitatively altered microbiota composition of the reproductive tract, the genetic-epigenetic theory on the pathogenesis of endometriosis, which is based on mutations that accumulate directly under the influence of infectious agents, as well as the mechanisms of an abnormal immune response modeled by microorganisms, reflect the interconnection between the microbiota and the pathogenesis of endometriosis. Based on a number of studies, the relationship between the intestinal microbiota and the abdominal microbiome has been confirmed. Since endometriosis is the estrogen-dependent disease, of importance is the ability of the intestinal microbiota to produce β-glucuronidase, which is enhanced by gut microbial dysbiosis, thus possibly contributing to the progression of endometriosis. One of the important practical directions is the drug correction of dysbiotic conditions. The effectiveness of antibiotic therapy has been demonstrated by experimentally induced endometriosis model. Currently, there are very few highly specific methods for non-invasive diagnosis of the disease, therefore, the study of the reproductive tract and intestinal microflora of women with endometriosis is promising for the introduction of new laboratory diagnostic methods.

BACKGROUND: In the context of the COVID-19 pandemic caused by the SARS-CoV-2 virus, viral pneumonia is the leading clinical form of coronavirus infection and a significant cause of maternal mortality.

AIM: The aim of this study was to assess the course of severe and extremely severe forms of COVID-19, its impact on pregnancy and fetus, as well as on maternal mortality.

MATERIALS AND METHODS: In this retrospective study, we evaluated 39 case histories of patients with severe and extremely severe COVID-19, which were divided into two groups. Group 1 included 22 pregnant women with a severe course of coronavirus infection and a favorable outcome. Group 2 comprised 17 pregnant women in whom complications caused by SARS-CoV-2 were fatal.

RESULTS: More than 80% of patients with severe disease course had anaemia in pregnancy. The most significant clinical and anamnestic factors of adverse outcome were gestational diabetes mellitus (p = 0.02), preeclampsia (p = 0.05), and oligoamnios (p = 0.01). Obesity in group 2 was twice more common. The clinical manifestations of the disease in the both study groups were dominated by fever, shortness of breath, weakness and dry cough. In patients with a fatal outcome at the height of the disease, the levels of leukocytosis, urea and lactate dehydrogenase were higher than in those who recovered (p = 0.05). Besides, the levels of alanine transferase and aspartate transaminase were twice as high as in pregnant women who recovered later. Patients in the both study groups required oxygen support as respiratory failure progressed. The vast majority of patients with severe and extremely severe forms of coronavirus infection were in the third trimester of pregnancy.

CONCLUSIONS: Women in the third trimester of pregnancy are more susceptible to severe and extremely severe COVID-19 with an unfavorable outcome. Gestational diabetes mellitus, preeclampsia and oligoamnios are significant comorbidities that predispose to severe course and poor outcome in pregnant women and puerperas with COVID-19. The characteristic clinical manifestations of the severe course of coronavirus infection are shortness of breath and fever against a backdrop of significant damage to the lung tissue. A pronounced increase in hepatic enzymes and placental insufficiency is a harbinger of an unfavorable outcome as a manifestation of multiple organ failure.

AIM: The aim of this study was to improve the results of surgical treatment of patients with postcoital recurrent cystitis.

MATERIALS AND METHODS: From 2005 to 2021, in our clinic, extravaginal urethral transposition according to the method developed by us (RU No. 2408296 10.01.2011) was performed in 438 women aged 18 to 61 years (24 ± 1.3 years). The examination involved taking the anamnesis, physical examination, examination of the genitals, evaluation of urinalysis and urine culture, and bladder ultrasound.

RESULTS: Out of 438 women we operated on, 315 (71.9%) patients were examined in the long-term postoperative period. 297 (94.3%) patients had a positive result. Of these, 230 women had a full recovery and in 67 patients, cystitis occurs once or twice a year and is not always associated with intercourse. In 18 (5.7%) patients, the operation was ineffective, of which seven patients had exacerbations of cystitis after intercourse three years after the operation, and eleven patients had a reverse displacement of the urethra and the resumption of episodes of cystitis within a year after it. The repeated operation was performed in eight patients, it being effective in seven of them.

CONCLUSIONS: The new method of extravaginal transposition of the urethra according to Komyakov allows for avoiding the disadvantages of previously used operations. The main indication for the intervention is the direct relationship of cystitis episodes with sexual intercourse. The best results may be achieved with the correct selection of patients and compliance with all the technical features of the operation developed in our clinic.

BACKGROUND: To date, no test provides sufficient sensitivity and specificity for the early diagnosis of severe preeclampsia. Meanwhile, severe preeclampsia is a condition that threatens the life of not only the mother, but also the fetus, and requires a solution to the issue of delivery. Therefore, the search for markers of severe preeclampsia is still relevant today.

AIM: The aim of this study was to create a technology that allows for early differential diagnosis of hypertensive disorders during pregnancy based on a comprehensive analysis of echocardiographic data.

MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 112 cases of labor was carried out. The total sample was divided into five study groups: 30 relatively healthy women (group 1); 25 patients with chronic arterial hypertension (group 2); 21 patients with gestational arterial hypertension (group 3); 13 patients with moderate preeclampsia (group 4); and 23 patients with severe preeclampsia (group 5). The groups were formed in accordance with current clinical guidelines. Echocardiographic examination in all cases was carried out upon admission to the hospital. Statistical processing of the results was performed using the IBM SPSS Statistics Version 25.0 program.

RESULTS: The technology for early differential diagnosis of hypertensive disorders during pregnancy is implemented based on a multilayer perceptron, the percentage of incorrect predictions being 20.5 %. The structure of the trained neural network included six input neurons: gestational age, left atrium size in the parasternal position, right ventricular size, interventricular septal thickness, systolic blood flow velocity, and pressure gradient in the pulmonary artery.

CONCLUSIONS: Comprehensive analysis of echocardiographic data allows for early differential diagnosis of hypertensive disorders during pregnancy, while considering the result of neural network analysis as an additional criterion for severe preeclampsia. In the future, the use of this technology in clinical practice will not only optimize the tactics of managing patients with hypertensive disorders at admission to the hospital, but also reduce the incidence of adverse obstetric and perinatal outcomes.

BACKGROUND: Uterine fibroids are a benign tumor found in two out of three women of reproductive age. The most modern methods of organ preserving treatment of uterine fibroids are uterine artery embolization, which is a minimally invasive procedure, and high intensity focused ultrasound (HIFU) ablation, which is a non-invasive procedure. According to the literature and our own experience, uterine artery embolization is ineffective in 17.1% of cases and HIFU ablation in 16% of cases, mainly due to the peculiarities of blood supply to myomatous nodes.

AIM: The aim of this study was to compare the effectiveness of the treatment of uterine fibroids using an isolated HIFU ablation technique and combined sequential application of selective embolization of uterine artery supplying the myomatous node and HIFU ablation.

MATERIALS AND METHODS: This study included two groups of patients with symptomatic uterine fibroids. Group 1 consisted of 133 patients treated using the isolated HIFU ablation, and group 2 comprised 90 patients treated sequentially using supplying the myomatous node and HIFU ablation. Age and clinical manifestations of the disease (menometrorrhagia, pain syndrome, impaired function of adjacent organs, anemia) did not differ in the both groups.

RESULTS: The following parameters were different in the study groups: the duration of ultrasound ablation (p < 0.005) and the decrease in the volume of myomatous nodes in one, six and 12 months after surgery (p < 0.001). The duration of ultrasound ablation was 610.84 (56.26) minutes in group 1 and 215.28 (70.57) minutes in group 2. In group 1, the decrease in the volume of myomatous nodes was 12.2% in one month and 58.97% in 12 months after surgery, compared to the initial value. In group 2, the decrease was 42.9% and 67.5%, respectively.

CONCLUSIONS: The combined treatment of uterine fibroids using supplying the myomatous node and FUVI ablation techniques allowed for reducing the duration of the FUVI ablation operation three times and the volume of the node by 67.5% within one year compared to group 1 (58.97%).

AIM: The aim of this study was to determine the effectiveness of predicting the development of placental or maternal preeclampsia (PE) by clinical and anamnestic risk factors and results of the combined screening in first trimester of pregnancy.

MATERIALS AND METHODS: This two-center retrospective case-control study included the data analysis of somatic status, the obstetric and gynecologic anamnesis, and the results of the combined screening of 373 women in the first trimester of pregnancy. The control group consisted of 200 women with physiological course of pregnancy and labor. The main group comprised 173 patients whose pregnancy was complicated by early-onset (n = 44, 25%) or severe late-onset (n = 129, 75%) PE. We analyzed more than 100 clinical and anamnestic risk factors for PE implementation and evaluated the risk of developing PE at 11.0-13.6 weeks of gestation using the Fetal Medicine Foundation calculator.

RESULTS: Maternal risk factors for PE development are identical for clinical phenotypes, except for the family anamnesis of arterial vascular accidents in first-line relatives under 45 years of age, which are significantly interfaced to risk of placental PE development (OR 6.38, 95% CI 2.00–2.28; p = 0.0017). A comprehensive assessment of clinical and anamnestic data at 11.0-13.6 weeks of gestation allows for predicting the implementation of maternal severe PE in 36.7% of cases and placental PE in 29.6% of cases with an identical false positive rate of 10.5%. Carrying out the combined screening in the first trimester allows for determining the risk of PE development up to 37 weeks without differentiation by clinical phenotypes, with a test sensitivity of 53.9% at a false positive rate of 34.7%.

CONCLUSIONS: The prediction of placental or maternal PE development in the first trimester of pregnancy is possible only by maternal, clinical and anamnestic risk factors with a low predictive value of the test. Carrying out the combined screening with the inclusion of maternal risk factors, uterine artery pulsation index and pregnancy-associated plasma protein-A level increases the predictive value of the test for PE development up to 37 weeks from 37.6% to 53.6% at a high rate of false positive results. Validation of medical technologies for predicting clinical PE phenotypes in the population of women, taking into account a territorial origin and risk factors, will allow for defining the shortcomings of the model and improving its predictive value.