Vol 71, No 6 (2022)

Massive subchorionic thrombohematoma, also termed in the literature as Breus’ mole, is a rare condition in which a large maternal blood clot separates the chorionic plate from the chorionic villi. The etiology and pathogenesis of this condition are yet unclear, and the very concept of massive subchorionic thrombohematoma remains vague due to the singularity of clinical cases and the necessity to distinguish it from other types of hematomas. The lack of a unified view on the pathology and clear-cut clinical, laboratory and ultrasound criteria can lead to insufficient attention of doctors and untimely or even incorrect establishing diagnosis, which significantly worsens the prognosis of pregnancy and increases the risk of potential complications. Patients with massive subchorionic thrombohematoma require increased attention due to the high rate of such manifestations as antenatal death, fetal growth retardation, late miscarriage, and preeclampsia. Each case should be carefully analyzed in order to find predictors of thrombohematomas and methods of their prevention.

Arterial hypertension occurs in 8–29% of pregnant women and is a common form of endothelial dysfunction during gestation. In recent decades, the prevalence of arterial hypertension has increased several times largely due to the increasing maternal age of primiparous women and the increased incidence of obesity, diabetes mellitus, and carbohydrate metabolism disorders.

The aim of this study was to formulate the management tactics for pregnant patients with high blood pressure, based on the current understanding of the causes and mechanisms of the disease and the ability to influence the molecular links of pathogenesis, and to identify possible markers for predicting the progression of endothelial dysfunction in pregnant women with arterial hypertension. This review, based on the literature, raises the problem of modern diagnosis of arterial hypertension in pregnancy. We discuss the consequences of late initiation of the therapy and evaluate possible complications.

The severity of arterial hypertension is assessed differently in pregnant and non-pregnant women, according to current clinical guidelines. Thus, chronic arterial hypertension in pregnant women corresponds to grade II arterial hypertension in non-pregnant women, according to the American Heart Association and American College of Cardiology classification. Both untimely diagnosis and delayed or inadequate treatment result in adverse obstetric outcomes. Recent studies indicate the ability of earlier antihypertensive therapy (already at stage I according to the American Heart Association and American College of Cardiology classification) to reduce maternal and fetal adverse effects and prolong pregnancy. The CHAP 2022 study showed that using a blood pressure treatment threshold of 140/90 mmHg for pregnant women with chronic arterial hypertension provides better outcomes compared to treatment at higher numbers. Despite early initiation of therapy, some patients with elevated blood pressure subsequently develop thrombotic and gestational complications associated with endothelial dysfunction. There is an obvious need to introduce early preclinical diagnostic methods that would narrow the risk group and prevent late complications. The authors’ consensus on personalization of acetylsalicylic acid intake has emerged. The review analyzes the potential mechanisms of aspirin resistance, as well as the influence of genetic (the PTGS1, PTGS2, ITGB3, ITGA2, GP6, GP1BA, P2RY1, P2RY12 genes, other genes, and associated microRNA) and biochemical markers (11-dehydrotromboxane B2), which presumably may have prognostic value and applicability in clinical practice.

Our current understanding of the problem of diagnosis and early treatment of arterial hypertension in pregnancy can reduce the number of complications. The problem of predicting the development of endothelial dysfunction remains unresolved to the end. Active implementation of the studied markers into practice requires a further more detailed study of this area and the optimization of research design.

BACKGROUND: The high frequency of neurological and mental diseases in children who had intrauterine retardatiojn development indicates the need to study specific markers of disorders of fetal brain functional development, in particular, the state of the serotonergic system, which plays a key role in the morpho-functional development of the brain in early ontogenesis.

AIM: To study the content of serotonin in full-term newborns with intrauterine development delay in comparison with quantitative and qualitative characteristics of sleep.

MATERIALS AND MЕTHODS: The main group consisted of 26 newborns, whose intrauterine development took place in conditions of chronic placental insufficiency, which led to the formation of an asymmetric form of intrauterine retardatiojn development. The control group consisted of 72 healthy newborns from healthy mothers without pregnancy complications. Children of each group are divided into three subgroups depending on gestational age: I — 37, II — 38, III — 39–40 weeks. In all children, 7–12 hours after birth, an electropoligram of sleep was recorded (an electroencephalograph of the company “Mizar”, Russia) and its quantitative and qualitative analyses were carried out, highlighting the orthodox, paradoxical phase and undifferentiated state. The serotonin content was determined in platelet-rich plasma of blood from the umbilical cord vein after birth, as well as in a platelet suspension prepared from venous blood taken on the first day of life. The content of serotonin in platelets was judged by the indicator obtained by dividing the amount of serotonin in the platelet suspension by the platelet level. The amount of serotonin was determined by high-performance liquid chromatography with electrochemical detection. Statistical analysis was performed using the Statistica 6 program (Statsoft Inc, USA).

RESULTS: We report here a low content of serotonin in platelet-rich plasma and platelets of newborns with intrauterine growth retardation and the absence of its normal increase in weeks 37–39 of intrauterine development, as well as a violation of the genetic programming for the sleep-wake cycle organization.

CONCLUSIONS: Assessment of the serotonin-producing system of the brain in comparison with the newborn sleep pattern can serve as a diagnostic marker of brain damage and substantiate the need for timely application of neuroprotection.

BACKGROUND: In recent years, an important role in the pathogenesis of adenomyosis has been assigned to invasive properties of the cells of the basal layer of the endometrium, which provide them with the capacity to grow into the underlying layers of the myometrium.

AIM: The aim of this study was to evaluate the invasive and migratory properties of the ectopic and heterotopic endometrium in patients with adenomyosis.

MATERIALS AND METHODS: We performed clinical, morphological and immunohistochemical analyses of the surgical material of 98 patients with adenomyosis. Immunohistochemical study was carried out according to the standard avidin-biotin method, using mouse monoclonal antibodies to estrogen receptors, matrix metalloproteinase type 9, vimentin, and fibronectin (DAKO, Denmark) as primary immune sera.

RESULTS: The maximum number of estrogen receptors in both the proliferation and secretion phases was found in the endometrial glands and superficially located endometrioid heterotopias. A weaker expression of this marker was also found in the cells of the cytogenic stroma. In the foci of adenomyosis, located in the deep layers of the myometrium, the expression of estrogen receptors in the epithelial and stromal components of heterotopias varied in a wide range from 0 to 100%. The most pronounced expression of matrix metalloproteinase type 9 was characteristic of the epithelial component of superficial endometrioid heterotopias. In the foci of adenomyosis, located in the deep parts of the myometrium, a pronounced expression of matrix metalloproteinase type 9 was preserved in the proliferation phase, and its significant decrease was found in the secretion phase. The glands of the eutopic endometrium were also characterized by a more significant level of matrix metalloproteinase type 9 expression in the proliferation phase in comparison with the secretion phase. A pronounced expression of vimentin was detected in the epithelium of the glands of both superficial and deep foci of adenomyosis, as well as in the eutopic endometrium (100%). In the cytogenic stroma, the largest area of vimentin expression was found in the eutopic endometrium and superficially located endometrioid heterotopias. However, its value significantly decreased in the foci of adenomyosis located in the deep parts of the myometrium. The largest area of fibronectin expression was characteristic of the cytogenic stroma of superficial adenomyosis foci.

CONCLUSIONS: The displacement of elements of the eutopic endometrium into the thickness of the myometrium and further progression of adenomyosis is provided by two parallel pathogenetic mechanisms, namely, invasive growth due to matrix metalloproteinase type 9 activation and epithelial cell migration due to the epithelial-mesenchymal transition.

This article provides information on the history of the evolution of laparoscopy in the Northern Scientific Medical School of Obstetricians and Gynecologists. D.O. Ott discovered a way of visualising the organs of abdominal cavity (ventroscopy) and became the first surgeon in the world who performed the endoscopic interventions of the organs in abdomial cavity. Foreign and Russian scientists, including those from Arkhangelsk, as well as practitioners, who are presented in this article, have contributed a lot to the development of laparoscopy in gynecology. Laparoscopy in gynecology of today is an endovideosurgery, which has become a part of the routine practice of gynecologists. Laparoscopic surgery has become one of the most promising areas in gynecology for residents of the European North of Russia, focused on minimizing surgical trauma and improving the quality of patient care.

This article traces the historical path of operative obstetrics up to the present time. The issues of the high frequency of cesarean section, its impact on perinatal mortality, reproductive health of the female population, mental health of the future generation (children by operation), and qualification of obstetricians and gynecologists are raised. The authors point out that there is no direct correlation between the frequency of cesarean section and perinatal mortality rates, since antenatal fetal death dominates its structure, which does not depend on the method of delivery.

The article describes a clinical case of successful surgical treatment of a patient with deep endometriosis involving the rectum using the Da Vinci Surgical System. The use of the Da Vinci robotic complex allows for increasing the radicalism of the operation by improving visualization and expanding the surgeon’s manual capabilities. This starts to be possible thanks to the technical advantages of this technology, specifically 3D imaging and the use of EndoWrist instruments with artificial wrists and seven degrees of freedom that provide greater precision when manipulating in a minimally invasive environment. Surgical treatment of colorectal endometriosis includes three types of operations — focus shaving, discoid and circular bowel resections with anastomosis. When choosing a treatment strategy, one needs to take into account the clinical course of the disease, the results of conservative treatment and instrumental methods of research (ultrasound, MRI), and the woman’s reproductive plans. The excision of the infiltrate is an effective method of treating patients with colorectal endometriosis in terms of pain relief, improving the quality of life and restoring reproductive function. Performing such operations is optimal in medical institutions with a multidisciplinary approach.