Vol 69, No 3 (2020)

Hypothesis/aims of study. In the past 15 years, statistical reports have standardly identified five main causes of perinatal loss: hypoxia / asphyxia and its consequences, congenital malformations, respiratory disorders, intrauterine infections, and birth injuries. The cause of perinatal loss is indicated in 17-83% of cases, but this percentage can be increased by a careful analysis of the course of pregnancy, childbirth, and the results of autopsy. The aim of this study was to analyze the frequency of verification of the causes of perinatal death in St. Petersburg and the Leningrad Region for 2006-2018.

Study design, materials and methods. The methodology of determining the cause of perinatal loss in St. Petersburg and the Leningrad Region for 2006-2018 was analyzed according to the reports of the St. Petersburg State Budgetary Healthcare Institution “Medical Information and Analytical Center”) and the Leningrad Regional State Budgetary Healthcare Institution “Medical Information Analytical Center”, as well as the Leningrad Regional Pathological and Anatomical Bureau. Further, the frequency of cases in which the cause of perinatal loss was not indicated was estimated in dynamics over the analyzed period.

Results. The methodology and problems arising in establishing the basic diagnoses were studied: intrauterine hypoxia (P20.0), asphyxia during childbirth (P21), respiratory disorders in the newborn that occurred in the perinatal period (P22-P28), and hemorrhagic and hematological disorders in the fetus and newborn (P50-P61). Differences in the frequency of diagnosis of causes of death in Leningrad Regional Pathological and Anatomical Bureau are explained. Those are due to the methodology for establishing a diagnosis of chronic placental insufficiency (O43.8, other placental disorders: dysfunction, heart attack) based on the detection of hypoxic cardiopathy at autopsy, and due to the approach developed by the institution to detect intrauterine infections. The frequency of cases in which the cause of perinatal loss was not indicated was estimated, the reasons and possibilities of this being explained.

Conclusion. Low information content of the official statistical reports makes it difficult to analyze the real causes of perinatal loss.

Hypothesis/aims of study. Ovarian insufficiency is present in more than 30% of reproductive-age obese women. The role of leptin in the pathogenesis of ovarian insufficiency is not yet established and has to be clarified. It is of interest to study the effect of obesity therapy on hyperleptinemia, hormonal and ovulatory function in reproductive-age women with alimentary obesity. The aim of this study was to assess the effect of obesity therapy on leptin level and hormonal ovarian function in women of reproductive age.

Study design, materials and methods. All studied women underwent a clinical and laboratory examination, including: medical history, anthropometry (height and weight measurement, waist and hip circumferences, body mass index calculation), blood pressure measurement, gynecological examination, ultrasound examination of the pelvic organs, osteodensitometry, determination of serum gonadotropins, sex hormones, insulin, leptin, and blood biochemical parameters, morning fasting blood glucose, and glucose after the glucose tolerance test. The survey and objective examination data were recorded in a specially developed application form, including the following parameters: the patient’s age, menarche age, the type of the menstrual cycle, data on pregnancies, childbirth and reproductive plans, gynecological and somatic diseases.

Results. The relationship between the initial levels of leptin, estradiol, HOMA-IR, the number of follicles in the ovaries and the restoration of ovulatory function after the weight loss was revealed. The analysis produced a mathematical model to estimate the predictive value of these indicators in relation to the recovery of ovulation after the weight loss. An analysis was made of the effectiveness of drugs used to treat excess body weight (metformin and sibutramine).

Conclusion. The predictive value of the baseline levels of leptin and estradiol, the number of antral follicles and insulin resistance in relation to the achievement of ovulation after the reduction of body weight in patients with anovulation caused by excess body weight and obesity has been established. Ovulation recovery did not depend on the choice of a drug used to treat excess body weight. When comparing the groups of women who received medication for alimentary obesity using metformin and sibutramine, no significant differences in the frequency of ovulation recovery were found.

The review presents the results of clinical and experimental studies that indicate a high frequency of neuropsychiatric diseases and mechanisms of adverse effects during intrauterine development, determining long-term effects in offspring of obese and / or diabetic mothers. Approaches to prevention in the planning stage and during pregnancy are also discussed in the review.

Hypothesis/aims of study. Endometriosis is a multifactorial, chronic and recurring condition that has a multifaceted negative impact on women’s fertility. The aim of the study was to assess the effect of genital endometriosis on the female reproductive system and pregnancy using the literature.

Study design, materials and methods. The review was performed by analyzing the articles published mainly over the last 5 years and deposited in PubMed Central, ScienceDirect, and Cyberleninka bibliographic databases.

Results. Current data for the management of patients with endometriosis, pathogenetic and pathophysiological mechanisms of infertility, and complications arising during pregnancy in patients with endometriosis are presented in this review article.

Conclusion. In patients with endometriosis, individualized management of the disease, full periconceptional multivitamin supplementation and the developed strategy of prenatal care should be taken to overcome infertility and to prevent or minimize the risk of complications associated with pregnancy.

This article presents a clinical case of pubic symphysis diastasis in a pregnant woman with atypical clinical features. From 24 weeks of gestation, the patient noticed an intermittent low back aching pain radiated to posterior surface of the right thigh. The pain was regarded as a manifestation of lumbar osteochondrosis, and the patient did not receive specific treatment. At 39-40 weeks of pregnancy, the woman complained of severe pain in the left iliac region that appeared while lying on the left side or turning in bed. The differential diagnosis included acute abdomen and pubic symphysis diastasis. During diagnostic research, clinical features of acute abdomen were not found. The diagnostic tests such as tenderness palpation of pubic symphysis, P4 test, Patrick’s test, modified Trendelenburg’s test, and Mennell’s test were positive. Accor­ding to ultrasound, the width of the pubic symphysis was 8.9 mm, with a 2 mm deviation of pubic ramus relative to the sagittal plane, ill-defined margin and inhomogeneous structure of the symphysis due to hypoechogenic inclusions with a total area of about 50%. Thus, the patient was diagnosed with pubic symphysis diastasis of the 2^nd degree. Given the severe pain syndrome and a high risk of pubic symphysis fracture during labor, this case required surgical delivery. The postoperative period elapsed without complication.

Hypothesis/aims of study. The perinatal mortality rate is a comprehensive indicator of social well-being, economic deve­lopment and the state of medical care in any country. The aim of this study was to analyze perinatal loss dynamics in St. Petersburg and the Leningrad Region for 2006-2018 so as to determine the reserves for the reduction of perinatal mortality.

Study design, materials and methods. Regional statistical reports on perinatal mortality in St. Petersburg and the Leningrad Region for 2006-2018 were analyzed.

Results. A retrospective analysis of perinatal loss dynamics in St. Petersburg and the Leningrad Region was carried out. The structure of perinatal losses by birth weight of the fetus / newborn was surveyed. The proportion of children who died perinatally in the total number of deaths before reaching the age of 18 was determined. The main reserves for reducing perinatal mortality have been identified.

Conclusion. With a clear tendency for perinatal mortality in St. Petersburg and the Leningrad Region to decrease during the study period, the absolute number of stillbirths does not show such a tendency.