卷 70, 编号 1 (2021)

HYPOTHESIS/AIMS OF STUDY: Systemic endotoxinemia resulting from intestinal dysbiosis activates the Th1 immune response and excessive production of proinflammatory cytokines, which can cause abortion. This study was aimed at assessing interleukin levels in women with the threat of miscarriage and exploring their dependence on intestinal microbiocenosis and the level of endotoxinemia.

STUDY DESIGN, MATERIALS AND METHODS: The study involved 87 women aged 18 to 43 years in pregnancy from six to 22 weeks. The main group consisted of 50 women with a threatened miscarriage. The control group included 37 women with normal pregnancy. A qualitative and quantitative analysis of intestinal microbiocenosis was performed by real-time PCR, with endotoxin and interleukin levels evaluated using conventional methods.

RESULTS: In patients of the main group, intestinal dysbiosis of grade I was detected in 30 % (n = 15), of grade II in 46 % (n = 23), and of grade III in 24 % (n = 12) of cases. In the control group, intestinal microflora disorders corresponded to grade I dysbiosis in 67.6 % (n = 25) and grade II dysbiosis in 32.4 % (n = 12) of cases, there being no cases of severe dysbiosis revealed. The level of endotoxin in pregnant women of the main group was 0.57 ± 0.02 nmol / ml and was classified as “increased”. The endotoxin level in the blood serum of pregnant women of the control group was 0.34 ± 0.02 nmol / ml and was characterized as “low” (p < 0.001). A strong correlation was found (r = 0.8, p < 0.001) between the grade of intestinal dysbiosis and the level of endotoxinemia. The cytokine profile in patients of the main group was characterized by increased concentrations of pro-inflammatory cytokines (IL-1β — 4.9 ± 1.6 pg / ml, IL-6 — 4.8 ± 1.5 pg / ml) and a decreased concentration of anti-inflammatory cytokine (IL-10 — 18.0 ± 4.5 pg / ml), when compared to the control group (IL-1β — 1.8 ± 0.2 pg / ml, IL-6 — 2.1 ± 0.2 pg / ml, IL-10 — 30.3 ± 4.4 pg/ml). There were a statistically significant moderate positive correlation between the level of endotoxinemia and the concentration of pro-inflammatory cytokines and a weak negative correlation between the endotoxin level and the concentration of anti-inflammatory IL-10.

CONCLUSION: Endotoxinemia, which occurs as a result of intestinal microflora dysbiosis and activates pro-inflammatory pathways, can really be as a triggering factor in the pathogenesis of miscarriage in pregnant women.

研究现实性。围产期病理引起的神经精神疾病的发展表明需要研究新生儿脑损伤的生化标志，以便及时预防不良后果。血清素在个体发育的早期阶段提供了神经元结构和大脑皮质网络的密集发育。它们参与睡眠的周期性组织的形成，这是大脑形态功能发育的一个微妙标准。

本工作目的为研究健康足月新生儿的血清素含量，并将其与睡眠电描记术的定量和定性特征进行比较。

材料与研究方法。以检查84名健康的新生儿，根据胎龄将其分为三组：第一组-37周（20人）， 第二组-38周（24人），第三组-39-40周（40人）。用高效液相色谱-电化学检测法测定出生后第一天和第五天的脐带静脉富含血小板的血浆和由母婴静脉血制备的血小板悬浮液中的血清素含量。出生后7-12小时进行了睡眠电描记图的定量和定性分析。

研究成果。儿童脐带血中富含血小板的血浆中的血清素含量比母亲的静脉血中的血清素含量低2倍（0.379±0.116对0.756±0.200μM/L），但各项指标之间具有高度相关性（r = 0.8， p ＜ 0.05）。在胎龄为39-40周时，富含血小板的血浆和静脉血小板中的血清素水平显着高于37周出生时的血清素。在后者中，血小板的血清素含量在出生后继续增加（第一天为0.539±0.149 nM/109 Tr，第五天为0.846±0.094 nM/109 Tr；p < 0.05），而在妊娠39-40周时出生的婴儿的指标没有变化（分别为0.797±0.190和0.749±0.142 nM/109 Tr）。在胎儿宫内发育和出生后最初几天的第37周至39周之间，富含血小板的血浆和婴儿血小板中的血清素含量增加，与正相睡眠阶段的表示增加有关。

结论。健康新生婴儿新生儿早期血清素含量变化和睡眠的周期性组织的一般规律性表明，有可能使用获得的血清素标准值作为大脑功能发育的生化指标。

HYPOTHESIS/AIMS OF STUDY: The prevalence of diabetes mellitus in pregnant women is increasing. Physiological hyperlipidemia is usually developed during the last third of gestation, increases during pregnancies complicated by diabetes mellitus. Abnormal lipid profiles are associated with adverse perinatal outcomes. However, the associations between maternal dyslipidemia and pregnancy complications in women with different diabetes mellitus types remain unclear. The aim of this study was to assess the lipid profile in women with different types of diabetes mellitus (Type 1, Type 2, and gestational diabetes) based on the therapy in the third trimester of pregnancy, to investigate the associations between serum lipid profile and perinatal complications, and to determine possible prognostic value of lipids in the development of adverse pregnancy outcomes.

STUDY DESIGN, MATERIALS AND METHODS: The study included 277 women who were divided into several groups depending on the type of diabetes mellitus and its therapy method, a group of patients with preeclampsia, and the control group. We analyzed the clinical and laboratory data of outpatient and inpatient cards of pregnant women in the period between 2010 and 2017. Maternal blood samples were collected between 28 and 32 weeks of gestation. The samples were assayed for fasting triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol concentrations, as well as the atherogenic index of plasma. We also assessed the incidence of gestational arterial hypertension, preeclampsia, intrauterine growth restriction, and preterm birth.

RESULTS: Pregnant women with various types of diabetes mellitus were characterized by a significant rise in serum triglycerides and very-low-density lipoprotein cholesterol levels, an increase in the atherogenic index of plasma, and a significant decrease in antiatherogenic, high-density lipoprotein cholesterol levels. These changes were most pronounced in pregnant women with pregestational diabetes mellitus types and in groups receiving insulin therapy. Correlation analysis revealed weak positive correlations between serum triglycerides concentrations and macrosomia (r = 0.26) and between the atherogenic index of plasma and severe preeclampsia (r = 0.26). The analysis of the ROC curve showed that triglycerides, very-low-density lipoprotein cholesterol, and the atherogenic index of plasma are predictors of severe preeclampsia.

CONCLUSION: Diabetic pregnancies are associated with increased dyslipidemia, which plays an essential role in the pathogenesis of perinatal complications. Evaluating lipid profile markers in the third trimester of diabetic pregnancy may be valid predictors of severe preeclampsia.

HYPOTHESIS/AIMS OF STUDY: According to the number of oocytes retrieved in IVF/ICSI protocols, the ovarian response to controlled ovarian stimulation is divided into: poor (0–3 oocytes), suboptimal (4–9 oocytes), normal (10–15 oocytes) and excessive (>15 oocytes) response. However, the effectiveness of IVF / ICSI programs in women with a suboptimal response is poorly understood, since this cohort of patients is often fallen into the category of women with a normal response. The aim of this study was to determine the main characteristics of IVF / ICSI programs in patients with suboptimal response to be further compared to those in women with normal response to controlled ovarian stimulation.

STUDY DESIGN, MATERIALS AND METHODS: This retrospective study included 568 patients: 470 women with suboptimal response and 98 women with normal response to controlled ovarian stimulation. The comparative analysis comprised clinical and anamnestic data, as well as the main characteristics of assisted reproductive technology programs in the selected clinical groups.

RESULTS: It was found that patients with suboptimal response to controlled ovarian stimulation had significantly more frequent history of pelvic surgery (71.3 % vs. 55.1 %; p < 0.01) and pelvic inflammatory diseases (70.9% vs. 60.2%; p < 0.05). Parameters of ovarian reserve (serum anti-Müllerian hormone level and antral follicle count) in women with suboptimal response were significantly lower (p < 0.001). In addition, the number of mature oocytes, 2PN zygotes, good quality embryos (p < 0.001), as well as the clinical pregnancy rate in women with suboptimal response were found to be significantly lower than in patients with normal response to controlled ovarian stimulation (27.2% vs. 41.7%; p < 0.01). It was noted that concomitant uterine fibroids enhanced the negative impact on the effectiveness of IVF / ICSI programs in women with suboptimal response to controlled ovarian stimulation (OR = 0.5; 95% CI: 0.3–0.9; p = 0.03). ROC analysis identified predictors of suboptimal response to controlled ovarian stimulation, such as serum anti-Müllerian hormone level (AUC = 0.80) with the cut-off value of ≤2.57 ng / ml (sensitivity 74%, specificity 75%) and antral follicle count (AUC = 0.90) with the cut-off value of ≤10 follicles (sensitivity 80%, specificity 94%).

CONCLUSION: In women with suboptimal response to controlled ovarian stimulation, IVF / ICSI success rates are significantly reduced when compared to those in women with normal response. Concomitant uterine fibroids may further decrease the effectiveness of IVF / ICSI protocols in patients with suboptimal response. Predictors of suboptimal response include the serum anti-Müllerian hormone level and antral follicle count.

This article presents data of monitoring critical obstetric conditions (maternal near miss) for the purpose of auditing the quality of medical care and prevention of maternal mortality, obtained on the basis of an analysis of statistical data from eleven federal subjects of the Northwestern Federal District of the Russian Federation for 2018-2019. We characterized the critical obstetric conditions that allow avoiding maternal mortality cases, which, in modern legal practice, most often require forensic examinations on the fact of providing obstetric and gynecological medical care of inadequate quality. We determined that the main causes of maternal mortality cases (83.1% in 2018 and 84.0% in 2019) were massive obstetric bleeding and complications of severe preeclampsia, which more often occurred during childbirth and the first days of the postpartum period. All patients who survived a near death condition belonged to the group of high obstetric and perinatal risk, but most of them were delivered in obstetric hospitals of the second level, with more than half of the women by caesarean section.

We discussed the main ways of preventing and reducing the incidence of critical obstetric conditions and maternal mortality based on the improved modern integral model of internal quality control of medical care in obstetric institutions. We also discussed the findings based on the introduction into practice of medical, organizational and methodological (including telecommunication and other) technologies aimed at increasing professional competencies in the regions of the country. Special attention is drawn in this article to the need to systematize and develop uniform and clear criteria for assessing critical obstetric conditions.