卷 70, 编号 2 (2021)

BACKGROUND: Uterine developmental anomalies have a negative impact on the implementation of female reproductive function, leading to a high risk of reproductive failures, premature birth, placental insufficiency, intrauterine growth retardation syndrome, labor anomalies and postpartum bleeding. The presence of both structural anomalies themselves and the high frequency of reproductive failures leads to repeated intrauterine interventions, which are considered as a premorbid background for the endometrial pathology development. Despite the combined causes of reproductive failure, morphological studies of the endometrium in women with various uterine anomalies are scarce.

AIM: The aim of this study was to evaluate the clinical and anamnestic data and morphological characteristics of the endometrium in women with uterine anomalies and reproductive failures in the anamnesis.

MATERIALS AND METHODS: We examined 123 women with uterine developmental anomalies (49 patients with an arcuate uterus, 38 patients with a uterine septum, 16 patients with a bicornuate uterus, 10 patients with an unicornuate uterus, 10 patients with dimetria). Standard clinical and laboratory work-up, hysteroscopy with endometrial biopsy and laparoscopy were performed in all patients. Histological and immunohistochemical examination of the endometrium was carried out according to the standard technique with assessment of the relevant receptor profile (estrogen and progesterone receptors) and pro-inflammatory markers (CD8⁺, CD20⁺, CD4⁺, and CD138⁺).

RESULTS: Clinical and anamnestic data evaluation in patients with uterine anomalies revealed menstrual abnormalities, commonly, dysmenorrhea. Regardless of the type of uterine anomaly, a high incidence of pelvic inflammatory disease, endometriosis and a high frequency of reproductive failures were found. The morphological structure of the endometrium with uterine anomalies was characterized by a higher frequency of endometrial hyperplasia, impaired secretory transformation and the presence of chronic endometritis.

CONCLUSIONS: Patients with a variety of uterine developmental anomalies are characterized by menstrual irregularities, a high incidence of gynecological pathology and reproductive failures. There is no association between pathognomonic signs of endometrial morphofunctional abnormalities and the type of uterine anomaly; however, they are similar to those seen in recurrent miscarriages and infertility of various origins.

BACKGROUND: Despite numerous studies, the etiopathogenesis of preterm birth in multiple pregnancy remains unclear, which determines the low effectiveness of measures for the prevention of preterm birth. This fact makes it necessary to study possible ways of implementing preterm birth in multiple pregnancies and to search for new biomarkers of their pathogenetic links. Experimental and clinical studies have demonstrated the contribution of the pleiotropic hormone relaxin to the regulation of a wide range of physiological processes and its role in the implementation of the pathogenetic mechanisms of pregnancy complications, primarily premature birth. The proven autocrine / paracrine mechanism of placental relaxin action, which implements important local effects, determines the prospects for studying the contribution of its dysregulation to the implementation of spontaneous preterm labor in multiple pregnancies.

MATERIALS AND METHODS: A morphological examination of 92 placentas from 46 deliveries of dichorionic diamniotic twins was performed: 24 of them were spontaneous premature births and 22 spontaneous term births. Histological examination of placentas along with immunohistochemical verification of relaxin 2 expression in the chorionic villus of the dichorial twins’ placentas were carried out.

RESULTS: Histological examination of the dichorionic twins’ placentas revealed that those from spontaneous preterm birth were characterized by a higher frequency of chronic placental insufficiency with reduced compensatory and adaptive mechanisms and more pronounced circulatory disorders in the circulatory bed of the villous tree, when compared to placentas from spontaneous term labor. The first verification of relaxin 2 expression in the chorionic villi of the dichorionic twins’ placenta showed the role of the peptide in the initiation of spontaneous preterm birth. The relative area of relaxin 2 expression in spontaneous preterm labor was significantly higher (p < 0.05) compared to that in spontaneous term labor.

CONCLUSIONS: The data obtained confirm the hypothesis put forward about the involvement of placental relaxin in the pathogenesis of spontaneous preterm labor in multiple pregnancies. The authors were the first to propose the definition of a “relaxin-dependent” way of implementing spontaneous preterm labor. To help define new preventive strategies, the prospects for further studies of the role and significance of relaxin in the implementation of pathogenic processes involved in spontaneous preterm birth in multiple pregnancies have been outlined.

AIM: The aim of this study was to investigate the morphometric features of tissues after exposure to bipolar energy of various electrosurgical generators and surgical hemostatic instruments used in vaginal hysterectomy.

MATERIALS AND METHODS: The study included 48 individuals who underwent a vaginal hysterectomy. The patients were divided in three groups based on the instrument used for sealing blood vessels: a BiClamp^® was applied in Group 1 (n = 16), a TissueSeal PLUS COMFORT^® in Group 2 (n = 16), and a Thunderbeat^® in Group 3 (n = 16). The maximum temperature of tissue measured using a Fluke FLK TIS 40 9HZ thermal imaging infrared camera was compared within the groups.

RESULTS: The maximum tissue temperature between the branches on electroligation, the minimum tissue temperature, and the tissue temperature at the coagulation boundary were significantly lower when using a TissueSeal PLUS COMFORT^® clamp than when using BiClamp^® and Thunderbeat^® clamps (H value = 41.8, p ≤ 0.01). Morphometric parameters (prevalence, coagulation depth and area) were the smallest with a TissueSeal PLUS COMFORT^® clamp compared to other clamps.

CONCLUSIONS: Using a TissueSeal PLUS COMFORT^® clamp during vaginal hysterectomy is effective and safe and has the best thermometric and morphometric characteristics when applied to the tissue, thereby reducing the risk of lateral thermal damage. The possibility of perifocal heat transfer varies with the type of tool and with the temperature at the coagulation boundary.

AIM: The aim of this study was to assess the actual nutrition of pregnant women in the first trimester as the basis for a personalized approach to pregnancy management.

MATERIALS AND METHODS: The actual nutrition during pregnancy was studied by analyzing the frequency of food consumption using the food weighing method, and the average daily indicators were calculated based on data for a period of one week. In total, 417 women were surveyed. The diet was characterized to identify deficiencies of the vitamins and minerals most significant for the reproductive system using the Individual Diet (My Body 3.0 version) software. Descriptive statistics methods were used to quantify the results. In the course of the work carried out, descriptive statistics methods were used.

RESULTS: The energy value of the daily diet of pregnant women averaged 2294.3 ± 487.21 kcal, which is within normal values (2070.0–3507.5 kcal / day), a surplus being observed in almost a third of the respondents (n = 118, 28.3%). The analysis of the diet showed that most of the patients had a deficiency in vitamins, macro- and microelements most significant for the reproductive system. On average, pregnant women consumed 155.0 ± 0.52 μg / day of folic acid with food, no woman receiving enough folic acid to prevent congenital malformations of the fetus. The average dietary intake of iodine was 70 μg / day. Thus, focusing on the recommendations for pregnant women, a diet deficient in iodine was observed in 90% of the respondents, and only five women (1.2%) consumed a sufficient amount of iodine-containing products. It was found that pregnant women consumed 5.9 ± 2.10 mg / day of zinc, with the recommended intake level of more than 12.5 mg / day not recorded in any woman. Iron deficiency was found in 289 respondents (69%). According to the survey results, more than half of the respondents (n = 269, 64.5%) had insufficient selenium intake. Calcium deficiency was registered in half of pregnant women (n = 210, 50.0%). Only every tenth woman (n = 48, 10.0%) consumed a sufficient amount of calcium containing food. Poor magnesium consumption was rarer and was found in only one third of the respondents (n = 135, 32.0%).

CONCLUSIONS: The data obtained indicate the need to study the individual level of actually consumed vitamins and nutrients, which may be the basis for personalized selection of drugs and efficient microelement dosing strategy.

现实意义的题目怀孕期间的贫血，没有得到诊断和及时治疗，是导致各种产科并发症的原因——自然流产、早产、子宫胎盘 - 胎儿系统的循环障碍、产科出血、产前和产时胎儿死亡。

目的是研究孕妇缺铁性贫血的频率，考虑到体质类型，并为这种疾病的发生开发一个预后模型。

材料和方法。对390名孕妇进行了检查。体格测定法按照 R.N. Dorokhova 怀孕不超过 9-10 周。 在观察到的孕妇中，110 名代表巨大体型，173 名代表中型，107 名代表小体型。根据已知方法测定血红蛋白和红细胞的水平。通过使用一套试剂“Parma Iron”（LLC“Parma Diagnostics”）用铁锌比色法评估血液中的铁含量。通过ELISA分光光度法测定血清铁调素。

结果。与中体型相比，大体型和小体型代表在怀孕期间最常发生缺铁性贫血(p<0.05)。观察组无严重贫血。与没有贫血迹象的孕妇组相比，有潜在贫血病程的孕妇组的血液学参数（血清中的铁和铁调素）浓度显着更高（p<0.05）。在妊娠中期，潜伏组妇女出现缺铁性贫血。通过多元回归分析，得到了预测不同体型孕妇缺铁性贫血发病的公式。

结论。血液学参数（血清中的铁和铁调素）应归因于缺铁性贫血的标志物，并应及时预测病理的发生。数学公式可以让您准确判断孕妇缺铁性贫血的发病情况，同时兼顾怀孕前三个月的体质类型，防止病理发展。

1 型糖尿病的发病率在全球范围内呈上升趋势，所有年龄组（包括儿童和青少年）中缺乏维生素 D 的人数也在增加。近几十年来，研究表明维生素 D 除了调节钙稳态和骨代谢外，还具有抗炎和免疫调节作用。流行病学数据表明维生素 D 缺乏与 1 型糖尿病的发病机制有关。对维生素 D 代谢很重要的基因多态性也会调节 1 型糖尿病的风险。多项研究评估了维生素 D 作为辅助免疫调节疗法在新诊断的 1 型糖尿病患者中的作用。本综述的目的是提供有关维生素 D 参与 1 型糖尿病发病机制的最新数据，并评估其作为预防该疾病和额外用于胰岛素治疗的药物的作用。

Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic glycoprotein that promotes proliferation, differentiation and activation of myeloid lineage cells. The abundant presence of G-CSF receptors in the female reproductive system highlights its possible importance in oogenesis, ovulation, implantation, and pregnancy development. This literature review describes the main aspects of G-CSF use in reproductive medicine, such as ovulation induction in women with the luteinized unruptured follicle syndrome, the improvement of folliculogenesis, overcoming repeated implantation failures, therapy of thin endometrium and recurrent pregnancy loss.

This article analyzes a clinical case of feto-fetal transfusion syndrome development in dichorionic diamniotic twin pregnancies with fused placentas. Feto-fetal transfusion syndrome is a typical complication of the monochorionic type of placentation, but it is quite rare in the dichorionic type of placentation. In this case, the syndrome development became possible due to the close anatomical location of the placentas, which probably led to their fusion and the development of unbalanced interplacental anastomoses. During the observation of the patient in an antenatal clinic, no ultrasound signs of feto-fetal transfusion syndrome were detected. At a 25⁺⁵-week gestation period, the patient complained of cramping pains in the lower abdomen and liquid discharge from the genital tract. The patient was hospitalized at the second stage of labor and gave birth through the natural birth canal. The first fetus had polyhydramnios, the second one having extremely low water. The first was a premature boy in the occiput posterior position weighing 980 g and 32 cm in height in a state of severe asphyxia with an Apgar score of 1, 4 and 6 points. The second was a premature boy in breech position weighing 490 g and 32 cm in height, also in a state of severe asphyxia with an Apgar score of 1, 4 and 6 points. The first child developed severe multiple organ failure, which caused death on the twelfth day. The second newborn developed respiratory distress followed by death on the second day of the neonatal period.