卷 71, 编号 1 (2022)

论证。在由SARS-CoV-2病毒引起的COVID-19大流行的背景下，病毒性肺炎是冠状病毒感染的主要临床形式，也是孕产妇死亡的一个重要原因。

本研究的目的是评估COVID-19严重与极端严重形式的病程性质、其对怀孕和胎儿的影响以及孕产妇死亡率。

材料与方法。对39例重度与极重度COVID-19患者的病历进行了回顾性评估。患者被分为两组。第一组包括22名冠状病毒感染过程严重且结果良好的孕妇；第二组包括17名孕妇，其中SARS-CoV-2引起的并发症导致了致命的结果。

结果。严重病程患者80%以上为孕妇贫血。最重要的临床和内科不良结果因素是妊娠期糖尿病（p=0.02）、先兆子痫（р=0.05）和缺水（р=0.01）。在死亡的患者中，被诊断为肥胖的人数比其他患者高两倍。两组患者临床表现均以发热、气短、乏力、干咳为主。在实验室检测中，在疾病最严重时死亡的患者白细胞增多，尿素和乳酸脱氢酶水平高于恢复的患者（p=0.05）。两组患者丙氨酸转氨酶和天门冬氨酸转氨酶活性均升高。死亡患者的平均转氨酶值比康复后孕妇高两倍。随着呼吸衰竭增加，两组患者均需要氧支持。绝大多数重症与极端重症患者在妊娠晚期暴露于冠状病毒感染。

结论。在晚期妊娠，COVID-19的严重与极端严重的病程更容易引起不良后果。妊娠期糖尿病、子痫前期和缺水是COVID-19孕妇易发生严重病程和预后不良的主要伴随疾病。冠状病毒感染的严重过程伴随着呼吸急促和发烧，并有明显的肺组织损伤。肝酶活性的显著增加和胎盘功能不全的增加可作为多器官功能衰竭的一种表现，提示预后不良。

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.

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.