Vol 71, No 2 (2022)

March 24, 2022 marks the 80^th anniversary of the birth of the outstanding Russian neonatologist and scientist, Doctor of Medicine, Professor Inna I. Evsyukova.

An external audit of the childbirth outcomes was conducted in accordance with M. Robson’s 10-group classification. The main determinants of indications and the frequency of cesarean section in obstetric medical organizations of St. Petersburg in 2020-2021 were analyzed in order to find effective mechanisms for reducing the frequency of сesarean delivery within the framework of compliance with modern principles of perinatal-oriented obstetrics and the preservation of a woman’s reproductive health. Possible effective reserves for reducing the frequency of CS are presented: personalized pre-gravidar preparation in high-perinatal risk women groups, personalized approach to methods of pre-induction and induction of labor in high-risk groups’ patients, rational management of labor in compliance with modern clinical recommendations, wider use of current classical external manual methods for antenatal correction of fetus pelvic presentation, prevention the primary cesarean deliveries, increase in the rate of vaginal deliveries among women with previous cesarean deliveries, optimization of effective antenatal psychological consultation about the delivery methods among pregnant women with breech presentation, previous cesarean deliveries and multiple pregnancy.

AIM: The aim of this study was to analyze the association between the SNP surviving, the p53 gene polymorphisms and the risk of developing genital endometriosis and type 1 diabetes mellitus.

MATERIALS AND METHODS: The frequency of allelic variants of the BIRC5 and TP53 genes was studied by PCR-RFLP analysis in 243 women, including 84 patients with genital endometriosis (stages I–IV), 85 patients with type 1 diabetes mellitus, 47 women with diabetes mellitus type 1 and endometriosis and 27 women of the control group represented by the population sample.

RESULTS: It was found that the frequency of the allele C polymorphic variant of rs9904341 in the BIRC5 gene was significantly higher in the group of patients with diseases compared to the population sample (p < 0.05). Significant differences for the C / C genotype in patients with genital endometriosis relative to the control group (p = 0.01) According to the odds ratio, the risk of developing genital endometriosis was 56 times higher for this genotype (ОR 56.31, CI 2.52–1258.7). Significant differences for the ins/ins genotype of TP53(p16) gene in patients with genital endometriosis relative to the control group (p = 0.005). According to the odds ratio, the risk of developing genital endometriosis was 94 times higher for this genotype (ОR 94.29, CI 3.88–2288.81). In addition, the frequency of the allele ins polymorphic variant of p16 in the TP53 gene was significantly higher in the group of patients with diseases compared to the control group (p < 0.05). The same results for the P allele of the rs1042522 polymorphism in the TP53 gene (p < 0.05). According to the odds ratio, the risk of developing genital endometriosis with diabetes mellitus type 1 was 3 times higher for G/A genotype of rs9930232 (p6) than for other genotypes (ОR 3.1, CI 2.52–1258.7)

CONCLUSIONS: The investigated factors can be considered as risk markers for the development of genital endometriosis and diabetes mellitus type one.

BACKGROUND: Placental adhesive disorder is associated with a high risk of massive bleeding during pregnancy and caesarean delivery. Abnormal trophoblast invasion and pathological hypervascularization detected in these patients may be due to the imbalance of angiogenic factors such as PlGF and sFlt-1, which makes their study an important area of scientific and clinical practice.

AIM: The aim of this study was to evaluate sFlt-1 and PlGF levels in women with placenta accrete spectrum and to compare the data with the results in women with normal pregnancy.

MATERIALS AND METHODS: This “case-control” study included 71 pregnant women in the third trimester of pregnancy. The main group (n = 32) consisted of patients with prenatally diagnosed placenta previa and abnormally invasive placenta; the control group (n = 39) included patients with normal pregnancy. In the study groups, the levels of sFlt-1 and PlGF were determined, with ultrasound and MRI characteristics evaluated. Statistical analysis was performed using IBM® SPSS® Statistics 26.0.

RESULTS: Serum sFlt-1 and PlGF levels in the study group differed as compared to controls. In women with placenta accreta spectrum, the median sFlt-1 level was 2886.0 [2175.0–4127.0] pg/ml vs. control: 1890.0 [1807.0–2205.0] pg/ml (р < 0.001); the median PlGF level was 233.5 [171.4–460.5] pg/ml vs. control: 880.9 [746.6–1210.0] pg/ml (p < 0.001). A correlation was revealed between the angiogenic factor levels and the degree of pathological hypervascularization and collaterization according to MRI data. When comparing the probability of abnormally invasive placenta (PAS Grades 2 or 3) and the sFlt-1/PlGF ratio, an ROC curve was obtained with the AUC of 0.74 ± 0.13 (95% CI: 0.48–1.0; p = 0.021).

CONCLUSIONS: Patients with placental adhesive disorder had increased sFlt-1 levels and decreased PlGF levels compared to patients with normal pregnancy. The above levels correlated with the degree of pathological hypervascularization and collaterization detected by MRI. A prognostic model has been obtained, according to which the threshold value of the sFlt-1/PlGF ratio of 4.22 allows for distinguishing patients with deep placental invasion (PAS Grades 2 or 3).

AIM: The aim of this study was to define and standardize the clinical and diagnostic criteria for borderline ovarian tumors at the preoperative stage.

MATERIALS AND METHODS: A retrospective analysis of 35 clinical case histories of patients with morphologically established borderline ovarian tumors has been conducted. Clinical and morphological data were analyzed: age, anamnesis, examination data, disease stage, histological study results. Laboratory parameters were assessed: CA-125 tumor marker level and ultrasound characteristics using criteria defined by IOTA, ADNEX and O-RADS groups.

RESULTS: A single cyst with a solid component was a typical ultrasound type of borderline ovarian tumors (45.71%). The application of the simple IOTA rules in regards to evaluating the formations proved possible in 100% of the cases and the formation was regarded as undefined in 62.86% of the cases. In 51.43% of the cases, the formation belonged to O-RADS 4 (10% to <50% risk of malignancy). The study of CA-125 tumor marker levels showed insufficient sensitivity, only 57.14% of patients having the parameter above the norm.

CONCLUSIONS: The application of the IOTA and O-RADS criteria allows for differentiating not only benign and malignant, but also borderline ovarian tumors, thus determining the choice of an organ-preserving treatment for patients of reproductive age.

The review was made based on https://cyberleninka.ru/, PubMed, MedArt and https://rucml.ru/. Uterine fibroid is one of the most common noninflammatory diseases of female reproductive system of reproductive age. Estrogens and progesterone are tightly connected with various growth factors such as transforming growth factor beta, insulinlike growth factor, endothelial growth factor etc. Dysfunction of sex steroids, alteration of myometrium vascularization and proinflammatory changes of endometrium, associated with leiomyoma can prevent from adequate preparation of endometrium to implantation. The situation is often complicated by combination of leiomyoma and adenomyosis. Pregnancy in women with leiomyoma is associated with increased risk of miscarriage, preeclampsia and placental insufficiency. Isthmic localization of uterine fibroid is considered to be the most unfavorable as it increases the risk of cervical insufficiency. Thus, uterine fibroid is a serious reproductive problem associated with fertility reduction and other problems with childbearing.

Congenital diaphragmatic hernia is a condition characterized by a defect in the diaphragm that leads to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the fetal lungs. The defect may range from a small aperture in the posterior muscle rim to complete absence of the diaphragm. The pathophysiology of congenital diaphragmatic hernia is a combination of lung hypoplasia and immature birth associated with persistent pulmonary hypertension of the newborn and cardiac dysfunction. Prenatal assessment of the lung-to-head ratio and the position of the liver (presence or absence of a liver lobe in the chest) by ultrasound are used to diagnose and predict outcomes. Delivery of infants with congenital diaphragmatic hernia is recommended close to term gestation. Immediate management at birth includes bowel decompression, avoidance of mask ventilation and endotracheal tube placement if required. The primary focus of management includes gentle ventilation of the lungs, hemodynamic monitoring and treatment of pulmonary hypertension, followed by preparation for surgery only after stabilization of the newborn’s condition. Although the US Food and Drug Administration do not approve inhaled nitric oxide, it is commonly used to treat persistent pulmonary hypertension of the newborn induced by congenital diaphragmatic hernia. Extracorporeal membrane oxygenation is usually considered after failure of standard resuscitative interventions in neonates with congenital diaphragmatic hernia born at ≥34 weeks of gestational age or with body weight >2 kg and no associated gross fetal anomalies. Multiple factors such as premature birth, congenital anomalies, severity of pulmonary hypertension, type of postpartum recovery, and the need for extracorporeal membrane oxygenation affect the overall survival of infants with congenital diaphragmatic hernia. Thanks to advances in the management of patients with congenital diaphragmatic hernia, overall survival has increased, reaching 70–90 %, and with the use of extracorporeal membrane oxygenation up to 50 %.

Spontaneous ovarian hyperstimulation syndrome is an extremely rare complication that develops during or after a spontaneous pregnancy and requires timely diagnosis and appropriate intensive care. This article presents a rare clinical case of spontaneous ovarian hyperstimulation syndrome with the development of its severe clinical picture in the postpartum period. The article focuses on the fact of the difficult diagnosis of this syndrome in the postpartum period and the difficulties of differential diagnosis with systemic inflammatory response syndrome associated with current infection process. The correct diagnosis changed the treatment landscape, when the administration of the right therapeutic doses of low molecular weight heparin provided positive changes in the disease course with a benign outcome.