BACKGROUND: Late-onset fetal growth restriction is characterized by changes in fetal cerebral hemodynamic patterns. Blood flow parameters in the anterior, middle, and posterior cerebral arteries have been studied previously, and there was shown a relationship between changes in certain cerebral artery vascular resistance parameters and increased risk of adverse perinatal outcomes such as fetal hypoxia in labor, cesarean section, and stillbirth. AIM: The aim of this study was to search for cerebral hemodynamic patterns in fetuses with late-onset fetal growth restriction after week 32 of gestation. MATERIALS AND METHODS: This prospective study included 110 pregnant women at week 32 or more of gestation who underwent fetal ultrasound (fetometry and Doppler with additional measurement of vascular resistance parameters in the anterior and posterior cerebral arteries). Ultrasound findings were assessed for the presence of late-onset fetal growth restriction. The systole-diastolic ratio, resistance index, and pulsatility index were evaluated in appropriate-for-gestational-age fetuses and in fetuses with late-onset fetal growth restriction. RESULTS: A total of 128 middle, 86 anterior, and 87 posterior cerebral arteries measurements were included in the calculations. From weeks 32–33 to preterm gestation in appropriate-for-gestational-age fetuses, a decrease in the middle cerebral artery parameters was observed, while in the anterior and posterior cerebral arteries, the vascular resistance parameters remained at the same level or slightly increased. A nonlinear trend of blood flow changes in the anterior and posterior cerebral arteries was observed in fetuses with fetal growth restriction — the values increased by weeks 34–36 of gestation and decreased in preterm gestation. At the same time, differences (р 0.05) were found between the median values of the systolic-diastolic ratio, resistance index and pulsatility index in the anterior and posterior cerebral arteries at weeks 34–36 and those at preterm gestation. CONCLUSIONS: Changes in fetal cerebral hemodynamics in fetal growth restriction, in particular, a shift in the peak values of vascular resistance parameters to later gestational periods may be associated with changes in the development of integrative functions of the central nervous system and neurovascular development of the fetal brain (cortex), which occurs predominantly in the third trimester of pregnancy.
{"title":"Changes in cerebral hemodynamics after week 32 of gestation in fetuses with late-onset fetal growth restriction","authors":"Sofia R. Yusenko, S. V. Nagorneva, I. Kogan","doi":"10.17816/jowd629299","DOIUrl":"https://doi.org/10.17816/jowd629299","url":null,"abstract":"BACKGROUND: Late-onset fetal growth restriction is characterized by changes in fetal cerebral hemodynamic patterns. Blood flow parameters in the anterior, middle, and posterior cerebral arteries have been studied previously, and there was shown a relationship between changes in certain cerebral artery vascular resistance parameters and increased risk of adverse perinatal outcomes such as fetal hypoxia in labor, cesarean section, and stillbirth. \u0000AIM: The aim of this study was to search for cerebral hemodynamic patterns in fetuses with late-onset fetal growth restriction after week 32 of gestation. \u0000MATERIALS AND METHODS: This prospective study included 110 pregnant women at week 32 or more of gestation who underwent fetal ultrasound (fetometry and Doppler with additional measurement of vascular resistance parameters in the anterior and posterior cerebral arteries). Ultrasound findings were assessed for the presence of late-onset fetal growth restriction. The systole-diastolic ratio, resistance index, and pulsatility index were evaluated in appropriate-for-gestational-age fetuses and in fetuses with late-onset fetal growth restriction. \u0000RESULTS: A total of 128 middle, 86 anterior, and 87 posterior cerebral arteries measurements were included in the calculations. From weeks 32–33 to preterm gestation in appropriate-for-gestational-age fetuses, a decrease in the middle cerebral artery parameters was observed, while in the anterior and posterior cerebral arteries, the vascular resistance parameters remained at the same level or slightly increased. A nonlinear trend of blood flow changes in the anterior and posterior cerebral arteries was observed in fetuses with fetal growth restriction — the values increased by weeks 34–36 of gestation and decreased in preterm gestation. At the same time, differences (р 0.05) were found between the median values of the systolic-diastolic ratio, resistance index and pulsatility index in the anterior and posterior cerebral arteries at weeks 34–36 and those at preterm gestation. \u0000CONCLUSIONS: Changes in fetal cerebral hemodynamics in fetal growth restriction, in particular, a shift in the peak values of vascular resistance parameters to later gestational periods may be associated with changes in the development of integrative functions of the central nervous system and neurovascular development of the fetal brain (cortex), which occurs predominantly in the third trimester of pregnancy.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Shelaeva, E. Kopteeva, E. Alekseenkova, R. Kapustin, I. Kogan
BACKGROUND: During pregnancy complicated by diabetes mellitus, the risks of developing fetal macrosomia and other perinatal complications increase. Redistribution of blood flow in the fetal umbilical-portal venous system may be an important but poorly understood compensatory mechanism that affects macrosomic fetal growth. AIM: The aim of this study was to determine the features of the fetal umbilical-portal venous hemodynamics in pregnant women with various types of diabetes mellitus and the absence of carbohydrate metabolism disorders, taking into account the gestational age and the macrosomic fetal growth. MATERIALS AND METHODS: In this prospective cohort study, 86 pregnant women with pregestational diabetes mellitus, 44 pregnant women with gestational diabetes mellitus and 58 patients without carbohydrate metabolism disorders underwent ultrasound examinations from 30+0 to 41+3 weeks of gestation. During ultrasound, we performed Doppler assessment of venous hemodynamic parameters in the vessels of the umbilical-portal venous system, with volumetric blood flow calculated for each vessel. Additionally, the total liver volumetric blood flow and ductus venosus shunt fraction were calculated. RESULTS: The presence of fetal macrosomia in patients from the pregestational diabetes mellitus group is associated with an increase in the volumetric blood flow of the umbilical vein by 89.5 ml/min (p = 0.003) and the left portal vein by 33.3 ml/min (p = 0.008), as well as the total volumetric blood flow of the fetal liver by 95.7 ml/min (p = 0.001) compared with normal-weight fetuses. At the same time, the ductus venosus shunt fraction decreased in macrosomic fetuses by 3.83% (p = 0.001). In the gestational diabetes mellitus and control groups, despite the tendency for these parameters to increase in fetuses with macrosomia, the differences did not reach statistical significance. With a left portal vein volume flow threshold of 94.51 ml/min, the sensitivity and specificity for predicting large births were 84.46 and 72.09%, respectively. CONCLUSIONS: Pregestational diabetes mellitus in the mother is associated with a priority redistribution of blood flow to the fetal liver and is accompanied by a decrease in the ductus venosus shunt fraction. The severity of these hemodynamic changes increases in the presence of fetal macrosomia, which confirms the role of liver perfusion in the regulation of fetal growth in uncomplicated pregnancy and maternal diabetes mellitus.
{"title":"The role of umbilical-portal venous hemodynamics in fetal macrosomia pathogenesis in pregnancy complicated by diabetes mellitus","authors":"E. Shelaeva, E. Kopteeva, E. Alekseenkova, R. Kapustin, I. Kogan","doi":"10.17816/jowd629597","DOIUrl":"https://doi.org/10.17816/jowd629597","url":null,"abstract":"BACKGROUND: During pregnancy complicated by diabetes mellitus, the risks of developing fetal macrosomia and other perinatal complications increase. Redistribution of blood flow in the fetal umbilical-portal venous system may be an important but poorly understood compensatory mechanism that affects macrosomic fetal growth. \u0000AIM: The aim of this study was to determine the features of the fetal umbilical-portal venous hemodynamics in pregnant women with various types of diabetes mellitus and the absence of carbohydrate metabolism disorders, taking into account the gestational age and the macrosomic fetal growth. \u0000MATERIALS AND METHODS: In this prospective cohort study, 86 pregnant women with pregestational diabetes mellitus, 44 pregnant women with gestational diabetes mellitus and 58 patients without carbohydrate metabolism disorders underwent ultrasound examinations from 30+0 to 41+3 weeks of gestation. During ultrasound, we performed Doppler assessment of venous hemodynamic parameters in the vessels of the umbilical-portal venous system, with volumetric blood flow calculated for each vessel. Additionally, the total liver volumetric blood flow and ductus venosus shunt fraction were calculated. \u0000RESULTS: The presence of fetal macrosomia in patients from the pregestational diabetes mellitus group is associated with an increase in the volumetric blood flow of the umbilical vein by 89.5 ml/min (p = 0.003) and the left portal vein by 33.3 ml/min (p = 0.008), as well as the total volumetric blood flow of the fetal liver by 95.7 ml/min (p = 0.001) compared with normal-weight fetuses. At the same time, the ductus venosus shunt fraction decreased in macrosomic fetuses by 3.83% (p = 0.001). In the gestational diabetes mellitus and control groups, despite the tendency for these parameters to increase in fetuses with macrosomia, the differences did not reach statistical significance. With a left portal vein volume flow threshold of 94.51 ml/min, the sensitivity and specificity for predicting large births were 84.46 and 72.09%, respectively. \u0000CONCLUSIONS: Pregestational diabetes mellitus in the mother is associated with a priority redistribution of blood flow to the fetal liver and is accompanied by a decrease in the ductus venosus shunt fraction. The severity of these hemodynamic changes increases in the presence of fetal macrosomia, which confirms the role of liver perfusion in the regulation of fetal growth in uncomplicated pregnancy and maternal diabetes mellitus.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Bezhenar, A. V. Dyachuk, D. V. Fedosova, Ilarion A. Barnash, Maria G. Chmaro, Valeria A. Ageeva
This article sheds light on the personal and professional paths of Professor Viktor Baskakov, who was an outstanding obstetrician-gynecologist, an endometriosis specialist, and the author of the first fundamental scientific works on endometriosis in Russia. The paper explores the milestones of the professor’s scientific career and discusses the peculiarities of clinical work and surgical techniques in the treatment of deep infiltrative endometriosis, in particular. In addition, new methods of management of the early postoperative period, as well as prevention and rehabilitation of gynecological patients are described. Viktor Baskakov was a talented teacher and mentor, a skilled surgeon, a competent scientific and clinical supervisor who had an innovative and bold view of the problems of treatment and diagnosis of endometriosis, which at that time were especially relevant and under-investigated. Special attention is paid to the many memories of colleagues and grateful patients of Professor Viktor Baskakov.
{"title":"Viktor P. Baskakov: life, science, and heritage (on the 100th anniversary of his birth)","authors":"V. Bezhenar, A. V. Dyachuk, D. V. Fedosova, Ilarion A. Barnash, Maria G. Chmaro, Valeria A. Ageeva","doi":"10.17816/jowd630149","DOIUrl":"https://doi.org/10.17816/jowd630149","url":null,"abstract":"This article sheds light on the personal and professional paths of Professor Viktor Baskakov, who was an outstanding obstetrician-gynecologist, an endometriosis specialist, and the author of the first fundamental scientific works on endometriosis in Russia. The paper explores the milestones of the professor’s scientific career and discusses the peculiarities of clinical work and surgical techniques in the treatment of deep infiltrative endometriosis, in particular. In addition, new methods of management of the early postoperative period, as well as prevention and rehabilitation of gynecological patients are described. Viktor Baskakov was a talented teacher and mentor, a skilled surgeon, a competent scientific and clinical supervisor who had an innovative and bold view of the problems of treatment and diagnosis of endometriosis, which at that time were especially relevant and under-investigated. Special attention is paid to the many memories of colleagues and grateful patients of Professor Viktor Baskakov.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141830425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kseniia A. Rudenko, V. V. Ishkaraeva, I. Zazerskaya
The aim of this study was to present the latest data on the association of preeclampsia and coronavirus infection and on the preeclampsia-like syndrome, and to analyze the current literature on the pathogenetic relationships between COVID-19 and preeclampsia and on morphological changes in placental tissue in patients with these gestational complications. A significant portion of studies indicate an increased risk of developing preeclampsia in patients with coronavirus infection during pregnancy, regardless of gestational age, especially in severe COVID-19, but other researchers report no association between coronavirus infection and the onset of preeclampsia. The supposed pathogenetic connection between these pathologies consists in the development of systemic endothelial dysfunction and dysregulation of the renin-angiotensin-aldosterone system, while the direct effect of SARS-CoV-2 on the placentation is poorly understood and is a subject of debate. A new concept of the so-called “preeclampsia-like syndrome” has been introduced, which presumably occurs in patients with a severe form of the novel coronavirus infection as its extrapulmonary manifestation. The measurement of the ratio of soluble fms-like tyrosine kinase-1 activity to the level of placental growth factor ratio has been proposed as a differential diagnostic test between preeclampsia and the preeclampsia-like syndrome, but its prognostic value remains ambiguous. The morphological examination of placentas in patients with coronavirus infection and preeclampsia indicates the signs of maternal and fetal vascular malperfusion. The literature on the association between coronavirus infection and preeclampsia remains controversial, however, the better half of the researchers is indicative of a significant increase in the risk of developing this serious complication in pregnant women with COVID-19, especially for its severe form. New information about the preeclampsia-like syndrome, as well as the virtual absence of studies of placental morphology in patients with preeclampsia and coronavirus infection during pregnancy, dictate the need for further study to better understand the association between these two pathologies, determine the possibilities of patient surveillance and prevent complications.
{"title":"Pathogenetic traits of preeclampsia in COVID-19. A relevant literature review","authors":"Kseniia A. Rudenko, V. V. Ishkaraeva, I. Zazerskaya","doi":"10.17816/jowd595741","DOIUrl":"https://doi.org/10.17816/jowd595741","url":null,"abstract":"The aim of this study was to present the latest data on the association of preeclampsia and coronavirus infection and on the preeclampsia-like syndrome, and to analyze the current literature on the pathogenetic relationships between COVID-19 and preeclampsia and on morphological changes in placental tissue in patients with these gestational complications. \u0000A significant portion of studies indicate an increased risk of developing preeclampsia in patients with coronavirus infection during pregnancy, regardless of gestational age, especially in severe COVID-19, but other researchers report no association between coronavirus infection and the onset of preeclampsia. The supposed pathogenetic connection between these pathologies consists in the development of systemic endothelial dysfunction and dysregulation of the renin-angiotensin-aldosterone system, while the direct effect of SARS-CoV-2 on the placentation is poorly understood and is a subject of debate. A new concept of the so-called “preeclampsia-like syndrome” has been introduced, which presumably occurs in patients with a severe form of the novel coronavirus infection as its extrapulmonary manifestation. The measurement of the ratio of soluble fms-like tyrosine kinase-1 activity to the level of placental growth factor ratio has been proposed as a differential diagnostic test between preeclampsia and the preeclampsia-like syndrome, but its prognostic value remains ambiguous. The morphological examination of placentas in patients with coronavirus infection and preeclampsia indicates the signs of maternal and fetal vascular malperfusion. \u0000The literature on the association between coronavirus infection and preeclampsia remains controversial, however, the better half of the researchers is indicative of a significant increase in the risk of developing this serious complication in pregnant women with COVID-19, especially for its severe form. New information about the preeclampsia-like syndrome, as well as the virtual absence of studies of placental morphology in patients with preeclampsia and coronavirus infection during pregnancy, dictate the need for further study to better understand the association between these two pathologies, determine the possibilities of patient surveillance and prevent complications.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Talantova, T. B. Postnikova, A. Mikhailova, O. Bespalova
The article provides an overview current literature covering the issues of preconception carrier screening. Hereditary diseases make a large contribution to disability, deterioration in quality of life and reduction in life expectancy, primarily among the child population. Treatment and rehabilitation of patients with hereditary diseases is accompanied by serious economic costs, as well as psychological and social problems. In many countries, preference for preventive measures over treatment measures is enshrined in law. Awareness of preconception carrier screening among non-genetic doctors and the general population is currently very low. The development and introduction into practical healthcare of effective approaches to the prevention of hereditary diseases is of paramount importance in reproductive medicine. Conducting expanded carrier screening before pregnancy will allow for identifying in future parents the latent carriage of hereditary diseases responsible for infertility, miscarriage, infant or child mortality, and fetal development abnormalities, as well as formulating optimal tactics to prepare and introduce pregnancy, including the use of diagnostic and preventive measures.
{"title":"Modern view of preconception carrier screening","authors":"O. Talantova, T. B. Postnikova, A. Mikhailova, O. Bespalova","doi":"10.17816/jowd623670","DOIUrl":"https://doi.org/10.17816/jowd623670","url":null,"abstract":"The article provides an overview current literature covering the issues of preconception carrier screening. \u0000Hereditary diseases make a large contribution to disability, deterioration in quality of life and reduction in life expectancy, primarily among the child population. Treatment and rehabilitation of patients with hereditary diseases is accompanied by serious economic costs, as well as psychological and social problems. In many countries, preference for preventive measures over treatment measures is enshrined in law. Awareness of preconception carrier screening among non-genetic doctors and the general population is currently very low. \u0000The development and introduction into practical healthcare of effective approaches to the prevention of hereditary diseases is of paramount importance in reproductive medicine. Conducting expanded carrier screening before pregnancy will allow for identifying in future parents the latent carriage of hereditary diseases responsible for infertility, miscarriage, infant or child mortality, and fetal development abnormalities, as well as formulating optimal tactics to prepare and introduce pregnancy, including the use of diagnostic and preventive measures.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Igor P. Nikolayenkov, Dmitry V. Shakalis, D. S. Sudakov
This review article analyzes current literature on the mechanisms of damage to the nervous system in fetal growth restriction, which is a leading cause of perinatal morbidity and mortality in the economically developed countries. In some cases, this condition is associated with damage to the fetal nervous system, the symptoms of which can persist throughout life. Foundation of the effective pathogenetic therapy for intrauterine growth restriction during pregnancy would significantly reduce child mortality, morbidity and disability, and ease the financial burden on the healthcare system and social institutions.
{"title":"Mechanisms of injury in the nervous system in fetuses with growth restriction","authors":"Igor P. Nikolayenkov, Dmitry V. Shakalis, D. S. Sudakov","doi":"10.17816/jowd501748","DOIUrl":"https://doi.org/10.17816/jowd501748","url":null,"abstract":"This review article analyzes current literature on the mechanisms of damage to the nervous system in fetal growth restriction, which is a leading cause of perinatal morbidity and mortality in the economically developed countries. In some cases, this condition is associated with damage to the fetal nervous system, the symptoms of which can persist throughout life. Foundation of the effective pathogenetic therapy for intrauterine growth restriction during pregnancy would significantly reduce child mortality, morbidity and disability, and ease the financial burden on the healthcare system and social institutions.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. A. Bettikher, O. A. Belyaeva, Albina I. Dukovich, O. Vorobeva, Tat'yna G. Tral', G. Tolibova, Victor A. Bart, I. Kogan, I. Zazerskaya
BACKGROUND: The serotonergic system during pregnancy plays an important role not only in carbohydrate metabolism, but also in the laying and regulation of the fetoplacental complex, growth and development of the fetus. The study of the expression of placental serotonin 5-HT2A receptor and serotonin transporter (SERT) in gestational diabetes mellitus is foremost for scrutinizing the pathogenesis of perinatal complications, as it may allow for finding new opportunities for their prevention and correction. AIM: The aim of this study was to compare the expression patterns of the serotonin 5-HT2A receptor and SERT in placental tissue in gestational diabetes mellitus and in normal pregnancy. MATERIALS AND METHODS: This comparative cohort study included pregnant women with gestational diabetes mellitus (n = 6) and patients with normal pregnancy (n = 10). The expression of serotonin 5-HT2A receptor (Abcam, USA) and SERT (Bioss Antibodies, USA) was studied in placenta samples from the both study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia). RESULTS: The relative area of SERT expression in the placenta in gestational diabetes mellitus was higher compared to normal pregnancy (p 0.001). The relative areas of expression of the serotonin 5-HT2A receptor in the placenta did not differ between the study groups (p = 0.5). CONCLUSIONS: Higher SERT expression in the placentas of patients with gestational diabetes mellitus compared to those from women with normal pregnancies may reflect the level of tension of compensatory mechanisms in gestational diabetes mellitus and the effect of insulin therapy on these mechanisms.
{"title":"Serotonin receptor and serotonin transporter expressions in the placental villous tree in gestational diabetes mellitus","authors":"O. A. Bettikher, O. A. Belyaeva, Albina I. Dukovich, O. Vorobeva, Tat'yna G. Tral', G. Tolibova, Victor A. Bart, I. Kogan, I. Zazerskaya","doi":"10.17816/jowd562735","DOIUrl":"https://doi.org/10.17816/jowd562735","url":null,"abstract":"BACKGROUND: The serotonergic system during pregnancy plays an important role not only in carbohydrate metabolism, but also in the laying and regulation of the fetoplacental complex, growth and development of the fetus. The study of the expression of placental serotonin 5-HT2A receptor and serotonin transporter (SERT) in gestational diabetes mellitus is foremost for scrutinizing the pathogenesis of perinatal complications, as it may allow for finding new opportunities for their prevention and correction. \u0000AIM: The aim of this study was to compare the expression patterns of the serotonin 5-HT2A receptor and SERT in placental tissue in gestational diabetes mellitus and in normal pregnancy. \u0000MATERIALS AND METHODS: This comparative cohort study included pregnant women with gestational diabetes mellitus (n = 6) and patients with normal pregnancy (n = 10). The expression of serotonin 5-HT2A receptor (Abcam, USA) and SERT (Bioss Antibodies, USA) was studied in placenta samples from the both study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia). \u0000RESULTS: The relative area of SERT expression in the placenta in gestational diabetes mellitus was higher compared to normal pregnancy (p 0.001). The relative areas of expression of the serotonin 5-HT2A receptor in the placenta did not differ between the study groups (p = 0.5). \u0000CONCLUSIONS: Higher SERT expression in the placentas of patients with gestational diabetes mellitus compared to those from women with normal pregnancies may reflect the level of tension of compensatory mechanisms in gestational diabetes mellitus and the effect of insulin therapy on these mechanisms.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Currently, diabetes mellitus is considered one of the most common problems in obstetrics and neonatology, associated with its high incidence and complications it causes — perinatal loss and morbidity of newborns, as well as further negative consequences for the child’s health. The incidence of diabetes mellitus is increasing in the world every year. According to forecasts of the International Diabetes Federation, there is no tendency to decrease the incidence in the near future. The increase in the incidence of diabetes mellitus is also due to a change in the criteria for diagnosis set out in the Gestational Diabetes Mellitus Treatment Guidelines. In addition, patients often do not understand the seriousness of the complications that occur with the disease, thereby not following the doctor’s treatment recommendations. To date, it has been proven that diabetes mellitus is a main cause of perinatal morbidity and mortality. According to the World Health Organization, even slight hyperglycemia in the mother during pregnancy is associated with the development of diabetic fetopathy. This article provides an analytical review of current literature covering the issues of perinatal and neonatal outcomes in the presence of diabetic fetopathy. Its characteristic phenotypic signs include macrosomia (due to increased fat deposition in subcutaneous tissue associated with increased production of somatotropic hormone) or microsomia (due to primary placental insufficiency), general pastiness, skin hyperemia, characteristic сushingoid-type appearance, body disproportion, puffy face in combination with other signs of immaturity, as well as transient hypertrophic cardiomyopathy and hepatosplenomegaly.
{"title":"Diabetes mellitus during pregnancy — complications for the fetus and newborn","authors":"Patimat Kh. Gadzhieva, Lyudmila V. Dikareva","doi":"10.17816/jowd394645","DOIUrl":"https://doi.org/10.17816/jowd394645","url":null,"abstract":"Currently, diabetes mellitus is considered one of the most common problems in obstetrics and neonatology, associated with its high incidence and complications it causes — perinatal loss and morbidity of newborns, as well as further negative consequences for the child’s health. The incidence of diabetes mellitus is increasing in the world every year. According to forecasts of the International Diabetes Federation, there is no tendency to decrease the incidence in the near future. The increase in the incidence of diabetes mellitus is also due to a change in the criteria for diagnosis set out in the Gestational Diabetes Mellitus Treatment Guidelines. In addition, patients often do not understand the seriousness of the complications that occur with the disease, thereby not following the doctor’s treatment recommendations. To date, it has been proven that diabetes mellitus is a main cause of perinatal morbidity and mortality. According to the World Health Organization, even slight hyperglycemia in the mother during pregnancy is associated with the development of diabetic fetopathy. \u0000This article provides an analytical review of current literature covering the issues of perinatal and neonatal outcomes in the presence of diabetic fetopathy. Its characteristic phenotypic signs include macrosomia (due to increased fat deposition in subcutaneous tissue associated with increased production of somatotropic hormone) or microsomia (due to primary placental insufficiency), general pastiness, skin hyperemia, characteristic сushingoid-type appearance, body disproportion, puffy face in combination with other signs of immaturity, as well as transient hypertrophic cardiomyopathy and hepatosplenomegaly.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. O. Golubenko, M. Savelyeva, V. V. Korennaya, Natalia M. Podzolkova
BACKGROUND: 30% of women with luminal breast cancer receiving adjuvant tamoxifen experience disease recurrence within 15 years. This demonstrates the wide variability in clinical response to tamoxifen. Both nongenetic (age, gender, body mass index, duration of drug use) and genetic factors have been described to influence the high variability of response to tamoxifen. Differences in the genes encoding the enzymes CYP2D6, CYP2C, and CYP3A (CYP2D6*4, CYP3A5*3, CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*3) and the ABCB1 gene (C3435T) may also be the main factors of susceptibility to the occurrence of undesirable effects when taking tamoxifen, which in turn may lead to decreased patient adherence to therapy. AIM: The aim of this study was to create a concept and an algorithm for a personalized approach to outpatient management of patients taking tamoxifen by a gynecologist in connection with the carriage of polymorphisms of cytochrome P450 and drug transporter genes. MATERIALS AND METHODS: In 2017–2018, the outpatient records of 230 patients with breast cancer were analyzed retrospectively. A single-stage pharmacogenetic study of 120 women with stage I–III luminal breast cancer taking tamoxifen was conducted prospectively for the presence of cytochrome P450 gene polymorphisms using the polymerase chain reaction method and assessing associations with adverse drug reactions, and 54 patients were interviewed after five-year follow-up to assess adherence and satisfaction with medical supervision. RESULTS: The likelihood of developing endometrial hyperplasia has been shown to increase while taking tamoxifen with increasing average age, body mass index, duration of tamoxifen use, and postmenopause. Significant associations have been identified between the carriage of the CYP2D6, CYP2C9, CYP2C19, CYP3A5, and ABCB1 gene polymorphisms and the development of adverse drug reactions. Predictive models have been developed to determine the risk of adverse drug reactions. All studied adverse drug reactions associated with various genetic polymorphisms predominated in the group of patients who stopped taking tamoxifen due to poor intolerance. Gynecologists regularly observed 57.4% of patients. Moreover, the higher the adherence to therapy was, the higher was the regularity of observation by a gynecologist. CONCLUSIONS: A plan for outpatient management of patients receiving adjuvant endocrine therapy with tamoxifen by a gynecologist has been developed.
{"title":"Personalized approach to outpatient management of patients taking tamoxifen by gynecologists","authors":"E. O. Golubenko, M. Savelyeva, V. V. Korennaya, Natalia M. Podzolkova","doi":"10.17816/jowd608183","DOIUrl":"https://doi.org/10.17816/jowd608183","url":null,"abstract":"BACKGROUND: 30% of women with luminal breast cancer receiving adjuvant tamoxifen experience disease recurrence within 15 years. This demonstrates the wide variability in clinical response to tamoxifen. Both nongenetic (age, gender, body mass index, duration of drug use) and genetic factors have been described to influence the high variability of response to tamoxifen. Differences in the genes encoding the enzymes CYP2D6, CYP2C, and CYP3A (CYP2D6*4, CYP3A5*3, CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*3) and the ABCB1 gene (C3435T) may also be the main factors of susceptibility to the occurrence of undesirable effects when taking tamoxifen, which in turn may lead to decreased patient adherence to therapy. \u0000AIM: The aim of this study was to create a concept and an algorithm for a personalized approach to outpatient management of patients taking tamoxifen by a gynecologist in connection with the carriage of polymorphisms of cytochrome P450 and drug transporter genes. \u0000MATERIALS AND METHODS: In 2017–2018, the outpatient records of 230 patients with breast cancer were analyzed retrospectively. A single-stage pharmacogenetic study of 120 women with stage I–III luminal breast cancer taking tamoxifen was conducted prospectively for the presence of cytochrome P450 gene polymorphisms using the polymerase chain reaction method and assessing associations with adverse drug reactions, and 54 patients were interviewed after five-year follow-up to assess adherence and satisfaction with medical supervision. \u0000RESULTS: The likelihood of developing endometrial hyperplasia has been shown to increase while taking tamoxifen with increasing average age, body mass index, duration of tamoxifen use, and postmenopause. Significant associations have been identified between the carriage of the CYP2D6, CYP2C9, CYP2C19, CYP3A5, and ABCB1 gene polymorphisms and the development of adverse drug reactions. Predictive models have been developed to determine the risk of adverse drug reactions. All studied adverse drug reactions associated with various genetic polymorphisms predominated in the group of patients who stopped taking tamoxifen due to poor intolerance. Gynecologists regularly observed 57.4% of patients. Moreover, the higher the adherence to therapy was, the higher was the regularity of observation by a gynecologist. \u0000CONCLUSIONS: A plan for outpatient management of patients receiving adjuvant endocrine therapy with tamoxifen by a gynecologist has been developed.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Rusina, Maria M. Zhevlakova, Elizaveta V. Shelayeva, M. Yarmolinskaya
BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life. AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age. MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure. RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires. CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the
{"title":"Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction","authors":"E. Rusina, Maria M. Zhevlakova, Elizaveta V. Shelayeva, M. Yarmolinskaya","doi":"10.17816/jowd624506","DOIUrl":"https://doi.org/10.17816/jowd624506","url":null,"abstract":"BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life. \u0000AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age. \u0000MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure. \u0000RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires. \u0000CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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