N. B. Kuznetzova, Viktoria V. Barinova, I. Bushtyreva, Pyotr Zh. Zavarzin
BACKGROUND: The annual increase in operative deliveries in obstetrics is steadily leading to an increase in the number of women with placenta accreta spectrum disorders. Cesarean section in patients with placenta accreta spectrum can be done only by surgeons of the highest qualification in operating rooms with the best technical equipment. Every year, the surgical delivery techniques for such patients get better and better, pursuing the goal of preserving the uterus and minimizing intraoperative complications and blood loss. AIM: The aim of this study was to assess the effectiveness of the intraoperative bladder filling technique during delivery in patients with placenta accreta spectrum. MATERIALS AND METHODS: All patients were randomly divided into two groups: 22 pregnant women (Group 1) who underwent caesarean section with metroplasty using intraoperative bladder filling technique and 19 pregnant women (Group 2) who underwent caesarean section with metroplasty without bladder filling. We analyzed the course of the operation, the measures taken to prevent blood loss, the time and scope of surgery, as well as surgical complications. Statistical analysis was performed using the non-parametric Mann-Whitney U-test and Fishers exact test. RESULTS: Patients of the both study groups were comparable in age, number of pregnancies in history, number of medical abortions, spontaneous abortions and non-developing pregnancies, as well as in the number of uterine scars in history. The total blood loss was 2177.8 114.9 ml in Group 1 and 2545.7 158.8 ml in Group 2 (p 0.05). Duration of surgery was 2 hours 45 7.1 minutes in Group 1 and 3 hours 31 4.1 minutes in Group 2. The bladder injury occurred in one patient in Group 1 in three patients in Group 2 (p 0.05). CONCLUSIONS: In patients with placenta accreta spectrum, the use of the bladder filling technique and mobilization of the bladder during cesarean section with metroplasty can reduce the percentage of intraoperative complications (incidence of bladder injury), intraoperative blood loss and the duration of surgery.
{"title":"The technique of intraoperative bladder filling to prevent surgical injuries of the urinary system during delivery in patients with placenta accrete","authors":"N. B. Kuznetzova, Viktoria V. Barinova, I. Bushtyreva, Pyotr Zh. Zavarzin","doi":"10.17816/jowd119486","DOIUrl":"https://doi.org/10.17816/jowd119486","url":null,"abstract":"BACKGROUND: The annual increase in operative deliveries in obstetrics is steadily leading to an increase in the number of women with placenta accreta spectrum disorders. Cesarean section in patients with placenta accreta spectrum can be done only by surgeons of the highest qualification in operating rooms with the best technical equipment. Every year, the surgical delivery techniques for such patients get better and better, pursuing the goal of preserving the uterus and minimizing intraoperative complications and blood loss. \u0000AIM: The aim of this study was to assess the effectiveness of the intraoperative bladder filling technique during delivery in patients with placenta accreta spectrum. \u0000MATERIALS AND METHODS: All patients were randomly divided into two groups: 22 pregnant women (Group 1) who underwent caesarean section with metroplasty using intraoperative bladder filling technique and 19 pregnant women (Group 2) who underwent caesarean section with metroplasty without bladder filling. We analyzed the course of the operation, the measures taken to prevent blood loss, the time and scope of surgery, as well as surgical complications. Statistical analysis was performed using the non-parametric Mann-Whitney U-test and Fishers exact test. \u0000RESULTS: Patients of the both study groups were comparable in age, number of pregnancies in history, number of medical abortions, spontaneous abortions and non-developing pregnancies, as well as in the number of uterine scars in history. The total blood loss was 2177.8 114.9 ml in Group 1 and 2545.7 158.8 ml in Group 2 (p 0.05). Duration of surgery was 2 hours 45 7.1 minutes in Group 1 and 3 hours 31 4.1 minutes in Group 2. The bladder injury occurred in one patient in Group 1 in three patients in Group 2 (p 0.05). \u0000CONCLUSIONS: In patients with placenta accreta spectrum, the use of the bladder filling technique and mobilization of the bladder during cesarean section with metroplasty can reduce the percentage of intraoperative complications (incidence of bladder injury), intraoperative blood loss and the duration of surgery.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79036448","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}
G. Safarian, L. Dzhemlikhanova, I. Kogan, D. Niauri, O. Bespalova, I. Krikheli, Ksenia V. Ob’edkova, E. Lesik, E. Komarova, A. Gzgzyan
BACKGROUND: According to reports, the efficiency of in vitro fertilization and intra cytoplasmic sperm injection protocols is decreased in patients positive for various autoantibodies, as opposed to autoantibody negative patients. However, there are contradictory data indicating no autoantibody effect on the outcome of infertility treatment using assisted reproductive technology. AIM: The aim of this study was to evaluate the embryological outcome and clinical efficiency of infertility treatment in in vitro fertilization and intra cytoplasmic sperm injection protocols in women in the presence of reproductively significant autoantibodies. MATERIALS AND METHODS: This prospective study enrolled 90 infertile patients undergoing assisted reproductive technology treatment. The follicular fluid obtained on the day of oocyte retrieval was evaluated for a wide autoantibody panel using commercial ELISA kits. The main group (n = 52) included women with autoantibody levels determined in the follicular fluid of more than three standard deviations from the mean values determined among all patients. The comparison group consisted of 38 women with autoantibody levels of less than three standard deviations from all subjects. The intergroup comparative analysis included clinical and anamnestic data, hormonal parameters, ovarian reserve, embryological data, and in vitro fertilization and intra cytoplasmic sperm injection efficiency. RESULTS: Reliably lower ovarian reserve parameters (anti-Mullerian hormone levels 1.9 (1.4; 4.0) vs. 3.3 (2.2; 6.5) ng/ml; p = 0.005; number of antral follicles 8.5 (6.0; 12.0) vs. 11.0 (9.0; 17.0); p = 0.003) have been noted in the main group relatively to the comparison group. The autoantibodies to thyroid peroxidase and cardiolipin content in the follicular fluid has been shown to be negatively associated with the number of two-pronuclear zygotes, the presence of autoantibodies to aromatase correlating negatively with the fertilization rate. Furthermore, the follicular fluid levels of autoantibodies to thyroid peroxidase (105 IU/ml) and cardiolipin (5.1 IU/ml) are reliably associated with a higher frequency of a suboptimal response to previous controlled ovarian stimulation, a lower incidence of high quality embryos on days 3 and 4 of in vitro cultivation, a decreased number of top-quality blastocysts, and the clinical efficiency of in vitro fertilization and intra cytoplasmic sperm injection programs. CONCLUSIONS: The presence of reproductively significant autoantibodies is an independent risk factor for reducing the total efficiency of assisted reproductive technology treatment.
背景:据报道，与自身抗体阴性的患者相比，各种自身抗体阳性的患者体外受精和细胞质内精子注射方案的效率降低。然而，有相互矛盾的数据表明，自身抗体对使用辅助生殖技术治疗不孕症的结果没有影响。目的:本研究的目的是评估体外受精和细胞质内精子注射方案中存在生殖显著自身抗体的女性不孕症治疗的胚胎学结局和临床疗效。材料与方法:本前瞻性研究纳入90例接受辅助生殖技术治疗的不孕症患者。卵母细胞提取当天获得的卵泡液使用商用ELISA试剂盒进行广泛的自身抗体评估。主要组(n = 52)包括卵泡液中自身抗体水平与所有患者的平均值相差超过三个标准差的妇女。对照组由38名自身抗体水平小于3个标准差的女性组成。组间比较分析包括临床和记忆资料、激素参数、卵巢储备、胚胎学资料、体外受精和细胞质内精子注射效率。结果:可靠地降低卵巢储备参数(抗苗勒管激素1.9 (1.4;4.0) vs. 3.3 (2.2;6.5 ng / ml;P = 0.005;卵泡数8.5个(6.0个;12.0) vs. 11.0 (9.0;17.0);P = 0.003)显著高于对照组。卵泡液中甲状腺过氧化物酶自身抗体和心磷脂含量与双原核受精率呈负相关，芳香化酶自身抗体的存在与受精率呈负相关。此外，卵泡液中甲状腺过氧化物酶自身抗体(105 IU/ml)和心磷脂(5.1 IU/ml)水平与先前控制卵巢刺激的次优反应频率较高、体外培养第3天和第4天高质量胚胎的发生率较低、高质量囊胚数量减少以及体外受精和细胞质内精子注射方案的临床效率有关。结论:生殖显著性自身抗体的存在是降低辅助生殖技术治疗总效率的独立危险因素。
{"title":"The influence of reproductively significant autoantibodies determined in the follicular fluid on the quality of the obtained oocytes and embryos, as well as on the implantation rate in assisted reproductive technology cycles","authors":"G. Safarian, L. Dzhemlikhanova, I. Kogan, D. Niauri, O. Bespalova, I. Krikheli, Ksenia V. Ob’edkova, E. Lesik, E. Komarova, A. Gzgzyan","doi":"10.17816/jowd115062","DOIUrl":"https://doi.org/10.17816/jowd115062","url":null,"abstract":"BACKGROUND: According to reports, the efficiency of in vitro fertilization and intra cytoplasmic sperm injection protocols is decreased in patients positive for various autoantibodies, as opposed to autoantibody negative patients. However, there are contradictory data indicating no autoantibody effect on the outcome of infertility treatment using assisted reproductive technology. \u0000AIM: The aim of this study was to evaluate the embryological outcome and clinical efficiency of infertility treatment in in vitro fertilization and intra cytoplasmic sperm injection protocols in women in the presence of reproductively significant autoantibodies. \u0000MATERIALS AND METHODS: This prospective study enrolled 90 infertile patients undergoing assisted reproductive technology treatment. The follicular fluid obtained on the day of oocyte retrieval was evaluated for a wide autoantibody panel using commercial ELISA kits. The main group (n = 52) included women with autoantibody levels determined in the follicular fluid of more than three standard deviations from the mean values determined among all patients. The comparison group consisted of 38 women with autoantibody levels of less than three standard deviations from all subjects. The intergroup comparative analysis included clinical and anamnestic data, hormonal parameters, ovarian reserve, embryological data, and in vitro fertilization and intra cytoplasmic sperm injection efficiency. \u0000RESULTS: Reliably lower ovarian reserve parameters (anti-Mullerian hormone levels 1.9 (1.4; 4.0) vs. 3.3 (2.2; 6.5) ng/ml; p = 0.005; number of antral follicles 8.5 (6.0; 12.0) vs. 11.0 (9.0; 17.0); p = 0.003) have been noted in the main group relatively to the comparison group. The autoantibodies to thyroid peroxidase and cardiolipin content in the follicular fluid has been shown to be negatively associated with the number of two-pronuclear zygotes, the presence of autoantibodies to aromatase correlating negatively with the fertilization rate. Furthermore, the follicular fluid levels of autoantibodies to thyroid peroxidase (105 IU/ml) and cardiolipin (5.1 IU/ml) are reliably associated with a higher frequency of a suboptimal response to previous controlled ovarian stimulation, a lower incidence of high quality embryos on days 3 and 4 of in vitro cultivation, a decreased number of top-quality blastocysts, and the clinical efficiency of in vitro fertilization and intra cytoplasmic sperm injection programs. \u0000CONCLUSIONS: The presence of reproductively significant autoantibodies is an independent risk factor for reducing the total efficiency of assisted reproductive technology treatment.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73213913","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}
Chronic kidney disease represents a heterogeneous group of diseases characterized by changes in the kidneys structure and functions. It significantly increases the risks of adverse maternal and perinatal outcomes. These risks increase with worsening renal dysfunction corresponding to an increase in the degree of proteinuria and arterial hypertension. Anatomical and physiological changes in the kidneys during pregnancy are characterized by dilatation of the pelvicalyceal system, a decrease in systemic and renal vascular resistance, and an increase in the glomerular filtration rate. These clinically significant changes can complicate the diagnosis of the renal dysfunction, as well as its progression. Pregnancy can affect the kidney as it can manifest as declining kidney function, especially in the context of concomitant arterial hypertension and proteinuria, while chronic kidney disease, regardless of the stage, contributes to a higher risk of adverse pregnancy outcomes including preeclampsia, premature birth and fetal growth restriction. Optimization strategies of pregnancy outcomes include strict control of blood pressure, treatment of hypertension and proteinuria, and prevention of preeclampsia. The latter is difficult to diagnose in pregnant women with chronic kidney disease. Serum markers such as soluble fms-like tyrosine kinase 1 and placental growth factor may aid in definitive diagnosis. The choice of delivery mode in women with chronic kidney disease should be based on common obstetric indications. A multidisciplinary team, including an obstetrician-gynecologist, a nephrologist, an anaesthesiologist and a neonatologist, must focus on preconception medical care, antenatal care and treatment of pregnant women with chronic kidney disease for a successful pregnancy outcome.
{"title":"Chronic kidney disease and pregnancy: an interdisciplinary assessment of gestational risks and complications. A literature review","authors":"Olesya A. Grigoryeva, V. Bezhenar","doi":"10.17816/jowd114857","DOIUrl":"https://doi.org/10.17816/jowd114857","url":null,"abstract":"Chronic kidney disease represents a heterogeneous group of diseases characterized by changes in the kidneys structure and functions. It significantly increases the risks of adverse maternal and perinatal outcomes. These risks increase with worsening renal dysfunction corresponding to an increase in the degree of proteinuria and arterial hypertension. Anatomical and physiological changes in the kidneys during pregnancy are characterized by dilatation of the pelvicalyceal system, a decrease in systemic and renal vascular resistance, and an increase in the glomerular filtration rate. These clinically significant changes can complicate the diagnosis of the renal dysfunction, as well as its progression. Pregnancy can affect the kidney as it can manifest as declining kidney function, especially in the context of concomitant arterial hypertension and proteinuria, while chronic kidney disease, regardless of the stage, contributes to a higher risk of adverse pregnancy outcomes including preeclampsia, premature birth and fetal growth restriction. \u0000Optimization strategies of pregnancy outcomes include strict control of blood pressure, treatment of hypertension and proteinuria, and prevention of preeclampsia. The latter is difficult to diagnose in pregnant women with chronic kidney disease. Serum markers such as soluble fms-like tyrosine kinase 1 and placental growth factor may aid in definitive diagnosis. The choice of delivery mode in women with chronic kidney disease should be based on common obstetric indications. A multidisciplinary team, including an obstetrician-gynecologist, a nephrologist, an anaesthesiologist and a neonatologist, must focus on preconception medical care, antenatal care and treatment of pregnant women with chronic kidney disease for a successful pregnancy outcome.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84171256","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. Malysheva, A. K. Beganova, E. Vashukova, M. Shalina, M. Yarmolinskaya, A. Glotov
BACKGROUND: Adenomyosis is a common gynecological disease with unknown pathogenesis. The HOXA10, HOXA11 and WNT4 genes may play an important role in the pathogenesis of adenomyosis both at the stage of embryonic development and in the postnatal period. The study of their expression in the endometrium of patients with adenomyosis can expand the understanding of the pathogenesis of this disease. AIM: The aim of this work was to study the peculiarity of the WNT4, HOXA10 and HOXA11 gene expression in the eutopic endometrium of patients with isolated adenomyosis. MATERIALS AND METHODS: The study included 38 women: the main group involved patients with isolated adenomyosis established by ultrasound / magnetic resonance imaging (n = 20) and the control group consisted of healthy patients (n = 18). Endometrial sampling was obtained during surgery or by aspiration biopsy at 512 day of the menstrual cycle (proliferative phase) or 2024 day of the menstrual cycle (secretory phase). The expression of the WNT4, HOXA10 and HOXA11 genes in endometrial samples was assessed by a real-time reverse transcription polymerase chain reaction. RESULTS: In the proliferative phase endometrial samples of patients with adenomyosis, a significant increase in the WNT4 (of almost two times), HOXA10 and HOXA11 (of one and a half to two times) gene expression levels was shown compared to the control group. In 88% of patients with adenomyosis, there is a significant increase (up to the level of fourth quartile) in the expression of at least one of these genes, such changes being not typical for the endometrium of women in the control group. In the secretory phase endometrial samples, the expression of the studied genes did not differ from the level characteristic of the corresponding groups in the proliferative phase of the cycle. CONCLUSIONS: The aberrant expression of the WNT4, HOXA10 and HOXA11 genes in the endometrium of patients with adenomyosis indicates a significant role of these genes in the development of the disease and infertility associated with adenomyosis.
{"title":"The role of WNT and HOXA signaling cascades in the pathogenesis of adenomyosis","authors":"O. Malysheva, A. K. Beganova, E. Vashukova, M. Shalina, M. Yarmolinskaya, A. Glotov","doi":"10.17816/jowd121803","DOIUrl":"https://doi.org/10.17816/jowd121803","url":null,"abstract":"BACKGROUND: Adenomyosis is a common gynecological disease with unknown pathogenesis. The HOXA10, HOXA11 and WNT4 genes may play an important role in the pathogenesis of adenomyosis both at the stage of embryonic development and in the postnatal period. The study of their expression in the endometrium of patients with adenomyosis can expand the understanding of the pathogenesis of this disease. \u0000AIM: The aim of this work was to study the peculiarity of the WNT4, HOXA10 and HOXA11 gene expression in the eutopic endometrium of patients with isolated adenomyosis. \u0000MATERIALS AND METHODS: The study included 38 women: the main group involved patients with isolated adenomyosis established by ultrasound / magnetic resonance imaging (n = 20) and the control group consisted of healthy patients (n = 18). Endometrial sampling was obtained during surgery or by aspiration biopsy at 512 day of the menstrual cycle (proliferative phase) or 2024 day of the menstrual cycle (secretory phase). The expression of the WNT4, HOXA10 and HOXA11 genes in endometrial samples was assessed by a real-time reverse transcription polymerase chain reaction. \u0000RESULTS: In the proliferative phase endometrial samples of patients with adenomyosis, a significant increase in the WNT4 (of almost two times), HOXA10 and HOXA11 (of one and a half to two times) gene expression levels was shown compared to the control group. In 88% of patients with adenomyosis, there is a significant increase (up to the level of fourth quartile) in the expression of at least one of these genes, such changes being not typical for the endometrium of women in the control group. In the secretory phase endometrial samples, the expression of the studied genes did not differ from the level characteristic of the corresponding groups in the proliferative phase of the cycle. \u0000CONCLUSIONS: The aberrant expression of the WNT4, HOXA10 and HOXA11 genes in the endometrium of patients with adenomyosis indicates a significant role of these genes in the development of the disease and infertility associated with adenomyosis.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78589385","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}
Olga V. Pachuliia, V.V. Khalenko, Margarita O. Shengeliia, O. Bespalova
The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, and repair to the original state, which is a dense long tubular structure. In this review, the problem of impaired cervical remodeling is discussed in both preterm birth and delayed transformation, which leads to the unpreparedness of the cervix for childbirth and prolongation of pregnancy. Histological, immunological and structural dynamic changes in the cervix begin long before delivery and are noted as early as the first trimester of gestation. There are a few ways to assess the maturity of the cervix. In the second and third trimester, in order to predict preterm birth, these are ultrasound cervicometry and a cervical phosphorylated insulin-like growth factor binding protein-1 test. At full term, in order to determine its readiness for delivery, this is a palpation assessment. Inadequate assessment of the cervical characteristics is one of the factors of untimely prevention of preterm birth, and at full term leads to inappropriate choice of method of preparation for labor. It is necessary to develop new approaches to the comprehensive assessment of the cervix, using existing methods, and to discover new ways to assess its maturity. In this review, the problem of cervical maturation diagnosis is considered based on literature data from such databases as PubMed, ResearchGate, and Google Scholar, as well as from electronic resources of the M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes data on molecular, biochemical and histophysiological processes occurring during cervical maturation at all stages of gestation. It is generally accepted that the main role in cervical changes at all stages of gestation is played by: collagen fiber restructuring / desorganization, decreased concentrations of collagen and elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level and tissue hydrophilicity, increased cervical vascularization, as well as changes in glycosaminoglycan and matrix metalloproteinase content. Palpatory technique and ultrasound cervicometry are the most common methods of determining the cervical length, which have insufficient sensitivity, probably because they do not cover all pathogenetic pathways of remodeling and cannot assess all cervical characteristics. Improvement of efficiency is possible through the introduction of combined techniques and the use of promising methods such as elastography, ultrasound diagnosis of the cervix with Doppler assessment of its vessels, determination of a disintegrin and metalloprotease with thrombospondin-like repeats-1 and placental 1-microglobulin in cervical secretion, and relaxin in maternal blood. Understanding the molecular, biochemical and histophysiological processes that occur during cervical remodeling is crucial for predicting preterm birth, diagnosing isthmic-cervical insufficiency, understanding the lack of timely cerv
{"title":"Biomechanisms of cervical remodeling and current approaches to maturity assessment","authors":"Olga V. Pachuliia, V.V. Khalenko, Margarita O. Shengeliia, O. Bespalova","doi":"10.17816/jowd114934","DOIUrl":"https://doi.org/10.17816/jowd114934","url":null,"abstract":"The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, and repair to the original state, which is a dense long tubular structure. In this review, the problem of impaired cervical remodeling is discussed in both preterm birth and delayed transformation, which leads to the unpreparedness of the cervix for childbirth and prolongation of pregnancy. Histological, immunological and structural dynamic changes in the cervix begin long before delivery and are noted as early as the first trimester of gestation. There are a few ways to assess the maturity of the cervix. In the second and third trimester, in order to predict preterm birth, these are ultrasound cervicometry and a cervical phosphorylated insulin-like growth factor binding protein-1 test. At full term, in order to determine its readiness for delivery, this is a palpation assessment. Inadequate assessment of the cervical characteristics is one of the factors of untimely prevention of preterm birth, and at full term leads to inappropriate choice of method of preparation for labor. It is necessary to develop new approaches to the comprehensive assessment of the cervix, using existing methods, and to discover new ways to assess its maturity. \u0000In this review, the problem of cervical maturation diagnosis is considered based on literature data from such databases as PubMed, ResearchGate, and Google Scholar, as well as from electronic resources of the M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes data on molecular, biochemical and histophysiological processes occurring during cervical maturation at all stages of gestation. \u0000It is generally accepted that the main role in cervical changes at all stages of gestation is played by: collagen fiber restructuring / desorganization, decreased concentrations of collagen and elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level and tissue hydrophilicity, increased cervical vascularization, as well as changes in glycosaminoglycan and matrix metalloproteinase content. Palpatory technique and ultrasound cervicometry are the most common methods of determining the cervical length, which have insufficient sensitivity, probably because they do not cover all pathogenetic pathways of remodeling and cannot assess all cervical characteristics. Improvement of efficiency is possible through the introduction of combined techniques and the use of promising methods such as elastography, ultrasound diagnosis of the cervix with Doppler assessment of its vessels, determination of a disintegrin and metalloprotease with thrombospondin-like repeats-1 and placental 1-microglobulin in cervical secretion, and relaxin in maternal blood. \u0000Understanding the molecular, biochemical and histophysiological processes that occur during cervical remodeling is crucial for predicting preterm birth, diagnosing isthmic-cervical insufficiency, understanding the lack of timely cerv","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80664198","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}
N. Tatarova, Nikolay V. Darmogray, Tatyana Dudnichenko
The article presents the life path of Doctor of Medical Sciences, Professor Susloparov Leonid Andreyevich, his scientific achievements, pedagogical and clinical work.
本文介绍了苏斯洛帕罗夫·列昂尼德·安德烈耶维奇教授的人生轨迹、他的科学成就、教学和临床工作。
{"title":"To the 90th anniversary of Professor Leonid Andreyevich Susloparov","authors":"N. Tatarova, Nikolay V. Darmogray, Tatyana Dudnichenko","doi":"10.17816/jowd127989","DOIUrl":"https://doi.org/10.17816/jowd127989","url":null,"abstract":"The article presents the life path of Doctor of Medical Sciences, Professor Susloparov Leonid Andreyevich, his scientific achievements, pedagogical and clinical work.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"50 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72482539","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. Bettikher, O. Belyaeva, Albina I. Dukovich, O. Vorobeva, T. Tral, G. Tolibova, V. A. Bart, I. Kogan, I. Zazerskaya
BACKGROUND: The serotonergic system plays an important role in the formation and development of the feto-placental complex. The study of the expression of the serotonin system components, including placental 5-HT2A (serotonin receptor) and SERT (serotonin transporter), in preeclampsia will create prerequisites for discovering new ways to correct hypertensive pregnancy complications and methods of influencing pregnancy outcomes. AIM: The aim of this study was to compare the expressions of 5-HT2A and SERT in placental tissue in pure preeclampsia and its combinations with other complications of pregnancy. MATERIALS AND METHODS: A comparative cohort study was conducted among patients with different preeclampsia phenotypes: preeclampsia (n = 6), preeclampsia and gestational diabetes mellitus (n = 6), gestational diabetes mellitus and superimposed preeclampsia (preeclampsia + chronic arterial hypertension) (n = 6), and normal pregnancy without pregnancy complications (n = 6). The expression of 5-HT2A (Abcam, USA) and SERT (BiossAntibodies, USA) was studied in placenta samples from all study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia). The database was constructed and statistical processing was performed using Microsoft Excel 2007 (Microsoft Corporation, USA) and the StatTech program v. 2.6.4 (Stattech Ltd., Russia). RESULTS: The expression of SERT and 5-HT2A is higher in the studied pregnancy complications when compared to the normal one. The relative 5-HT2A expression area in the placenta among the studied nosologies is higher in preeclampsia without gestational diabetes mellitus or in superimposed preeclampsia in combination with chronic arterial hypertension compared to expression in placentas in preeclampsia in combination with gestational diabetes mellitus or in preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.02 and p = 0.017, respectively). The relative area of SERT expression is higher in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension and in preeclampsia in combination with gestational diabetes mellitus compared to preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.002 and p = 0.012, respectively). CONCLUSIONS: The highest expressions of 5-HT2A and SERT among the studied preeclampsia phenotypes were found in placentas in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension.
{"title":"Expression of the serotonergic system components in the placenta in various types of preeclampsia","authors":"O. Bettikher, O. Belyaeva, Albina I. Dukovich, O. Vorobeva, T. Tral, G. Tolibova, V. A. Bart, I. Kogan, I. Zazerskaya","doi":"10.17816/jowd110890","DOIUrl":"https://doi.org/10.17816/jowd110890","url":null,"abstract":"BACKGROUND: The serotonergic system plays an important role in the formation and development of the feto-placental complex. The study of the expression of the serotonin system components, including placental 5-HT2A (serotonin receptor) and SERT (serotonin transporter), in preeclampsia will create prerequisites for discovering new ways to correct hypertensive pregnancy complications and methods of influencing pregnancy outcomes. \u0000AIM: The aim of this study was to compare the expressions of 5-HT2A and SERT in placental tissue in pure preeclampsia and its combinations with other complications of pregnancy. \u0000MATERIALS AND METHODS: A comparative cohort study was conducted among patients with different preeclampsia phenotypes: preeclampsia (n = 6), preeclampsia and gestational diabetes mellitus (n = 6), gestational diabetes mellitus and superimposed preeclampsia (preeclampsia + chronic arterial hypertension) (n = 6), and normal pregnancy without pregnancy complications (n = 6). The expression of 5-HT2A (Abcam, USA) and SERT (BiossAntibodies, USA) was studied in placenta samples from all study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia). The database was constructed and statistical processing was performed using Microsoft Excel 2007 (Microsoft Corporation, USA) and the StatTech program v. 2.6.4 (Stattech Ltd., Russia). \u0000RESULTS: The expression of SERT and 5-HT2A is higher in the studied pregnancy complications when compared to the normal one. The relative 5-HT2A expression area in the placenta among the studied nosologies is higher in preeclampsia without gestational diabetes mellitus or in superimposed preeclampsia in combination with chronic arterial hypertension compared to expression in placentas in preeclampsia in combination with gestational diabetes mellitus or in preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.02 and p = 0.017, respectively). The relative area of SERT expression is higher in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension and in preeclampsia in combination with gestational diabetes mellitus compared to preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.002 and p = 0.012, respectively). \u0000CONCLUSIONS: The highest expressions of 5-HT2A and SERT among the studied preeclampsia phenotypes were found in placentas in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78026041","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}
A. M. Ziganshin, I. G. Mukhametdinova, Victoria F. Allayarova, Elina A. Shayhieva
The relevance of surgical treatment of pelvic organ prolapse is beyond doubt, due to the high prevalence and risk of surgical intervention during life. Surgical treatment of prolapse today remains the only effective method, however, despite more than 400 methods of surgical correction, the number of complications and relapses does not tend to decrease. This article presents a clinical case of ineffective choice of surgical treatment of genital prolapse with own tissues and vaginal hysterectomy, which subsequently led to the development of enterocele. In the future, the lack of postoperative follow-up and the preservation of a lifestyle that included the performance of hard physical labor led to a rupture of the dome of the vagina and prolapse of the loops of the small intestine. Today, for the prevention of complications and recurrence of genital prolapse, it is mandatory for patients to go through a careful selection for surgical treatment, which should include a clinical study and study of risk factors. When choosing an operative approach, complex treatment is necessary, including the use of the patients own tissues and modern materials that allow creating a reliable physiological framework to strengthen the pelvic organs. When performing this surgery, it is necessary not only to replace the damaged defective pelvic fascia with a new one, but also to create a neofascia that ensures the preservation of the normal function of the pelvic organs.
{"title":"Small intestine prolapse after vaginal hysterectomy with vaginal dome rupture. A clinical case","authors":"A. M. Ziganshin, I. G. Mukhametdinova, Victoria F. Allayarova, Elina A. Shayhieva","doi":"10.17816/jowd112118","DOIUrl":"https://doi.org/10.17816/jowd112118","url":null,"abstract":"The relevance of surgical treatment of pelvic organ prolapse is beyond doubt, due to the high prevalence and risk of surgical intervention during life. Surgical treatment of prolapse today remains the only effective method, however, despite more than 400 methods of surgical correction, the number of complications and relapses does not tend to decrease. \u0000This article presents a clinical case of ineffective choice of surgical treatment of genital prolapse with own tissues and vaginal hysterectomy, which subsequently led to the development of enterocele. In the future, the lack of postoperative follow-up and the preservation of a lifestyle that included the performance of hard physical labor led to a rupture of the dome of the vagina and prolapse of the loops of the small intestine. \u0000Today, for the prevention of complications and recurrence of genital prolapse, it is mandatory for patients to go through a careful selection for surgical treatment, which should include a clinical study and study of risk factors. When choosing an operative approach, complex treatment is necessary, including the use of the patients own tissues and modern materials that allow creating a reliable physiological framework to strengthen the pelvic organs. When performing this surgery, it is necessary not only to replace the damaged defective pelvic fascia with a new one, but also to create a neofascia that ensures the preservation of the normal function of the pelvic organs.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84662262","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}
This article traces the historical path of operative obstetrics up to the present time. The issues of the high frequency of cesarean section, its impact on perinatal mortality, reproductive health of the female population, mental health of the future generation (children by operation), and qualification of obstetricians and gynecologists are raised. The authors point out that there is no direct correlation between the frequency of cesarean section and perinatal mortality rates, since antenatal fetal death dominates its structure, which does not depend on the method of delivery.
{"title":"Evolution of views on operative delivery","authors":"E. K. Ailamazyan, Tatyana U. Kuzminykh","doi":"10.17816/jowd119829","DOIUrl":"https://doi.org/10.17816/jowd119829","url":null,"abstract":"This article traces the historical path of operative obstetrics up to the present time. The issues of the high frequency of cesarean section, its impact on perinatal mortality, reproductive health of the female population, mental health of the future generation (children by operation), and qualification of obstetricians and gynecologists are raised. The authors point out that there is no direct correlation between the frequency of cesarean section and perinatal mortality rates, since antenatal fetal death dominates its structure, which does not depend on the method of delivery.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"277 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80068683","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}
Ekaterina V. Kopteyeva, Elizaveta V. Shelayeva, E. Alekseenkova, S. V. Nagorneva, R. Kapustin, I. Kogan
BACKGROUND: The high risk of adverse maternal and perinatal complications in patients with fetal growth restriction and diabetes mellitus requires a detailed assessment of the major risk factors and outcomes. AIM: The aim of this study was to determine the main risk factors for fetal growth retardation in pregnant women with pregestational and gestational diabetes mellitus, and to assess obstetric and perinatal outcomes in these patients. MATERIALS AND METHODS: We conducted a retrospective single-center cohort study at the premises of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The study included 103 patients with type 1 diabetes mellitus, type 2 diabetes mellitus, or gestational diabetes mellitus with fetal growth retardation who delivered a singleton neonate from January 2017 to December 2021. Based on the antenatal diagnosis, the patients were divided into the following comparison groups: group I early fetal growth retardation (n = 29), group II late fetal growth retardation (n = 27), group III small for gestational age (n = 47). Relative risk calculations were used to assess the contribution of risk factors and the risk of developing secondary outcomes. RESULTS: Pregestational diabetes mellitus was the major risk factor for early fetal growth retardation development (relative risk 1.91; 95% confidence interval 1.043.50); especially type 1 diabetes mellitus (relative risk 1.64; 95% confidence interval 1.022.74) and more than 10 years of pregestational diabetes mellitus duration (relative risk 2.62; 95% confidence interval 1.126.17). Chronic hypertension increases the risk of early fetal growth retardation (relative risk 2.11; 95% confidence interval 2.213.68), while gestational hypertension was a significant risk factor for late fetal growth retardation development (relative risk 1.81; 95% confidence interval 1.013.70). Preeclampsia is associated with both early and late forms of fetal growth retardation. Maternal characteristics, such as age over 35 years, obesity, and in vitro fertilization pregnancy, increased the risk of early fetal growth retardation development. In turn, the presence of fetal growth retardation in patients with diabetes mellitus is associated with increased risk of cesarean section, prolonged stay of the newborn in the neonatal intensive care unit (5 days), low Apgar scores (7 at the 5th minute), and neonatal hypoglycemia. Early fetal growth retardation is a significant risk factor for preterm birth (relative risk 6.23; 95% confidence interval 2.8713.42) and fetal distress (relative risk 5.51; 95% confidence interval 2.2813.33). CONCLUSIONS: Being associated with a highly increased risk of adverse obstetric and perinatal outcomes, early fetal growth retardation in diabetic pregnancy is related to pregestational diabetes mellitus, especially type 1 diabetes mellitus, with a long history, as well as with hypertension in pregnancy.
{"title":"Fetal growth restriction in diabetic pregnancy: a retrospective single-center study","authors":"Ekaterina V. Kopteyeva, Elizaveta V. Shelayeva, E. Alekseenkova, S. V. Nagorneva, R. Kapustin, I. Kogan","doi":"10.17816/jowd115018","DOIUrl":"https://doi.org/10.17816/jowd115018","url":null,"abstract":"BACKGROUND: The high risk of adverse maternal and perinatal complications in patients with fetal growth restriction and diabetes mellitus requires a detailed assessment of the major risk factors and outcomes. \u0000AIM: The aim of this study was to determine the main risk factors for fetal growth retardation in pregnant women with pregestational and gestational diabetes mellitus, and to assess obstetric and perinatal outcomes in these patients. \u0000MATERIALS AND METHODS: We conducted a retrospective single-center cohort study at the premises of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The study included 103 patients with type 1 diabetes mellitus, type 2 diabetes mellitus, or gestational diabetes mellitus with fetal growth retardation who delivered a singleton neonate from January 2017 to December 2021. Based on the antenatal diagnosis, the patients were divided into the following comparison groups: group I early fetal growth retardation (n = 29), group II late fetal growth retardation (n = 27), group III small for gestational age (n = 47). Relative risk calculations were used to assess the contribution of risk factors and the risk of developing secondary outcomes. \u0000RESULTS: Pregestational diabetes mellitus was the major risk factor for early fetal growth retardation development (relative risk 1.91; 95% confidence interval 1.043.50); especially type 1 diabetes mellitus (relative risk 1.64; 95% confidence interval 1.022.74) and more than 10 years of pregestational diabetes mellitus duration (relative risk 2.62; 95% confidence interval 1.126.17). Chronic hypertension increases the risk of early fetal growth retardation (relative risk 2.11; 95% confidence interval 2.213.68), while gestational hypertension was a significant risk factor for late fetal growth retardation development (relative risk 1.81; 95% confidence interval 1.013.70). Preeclampsia is associated with both early and late forms of fetal growth retardation. Maternal characteristics, such as age over 35 years, obesity, and in vitro fertilization pregnancy, increased the risk of early fetal growth retardation development. In turn, the presence of fetal growth retardation in patients with diabetes mellitus is associated with increased risk of cesarean section, prolonged stay of the newborn in the neonatal intensive care unit (5 days), low Apgar scores (7 at the 5th minute), and neonatal hypoglycemia. Early fetal growth retardation is a significant risk factor for preterm birth (relative risk 6.23; 95% confidence interval 2.8713.42) and fetal distress (relative risk 5.51; 95% confidence interval 2.2813.33). \u0000CONCLUSIONS: Being associated with a highly increased risk of adverse obstetric and perinatal outcomes, early fetal growth retardation in diabetic pregnancy is related to pregestational diabetes mellitus, especially type 1 diabetes mellitus, with a long history, as well as with hypertension in pregnancy.","PeriodicalId":16623,"journal":{"name":"Journal of obstetrics and women's diseases","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86275553","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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