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Obstetrics, Gynecology and Reproduction

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EDITORIAL 

127
Abstract

As shown by numerous studies conducted during the pandemic, the severe course of COVID-19 is accompanied by multiple organ failure. Cytokine storm, hypercoagulation, complement hyperactivation and other arms comprise the overall picture of the pathogenesis of the severe disease course. The frequent diagnosis of multiple microvascular thrombosis in lung, heart, and kidneys, as well as the presence of platelet-fibrin thrombi there and signs of terminal organ damage, suggest a possible involvement of thrombotic microangiopathy (TMA) in the development of multiple organ failure. In this regard, it is especially important to timely diagnose TMA and start pathogenetic therapy. These measures can significantly reduce mortality due to the novel disease. Heparins and direct oral anticoagulants are the mainstay for prevention and treatment of venous thromboembolism in patients with COVID-19, but their effectiveness in the presence of TMA is questionable. It has been proven that anticoagulants use in critically ill patients with COVID-19 for prevention of large vessel thrombosis is effective, but their role in the prevention of microthrombosis is not clear. Here we review the currently available information on thrombotic microangiopathy, as well as a review of literature data describing TMA-like conditions in COVID19, discuss potential pathophysiology of the condition development and proposed therapeutic approaches.

ОRIGINAL ARTICLES 

77
Abstract

Introduction. There are few epidemiological data on violations of purine and carbohydrate metabolism in association with testosterone deficiency in men with overweight due to adipose tissue and metabolic syndrome (MS).

Aim: to study the relationships between disturbances in carbohydrate and purine metabolism and testosterone level in men with excess adipose tissue and MS.

Materials and Мethods. There were enrolled 64 overweight men to the study. The patients were divided into 3 groups based on the body mass index (BMI): group 1 – with overweight (n = 24), group 2 – with the first degree of obesity (n = 21), group 3 – with the second and third degree of obesity (n = 19). A correlation analysis was carried out between the data of carbohydrate and purine metabolism in relation to testosterone level and body composition, as well as additionally assessing the level of inter-group difference.

Results. The relationship between the parameters of carbohydrate and purine metabolism and the level of total testosterone has been identified, and it's formed against the background of overdeveloped adipose tissue. A weak negative correlation was found across the sample between testosterone and glucose, insulin, and the НОМА-IR (Homeostasis Model Assessment of Insulin Resistance) index. That is, the higher the level of glucose, the НОМА-IR index, the lower the testosterone level. In addition, it was noted that an increase in BMI caused higher insulin levels. The number of patients with fasting blood glucose levels above 5.6 mmol/L and insulin resistance also increased. In the group with I degree of obesity, a negative correlation was found between the levels of total testosterone and uric acid.

Conclusion. Thus, the thesis is confirmed that the more significant the violation of carbohydrate and purine metabolism, the more significant androgenic deficiency. It is obvious that the most effective solution in choosing a strategy for treating androgen deficiency and disorders of carbohydrate and purine metabolism in overweight men is to normalize body composition and get rid of excess adipose tissue.

74
Abstract

Aim: to study the reproductive function of patients who underwent organ-preserving delivery using a modified method of suturing the uterine cavity with ingrowth of the placenta.

Materials and methods. The studied groups were comparable. The ultrasound assessment of the size of the uterus when comparing subgroups A and B, showed a significantly less severity of postoperative changes in the uterine cavity and the shape of the uterus. Retrospectively analyzed 77 cases of planned delivery of patients in 2018–2020. Group 1 (control) – 32 patients with a scar on the uterus after a previous cesarean section and group 2 (main) – 45 patients with a diagnosis of placental ingrowth which was divided into 2 subgroups – 2A (n = 23) where a modified method of suturing the uterine cavity was used, and subgroup 2B (n = 22) where a linear method was used.

Results. The studied groups were comparable. After 6 months, we check the changes in the size of the uterus was revealed in comparison with the control group, statistical differences were observed in the 2A subgroup compared to the control (p < 0,05 in width and length of the uterus) and in subgroup 2B (also p < 0.05 for all indicators). The study of intrauterine blood flow did not reveal significant differences between the compared groups (p > 0.1), and ultrasound assessment of the size of the uterus when comparing subgroups A and B, showed a significantly less severity of postoperative changes in the uterine cavity and the shape of the uterus.

Conclusion. Evaluation of a new method of suturing the uterine cavity in patients with placental ingrowth has shown significant efficiency in maintaining the anatomically most natural shape of the uterus and uterine cavity. Despite the results obtained, the problem of restoring the reproductive function of women who underwent organ-preserving delivery remains relevant and requires further study.

REVIEW ARTICLE 

78
Abstract

Aim: to analyze and summarize the available data of studies aimed at deepening knowledge in the field of the influence of alcohol on the course of pregnancy, possible consequences; to study the prevalence of alcohol consumption by Russian women, as well as possible preventive measures.

Materials and Methods. The results of Russian and foreign studies on the effect of alcohol on the fetus and pregnancy outcome, published in the international databases Scopus, Web of Science, PubMed/MEDLINE, Cochrane Library, have been analyzed. The search for scientific publications was limited to the period from 2012 to 2021. We used search queries in Russian ("alcohol", "pregnancy", "prevention", "fetus", "fetal alcohol syndrome") and English ("alcohol", "pregnancy", "prophylaxis", "fetus", "fetal alcohol syndrome").

Results. The presented data analysis indicates an extremely negative effect of alcohol on the body of pregnant women, as well as on the health of our future generation. This article proves the importance of the problem, the need for further research on the mechanisms of fetal alcohol syndrome (FAS) and the development of effective prevention measures, possible methods of treatment, and assistance for alcoholic fetal syndrome. Today in Russia there is an acute lack of information on the real extent of the problem with maternal alcohol consumption during pregnancy. There is still no exact data on the prevalence of FAS in Russia.

Conclusion. From the analysis of domestic and foreign literature, it can be concluded that the problem of preventing fetal alcohol syndrome is an urgent and unexplored problem in Russia. There is a need for doctors to conduct pregravid preparation of a married couple when they plan to conceive a healthy child. It is necessary to raise awareness and improve the quality of training for obstetricians and gynecologists in order to identify women with high risk factors for alcohol abuse and childbirth with FAS in the early stages of pregnancy management. It is also necessary to identify new or use already known biomarkers of maternal blood to verify excessive alcohol consumption during pregnancy.

CLINICAL CASE 

38
Abstract

Thrombosis of the umbilical cord vessels is a rare complication of pregnancy, combined with a high level of perinatal morbidity and mortality. Among the risk factors for the development of thrombosis of the vessels of the umbilical cord are anomalies of vascular attachment (meningeal attachment), pathology of the umbilical cord (hyperspiralization, short or long umbilical cord), intrauterine infections, diabetes mellitus and preeclampsia in the mother, as well as the presence of meconium in the amniotic fluid. The article presents two clinical observations of umbilical vein thrombosis at full-term pregnancy. In both cases, during pregnancy and childbirth, there were no signs of umbilical cord pathology according to cardiotocography and Doppler, despite this, the birth of children in a state of hypoxia. Both newborns were transferred to the second stage of treatment due to suspected intrauterine pneumonia. Of the risk factors for thrombosis of the umbilical cord vessels in the above examples, it is possible to distinguish the sheathing of the umbilical cord vessels, intrauterine infections, in the second case, the presence of meconium in the amniotic fluid. During pregnancy, both patients underwent a clinically confirmed novel coronavirus infection (COVID-19) in the second trimester of gestation, and were also in contact with patients with COVID-19 in the third trimester of gestation. It is likely that endothelial damage caused by the new coronavirus SARS-CoV-2 was one of the risk factors for the development of umbilical vein thrombosis, but this issue requires further research.



ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)