Obstetrics, Gynecology and Reproduction

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Vol 14, No 2 (2020)


123-131 7848

COVID-19 is an infectious disease caused by the beta-coronavirus SARS-CoV-2 that in 2020 has spread worldwide. In most severe patients, the clinical picture begins with respiratory failure further deteriorating up to multiple organ failure. Development of coagulopathy is the most adverse prognostic. Analyzing currently available clinical data revealed that 71.4 % and 0.6 % of survivors and fatal cases, respectively, demonstrated signs of overt disseminated intravascular coagulation (DIC). Monitoring D-dimer level, prothrombin time, platelet count and fibrinogen content is important for determining indications for treatment and hospitalization in COVID-19 patients. In case such parameters deteriorate, a more pro-active “aggressive” intensive care should be applied. Low molecular weight heparin (LMWH) should be administered to all patients with diagnosed COVID-19 infection (including non-critical patients) requiring hospitalization, but having no contraindications to LMWH.

132-147 3002

The pandemic of a novel coronavirus infection COVID-19 has become a real challenge to the mankind and medical community and has raised a number of medical and social issues. Based on the currently available information on COVID-19 clinical cases, it follows that COVID-19 patients in critical condition exhibit a clinical picture of disseminated intravascular coagulation (DIC), septic shock with developing multiple organ failure, which justifies use of anticoagulant therapy in COVID-19 patients. In addition to isolating virus RNA from biological material and polymerase chain reaction diagnostics, use of simple and easily accessible laboratory blood markers is necessary for management of COVID-19 patients. If the activation of coagulation processes is sufficient enough, consumption of platelets and blood clotting factors can be diagnosed by laboratory methods as prolongation of routine blood clotting tests and increasing thrombocytopenia. Hyperfibrinogenemia, increased D-dimer level, prolonged prothrombin time, thrombocytopenia, lymphopenia, leukocytopenia, increased concentration of interleukin-6 and ferritin are observed in most COVID19 patients. The degree of increase in these changes correlates with severity of the inflammatory process and serves as a prognostically unfavorable sign. Here we discuss value of laboratory monitoring playing an essential role in such pathological crisis that contributes to patient screening, diagnosis as well as further monitoring, treatment and rehabilitation.


159-162 1620

Dear editors of Obstetrics, Gynecology and Reproduction Journal! Due to the particular urgency of the problem of managing patients with a new coronavirus infection (COVID-19), we are sending a letter outlining our position on this issue.


163-173 498

Aim: to evaluate the endometrial expression of e-cadherin in relation to the estrogen-progesterone-receptor status of the endometrium.

Materials and methods. In total 137 women were examined including 81 patients with infertility and 40 with a history of early pregnancy loss (main group); for comparison, 16 healthy fertile women (control group) were also examined. Endometrial aspiration biopsy was performed on 6–8 days after ovulation; in parallel, a peripheral blood sample was taken to determine the levels of estradiol and progesterone. A histological and immunohistochemical study of the endometrium with determination of estrogen (ER) and progesterone (PR) receptors and e-cadherin expression was carried out.

Results. All fertile women (n = 16) and only 44 % (n = 53) of patients in the main group had the normal pattern of hormonereceptor endometrial interactions, i. e., low expression of ER and PR in the endometrial glands as well as reduced expression of ER and high expression of PR in the endometrial stroma. The endometrial e-cadherin expression was assessed in the following cohorts: a) women with normal hormone-receptor interactions (16 women in the control group and 53 women in the main group); b) with abnormal variants of hormone-receptor interactions in the endometrium (68 patients in the main group). The frequency of reduced e-cadherin expression was significantly lower in the cohort of women with normal estrogenprogesterone-receptor endometrial status (a) than in the cohort of women with abnormal variants of the endometrial “response” (b): in the luminal epithelium – in 5 % (3 out of 63) (а) vs. 17 % (8 out of 47) (b) (p < 0.05); in the glands – in 13 % (9 out of 69) (a) vs. 37 % (25 out of 68) (b) (p < 0.05).

Conclusion. The estrogen-progesterone-receptor status of the endometrium is significant for the e-cadherin expression in the luminal epithelium and glands of the endometrium.

174-181 676

Aim: to improve efficacy of predicting preterm labor in the first trimester of pregnancy by combining diverse parameters of cervical ultrasound examination.

Materials and methods. A prospective cohort study of 1517 women with uncomplicated pregnancy was performed. Inclusion criteria were: females underwent cervicometry at 11–14 weeks of gestation, singleton pregnancy, revealing no complaints at the onset of examination. All women were subdivided into four groups: Group 1 – 27 pregnant women with shortened cervix (less than 30 mm); Group 2 – 24 pregnant women without cervical gland area (СGA); Group 3 – 30 pregnant women with two risk factors (shortened cervix less than 30 mm and lacked СGA); Group 4 (control) consisted of 1436 pregnant women with cervix length exceeding 30 mm and presence of СGA.

Results. Average delivery term in Group 1 was 35.7 weeks (95 % CI = 34.7–36.8), in Group 2 – 34.7 weeks (95 % CI = 33.59–35.0), in Group 3 – 33.23 weeks (95 % CI = 31.6–34.8), in Group 4 (control) – 38.11 weeks (95 % CI = 38.06–38.17). A significant moderate correlation (Rxy = 0.534) between shortened cervix, absence of СGA and delivery term was found (p < 0.001). A regression model consisting of cervical length and presence of СGA was simulated based upon 50.8 % factors underlying probability of preterm birth, revealing 42.6 % sensitivity, 99.1 % specificity, and 96.6 % overall diagnostic value. The area under the ROC curve was 0.902 ± 0.022 (95 % CI = 0.860–0.945). The data obtained reflect diverse biochemical changes such as collagen decomposition, altered glucosamine level and fluid amount within cervical tissues. Such processes result in shortened, softened and expanded (matured) cervix. Uncovering markers for preterm cervical maturation underlies a logical strategy to predict miscarriage.

Conclusion. Untrasound cervical measurement in the first trimester of pregnancy allows for revealing valuable miscarriage predictors (shortened cervix and absence of GI). Risk assessment by combining diverse ultrasound cervix parameters would allow to improve overall predictive efficacy.

182-191 877

Aim: to assess the effectiveness of using dienogest in combination with postoperative interventions in patients with endometriosis.

Materials and methods. There were enrolled 102 patients with signs of external endometriosis underwent examination and surgical treatment, subdivided into 2 groups: 67 – main group (after surgical treatment, received dienogest 2 mg/day for 6 months), 35 – comparison group received no hormone therapy in the postoperative period. Surgical treatment included removal of endometrioid ovarian cysts, endometriosis foci on the pelvic peritoneum and sacral uterine ligaments. Course of the early postoperative period (up to 1 month after the intervention) as well as the long-term dynamics of the disease manifestations (3, 6, 12 and 15 months later) were assessed.

Results. Dienogest was administered after surgical treatment due to endometriosis that reduced the severity of dyspareunia and intensity of chronic pelvic pain by 3.5- and 2-fold, respectively. The probability of achieving control over uterine bleeding 6 month after the onset of treatment due to endometriosis manifested with metrorrhagia showed that combination treatment (consisting of dienogest) was 3.19-fold higher compared to surgical treatment alone (OR = 3.19; 95 % CI = 1.70–11,0; p < 0,05). Recovery of normal menstrual cycle in 63 (94.0%) women of the main group was established 1.5–2 months after completing of hormonal treatment, while in the comparison group pain and dysmenorrhea relapsed in some patients at the 6-month follow-up. Decreased libido as a side effect in patients who treated with dienogest was observed in 2 (3.0 %) women.

Conclusion. Dienogest was highly effective in the combination treatment of patients with verified endometriosis that resulted in reduced severity of pain and metrorrhagia. The drug was featured by low level of side effects. Thus, a combination treatment of endometriosis containing dienogest at a dose of 2 mg/day applied during postoperative period allows to reduce the severity of the disease clinical manifestations and improve treatment outcome.

192-202 536

Aim: to study the association between prothrombin activity in the blood plasma and gestational complications in women with the prothrombin G20210A mutation.

Materials and methods. A prospective clinical cohort study including 290 pregnant women aged 18 to 45 years was conducted from 2012 to 2018. Two cohorts were formed: a study group of 140 patients with the GA genotype and a control group of 150 women with the GG genotype. In the groups, the activity of prothrombin (Factor II) in the venous blood plasma was evaluated during pregnancy. The stages of cytotrophoblast invasion were taken into account when relating the prothrombin activity to gestational complications.

Results. The median prothrombin activity in the control group ranged from 108 % during the preconception period to 144 % during pregnancy (95 % CI = 130–150). In the study group with the GA genotype, the activity was significantly higher at the same periods: from 149 to 181 % (95 % CI = 142–195; p < 0.0001). With the prothrombin activity from 148.5 to 180.6 %, the pregnancy in the study group progressed normally. Higher levels of prothrombin activity were associated with early and/or severe preeclampsia (PE), and fetal growth retardation (FGR).

Conclusion. The obtained data on prothrombin activity in the blood plasma during pregnancy complications suggest that the manifestation of the GA genotype in the form of early and/or severe PE and FGR is associated with the level of plasma prothrombin activity. The threshold value of Factor II activity was calculated for patients with the G20210A mutation; based on this value it becomes possible to predict PE at the preconception stage (171.0 %; AUC – 0.86; p < 0.0001) and at a gestational age of 7–8 weeks (181.3 %; AUC – 0.84; p < 0.0001).

203-210 1046

Aim: to assess the psycho-emotional profile in patients with vulvar lichen sclerosus.

Materials and methods. We examined 57 patients with a diagnosis of vulvar lichen sclerosus, the average age of 35.0 ± 0.6 (from 18 to 45) years. The control group included 45 healthy women without dystrophic changes in the external genital organs, who applied for a routine examination. The following methods were used to analyze the psycho-emotional profile: WAM questionnaire (well-being, activity, mood), Hospital Anxiety and Depression Scale (HADS), the Dermatology Life Quality Index (DLQI).

Results. In patients with vulvar lichen sclerosus a decrease in indicators “well-being” (24.3 ± 1.7 versus 52.4 ± 5.6 scores) and “mood” (28.7 ± 3.6 versus 58.1 ± 6.1 scores) was revealed; “activity” was changed slightly (41.2 ± 3.2 against 47.4 ± 4.9 scores). Depressive (75.4 % versus 15.6 %) and anxiety (68.4 % versus 20 %) disorders were also more common in this group. Significant deterioration in the quality of life in patients was confirmed by a DIQL (18.79 ± 4.98 scores).

Conclusion. Psycho-emotional profile of patients with vulvar lichen sclerosus is characterized by a change in most of the analyzed parameters. The presence of anxiety-depressive disorders can aggravate both the general somatic state and the course of the underlying disease. So activities aimed at improving the quality of life should be included in the rehabilitation of these patients.

211-217 594

Aim: to study the peculiarities of the formation of secondary sexual characteristics and menstrual function in girls with hyperandrogenism (HA) during puberty.

Materials and methods. We examined 137 adolescent girls with HA aged 12–17 years. All examined girls were divided into 3 groups: 12–13 years (Group I, n = 27); 14–15 years (Group II, n = 63); 16–17 years (Group III, n = 47). The intensity of secondary sexual characteristics was determined by Tanner scale; the severity of hirsutism was assessed by Ferriman–Galway scale. The studied parameters were compared with previously published data from 42 girls without HA symptoms with normal indicators of physical and sexual development that were also divided into 3 age groups: 12–13 years (n = 16), 14–15 years (n = 14), 16–17 years (n = 12).

Results. Girls with HA in puberty, starting from 14–15 years, had marked reduction of mammary glands and enhancement of axillary and suprapubic hair growth. In 32.8 % of girls with HA menstrual function was normal; in 67.1 % menses disorders and menstrual irregularities were observed that manifested by opsomenorrhea (31.5 %), juvenile bleedings (19.6 %), oligomenorrhea (18.5 %), amenorrhea (16.3 %), algodismenorrhea (14.1 %).

Conclusion. HA in puberty, regardless of origin that caused this pathology, is a high risk factor for pathologies of sexual development and the formation of menstrual dysfunction.


148-158 1724

In December 2019, a new type of coronavirus was identified in China, called SARS-CoV-2 (COVID-19) that quickly spread not only within the People’s Republic of China, but also far beyond its borders. On March 11, 2020, the World Health Organization announced that the infection caused by novel coronavirus SARS-CoV-2 became a pandemic. Prior to this, two global epidemics were caused by pathogenic coronaviruses: in 2002 – by SARS-CoV that caused severe acute respiratory syndrome (SARS), and in 2012 – by MERSCoV that resulted in the Middle East respiratory syndrome (MERS). All coronavirus infections in humans are characterized by damage of lower respiratory tract with development of severe pneumonia and respiratory distress syndrome. According to reports, males become sick more often than females. It is known that due to developing immunological suppression pregnant women are at higher risk of contracting infectious diseases. However, the clinical course of SARS-CoV-2 infection during pregnancy, its effect on outcome of gestation, and the likelihood of vertical transmission to the fetus still remain unanswered. In this review, we present data on cases of SARS-CoV-2 disease during pregnancy published globally, its effect on outcome of gestation, as well as data on potential routes of infection for fetus and neonates. In addition, we also provide currently available clinical recommendations released by the Royal Society of Obstetricians and Gynecologists (UK), the American Society of Obstetricians and Gynecologists (USA), and the National Institute for Reproductive Health Research (India) on the management of pregnant patients infected with SARS-CoV-2.

218-228 1211

Aim: to assess a role of genetic factors and human papillomavirus (HPV) in developing cervical neoplasia based on analyzing current publications on virus-induced carcinogenesis.

Materials and methods. A systematic overview on publications dedicated to examining genetic predisposition to developing cervical cancer (CC) available in electronic databases was performed by searching in the International Scientific Databases (ISDB) PubMed/MEDLINE as well as manually by accessing enlisted input documents related to the above noted studies. Full-text publications were solely selected for analysis.

Results. CC is a multifactorial disease implicating host genetic predisposition being caused by persistent high oncogenic risk HPV-infection. Immune system plays a major role in HPV-infection. Altered cell-mediated immune response is responsible for impaired potential to HPV eradication. On the other hand, immune evasion contributes to viral persistence and cancer progression. Oncogenes, cancer suppressor genes (Rb and TP53), cytokine (ILs, IFNG) and chemokine (CXCL) genes, the genes involved in antigen processing, as well as an impact for each gene polymorphism or even haplotypes playing a role in cervical carcinogenesis are mainly involved in CC developing.

Conclusion. The data obtained allowed to demonstrate a role for genetic polymorphisms in the genes encoding cytokines, chemokines, diverse receptors as well as those involved in antigen processing, and cancer suppressor genes in perpetuation of HPV-infection.

229-238 659

Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) in the genus Flavivirus and the Flaviviridae family. In 1947 and 1948 ZIKV was first isolated from a nonhuman primate as well as from mosquitoes in Africa, respectively. For half a century, ZIKV infections in human were sporadic prior to 2015–2016 pandemic spreading. Transmission of ZIKV from mother to fetus can occur in any trimester of pregnancy, even if mother was an asymptomatic carrier. The clinical signs of ZIKV infection are nonspecific and can be misdiagnosed as some other infectious diseases, especially those caused by arboviruses such as Dengue and Chikungunya. ZIKV infection was solely associated with mild illness prior to the large French Polynesian and Brazil outbreaks, when severe neurological complications, Guillain–Barre syndrome and dramatically increased rate of severe congenital malformations (including microcephaly) were reported. The adaptation of ZIKV to an urban cycle in endemic areas suggests that the incidence of ZIKV infections may be underestimated. The pandemic of novel coronavirus infection (COVID-19) demonstrates that lessons from ZIKV pandemic propagation has not been learned properly.


239-244 1157

Here we describe a rare clinical case of female with a history of surgical sterilization coupled to ectopic pregnancy in the fallopian tube stump, comprising on average 1.19 % of total ectopic pregnancies. The patient E. was admitted to the gynecological department complaining of aching pain in the lower left abdominal quadrant, blood discharge from the genital tract, and delayed menstruation. Due to a previous operation for sterilization, no onset of pregnancy was expected. A positive urinary test for human chorionic gonadotropin was obtained, whereas ultrasound examination did not reliably confirm the onset of pregnancy. However, taking into account the ultrasound signs of the hematoperitoneum, a culdocentesis was performed that revealed dark liquid non-clotting blood. Laparoscopic surgery was performed on emergency indications. Intraoperatively: the stump of the left fallopian tube was dilated, cyanotic, and blood was leaking from the fimbria lend. Bilateral excision of fallopian tube stumps was performed. The primary clinical diagnosis was interrupted left-sided tubal pregnancy (in the fallopian tube stump) that was confirmed by pathomorphological examination. Thus, the clinical case described by us demonstrates properly conducted differential diagnostics as well as timely management and therapeutic interventions. Hence, previous surgical sterilization recorded in patient history should not rule out a diagnosis of ectopic pregnancy.


246-251 845

Here, we discuss essential milestones in developing and establishing method in vitro fertilization (IVF). Moreover, we also outline most prominent breakthroughs and discoveries performed in diverse time, each of which brought mankind closer to emergence of the first successful results after applying IVF in human. In addition, we also consider a history of IVF introduced in Russia as well as current issues requiring to be solved in the nearest future.

252-254 426

Here, issues related to envisioning mother holding a child in fine arts are discussed.


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