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Obstetrics, Gynecology and Reproduction

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Vol 14, No 5 (2020)

Original articles

551-567 107
Abstract

Aim: to study the severity of surgical menopause (postovariectomy syndrome), anxiety, depression and sexual function in patients with borderline ovarian tumors (BOTs) after radical treatment, depending on management in the rehabilitation period.
Materials and Methods. There were examined 62 women of reproductive age (42.0 ± 4.1 years) after radical treatment of BOTs: Group I - 29 patients were observed during rehabilitation period according to the standards and the National Clinical Guidelines and underwent a 12-month Comprehensive Personalized Rehabilitation Program; Group II - 33 non-participating rehabilitation program patients. The Modified Menopausal Index (MMI) and all related constituent subscales, the level of anxiety and depression according to the HADS (Hospital Anxiety and Depression Scale), as well as sexual function according to the FSFI (Female Sexual Function Index) scale were assessed prior to surgery as well as 1, 6, and 12 months afterwards.
Results. All study participants noted significantly aggravated symptoms related to surgical menopause as early as 1 month after treatment: the total MMI increased from 10.9 ± 2.2 score (lacked manifestations of surgical menopause) up to 37.0 ± 6.3 score (moderate manifestations) in Group I and from 10.5 ± 2.0 score (lacked manifestations of surgical menopause) up to 35.8 ± 4.3 score (moderate manifestations) in Group II. By the 12 months, MMI decreased down to 22.2 ± 4.6 score (mild manifestations) in Group I and remained almost unchanged in Group II - 36.9 ± 8.0 (moderate manifestations). In 93.1 % and 81.8 % women from Group I and Group II, respectively, 1 month after antitumor therapy, disorders of the psycho-emotional sphere were observed. In Group I, after 12 months parameters returned to preoperative baseline magnitude, whereas in Group II 87.9 % of patients noted their significant altered values. A twofold decrease in anxiety values according to the HADS was observed in Group I after 12 months of rehabilitation therapy, whereas in Group II, it was also decreased, but to a lower degree. While assessing level of depression, it was found to gradually increase in Group II within the first year after the operation, whereas in Group I it was steadily decreased. Within 1 month after radical treatment of BOTs, a significant decrease in sexual function and the FSFI index was observed in all women of reproductive age (from 23.7 ± 5.5 to 4.0 ± 1.2 score in Group I and from 23.4 ± 5.3 up to 4.0 ± 1.3 score in Group II). After 12 months of comprehensive rehabilitation, sexual function was almost completely recovered in Group I (22.5 ± 5.4 score), whereas in Group II sexual dysfunction was markedly evident (14.9 ± 6.4 score).
Conclusion. Comprehensive personalized rehabilitation can reduce the negative symptoms of surgical menopause, normalize the psycho-emotional state, increase sexual function, and hence, improve the quality of life of patients with BOTs of reproductive age after radical treatment.

568-576 20
Abstract
Aim: to assess the seasonality of prematurity, stillbirth, perinatal mortality and deficiency of serum folic acid in pregnant women at the Gyanja Perinatal Center (Gyanja, Azerbaijan).
Materials and Methods. In 2016, 3,221 pregnant women were hospitalized at gestational age of at least 22 full weeks or more. A case of hospitalization for obstetric care of pregnant women at gestation age of 22 full weeks was used as a unit of statistical observation. All female patients were stratified in accordance of hospitalization date by calendar months and annual seasons. In each season (winter - January, spring - April, summer - July, autumn - October) in 50 pregnant women at trimester I and III (8 groups of pregnant women) serum folic acid, homocysteine, С-reactive protein, fibrinogen and alkaline phosphatase were measured.
Results. The smallest and largest percentage of infants with very low birth weight (< 1500 g) was among children born in January (2.28 ± 0.75 %; 95 % Cl = 0.78-3.78) and November (13.99 ± 2.49%; 95% Cl = 9.01-18.97), respectively (р < 0.01). Comparatively assessed proportion of newborns with very low body weight in the summer and winter periods (4.55 ± 0.55 % and 4.90 ± 0.51 %, respectively) confirmed lack of significant intergroup difference (р > 0.05). Stillbirth rate between infants born in the summer and winter periods differed (1.92 ± 0.36 % and 2.53 ± 0.37 %, respectively) insignificantly (р > 0.05). Seasonal change in risk of prematurity, stillbirth and perinatal mortality was associated with seasonal changes in the level of serum folic acid, homocysteine, C-reactive protein, fibrinogen and alkaline phosphatase.
Conclusion. Infants born with low and very low weight, stillbirth and perinatal losses are relatively common in autumn - from September 21 till December 20.
577-586 29
Abstract
Aim: to assess an opportunity of using infrared thermometry in predicting obstetric perineal tear.
Materials and Methods. There was conducted a prospective analysis of 40 childbirth cases recorded in 2019-2020. There were stratified 2 study groups: Group 1 included 30 women without perineal injuries; Group 2 - 10 women with obstetric perineal rupture. Infrared thermometry in the posterior perineal junction projection was performed during the second period of labor at two timepoints: 1 - onset of the second labor period; 2 - descent of fetal head parietal tubercles.
Results. The temperature difference between the first and second timepoints in Group 1 was 1.8 [1.71; 1.99] °C, in Group 2 - 2.7 [2.42; 2.82] °C (U = 54.000, p = 0.002). The rate of perineal temperature decline > 2.0 °C in Group 1 was 20 % (6/30), in Group 2 - 80 % (8/10) of cases (х2 = 11.868; p = 0.001). Such observation exhibited relatively high strength of relationship (V = 0.545). It is noteworthy that if perineal temperature decline at least by 2.0 °C for 2 minutes from descent of fetal head parietal tubercles to full birth of fetal head, the perineal rupture occurred in 100 % of cases (х2 = 7.556; p = 0.006), also featured with relatively high strength (V = 0.435).
Conclusion. Perineal skin temperature decline at least by 2.0 °C for 2 minutes or more from descent of fetal head parietal tubercles may potentially be used as a criterion justifying episiotomy.
587-599 43
Abstract
Aim: to assess dynamic changes in insulin resistance (IR), hyperinsulinemia (HI) and related parameters of carbohydrate and lipid metabolism, endothelial dysfunction, pro-inflammatory and prothrombotic states in pregnancy complicated with preeclampsia (PE).
Materials and Methods. A prospective observational study was conducted consisting of laboratory monitoring 148 high-PE-risk pregnant women comprising Group I - 72 women with overt PE; 36 healthy women with physiological course of pregnancy were included into Group II. All women were assessed level of venous blood glucose, insulin, total cholesterol, high-density lipoproteins (HDL), triglycerides (TG), leptin, placental lactogen, uric acid, tumor necrosis factor-a, C-reactive protein, circulating endothelial cells, fibronectin, nitric oxide metabolites, platelet aggregation at gestational periods 11-14 weeks, 18-21 weeks and 30-34 weeks. We also calculated insulin resistance index, atherogenic coefficient, and TG/HDL ratio, estimating accumulation and distribution of adipose tissue.
Results. There were found physiological changes in IR and HI, lipid, endothelial-hemostasis axis, pro-inflammatory, placental parameters supposed to provide proper fetal energy supply during normal pregnancy. During PE, these parameters were aberrantly elevated starting from early pregnancy stage due to failure of gestational adaptation mechanisms, which acquire important pathogenetic significance therein.
Conclusion. A holistic view at the mechanisms of forming atherogenic transformation of the lipid profile, endothelial dysfunction, pro-inflammatory and prothrombotic status, oxidative stress, hyperuricemia, visceral type of abdominal wall fat deposition as well as correlation analysis data indicate that all such changes were associated with unified pathogenetic arm consisting of pathological IR and HI serving as early baseline mechanisms in PE development.
600-610 20
Abstract
Aim: to analyze an effect of endothelial dysfunction on development of obstetric, perinatal and pediatric pathology by using morphometric studies of peripheral blood desquamated endothelial cells (DECs).
Materials and Methods. A prospective cohort clinical study included 163 female patients with singleton pregnancy. All pregnant women in the first trimester underwent DECs computer morphometry together with clinical and statistical examining course of pregnancy, labor as well as follow-up observation of born children under the age of 1 year.
Results. The study demonstrated that endothelial damage in the first trimester of pregnancy profoundly affected maternal, perinatal and pediatric morbidity: detection of DECs in the first trimester with mean diameter less than 30 mkm increased probability of developing placental insufficiency by 52.0 %, preeclampsia - by 48.8 %, threatened preterm labor - by 32.4 %, premature detachment of the normally situated placenta - by 6.0 %. Identifying in DECs in the first trimester with mean diameter less than 40 mkm was associated with increased risk of acute fetal hypoxia in labor by 7.9 %, pediatric central nervous system disorders - by 37.9 %, increased rate of acute respiratory viral infections in children under 1 - by 17.3 %.
Conclusion. Examining state of vascular endothelium in the first trimester of pregnancy represents an important component of prenatal diagnostics and opens up new avenue for prevention and treatment of obstetric, perinatal and pediatric pathology.
611-618 22
Abstract

Aim: to perform structural and functional analysis of the activity of reparative osteogenesis processes at pre- and postmenopausal women with diabetes mellitus (DM).
Materials and Methods. There were enrolled 142 pre- and postmenopausal patients with type I and type II diabetes mellitus type (DM-1 and DM-2) as well as 43 females in control group. Subjects taking medicines acting on bone metabolism comorbid with chronic diseases were excluded from the study. All patients underwent Dual-energy X-ray Absorptiometry (DXA) to assess bone mineral density (BMD, T-score). Serum markers of bone remodeling (alkaline phosphatase, ALP; procollagen type I N propeptide, PINP; beta-Cross laps, b-CTx), metabolic and hormone parameters (glycated hemoglobin, parathyroid hormone, calcitonin, vitamin D, electrolytes) were also measured.
Results. A positive correlation was found between the duration of DM-1 and DM-2 and b-CTx level (DM-1: г = 0.349, р = 0.08; DM-2: г = 0.214, р = 0.04). A negative correlation was found between the lumbar spine T-score and the duration of diabetes (DM-1: r = -0.568, p = 0.001; DM-2: r = -0.267, p = 0.04). A statistically significant correlation was found between the lumbar spine T-score and b-CTx levels (DM-1: r = -0.452, p = 0.002; DM-2: r = -0.357, p = 0.09).
Conclusion. The results of current study suggest that reparative osteogenesis in patients with post-menopausal DM-1 vs. DM-2 and the control group was moderately increased. In patients with DM-2, a less pronounced change in BMD was determined in parallel with inconsistent bone remodeling processes, which casts doubt on the ability of DXA to predict fractures in these patients. Such changes contribute to decreased bone quality, which distinguishes diabetic osteopathy from traditional menopausal osteoporosis manifested mainly by low BMD.

 

619-629 22
Abstract
Aim: to assess a role of pharmacy workers in maintaining women's reproductive health.
Materials and Methods. There were involved 150 pharmacy workers advising patients directly and selling them drugs and pharmacy product range, who answered the questionnaire about cause and rate of patient visits to the pharmacy for advice in various situations related to women's health. Some of such questions were devoted to choice factors in selecting recommended product. The survey was conducted anonymously.
Results. Most often (92.0 %), respondents advise female patients with vulvovaginal candidiasis at least once a week. In addition, pharmacy workers respond to complaints related to menopause, premenstrual syndrome, and contraception: 50-70 % of respondents deal with similar requests at least once a week. Women also visit pharmacy requesting to recommend treatment for dysmenorrhea and mastopathy as well as agents preventing uterine fibroids. Quite rarely, visitors asked pharmacy workers for advice while planning a desired pregnancy: 30.7 % of the first-responders indicated that they did not consult such patients. Drug efficiency was the most prominent factor for 88.0 % of respondents in choosing the recommended product, whereas drug safety held the second place among 70.0 % responders. Most commonly pharmacy workers assess properties of drugs based on own personal experience (88.7 % of respondents).
Conclusion. Women often turn to the pharmacy for help beyond pharmacy worker expertise. Improving the knowledge of pharmacy workers in the field of obstetrics and gynecology is a necessary socially-significant task.

SHORT REPORT

630-633 34
Abstract

The long-term effects (marital status, attitude to breastfeeding, re-pregnancy rate) underage (aged 13-17 years) labor who gave birth within and outside the specialized educational program were studied. It was revealed that the girls who attended program classes, continued breastfeeding significantly longer. At the same time, no significant difference in the frequency of early re-pregnancy was found. Apparently, educational programs are not effective enough and require revision.

REVIEW ARTICLES

634-643 35
Abstract
Here we analyze prerequisites and risk factors resulting in stillbirth. For this, we searched for key words in the electronic databases Scopus, MedLine, The Cochrane Library, CyberLeninka, RSCI etc. Social and medical history (obstetric and gynecological history, previous and identified extragenital diseases prior to pregnancy), bad habits, anthropometry data and pregnancy complications were assessed. Factors unambiguously linked to increased risk of stillbirth were identified.
644-655 40
Abstract

During pregnancy, a woman becomes more susceptible to respiratory and viral diseases, including novel coronavirus infection (COVID-19). Pregnancy exacerbates the acute inflammation typical to COVID-19, elevating a risk of developing cytokine storm, characterized by an avalanche-like spike of inflammation marker concentrations (C-reactive protein, interleukin-1 в, interleukin-6, interferon-Y, ferritin, erythrocyte sedimentation rate etc.). Cytokine storm increases a risk of pregnancy loss and contribute to formation of multiple organ dysfunction syndrome in pregnant women and fetus. In particular, erythrocyte degradation due to acute inflammation leads to hypoxia and uncontrolled inter-tissue iron redistribution. As a result, conditions are created simultaneously for developing pulmonary hemosiderosis and hemosiderosis of other tissues in pregnant woman and fetus, as well as for augmenting iron loss from the body, which exacerbates iron deficiency anemia (IDA). It is important to emphasize that a surge of ferritin level distinctive for severe COVID-19, does not indicate iron overload. Therefore, recommendations to cancel IDA correction and even to use iron chelators in COVID-19 may increase hypoxia and harm the health of pregnant women.

656-666 46
Abstract

The pandemic of the novel coronavirus disease 2019 (COVID-19) makes us to think about effective preventive methods in pregnant women, because the course of such infection is accompanied by a high risk of severe endotheliopathy, disseminated intravascular coagulation, septic shock, thromboembolic complications and maternal mortality. Undoubtedly, vaccination is the most effective method of protection during pandemic, which experience in some infections in pregnant women has been accumulated in the world practice and may be also used for the COVID-19 vaccine. Here we discuss the issues of vaccination for pregnant women to expand the view of medical doctors and eliminate prejudice against immunization of pregnant women.

CLINICAL CASE

667-673 31
Abstract
The placental site trophoblastic tumor is a rare highly malignant form of trophoblastic disease, which occurs in as few as 0.4-2.0 % of all trophoblastic tumors. Available publications describes not more than 200 clinical cases of this pathology often affecting patients of reproductive age, thereby underscoring special importance of its diagnostics and treatment. Here we describe the rare clinical case of spontaneous uterine rupture in pregnant woman at 26 weeks of gestation carrying placental site trophoblastic tumor, previously undescribed in research literature. The complexity of diagnosing such pathology that resulted in antenatal fetal death and hysterectomy is demonstrated.

HISTORIC CASES

674-676 22
Abstract
Samuel Kristeller (1820-1900) was one of the innovators in the XIX century German obstetrics and gynecology. In entire world, none of gynecologists and obstetricians could be unaware of knowing the name of such prominent human.


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