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Obstetrics, Gynecology and Reproduction

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Vol 15, No 2 (2021)

Original articles 

121-131 61
Abstract

Aim: to objectively assess potential for early generalized postpartum infection diagnostics prior to the onset of irreversible organ changes based on a retrospective analysis.

Materials and Methods. Сlinical and laboratory forensic medical data were examined by analysing 29 cases of severe maternal outcomes coupled to sepsis: including 17 «near miss» and 12 deceased patients (maternal mortality). The control group consisted of 30 patients who had chorioamnionitis in labor and successfully completed pregnancy. Statistical data analysis was carried out by using nonparametric statistics by creating conjugacy tables and assessing a relationship between parameters with Pearson χ2 distribution.

Results. There were found significant differences in rate of some symptoms in both groups. Patients with severe maternal outcomes vs. control group were significantly more likely to develop hyperthermia ≥ 38.0 °C or hypothermia ≤ 36.0 °C, hectic fever, leukocytosis ≥ 12×109/L or leukopenia ≤ 4×109/L before the end of pregnancy; after pregnancy, persistent subfebrility, febrility or hypothermia, hectic fever, multiple-organ failure syndrome (PON), as well as uterine subinvolution and abnormal discharge from the genital tract were observed.

Conclusion. Early identification of recognized symptoms of systemic inflammatory response syndrome and PON allows to properly assess severity of patient condition, taking into account the risk of generalized infection, contributes to making correct diagnosis and timely implementation of adequate organizational and therapeutic measures.

132-142 52
Abstract

Introduction. At present, hemostasis disorders still hold one of the lead places in the pathogenesis of reproductive losses associated with high risk of miscarriage and remain one of the major causes for developing serious obstetric complications. Relevance, efficacy and safety of using drugs containing acetylsalicylic acid (ASA) and low molecular weight heparins (LMWH) in pregnant women with thrombocytopenia comorbid with intravascular coagulation activation remain pressing issues. The study of thrombocytopenia pathogenesis during pregnancy and search for new methods of hemostasis correction are accounted for by high risk of developing diverse perinatal complications and necessity to conduct prophylactic measures for their prevention.

Aim: to study hemostasis changes and clinical outcomes in pregnant women with thrombocytopenia, to substantiate the use of antiplatelet agents and anticoagulants in pregnant women with activated intravascular blood coagulation for preventing development of thromboembolic and placenta-associated complications of pregnancy.

Materials and Methods. A multicenter prospective study was conducted by enrolling 299 pregnant women at a gestational age of

22.85 [22.00; 25.00] weeks, whose average age was 31.06 [27.75; 35.00] years. There were distinguished three groups: main group (n = 124) consisted of pregnant women with lowered platelet count and activated intravascular blood coagulation, who received ASA preparations and LMWH in prophylactic doses for 4 weeks; pregnant comparison groups (n = 125) received no such drugs; control group (n = 50) consisted of women with normal platelet counts during physiological pregnancy. All patients underwent clinical, anamnestic and laboratory examination, and the clinical outcomes of pregnancy were assessed.

Results. It was found that use of ASA (a combined drug: ASA 75 mg + magnesium hydroxide 15.2 mg/day) and LMWH (enoxaparin sodium) in pregnant women from the main group were noted to improve hemostasis parameters: via markedly increased platelet count, decreased fibrinogen level, prothrombin index as well as normalized antithrombin III level (p < 0.01). It was also found during treatment that the D-dimer level and the rate (83.6 ± 2.3 % and 72.4 ± 2.7 %) and the degree (86.4 ± 2.7 % and 74.4 ±

2.8 %) of platelet aggregation in the main group (in contrast with comparison group) were significantly decreased (p < 0.01). The frequency of detected chronic placental insufficiency was significantly higher (p < 0.01) in the comparison group (n = 50; 41.32 %) vs. the main group after receiving ASA and LMWH (n = 20; 16.52 %). The incidence of moderate (p = 0.016) and severe (p = 0.018) preeclampsia was significantly higher in the comparison group vs. the main group. While comparing the volume of blood loss during delivery, there were no differences between the main group and the comparison group (p = 0.46); it was noted only a statistically significant difference compared to the control group (p = 0.04), in which the lowest blood loss was found (337.9 [200.0; 600.0] ml) in comparison with the other two groups (p1,3 = 0.05; p2,3 = 0.04). It should be noted that the volume of blood 

loss in all groups remained within the physiological permissible range.

Conclusion. Our clinical and laboratory study allowed to substantiate relevance of using ASA and LMWH drugs in pregnant women with thrombocytopenia comorbid with confirmed activation of intravascular blood coagulation, for prevention of thromboembolic and placenta-associated complications of pregnancy as well as proved safety of such drugs during pregnancy.

143-155 318
Abstract

Introduction. Cerebral circulation disorders (CCD) hold the third place in the structure of complications coupled to combined oral contraceptives (СОСs). Acute disturbance of the cerebral blood supply is the main etiological factor for such complication; and hidden predisposition to thrombotic conditions such as thrombophilia plays a pivotal role in its pathogenesis, which is manifested due to administered hormonal contraceptives.

Aim: to assess rate of detected genetic thrombophilic hemostatic defects, congenital and acquired ADAMTS-13 deficiency, antiphospholipid antibodies (APA), antibodies to phospholipid cofactors, hyperhomocysteinemia in patients with CCD administered with СОСs.

Materials and Methods. A prospective analysis of 89 COCs use cases in women of reproductive age was carried out, among which 60 cases were selected for this study satisfying to the inclusion and exclusion criteria. Group I consisted of 30 patients manifested with various CCD types due to COCs use, group II – 30 women taking COCs for at least 1 year lacking any thrombotic complications.

Results. Women administered with COCs are at the peak CCD risk within the first 2 months after the onset. Somatic diseases differed little in patients from groups I and II. In group I, 5 (41.7 %) patients with venous thrombosis did not have classical thrombophilia, but 4 (33.3 %) women had anti-ADAMTS-13 antibodies combined with elevated von Willebrand factor (vWF) level. Inherited thrombophilia was less prevalent in patients with arterial thrombosis and transient ischemic attack (TIA): 1 (5.5 %) case of Leiden factor V mutation compared to patients with venous blood flow disorders (p < 0.05). Such patients more frequently had criterial APA (61.1 %), so that 5 (27.8 %) patients were found to have more than one type of criterial APA. In 4 (22.2 %) cases these were patients with ischemic stroke, 3 (37.5 %) of which had combination of three criterial APA (triple positivity) and 1 (12.5 %) had two criterial APA (double positivity); among them detection rate of criterial APA was 50.0 %. One patient (double positivity) was with TIA.

Conclusion. It was found that: i) genetic and acquired factors were identified at high rate in patients with CCD administered with COCs, contributing to coagulopathy (86.7 %); ii) in case of venous thrombotic CCD coupled to administered COCs, inherited thrombophilia (58.3 %) prevails, in arterial thrombosis – APA circulation (50.0 %); iii) etiopathogenetic role of APA circulation in impaired cerebral blood flow depends on antibody type (criterial APA) and titer; iv) preexisting hypercoagulability leading to CCD coupled to COCs may be linked to several thrombophilic defects unrelated to classical thrombophilia.

156-165 30
Abstract

Introduction. Male infertility poses a pressing issue due to escalating prevalence of males with reproductive system diseases, the most common among which is varicocele being diagnosed in childhood and adolescence. Measuring level of hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol is the key element while assessing the reproductive male potential.

Aim: to compare the parameters of hormonal status in adolescents with varicocele as well as males with diagnosed infertility and identify predictors of hypogonadism in pubertal period.

Materials and Methods. Males with diagnosed infertility as well fertile males underwent a single measurement of serum FSH, LH, testosterone and estradiol levels. Adolescents with/without varicocele were measured the serum hormones noted above in dynamics annually between studies for the period within the 14 to 17 years of age. The data obtained were compared in infertile and fertile males, adolescents with/without varicocele, as well as assessed hormone status between different age groups in both cohorts and adolescents aged 17 years.

Results. Our study allowed to identify significant differences in hormone level in male patients with infertility and varicocele lacking reproductive pathology. Infertile males had significantly higher levels of LH and estradiol (for both: p < 0.001). The LH level in infertile vs. fertile males was 5.01 ± 2.69 IU/L vs. 3.40 ± 1.17 IU/L, respectively, whereas estradiol level was 136.51 ± 92.79 pmol/l and 82.49 ± 48.33 pmol/l, respectively that might indicate at lowered testosterone level. Fifteenand sixteen-year-old-adolescents with varicocele had significantly lower LH level: 15 years old – 3.72 ± 1.92 IU/L vs. 2.71 ± 1.65 IU/L (p < 0.0123) in subjects without vs. with varicocele; 16 years old – 3.42 ± 1.16 IU/L vs. 2.81 ± 1.66 IU/L (p < 0.0381) in subjects without vs. with varicocele. It may account for decreased testosterone level. Active puberty in adolescents is accompanied by dynamically increased testosterone levels. Starting from the age of 15 years, adolescents with varicocele had significantly increased testosterone level in each subsequent age group. Thus, at 14 and 15 years of age, testosterone level in adolescents with varicocele was 10.61 ± 4.70 nmol/l and 13.60 ± 5.64 nmol/l (p < 0.0001), respectively, whereas at 16 and 17 years of age it continued to rise reaching 16.65 ± 6.44 nmol/l (p < 0.001) and 19.22 ± 7.36 nmol/l (p < 0.0160), respectively. In contrast, age-matched adolescents without varicocele had significantly elevated testosterone level solely at age of 15 vs. 14 years. Whereas at 14 years of age testosterone level in comparison group was 15.73 ± 7.2 nmol/l, at 15 years of age it was significantly increased up to 21.45 ± 9.51 nmol/l (p < 0.0113). In the subsequent age categories of this group, no significant difference in testosterone level was found. While comparing such parameter between the main and control adolescent groups, testosterone level was significantly higher in adolescents lacking varicocele at the age of 14, 15 and 16 years compared with age-matched subjects with varicocele. At 14 years of age, testosterone level in adolescents without/with varicocele was 15.73 ± 7.2 nmol/l vs. 10.61 ± 4.7 nmol/l (p < 0.0007), respectively, at 15 years of age – 21.45 ± 9.57 nmol/l vs. 13.60 ± 5.64 nmol/l (p < 0.0001), respectively, at 16 years of age – 20.02 ± 5.84 nmol/l vs. 16.65 ± 6.44 nmol/l (p < 0.0268), respectively. The FSH level in infertile males and adolescents with varicocele was 5.16 ± 2.67 IU/L and 4.1 ±

2.63 IU/L (p < 0.0081), whereas LH level was 5.01 ± 2.69 IU/L and 2.76 ± 1.65 IU/L (p < 0.04), respectively. In adolescents with varicocele and infertile males, estradiol level was 177.45 ± 70.63 pmol/l and 136.51 ± 92.79 pmol/l (p < 0.001), respectively. While comparing hormone levels in fertile males and adolescents lacking varicocele, a significantly higher estradiol level was found in adolescents 181,87 ± 27.14 pmol/l vs. 82.49 ± 48.33 pmol/l (p < 0.001).

Conclusion. A study of the hormonal status in infertile vs. fertile males revealed decreased testosterone production accompanied with higher levels of LH and estradiol. Due to profound changes in LH and testosterone levels detected in adolescents with varicocele as well as in infertile males, it is plausible that such hormones may serve as predictors of hypogonadism in the pubertal period. Adolescents with varicocele taking into consideration progressive course of the disease and verified lower testosterone level require further monitoring of hormone level to prevent endocrine infertility.

166-172 36
Abstract

Aim: to study a relation between a single-nucleotide polymorphism in the estrogen receptor beta (ESR2) gene and age of menarche in women of the Central Black Earth region of Russia.

Materials and Мethods. There were enrolled 696 women to the retrospective study. All subjects were interrogated data regarding the age of menarche. Three polymorphic loci rs4986938, rs1256031, and rs10144225 of the ESR2 gene were genotyped by using the TaqMan probe polymerase chain reaction. The functional epigenetic effects of the rs4986938 ESR2 menarche-associated polymorphism were studied by using the online HaploReg software.

Results. There were found out associations of ESR2 rs4986938 polymorphism with the age of menarche in Russian women of the Central Black Earth region of the Russian Federation. Women with the rs4986938 ESR2 polymorphism allele A in the genotype (genotypes A/A and G/A) had menarche at the age of 12.71 ± 1.03 years, which is 0.20 years later than in women lacking it in the genotype (genotype G/G), who had menarche at age of 12.51 ± 1.05 years (pperm = 0,01). The rs4986938 ESR2 polymorphism is characterized by pronounced epigenetic effects: it affects affinity for five transcription factors – CTCF, Nr2f2, Pax-6, Pax-8, and RAR, being associated with enhancer and promoter sites in various menarche-significant body tissues and organs, and associated with the expression of the ESR2 geneepigenetic effects: it affects affinity for five transcription factors – CTCF, Nr2f2, Pax-6, Pax-8, and RAR, being associated with enhancer and promoter sites in various menarche-significant body tissues and organs, and associated with the expression of the ESR2 gene.

Conclusion. The rs4986938 polymorphic locus of the ESR2 gene is associated with age of menarche in women in the European part of Russia.

REVIEW ARTICLES 

173-181 22
Abstract

The study is aimed at using combined oral contraceptives (COCs) and subsequent risk of developing cerebral circulation disorders (CCD), which is posed at the fine border between gynecology, hemostasiology and neurology. We discuss risk factors for thrombotic complications occurring upon COCs administration, pathogenetic mechanisms behind CCD, a COCs impact on hemostasis system, and their relation to risk of developing diverse stroke types. Inherited and acquired thrombophilia are discussed as one of the most important factors determining elevated CCD risk related to COCs use. We provide a detailed description of most thrombogenic genetic polymorphisms such as mutated Factor V Leiden gene, prothrombin G20210А gene etc., their role in stroke development, including conditions for COCs use. Special emphasis is made on insights into inherited and acquired АDАMTS-13 deficiency as well as antiphospholipid syndrome as factors contributing to stroke in females receiving hormonal contraceptives.

182-188 17
Abstract

To understand a role for anti-Muller hormone (AMH) in the development and course of genital endometriosis, we sought out for and analyzed scientific papers in open electronic sources: PubMed, Scopus, eLibrary. We review a role of AMH in females as well as its importance in functioning of the reproductive system, noting that in developing external genital endometriosis its blood level decreases that may either due to ovarian damage or one of the links in the disease pathogenesis. Potential negative consequences of surgical interventions for ovaries as well as means for their prevention are described.

189-200 88
Abstract

Fetal growth retardation (FGR) is a complication of pregnancy that determines perinatal morbidity and mortality. It is a complex and multifaceted medical problem that does not lose its relevance. Impaired fetal development and delayed growth result from various etiopathogenesis of pathological processes occurring in the "mother–placenta–fetus" interface. Thrombophilia is one of the factors that can initiate disturbed placental function and the utero-placental blood flow. Here we describe the clinical FGR variants and etiopathogenetic factors of developing this complication of pregnancy (placental, maternal, and fetal). Special attention is paid to genetic and acquired thrombophilia (due to the circulation of antiphospholipid antibodies) and their role in development of such complication of pregnancy.

CLINICAL CASE 

201-207 50
Abstract

Endometriosis of the anterior abdominal wall is a rare disease comprising 0.3–3.5 %. In turn, its diagnosis is quite challenging due to the nonspecific picture, including pain in the anterior abdominal wall during menstruation. Upon clinical examination, a thickened area may be observed in the anterior abdominal wall, usually in the area of tissue involved in surgery. Ultrasound examination is a simple, economical, and reliable method of choice to diagnose extragenital endometriosis. Here we describe a case report of the patient after surgery of anterior abdominal endometriosis localized in the rectus abdominis muscle in the umbilical region and confirmed by ultrasound test and morphological examination of excised macroscopic sample.

LECTURE 

208-217 18
Abstract

Assessment of fetal cardiac function is one of the essential components of fetal echocardiography. Functional impairment is associated with a high risk of adverse perinatal outcomes and even antenatal death. Prenatal detection of hemodynamics changes requires immediate prenatal actions to identify the causes and eliminate the consequences that may require conservative treatment, intrauterine surgical treatment, and early delivery in perinatal centers.

HISTORIC CASES 

218-220 18
Abstract

The article highlights historic aspects of medical and research work of the Greek physician Soranus of Ephesus.



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