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Obstetrics, Gynecology and Reproduction

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Vol 16, No 2 (2022)

ОRIGINAL ARTICLES 

108-121 509
Abstract

Aim: to evaluate the expression of estrogen (ER) and progesterone (PR) receptors in the endometrium during the "implantation window" in women with a history of reproductive dysfunction with different endometrial thickness.

Materials and Methods. A prospective single-center cohort comparative study was conducted. The main group included patients with hypoplastic (< 7 mm according to ultrasound data on preovulatory days) endometrium (n = 52), the comparison group consisted of women with normal endometrial thickness (n = 62) (women of both groups with reproductive dysfunctions of unclear cause), the control group included 16 healthy fertile women. An aspiration biopsy of the endometrium was performed on day 6–8 after ovulation with simultaneous collection of peripheral blood sample to measure level of estradiol (P). Endometrial biopsies were examined with histological and immunohistochemical (expression of ER, PR) methods.

Results. All women had an ovulatory cycle, serum progesterone level ≥ 16.1 nmol/L (6–8 days after ovulation) and normoestrogenemia. E2/P was similar in all cohorts (p > 0.05). Indicators of endometrial expression of ER, PR, similar to healthy women (n = 16), were found in 21 % (n = 11 out of 52) and 32 % (n = 20 out of 62) in women from main and comparison groups, respectively. The remaining 79 % (n = 41 out of 52) of women with "thin" endometrium (main group) and 68 % (n = 42 out of 62) of patients with normal endometrial thickness (comparison group) had ER and PR expression indices in the endometrial glands and stroma with significant differences (p < 0.05) in all parameters (excepting PR in the endometrial stroma) from those of healthy women (control group), but without relevant differences between these cohorts (p > 0.05) regardless of endometrial thickness.

Conclusion. In women with a history of reproductive disorders, parameters of ER and PR expression similar to those in women without reproductive problems, were noted with a "thin" (< 7 mm) endometrium by 50 % less often than those with normal thickness of the uterine mucosa. At the same time, the "thin" endometrium is not an absolute predictor of disorders of the hormone-receptor characteristics of the endometrium: in every fifth case, magnitude of endometrial expression ER, PR similar to healthy women were determined.

122-133 259
Abstract

Introduction. Chronic pain syndrome with external genital endometriosis (EGE) causes profound psychoemotional changes, anxiety disorders, decreased physical and social activity, general well-being and mood, sexual dysfunction, and as a consequence, deteriorated quality of patients' life.

Aim: to study an influence of psychoemotional disorders on the quality of life of women with painful and painless forms of EGE.

Material and Methods. There were enrolled 160 patients (110 women with painful and 50 with painless forms of EGE) of reproductive age with laparoscopically and morphologically verified diagnosis, according to the Revised American Fertility Society score (R-AFS) classification. Pain syndrome and psychoemotional status were assessed using various quality of life assessment questionnaires: Visual Analog Scale (VAS), Endometriosis Health Profile-30 (EHP-30), Hospital Anxiety and Depression Scale (HADS). After surgical treatment, 8 patients refused to participate in the work (6 with painful form of EGE and 2 with painless form). Thus, 152 women passed all stages of the study. The patients were divided into 4 groups depending on the presence and/or absence of pain syndrome and tactics of the rehabilitation period ("active" or "passive"): group IA consisted of 49 (47.1 %) women with pain syndrome and "active" rehabilitation; group IБ – 55 (52.9 %) women with pain syndrome and "passive" rehabilitation tactics; group IIA – 23 (47.9 %) patients without pain syndrome and with "active" rehabilitation; group IIБ – 25 (52.1 %) patients without pain syndrome and with "passive" rehabilitation tactics.

Results. It was found that painful vs. painless form of EGE differs by a more severe course of the disease and markedly decreased quality of life. In a comparative analysis of the four groups it was noted that women with "active" tactics of rehabilitation measures (IA and IIA) had a decrease in pain syndrome, improved emotional, social and sexual activity, decreased depression and anxiety scores as compared to the patients (IБ and IIБ) who underwent a set of rehabilitation measures within the National clinical guidelines.

Conclusion. Timely diagnostics and correction of psychoemotional disorders will allow to develop a differentiated approach to provide specialized medical and psychological care and improve the quality of life of patients with EGE.

134-142 276
Abstract

Aim: to evaluate the effectiveness of using low molecular weight heparin (LMWH) and low-dose acetylsalicylic acid (ASA) in preventing recurrence of early and late fetal growth retardation (FGR) in patients with antiphospholipid syndrome (APS) and/or genetic thrombophilia.

Materials and Methods. A prospective randomized controlled study was conducted by examining 32 patients aged 23 to 43 years with a history of early and late II and III FGR as well as thrombophilia. Prevention protocol using LMWH and ASA was carried out from the pregravid period or early pregnancy. The control group included 35 women with uncomplicated pregnancy. Antiphospholipid antibodies (APA) were measured according to the Sydney antiphospholipid syndrome (APS) criteria by using enzyme immunoassay (ELISA): cardiolipin, β2-glycoprotein 1 and additionally antibodies to annexin V, prothrombin, etc. (IgG/IgM isotypes); lupus anticoagulant – by a three-stage method with Russell's viper venom; antithrombin III and protein C levels – by chromogenic method; prothrombin gene polymorphisms G20210A as well as factor V Leiden polymorphism – by chain reaction; homocysteine – by ELISA.

Results. It was found that prevention protocol was effective in 78.1 % cases. FGR re-developed in 7 (21.9 %) pregnant women: in 2 (6.3 %) at 20 and 22 weeks, in 3 (9.4 %) at 30–32 weeks, in 2 (6.3 %) after 34 weeks of pregnancy. All these patients were found to have APA exceeding 40 U/ml with low dynamics of decline, 3 (9.4 %) were older than 35 years, 2 (6.3 %) had chronic kidney pathology and 1 (3.1 %) had a hypertension in the anamnesis.

Conclusion. The use of LMWH and low-dose ASA starting from the pre-pregnancy period and early pregnancy as a part of complex therapy allows to effectively prevent re-development of FGR in patients with thrombophilia. In case of high APA titers, the use of LMWH and low-dose ASA may be ineffective, and alternative treatment methods in addition to anticoagulant therapy should be used to improve obstetric results.

143-157 224
Abstract

Aim: to evaluate effectiveness of a personalized comprehensive rehabilitation program in patients after surgical treatment of endometrial cancer (EC).

Material and Methods. There were enrolled 61 patients of reproductive age (44.46 ± 3.84 years) after radical treatment of endometrioid adenocarcinoma by stratifying subjects into 2 groups: group I – «active» rehabilitation with a comprehensive program of restorative measures (n = 29), group II – «passive» rehabilitation with standard management of the postoperative period in accordance with volume and timeframe determined by clinical recommendations (n = 32). Quality of life (QоL) was determined using the following questionnaires: Functional Assessment of Cancer Therapy for Patients with Endometrial Cancer (FACT-En), Kupperman-Uvarova Modified Menopausal Index (MMI), The Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS). The program was based on four patient visits expected to occur at week 1 as well as 3, 6, 12 months after surgery, respectively.

Results. In was found that 12 months post-surgery MMI in group I was decreased from 40.75 ± 5.69 down to 26.45 ± 4.84 score corresponding to mild postovariectomy syndrome (POES), whereas in group II – from 39.62 ± 5.37 to 36.15 ± 4.06 score estimated as moderate POES. In addition, at this time point patients in group I were noted to virtually fully recover sexual function assessed by FSFI (24.93 ± 2.86 score), whereas in group II it was at markedly lower level (13.39 ± 2.55 score; p < 0.001). According to the HADS, all subjects had level exceeding score of 11 at week 1 post-surgery corresponding to clinically significant anxiety and depression. Moreover, 6- and 12-months post-surgery subjects in group I lacked significant symptoms (score < 7 for each parameter), whereas in group II 12-month follow-up demonstrated subclinical level of anxiety and depression. According to the FACT-En, subjects in group I vs. group II revealed markedly higher QoL on visit 4 reaching 141.31 ± 6.45 and 112.84 ± 6.48 score, respectively.

Conclusion. The «active» personalized comprehensive rehabilitation program proposed here demonstrated high efficacy in EC patients after radical surgery compared to subjects underwent standard management in rehabilitation period. Use of the program during 12 months post-surgery allowed to minimize negative manifestations related to POES, positively impacted psycho-emotional status, significantly improved sexual function as well as QoL. Organizing comprehensive rehabilitation in post-surgical EC patients should be considered as one of high-priority approaches in public healthcare.

REVIEW ARTICLE 

158-175 528
Abstract

These days, anticoagulants are in great demand. They are used as a prophylaxis for thromboembolic complications in various diseases and conditions in general therapeutic practice, cardiology, neurology, as well as obstetrics to manage high-risk pregnancies. The relevance of anticoagulants competent use has come to the fore in connection with the emergence of a new disease – COVID-19 and its serious complications such as developing thrombotic storm, in which the timely applied anticoagulant therapy is the key to the success of therapy. The risk of bleeding should be considered when using any anticoagulant. Age, impaired renal function and concomitant use of antiplatelet agents are common risk factors for bleeding. Moreover, only vitamin K antagonists and heparin have specific antidotes – vitamin K and protamine, respectively. Inhibitors of other anticoagulants are universal presented as inactivated or activated prothrombin complex concentrate and recombinant factor VIIa. Hemodialysis effectively reduces dabigatran concentration, activated charcoal is effective in the case of recent oral administration of lipophilic drugs. Research on new antidotes of currently available anticoagulants is under way, similar to testing of new types of anticoagulants that are sufficiently effective in preventing and treating thromboembolic complications with minimal risk of hemorrhagic. The main contraindication to anticoagulants use is the doctor's ignorance of the mechanisms of drug action and opportunities for suppressing its effect.

176-181 464
Abstract

The latest data on the impact of the novel coronavirus infection (COVID-19) on female and male reproductive health are reviewed. Pathological changes in organs and tissues of human reproduction system after COVID-19 as well as  recommendations for rehabilitation of couples planning pregnancy after COVID-19 are discussed. Moreover, issues of the reproductive health resulting from altered psychologic status in women after COVID-19 were highlighted as well.

182-193 372
Abstract

The relevance of the problem of group B streptococcus (GBS) in obstetric practice casts no doubt. Attracting the close attention of leading experts, introducing new solutions and based on practical experience gained, it is still not possible to prevent all cases of neonatal infections associated with GBS. The review article demonstrates the current view of the problem. According to the literature, African-American race in combination with sexually transmitted infections are predisposing risk factors for GBS colonization. A direct relationship between obesity and the percentage of GBS carriers was revealed. GBS-colonized primigravidas have a 50 % increased chance of detecting the pathogen in subsequent pregnancies. Absolute factors for massive GBS colonization of the birth tract include GBS-associated asymptomatic bacteriuria and a history of GBS-colonized children. It is assumed that such virulence factors as hemolytic pigment and hyaluronidase contribute to the GBS pathogenic potential. The protective function in the immune system is performed by Kaschenko–Gofbauer cells, but their role is ambiguous. Early neonatal GBS infection realized in 90 % of newborns that manifested by sepsis, pneumonia and purulent meningitis. Implemented measures to prevent early neonatal GBS infection have a number of disadvantages. False-negative results of culture screening for GBS antigen at gestational age of 35–37 weeks increase a risk of vertical transmission, whereas false-positive results underlie a reason for prescribing irrational intranatal antibiotic prophylaxis. Moreover, antenatal GBS microbiological screening and antibiotic prophylaxis at birth do not prevent the risks of late-onset neonatal GBS infection.

CLINICAL CASE 

194-203 308
Abstract

Ph-negative myeloproliferative disorders such as polycythemia vera (PV), essential thrombocythemia, and primary myelofibrosis are rare clonal hematopoietic diseases that typically occur at age over 50. Only 10–15% of PV cases are diagnosed during the reproductive years, most commonly manifested as splanchnic venous thrombosis (SVT). Here, we demonstrate a case of a 6-weeks pregnant woman with a history of stillbirth and miscarriage presented with SVT. A terminal ileal resection and right hemicolectomy were performed, as well as the appointment of low molecular weight heparin in the postoperative period was initiated that allowed the patient to continue the pregnancy and deliver a child. The JAK2 V617F mutation was detected and masked PV was diagnosed according to bone marrow findings. In this article, we discuss the etiology of SVT in adults and effect of JAK2 V617F mutation on pregnancy outcomes as well as summarize current knowledge about pregnancy outcomes in PV.

LECTURE 

204–212 314
Abstract

The main role of platelets is traditionally assigned to participation in hemostasis reactions. In recent years, the data have appeared on the non-hemostatic platelet-related role and their active participation in inflammatory reactions. These platelet functions are predetermined by their ability to activate and secrete various immunomodulatory cytokines and chemokines. In addition, activated platelets can directly interact with viral receptors. Recently, there has been growing the knowledge regarding platelet-related regulation of diverse cell types. The result of this interaction is, among others, the formation of platelet-leukocyte aggregates, the focusing of neutrophils at the sites of injury, and generation of a scaffold for developing extracellular traps. Thus, platelets are not only participants in coagulation processes, but also important players in the inflammatory process. This lecture details the issues of platelets controlling and modulating host response to viral infection, as well as potential targets for therapeutic intervention.

HISTORIC CASES 

213-216 169
Abstract

The article highlights historic aspects of medical and research work for one of the prominent anesthesiologists ever – Virginia Apgar.

EVENTS 

 
217-219 129
Abstract

Alexander Davidovich Makatsaria – obstetrician-gynecologist and world-renowned specialist in clinical hemostasiology, Professor, Doctor of Medical Sciences, Academician of the Russian Academy of Sciences, Vice-president of the Russian Society of Obstetricians and Gynecologists is an Adjunct Professor of the University of Vienna (Austria). In March 2022, the Rector's Office and the Academic Council of the Medical University of Vienna extended the powers of A.D. Makatsariya until 2025.



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