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Vol 8, No 3 (2021)

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Hepatitis B and C during pregnancy

Kaptilnyy V.A., Reyshtat D.Y., Berishvili M.V., Zholobova M.N.


The purpose of this article is to provide a comprehensive overview of current knowledge about pregnancy and hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and current methods to reduce mother-to-child transmission (MTCT). Maternal infection with HBV or HCV is associated with complicated pregnancy and childbirth outcomes, including MTCT. In countries, including the United States, which introduced postpartum HBV vaccination and immunization with hepatitis B immunoglobulin, MTCT overall decreased to about 5%. However, with maternal HBV levels greater than 200,000 IU/ml, the transmission rate of HBV to neonates is almost 30%. For these patients, there are new recommendations from the European Association for the Study of the Liver (EASL), which indicate that, in addition to vaccination of newborns and their immunization, treatment with antiviral drugs such as tenofovir disoproxil fumarate or telbivudine, used during pregnancy, starting from 32 weeks is necessary, that are safe and effective in preventing mother-to-child transmission. Unlike HBV, no therapy is yet available or recommended to further reduce the risk of mother-to-child transmission of HCV infection, which remains by 3–10%. MTCT of HCV can be minimized by avoiding obstetrics and birth trauma if possible. Young women with HCV should be sent for treatment after delivery, and newborns should be closely monitored to rule out infection. Newer, better tolerated HCV regimens have become more available and should reduce the number of women and babies infected.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):121-131
pages 121-131 views

Dysmenorrhea and endometriosis in teenage girls (review)

Unanyan A.L., Pivazyan L.G., Avetisyan D.S., Siordiya A.A., Ishchenko A.I.


Most adolescents experience discomfort during menstruation. Usually, girls are diagnosed with primary dysmenorrhea in the early reproductive period and respond well to symptomatic treatment with non-steroidal anti-inflammatory or hormonal drugs. If first-line therapy does not improve the symptoms of dysmenorrhea, transabdominal ultrasonography is indicated. Most often, these patients are diagnosed with endometriosis, which is the main cause of secondary dysmenorrhea in adolescents. Endometriosis should be assumed in patients with persistent, clinically pronounced dysmenorrhea that does not respond to treatment with hormonal drugs and non-steroidal anti-inflammatory drugs, especially if no other cause of chronic pelvic pain or secondary dysmenorrhea is detected on the basis of history, physical examination, and ultrasonography of pelvic organs. The aim of the therapy is to relieve symptoms, suppress disease progression, and protect future fertility.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):133-138
pages 133-138 views

Original articles

Comparison of prenatal functional markers of retardation of fetal growth and delayed fetal development with expression of vascular growth factors in the placenta

Dyusembinova S.D., Pavlova N.G., Klikunova K.A.


AIM: The study aimed to investigate and compare Doppler metric indicators in the main arteries of the functional system of the mother, placenta, and fetus as well as the parameters of the activity–rest cycle in fetuses with vascular endothelial growth factor (VEGF) expression and placenta growth factor (PlGF) in the presence of physiological pregnancy and placental insufficiency to analyze morphofunctional parallels between these indicators in the third trimester of pregnancy.

MATERIALS AND METHODS: Twenty-nine women on the 34–35 weeks of pregnancy (period of physiological maturity of the activity–rest cycle in the fetus) were screened. The main group consisted of 19 patients. The inclusion criteria were as follows: single-fetal pregnancy, fetometric indicators below the 10th percentile, and presence of blood flow disorders in the main vessels of the mother–placenta–fetus functional system. The comparison group included 10 relatively healthy women. The criteria for inclusion in the comparison group were as follows: single-fetal physiological pregnancy, fetometric indicators above the 10th percentile, and absence of Doppler disorders of placental blood flow. Fetometry and Doppler studies of the placental blood flow in the main arteries of the functional system of the mother, placenta, fetus were performed using the Voluson 730 Expert ultrasound device (GE, USA). The activity–rest cycle in the fetus was evaluated using Sonicaid Team Care fetal monitor (Oxford, UK). Placental tissue was taken from the central placental area for immunohistochemical analysis of VEGF and PlGF expression with primary monoclonal antibodies of the main women group and comparison group after childbirth (1:100, Abcam, UK).

RESULTS: A direct correlation between the expression of VEGF in the central zone of the placenta and index resistance (IR), ripple index (RI) in the uterine arteries, as well as the cerebroplacental relationship — CPR (r1=0.487; p1=0.035; r2=0.487; p2=0.035; r3=0.578; p3=0.030, respectively) in women of the main group was found. A direct correlation was established between the expression of VEGF in the central zone of the placenta and IR in the umbilical artery (r=0.49; p=0.033) in patients of the main group. The analysis of the rest–activity cycle in fetuses of women of the main group showed that at 34–35 weeks 73% of them do not form it: the behavior of fetuses is represented only by the activated state. An inverse relationship was found between VEGF expression and the motor-cardiac reflex amplitude (r=–0.866; p=0.05) as well as the heart rate oscillation amplitude (r=–0.866; p=0.05) in fetuses of women of the main group.

CONCLUSIONS: The identified morphofunctional parallels will allow to develop non-invasive pathogenetic prognostic models for prenatal diagnosis of fetal development delay with different degrees of growth restriction.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):139-147
pages 139-147 views

Possibilities of antenatal pathology diagnostics in women after assisted reproductive technologies

Kamaeva T.A.


PURPOSE: improving the efficiency of diagnosis of placental insufficiency using modern diagnostic methods.

MATERIALS AND METHODS: The analysis of individual cards, analysis of the gynecological history and somatic morbidity of 426 pregnant women who did not have somatic pathologies and underwent screenings in accordance with the current regulations were performed. The main group of them consisted of 290 women, who showed signs of chronic placental insufficiency at different stages of pregnancy. The control group consisted of 136 women who had no signs of placental insufficiency throughout their pregnancy.

RESULTS: It was revealed that the main reasons for the development of chronic placental insufficiency of the main group are preeclampsia (68.4%), the threat of termination of pregnancy (34.7%), burdened obstetric and gynecological history (32.5%), isoserological incompatibility (25.6%), pyelonephritis during pregnancy (14.2%) and anemia of pregnant women (13.2%). It was revealed that visualization of the fetoplacental complex and measurement of peripheral resistance in the umbilical artery during the second trimester of pregnancy are not very informative. To reduce the negative impact of fetoplacental insufficiency and its timely diagnosis, it is necessary to use radiation methods for examining the mother–placenta–fetus system.

CONCLUSIONS: For timely diagnosis of fetoplacental insufficiency and reduction of its negative impact, it is necessary to use radiation methods of studying the mother-placenta-fetus system.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):149-154
pages 149-154 views

Efficacy of immunological antivirus therapy for papillomavirus-associated grade I cervical intraepithelial neoplasia

Vinogradova O.P., Andreeva N.A., Epifanova O.V., Artemova O.I.


AIM: The study aimed to assess the effectiveness of alloferon in human papillomavirus (HPV)-associated cervical neoplasia (grade I) based on the analysis of the cytokine profile in cervical mucus as well as markers of apoptosis in cervical epithelial cells.

MATERIALS AND METHODS: The study enrolled 98 women, including 55 women of reproductive age with cervical intraepithelial neoplasia (CIN) associated with HPV infection and 43 conditionally healthy women without HPV infection. Factors of cytokine response and markers of apoptosis under normal and pathology conditions were assessed and compared.

RESULTS: The imbalance of pro-inflammatory and anti-inflammatory cytokines, in favor of the latter, is an important factor that supports the persistence of HPV-associated grade I CIN. Reducing caspase-3 and caspase-9, increasing interleukin-18, and subsequent activation of interferon gamma against the background of alloferon use are favorable signs of substantial elimination of the HPV.

CONCLUSIONS: The results of this study show considerable elimination of HPV in patients with grade I CIN when using immunological antivirus therapy.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):155-166
pages 155-166 views

Analysis of the cellular immunity status in patients with pathological placentation

Berg E.A., Yashchuk A.G., Musin I.I., Naftulovich R.A., Popova E.M.


AIM: The study aimed to investigate the cellular immunity in patients with placental disposition.

MATERIALS AND METHODS: A prospective study analyzed birth histories and clinical and laboratory parameters of 10 patients with placental disposition. The cellular immunity status was determined by analyzing lymphocytes with a cluster of differentiation (CD), including CD3+, CD4+, CD8+, CD16+56, CD3-СD8+, TNK, and CD38+8+. Obtained data were analyzed statistically.

RESULTS: Patients were 32.0 (29.0; 36.0) years old. As regards reproductive history, 60.0% had a history of three pregnancies, 20% had two pregnancies, 10% had their first pregnancy, and 10% had their fourth pregnancy. Moreover, placenta dispositions most often occurred at the second pregnancy in 70.0%, at the third pregnancy in 20.0%, and first pregnancy in 10%. In terms of cell immunity in comparison with normal indicators, the relative number of natural killer cells (CD16+56+), including activated CD3-СD8+, tended to increase. A relative increase in cytotoxic T-lymphocytes (СD8+) was found against the background of lower number of T-helper cells, along with general immunodeficiency (immunoregulatory index in the absolute number of women was less than 1.5).

CONCLUSIONS: Further investigation of cellular immunity in women with placental pathology is relevant to detect additional pathogenetic mechanisms of the development of obstetric complications.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(3):167-172
pages 167-172 views

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