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Vol 8, No 4 (2021)

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Literature reviews

Strategies for treating pregnant women with hepatitis B and C

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

Abstract

This multilateral review provides current knowledge regarding pregnancy and infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), as well as discusses modern methods to reduce mother-to-child transmission (MTCT) of these infections. Maternal HBV or HCV infection is associated with adverse outcomes of pregnancy and childbirth, including MTCT. In countries, including the United States, where postpartum HBV vaccination and immunoprophylaxis with hepatitis B immunoglobulin have been introduced, MTCT has generally decreased to approximately 5%. Unlike that for HBV infection, there is no available or recommended therapy to reduce the risk of MTCT of HBV infection, and the risk remains at 3–10%. MTCT of HCV can be minimized if do not use obstetric care and avoid birth injuries. Young women with HCV should be referred for treatment after childbirth, and newborns should be closely monitored to rule out infection. New, more affordable, and better tolerated HCV treatment regimens are now emerging that will help reduce the number of infected women and infants.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):177-184
pages 177-184 views

Nursing profoundly premature newborns with artificial placentae: a review

Oyedele A., Oyedele M., Murashko A.V.

Abstract

Neonatal mortality and morbidity are substantial issues affecting the maternal healthcare sector. Extremely premature infants, notably those born before the 28-week mark, experience significant morbidity and mortality rates during neonatal care. This is a result of developmental immaturity and iatrogenic injury. Several attempts have been made to develop a womb-like environment to mimic uteroplacental physiology, but limited success has been noted over the last decade. This review aims to summarize the current literature on improved techniques implemented in creating an artificial placenta, the principles of these procedures, and their limitations. Our findings indicate that implementing techniques that closely mimic uteroplacental pathophysiology is crucial in decreasing the excessive neonatal mortality and morbidity rates seen in extremely premature infants.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):185-190
pages 185-190 views

Current status of endometrial dysfunction in the combined pathology of uterus: a literature review

Burova N.A., Zharkin N.A., Murzina O.Y., Shatilova Y.A.

Abstract

Currently, the concern of endometrial dysfunction is still relevant and is of increasing interest. This is because of new factors have been identified that affect the reproductive function in women. Chronic endometritis and endometriosis mainly affect women of childbearing age, which threatens normal cyclic transformation of the endometrium and tissue receptivity. This consequently affects the main function of the endometrium, which is to ensure successful implantation of the fertilized egg and the development of the chorion and embryo. A detailed understanding of the functioning of the endometrium with a combination of chronic endometritis and endometriosis will improve their diagnosis and treatment.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):191-198
pages 191-198 views

Modern aspects of the fascial structure of the pelvic floor (literature review)

Musin I.I., Yashchuk A.G., Kazikhinurov R.A., Molokanova A.R., Serafima M.Y.

Abstract

The pelvic floor fascia in women has attracted the attention of obstetricians-gynecologists, proctologists and rehabilitologists due to their possible role in the development of pelvic organ prolapse and the appearance of pelvic pain. The development and improvement of new surgical techniques entails a comprehensive study of previously known approaches. For instance, regarding fascial tissues, studying the actual use of fascial flaps in plastic and reconstructive surgeries is of particular interest. This necessitates an accurate definition of and knowledge about structure of the fascia and their variations. In addition, knowledge of the fascial structure of surgical methods for treating prolapse, such as the installation of mesh prostheses in the reconstruction of the pelvic floor in the absence of alternative methods of correction. Primarily postoperative pain, a more in-depth study of the fascial anatomy of the pelvic floor can help reduce these adverse outcomes. The morphological and physiological characteristics of the perineal fascia presented in the teaching materials and teaching aids are not descriptive in nature and are far from the descriptive practice of obstetricians-gynecologists in the selection of methods for surgical correction of genital prolapse. This work is a literature review compiled from the sources of the electronic national bibliographic database of scientific citation of the Russian Science Citation Index and the English-language text database of medical and biological publications PubMed, created by the National Center for Biotechnological Information of the USA. To search for data, such key queries as “fascia”, “pelvic floor”, “pelvic floor anatomy”, “genitourinary diaphragm”, “chronic pelvic pain” were used, both individually and collectively.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):199-206
pages 199-206 views

Possibility of use and effectiveness of oral hypoglyctic drugs in gestational diabetes mellitus: a literature review

Russkova N.E., Shumak A.V., Timokhina E.V.

Abstract

Gestational diabetes mellitus (GDM) is a serious and frequent concern in pregnancy. Worldwide, the prevalence of GDM ranges from 8 to 20%. In 5% of cases, this pathology is accompanied by complications such as diabetic fetopathy, preeclampsia, neonatal hypoglycemia, and hyperbilirubinemia. Modern national and foreign guidelines for detecting hyperglycemia during pregnancy and diagnosing GDM recommend lifestyle changes and adherence to a carbohydrate-restricted diet as initial therapy. In the absence of positive dynamics against the background of non-drug therapy, the Russian Federation recommends only the use of insulin.

A number of foreign guidelines consider the use of oral hypoglycemic agents (metformin and/or glibenclamide) during pregnancy as an alternative to injectable drugs. In this review, we compared the efficacy and safety of metformin and/or glibenclamide for treating GDM. Metformin and glibenclamide are reliable and safe for correcting the level of blood glucose in pregnant women, but the optimal therapeutic strategy includes their combined use or combined use with insulin.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):207-212
pages 207-212 views

Original papers

Course of pregnancy and childbirth in comorbid patients with gestational diabetes mellitus

Zharkin N.A., Zabolotneva K.O.

Abstract

AIM: This study aimed to assess the course of pregnancy and childbirth in comorbid patients with gestational diabetes mellitus (GDM).

MATERIALS AND METHODS: This retrospective analysis enrolled 168 individual cards of pregnant women and women in labor with GDM between 2018 and 2020.

RESULTS: Analysis of the comorbid background of pregnant women revealed the presence of overweight and obesity in 48.2% of patients. Thus, these conditions were attributed as determinants in the development of GDM. In 58.7% patients, delivery was performed by cesarean section; however, in 11.3% of pregnant women, surgical delivery was performed for the first time; the main indication for it was a large fetus.

CONCLUSION: Comorbid background in pregnant women contributes to GDM development, which causes a high percentage of obstetric complications and diabetic fetopathy. The risk strategy for this pathology involves predicting complications using continuous outpatient observation, timely treatment, and hospitalization in accordance with the degree of risk.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):213-219
pages 213-219 views

Conformational changes in plasma proteins and erythrocytes in puerperal women and strategies of managing the perioperative period

Medzhidova D.R., Shifman E.M., Abdullaev V.R., Kulikov A.V.

Abstract

BACKGROUND: Cesarean delivery is associated with prolonged hospitalization compared to spontaneous delivery and the risk of intra- and postoperative complications. The introduction of an accelerated recovery program after a planned cesarean section contributes to the rapid recovery of the patient by optimizing various elements of care.

AIM: To study the effect of the components of the accelerated recovery program on the severity of oxidative stress during abdominal delivery at different stages of the perioperative period.

MATERIALS AND METHODS: This was a comparative study assessing conformational changes in plasma proteins and erythrocytes in the blood of puerperal women using fluorescence spectroscopy. The study included 81 patients from the perinatal center of Makhachkala who underwent a planned cesarean section under spinal anesthesia. The enrolled women were grouped into the following: control group (n=38), in which perioperative period was traditionally managed, i.e. fasting for 8 h before the operation and introducing an antibiotic after clamping the umbilical cord. Within this group, blood sampling was conducted in all 38 patients at different intervals. In total, 152 samples of the material under study were obtained from control mothers. The 2nd group was the main (n=43) and included women in labor; in this group, perioperative period was managed using accelerated recovery program, by introducing the antibiotic cefazolin and with the intake of a glucose-containing drink 2 h before the operation. In total, 172 samples of the material under study were obtained from the mothers of the 2nd group. Methods for the pre-preparation of biological material and spectral methods of analysis were used in this study.

RESULTS: At all stages of preparation of delivery by cesarean section (CS) after spinal anesthesia, minor conformational changes occur in the blood plasma proteins, including umbilical cord blood. In the main group, antibiotic use an hour before delivery increased the oxidative degradation of blood plasma proteins. In the control group, a change in the structural-dynamic parameters of erythrocyte membrane proteins was observed, as indicated by the blue shift in the maximum fluorescence spectrum. This was not observed in the erythrocytes of the main group of puerperal women who received a glucose-containing drink.

CONCLUSION: According to total fluorescence data of plasma proteins and umbilical cord blood, it can be assumed that using a glucose-containing drink 2 hours before CS along with an antibiotic helps restore some parameters of the fluorescence of erythrocyte membrane proteins. The data obtained do not indicate any persistent pathological phenomena in mother’s body at all stages of preparation for CS delivery using spinal anesthesia against the background of antibiotic use.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2021;8(4):221-232
pages 221-232 views


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