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Vol 9, No 1 (2022)

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The role of integrins in the formation of the placental increment (placenta accreta spectrum)

Efimova V.A., Rudenko E.E., Murashko A.V., Lobanova O.A.


One of the most serious pregnancy complications is currently considered as a violation of cytotrophoblast invasion, particularly, a pathologically increased depth of invasion, leading to the formation of the placental increment (placenta accreta), ingrowth (placenta increta), and germination (placenta percreta). Cytotrophoblast invasion is regulated through subtle intercellular interactions, an important role among which is played by integrins, transmembrane glycoproteins that contribute to the immersion of cytotrophoblast in the endometrium and myometrium. The balance disturbance in the expression of α1β1, α5β1, and α6β4 integrins after normal implantation form a pathological extravillous trophoblast (EVT) phenotype by the blastocyst. This review examines the importance of integrins, collagens, and fibronectin in the formation of placental ingrowth (placenta accreta spectrum).

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):5-12
pages 5-12 views

Treatment of habitual pregnancy miscarriage of various origins

Unanyan A.L., Pivazyan L.G., Zakaryan A.A., Siordiya A.A., Ishchenko A.I.


Habitual pregnancy miscarriage is one of the serious problems of reproductive health in the modern world. Habitual miscarriage is defined as the spontaneous termination of two or more pregnancies before the fetus reaches viability from conception to 24 weeks of pregnancy. However, some differences of opinion are determined among specialists in habitual miscarriage. Some experts in their clinical practice for habitual miscarriages use the definition of three or more consecutive miscarriages. Habitual miscarriage occurrence varies from 0.5 to 2.3%, but the exact prevalence is very difficult to estimate, which depends on the used definition. The pathogenesis of habitual miscarriage is determined based on the age of the mother and the gestational age of the fetus. Habitual miscarriage can be caused by chromosomal errors, autoimmune disorders, endometrial dysfunction, endocrinopathies, hormonal and metabolic disorders, infections, and uterine anatomical defects. Currently available treatments target suspected risk factors for miscarriage, although the effectiveness of many medical interventions appears to be controversial.

This study aimed to evaluate the effectiveness of treatments for habitual miscarriage of various origins, such as antiphospholipid syndrome, subclinical hypothyroidism, and idiopathic habitual miscarriage.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):13-21
pages 13-21 views

Original articles

Clinical manifestations of polycystic ovary syndrome: a modern view

Sosnova E.A., Gracheva T.S., Pesegova S.V.


INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the urgent problems of gynecological endocrinology. The main signs of PCOS include a violation of menstrual and/or ovulatory function and clinical and/or biochemical hyperandrogenism, as well as polycystic ovarian morphology according to the ultrasound results. PCOS leads to infertility, obesity, and cardiovascular system diseases. PCOS is an important symptom complex in the diagnosis, which directly affects the reproductive function of females, hence the percentage of fertility. This study aimed to analyze the features of clinical, laboratory, and instrumental parameters in females with a previously established PCOS diagnosis referred for surgical treatment. The obtained results were studied from the point of view of the clinical guidelines of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology (2003), International PCOS Network (2018), and the Ministry of Health of the Russian Federation (2021).

MATERIALS AND METHODS: The study included 121 females who were admitted to hospitals in Moscow for surgical treatment. Among the gynecological surgical hospitals, the following medical institutions were allocated: the city clinical hospital, the research center, and the commercial clinic we conditionally divided into three levels.

The city clinical hospital had 54 females (1st group) aged 21–37 years, the research center with 48 females (2nd group) aged 22–42 years, and the commercial clinic with 19 females (3rd group) aged 25–41. Before the ovarian surgery for PCOS, all patients underwent an additional examination, including the collection of anamnesis, particularly, features of menstrual and generative function, anthropometric indicators, body weight, and height study. Based on these parameters, the body mass index (BMI) was calculated, the clinical signs of hyperandrogenism (acne, excessive hair growth on the body and face, and the degree of hirsutism) were assessed, and the hormonal profile was determined to detect biochemical hyperandrogenism (free testosterone). Additionally, the level of glucose and insulin in the blood plasma was determined in all patients, and a pelvic ultrasound examination (ultrasound) was performed.

RESULTS: Menstrual irregularities were revealed, of which complaints were presented by a total of 49.5% of patients. The results of the preliminary selection of patients with PCOS for surgical treatment revealed that 108 (89.2%) had primary and secondary infertility, of whom 64 (52.9%) had BMI within the normative values, 29 (23.9%) were overweight, and 25 (20.6%) were obese. Clinical manifestations of hyperandrogenism were present in 61 (50.4%) patients included in the study. The level of free testosterone above the normative values (>2.85 pg/ml) was diagnosed only in 9 (7.4%) patients out of 121 who are included in the study. Additionally, this parameter was within the upper limit of the norm (average value of 2.78±0.36 pg/ml) in 112 females but was combined with clinical manifestations of hyperandrogenism. Black acanthosis was noted in 6 (5.0%) patients with free testosterone levels in 3.01–3.64 pg/ml. Increased blood glucose levels were combined with obesity in 3 (5.5%) patients of 1st group and 1 (2.1%) in 2nd group. Insulin levels significantly exceeded the upper limit of the norm in 6 (5.0%) patients. The ultrasound result in all patients (n=121) revealed the presence of echographic signs of PCOS in PCOS was confirmed by ultrasound in 54 females in 1st group, 48 females in 2nd group, and 19 females in 3rd group.

CONCLUSION: Our results suggest an unreasonably broad interpretation of PCOS diagnosis. Therefore, PCOS diagnosis should be primarily remembered as a diagnosis-exception. Only repeated, extended, thorough, and comprehensive examination of patients with a presumed PCOS diagnosis will allow you to better navigate the individual characteristics of patients and offer adequate methods for correcting the symptom complex to improve the overall health, fertility, and quality of life.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):23-31
pages 23-31 views

The effectiveness of correction methods for isthmic-cervical insufficiency: cohort study results

Pesegova S.V., Timokhina E.V., Strizhakov A.N.


AIM: To assess the pregnancy outcomes in patients with isthmic-cervical insufficiency (ICN) and the effectiveness of modern methods of correction, namely cervical cerclage, obstetric discharge pessary, and progesterone preparations.

MATERIALS AND METHODS: The retrospective analysis included 184 females with ICN, who were divided into three groups based on ICN correction methods: 1st group consisted of 82 (44.6%) females who were corrected by cervical cerclage; 2nd group with 67 (36.4%) females by obstetric pessary; and 3rd group with 35 (19.0%) females by progesterone therapy with ICN sign appearance.

RESULTS: According to the obtained data, every second patient (53.3%) in our study had risk factors for ICN development due to the mechanical expansion of the cervical canal in cervical anamnesis. In most cases, ICN was diagnosed in 20 weeks and more, and the median period of correction was 21 [20–22] weeks in 1st group, 24 [22–26] weeks in 2nd group, and 22 [20–22] weeks in 3rd group (p <0.001). The overall incidence of preterm birth (PTB) in 1st group was 48.8%, whereas 40.3% in 2nd group and 60% in 3rd group. The share of timely births accounted for 41.5% in 1st group, whereas 53.7% in 2nd group and 11.4% in 3rd group.

CONCLUSION: Correction of ICN with cervical cerclage and obstetric pessary showed similar effectiveness and allowed prolonged pregnancy to more favorable terms. The correction group with only progesterone preparations noted a high frequency of premature pregnancy termination since this group initially included females with a higher risk of PTB and adverse factors for further prolonged pregnancy.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):33-40
pages 33-40 views

The importance of assessing nucleotide polymorphisms of the tp53 signaling pathway genes in uterine infertility factor diagnosis

Putilo A.O., Dzhibladze T.A., Pozdnyakova N.V., Grygortsevich N.Y., Svidinskaya E.A., Zuev V.M., Khokhlova I.D.


INTRODUCTION: The WHO reported a 30% frequency of female infertility, which does not tend to decrease. Concurrently, the uterine factor occupies one of the most important places in infertility structure, reaching 50%. Improvement of assisted reproductive technology methods can successfully overcome many causes of infertility, but the possibilities of the method are limited in the uterine factor of infertility.

AIM: To assess the presence of nucleotide polymorphisms of the TP53 signaling pathway genes (LIF rs41281637, c.256G>A; LIF rs929271, n.397-2854T>G; MDM2 rs2279744, c.14+309T>G; MDM4 rs1563828, c.558+572A>G; TP53 rs1042522, c.215C>G) in the endometrium in patients with primary and secondary infertility.

MATERIALS AND METHODS: In 2018–2021, the V.F. Snegirev Clinic of Obstetrics and Gynecology examined and treated 54 patients aged 26 to 48 years with primary or secondary infertility, including a genetic endometrial sample examination. The first group consisted of 28 patients with primary infertility aged 26 to 42 years. The 2nd group included 26 patients aged 29 to 48 years with secondary infertility.

RESULTS: The study evaluated the expression of nucleotide polymorphisms of the TP53 signaling pathway genes in patients with primary and secondary infertility. Study results, data were obtained indicating various variants of nucleotide polymorphisms LIF, MDM2, MDM4, and TP53 in primary and secondary infertility, as well as the identity of a marker, such as LIF rs41281637 (G/A) in patients of both groups.

CONCLUSION: The experimental data obtained indicate an important contribution of genetic polymorphisms in the genes of the TP53, LIF and MDM4 signaling pathway to the development of primary and MDM2 — secondary infertility in women.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):41-48
pages 41-48 views

Effectiveness of the choice of the optimal method for surgical treatment of genital prolapse

Musin I.I., Yashchuk A.G., Urmantsev M.F., Berg E.A., Molokanova A.R., Berg P.A.


AIM: This study aimed to evaluate the effectiveness of the choice of surgical method for treating genital prolapse, depending on the intensity of pelvic floor tissue perfusion.

MATERIALS AND METHODS: The study assessed the relationship of extragenital pathology, medical history of women operated for genital prolapse and medical history of women without genital prolapse during peri- and post-menopause (control group, n=67) with indicators of vaginal perfusion intensity. Overall, 328 patients with pelvic organ prolapse (II–IV degree) underwent surgery according to the Pelvic Organ Prolapse Quantification system. Of these, 287 patients were examined after 2 years to diagnose disease recurrence; these patients were included in the main study group (n=287). For statistical processing of the obtained results, the STATISTICA 10.0 and EViews 12.0 software packages were used.

RESULTS: Correlation analysis revealed an inverse relationship between vaginal microcirculation intensity with age (rs=−0.187; р=0.025), menopause duration (rs=−0.390; р=0.001), genital prolapse duration (rs=−0.245; р=0.046), and surgical menopause (rs=−0.442; р <0.001). The study of microcirculation intensity in the anterior and posterior vaginal walls, depending on the presence of somatic diseases, revealed an inverse correlation with diseases such as hypertension (rs=−0.291; р <0.001), coronary heart disease (rs=−0.169; р=0.044), and diabetes mellitus (rs=−0.223; р=0.008). When choosing a method of surgical treatment that minimizes the contact of mesh prosthesis with native tissues in women with comorbid pathology, a relapse of the disease after 2 years was detected in only 2.4% women.

CONCLUSION: The choice of the optimal method for treatment in patients with somatic burden and low perfusion capacity of pelvic organs and tissues can reduce the number of complications after surgical treatment of pelvic prolapse.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):49-55
pages 49-55 views

Quality assessment of medical care for females with stillbirth according to a questionnaire

Mysovskaya Y.S., Marshalov D.V., Shifman E.M., Kuligin A.V., Zeulina E.E.


BACKGROUND: Death is a leading factor in post-traumatic stress disorder development. The adequacy of medical and psychological support for childbirth with a dead fetus plays a key role in severe psychological disorder prevention.

MATERIALS AND METHODS: The authors have developed a questionnaire to assess the quality of obstetric, anesthesiological, and psychological assistance to females with death. The questionnaires of 173 respondents were analyzed. The duty factor or completeness of answers was 0.96. Of the cases, 55% of childbirth with a dead fetus occurred after 34 weeks of gestation, whereas the time interval from the moment of delivery to the questionnaire did not exceed 2 years in 60% of cases.

RESULTS: The heavy emotional state was rated by 70% of females. Psychological assistance was recognized as unsatisfactory in 52% of cases. Most females (63%) wanted to be conscious at the time of the birth of a child and contact with him. This issue was not discussed with females in labor in 51% of cases. Neuroaxial methods of analgesia were used in 36% of cases in vaginal childbirth, whereas anesthesia was not performed in 40% of patients. Sedative therapy was needed by 76% of females in the postpartum period, which was prescribed only in 25% of cases. A third of respondents rated unsatisfactory medical care provided, and 94% of females believe that special training and seminars on communication with patients who have had a stillbirth are necessary for medical workers.

CONCLUSION: The analysis of questionnaires filled out by women with stillbirth revealed several problems in the quality of medical care provided to them, wherein the most significant was the insufficient realization of the patient’s desire for contact with a dead child, insufficient anesthesia in childbirth, and sedation in the postpartum period, as well as unsatisfactory psychological care provided by doctors of an interdisciplinary team and a clinical psychologist, according to respondents.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(1):57-66
pages 57-66 views

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