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Vol 9, No 3 (2022)

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Prospects for the use of biochemical markers in placental in-growth

Yashchuk A.G., Musin I.I., Berg E.A., Gromenko D.D., Yanbarisova A.R., Gromenko I.D., Berdigulova E.F.


Placental in-growth is a severe obstetric pathology characterized by invasive placentation and associated with a high-risk of life-threatening hemorrhage. Despite the widespread use of instrumental methods of examination, timely diagnosis of placental in-growth is a challenging issue. Here, we reviewed the existing biochemical markers used for early detection and confirmation of placental in-growth, their specificity and sensitivity, and correlation with gestational age. Significant results were found for the following substances: pregnancy-associated plasma protein A (PAPP-A) in the first trimester, alpha-fetoprotein (AFP) and human beta-chorionic gonadotropin (Beta-hCG) in the second trimester, brain natriuretic peptide, antithrombin III, plasminogen activator inhibitor type I, soluble Tie-2 receptor (endothelial cell-specific tyrosine kinase receptor), and soluble vascular endothelial growth factor receptor-2. Our findings support the use of the aforementioned biomarkers as screening method for placental in-growth in medical practice.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(3):133-142
pages 133-142 views

Original articles

Morphological pattern and misdiagnosis in polycystic ovarian syndrome

Sosnova E.A., Gracheva T.S., Demura T.A., Krot M.A.


INTRODUCTION: Polycystic ovarian syndrome (PCOS) is currently one of the most common diseases in women. Ovarian dysfunction (irregular menstrual cycle and anovulation), hyperandrogenism, and polycystic ovarian morphology are the most frequent manifestations of the syndrome. Its main macroscopic sign is bilateral enlargement of the ovaries with multiple cystic and atretic follicles. Moreover, an ovarian biopsy is usually performed in addition to clinical examination allowing for an accurate diagnosis and management.

AIM: In this study, we sought to analyze the morphological verification of PCOS.

MATERIALS AND METHODS: We analyzed 121 patients admitted to Moscow hospitals for surgical treatment diagnosed of PCOS by pathologists. Initially, PCOS was diagnosed at the outpatient examination. Thus, 121 women of reproductive age were included in the study after excluding tubal-peritoneal factors, male infertility factors, and menstrual dysfunction. Intraoperatively, all patients (n=121) were sampled for histological examination.

The patients were referred to different gynecological hospitals: a municipal clinical hospital (group 1, n=54), a research center (group 2, n=48) and a commercial clinic (group 3, n=19). We processed data using parametric and non-parametric me thods in the STATISTICA Base software package. Arithmetic means, standard deviations, medians, and percentiles were equally determined. Confidence intervals for the arithmetic mean were determined using on the Student-t distribution. Moreover, we determined the 95% confidence intervals to the frequencies and the significance of differences in frequencies between the groups using binomial distribution and the Chi-square test, respectively.

Some indicators exhibited significantly different distributions from the norm; therefore, non-parametric Mann-Whitney (p2) and Wilcoxon criteria were further applied. Differences were considered significant at p <0.05.

RESULTS: Histological findings in 121 (100%) women of reproductive age with a clinical diagnosis of PCOS after surgical treatment were analyzed. After primary analysis, the clinical diagnosis was not confirmed in 78 (64%) patients, and histological findings of PCOS or PCOS that could not be excluded were obtained for only 43 (36%) women. Re-examination of histological samples from these 43 women let to the identifying of two groups of patients: group 1 with a typical histological pattern of PCOS (n=6, 14%) and group 2 with the so-called PCOS-like conditions (n=37, 86%).

CONCLUSIONS: Significant differences were found between the morphological pattern of true PCOS and PCOS-like conditions. Thus, the final diagnosis should made clinically and through imaging, as well as through mandatory morphological examination of ovarian biopsy specimens after surgical treatment.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(3):143-151
pages 143-151 views

Risk factors for premature placental abruption: a retrospective observational comparative study

Rudakova I.S., Shifman E.M., Tikhova G.P.


AIM: This study aimed to determine the risk factors for premature placental abruption (PPA).

MATERIALS AND METHODS: A retrospective comparative study was conducted at the Republican Perinatal Center of Petrozavodsk. The study group included 106 patients with a confirmed diagnosis of PPA from 2007 to 2017. The control group (comparison) included 106 women without PPA and abnormal placenta.

RESULTS: The statistical data analysis revealed the following risk factors of PPA: lack of higher education in the patient (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28–0.90); smoking (OR: 3.41, 95% CI: 1.29–8.97); chronic liver disease (OR: 7.29, 95% CI: 1.60–33.06); uterine abnormalities (OR: 8.57, 95% CI: 1.05–69.79); and pelvic inflammatory disease (OR: 6.12, 95% CI: 2.56–14.62). The effect of chronic hypertension, chronic kidney disease, and anemia on the occurrence of PPA in our study was not significant.

CONCLUSION: An increased risk of PPA was found in patients who smoke without higher education with chronic liver disease, uterine abnormalities, and pelvic inflammatory diseases.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(3):153-161
pages 153-161 views

Newborns in the early neonatal period in a group of mothers at high obstetric and perinatal risk

Samchuk P.M., Tsaroeva I.K., Ishchenko A.I., Azoeva E.L.


AIM: We aimed at assessing the status of newborns in the early neonatal period in a group of mothers at high prenatal risk for preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PTB), and fetal chromosomal abnormalities (FCA).

MATERIALS AND METHODS: We prospectively analyzed the status of 435 singletons. Mothers in the first-trimester underwent prenatal screening with risk assessment. Group 1 (study group, n=231) included high-risk subgroups for FCA (subgroup 1A, n=67), maternal PE (subgroup 1B, n=66), FGR (subgroup 1C, n=46), and PTB (subgroup 1D, n=52). We excluded risk combinations. Group 2 (controls) included 204 children of low-risk women.

RESULTS: Group 1 had a higher incidence of mild-to-moderate asphyxia compared with group 2 (p <0.05) and was more frequent in 1B, 1C, and 1D subgroups. Moreover, the frequency of severe asphyxia was similar between the groups (p >0.05). Intrauterine growth restriction (IUGR) and developmental delay were more frequent in group 1 than in group 2 (p <0.05). Moreover, group 1 children required monitoring and treatment more frequently that in group 2 (p <0.05). The frequency of infectious complications in group 1 and 1A, 1B, and 1C subgroups was equally higher than that of group 2 (p <0.05), while respiratory distress syndrome predominated in group 1 (subgroup 1D) and was not observed in group 2. The discharge rate was 95.7% in group 1 and 84.0% in group 2 (p <0.05). On days 3 to 5, 16% and 3.4% of children in groups 1 and 2, respectively, were transferred to the second stage of aftercare (p <0.05).

CONCLUSIONS: In the early neonatal period, children born to high-risk mothers, as opposed to those born to low-risk mothers, were significantly more likely to have asphyxia, IUGR, infectious complications, and indications for continued treatment in the second stage of nursing.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(3):163-171
pages 163-171 views

Correction of iron deficiency in patients with abnormal uterine bleeding

Ozolinya L.A., Savchenko T.N., Golovko E.D.


INTRODUCTION: Iron deficiency (ID) occurring latently or as iron deficiency anemia (IDA) is common in gynecology, particularly in patients with abnormal uterine bleeding (AUB).

AIM: We aimed at exploring the efficiency of a medication containing ferrous sulfate and multivitamins for the correction of latent ID and treatment of mild IDA in AUB patients.

MATERIALS AND METHODS: We performed a comprehensive clinical, laboratory, and instrumental examination of 60 women aged 35 to 50 years with AUB, revealing many gynecological pathologies (endometrial polyps or hyperplasia, ade nomyosis, and uterine myoma). The examined patients with AUB were divided into two groups: women with latent ID (group 1, n=38) and women with IDA (group 2, n=22). Moreover, all the patients had extragenital pathology in addition to gynecological diseases. As a treatment, ferrous sulfate with multivitamins was prescribed for 1–3 months.

RESULTS: Before treatment, the hemoglobin level in the examined patients ranged from 95 to 130 g/L, with an average of 127.1±1.8 g/L in group 1 and 100.3±2.1 g/L in group 2. Serum iron concentrations in the examined groups were 9.8±0.2 and 6.9±1.3 μmol/L, respectively. After treatment, the average levels of hemoglobin and serum iron increased significantly and reached normal levels in all those examined. Hemoglobin was 143.3±1.8 g/L in group 1 and 122.5±1.5 g/L in group 2, whereas serum iron was 14.9±0.2 μmol/L in group 1 and 13.5±1.0 μmol/L in group 2. Furthermore, a significant increase to normal values was observed in other indicators of complete blood count and biochemical analysis.

CONCLUSIONS: The results of the study reveal a high clinical efficiency of ferrous sulfate and multivitamins in the treatment of ID in patients with AUB.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(3):173-180
pages 173-180 views

History of preeclampsia: The significance of first-trimester biochemical screening of pregnancy-associated plasma protein A and human chorionic gonadotropin in predicting recurrence

Galeeva S.A., Fatkullina I.B., Gareev E.M., Tadzhiboeva N.A., Stetsenko N.A., Lazareva A.Y., Sitdikova D.G.


AIM: We aimed at assessing the significance of first-trimester biochemical screening of pregnancy-associated plasma protein A (РАРР-А) and human chorionic gonadotropin (hCG) in predicting the recurrence of preeclampsia (PE) in pregnant women with early and late history of gestational PE.

MATERIALS AND METHODS: A retrospectively included 94 labor histories and prenatal medicals records of pregnant women (2020–2021). Moreover, their first-trimester biochemical screening parameters (РАРР-А and hCG) with a gestational PE history were performed to predict the recurrence of PE. They were divided into three groups (two study groups and a control group). Groups 1 and 2 included 31 labor histories each with late- and early-onset PE, respectively. Group 3 (controls) consisted of 32 labor histories with uncomplicated pregnancies.

RESULTS: In the groups with a gestational PE history and recurrence, a significant decrease in РАРР-А levels was found at 11–14 weeks of gestation. We equally observed high levels of first-trimester hCG in late-onset PE, most probably due moderate degrees of PE recurrence and not gestational age. However, severe degrees of recurrence prevailed in early-onset PE.

CONCLUSIONS: A decrease in РАРР-А levels measured at 11–14 weeks of gestation is a significant predictor of recurrence of PE in the group of pregnant women with a gestational PE history.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(3):181-188
pages 181-188 views

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