Vol 10, No 3 (2023)

Abnormal uterine bleeding (AUB) not related to pregnancy has been one of the leading reasons for visiting a gynecologist for many years. The incidence of AUB is approximately 30% among patients of reproductive age and can increase to 70% during the perimenopausal period. Recurrent AUB leads to the development of iron deficiency anemia, significantly reducing the quality of life, and also resulting in additional costs for hygiene products.

This clinical lecture provides a modern classification of AUB. It focuses on the main mechanisms of development of this pathology in adolescence and reproductive age. The causes of AUB are analyzed, and the classification, symptomatology, and clinical presentation of the studied conditions are presented. The lecture covers international criteria for pathologic uterine bleeding, clinical criteria for assessing bleeding severity according to Mansfield–Vode–Jorgensen scale and estimation of blood loss volume according to Algover index. Detailed consideration is given to the issues of differential diagnosis, general principles of therapy, and indications for traditional, hormonal, and surgical hemostasis. The lecture also outlines the algorithm of diagnostic search for patients in the adolescent, reproductive, postmenopausal age groups, as well as for patients on the background of menopausal hormonal therapy.

Peripheral neuropathy is a general scientific term used to describe disorders of the peripheral nerves of any etiology. Along with postinfectious, diabetic, paraneoplastic, and alcoholic neuropathy, neuropathy of pregnancy represents one of the forms of this pathology. In this study, the authors conducted an analysis of domestic and foreign literature from open sources over the past 20 years. The study of available data revealed that the most common peripheral neuropathies observed during pregnancy are carpal tunnel syndrome, Bell’s palsy, and neuropathies affecting the lower extremities. Despite the paucity of information on peripheral neuropathy in pregnant women, its relevance is very high as it can significantly impair the quality of life during pregnancy and does not always disappear immediately after delivery, sometimes persisting for a certain period of time. The literature search was conducted in Scopus, Web of Science, PubMed, ScienceDirect, CyberLeninka, and RSCI databases using the following keywords: pregnancy; neuropathy; carpal tunnel syndrome; Bell’s palsy; review.

Uterine leiomyosarcoma is a rare malignant neoplasm consisting of smooth muscle cells, characterized by an aggressive course and poor prognosis.

Differential diagnosis of uterine leiomyosarcoma is challenging due to the nonspecificity and low severity of symptoms, particularly in the early stages. Patients with uterine leiomyosarcoma commonly present with complaints in of pelvic pain, abnormal uterine bleeding, and symptoms of compression of nearby organs. The same clinical symptoms are characteristics of patients with uterine leiomyomas.

Leiomyosarcoma is often detected after histologic examination of material obtained during surgery for uterine myoma. At the same time, preoperative verification of the malignant nature of the neoplasm is crucial in determining the optimal tactics of surgical treatment. For instance, the use of organ-preserving techniques and morcellation in the treatment of presumed uterine leiomyoma may result in the dissemination of tumor cells and significantly worsen the prognosis in patients with undiagnosed leiomyosarcoma.

This review discusses existing methods of preoperative diagnosis of uterine leiomyosarcoma, their efficacy, as well as the possibilities of application in clinical practice.

Background. The prevalence of impaired carbohydrate metabolism among women of reproductive age is increasing worldwide. Despite tremendous progress in the treatment and management of blood glucose levels, pregnancy in women with pregestational diabetes still carries risks for the fetus.

This study aims to develop a calculator for predicting perinatal complications in women with pregestational diabetes mellitus by mathematical modeling.

Materials and Methods. This observational analytical study with a case-control design was conducted at the Altai Regional Clinical Perinatal Center “DAR” (Barnaul). The study included 147 women, with the main group comprising 95 pregnant women, including 47 with type 1 diabetes mellitus (group 1A) and 48 with type 2 diabetes mellitus (group 1B). No carbohydrate metabolism disorders were detected in 52 patients of the control group. All patients in the main group received insulin therapy. Medical documentation was analyzed, and statistical processing of the data was performed using mathematical modeling methods with appropriate software.

Results. In order to predict the combined indicator of perinatal complications, logistic regression analysis was used to calculate coefficients (b) for each of the indicators that have the most significant influence on the formation of complications.

The calculated values of regression coefficients can be utilized to predict the risk of perinatal complications in women with type 1 diabetes mellitus. For more practical use, a calculator for assessing the risk of perinatal complications in type 1 and type 2 diabetes mellitus was created using a computer program.

Diagnostic evaluation of the prognostic scale (calculator) for assessing perinatal complications risk assessment in type 2 diabetes mellitus demonstrated a sensitivity of 97.6%, specificity of 87.5%, and a prognostic value of positive risk assessment of 97.5%. Therefore, the calculator enables the prediction of the risk of perinatal complications in 97.5% of cases. At the same time, the prognostic scale of perinatal complications risk and the Perinatal Complications Risk Calculator for type 1 diabetes mellitus created on its basis showed 100% sensitivity and specificity.

Conclusion. The frequency of perinatal complications remains high, so the creation of a sufficiently effective prognostic model will make it possible to predict perinatal complications and influence the tactics of management of pregnant women and their newborns.

Background. Preeclampsia is recognized as one of the leading causes of maternal morbidity and mortality. In the majority of observations in the postpartum period, symptoms of preeclampsia appear in patients with antenatal hypertensive complications. These symptoms appear within the first 7–10 days after delivery and are accompanied by high blood pressure (BP) and neurologic symptoms, commonly presenting as headaches. According to the literature, common risk factors for the progression of preeclampsia in the postpartum period include maternal age over 35–40 years, obesity, cesarean section delivery, and non-Hispanic black race. Patients with progression of antenatal preeclampsia in the postpartum period often require readmission after discharge from the hospital.

Description of clinical cases. The first clinical observation involves a 25-year-old female patient was transferred to the cardiology department of the hospital on the fourth day after her first spontaneous labor due to a significant increase in BP combined with complaints of intense headache, nausea, and itching of the palms. Progression of antenatal preeclampsia complicated by the cholestasis was detected. The implementation of a complex treatment led to the normalization of clinical and laboratory parameters. In the second clinical observation, a 31-year-old first-pregnant patient at the gestational age of 27 weeks underwent emergency cesarean section due to the development of eclampsia. The patient developed thrombocytopenia and massive proteinuria a day after delivery for the first time, along with high BP, which was not present during pregnancy. The application of a personalized approach to treatment helped stabilize the maternity patient’s condition.

Conclusion. The presented clinical observations demonstrate the progression of antenatal preeclampsia in the postpartum period. In both cases, disturbances of laboratory parameters, high arterial hypertension, resistant to previously conducted antihypertensive therapy, were noted. Given that preeclampsia is a risk factor for severe complications, patients should not be discharged after delivery until clinical and laboratory parameters have completely normalized.