Vol 11, No 3 (2024)

The urgency of the problem of preterm birth (PB) is because of its high prevalence and neonatal mortality. The effects of PB on the fetus are often fatal, and PB accounts for 70% of neonatal mortality and 36% of infant mortality. Severe neurological deficits (e.g., cerebral palsy, epilepsy, intraventricular hemorrhages, retinopathy, blindness, hearing loss, delayed neuropsychiatric and motor development) occur in 68% of surviving premature infants. Additionally, children born prematurely have a high risk for purulent septic diseases. The metabolic consequences of prematurity cause diseases such as metabolic syndrome and hypertension. Thus, tocolytic therapy is a crucial therapeutic measure in obstetrics. However, most known and actively used tocolytic drugs induce insufficient effect for long-term prolongation of pregnancy or have serious side effects. Currently, there is a search for new tocolytics to obtain safe, adequate, and long-term effects. This review examines promising and relevant drugs that may be used in routine obstetric practice. Scientific articles, meta-analyses, and systematic reviews from the databases PubMed, Embase, Web of Science, and Google Scholar, and RSCI were analyzed. For the analysis, publications in English and posted no more than 5 years before the study was conducted were selected, except for fundamental works with a longer publication period.

Infertility is a global health problem that affects up to 17.5% of the world’s population. The use of assisted reproductive technologies makes it possible to solve this problem; however, it is not adequately efficient in all observed cases. Implantation failure remains a serious and multifaceted problem faced by clinicians in reproductive technology, despite the significant advances that have been made in this area. This review highlights promising studies on medical and invasive intervention methods and their possible combinations, which potentially improve the clinical treatment of implantation failures. Nevertheless, further study is required to assess the effectiveness and safety of each therapeutic approach, which can introduce new prospects in the treatment of infertility and increase the chances of successful implantation and pregnancy.

Postpartum depression has become an increasingly urgent problem of modern medicine and psychology. This condition is a mental disorder that causes emotional, behavioral, and physical changes associated with the postpartum period. Despite the presence of a wide range of signs, the diagnosis of postpartum depression remains challenging for specialists. A woman experiencing this type of depression may find it difficult to realize her condition on her own and seek help. However, even if properly diagnosed, the fact of having postpartum depression can be a negative experience for a woman. Young mothers often feel fear or shame in front of family members and the society and hide their diagnosis. This creates additional barriers to getting the necessary help and support.

This review aimed to identify and analyze risk factors of depressive disorders in women in the postpartum period and investigate some manifestations of postpartum depression.

The scientific databases CyberLeninkа, eLibrary, and PubMed were used. The articles were searched for the following keywords: “postpartum period,” “depressive disorder,” “postpartum depression,” “postpartum depression and risk factors,” and “development of depressive disorders in the postpartum period.” The study included articles published over the past 5 years. After sampling by annotations and keywords, 53 articles were analyzed: 6 Russian and 47 English speakers. The risk factors described in modern domestic and foreign literature were analyzed and were classified as unmodified and modifiable, which was further characterized as modifiable by the mother and/or her family and modifiable only by healthcare.

Chronic salpingophoritis is a critical inflammatory disease of the pelvic organs and is a risk factor of diminished ovarian reserve. Notably, chronic salpingophoritis is accompanied by decreased blood supply in the uterus. Circulation in the peripheral bloodstream of pathological inflammatory factors and immune complexes in the blood contributes to the development of oxidant stress, which damages the endothelium vessels and leads to impairment of its functions. Against the background of long-term pathological reactions in the inflammation center forms a vicious circle, wherein endothelial dysfunction plays a crucial role in the development of sclerotic processes in the ovarian tissues and endocrine function of the organ. These persistent morphofunctional disorders contribute to the delay of follicle maturation, which leads to decreased ovarian reserve. The result of the study reveals that, in women, during the peak of reproductive function, having chronic salpingophoritis and reduced ovarian reserve, blood flow in the ovarian arteries deteriorates. Pronounced changes in the dopplerometric blood flow parameters in the ovarian arteries are caused by damage to the vascular wall such as distortion of its tone and disorders in the production of vasoconstrictors and vasodilators (NO and ET-1). This is exacerbated by blood vessel endothelial thrombogenicity and results in long-term endothelial dysfunction, which contributes to impaired hormonal function of the ovaries. Notably, a persistent disorder of vasodimotor and thrombogenic endothelial function leads to a decrease in recruitment of follicles in the ovaries and reduction in ovarian reserve in the selected patient population.

BACKGROUND: Ethanol sclerotherapy is an effective and a safe surgical treatment method for ovarian endometrioma (OMA). Destruction with 95% ethanol solution of the capsule allows minimal impact on the ovarian reserve. However, this method should be thoroughly evaluated for the possibility to be used more frequently in practice.

AIM: To determine the indications for the use of transvaginal sclerotherapy in surgical treatment of OMA.

MATERIAL AND METHODS: Between October 2021 and October 2023, 17 patients with OMA were operated at the Moscow Regional Research Institute of Obstetrics and Gynecology, with sclerotherapy performed by transvaginal access. Clinical manifestations included pelvic pain (76.4%), dysmenorrhea (82.3%), dyspareunia (47.0%), bowel symptoms (35.3%), polymenorrhea (47.0%), and infertility (64.7%). Eleven (64.7%) of the patients had been previously operated because of ОМА.

RESULTS: Postoperative anti-Mullerian hormone (AMH) levels were slightly reduced (mean difference before and after the surgery was 0.47 ng/ml). The mean antral follicle count in the both ovaries were 10.8 before surgery and 8.6 after surgery. The volume of the ovary decreased from 2 to 6 times after sclerotherapy of the endometrioma. Symptoms recurred in four women. Six (35.2%) recurrences of endometrioma were noted with ultrasound control after 3, 6, and 12 months postoperatively. Endometrioid detritus in the cyst capsule was not detected in 64.8% of cases.

CONCLUSION: Preliminary results indicates the use of sclerotherapy by transvaginal access with ultrasound control for the treatment of endometriomas in women of reproductive age and patients planning pregnancy by ART with any level of ovarian reserve and recurrent, previously histologically confirmed, symptomatic endometriomas in women of reproductive age with no plans for pregnancy presently with a reduced ovarian reserve (AMH <1.2 ng/ml) and with any level of ovarian reserve but with symptomatic endometrioma in the preserved ovary. Transvaginal access is applicable for symptomatic endometriomas in women who had undergone several operations in the past.

BACKGROUND: Thyroid dysfunction can cause adverse effects on metabolic changes in the body and disturbances during the gestational period and intrauterine development of the fetus. In developing prevention methods, it is crucial to objectively substantiate and re-confirm theoretical assumptions.

AIM: To assess the functional state of the fetus in pregnant women with certain thyroid diseases.

MATERIAL AND METHODS: The results of instrumental studies in 118 pregnant women, who were divided into three clinical groups, were analyzed. Group 1 (44 people) consisted of patients with autoimmune thyroiditis (AIT). Group 2 (52 people) included patients with diffuse toxic goiter. Group 3 (control group) consisted of 22 pregnant women who had no somatic pathology and gestational complications. Thyroid diseases were diagnosed by an endocrinologist during a consultation in the third trimester of pregnancy based on laboratory and instrumental data. The functional state of the fetus was assessed using the total result of cardiotocographic and ultrasound studies, for which Partecust (Siemens, Germany) and Aloka-1700 (Hitachi, Japan) were used. Statistical processing of clinical material was performed using StatSoft software (Russia).

RESULTS: A comprehensive assessment of the adaptive capabilities of the fetus showed changes in its functional state in pregnant women with thyroid pathology. Prognostically, the most crucial characteristic in pregnant women with autoimmune thyroiditis and diffuse toxic goiter is a decrease to 0–1 point in indicators that determine motor activity and tone, respiratory movements, and reaction to a non-stress test. Among patients with autoimmune thyroiditis and diffuse toxic goiter, a high assessment of the biophysical profile of the fetus occurred 4 and 3.4 times, respectively, less often than among women with a normal pregnancy (among pregnant women without somatic pathology and gestational complications).

CONCLUSION: Disturbances in thyroid gland function during the gestational period can have an adverse effect on the development of the fetus, which is a theoretical basis for the development of treatment and preventive methods aimed at improving perinatal outcomes in this group of patients.

Pathological placental invasion is a dangerous anomaly during pregnancy, which causes increased maternal morbidity and mortality. Patients with abnormal placental invasion may experience life-threatening uterine bleeding during delivery, particularly in cases of placenta percreta. This often requires surgical intervention, specifically a hysterectomy, which some researchers refer to as the “gold standard” treatment for pathological placental invasion, with rates ranging from 47% to 77.8%. Conversely, other researchers recommend a conservative approach, involving the complete removal of the placenta percreta, excision of damaged areas on the uterine walls and bladder, and metroplasty and restoration of the integrity of the.

This article presents a clinical case of a 40-year-old patient with a complicated obstetric history, including abnormal placental invasion (placenta percreta) involving the anterior wall of the uterus and the bladder.

Delayed diagnosis of such pathology leads to inappropriate treatment and, consequently, acute massive bleeding, posing a risk to the patient’s health and life. The applied comprehensive diagnostic and therapeutic measures facilitated the preservation of the pelvic organs and restoration of the patient’s reproductive function.

This article presents two cases of ectopic pregnancy in the ovary and rudimentary horn, which had a life-threatening course. Despite availability of modern high-quality diagnostics, determining the condition remains challenging, because the definitive diagnosis is established and confirmed only intraoperatively. Hence, the clinical picture can be used primarily in making a diagnosis and choosing an appropriate treatment strategy. Rare localizations, such as in the ovary and rudimentary horn, which cause difficulties in making a diagnosis, should not be overlooked. If an ectopic pregnancy is not detected promptly and the risks are underestimated, death may occur. Two clinical cases clearly demonstrate timely diagnosis, regardless of additional examination methods (e.g., pelvic ultrasound, human chorionic gonadotropin test), and adequate choice of access and scope of surgical intervention. Moreover, the lack of awareness among women about this type of pathology should be considered. Patients often do not complain, do not remember the date of their last menstruation, do not monitor their menstrual cycle, and do not seek medical help in a timely manner. The combination of several factors can lead to fatal events. In this study, both cases of ectopic pregnancy with a rare localization ended favorably.