Vol 9, No 1 (2022)

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).

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 (1^st group) aged 21–37 years, the research center with 48 females (2^nd group) aged 22–42 years, and the commercial clinic with 19 females (3^rd 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 1^st group and 1 (2.1%) in 2^nd 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 1^st group, 48 females in 2^nd group, and 19 females in 3^rd 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.

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.

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.