The review presents modern aspects of the etiology of placental insufficiency (uteroplacental vascular insufficiency), fetal growth restriction and preeclampsia, which arises primarily due to deficient remodeling of the uterine spiral arteries supplying the placenta during early pregnancy. The embryonic, maternal and placental factors of the occurrence of placental insufficiency and placental-related pathology considered. The issues of prevention and treatment of placental insufficiency are considered taking into account the common pathogenesis of this pathological condition.
Aim. To evaluate the effects of maternal pre-pregnancy body weight and excessive gestational weight gain (GWG) on the risk of different subtypes of preeclampsia (PE).
Methods. A cohort study of 289 pregnant women: 41 with early-onset (less than 34 weeks) preeclampsia (EPE), 76 with late-onset (more than 34 weeks) preeclampsia (LPE) and 172 normotensive women (control). Associations between anthropometric indicators (pre-pregnancy BMI, GWG, fat mass in the 1st, 2nd, 3rd trimesters, on the 2–3rd day after birth) and risk of PE and its subtypes were evaluated.
Results. Pre-pregnancy body weight (r = 0.36; р = 0.000) and BMI (r = 0.38; р = 0.000) moderately increased risk of PE. GWG had independent risk of developing PE (r = 0.46; р = 0.000). Women with excessive GWG had an increased risk of PE in normal BMI (RR = 2.2; р = 0.019), in overweigh (RR = 2.7; р = 0.028), in obese (ОР = 5.2; р = 0.000). The risk of developing preeclampsia increased in normal weight with GWG more than 500 g per week in the 2nd trimester (р = 0.000) and more than 400 g per week in the 3d trimester (р = 0.000), total GWG more than 16.5 kg increased risk of preeclampsia in 3.4-fold (ОР = 3.4; р = 0.001). Overweight and obesity had an increased risk of late-onset preeclampsia (RR = 4.9; р = 0.000). No association was found for early-onset preeclampsia (p > 0.050). Gestational metabolic disorders were independent risk of LPE: weekly GWG and the per cent of fat mass in normal weight pregnant women with LPE were significantly higher compared to the women with EPE and control. The per cent of fat mass in the 1st trimester in PPE (23.90 ± 4.40 %) exceeded control (20.50 ± 4.30 %; р = 0.003) and EPE (21.20 ± 3.65 %; р = 0.008) groups. Differences were aggravated during pregnancy (р < 0.050).
Conclusions. Pre-pregnancy overweight and obesity, excessive GWG and gain of fatty mass were an independent risk of developing PE with synergistic negative effect. Pre-pregnancy and gestational lipid dismetabolism were associated with LPE. Our results suggested that no correlation between pre-pregnancy BMI, GWG, fatty mass and risk of EPE.
21-hydroxylase deficiency is the most common genetically determined adrenal steroidogenesis defect. One of the consequences of the disease developing as a result of this defect, congenital dysfunction of the adrenal cortex (CDAC), is a decrease in fertility in the form of infertility or early pregnancy loss. The problem of reducing the fertility associated with CDAC is still not overcome due to a lack of understanding of the causes of negative pregnancy outcomes or the origin of infertility with preserved ovulatory function of the ovaries. A likely factor in reducing fertility in patients with CDAC is hyperandrogenism. But attempts at his glucocorticoid therapy have not been clinically successful. Thus, the issues of fertility restoration in women with CDAC are still relevant. At the moment, the only method of preventing the usual miscarriage and other complications of pregnancy in patients with CDAC is the use of progestogens, subject to their early, preconception purpose.
Objective: to assess the reproductive health features of women with fat metabolism disorders and the safety of using combined oral contraception in them.
Materials and methods. 150 women of childbearing age (mean age 29.8 ± 4.7 years) were examined, which were divided into three groups depending on the type of impaired fat metabolism: the first group included patients with obesity and dyslipidemia (n = 50); the second group – women with obesity without dyslipidemia (n = 46); the third group – patients with a normal body mass index and dyslipidemia (n = 54). All patients underwent clinical and laboratory examination with the assessment of biochemical, metabolic and hormonal blood parameters. At the second stage of the study, the safety assessment of the use of combined oral contraceptive with chlormadinone acetate (COC–CMA) in women in need of pregnancy protection was performed.
Results. Women with fat metabolism disorders have a high prevalence of menstrual irregularities. The most commonly detected were polycystic ovary syndrome (PCOS), phenotypes A, C, D. In the absence of PCOS in obese women or patients with dyslipidemia at normal weight, the formation of endocrine pathology was observed, associated with hyperandrogenemia or a tendency to hypogonadotropic hypogonadism. Patients with obesity and dyslipidemia had the worst fertility profile and high prevalence of infertility and miscarriage. Taking COC–CMA did not have a significant effect on fat metabolism.
Conclusion. Dyslipidemia and obesity are independent factors in reproductive health problems. Clinical portraits of gynecological endocrine pathology in patients with obesity, dyslipidemia and their combination are different. The assessment of carbohydrate and fat metabolism should be considered one of the important components of the examination of patients with menstrual dysfunction or impaired fertility. COC–CMA can be considered the drug of choice for contraception in women with impaired fat metabolism.
The article discusses the most common non-infectious liver pathology that complicates the course of the first half of pregnancy. Supraphysiological increase in sex hormone levels and exogenous hormonal effects when using assisted reproductive technologies contribute to the early manifestation of intrahepatic cholestasis in pregnant women and can cause liver damage in the first half of pregnancy. Non-alcoholic fatty liver disease during pregnancy is the most common cause of an unexplained increase in hepatic transaminases. An increase in liver transaminases before pregnancy and in its early stages is associated with the development of preeclampsia and perinatal complications. Safe hepatotropic drugs in the first half of pregnancy include ursodeoxycholic acid, essential phospholipids and solutions of low molecular weight sugars.
The task of active longevity is a priority for world and national health care. One of the resources to ensure the quality of life for aging women is the rationalization of nutrition using biologically active additives (BAA), which include substances that have proven effective in stopping the symptoms that accompany the menopausal transition and early postmenopause. Given the association of vasomotor symptoms with an increased risk of cardiovascular disease, it can be assumed that solving the problem of improving the quality of life will positively affect cardiovascular risk. Based on this hypothesis, we set the goal of the study to assess the effect of dietary supplements containing phytoestrogens on the quality of life and markers of cardiovascular risk in women during menopausal transition and postmenopause. An open, controlled study involved women aged 46–58 years who took Estrovel dietary supplement or a vitamin complex without herbal supplements, examined using questionnaires to determine the severity of menopausal complaints, assess mental status, vegetative support, as well as monitor blood pressure, and samples for vegetative providing, analysis of heart rate variability. The results of the study showed that women taking Estrovel dietary supplement to improve the quality of life, in addition to stopping the symptoms of pathological menopause, receive additional benefits in the form of improved psycho-vegetative status and markers of cardiovascular risk with high safety and good tolerance of the method.
In order to study the characteristics of the obstetric and gynecological history in women with preterm birth and to identify the most significant factors affecting premature termination of pregnancy, 297 cases of preterm birth were analyzed for a period of 22 to 37 weeks of gestation. In the group with preterm birth, statistically significantly more common were women with a history of miscarriage (31.4 %; p = 0.003), with a high parity of childbirth (more than three) (14.8 %; p = 0.0024), with overweight body and obesity of varying severity (37.3 %; p = 0.0012), anemia (58.9 %; p = 0.003), neck diseases with surgical treatment (17.1 %; p = 0.003), nonspecific vaginitis (18.2 %; p = 0.004), bacterial vaginosis (26.3 %; p = 0.002) and abnormalities of the uterus (4.0 %; p = 0.04). Pregnancy was most often complicated by placental insufficiency (63.6 %; p = 0.001), the threat of termination (59.2 %; p = 0.001), amniotic fluid pathology (37 %; p = 0.002) and preeclampsia (22.2 %; p = 0.024). 67 % of patients were noted with preterm birth, dysbiosis of the vaginal tract of varying severity.
Objective. To increase the effectiveness of early diagnosis and to develop a differentiated approach to the treatment of adolescent girls with primary dysmenorrhea (PD).
Material and methods. The study was conducted on 100 adolescent girls aged 15 to 17 years, diagnosed with primary dysmenorrhea, who were initially divided into study and control groups depending on the presence or absence of dysplasia of connective tissue (DCT). Then, to compare the two proposed treatment regimens, each group was divided by randomization into two subgroups. Basic therapy included drug NSAIDs and vitamin-mineral complex with a content of calcium 1 000 mg and vitamin D3 800 IU per day. The second scheme: the basic treatment was added to the drug L-carnitine 800 mg, affecting collagen formation. Self-assessment of menstrual pain was performed using McGill’s pain questionnaire. The levels of free hydroxyproline, MMP-2 and -9, tumor necrosis factor α, serum magnesium, autoantibodies IgG to cardiolipin, antinuclear antibodies were determined.
Results. In adolescent girls with DCT, the level of free blood hydroxyproline was almost two times higher than in patients with PD without DCT (276.78 ± 117.10 and 142.64 ± 90.40 ng/ml respectively to the groups; p < 0.05). In both groups, no cases of magnesium deficiency in the blood were detected. In the analysis of biochemical parameters in serum after treatment, in all groups all blood parameters significantly improved-free hydroxyproline decreased on average in 2.5 times, MMP in 3.0 times, TNF-α in 2.0 times, MMP-9 increased in 4.0 times and autoantibodies IgG to cardiolipin decreased on average in 4.0 times (p < 0.05).
Conclusions. The proposed PD therapy with NSAIDs and vitamin-mineral complex, including calcium and vitamin D, the effectiveness of which is confirmed not only by clinical data, but also by biochemical studies, it is advisable to appoint patients with PD, including those with signs of DST. The results of our own research and literature data allow us to recommend prophylactic intake of vitamin and mineral complex containing calcium and vitamin D to adolescent girls suffering from PD, to improve the quality of life, reduce the drug load and prevent reproductive disorders in the future.
The study was performed to find association between some cytokine status indicators, level of vascular endothelial growth factors and vitamin D in women with infertility and external genital endometriosis (EGE) in order to increase the effectiveness of its treatment. The low vitamin D status in the dynamics was determined in 240 patients aged 25 to 35 years with EGE planning pregnancy by determining the level of 25 (OH) D in the blood serum using the chemiluminescent method. Interleukin status (IL-1β, IL-6, IL-4), TNF-α, VEGFR-1 in blood serum was determined using enzyme-multiple immunoassay. The results of the studies revealed an increased level of IL-6, IL-1β and TNF-α in groups with low vitamin D content. In normal vitamin D significantly lower levels of vascular endothelial growth factor (VEGFR-1 ) in the blood serum were registered. Pregnancy rates were higher in groups with normal 25(OH)D levels in the blood serum. The mean serum VEGFR-1 level in pregnant women who became pregnant on their own was 1.3–1.5 times lower.
Introduction. Malignant neoplasms of the reproductive system dominate the structure of cancer incidence in women in the Russian Federation. In the structure of oncogynecological diseases, uterine body cancer (UBC) leads the way.
The purpose of the study: to analyze the dynamics of UBC incidence in the Omsk region in comparison with data for the Russian Federation in 2002–2018 years to determine the priorities of cancer prevention.
Results. There was a moderate tendency to increase the incidence of UBC in the region (Rg. = +1.8 %; p < 0.001) and for the Russian Federation (Rg. = +1.7 %; p < 0.001). The maximum percentage was among patients of 60–69 years old (32.3 %). There was a moderate trend in increasing UBC among women of 30–39 years old, and in the group of women of 35–39 years old there was a distinct trend in increasing the incidence (Rg. = +5.6 %; p < 0.050). The article presents the epidemiological features of UBC in comparison with cervical cancer in the region: the increase in the incidence of UBC (Rg. =+1.8 %) and the stability of the indicator at cervical cancer (Rg. = +0.050 %), the trend to rejuvenate both locations of cancer.
Conclusion. In Omsk Region, there is a unidirectional increase in the incidence of UBC with the Russian Federation, a trend in rejuvenating the disease, which dictates the need for cancer prevention in the practice of an obstetrician-gynecologist.
ISSN 2949-2807 (Online)
