Vol 22, No 2 (2020)

Relevance. On February 11, 2020, the World Health Organization (WHO) gave the official name for the disease caused by the SARS-CoV-2 coronavirus – COVID-19 (Coronavirus disease 2019), and on March 11, 2020, the Director-General (WHO) stated that the world the community is facing a new pandemic. The rapid spread of this disease requires new knowledge on its diagnosis and treatment. At the same time, it must be remembered that 30–40% of the entire world population is sick with other acute respiratory viral diseases every year. In our country, annually from 27 to 41 million cases of acute respiratory viral infection (ARVI), acute respiratory disease (ARI) and flu are recorded. Based on the foregoing, the authors set a goal – on the basis of modern data to form the theoretical basis for obstetrician-gynecologists for practical work with pregnant patients with new coronavirus infection and respiratory viral diseases.

Materials and methods. The information material includes data from foreign and domestic scientific articles available in Pubmed and Internet resources on this topic, published over the past 5 years.

Results. A systematic analysis of the data contained in the modern literature on various infectious and inflammatory diseases of the respiratory system and COVID-19 has been carried out. Historical information on pandemics associated with respiratory diseases is presented. Clinical features of the course of acute respiratory viral diseases, flu and coronavirus infection, as well as various types of pneumonia, were noted. Attention is drawn to the importance of carrying out preventive measures to prevent the spread of infections. Introduced obstetric management of pregnant women with a new coronavirus disease. Part of the information is presented in the form of tables and figures summarizing the analyzed material, which makes the information presented especially memorable.

Conclusion. It is hoped that the prepared lecture will not only enhance information and educational knowledge, but will also be useful for the work of an obstetrician-gynecologist, including in the epidemiological period that is unfavorable for respiratory viral diseases.

Aim. Aim of the study was to the effectiveness of various endometrial preparation protocols in IVF frozen embryo transfer cycles.

Materials and methods. The study included 288 women, which were stratified into two groups depending on the onset of pregnancy: group 1 – pregnancy + (n=92), group 2 – pregnancy - (n=196). Then endometrium preparation features were evaluated.

Results. The pregnancy rate after frozen-thawed embryo transfer was a bit higher in the natural menstrual cycle (41.2%) compared to the hormonal replacement therapy (30.0%); p=0.083. There were no significant differences in the use of various estrogen and progestogen drugs, the average estrogen dose, progestogen administration and the endometrium thickness. In the natural cycle, the odds ratio of pregnancy with the duration menstrual cycle from 28 to 30 days was 4.25 (95% CI 1.15; 17.23).

Conclusion. Thus, the pregnancy rate is slightly higher in natural cycle frozen-thawed embryo transfer. However, the duration of the menstrual cycle (from 28 to 30 days) has a key effect on the effectiveness of the IVF program in this case.

According to the World Health Organization, about 2 million new couples experience infertility annually, and their number is growing. An effective way to overcome infertility is assisted reproductive technology (ART). Cryopreservation will rationally solve the issue of preservation and further use of embryos: to delay pregnancy for some time considering woman’s desire and to prevent ovarian hyperstimulation syndrome. Embryo freezing allows to reduce the rate of repeated ovarian stimulation and perform preimplantation genetic diagnosis. Over the past decades, various cryotransfer options have been proposed to increase ART treatment efficacy, including the use of a culture medium with a high concentration of hyaluronic acid, but there are conflicting data on the use of such a medium in ART programs.

Aim. Evaluation of thawed embryo transfers efficacy using the hyaluronic acid-containing culture medium. To achieve the goal, the following tasks were set: to evaluate clinical and medical history data of patients with tubal infertility in cryoprotocols, to analyze the previous cycle of in vitro fertilization and embryological stage, to evaluate the effectiveness of the culture medium with a high content of hyaluronic acid.

Materials and methods. A detailed description of the patient sample, inclusion and exclusion criteria, embryological stage, embryo grading, devitrified embryo transfer technique. The article includes 3 tables which present the groups’ general clinical characteristics, the embryological stage, the rate of pregnancy, depending on the cultivation day.

Results. The authors established that in patients with a history of pelvic surgery and sexually transmitted infections, it is advisable to use the culture medium with a high content of hyaluronic acid to transfer the thawed embryo. It was shown that pregnancy rate is 1.5 times higher when transferring devitrified embryos on the 5th day of development with the use of hyaluronic acid-containing culture medium.

The conclusion about the pregnancy rate in obese patients is not indisputable, which requires further study. The authors also provide practical recommendations on the use of the culture medium with hyaluronic acid in cryoprotocols.

Conclusion. The study allows to optimize the devitrified embryo transfer in patients with tubal infertility using a culture medium with a high content of hyaluronan. This work has undoubted scientific and practical significance.

Multiple sclerosis (MS) is a chronic autoimmune disease characterized by the formation of lesions in the white matter as a result of autoimmune inflammation, neurodegeneration and demyelination and leading to severe disability of patients. Women get sick more often than men; young women of reproductive age account for about 2/3 of all MS patients. It was established that pregnancy and childbirth with MS have a beneficial effect on the course of the disease, however, patients with MS need pregravid preparation, which will reduce the risk of exacerbations. Exacerbations are observed in most cases during the first 3–6 months of the postpartum period, which is associated with a change in hormonal status, emotional and physical stress on the woman’s body, and also with the cessation of physiological immunosuppression in a pregnant woman. The analysis of modern literature sources on the issues of pregravid preparation, pregnancy and childbirth, and the features of postpartum period in multiple sclerosis, as well as new ideas concerning the disease etiology and pathogenesis. 47 literature sources (national and foreign) were analyzed using various databases (PubMed, PubMed Central, Google Scholar, UpToDate).

The article presents a clinical case of delayed puberty in a 13-year-old girl with Fanconi anemia who was sent to the Department of gynecology of children and adolescents for removal of the sexual glands due to the detection of a Y-chromosome in the karyotype at the place of residence. A personalized multidisciplinary approach to the management of a patient with Fanconi anemia with the presence of the Y-chromosome in the karyotype against the background of delayed puberty allowed to identify iatrogenic chimerism and avoid unjustified castration.

The article presents the modern view on pathogenetic mechanisms of the cholelithiasis development in women, illustrated by clinical observations. Gender-associated risk factors for cholelithiasis are pregnancy and childbirth, female sex hormones administration and polycystic ovary syndrome. The gallstone disease risk factors in women taking hormonal oral contraceptives and menopausal hormone therapy are hereditary predisposition, impaired lipid, carbohydrate metabolism and functional gallbladder disorders. Patients at high risk of developing cholelithiasis are recommended to perform a gallbladder ultrasound examination before and during hormonal therapy. The ursodeoxycholic acid treatment is safe, effective and compatible with female sex hormone administration in patients with detected biliary sludge.