Vol 22, No 5 (2020)


Dynamics of the epidemic process and the course of the COVID-19 in pregnant women of the Far Eastern and Siberian Federal Districts

Belokrinitskaya T.E., Artymuk N.V., Filippov O.S., Shifman E.M.


The objective of the study was to evaluate an epidemiological characteristic and the course of COVID-19 in pregnant women from the Far East and Siberian Federal Districts of Russia.

Materials and methods. The analysis of operational information on the incidence of COVID-19 and the its features in pregnant women and after childbirth provided by the chief obstetrician-gynecologists of the Far Eastern Federal District and Siberian Federal District on May 25, 2020 and August 25, 2020 is carried out. Mathematical analysis included descriptive statistics methods, analysis of contingency tables, where the χ2 value, the achieved significance level (p)

Results. On August 25, 2020, 2010 cases of COVID-19 in pregnant women were detected in two subjects, including 134 active cases. In the population, the proportion of pregnant women among cases of COVID-19 was 1.45%. Pneumonia in pregnant women was registered in 44.8% of cases, severe course of the disease - in 3.7%, hospitalization in RAW - in 1.9% of cases, mechanical ventilation - 0. In the population, pneumonia was registered in 24.4% of cases, hospitalized in RAW - 2.1%, on mechanical ventilation - 0.77%. The incidence in pregnant women was 1464.7 per 100 000 (in the population - 591.8 per 100 000). 23 (1.76%) COVID-19 (+) newborns were identified, despite preventive measures and separation of mother and child immediately after childbirth, which does not exclude vertical transmission of the disease. Maternal mortality was 2 cases (0.1%) vs population mortality 1.49%. Perinatal mortality was 7 cases (0.35%). There were 5 (0.25%) stillbirths. Early neonatal mortality was 2 (0.1%) cases.

Conclusion. The incidence of COVID-19 in pregnant women in the Far East and Siberia is higher than in the general population with a higher incidence of pneumonia, but a milder course: less need for ICU, mechanical ventilation and mortality. 23 cases of SARSCoV-2-positive newborns, despite the separation of mother and child, do not exclude the possibility of vertical transmission of infection.

Keywords: COVID-19, pregnancy, epidemiology, incidence, pneumonia, mortality

Gynecology. 2020;22(5):6-11
pages 6-11 views

The result of 10 years of experience in monitoring indicators of infant and perinatal mortality in Khabarovsk Krai

Pestrikova T.Y.


Aim. To evaluate the effectiveness of the obstetric care service in Khabarovsk Krai, based on a comparison of the dynamics of infant and perinatal mortality rates for the period 2009–2018.

Materials and methods. A comparative analysis of official statistics of the Ministry of Health of Khabarovsk Krai and other territories of the Far Eastern Federal District was carried out using the Rosstat database for the period 2009–2018, taking into account the indicators of infant, perinatal mortality, and preterm birth. The trend of the dynamics was determined in the process of graphical analysis of the chart and by modeling trends. The results of the studies were subjected to methods of statistical processing of information.

Results. The results revealed in our study indicate that over the 10-year interval, the infant and perinatal mortality rates in Khabarovsk Krai decreased by 2 times, the rate of decrease was higher than similar processes in the Far Eastern Federal District and the Russian Federation. A graphical representation of infant and perinatal mortality rates underlines the instability of these values in Khabarovsk Krai. Тhe decrease in infant and perinatal mortality in Khabarovsk Krai is mainly due to a decrease in early neonatal mortality. The ratio of stillbirth to early neonatal mortality indicates an excess of stillbirth by 7.88 and 6.95 times in 2017–2018. The relatively high stillbirth rate in Khabarovsk Krai indicates the instability of the results in providing assistance to pregnant women and women in childbirth.

Conclusion. The infant mortality rate is the main quality indicator recommended by WHO for assessing the level of care. This indicator must be considered in conjunction with the indicator of perinatal mortality, especially its constituent components of stillbirth and early neonatal mortality, namely the ratio of stillbirth to early neonatal mortality. The deformation of this proportion towards a multiple increase in stillbirth, against the background of a progressive decrease in early neonatal mortality, indicates the presence of an inadequate assessment of the organization of medical care in the obstetric care service.

Gynecology. 2020;22(5):12-16
pages 12-16 views

A prognostic model to calculate the probability of severe preeclampsia in healthy young reproductive age woman

Frolova N.I., Belokrinitskaya T.E., Kolmakova K.A.


Aim. To develop the prognostic model to calculate the probability of severe preeclampsia in healthy young reproductive age woman.

Materials and methods. This study included two groups of healthy women aged 18–35 years with spontaneous singleton pregnancy: 100 patients with severe preeclampsia (patient group), and 100 women with non-complicated pregnancy (control group). All women had not a risk factors of preeclampsia such as history of hypertension, autoimmune, metabolic, renal, or cardiac diseases, and family or individual history preeclampsia or thromboembolism before this pregnancy. Their body mass index in the 1-st trimester of gestation was <35 kg/sq. m. Gene polymorphisms were detected using the polymerase chain reaction-real time technique. The data were analyzed with methods of binary and multifactorial mathematical statistics. Our analysis of the predictive models was performed by using logistic regression. To determine the diagnostic value of the predictive models used the ROC-curve is followed by determining the area under it (AUC).

Results. Some prognostic models to calculate the probability of severe preeclampsia were build using an anamnestic, clinical and genotypic characteristics and multifactorial analysis. Combination of genotypes AGTR2-1675АA/eNOS3-786СC; tobacco smoking; bacteriuria; acute respiratory infections and/or acute vulvovaginitis during 2–3 trimester of gestation were determinate as most informative predictors of severe preeclampsia. Logistic model included three predictors: bacteriuria; acute respiratory infections and/or acute vulvovaginitis during 2–3 trimester of gestation had higher prognostic value. ROC analysis identified a high specificity (89.58%) and sensitivity (76.47%) of the model, and the integral index of the effectiveness of predictive markers (AUC=0.885), according to the expert scale of values which is indicative of a very high quality model.

Conclusion. It is recommended to use this elaborated predictive model for the purpose of individual risk assessment of severe preeclampsia in healthy young reproductive age woman.

Gynecology. 2020;22(5):17-21
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The efficacy and safety of using the topical medicine with combined action in patients with opportunistic vaginal infections

Prilepskaya V.N., Bairamova G.R., Mezhevitinova E.A., Donnikov A.E., Trofimov D.Y., Ivanets T.Y., Kukes I.V.


Relevance. Infections of the lower genital tract are one of the most common reasons for women to visit a gynecologist. According to various authors, among all vulvovaginitis, the highest percentage of patients visiting a doctor is bacterial vaginosis (20–50%), vulvovaginal candidiasis (17–39%), trichomoniasis (10%) and other genital infections (10%). In the management of patients with infectious processes of the genitals, the choice of the method of therapy is of great importance, which allows not only to influence the microbes-associates, detected in high concentrations in the woman’s vagina during the initial episode of the disease, but also to prevent the development of relapses.

Aim. To evaluate the clinical and laboratory efficacy, adherence and long-term results of benzydamine use in patients with vulvovaginal candidiasis, aerobic vaginitis and bacterial vaginosis

Materials and methods. The study included 31 women aged 18 to 49 years, who complained of abundant discharge from the genital tract, itching, burning, dyspareunia. A comprehensive clinical and laboratory examination was carried out, including the collection of anamnestic data, general and special gynecological examination, microscopy of vaginal smears, KOH test, determination of the pH of the vaginal environment, assessment of vaginal microbiocenosis by quantitative PCR in real time. All patients were prescribed benzydamine hydrochloride, which was used as monotherapy in the form of a vaginal solution according to the recommended treatment regimen specified in the instructions for medical use of the drug Tantum® Rosa 1 (irrigation 2 times a day for 10 days).

Results. In 12–19 days after beginning treatment, 25 (80.6%) of 31 patients with laboratory signs of vaginal microflora alterations showed restoration of the normal vaginal biocenosis laboratory parameters. Of them, 8 patients initially had dysbiosis, 12 patients – yeast-like fungi, 4 patients – aerobic vaginitis and 1 patient – a combination of dysbiosis and fungi. Herewith, all patients also noted clinical signs of improvement. In 12–19 days after beginning treatment, 6 (1.4%) of 31 patients with laboratory signs of vaginal biocenosis alterations had unsatisfactory laboratory parameters; that is vaginal biocenosis alterations (a decrease in Lactobacillus spp. percentage). At the same time, there were no clinical signs of pronounced inflammation such as pathological discharge, hyperemia, vaginal swelling.

Conclusion. Benzydamine hydrochloride can be widely used in gynecological practice due to its combined effects on inflammation of the vagina, good clinical and microbiological results. It is important to note that additional therapy with drugs which contain lactobacilli is required only in 19.4% of cases. The clinical and laboratory effectiveness of benzydamine hydrochloride (Tantum® Rosa) was 96.8%, since the relapse rate after 30–60 days of the study did not exceed 3.2%.

Gynecology. 2020;22(5):22-26
pages 22-26 views

Features of the ovarian reserve of women of reproductive age suffering from autoimmune diseases

Andreeva E.N., Grigoryan O.R., Absatarova Y.S., Yarovaya I.S., Mikheev R.K.


The reproductive potential of a woman depends on indicators of the ovarian reserve, such as the anti-Muller hormone (AMH) and the number of antral follicles (NAF). Autoimmune diseases have a significant effect on fertility and contribute to the development of premature ovarian failure.

Aim. To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women.

Materials and methods. In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women.

Results. In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found.

Conclusion. The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.

Gynecology. 2020;22(5):27-30
pages 27-30 views

Promising directions of medical technologies for the correction of sleep disorders in menopausal women of various ethnic groups

Semenova N.V., Madaeva I.M., Kolesnikova L.I.


ethnic groups.

Materials and methods. The objects of the study were menopausal women of Russian and Buryat ethnic groups (n=466), who were divided into a control group (without sleep disturbances) and main subgroups (with insomnia and comorbidity of insomnia with obstructive sleep apnea syndrome). All women underwent clinical and anamnestic examination, genotyping for 3111T/C Clock gene polymorphism, determination of the circadian profile of melatonin secretion, parameters of lipid metabolism and the system «lipid peroxidation – antioxidant protection».

Results. In Caucasians with sleep disorders, a higher prevalence of the 3111T/T genotype and the Clock gene 3111T allele was revealed as compared to the control (p<0.05). Perimenopausal Caucasians showed a shift in the peak of melatonin secretion to the morning hours; in Mongoloids, both peri- and postmenopausal women, a decrease in melatonin total levels was revealed. Dyslipoproteinemia is characteristic of both races patients who have comorbidity of insomnia and obstructive sleep apnea syndrome, and it is more pronounced in postmenopausal Caucasians. Oxidative stress in sleep disorders is more pronounced in Mongoloids. The medical technologies directions for correction of sleep disorders are proposed: the use of melatonin drugs in the evening and light therapy in the early morning hours in Caucasians who are carriers of the 3111T Clock gene allele; melatonin drugs to increase its total level in Mongoloids; personalized prescription of antioxidant therapy in all patients; specific therapy to eliminate breathing disorders during sleep in those who have obstructive sleep apnea syndrome.

Conclusions. Presence of insomnia, chronobiological rhythms of melatonin secretion, lipid peroxidation processes in sleep disorders are ethnospecific.

Gynecology. 2020;22(5):31-36
pages 31-36 views


Vaginal bleeding during menopause hormone therapy. Is it always endometrial cancer? How to choose the appropriate tactics for examination and management of patients?

Protasova A.E., Solntseva I.A., Vandeeva E.N.


The article provides an overview of the possible causes of bleeding from the genital tract in peri- and postmenopausal women. The correct approach to patients with abnormal uterine bleeding during menopausal hormone therapy is described. A modern analysis of data on the diagnosis and treatment of postmenopausal vaginal bleeding against the background of menopausal hormone therapy was carried out. The modern possibilities of endometrial diagnostics and treatment are shown.

Gynecology. 2020;22(5):37-43
pages 37-43 views

Ovarian endometriosis associated infertility: a modern view to the problem

Orazov M.R., Khamoshina M.B., Abitova M.Z., Mikhaleva L.M., Volkova S.V., Aryutin D.G., Shustova V.B.


This review summarizes current understanding of the pathogenesis of one of the most common forms of external genital endometriosis – ovarian endometrioma’s. Due to their frequent occurrence in young women of reproductive age and extremely negative impact on the morphophysiological state of the ovaries, this disease makes a significant contribution to the structure of endometriosis-associated infertility. The main determinant of the negative effect of ovarian endometrioma’s on reproductive function is a decrease in ovarian reserve, which can occur either due to the direct gonadotoxic effect of the endometriod cyst itself, or due to the unintentional removal of healthy ovarian tissue during surgery or the use of aggressive methods of electrosurgery. Hence, the question of methods for achieving hemostasis during surgery in terms of iatrogenic effects on healthy ovarian tissue is debatable. The management strategy for patients with infertility associated with ovarian endometriosis consists of two components: surgical treatment and/or the use of assisted reproductive technologies. Laparoscopic cystectomy is indicated for cysts larger than 3 cm. Repeated surgical interventions in case of endometriosis do not improve fertility outcomes. Assisted reproductive technologies methods should be considered as a priority tactic in patients of older reproductive age with low ovarian reserve indicators or infertility duration of more than 2 years, as well as in cases of recurrent ovarian endometrioma’s. Management of such patients must be personalized and take into account the age, state of the ovarian reserve, duration of infertility, stage and number of surgical interventions for this disease.

Gynecology. 2020;22(5):44-49
pages 44-49 views

Deep infiltrative endometriosis. Contentious issues: pros and cons

Rusina E.I., Yarmolinskaya M.I., Piankova V.O.


Relevance. Deep infiltrative endometriosis (DIE) is a particular form of endometriosis with a more severe symptoms and dysfunction of the neighboring organs. Inspite of the fact that in recent years, much had been done to understand the pathogenesis of the disease and its associated symptoms; there are still several unresolved issues.

Aim. To describe debated issues of pathogenesis and management of patients with DIE using current data.

Materials and methods. Foreign and domestic scientific articles on this topic that is available in PubMed database and on Internet resources have been examined over the past 5 years.

Results. The review consisted of a system analysis of data on the pathogenesis of pain, infertility, the choice of conservative or surgical treatment in dealing with specific problems of managing patients with DIE.

Conclusion. Despite there are different options of managing and treating, most specialists agree that the treatment strategy should be based on the assumption that it is a chronic recurrent disease. The treatment choice should be personal depending on the severity of symptoms, dysfunction of the neighboring organs affected by endometriosis, such as the intestines, bladder, ureters, as well as the woman’s age and reproductive life plans. Depending on the clinical case, it is possible to use various regimens of conservative management. Surgical management planning should be highly balanced. A radical surgery with removing foci of endometriosis performed by an experienced surgeon in a specialized hospital in coupled with pharmacotherapy and assisted reproductive technologies increases the patient’s chances of pregnancy, a healthy childbearing. Subsequent combination therapy provides a long-term remission. Pregnancy and childbirth in patients with deep infiltrative endometriosis should be considered as a high risk condition for the severe complications.

Gynecology. 2020;22(5):50-56
pages 50-56 views

Current views on the molecular mechanisms of the initial stages of folliculogenesis

Marchenko L.A., Mashaeva R.I., Chernukha G.E.


The ovary is a unique structure of the female body, which simultaneously presents various morphohistological units-from primordial to dominant follicles. Over the past decades, scientists have focused on studying the mechanisms of folliculogenesis at the gonadotropin-dependent stage. While more complex and lengthy processes that determine the fate of the follicle occur from the moment of their recruitment to the preantral stage of maturity (about 290 days), another 60 days pass before the dominant maturity. Currently, it has been proved that intercellular communication is established within the follicle, which involves a bidirectional exchange of information between the oocyte and its “companions” – granulose and Teka cells through auto-and paracrine interactions using various genes, growth factors and cytokines. The purpose of this review was to study intrafollicular factors that control the early stages of folliculogenesis and other disorders that may ultimately lead to the development of premature ovarian failure.

Gynecology. 2020;22(5):57-60
pages 57-60 views

Omega-3 polyunsaturated fatty acids in supporting pregnancy and fetal development: dosing considerations

Gromova O.A., Torshin I.I., Grishina T.R., Maliavskaia S.I.


Being complex regulators of inflammation processes omega-3-polyunsaturated fatty acids (PUFAs) are vitally important for supporting pregnancy and fetal development. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are the most important omega-3-PUFAs. The article presents the results of a systematic analysis of 1973 studies of dose-dependent effects of DHA and EPA in nutritional support of pregnancy. The analysis results suggest that DHA/EPA donations for pregnant women are effective only in doses of at least 200 mg/day. According to the analysis results, the optimal doses of DHA/EPA are in the 400- to 800-mg/day range. The dose of omega-3-PUFA for a particular patient can be assessed by the measurement of the DHA and EPA levels in the erythrocyte membrane. To achieve specific therapeutic effects (for example, lowering triglyceride levels, therapy for postpartum depression, etc.), higher doses of omega-3-PUFAs (3–5 g/day) may be required. With an adequate choice of dosing regimen, DHA / EPA donations have a beneficial effect on the somatic health of women of reproductive age, help to prevent pregnancy complications and determine the child development program in the subsequent years of life. DHA/EPA drugs are effective in the adjuvant therapy of various chronic disorders.

Gynecology. 2020;22(5):61-69
pages 61-69 views

Cesarean scar defect: terminological aspects

Martynov S.A., Adamyan L.V.


The review aim was to summarize information and to provide terminological analysis of the foreign and Russian literature on assessing the status of the uterine scar after a caesarean section, as well as to identify terms that are most appropriate to use out and during pregnancy, in childbirth and in the postpartum period.

Gynecology. 2020;22(5):70-75
pages 70-75 views


Recurrent vulvovaginitis and vaginosis. Possibilities of effective therapy

Prilepskaya V.N., Uruimagova A.T., Ivanova A.A.


Infectious and inflammatory diseases of the genitals caused by various opportunistic and pathogenic microorganisms arefound in 70% of all gynecological patients who seek help from medical institutions. Currently, scientists and clinicians in their practice are increasingly faced with insufficient effectiveness of treatment of vulvovaginitis and vaginosis, a tendency to a long and protracted course, recurrence of the process. One of the reasons for the longer and more severe course, the recurrence of the process is the increasingly common mixed infection with the possible simultaneous predominance of aerobes, anaerobes, and Candida fungi, which suggests the appointment of appropriate drugs. One of these drugs is Tergynan, which demonstrates a good clinical effect and tolerability of the drug in the treatment of recurrent vulvovaginitis and dysbiotic conditions of the lower genital tract.

Gynecology. 2020;22(5):76-80
pages 76-80 views


Experience of pyomyoma treatment

Gabidullina R.I., Mingazetdinov M.A., Druzhkowa E.B., Sirmatova L.I.


Uterine pyomyoma is a rare and dangerous complication of uterine fibroids, which develops as a result of myomatous node infarction with the addition of an infectious component. In the literature there are descriptions of 50 cases of pyomyomas, half of which are associated with pregnancy. Incorrect diagnosis, lack of antibacterial and surgical treatment can lead to death of the patient. This article describes a clinical case of uterine piomioma development after the first birth by Caesarean section. Method of uterine artery embolization in combination with antibiotic therapy has helped keep the uterus of a young woman. On subsequent observation, menstrual function has fully recovered.

Gynecology. 2020;22(5):81-83
pages 81-83 views

Pelvic schwannoma

Sinchikhin S.P., Magakyan S.G., Magakyan O.G.


Relevance. A neoplasm originated from the myelonic sheath of the nerve trunk is called neurinoma or neurilemmoma, neurinoma, schwannoglioma, schwannoma. This tumor can cause compression and dysfunction of adjacent tissues and organs. The most common are the auditory nerve neurinomas (1 case per 100 000 population per year), the brain and spinal cord neurinomas are rare. In the world literature, there is no information on the occurrences of this tumor in the pelvic region.

Description. Presented below is a clinical observation of a 30-year-old patient who was scheduled for myomectomy. During laparoscopy, an unusual tumor of the small pelvis was found and radically removed. A morphological study allowed to identify the remote neoplasm as a neuroma. 

Conclusion. The presented practical case shows that any tumor can hide under a clinical «mask» of another disease. The qualification of the doctor performing laparoscopic myomectomy should be sufficient to carry out, if necessary, another surgical volume.

Gynecology. 2020;22(5):84-86
pages 84-86 views

Vitamin D deficiency and iron deficiency anemia in women in menopausal transition period. Clinical case

Tatarova N.A., Airapetian M.S.


Vitamin D is a regulator of immune response, and plays a role in the development of cardiovascular diseases, insulin resistance and diabetes mellitus, obesity, autoimmune disorders, iron binding, anemia, respiratory viral and other diseases. In addition, vitamin D deficiency contributes to the chronicity of infections and an increased risk for number of oncological pathology. The developing immunosuppression in women with iron deficiency anemia in the menopausal transition period does not allow to fully compensate for iron deficiency with monotherapy if vitamin D deficiency is present. The drug of choice in this situation is micellized (water-soluble) vitamin D(Aquadetrim®).

Gynecology. 2020;22(5):87-90
pages 87-90 views

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