Vol 22, No 5 (2020)

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

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.

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.

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.

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.

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.

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.

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.

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 D₃ (Aquadetrim^®).