Epidemiology of omphalocele: data analysis of regional congenital malformation registers in the Russian Federation

Omphalocele is a congenital malformation belonging to the group of abdominal wall defects. Objective. To determine the incidence of omphalocele and analyze its dynamics for the period 2011–2018 in the regions of the Russian Federation according to monitoring data of congenital anomalies. Materials and methods. Statistical analysis of omphalocele cases among newborns and fetuses with malformations for the period 2011–2018 in 22 regions of the Russian Federation was carried out. The incidence of malformations was calculated per 10,000 births. Results. A total of 1,073 cases of omphalocele were reported from 2011 to 2018, of which 69.34% were in fetuses eliminated due to the prenatal detection of malformation, 27.03% – in liveborn fetuses, and 3.63% – in stillborn fetuses. The male to female ratio was 1.56:1. The overall incidence of omphalocele was 2.95 (95% CI 2.77– 3.13) and the incidence among newborns excluding fetuses was 0.9 per 10,000 (95% CI 0.81– 1.01). There was a statistically significant positive time trend in the dynamics of the overall incidence of omphalocele between 2011 and 2018. Conclusion. The evaluation of the incidence of severe malformation – omphalocele – was obtained in different regions of the Russian Federation for the first time. The incidence of this malformation tended to increase over the study period. Male gender and maternal age over 35 years can be considered as risk factors. These results can be used in planning preventive measures. Key words: congenital malformation, monitoring, newborns, omphalocele, fetuses, incidence, epidemiology

Role of the audit of delivery methods for optimizing the indications for cesarean section and reducing its frequency in clinical practice

Objective. To analyze the frequency of indications for cesarean section (CS) and optimize obstetric tactics on the example of a level 3 perinatal center. Materials and methods. We performed retrospective analysis of 7,672 deliveries. Results. The indications for CS included abnormal labour (150; 6.3%), fetal distress (120; 5%), placental abruption (60; 3%), and narrow pelvis (34; 1.4%). Most often (23%) CS was performed in patients with CS scars. Conclusion. The most important step towards reducing the proportion of CS is the change of the approaches to the use of labour induction methods and assessment of the fetus condition. It is extremely important to develop a comprehensive strategy for choosing an optimal delivery method in women with post-CS scars, as well as to perform thorough analysis of the indications for planned and emergency CS. Key words: caesarean section, Robson classification, efficiency coefficient

Fetal growth restriction: unresolved issues of risk stratification, early diagnosis, and obstetric management

Fetal growth restriction (FGR) refers to pregnancy complications associated with an increased risk of perinatal morbidity and mortality and is defined in the Russian-language literature as the fetal size and weight retardation in relation to the norm for a given gestational age, and in the English-language literature – as the inability of the fetus to realize its genetically determined growth potential. FGR is the cause of 43% of stillbirths of unspecified etiology, and some cases remain undiagnosed even in high-risk populations due to the lack of universal diagnostic standards for this pathology. The review presents a critical analysis of the existing definitions of FGR, the latest data on risk factors, an assessment of diagnostic methods for its early and late forms, the prospects of using biomarkers and instrumental methods of examination in predicting adverse perinatal outcomes, and an algorithm for the management of pregnancy complicated by FGR. For a more complete coverage of the literature and deeper understanding of the nosology, attention is focused on FGR that is not accompanied by preeclampsia and other hypertensive disorders, which occur in about 30% of cases. Key words: placental insufficiency, fetometry, percentile, pulsatility index, fetal growth restriction For citation: Podzolkova N.M., Denisova Yu.V., Skvortsova M.Yu., Denisova T.V., Shovgenova D.S. Fetal growth restriction: unresolved issues of risk stratification, early diagnosis, and obstetric management. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2021; 20(5): 76–86. (In Russian). DOI: 10.20953/1726-1678-2021-5-76-86

Placenta as a target organ for maternal obesity

Maternal obesity is associated with pregnancy complications and increases the risk of obesity, diabetes, and cardiovascular diseases in children later in life. The risk of adverse perinatal outcomes in maternal obesity is associated with changes in placental function and morphological structure, including decidual arteriopathy and placental infarction, increased placental disc mass (>90th percentile) and chronic inflammation of villi with a decrease in their number. Maternal obesity is associated with placental hypoxia, intense angiogenesis, and increased levels of glucose and amino acid transporter transcripts, which can cause fetal metabolic disorders. It was found that maternal obesity more often leads to inflammatory changes in the placenta of female fetuses. The review describes the main adipokines operating in the maternal-placental-fetal system: leptin, adiponectin, chemerin, visfatin, resistin, and apelin. Conclusion. The analysis of the literature enabled to identify the main statements characterizing the placenta as a target organ and an organ that changes fetal metabolism in case of maternal obesity. This reveals the prospects for therapeutic intervention since timely initiated dietary correction of obesity can improve the course and prognosis of pregnancy and reduce the risk of adverse effects of intrauterine factors on the fetus. Key words: adipokines, maternal obesity, fetal metabolic disorders, perinatal outcomes

Twin-to-twin transfusion syndrome. A 15-year experience in using fetoscopic therapy

This article presents the aspects of fetoscopic laser coagulation of anastomoses (FLCA) for treatment of twin-to-twin transfusion syndrome in the Russian Federation and worldwide. Own experience is correlated with the world one. There is a significant need for domestic medicine to increase the number of clinics that provide this type of intervention. Nevertheless, there is no obvious lag in comparing the results of FLCA in the Russian Federation. Key words: monochorionic pregnancy, fetoscopy, laser coagulation of anastomoses, twin-to-twin transfusion syndrome

Miscarriage in patients with chronic endometritis and luteal phase deficiency. Principles of treatment and prevention

Permanent inflammation of the endometrium against the background of altered vaginal microbiota is accompanied by a violation of cyclic tissue changes. The revealed deficiency of the secretory phase of the cycle was formed independently of the synthesis of progesterone by the corpus luteum and led to impaired embryo implantation and miscarriage. Objective. To evaluate the efficiency of dydrogesterone in miscarriage in patients with chronic endometritis (CE) with luteal phase deficiency. Patients and methods. The study involved 127 women aged 25 to 40 years non-pregnant and during pregnancy with biopsyverified deficiency of the luteal phase of the cycle and CE of varying degrees of activity according to immunohistochemistry data. Women from group 1 (n = 83) continuously received dydrogesterone in a cyclic regimen from the moment of diagnosis until the 21st week of pregnancy; women from group 2 (n = 44) received dydrogesterone for 4 months of CE treatment, then it was discontinued and resumed again from the onset of pregnancy until the 21st week. Conclusion. There was no normalization of the structure of the endometrium after CE treatment with dydrogesterone removal from therapy in women with miscarriage and deficiency of the luteal phase of the cycle. Administration of dydrogesterone in a cyclic regimen with pregravid preparation before pregnancy, regardless of the initial level of progesterone in the blood, by women with miscarriage, CE and luteal phase deficiency contributes to normalization of morphological state of the endometrium in most patients, to significant decrease in the frequency of early miscarriage and duration of in-patient treatment, in contrast to women who canceled dydrogesterone. Key words: dydrogesterone, luteal phase deficiency, recurrent miscarriage, chronic endometritis

Assessment of the carotenoid pool using resonance Raman spectroscopy in pregnant women with preeclampsia

Objective. To assess the performance of resonance Raman spectroscopy in the evaluation of the carotenoid pool (antioxidants) in plasma of pregnant women with preeclampsia (PE). Patients and methods. We examined 60 pregnant women aged between 21 and 41 years, including 30 women with moderate PE, 18 women with severe PE, and 12 women with normal pregnancy. We used Raman spectroscopy to analyze serum specimens. Results. We evaluated diagnostic accuracy of Raman spectroscopy (as a method of express diagnostics) and measured normalized integrated Raman scattering intensity for carotenoids in women with moderate preeclampsia (5.0 ± 0.2), severe preeclampsia (6.1 ± 0.3) and normal pregnancy (10.1 ± 0.6). We also separated Raman luminescent spectra of plasma specimens obtained from patients in different groups: the accuracy of distinguishing between normal pregnancy and PE was 96%, while the accuracy of distinguishing between moderate PE and severe PE was 72%. Conclusion. Raman spectroscopy is a relatively simple, but highly effective method for rapid estimation of carotenoid levels in plasma of pregnant women with various grades of PE. Our findings suggest that Raman spectroscopy is a good method of preclinical diagnosis and prognosis of PE, particularly in women at high risk. Key words: carotenoids, discriminant analysis, preeclampsia, Raman spectroscopy, rapid diagnostics

Non-hormonal treatment for genitourinary syndrome of menopause

The genitourinary syndrome of menopause (GSM) is due to the development of atrophic and dystrophic processes in estrogendependent tissues and structures of the lower third of urinary tract in different periods of aging of the reproductive system. Nonhormonal treatment for GSM is considered as a first-line treatment and includes the use of gels, creams and suppositories that contribute to the restoration of hydrolipid balance, stimulating the collagen production that have an anti-inflammatory, antiseptic, regenerating effect, as well as increasing mucosal resistance and reducing the risk of adhesion of conditionally pathogenic infection. Objective. To evaluate the effectiveness, safety and acceptability of the vaginal cream for intimate hygiene EstrogialTM Plus in women with symptoms of vulvovaginal atrophy (VVA) and GSM. Patients and methods. 24 women aged 43 to 58 were examined. The inclusion criteria were the symptoms of GSM and VVA, the vaginal health index – no more than 20 points. During the course of the study, four visits were carried out, including standard observational procedures, filling the Quality of Life Questionnaire, the administration of treatment. The application of the cream Estrogial™ Plus in doses was prescribed 1 time per day on the vulvar vestibule for 30 days. The effectiveness of therapy was evaluated, all patients continued therapy for up to 60 days. According to the modified questionnaire for general clinical assessment, the state «very much improved» was revealed in 83.3% of patients with a severe form of GSM and VVA and in 66.7% with moderate VVA, «much improved» – in the rest. After treatment, 52% of patients had no symptoms of VVA, and 48% had symptoms in a mild form. Filling the Menopause-Specific Quality of Life Questionnaire (MENQOL), all 24 patients reported positive effects in the form of increased libido and reduced vaginal dryness during sexual intercourses. The study presents clinical cases of cured patients with GSM and VVA. Conclusion. The data obtained during the study make it possible to conclude that the intravaginal administration of the cream EstrogialTM Plus in doses is effective for the treatment of GSM and VVA. The proven therapeutic effects and safety of the use of local non-hormonal treatment enhance the prospects for providing treatment and preventive care for women during the menopausal transition and menopause. Key words: vulvovaginal atrophy, genitourinary syndrome of menopause, non-hormonal treatment, Estrogial™ Plus

Oral probiotics in women's health: experimental evidence and results from clinical trials

The review presents data from experimental research of the anti-inflammatory activity of Lactobacillus paracasei, L. plantarum, L. rhamnosus, the antitumor activity of L. rhamnosus GG and GR-1, L. gasseri, L. crispatus. The prospect of using probiotics in cancer treatment regimens with the aim to increase the tolerability of treatment was considered. The data confirming the ability of probiotic lactobacilli (L. reuteri and L. rhamnosus) to enhance barrier functions of endometrial epithelial cells in response to human papillomavirus-1 were presented. The perspectives of using microbiota modulation to prevent and/or protect the reproductive system against infection were discussed. The data of clinical trials using multi-strain probiotics containing Lactobacillus and Bifidobacterium in women with gestational diabetes were analyzed. A hypothesis on the role of microbiota in the pathogenesis of polycystic ovary syndrome (PCOS) was presented. Research results suggest that the use of probiotics can increase fertility in PCOS. Key words: viral infections, gestational diabetes mellitus, gynecological cancer, oral probiotics, polycystic ovary syndrome, Lactobacillus spp.

Clinical and pharmacological rationale for principles of therapy for bacterial vaginosis

Metronidazole and clindamycin have been the main medications for the treatment of bacterial vaginosis (BV) for 60 years. Despite the available arsenal of therapeutic agents, the frequency of disease recurrence remains high, and therefore the search for new therapeutic approaches remains relevant. In 2017, the FDA (Food and Drug Administration, USA) approved the use of secnidazole for the treatment of BV. As a member of the 5-nitroimidazole group, secnidazole differs structurally from metronidazole and tinidazole by radical groups attached to the annular nitrogen next to the nitro group. Structural differences may explain physicochemical and biochemical differences (e.g., tissue distribution, metabolic pathways) between these agents within the same pharmacological class of 5-nitroimidazoles. Secnidazole has the longest half-life compared to other medications in this group, which can significantly increase adherence to treatment, due to the possibility of achieving a clinical effect after a single use and a low incidence of adverse drug reactions, comparable to placebo. Key words: bacterial vaginosis, gardnerella vaginalis, lactobacilli, metronidazole, secnidazole