Journal of obstetrics and women's diseases

BACKGROUND: Symphysis pubis dysfunction is a pregnancy complication with significant statistical variations in incidence due to the lack of clear diagnostic criteria and overdiagnosis. One of the causes of this complication is excessive relaxin production, which induces structural changes in the fibrocartilaginous disc and resorption of the symphyseal margins. During normal pregnancy, this discrepancy is insignificant and amounts to 2–3 mm by the end of the third trimester; it is adaptive in nature, while facilitating the unimpeded passage of the fetus through the mother’s birth canal. However, if the pubic joint is excessively relaxed, it becomes unstable, with discomfort and lumbar or pelvic girdle pain appearing. To diagnose subluxation of the symphysis pubis, various provocative tests, echography, and radiography of the pubic joint are performed. However, the degree of discrepancy in the echographic picture rarely correlates with the severity of the clinical picture.

AIM: The aim of this study was to identify risk factors for symphysis pubis dysfunction and assess its ultrasound diagnostic criteria.

METHODS: We analyzed 40 medical histories of pregnant women with symphysis pubis dysfunction and 50 medical histories of those without the pathology. Risk factors were assessed and ultrasound diagnostics of the pubic joint was performed in all women before and after childbirth using Voluson 730 and Logiq 9 expert-class devices in three-dimensional mode with the 5–10 MHz linear sensor.

RESULTS: Most women with symphysis pubis dysfunction were multiparous under 35 years of age. Primiparous women were only diagnosed with grades I and II dysfunction (100%), while 14% of multiparous patients were diagnosed with grade III dysfunction. In patients with symphysis pubis dysfunction, inflammatory diseases of the uterus and appendages, infertility, and polycystic ovary syndrome were more common gynecological pathologies and were detected in 47.5%, 35% and 27.5% of cases versus 14%, 4% and 10% of cases in the control group, respectively (p < 0.05). Grades II and III dysfunction was most often detected in pregnant women with overweight and obesity – in 91.7% of cases (p < 0.05). In all patients with grade I dysfunction, the fetal weight was up to 3,500 g, while in the study groups with grades II and III dysfunction, the baby weighed more than 3,500 g and was large in 66.6% of patients (p < 0.05). During ultrasound examination, 83.3% of patients with grades II and III dysfunction, along with diastasis, revealed symptoms characteristic of inflammation (p < 0.05), and 28% of pregnant women in the control group were diagnosed with pubic symphysis divergence that corresponded to grades I and II dysfunction — 85.7% and 14.3% of cases, respectively. At the same time, no clinical manifestations were detected.

CONCLUSION: Important risk factors for symphysis pubis dysfunction are metabolic and endocrine disorders, inflammatory diseases of the female reproductive organs, repeated childbirth, and fetal weight of over 3,500 g. Ultrasound criteria for diagnosing this condition are not reliable for grade I dysfunction.

BACKGROUND: Prevention of birth defects in children is a pressing issue. The total Down syndrome screening detection rate depends on the exact adherence to the prenatal examination algorithm and the average age of pregnant women. The introduction of new technologies increases the efficiency of chromosomal abnormality detection during total screening.

AIM: The aim of this study was to assess the effect of organizational demographics on the frequency of births with chromosomal diseases, primarily Down syndrome, and to characterize additional factors to be taken into account when implementing a set of measures to prevent and avoid the birth of children with severe, uncorrectable and socially significant diseases.

METHODS: This study included the results of a survey of 2,083 women in case of pre- and postnatal diagnosis of chromosome 21 trisomy in St. Petersburg, Russia from 2013 to 2023. Statistical data processing was carried out using standard software.

RESULTS: We showed an increase in the average age of mothers and a decrease in the number of newborns in St. Petersburg over the specified period. The data on an increase in the efficiency of the prenatal diagnostics service were obtained, including using non-invasive prenatal testing for the group with an intermediate (from 1/101 to 1/1000) risk after combined screening. We also observed an increase in the timing of invasive diagnosis for prenatal karyotyping and the constant presence of a group of pregnant women who were not registered through city institutions and did not participate in preventive measures.

CONCLUSION: From 2013 to 2023, the average incidence of Down syndrome (diagnosed pre- and postnatally) increased from 1/412 to 1/258 newborns. In general, the effectiveness of prenatal diagnosis increased to 94%; however, it is necessary to strive to transfer invasive diagnosis to earlier pregnancy. The average incidence of newborns with Down syndrome remains stable (1/1231).

BACKGROUND: Bacterial vaginosis is an imbalance of the vaginal microbiome that is characterized by a decrease in lactobacilli and an overgrowth of opportunistic anaerobic bacteria. Given the high prevalence of bacterial vaginosis and the problem of antibiotic resistance, there is a need to develop new treatment methods and optimize the use of existing drugs.

AIM: The aim of this study was to evaluate the efficacy and tolerability of the sequential use of lactic acid with clindamycin or dequalinium chloride in the treatment of bacterial vaginosis in women of reproductive age.

METHODS: This study involved 127 women aged 18 to 45 years and diagnosed with bacterial vaginosis based on the Amsel criteria. The patients were randomly divided into four groups: Group 1 (34 women) received lactic acid; Group 2 (31 women) received clindamycin and lactic acid; Group 3 (32 women) received dequalinium chloride and lactic acid; and Group 4 (30 women) received clindamycin only. The effectiveness of treatment was assessed after 14 days based on the Amsel criteria. Three months post-treatment, complaints, vaginal discharge pH, amine tests and smears were analyzed if two or more Amsel criteria were present.

RESULTS: Two weeks after treatment, bacterial vaginosis symptoms persisted in 14.7% of women in Group 1, 3.2% of women in Group 2, and 13.3% of women in Group 4. Additionally, two weeks after therapy, vulvovaginal candidiasis was diagnosed in one woman (3.2%) in Group 3. Bacterial vaginosis recurrences three months after treatment were recorded in 6.9% of patients in Group 1, 3.3% of patients in Group 2, 6.5% of patients in Group 3, and 11.5% of patients in Group 4. In Group 2, one case of vulvovaginal candidiasis (3.3%) was also documented. The efficacy of lactic acid was 85.3% after 14 days and 93.1% after three months, while clindamycin demonstrated an efficacy of 86.7% after 14 days and 88.5% after three months. Combination therapy with clindamycin and lactic acid demonstrated an efficacy of 96.8% after 14 days and 96.7% after three months. Treatment with dequalinium chloride and lactic acid demonstrated an efficacy of 100% after 14 days and 93.5% after three months.

CONCLUSION: The data obtained confirm the high efficacy of the two-stage therapy using clindamycin with lactic acid and dequalinium chloride with lactic acid. This treatment method provides superior outcomes in terms of both cure rates and tolerability compared to traditional treatments. Given the growing resistance of microorganisms to antibiotics, the introduction of safe alternatives is particularly important, while offering new prospects for improving the treatment of bacterial vaginosis and enhancing the quality of life for patients.

BACKGROUND: The use of assisted reproductive technology programs to overcome infertility in some cases continues to be the only way to have a child. Unfortunately, the frequency of reproductive loss reaches average values in the population. Endometrial dysfunction is the cause of the abnormal morphogenesis of the gravid endometrium transformation as a significant factor of reproductive loss in assisted reproductive technology programs and habitual miscarriage.

AIM: The aim of this study was to compare the morphological features of aborted fetal tissue in non-developing pregnancies of the first trimester that occurred after the use of assisted reproductive technology and in habitual miscarriage.

METHODS: This study was conducted on 97 samples of non-developing pregnancy at 5–8 weeks of gestation. Histological examination was performed using standard methods. Immunohistochemical study to evaluate the expression of progesterone-induced blocking factor, stromal cell-derived factor-1, apoptosis-inducing factor, and endothelial marker was performed according to a standard procedure. Digital microscopy was performed on an Olympus BX46 microscope (Olympus Co., Japan) using cellSens 47 Entry software (Olympus Co., Japan). The expression of markers was calculated using the VideoTesT-Morphology 5.2 program (VideoTesT Ltd., Russia), followed by statistical analysis using the SPSS 23.0 (USA) and GraphPad Prism 9 (USA) software packages.

RESULTS: With incomplete gravid transformation of the endometrium, we verified a decrease in the expression of progesterone-induced blocking factor and stromal cell-derived factor-1 in the stroma and glands, and an increase in the expression of apoptosis-inducing factor in the glands. In the endometrial glands with full-fledged gravid transformation after IVF, the expression of progesterone-induced blocking factor was higher compared to non-developing pregnancy with habitual miscarriage. Similar data on the expression of stromal cell-derived factor-1 in the stroma and glands and CD34⁺ in the stroma of the gravid endometrium were obtained by statistical comparison of markers during full-fledged gravid transformation after IVF and habitual miscarriage.

CONCLUSION: A decrease in the expression of progesterone-induced blocking factor and stromal cell-derived factor-1 in the gravid endometrium leads to a loss of local immunosuppression and can cause reproductive loss regardless of the method of pregnancy. An increase in the expression of apoptosis-inducing factor in the glands of the gravid endometrium and CD34⁺ in the endometrial stroma after IVF and in habitual miscarriage indicate pathological activation of angiogenesis and apoptosis.

Genetic and hormonal determinants not only define male and female fenotypes. Differences that occur from the early stages of embryogenesis can also cause normal and pathological phenotypic manifestations depending on fetal sex, as well as different predispositions to diseases in the future. Fetal growth restriction is one of the most common causes of perinatal mortality and morbidity in newborns that complicates a significant number of pregnancies. In this review, we summarized and analyzed the recent data posted on the eLibrary and PubMed platforms with reference to the relationship between the sex of the fetus and the development of fetal growth restriction. According to the available data, fetal growth restriction occurs more frequently in female fetuses than in male ones. This is because in pregnant women, the sex of the fetus determines its biological susceptibility to such risk factors for fetal growth restriction as gestational diabetes mellitus, gestational hypertension, preeclampsia, asthma, etc. In a male fetus, the developing placenta is primarily aimed at increasing fetal weight; while for a female fetus, the priority is on the multiple mechanisms that regulate immune protection, adaptability, and rapid response to modifiable adverse effects.

The incidence of fetal malformations has not shown a downward trend. Congenital malformations of the fetus often lead to perinatal mortality and disability of newborns. Fetal ultrasound is still the main method of diagnosing these defects. However, unfortunately, in some cases, anomalies are detected only in the neonatal period. This article describes Pierre Robin sequence, which is a congenital malformation of the maxillofacial region. The malformation is defined as a congenital anomaly characterized by the presence of glossoptosis, micrognathia, and airway obstruction, which leads to various complications. Early recognition and appropriate perinatal management are crucial for improving pregnancy outcomes. Clinical studies conducted in recent years have shown that early prenatal diagnosis and counseling of a geneticist are becoming increasingly important, especially for families with risk factors for having children with malformations. In addition, when comparing clinical cases and scientific data, attention is drawn to the fact that in all cases of children with Pierre Robin syndrome, respiratory failure (of varying severity) due to congenital pneumonia was noted.

Evgeny E. Polotsky was one of the leading obstetricians-gynecologists and health care organizers of the first half of the 20th century in Russia. This article tells about his student years, first at Smolensk State University and then at Voronezh State University, and his development as an obstetrician-gynecologist, occurred with the emerging interest in scientific and pedagogical activities. The article briefly describes his dissertation “Autotransplantation of ovaries” for the PhD degree. E.E. Polotsky held senior positions with the Voronezh Medical Institute, including as director from 1932 to 1934. From November 1934, his professional career continued at the Central Institute of Obstetrics and Gynecology, Leningrad, the USSR (currently the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, St. Petersburg, Russia). From 1937 to 1943, E.E. Polotsky as director of the above institute was also engaged in the organization of Evacuation Hospital No. 1015, which assisted the population during World War II and the Siege of Leningrad. Later, on January 10, 1943, in order to carry out a special assignment for the Leningrad Front, E.E. Polotsky left Leningrad for the active army. There he headed the Evacuation Hospital No. 283 of the Central Front, was the chief gynecologist of the Southern Front, then the 4th Ukrainian Front, and from January 1944 to May 1945, he was the chief gynecologist of the Belorussian-Lithuanian Military District. E.E. Polotsky completed his service with the rank of lieutenant colonel of the medical service in April 1945. After being discharged from the army and returning to Leningrad, he continued working at the Central Institute of Obstetrics and Gynecology as a senior research fellow at the Department of Operative Gynecology.