Marina Aleksandrovna Chechneva

Adhesions are an urgent and unsolved problem in modern surgery. Any surgical intervention on the abdominal cavity inevitably leads to the formation of adhesions, which are fibrous cords between abdominal organs, resulting from trauma to the peritoneum of any etiology. Despite the improvement of surgical approaches and techniques, methods that prevent adhesiogenesis at its earliest stages and an integrated approach to rehabilitation in the postoperative period, as well as morbidity associated with the adhesive process of the abdominal cavity, remain widespread. The clinical presentation of the pathological process is polymorphic; treatment requires significant effort and resources; and adhesiogenesis-induced complications have a high medical and social significance, cause harm to the healthcare economy, and negatively affect the quality of life of patients. At present, unified methods and classifications for assessing the severity and prevalence of adhesions in the abdominal cavity, concepts for preventing the formation of adhesions that affect the key links of pathogenesis, and noninvasive mechanisms for their early detection in the postoperative period, which determines the need for interdisciplinary multicenter studies in this field, have not been developed.

Objective. Optimisation of pregravidal preparation of patients with various forms of hyperprolactinemia to increase reproductive potential. Material and methods. Prospective examination and treatment of 58 patients with different types of hyperprolactinemia were carried out. Depending on the type of hyperprolactinemia all patients were divided into 4 groups: patients with functional hyperprolactinemia, microadenoma and macroadenoma of pituitary gland and macroprolactinemia’s phenomenon. The examination of patients included a standard range of laboratory and instrumental investigations. Results. The peculiarities of menstrual cycle and reproductive function disorders, frequency of development of concomitant endocrine and somatic diseases in different forms of hyperprolactinemia were studied. As a result of complex pregravidal preparation of patients with hyperprolactinemia pregnancy occurred in 25 (86%) out of 29 women who planned it. At the same time, 11 (44%) patients became pregnant against the background of cabergoline treatment and 3—6 months after its cancellation, and 14 (56%) patients additionally underwent ovulation stimulation cycles. Conclusion. To restore the regulation of menstrual cycle and reproductive function in patients with hyperprolactinemia of different genesis it is reasonable to use dopamine agonists, gestagens, as well as estrogens and inducers of ovulation.

INTRODUCTION. The heated oxygen-helium mixture has found application in treating acute respiratory failure in patients with the exacerbation of chronic obstructive pulmonary disease, postextubation stridor, croup and viral bronchiolitis in children, acute respiratory distress syndrome in newborns. The article presents the results of own study according to the results of applying inhalations of the heated oxygen-helium mixture (oxygen 30%, helium 70%) in order to improve reparative processes in postoperative gynecological cases (after myomectomy) and to treat placental insufficiency in pregnant women with diseases of the bronchopulmonary system. OBJECTIVE. То estimate efficacy of the heated oxygen-helium mixture on the reproductive health of pregnant women with bronchopulmonary pathology and gynecological cases with patients of reproductive age after myomectomy. RESULTS. Against the background of the treatment, there was an increase in blood oxygen saturation, normalization of indicators of fetoplacental hemodynamics and hormonal function of fetoplacental complex in pregnant women. Inhalations of the heated oxygen-helium mixture in gynecological cases after myomectomy led to an increase in blood flow velocity in the area of ligatures. CONCLUSION. The study has shown that the method of inhalation through the heated oxygen-helium mixture (70% helium, 30% oxygen) is effective, safe and prospective for applying in obstetric and gynecological practice.

Background: The incidence of pregnant women with uterine fibroids is increasing. As they are reactive to hormonal stimuli, in some cases, uterine fibroids tend to grow during pregnancy and potentially generate symptoms with different levels of severity, causing maternal–fetal complications. In very select cases, when other treatment strategies fail to manage symptoms and there is a substantial risk of adverse pregnancy outcomes, a surgical approach during pregnancy may be considered. Methods: From 2016 to 2021, the data from 28 pregnant women with symptomatic uterine fibroids who underwent laparotomic myomectomy during pregnancy were prospectively collected, and operative and maternal–fetal outcomes were analyzed (ClinicalTrial ID: NCT06009562). Results: The procedure was carried out between 14 and 16 weeks of pregnancy. Four (14.3%) patients had intraoperative complications (miscarriages) and nine (32.1%) had postoperative complications (threatened preterm birth). Overall, 24 (85.7%) women delivered at full term (mean: 38.2 gestational weeks), more than half (n = 13; 54.2%) by vaginal delivery, with normal fetal weights and 1 and 5 min Apgar scores. Conclusions: Laparotomic myomectomy during pregnancy can be considered in selected cases for uterine fibroids with severe symptoms when other treatment options have failed and there is high risk of adverse maternal–fetal outcomes.

Objective. Improvement of early diagnosis of chronic kidney disease (CKD), improvement of its quality in case of reduced renal function in pregnant women by means of renal arteries Dopplerometry. Material and methods. A total of 283 pregnant women were included in the study. The 1st (control) group included 50 healthy pregnant women and the 2nd (main) group included 233 pregnant women with CKD. Pregnant women were distributed according to the stages of chronic kidney disease taking into account the rate of glomerular filtration into the following subgroups: 2A — stage I CKD (143 patients), 2B — stage II CKD (34 patients), 2C — stage III CKD (45 women), 2D — stage IV CKD (7 pregnant women), 2E — stage V CKD (4 patients). Dopplerometry of renal, segmental, interlobular, and interlobular arteries on both sides was performed at the following gestational periods: before 12 weeks; 13—21, 22—25, 26—28, 29—31, 32—34, 35—37, and 38—40 weeks. The following dopplerometric parameters were analyzed: peak systolic blood flow velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistance index (IR), systolodiastolic ratio (S/D). Results. Measurement of peak systolic velocity in the interlobar arteries is the most informative. Pregnant women with CKD showed a decrease in PSV in the renal parenchyma vessels (interlobular vessels) on both sides, starting from stage I of CKD. In II and III trimesters of pregnancy, the separating values (cut-off thresholds) of PSV of the interlobar arteries were derived, with the help of which it was possible to differentiate the absence and presence of CKD in pregnant women in II and III trimesters, and in I, II, III trimesters — to differentiate chronic renal failure (CRF) from I and II stages of CKD. Conclusion. The most informative ultrasound marker of renal dysfunction in pregnant women is the maximum blood flow velocity in the interlobular arteries, which allows to determine the presence of CKD and differentiate CKD from CKD stages I and II.

Pregnancy in the uterine scar is the result of an increase in the frequency of repeated cesarean section. Late diagnostics and treatment can lead to irreparable consequences because the progression of pregnancy in the scar increases the probability of pathological conditions: presentation, tight placenta attachment or ingrowth, uterine rupture. Treatment for these complications is often radical, which significantly affects not only the physical, but also the emotional and psychological state of a woman. Currently, there are conservative and surgical methods for the treatment of patients with pregnancy in the uterine scar, but there is no single method of therapy, and the tactics usually depend on the surgeon’s preferences. This article presents clinical observations of pregnancy in the uterine scar in different gestational periods.

Ultrasound is an accessible and safe technique which is widely used in gynecology. The literature data on the intraoperative ultrasound investigation application in surgery and gynecology in particular are not numerous. The indications for the use of the intraoperative ultrasound investigation in the operative gynecology are considered in this article. The use of this technique enables to expand the limits of the performed surgeries and minimize the possible complications.

Objective. To improve perinatal outcomes in pregnant women with a new coronavirus infection COVID-19 by optimizing diagnostic, therapeutic, and prophylactic measures. Material and methods. The course of pregnancy, labor and perinatal outcomes were studied in 70 patients with COVID-19 during the present pregnancy who were delivered at the Moscow Regional Research Institute of Obstetrics and Gynecology (MORRIOG). The patients were divided into 2 groups depending on the timing of their visit to the outpatient department of MORRIOG: Group 1 comprised 45 pregnant women with new-onset coronavirus infection in the first to second trimesters of gestation, with subsequent presentation and follow-up at the MORRIOG outpatient department; Group 2 comprised 25 pregnant women who had new-onset coronavirus (NCD) infection during gestation and presented to the outpatient department before delivery. In addition to a general clinical examination, all pregnant women underwent an extended haemostatic analysis, including a thrombodynamic test. Results. Analysis of the findings showed that hypercoagulable changes in the hemostatic system were observed in pregnant women with COVID-19 infection during gestation, but standard hemostatic tests did not reflect the characteristic postinfectional changes compared with the results of an extended coagulation potential study using the thrombodynamics test. Hypercoagulative changes were revealed irrespective of the severity of the COVID-19, which could be due to the combination of several risk factors and the presence of concomitant extragenital diseases. Conclusion. The most favorable gestational outcome in patients who have suffered a COVID-19 infection during pregnancy depends on the timely of the detection of hemostasis abnormalities after comprehensive examination and on the composition of available pathogenetic therapy. Rational anticoagulant and antiplatelet therapy under control of the coagulation parameters and achievement of normalization of coagulation tests result in a significant reduction in adverse obstetric and perinatal outcomes.

Aim: The aim of the study was to optimize diagnostic, treatment and preventive measures in pregnant women who had a new coronavirus infection (NCI) COVID-19 during the gestation period. Design: Comparative study. Materials and methods. We studied the course of pregnancy, childbirth and perinatal outcomes in 60 women who had COVID-19 during this pregnancy, delivered in the conditions of the MONIAH. Patients were divided into two groups depending on the period of visit to the outpatient department of MORIAG. Group I consisted of 45 pregnant women who underwent NCI in the I–II trimesters with subsequent treatment and observation in the conditions of the polyclinic department of MONIAH, Group II — 15 pregnant women who had had NCI during gestation and applied to the polyclinic department before delivery. In the course of the work, in addition to the general clinical examination, an extended study of the hemostasis system was additionally carried out (during registration, before delivery and according to indications in order to control ongoing therapy), ultrasound and Doppler studies in dynamics, analysis of gestational and perinatal outcomes, the timing of the disease and course of the NCI. Results. During the first consultation, all participants in the study underwent ultrasound and an analysis of standard hemostasiological tests was performed. In pregnant women who received low molecular weight heparins, as well as in cases of placental insufficiency and/or structural changes in the placenta, thrombodynamics was studied (n = 21). Women of group II had a significantly lower APTT, a higher level of prothrombin in the blood, and they also had statistically significantly more signs of hemodynamic disturbances in the BMD. According to ultrasound findings, uteroplacental blood flow disorders were diagnosed in 13 patients; thrombodynamics test results demonstrate hypercoagulation in 17 women, while the data from the routine assessment of hemostasis did not go beyond the reference values. Structural changes in the placenta were found in 8 (53.4%) examined patients of group II, and a thrombodynamic test was performed in 5 of them. Hypercoagulation was detected in 4 (26.7%) patients in group II. In patients of group I, depending on the results obtained, correction of therapy was carried out, followed by ultrasound control of the structure of the placenta, as well as an assessment of the thrombodynamic test. Conclusion. Women who have undergone NCI during gestation, regardless of the clinical course and duration of infection with NCI, are characterized by hypercoagulable changes, however, standard hemostasiological tests do not fully reflect post-covid changes, in contrast to the thrombodynamic test in combination with careful placentometry, in which structural changes in the placenta and violations of intraplacental blood flow may indirectly indicate the presence of hypercoagulability. Rational anticoagulant and antiplatelet therapy under the control of indicators of the blood coagulation system and the structure of the placenta contributes to a significant reduction in the incidence of adverse obstetric and perinatal outcomes. Keywords: new coronavirus infection, pregnancy, placental insufficiency, doplerometry, thrombodynamic test.