Journal of obstetrics and women's diseases

BACKGROUND: Recurrent implantation failure remains a key reason for the ineffectiveness of assisted reproductive technology programs. It has been shown that a significant proportion of patients with recurrent implantation failure have impaired endometrial receptivity and uterine microflora dysbiosis, which necessitates an in-depth examination of the endometrial factor as a possible cause of unsatisfactory assisted reproductive technology outcomes.

AIM: The aim of this study was to increase the effectiveness of thawed embryo transfer programs by correcting the uterine microflora and individualizing the implantation window in patients with recurrent implantation failure.

METHODS: This prospective, controlled, non-randomized, open-label study included patients with recurrent implantation failure who underwent thawed embryo transfer programs. In the main group, Endometrial Receptivity Analysis (Igenomix, Spain) and Endometrial Microbiome Metagenomic Analysis (Igenomix, Spain) tests were performed, followed by adjustment for transfer timing and endometrial microbial composition. The implantation rate, clinical pregnancy rate and live birth rate were compared between the main and comparison groups, the univariate correlation analysis of risk factors being performed.

RESULTS: Of 107 patients in the main group, implantation window displacement was detected in 51.85%, a decrease in the proportion of Lactobacillus spp. in 74.08%, and dysbiosis in 14.81%. The implantation rate, clinical pregnancy rate and live birth rate were higher in the main group either with or without preimplantation genetic testing (p < 0.05). An association was established between the presence of intrauterine interventions and the development of dysbiosis (p = 0.0053), as well as between chronic endometritis and decreased receptivity (p = 0.006).

CONCLUSION: A comprehensive assessment of the microflora and endometrial receptivity with subsequent personalized correction can increase the effectiveness of assisted reproductive technology programs in patients with recurrent implantation failure. The use of molecular genetic tests can be recommended as an important stage of clinical examination in patients with recurrent implantation failure before repeated embryo transfer.

BACKGROUND: Extragenital pathologies occupy a leading place in the structure of obstetric and perinatal complications. Among those are hepatobiliary diseases, which adversely affect the course and outcome of pregnancy. However, pregnancy itself is a trigger for a particular pathology, including liver and biliary tract diseases. The liver is considered the central organ of metabolic and energy homeostasis, so any change in its function is dangerous. Given that the liver is the only organ for the synthesis of albumins, fibrinogen, prothrombin, and other coagulation factors, any severe damage to its parenchyma, for example, in preeclampsia, can lead to catastrophic consequences. Possessing a multifunctional potential, the hepatobiliary system, when damaged, reacts with a wide variety of pathological processes. Therefore, it should be studied to determine pregnancy management tactics and the methods of delivery.

AIM: The aim of this study was to assess the outcomes of pregnancy and childbirth in hepatobiliary pathology associated with pregnancy and chronic non-communicable liver pathology.

METHODS: This cross-sectional multicenter study included pregnant women with or without non-communicable liver diseases. Two main groups (I and II) consisted of pregnant women with hepatobiliary pathology, associated with pregnancy and complicated by preeclampsia and liver dysfunction, as well as intrahepatic cholestasis of pregnancy. Two comparison groups (III and IV) consisted of pregnant women with hepatic steatosis and normal pregnancy. We compared incidences of maternal and perinatal complications, as well as methods of delivery for different types of hepatopathy, with associations between diseases and outcomes being identified.

RESULTS: This study included 263 pregnant women. In the preeclampsia group, there was a high incidence of maternal and perinatal complications. In this group, the delivery period was 34.00 [31.00; 37.00] weeks; in 74% of cases, delivery was premature; in 94% of cases, operative delivery was performed; and in 28% of cases, neonatal asphyxia was diagnosed. In the groups with intrahepatic cholestasis of pregnancy and hepatic steatosis, we also found a high rate of abdominal delivery (56 and 83%, respectively). In the group with intrahepatic cholestasis of pregnancy, every third newborn was diagnosed with fetal growth restriction. In the hepatic steatosis group, the course of the neonatal period was complicated by hypoglycemia due to prematurity and impaired carbohydrate metabolism in the mother.

CONCLUSION: Hepatobiliary diseases adversely affect the course and outcome of pregnancy, particularly in the case of hepatopathy associated with gestation. In some cases, pregnancy itself triggers the onset of liver pathology due to the load exerted on the hepatobiliary system. The high incidence of maternal and perinatal complications associated with this condition increases the frequency of operative delivery.

BACKGROUND: The emergence of a new direction in biomedicine often leads to conflicting attitudes regarding its safety and potential short- and long-term consequences for patients and their families. The development of biobanking, which involves collecting biological samples for long-term storage and repeated use in the various types of research, is no exception. Initial survey results indicate insufficient awareness about the existence of biobanks, their functions, and safety among not only patients but also specialists. This lack of information leads to unfounded concerns about the safety of biobanking, which, in turn, complicates donor recruitment for research projects. This is particularly significant when attracting donors from vulnerable groups such as pregnant women. Studying the opinions of project participants will help assess not only the perceived safety of participation in a specific pregnancy-related project but also their willingness to be engaged in similar initiatives as an integral indicator of their experience.

AIM: The aim of this study was to examine the opinions of participants in a biobanking research project regarding the safety of donating biological samples during pregnancy and to evaluate their satisfaction with project participation.

METHODS: A pilot cross-sectional study was conducted. Using an 18-question online questionnaire, we conducted an anonymous survey among participants during pregnancy regarding their experiences in the biobanking research project.

RESULTS: We surveyed 51 women. The survey analysis revealed that 92% (47) of respondents had no concerns about the safety of providing researchers with personal data, 100% (51) of women had no concerns about sharing clinical data, and 96% (46) of women felt secure about donating biological material. According to the survey, 100% (51) of respondents reported no medical complications related to the biological sample collection procedure. Participants expressed high overall satisfaction with their participation in the biobanking research project: the average score was 9.0 (on a scale of 0.0 to 10.0). Additionally, 92% (47) of respondents expressed willingness to participate in other biobanking research projects.

CONCLUSION: The results of this pilot study are important for shaping the attitudes of both specialists involved in recruiting pregnant women for biobanking research projects and potential participants who may consider joining such projects based on the experiences of others.

BACKGROUND: Taking the synthetic form of folic acid (vitamin B₉ or pteroylmonoglutamic acid) at a dose of 400 mcg at the pregravid stage to correct plasma homocysteine levels can reduce the risk of neural tube defects in fetuses. Furthermore, the use of the reduced form of folic acid, 5-methyltetrahydrofolate, has been shown to offer advantages over synthetic folic acid, particularly in patients with the MTHFR c.665C>T polymorphism. However, the efficacy of 5-methyltetrahydrofolate has not been confirmed in large clinical trials, which makes it important to study its effect on methionine metabolism compared to that of synthetic folic acid.

AIM: The aim of this study was to assess folic acid accumulation in blood plasma and erythrocytes in women of reproductive age depending on vitamin B₉ forms and polymorphic variants of the genes involved in the folate pathway.

METHODS: This randomized controlled open-label prospective study included 60 women of reproductive age, who were divided into two groups of 30 individuals each. In the both study groups, the participants took one of the folic acid forms — 5-methyltetrahydrofolate or pteroylmonoglutamic acid — at a dose of 400 mcg for 3 months. All women were tested for folate pathway gene polymorphisms, while measuring serum homocysteine and vitamin B₁₂ levels, as well as plasma and red blood cell folate levels before and after folate supplementation.

RESULTS: In the both study groups, we observed an increase in folic acid concentrations in erythrocytes and blood plasma. In the group of women taking 5-methyltetrahydrofolate, these parameters increased from 152.86 to 205.99 ng/ml (p < 0.05) and from 10.96 to 25.39 nmol/l (p < 0.05), respectively. In the pteroylmonoglutamic acid group, the parameters increased from 144.33 to 228.46 ng/ml (p < 0.05) and from 14.08 to 33.37 nmol/l (p < 0.05), respectively. Moreover, in the both study groups, we noted a reliable increase in folic acid concentrations regardless of the presence of genetic defects in folate cycle enzymes.

CONCLUSION: Three-month folate supplementation in women of reproductive age increases plasma and red blood cell folate levels, regardless of the form of folic acid (5-methyltetrahydrofolate or pteroylmonoglutamic acid) taken or the presence of genetic defects in folate cycle enzymes.

This review article examines the role of oxidative stress in the pathogenesis of endometriosis and associated infertility, and discusses new treatment strategies aimed at improving the quality of life of patients with this pathology and the implementation of their reproductive life planning.

Genital endometriosis is one of the most pressing issues in modern gynecology. Being prevalent in 5–10% of women of reproductive age worldwide, this disease causes chronic pelvic pain, infertility and miscarriages, which leads to a significant deterioration in the quality of life and inevitably affects social, professional and psychological aspects. The pathogenesis of endometriosis remains unexplored due to its complexity. To date, there are a number of mutually exclusive and contradictory hypotheses and theories attempting to explain the etiology and pathogenesis of this mysterious disease. Oxidative stress is likely involved in various aspects of endometriosis. Numerous experiments conducted in recent years using anti-hyperproliferation drugs have shown that the development and progression of endometriosis may be a consequence of an imbalance of reactive oxygen species. There is growing evidence for the role of reactive oxygen species and mitochondrial dysfunction in reducing ovarian reserve in patients with endometriomas. This causes deterioration in the quality of oocytes, which negatively affects embryo development and leads to infertility.

Therapies targeting oxidative stress offer promising prospects in the treatment of endometriosis, allowing for both suppressing the progression of endometriotic lesions and reducing the associated chronic pelvic pain and infertility.

We analyzed 68 literature sources, both domestic and foreign ones, using various databases (PubMed, PubMed Central, Google Scholar, UpToDate).

Recent research has demonstrated the effectiveness of continuous glucose monitoring systems in improving obstetric and perinatal outcomes in women with diabetes mellitus. Furthermore, these systems have opened up opportunities for stratifying patients based on their glycemic profiles, known as glucotypes, which, in turn, enables a more personalized approach to predicting complications and choosing treatment strategies.

This article was aimed to analyze glycemic profile data obtained, using continuous glucose monitoring systems in pregnant women with pregestational diabetes mellitus, in order to study predictors of obstetric and perinatal complications, according to the available literature.

We conducted a systematic review of publications from MEDLINE, PubMed, EMBASE and CSCD databases from 2005 to 2024. Fourteen studies that met the inclusion criteria were included in the analysis. The primary endpoints were continuous glucose monitoring data, glycated hemoglobin levels, and the incidence of preeclampsia, preterm birth, macrosomia, and neonatal hypoglycemia.

Continuous glucose monitoring has been shown to be associated with lower glycated hemoglobin levels, increased time spent in the target glucose range, and decreased incidence of macrosomia, neonatal hypoglycemia, and neonatal intensive care unit admissions. The use of new methods of glycemic profile assessment such as glucotype allocation based on continuous glucose monitoring data opens up new opportunities for personalized pregnancy management.

Continuous glucose monitoring can significantly improve glycemic control in pregnant women with pregestational types of diabetes mellitus and optimize insulin therapy, while helping to reduce the incidence of adverse obstetric and perinatal outcomes. Stratification by glucotype may be a promising avenue for personalization of therapy.

Diagnosis and treatment of urinary incontinence generally pose no difficulties, as substantial global experience has been accumulated in solving this problem. However, the diagnosis of extraurethral urinary incontinence is relatively rare. It is crucial to remember that the mechanics of urination is a multi-component process, and the mechanisms of its impairment are extremely diverse. Thus, in determining a personalized treatment strategy, the clinician must consider the possible association of urinary symptoms with congenital urogenital abnormalities.

Patient B., 42, during her initial examination by an obstetrician-gynecologist, complained of involuntary urine leakage, unrelated to any factors contributing to urinary incontinence. Collecting her gynecological history revealed episodes of urinary incontinence since childhood, but the cause remained undetermined. In reproductive age, the patient experienced incontinence episodes up to twice a week but could stay “dry” for three weeks. Her obstetric history includes three normal full-term pregnancies, all of which ending in uncomplicated term deliveries. No diagnostic method provided complete information on any pathology.

Rare clinical cases like the one presented in this article can be influenced by incomplete diagnosis at one stage, errors in evaluating further examination results, and, as a consequence, incorrect surgical tactics and subsequent complications. Clinicians treating urinary incontinence in women must have a clear understanding of congenital urogenital abnormalities, their embryological development, as well as diagnostic and treatment options.

In commemoration of the 100th anniversary of the birth of Honored Scientist of the Russian Federation, Doctor of Medical Sciences, and Professor Nonna G. Kosheleva, we remember the renowned scientist and physician, who made an invaluable contribution to Russian obstetrics. For nearly 60 years, her life was deeply intertwined with one of the country’s leading medical institutions, the Ott Institute of Obstetrics and Gynecology, St. Petersburg, Russia.

Nonna G. Kosheleva was born in 1925 in the town of Podolsk, the USSR. During World War II, she was evacuated to Yoshkar-Ola, the USSR. In 1944, she entered the First Moscow Medical Institute, graduating with honors in 1949.

Since 1954, her professional life and scientific career had been rooted in the city of Leningrad, the USSR (now St. Petersburg, Russia). In 1955, she entered graduate school at the Institute of Obstetrics and Gynecology affiliated with the USSR Academy of Medical Sciences, where she began advanced medical studies in perinatology. In 1959, Nonna G. Kosheleva successfully defended her PhD thesis titled “The Response of the Pregnant Animal and Fetus to Cooling at Different Stages of Pregnancy,” and in 1971, her second doctoral dissertation titled “Experimental and Clinical Antecedents for the Prevention of Perinatal Morbidity and Mortality from Complications in the First Half of Pregnancy.” Nonna G. Kosheleva is the author of five monographs and over 250 scientific papers (articles, guidelines, and manuals), which demonstrates her notable contribution to medical science and practice.