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Обращение
Уваровой Елены Витальевны
Дорогие коллеги, друзья!
Благодаря данному ресурсу я, как внештатный специалист Минздрава Российской Федерации, отвечающий за организацию гинекологической службы детского и юношеского возраста в стране, получила уникальную возможность значительно усовершенствовать координацию и оценку работы детских гинекологов. Разделы посвященные обмену опытом позволяют оперативно получать Ваши предложения по улучшению работы службы. Спасибо за Ваше активное участие в развитии службы в РФ.
Самой главной нашей миссией, как не устаёт повторять наш Директор — академик РАН Геннадий Тихонович Сухих, – является уверенность врачей всех субъектов РФ в том, что есть высокопрофессиональные и дружественные специалисты, которые всегда могут объяснить и прийти на помощь в сложной ситуации.
Во время проведения региональных отчетных собраний во многих городах врачи подготовили к осмотру наиболее сложных пациенток подросткового возраста, которым требовалась помощь специалиста-эксперта нашего Центра. В зависимости от каждого конкретного случая принималось решение о сроке госпитализации, либо рекомендовалось дополнительное обследование и лечение на местном уровне, по результатам которого принималось окончательное решение о необходимости госпитализации в специализированное отделение Центра.
Важно указать, что мы принимаем не только плановых пациентов, но и при необходимости — в срочном порядке. Любой ребенок, в любое время может получить квалифицированную помощь у специалистов нашего учреждения.
Мы никогда не расстаемся с нашими юными пациентами и проводим полный цикл консультаций и лечения. Такое взаимодействие врачей позволяет повышать образовательный и профессиональный уровень, а нам — помогать детям России сохранить и улучшить свое репродуктивное здоровье!
Для облегчения организации маршрута наиболее сложных пациентов в рамках сайта разработан «паспорт пациента», который позволяет собрать профильную информацию о патологии, требующей консультации медицинских учреждений 2 и 3 уровней. Сейчас мы активно внедряем данную программу в регионах. Мы будем держать вас в курсе новых технологий и подходов, которые помогут улучшить качество работы службы!
Уварова Елена Витальевна,
Член-корреспондент РАН, доктор медицинских наук, профессор, заслуженный деятель науки РФ, заведующий 2 гинекологическим отделением (детского и юношеского возраста) ФГБУ «НМИЦ акушерства, гинекологии и перинатологии им. В.И.Кулакова» Министерства здравоохранения Российской Федерации, профессор кафедры акушерства, гинекологии, перинатологии и репродуктологии ИПО Первого МГМУ им. И.М.Сеченова Министерства здравоохранения Российской Федерации, главный внештатный специалист по гинекологии детского и юношеского возраста Министерства здравоохранения Российской Федерации, президент Ассоциации детских и подростковых гинекологов, главный редактор журнала «Репродуктивное здоровье детей и подростков»
Обращение
Сухих Геннадия Тихоновича
Приветствую вас на профессиональном портале Репродуктивное здоровье детей и молодежи.
Сегодня скорость распространения и обмена информацией позволяет максимально повышать качество медицинской помощи на местах. Развивается система телемедицинских консультаций, появилась возможность проведения дистанционных дискуссий и консилиумов.
Профессиональной площадкой специалистов, деятельность которых связана с охраной репродуктивного здоровья девочек является «Ассоциация гинекологов детей и подростков».
Президент Ассоциации — д.м.н., профессор Е.В. Уварова, заслуженный деятель науки РФ, главный специалист гинеколог детского и юношеского возраста Минздрава России, работает в нашем Центре, который в 2017 году приобрел статус Национального медицинского исследовательского центра. В старейшем в России отделении гинекологии детского и юношеского возраста ФГБУ «НМИЦ АГиП им. В.И. Кулакова» Минздрава России оказывают полный спектр современной, высокоспециализированной консультативной, диагностической и лечебной, в том числе хирургической, помощи девочкам от рождения до совершеннолетия с различными заболеваниями половых органов и проблемами полового созревания.
В 2018 году у Ассоциации появился модернизированный IT ресурс, который позволяет оперативно искать решения в вопросах консультирования и выбора маршрута обследования и лечения пациентов с учетом лицензионных прав локальных и федеральных медицинских учреждений.
На страницах портала представлена и будет постоянно обновляться информация о нормативно-правовых актах деятельности работников здравоохранения в целом и гинекологов детского и юношеского возраста, в частности.
Портал предоставляет своим пользователям уникальную возможность профессионального общения между собой, с главными специалистами субъектов и Федеральных округов России. Возможно осуществление интернет-конференций с обсуждением наиболее острых, требующих быстрого уточнения объема обследования, лечебной тактики, вплоть до определения конкретной даты госпитализации девочки во 2 гинекологическое отделение (детского и юношеского возраста) нашего Центра.
Вы также всегда найдете интересующую информацию об актуальных образовательных проектах непрерывного профессионального образования, которые проводятся под эгидой ФГБУ «НМИЦ АГП им. В.И. Кулакова» Минздрава России и «Ассоциации гинекологов детей и подростков».
Надеюсь, что портал будет полезен для обеспечения репродуктивного здоровья не только юных жительниц нашей страны, но и лечащих их врачей.
Сухих Геннадий Тихонович,
академик РАН, д.м.н., профессор Заслуженный деятель науки Российской Федерации, Директор ФГБУ «НМИЦ АГиП им. В.И. Кулакова» Минздрава России, Заведующий кафедрой акушерства, гинекологии
Репродуктивное здоровье женщин журнал
Obstetrics, Gynecology and Reproduction
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“Obstetrics, Gynecology and Reproduction” (“Akuserstvo, Ginekologia i Reprodukcia”) is a scientific and practical peer-reviewed journal for obstetricians, gynecologists and other experts in the area of women’s health. Our aims and priorities focus on scientific and information support to the members of the «professional community» in their pursuit of new ideas in obstetrics and gynecology research. In addition, the AGR journal proudly contributes to the continuing medical education (CME) of practitioners who specialize in various areas of women’s health including obstetrics, gynecology, in vitro fertilization (IVF) and assisted reproductive technology (ART).
“Obstetrics, Gynecology and Reproduction” (“Akuserstvo, Ginekologia i Reprodukcia”) was founded in 2007
The impact factor of this journal, as shown in the Russian Science Citation Index (RSCI) is among the highest for the periodicals on obstetrics, gynecology, perinatology and problems of women’s health. According to RSCI, the biennial impact factor was 0.509 in 2013, 0.810 in 2014, and 0.976 in 2015.
The journal publishes original articles on clinical and experimental studies, as well as reviews on obstetrics, gynecology, and human reproduction. Special attention is paid to publications on CME as well as historic aspects of obstetrics and gynecology. All manuscripts, both original research and literature reviews, are published upon a mandatory peer-review.
Languages: Russian, English
Periodicity: 6 issues per year.
The printed versions are distributed under the Creative Commons Attribution 4.0 License: full-text materials are freely available to the public in an open access repository.
Distribution of the printed version: Russia, the EurAsian Economic Community (EurAsEC) countries (Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Armenia, Moldova), Ukraine, Georgia.
The editorial board of “Obstetrics, Gynecology and Reproduction” (“Akuserstvo, Ginekologia i Reprodukcia”) includes leading scientists from Russia, Austria, Great Britain, Israel, USA, Croatia, Ukraine, Georgia, and Uzbekistan.
The editorial board of this journal maintains the policy of full compliance with all principles of publishing ethics. Our ethical standards and codes conform to those of top international science publishers.
All submitted materials undergo a mandatory double-blind peer review.
Media Certificate of Registration: ПИ №FS77-34885 of December 29, 2008.
ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)
By the decision of the Higher Attestation Commission (HAC) of Russia, “Obstetrics, Gynecology and Reproduction” (“Akuserstvo, Ginekologia i Reprodukcia”) is included in the «List of top peer-reviewed scientific journals and publications» where scientists seeking academic degrees are required to publish their results.
The “Obstetrics, Gynecology and Reproduction” (“Akuserstvo, Ginekologia i Reprodukcia”) journal appears in the Russian Universal Scientific Electronic Library (RUNEB) elibrary.ru and is also present in the database of the Russian Science Citation Index (RSCI). Concise versions of major articles from this journal are published by the All-Russian Institute for Scientific and Technical Information (VINITI). The journal is also indexed by «Ulrich’s periodicals Directory» – a global information system of periodicals and continued publications.
Current issue
Vol 17, No 2 (2023)
ОRIGINAL ARTICLES
176-187 297
Introduction. Antiphospholipid antibodies (APAs) exert multifaceted effects on the course of pregnancy by disrupting microcirculation, affecting the hemostasis, as well as damaging the endothelial membranes, leading to early reproductive loss and development of placenta-associated complications depending on the affected gestation stage. Planning and management of pregnancy in women in the absence of criteria for complete antiphospholipid syndrome (APS) currently remains unresolved issue. The absence of generally accepted treatment standards for this category of patients and inability to substantiate the diagnosis according to the APS classification criteria complicate selection of therapeutic tactics.
Aim: to conduct a comparative analysis of therapy-based complications and outcomes of pregnancy in APA carriers.
Materials and Methods. During the period 2019–2021 a prospective study of 150 patients who entered pregnancy with aggravated obstetric and gynecological history, serum APA level was examined. Considering the risks of developing obstetric and thrombotic complications, all patients were prescribed prophylactic doses of low molecular weight heparins (LMWHs) and low doses of acetylsalicylic acid (ASA). The patients were divided into 3 groups using a random number generator. Group 1 (n = 50), in addition to the prescribed LMWH (enoxaparin sodium 40 mg 1 time per day) and ASA (150 mg 1 time per day), also underwent plasmapheresis (PF) 4 sessions per 1 course in 6–8, 12–14 and 22–24 weeks of pregnancy; group 2 (n = 50) received courses of intravenous immunoglobulins (IVIG) at a course dose of 300 ml (15 g) simultaneously; group 3 (n = 50) received no additional therapies. Rate of pregnancy complications was comparatively assessed – development of fetal growth retardation (FGR), low birth weight fetus, gestational arterial hypertension (AH), moderate and severe preeclampsia (PE), anemia and delivery outcomes.
Conclusion. In the group of patients receiving complex therapy consisting of LMWHs prophylactic doses, low ASA doses and IVIG courses, the risks of developing placenta-associated complications and iron deficiency were reduced compared to other groups indicating about a higher efficiency of this therapy regimen. However, the development of intrahepatic cholestasis during pregnancy was less common in the group of patients receiving PF courses, in contrast to using IVIG courses, which can be accounted for by additional effect of efferent therapeutic methods and should be taken into account in a differentiated approach for management of patients with liver and gallbladder pathology.
188-201 139
Introduction. During pregnancy COVID-19 poses a serious threat to both maternal health and health of paired unborn child. Pregnant women have a high probability of complications due to respiratory viral infections followed by developing critical conditions caused by physiologically altered immune and cardiopulmonary systems. However, asymptomatic COVID-19 in pregnant women may be accompanied by fetal inflammatory response syndrome (FIRS) that results in unfavorable sequelae for neonatal life and health.
Aim: to assess a fetal inflammatory response resulting from maternal COVID-19 in pregnancy.
Materials and Мethods. A prospective randomized comparative study involving 92 pregnant women was carried out. The main group included 62 pregnant COVID-19 convalescent women: subgroup 1 consisted of 30 pregnant women found to be positive for SARS-CoV-2 by using polymerase chain reaction (PCR) 4–6 weeks before delivery; subgroup 2 – 32 pregnant women with SARS-CoV-2 detected by PCR earlier during pregnancy. The control group enrolled 30 healthy pregnant women. The level of circulating cytokines – interleukins (IL) IL-1α, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), macrophage inflammatory protein-1β (MIP-1β), C-X-C motif chemokine ligand 10 (CXCL-10) and cell markers (CD86, CD80, CD4, CD25, CD25, CCR7) were analyzed. In addition, all neonates underwent thymus gland ultrasound screening.
Results. Cord blood dendritic cells from neonates born to mothers in subgroup 1 vs. control group showed a significantly upregulated expression of CD80 and CD86 (p = 0.023). Moreover, such cord blood samples in subgroup 1 were found to have increased percentage of CD4+, CCR7+ T cells paralleled with decreased proportion of naive CD4+ T cells as compared with control group (p = 0.016). It was found that count of maternal regulatory CD4+CD25+Foxp3+ T cells (Treg) did not differ significantly, whereas Treg cell functional activity in mothers with severe COVID-19 (subgroup 2) was significantly suppressed. Significantly higher level of neonatal proinflammatory cytokines and chemokines was detected in subgroup 1 vs. control group (p < 0.05). However, the cytokines level in maternal peripheral blood samples in main and control groups upon delivery was changed insignificantly. SARS-CoV-2-positive pregnant women showed a strong antigen-specific T cell response. A reduced thymus size was found in neonates born to paired COVID-19 mothers.
Conclusion. Fetal inflammatory response syndrome occurs upon COVID-19, which is characterized by activated fetal immune system and increased production of pro-inflammatory cytokines. The disease severity in pregnant women has no correlation with FIRS intensity during neonatal period and can vary from minimally altered laboratory parameters to developing sequelae at organ and body system levels.
202-209 166
Introduction. Iron deficiency (ID) of varying severity is the most common and rather serious extra-gynecological complication of adenomyosis resulting from meno/metrorrhagia of varying intensity, up to abnormal uterine bleeding requiring surgical hemostasis. Taking into account the chronic course of the disease, the complexity of radical therapy as well as a systemic effect ID also particularly affecting reproductive system, an issue of sufficient and timely ID correction in patients with adenomyosis of varying severity remains relevant.
Aim: to study an efficacy of ID therapy with drug containing ferrous fumarate and folic acid in patients with adenomyosis.
Materials and Methods. An observational study was conducted, which included 90 patients with isolated adenomyosis of varying severity: 30 patients with degree 1 adenomyosis (group 1), 30 patients with degree 2 adenomyosis (group 2), 30 women with degree 3–4 (group 3). All patients received ferrous fumarate plus folic acid for 30 days. To identify an ID variant, the level of serum ferritin, iron, transferrin, total iron-binding capacity of blood serum (TIBC), clinical blood test parameters such as hemoglobin level, erythrocyte count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) were measured.
Results. A significant increase in ferrokinetic parameters was found in all patient groups. The most significant and clinically important dynamics was noted for serum iron level and TIBC. For instance, after the therapy, the level of serum iron increased in group 1 from 11.0 ± 0.6 μmol/l up to 15.0 ± 1.1 μmol/l, in group 2 – from 9.0 ± 1.6 μmol/l up to 14 .0 ± 0.8 μmol/l, in group 3 from 7.0 ± 1.3 μmol/l up to 12.0 ± 1.3 μmol/l (p < 0.05). In addition, a decreased TIBC was found in group 3: from 68.0 ± 1.8 μmol/l down to 58.0 ± 1.7 μmol/l (p < 0.05); in groups 2 and 3 TIBC level tended to insignificantly decrease.
Conclusion. The use of a preparation containing ferrous fumarate along with folic acid can effectively correct background ID of varying severity in patients with adenomyosis of varying intensity. An earlier and longer administration of iron preparations in patients with adenomyosis along with clinical and laboratory parameter monitoring is recommended to achieve more pronounced clinical effect.
211-220 159
Aim: to improve the efficiency of predicting a clinically narrow pelvis (СNP) using neural network data analysis and to evaluate its prognostic characteristics.
Materials and Мethods. The study was designed as a retrospective non-randomized clinical trial. An analysis of 184 born neonates was carried out: group 1 included 135 female patients whose delivery occurred through the natural birth canal, group 2 – 49 patients whose delivery was complicated by СNP development and ended up with emergency caesarean section. Examination of patients was carried out on the eve of childbirth (1–2 days) and included anamnesis, general and special obstetric examination, including pelvimetry, a clinical assessment of cephalopelvic disproportion was carried out during childbirth. The condition of newborns was assessed using the Apgar scale, height and body weight were measured. Neural network analysis was performed using the built-in Neural Networks module of SPSS Statistics Version 25.0 (IBM, USA).
Results. Despite hypothetically important role of anatomically narrowed pelvis in development of cephalopelvic disproportion, no significant inter-group differences were found. Significant parameters (abdominal circumference, uterine fundus height and woman’s weight, fetal head circumference, as well as data on the presence or absence of oligohydramnios and fetal macrosomia) were determined, which were included in the test database to create the basis for training the multilayer perceptron. Out of 135 patients of group 1, the prognosis was negative in 131 (97.0 %), positive in 4 (3.0 %); out of 49 patients in group 2, negative in 0 (0.0 %), positive in 49 (100.0 %). The forecast accuracy of the developed model was 98 % (sensitivity – 100 %, specificity –97 %). The information content of neural network data analysis in СNP predicting is presented in ROC analysis: area under the curve (AUC) = 0.99 (95 % confidence interval = 0.97–1.00). Neonatal anthropometric parameters were significantly higher in group 2 vs. group 1, and the Apgar score at 1 minute was correspondingly lower.
Conclusion. The use of neural network analysis of clinical data obtained on the eve of childbirth allows to predict СNP development at sufficient degree of accuracy (98.0 %), which, in the future, after being introduced into clinical practice, will optimize a choice of delivery method in patients at risk (anatomically narrow pelvis, large fetus), reduce emergency caesarean sections and improve birth outcomes.
221-230 119
Introduction. The pandemic of a novel coronavirus infection has demonstrated the importance of assessing the ADAMTS-13/vWF axis in patients with COVID-19, because a decline in this ratio mirrors disease severity. However very few data in the global literature on crosstalk and ADAMTS-13/vWF levels in pregnant women remaining very contradictory are available. Taking into consideration an impact of the ADAMTS-13/vWF axis on prevalence of thrombosis and disorders in the hemostasis system, investigation of this issue is highly demanded.
Aim: to assess the functioning of the ADAMTS-13/vWF axis during physiological pregnancy.
Materials and Methods. A controlled non-randomized study was conducted: main group included 44 women with physiologically occurring pregnancies at I, II and III trimesters; the control group consisted of 45 healthy non-pregnant women. The plasma level of ADAMTS-13 inhibitor (ADAMTS-13:i), ADAMTS-13 antigen (ADAMTS-13:Ag), vWF antigen (vWF:Ag), and ADAMTS-13 activity (ADAMTS-13:Ac) as well as relevant ratio (ADAMTS-13:Ac/vWF:Ag) were measured.
Results. It was shown that in parallel with increasing gestational age, significant changes occurred in the ADAMTS-13:Ac/vWF:Ag ratio. In main group, patients at II trimester were found to have level of ADAMTS-13:Ac/vWF:Ag 0.359 ± 0.121, in III trimester –0.253 ± 0.741, which significantly differed (p < 0.01) compared to control group with non-pregnant women (1,134 ± 0,308).
Conclusion. Our study provides new insights into the functioning of the ADAMTS-13:/vWF axis in women with physiologically occurring pregnancy at I, II and III trimesters. Decline in ADAMTS-13:Ac was demonstrated along with increasing vWF:Ag level observed in parallel with increasing gestational age. Apparently, the progressive decrease of ADAMTS-13 concentration during pregnancy is associated with its increased consumption due to high vWF level. However, due to the small single-center patient cohort, further studies with larger-scale studies are needed.
Источник https://prof.gyneforyou.ru/
Источник https://www.gynecology.su/
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