The aim of the study is to assess the frequency of pregnancy complications and the mode of delivery in COVID-19 women performing delivery in the district clinical hospital in the city of Khanty-Mansiysk. Materials and Methods. The authors retrospectively analyzed 148 medical histories of COVID-19 women, who delivered in Khanty-Mansiysk perinatal center. All patient medical records were divided into 4 subgroups depending on the delivery term, and 3 subgroups depending on the disease severity. Statistical analysis was carried out using analytics software packages Statistica 10 (USA) and StatTech v. 2.8.4 (Stattech, Russia, 2020). Given group heterogeneity, non-parametric statistical methods were used to calculate quantitative and qualitative parameters. Fisher Z transformation and the Mann-Whitney test were used to compare the parameters. Differences were considered statistically significant at p≤0.05, CI 95 %. Results. In all subgroups the most common pregnancy complication in COVID-19 patients was anemia. It was observed in 50.8 % to 74.3 % of cases. The maximum incidence of moderate preeclampsia was 2.7 %, that is below the average population value. Most placental abnormalities were detected in subgroups of women who gave birth during 3rd and 4th waves of COVID-19 (37.1 % and 33.8 % respectively). In the same subgroups, fetal growth retardation (28.6 % and 32.3 %), statistically significant increase in the proportion of preterm births (34.3 % and 38.5 %) and transfers to the neonatal intensive care unit (28.6 % and 26.2 %) were often observed.
Embryo implantation is a key factor limiting the effectiveness of assisted reproductive technologies, and depends on the quality of the blastocyst and the susceptibility of the endometrium. Various methods of treatment aimed at improving the receptivity of the uterine mucosa, including endometrial scratching, have been proposed. At the same time, the main mechanisms underlying this intervention remain unclear. Moreover, the optimal duration of exposure to the uterine mucosa and the groups of patients in which it can have a positive effect have not been determined. The study aims to investigate the main mechanisms and evaluate the effectiveness of local endometrial damage performed at various times before embryo transfer in the program of assisted reproductive technologies in women with and without a history of implantation failures based on the analysis of scientific literature. Clinical studies, systematic reviews and meta-analyses were studied in PubMed, Embase, Cochrane Library, Web of Science databases, Elsevier, Springer, Wiley publishers, on eLibrary, Research Gate platforms, in open sources of the scientific and educational segment of the Internet. The literature search was conducted by keywords: endometrial scratching, local endometrial damage, implantation failures, endometrial receptivity, assisted reproductive technologies, infertility. The search depth is 20 years. The main mechanisms of the effect of scratching on increasing endometrial receptivity include decidualization, the development of a local inflammatory reaction, as well as improved synchronization between the uterine mucosa and the transferred embryo by preventing premature maturation of the endometrium. Studies that showed a positive effect of local damage to the uterine mucosa were mainly conducted in patients with repeated implantation failures and with intervention in the luteal phase of the cycle preceding stimulation. At the same time, the work performed in a non-selective population of women and non-standardized by exposure time, in most cases, did not reveal the advantages of endometrial scratching. In this regard, additional qualitative randomized controlled trials with a large sample size and a clear identification of groups of patients for whom this intervention may benefit are required.
Since the beginning of the COVID-19 pandemic, there have been a number of studies related to the impact of SARS-CoV-2 on the course of pregnancy and fetus condition. As observed, the placentas of women who have had a new coronavirus infection often contain more villous agglutination and subchorionic thrombi than placentas in SARS-CoV-2-negative women. To date, several isolated publications have reported clinical cases of fetal death in mothers infected with coronavirus infection. The authors have made an assumption on the association of adverse outcomes with placental lesions. The aim of the study was to analyse a clinical case of a moderate-course new coronavirus infection in a pregnant woman at a long gestation period who underwent an antenatal fetal death, and evaluate the features of placental histopathology and their impact on adverse gestational outcomes. Material and methods. The authors have analysed Russian and international research publications from various sources, including eLIBRARY.RU, CyberLeninka, PubMed databases etc. and, considering the data obtained, investigated a clinical case of intrauterine fetal death in a pregnant woman infected with SARS-CoV-2. The placenta was studied in accordance with the clinical recommendations of the Russian Society of Pathologists "Rules for placental pathological and anatomical examination" and the international classification of placental lesions (Amsterdam, 2015). Results. The results obtained support the association between acute diseases of the upper respiratory tract and developing severe hemodynamic disorders in the "mother-placenta-fetus" system in pregnant women infected with SARS-CoV-2. Systemic inflammation associated with new coronavirus infection appears to be one of the mechanisms for developing placental disorders.
The aim of the study is to analyze the literature available, to examine bariatric surgery as a treatment for people with metabolic syndrome (a risk factor for atypical endometrial hyperplasia), and to evaluate bariatric surgery significance in reducing endometrial cancer incidence. Materials and Methods. The authors scanned the platforms Springer, Pubmed, IFSO, and Google Scholar using such key words as metabolic syndrome, simple and atypical endometrial hyperplasia, endometrial cancer and bariatric surgery, methods for the metabolic syndrome correction in patients with endometrial cancer, effects of bariatric surgery on endometrial cancer, treatment of metabolic syndrome in patients-at-risk for endometrial cancer. The authors examined the articles published in English and Russian no longer than 10 years ago. Results. Metabolic syndrome is a risk factor for endometrial cancer and comorbidity. It expands the bariatric surgery alternatives for patients with Class 1 and Class 2 obesity.
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