The aim: To find out whether or not the presence of pregnancy loss and preterm birth was associated with the history of healthcare-associated infection (HAI) of women reproductive tract. Materials and methods: We performed a retrospective cohort study was based on surveillance data. This study included 1,027 fertile women aged 21-50 years admitted to 8 hospitals from 2017-2019 with complaints to pregnancy loss or preterm birth. Definitions HAI of women reproductive tract were used from the CDC/ NHSN. Results: Of 1,027 fertile women with complaints to pregnancy loss or preterm birth, 702 (68.4%) HAIs of reproductive tract were detected. The predominant HAIs were: postpartum endometritis (19.1), bacterial vaginitis (15.8%), chorioamnionitis (11.3%), vaginal cuff infection (9.1%), and parametritis (5.6%). According to the statistical data, a significant association between HAI of women reproductive tract and the history of pregnancy loss (p < 0.05) was determined. The presence of HAI had no effect on the first trimester miscarriage (p > 0.05), but HAI women reproductive tract had strongly affected the second trimester pregnancy losses (p < 0.05). Main causative agents of HAI were Escherichia coli (31.5%), Enterobacter spp. (18.4%), Klebsiella pneumoniae (12.5%), Enterococcus faecalis (11.6%),Staphylococcus aureus (10.2%), Pseudomonas aeruginosa (8.4%). Conclusions: This study identified a significant association between healthcare-associated infection of women reproductive tract and a history of miscarriage. However, there was no association between HAI and a history of preterm birth.
Sleep disorders (dyssomnia) during pregnancy are of high prevalence and may be associated with negative peri- and postnatal outcomes. However, these conditions are often not effectively diagnosed and treated. In this review a systematic evaluation of the effectiveness of different methods of therapy to improve the quality of sleep and in the presence of insomnia during pregnancy was conducted.Systematic search in PubMed, Psycinfo and Medline databases was conducted without limiting the publication date till November 3, 2022. The relevant studies included pregnant women of any age and gestation; they included the clinical intervention schemes aimed at improving sleep quality; the data before and after treatment for one or more sleep-related results were reported. 16 studies were selected with a total of 988 pregnant women. According to the results of researches the effectiveness of different types of interventions was established: cognitive-behavioral therapy for sleep disorders, pharmacotherapy, acupuncture, yoga, relaxation and phytotherapy. The recent publications have determined that sleep disorders have a connection with the adverse pregnancy outcomes, including fetal growth restriction, premature births, weakness of uterine labor activity and high delivery frequency of caesarean section.There is an extremely high relevance and need for high-quality randomized controlled studies about sleep disorders during pregnancy and implementation of effective standard obstetric care programs. There is a necessity to improve psychological care and sleep care during pregnancy to maintain a positive pregnancy course, childbirth and postpartum period. Future clinical studies should be randomized and include a sufficient number of women for statistical efficacy, including checking the effectiveness of cognitive-behavioral insomnia therapy to prevent pregnancy/childbirth complications and somatic diseases in the long-term period.
Cervical insufficiency (CI) is one of the main pathological conditions that leads to pregnancy loss, in particular, recurrence miscarriages and premature births, which account for up to 5 % of all obstetric cases. Recurrence pregnancy losses caused by CI lead to serious psychological trauma for both the woman and her family members, as well as significant economic losses for the society. However, many women in some regions of the world still do not know about this pathology, and clinicians do not always diagnose this condition in time.At the same time, etiology of CI remains uncertain, and there are still ambiguous points regarding the diagnosis of this pathology and its treatment. The diagnosis of CI should be established by analyzing the medical history, clinical manifestations and results of ultrasound examination. Treatment of CI mainly includes surgical and conservative methods. Surgical treatment is performed with cervical cerclage, while conservative techniques mainly include the use of vaginal progesterone and insertion of various types cervical pessaries. This article summarizes the potential risk factors associated with cervical insufficiency that are of great attention and may be useful for future researches. Also, the review of the literature considers modern methods of diagnosis and treatment of CI to understand this pathology of the cervix better. From a modern standpoint, a consensus and problematic issues are presented in accordance with the recently updated recommendations, which are of practical importance, and are also important for further deeper research on this topical issue of modern obstetrics.
Background: Pregnancy and deliveries resulting from assisted reproductive technology (ART) in women of advanced maternal age (AMA) are reported to be associated with adverse maternal and perinatal outcomes. The aim of the study was to investigate the impact of a combination of AMA and assisted reproduction on obstetric and perinatal outcomes of nulliparous singleton pregnancies. Methods: Medical records of 201 live-born singletons, cephalic, non-anomalous nulliparous pregnancies were reviewed retrospectively. The IVF conception (90 AMA women after ART) and spontaneous conception (111 AMA women with spontaneous pregnancy) groups were formed. Results: Intrauterine growth restriction, nonreassuring fetal state, operative vaginal delivery, cesarean section, induction of labor, and massive obstetric hemorrhage were more common in AMA patients after ART compared with the spontaneous conception group. The incidence of preeclampsia and nonreassuring fetal status during pregnancy in the IVF conception group was more than 2 times higher than that in the spontaneous conception group. There were no significant differences in spontaneous preterm delivery, Apgar scores, and neonatal morbidity rates between the study groups. Discussion: Nulliparous AMA women with pregnancies obtained after ART have inherently higher risks of severe adverse maternal and perinatal outcomes and require careful dynamic monitoring of mother's and fetal conditions followed by prevention and, if possible, correction of disorders during pregnancy and delivery.
According to the WHO, neoplastic processes of the uterus remain one of the important and relevant areas of modern gynecology. Uterine leiomyoma is one of the most common tumors of the female reproductive system. According to the latest data, every 4–5th woman in the world is diagnosed with leiomyoma, the incidence of which under the age of 35 reaches 50%, and according to autopsy data reaches 80%.The article provides a review of the scientific publications in recent years devoted to the study of the problem of uterine fibroids – relevance, causes and mechanisms of development, provides a classification, clinical manifestations, modern diagnostics and management tactics.The etiological factors of leiomyoma are numerous, there is no a single theory of the disease. Among the pathogenetic factors of leiomyoma are hormonal disorders, genetic components, infections, injuries. There are several classifications of leiomyoma, the most common classification was proposed by the International Federation of Gynecology and Obstetrics, which reflects the types of leiomatous nodes depending on their location and relationship to the uterine cavity and myometrium.Clinical manifestations of uterine fibroids range from asymptomatic to painful sighns and hemorrhagic syndromes, symptoms of compression of adjacent organs, the development of uterine bleeding, which lead to severe anemia. The nature of clinical features significantly depend on the localization of the leiomyoma nodes in the uterine body and their relationship to the uterine cavity (submucosal, intramural, subserous), as well as their number, size and blood supply.Modern diagnosis of leiomyoma is based on anamnesis, bimanual gynecological examination, ultrasound examination, and in some cases – magnetic resonance imaging and computed tomography examinations, hysteroscopy and laparoscopy. Today, the main methods of treatment of leiomyoma are conservative, surgical and radiological methods (uterine artery embolization, magnetic resonance-guided focused ultrasound).In addition to the listed modern aspects of the clinic, diagnosis and treatment of uterine leiomyoma, the article emphasizes the importance of preventive measures to reduce the incidence of this gynecological pathology.
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