Ukrainian Journal «Health of Woman»

Modern understanding of the impact of stress on the immune system of pregnant women

I.V. Poladych — 2024-02-28

Today, there is increasing attention being paid to mental health, especially in pregnant women who are vulnerable to the risk of mental disorders such as depression, anxiety, and post-traumatic stress disorder. Despite scientific progress, research on the impact of stress on mental health during pregnancy is insufficient.

Purpose - to analyze the impact of stress on the immune system of pregnant women.

A search and analysis of 78 original studies investigating the impact of stress on the course of pregnancy were conducted. Keywords and article selection criteria were applied. The systematic review included the most relevant studies that met the established criteria.

The findings indicate that the immune system plays a significant role in the development of stress-related mental disorders during pregnancy. However, most studies do not establish a clear link between stress, inflammation, and mental disorders in pregnant women.

Conclusions. The review highlights the need for further research aimed at understanding the relationship between stress, the immune system, and mental health in pregnant women. This will help develop effective methods for the prevention and treatment of mental disorders in this population, promoting healthy pregnancy outcomes and the birth of healthy children.

No conflict of interests was declared by the authors.

Analysis of perinatal outcomes in women with a threat of miscarriage in the first trimester depending on the fact of retrochorial hematoma formation

Yu.M. Duka — 2024-02-28

Purpose - to evaluate the effectiveness of the developed personalized approach to the management of patients with a threat of miscarriage in the first trimester depending on the fact of the formation of a retrochorial hematoma (RCH) in order to prevent the occurrence of preeclampsia (PE) in them.

Materials and methods. A prospective analysis of the course of pregnancy and childbirth was conducted in 137 women with a threat of pregnancy aged from 20 to 47 years (the Group I - 60 patients with RCH, the Group II - 77 patients with a threat of termination of pregnancy without hematoma). Bibliosemantic analysis was used in the study; estimated anthropometric data; an enzyme-linked immunosorbent assay was performed to study hormone levels; polymerase chain reaction was used to determine polymorphisms of thrombophilia and angiogenesis genes; instrumental - to assess the condition of the fetus (ultrasound diagnosis of the fetus with Doppler blood flow of the umbilical artery, uterine arteries, middle cerebral arteries, non-stress test).

Results. The average age of women of the Group I was 31.2±0.6 (95% CI: 30.0-32.4) years, of the Group II - 32.2±0.6 (95% CI: 31.0-33.3) of the year (p=0.243 according to the t-criterion). According to the Alberta Perinatal Health Program (APHP) adapted perinatal risk scale, 21 (35.0%) and 36 (46.7%) patients were assigned to the low perinatal risk group, respectively, and 30 (50.0%) medium risk) and 32 (41.5%) women, and to the high-risk group - 9 (15.0%) and 9 (11.7%) at p>0.05. During the treatment and observation of women with a threat of miscarriage in the first trimester, the developed treatment algorithm was followed: stabilization of the hematoma, reduction of myometrial tone, hormonal support of pregnancy with further determination of the need for the use, dose and duration of low-molecular-weight heparin (LMWH) in combination with aspirin. Differences between the Groups I and II revealed by means of a comparative analysis made it possible to outline the clinical and anamnestic factors that can serve as predictors of the development of PE in women with RCH.

Conclusions. The occurrence of RCH at the stage of early placentation increases the risks of developing placental dysfunction and obstetric complications related to it. The early appointment of aspirin (up to 12 weeks) in women with a high risk of developing PE allows to reduce the synthesis of platelets and thromboxane while preserving the synthesis of prostacyclin in the vascular wall in the initial stages of placentation. The combination of aspirin with the use of LMWH in women with the presence of genetic polymorphisms of candidate genes for thrombophilia and angiogenesis prevents the delay in the onset of uteroplacental circulation and promotes full placentation. A personalised approach to the management of pregnancy in women with a threat of termination due to the formation of RCH in the first trimester of pregnancy has made it possible to improve perinatal outcomes in the management of this category of pregnant women.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

The influence of neurovegetative and psychological characteristics of infertile patients with long-term COVID-19 on the effectiveness of assisted reproductive technologies

O.G. Boichuk — 2024-02-28

The connection of the long-COVID-19 symptom with violations of various systemic factors, in particular with the female reproductive system, is considered, but the number of such studies is not large.

The purpose of the study is the influence of neurovegetative and psychological characteristics of infertile patients with long-term COVID-19 on the effectiveness of assisted reproductive technologies (ART).

Materials and methods. The main group consisted of 80 women with infertility and "long-COVID", the comparison group - 40 patients without a history of COVID-19. In the main group, 2 subgroups were distinguished: 1 - 64 women with unsuccessful ART and 2 - 16 patients in whom ART was successful (a live birth was obtained). Socio-economic status and stress factors (questionnaire), fear of stress-19 (FCV-19S scale), autonomic dysfunction were assessed using the O.M. questionnaire. Wayne (1998), Anxiety and Depression Levels on the Hospital Anxiety and Depression Scale (HADS). The used methods of variational statistics using the Student's t-test and Fisher's angular transformation with a critical significance level of p<0.05 were used to calculate the odds ratio (OR) and its confidence interval (CI).

Results. Women with infertility and "long-COVID-19" are characterized by a relatively low level of socio-economic status: a lower level of income, a smaller share of entrepreneurs and housewives, not comfortable enough living conditions. These patients have a higher level of stressogenic load: comorbidity with chronic somatic pathology (58.8%), conflict situations in the family (31.3%), dissatisfaction with their sexual relationships (58.7%), a significantly higher level of fear of COVID -19 (29.73±1.31 points). Vegetative dysfunction is diagnosed in 82.5% of patients. Symptoms that are typical for "long-COVID-19" are most often noted: reduced work capacity/fatigue (82.5%), attack-like headaches (72.5%), difficulty breathing (47.5%), sleep disturbances (47 .5%). Unfavorable medico-social and psychological risk factors for the failure of ART programs in patients with "long-COVID-19" can be a point assessment of the autonomic dysfunction syndrome above 25 (OR=5.80, CI 1.22-27.64), anxiety (OR=5.80, CI 1.56-21.62), presence of depression (OR=4.20, CI 1.27-13.89), chronic somatic disease (OR=4.20, CI 1.30-13.62), conflict situations (OR=3.86, CI 1.24-12.04).

Conclusions. Women with infertility and "long-COVID-19" need additional examinations to assess the medical and social status, vegetative function and psychological state, correction of detected violations.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research.

No conflict of interests was declared by the authors.

Cytological and morphological predictors of complex treatment of obstetric surgical wound infection in women in labor

A.B. Рrуlutska — 2024-02-28

Purpose - to determination of the course and effectiveness of treatment of obstetric surgical wound infection in women in labor when using drugs with sorption-detoxification and immunomodulatory properties based on the study of the morphology of the wound process through the use of histological and cytological studies.

Materials and methods. In the work, histological and cytological studies were used to monitor the course of the wound process in 115 parturients with purulent wounds of the anterior abdominal wall after caesarean section and perineum after episio- and perineotomy. Women are divided into groups depending on the method of treatment: the Group I - 42 parturients with purulent wounds, who were treated with organosilicon sorbent Gentaxan; the Group II - 45 women in labor with purulent wounds, who were treated with organosilicon sorbent Gentaxan and immunomodulator Laferon; the Group III - 28 women in labor with purulent wounds, who were treated with traditional methods - with subsequent statistical processing of the obtained results.

Results. Based on the analysis of cytological and histological data, it was determined that the course of reparative processes in the wound during complex treatment with a sorbent and an immunomodulator is faster than that of monotherapy with a sorbent and conventional therapy - by 1.5-2 and 4-5 days, respectively. This was confirmed by a decrease in leukocytes, microorganisms, neutrophils and an increase in lymphocytes and connective tissue cells in the wound, affected the faster cleaning of the wound of dead and non-viable tissues, the rapid elimination of swelling and inflammation in the wound, and the acceleration of reparative processes.

Conclusions. The complex use of an immunomodulator and a sorbent in the treatment of purulent wounds shows an advantage over sorbent monotherapy by accelerating the reparative processes in the wound by 1.5-2 days, and over traditional therapy by 4-5 days, which makes it possible to recommend them for use in practical medicine.

No conflict of interests was declared by the authors.

Prevention of complications during pregnancy and childbirth in women with uterine leiomyoma

О.V. Golyanovskiy — 2024-02-28

Purpose - to evaluate the clinical effectiveness of the proposed preventive and therapeutic complex using modern drugs and organ-preserving methods of surgical treatment in pregnant women with uterine leiomyoma FIGO (International Federation of Gynecology and Obstetrics) type 3-6.

Materials and methods. This prospective study was conducted with a comprehensive examination, selection of optimal tactics for pregnancy management and delivery in 70 pregnant women with uterine leiomyoma using the complex developed by us (main group), 41 pregnant women with uterine leiomyoma with standard pregnancy management (comparison group) and 50 pregnant women without uterine leiomyomas in the II-III trimesters of pregnancy and after childbirth at 4 clinical bases of the Department of Obstetrics and Gynecology No. 1 of the Shupyk National Healthcare University of Ukraine for 3 years - 2020-2023.

Results. 70 pregnant women of the main group, who used the treatment and prevention complex developed by us, had significantly lower rates of iron deficiency anemia, the frequency of the threat of premature birth, fetal distress, and hypotonic labor compared to the comparison group and approached the rates of the control group (p<0.05). A 1.8-fold decrease in the risk of premature birth among women in the main group was also noted, as well as a 1.3-fold decrease in the cesarean section rate. PPH volume during vaginal delivery and cesarean section in the main group was significantly lower compared to the comparison group (p<0.01) and had no statistical difference with the control group (p>0.05).

Conclusions. Pregnant women with uterine leiomyoma have an increased risk of iron-deficiency anemia, the threat of premature birth, weakness in labor, fetal distress, cesarean section, and PPH development. The treatment and prevention complex proposed by us and the optimal technique for performing cesarean sections allowed not only to reduce the frequency of complications during pregnancy and childbirth, but also to reduce the rate of PPH and reduce the indicators of maternal morbidity.

No conflict of interests was declared by the authors.

Clinical characteristics of women with female sexual dysfunction and endometriosis

O.I. Kryzhanovska — 2024-02-28

Endometriosis is a disease characterized by the presence of endometrial tissue outside the uterine cavity. Endometriosis refers to estrogen-dependent diseases, clinically manifested by dysmenorrhea, dyspareunia, dyschezia. Decreased fertility in women with endometriosis is associated with the presence of chronic inflammation that leads to pelvic pain and infertility. It is believed that endometriosis is associated with mood disorders such as anxiety or depression, which can create a pathological background for sexual dysfunction.

Purpose - to establish the relationship between female sexual dysfunction (FSD) and external genital endometriosis in order to optimize women's pregravid preparation.

Materials and methods. 100 women of reproductive age were examined. The main group (the Group I) consisted of 70 women who had external genital endometriosis (diagnosed by ultrasound examination of the pelvic organs, ovarian endometrioma size up to 5 cm). The main group was divided into 2 subgroups: IA - 40 women with FSD and endometriosis; IB - 30 women with FSD without endometriosis. The control group (the Group II) included 30 healthy reproductively active women in the pre-gravid stage. In the course of the study, the nosological unit approved by the World Health Organization (1999) was taken into account and taken as a basis - FSD, which include disorders of desire, arousal and reaching orgasm, dyspareunia and vaginismus. The results of clinical and biochemical studies were processed using a specialized package of statistical programs Statistica 8.0 (StatSoft Inc., USA). The following criteria were used for statistical processing of the obtained data: Kruskal-Wallis test, Mann-Whitney U test, Pearson chi-squared (χ²) test, Wilcoxon test.

Results. The analysis of the definition of FSD in women with endometriosis clearly indicates the presence of signs of FSD in all areas and is statistically significantly different from the indicator of healthy women.

Conclusions. There is a relationship between endometriosis and FSD that can be determined using the FSFI Questionnaire Calculator. Since FSD and endometriosis have a polymorbid background, treatment should be carried out by a multidisciplinary team of doctors and be personalized.

No conflict of interests was declared by the author.

Peculiarities of pregnancy and childbirth course in women with inflammatory bowel diseases

L.M. Kupchik — 2024-02-28

The problem of pregnancy management in women with inflammatory bowel diseases is becoming more urgent, due to the prevalence of such pathologies as Crohn's disease and ulcerative colitis in the age group of women 20-40 years old, during which reproductive function is mainly being realized.

Purpose - to investigate the course of pregnancy and labour in women whose pregnancy occurred on the background of the existing Crohn’s disease and ulcerative colitis.

Materials and methods. The main group (the Group I) included women with chronic inflammatory bowel diseases - Crohn’s disease (the Group I-A; n=27) and ulcerative colitis (the Group I-B; n=52); the control group (n=20) consisted of women without severe somatic pathology. Retrospective clinical and statistical analysis was performed using data from medical documentation. Obtained results were statistically processed in specialized programs.

Results. A statistically higher frequency of pregnancy complications was found in women with inflammatory bowel diseases, such as anemia (59.3% in the Group I-A and 69.2% in the Group I-B versus 30% in the control group); threatening abortion (40.7% in the Group I-A and 53.8% in the Group I-B against 15% in the control group); hyperemesis gravidarum (44.4% in the Group I-A and 67.3% in the Group I-B against 25% in the control group); preeclampsia (37% in the Group I-A and 44.2% in the Group I-B against 10% in the control group); premature rupture of fetal membranes (37% in the Group I-A and 21.1% in the Group I-B against 10% in the control group). At the same time, women of the main group had an earlier development of spontaneous labor and a slightly smaller mass of newborns.

Conclusions. Received results indicate presence of Crohn's disease and ulcerative colitis influence on the course of pregnancy in women, which requires joint management of such women with gastroenterologists.

No conflict of interests was declared by the authors.

Antibodies against human and bacterial 60kDa heat shock proteins in pregnant women with superimposed preeclampsia

O.K. Popel — 2024-02-28

Purpose - to measure the blood serum levels of anti-HSP60 and anti-GroEL antibodies in pregnant women with chronic hypertension and superimposed preeclampsia, to evaluate the prospects of using these indicators as superimposed preeclampsia predictors.

Materials and methods. Prospective cohort observational study, which consisted of 105 pregnant women with chronic hypertension and the control group - 34 healthy pregnant women. Blood samples were collected at 28 weeks (first study point), the second time at 36 weeks in case of preeclampsia absence or at 29-35 weeks if preeclampsia added (second study point). If preeclampsia occurred after 36 weeks, additional anti-HSP60 and anti-GroEL antibodies measurements were not performed. Anti-HSP60 and anti-GroEL antibodies were measured by immunosorbent assay.

Results. At 28 weeks anti-HSP60 and anti-GroEL antibodies growth was detected in the chronic hypertension and superimposed preeclampsia subgroups compared to the healthy subgroup (p<0.01 and p<0.001 respectively for anti-HSP60; p<0.0001 for anti-GroEL in both cases), no difference was found between chronic hypertension and superimposed preeclampsia subgroups.

At the second study point, anti-HSP60 antibodies were increased in the chronic hypertension and superimposed preeclampsia subgroups compared to the healthy subgroup (p<0.01 and p<0.0001, respectively); a statistically significant difference was found between chronic hypertension and superimposed preeclampsia subgroups (p<0.01). Anti-GroEL antibodies at the second study point were increased in the chronic hypertension and superimposed preeclampsia subgroups compared to the healthy subgroup (p<0.001 and p<0.0001), however, no statistically significant difference was found between levels in the chronic hypertension and superimposed preeclampsia subgroups.

Anti-HSP60 antibodies showed a strong correlation with anti-GroEL antibodies in all subgroups at the first study point, same was true for healthy and chronic hypertension subgroups at the second study point. There was no correlation between anti-HSP60 and anti-GroEL antibodies indicators in the superimposed preeclampsia subgroup at the second study point (p=0.059). There was no growth of anti-GroEL antibodies with gestational age increase in the chronic hypertension subgroup. Anti-HSP60 antibodies increase at the second study point compared to concentrations at 28 weeks in the chronic hypertension subgroup (p<0.001) and the superimposed preeclampsia subgroup (p<0.001).

Conclusions. Loss of immunological tolerance to HSP60 and exacerbation of immunological reactivity against GroEL accompany hypertensive disorders course during pregnancy. Anti-HSP60 antibodies may play a more significant role in superimposed preeclampsia development. Application of anti-HSP60 and anti-GroEL antibodies as superimposed preeclampsia predictors needs further study.

No conflict of interests was declared by the authors.

The effect of an elimination diet on the functional state of the gastrointestinal tract and liver of childbearing age women having symptomatic adenomyosis

M.S. Lonshakova — 2024-02-28

The existence of food intolerances disrupts the work of the gastrointestinal tract and the liver, the symptoms of which are largely similar to those of adenomyosis.

Purpose - to investigate the effect of the elimination diet on indicators of the functional state of the gastrointestinal tract and liver of women having symptomatic adenomyosis.

Materials and methods. 120 women with symptomatic adenomyosis were divided into 4 groups: the Group I - 30 women who were treated with dienogest; the Groups ІІ, ІІІ and IV - 30 women each, who were prescribed an elimination diet taking into account the identified type of food intolerance. A comprehensive clinical examination, coprological examination, and ultrasound steatometry of the liver were performed. Statistical data was processed by the SPSS 21 program.

Results. Compared with women of the Group I, patients of the Groups II, III, and IV showed a decrease in the pain symptoms of adenomyosis, the frequency of complaints from the digestive tract, amylorrhea, steatorrhea in feces, and markers of the inflammatory process in the intestine, as well as the frequency and severity of liver steatosis.

Conclusions. The elimination diet, taking into account the identified type of food intolerance, has a positive effect on well-being, the functional state of the gastrointestinal tract and reduces the symptoms of the disease of childbearing age women with adenomyosis.

No conflict of interests was declared by the author.

Clinical aspects of preeclampsia: a retrospective analysis

D.O. Govsieiev — 2024-02-28

Preeclampsia (PE) is a serious cause of maternal and perinatal mortality. Every year, more than 2 million cases of PE and about 76,000 deaths among women from this pathology are registered in the world. Preeclampsia can cause premature birth and increase the risk of complications. Clinical manifestations of the disease are diverse. Therefore, studying the clinical features of PE is necessary to improve its prevention, diagnosis and treatment.

Purpose - to study the frequency and clinical aspects of the course of PE in pregnant women to improve prevention, diagnosis and treatment of this pathology of pregnancy.

Materials and methods. 21,950 cases of childbirth from 2016 to 2022 were analyzed. The clinical characteristics of 1,209 patients with preeclampsia were analyzed. The obstetric history of women with PE was studied, their somatic status was assessed, and laboratory data were analysed. The results were statistically analysed using the methods of variation and alternative statistics.

Results. In 2016-2020, the frequency of PE was 5.5% of the total number of births. The increase in PE during the observation period was 51.5%, its severe degree was 70.5%. In women with PE, I-III pregnancies prevailed (79.5%) and I or II births in the anamnesis (97.4%). The severity of the disease was correlated with the body mass index, which varied from 22 to 43 kg/m2. Pathological changes in the objective status were revealed, including edema (53.8%) and neurological disorders (71.7%). Almost all pregnant women with PE had proteinuria. Thrombocytopenia was detected in 15.4%, hemoglobin decrease was in 25.6%. The majority of pregnant women had an increase in the prothrombin index (73.6%) and a decrease in fibrinogen (52.7%).

Conclusions. The study of clinical aspects of PE reveals a high frequency of this pathology, a wide range of clinical symptoms, hemostasis disorders and organ dysfunction, which indicates the need to develop effective strategies for its diagnosis and treatment.

No conflict of interests was declared by the authors.

Algorithm of differentiated treatment of patients with ovarian endometrioma and infertility

A.S. Sadullayev — 2024-02-28

Purpose - to improve fertility in women with ovarian endometrioma (ОЕ) and infertility using the proposed algorithm and treatment methods.

Materials and methods. The prospective study was conducted in 2 stages. In the first stage, 93 women with infertility were included in the study, who were divided into the following groups depending on the surgery performed: the Group 1 - with ОЕ sclerotherapy followed by platelet-rich plasma (PRP) injection into the ovarian tissue; the Group 2 - laparoscopic cystectomy followed by PRP injection into the ovarian tissue; the Control (C) group - with classical laparoscopic cystectomy.

After dynamic observation, assessment of ovarian reserve and control of pregnancy for 12 months, an algorithm for differentiated treatment of ОЕ in women with infertility was developed. At the 2^nd stage, 20 women (the Group 3) were treated with the proposed methods of treatment, such as sclerotherapy with ОЕ + PRP (the Subgroup 3a) and laparoscopic excision of the ОЕ + PRP capsule (the Subgroup 3b), based on the algorithm, and analyzed. Statistical processing of the results was performed using Microsoft Excel.

Results. The mean level of anti-mullerian hormone (AMH) in the Subgroup 3a increased from 1.76 (CI: 1.47-1.71) ng/ml to 1.87 (CI: 1.63-1.86) ng/ml (p=0.036). In the Subgroup 3b, AMH changed from 2.15 (CI: 1.89-2.48) ng/ml to 2.22 (CI: 1.91-2.53) ng/ml (p>0.05). The number of antral follicles (AF) in the Subgroup 3a increased from 8.88 (CI: 7.90-9.90) to 11.10 (CI: 10.40-11.80) (p<0.001). In the Subgroup 3b, from 10.60 (CI: 9.90-11.20) to 11.00 (CI: 10.50-11.50) (p>0.05). Spontaneous pregnancy within 6 months occurred in 6 (60%) patients from the Subgroup 3a, and in 4 (40%) women from the Subgroup 3b (p>0.05). After 6 months of follow-up, 2 underwent assisted reproductive technology. The remaining women from the Subgroup 3a (3 (30%)) and the Subgroup 3b (5 (50%)) also had spontaneous pregnancies by 1 year of follow-up (p>0.05).

Conclusions. The proposed methods of treatment of ОЕ, sclerotherapy + PRP and laparoscopy + PRP, showed a significant positive effect on the preservation of ovarian reserve. A differential approach to the treatment of ОЕ based on the proposed algorithm increases the occurrence of spontaneous pregnancy.

No conflict of interests was declared by the authors.

Maternal and fetal arrhythmia as a sign of hemodynamic deterioration: a case report

I.V. Lakhno — 2024-02-28

The co-existing maternal (MA) and fetal arrythmia (FA) are associated with maternal goiter disease, chorioamnionitis, or Ballantyne’s syndrome.

The aim of the study - to determine the involvement of maternal arrhythmia and fetal arrhythmia in the pathogenic scenario of hemodynamic deterioration in Ballantyne’s syndrome.

Clinical case. It is presented the case of sustained several weeks of MA and FA. A pregnant woman aged 36 years was admitted to the division of maternal and fetal medicine at 34 weeks of gestation. She was gravida 4 and para 3. She had complaints of rapid heartbeat, left-side chest discomfort, and lower extremities edema. The diagnosis of maternal sinus tachycardia was supported via electrocardiography. The indices of fetal, umbilical, and uteroplacental hemodynamics detected via Doppler ultrasound were appropriate. However, fetal heart rate was 209 beats/min. The transplacental attack of oral sotalol 80 mg thrice daily was prescribed. But maternal and fetal tachycardia persisted to stay. The tricuspid regurgitation was detected via Doppler ultrasound next day. The fetus was hydropic. The male baby of 2400 g, 46 cm length, 31 cm head circumference, and Apgar score 3→5 was delivered via caesarean. The newborn was discharged in 21 days. He was admitted again in one month for rehabilitation. Maternal heart rate reduced to 72 beats/min and edema regressed in three days after birth.

Conclusions. MA and FA before fetal hydrops are supposed to be the early signs of mirror syndrome. This speculation needs further investigation.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.