Introduction. The management of pregnant women in the conditions of the spread of a new coronavirus infection has become a priority task for doctors of all specialties, since it is with this pathology that an increase in the frequency of unfavorable gestation outcomes is currently associated.The aim of the study: to study obstetric and perinatal outcomes after a new coronavirus infection in the I and II trimesters of pregnancy.Objective. To study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.Materials and methods. A comparative study of the birth histories of women after coronavirus infection in 2021 was carried out. Group 1 (n = 26) consisted of patients with COVID-19 infection in the first trimester, group 2 (n = 30) – in the second trimester. The 3rd group is represented by relatively healthy women (n = 35). Statistical analysis was performed using the Statistica 7.0, SPSS 17 packages, as well as the statistical functions of MS Excel 2013.Results and discussion. The course of pregnancy after COVID-19 infection suffered in the first and second trimesters is associated with an increased risk of placental insufficiency (26.9 and 30%, respectively), the development of sympthoms of threatening termination (61.5 and 46.7%), anemia (38.5 and 43.3%), gestational hypertension (15.4 and 16.7%), bacterial vaginosis (19.2 and 20.0%), premature rupture of fetal membranes (34.6 and 16.7%), with the prevalence of urgent labor, but an increase in premature (13.3%) and operative labor (36.7%) with the manifestation of the disease in the second trimester. Newborns of mothers with COVID-19 infection are more often born in a state of asphyxia (65.4 and 53.3%). The structure of perinatal pathology is dominated by cerebral ischemia (42.3 and 40%), perinatal hypoxic damage to the central nervous system (19.2 and 23.3%), neonatal jaundice (11.5 and 23.3%), intrauterine pneumonia (15.4 and 10.0%), congenital malformations (7.7 and 30.0%; p1-2 = 0.04).Conclusion. The results of the study once again have confirmed the need for further study of the problem in order to find measures to reduce obstetric and perinatal complications in women after COVID-19 infection.

Introduction. Isthmic-cervical insufficiency (ICI) continues to be one of the main causes of miscarriage and premature birth (PB), contributing to the growth of reproductive losses and directly affecting the indicators of perinatal morbidity and mortality.Objectiveof the study – to study the features of the course of pregnancy, childbirth and perinatal outcomes in ICI, depending on the method of delivery.Material and methods.A retrospective analysis of birth histories (n = 144) with a diagnosis of Isthmic-cervical insufficiency was carried out, for the period from 2015 to 2020. 102 pregnant women who delivered through the natural birth canal (70.8%) made up group 1, and 42 women whose births ended with cesarean section (29.2%) made up group 2. The control groups included patients with a singleton uncomplicated pregnancy, which ended with an emergency delivery through the natural birth canal (group 3 – n = 96) and by caesarean section (group 4 – n = 58). Anamnestic data, peculiarities of the course of pregnancy, childbirth and perinatal outcomes were studied in detail. Statistical analysis was carried out using the programs Excel MS Office Professional and STATISTICA 7.0.Results and discussion. ICI is more common in repeat-bearing women with a male fetus (p < 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p >< 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p >< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes. >< 0.001), with a burdened obstetric and gynecological history, concomitant extragenital pathology, over the age of 30 years. In PB, conservative management of the birth act prevails against the background of ICI (70.8%) (p < 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p >< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001). The choice of delivery method in ICI determines the gestation period, fetal condition, the occurrence of urgent obstetric complications and premature rupture of fetal membranes. With ICI, the birth of children in a state of asphyxia prevails (p < 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p >< 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001). With operative delivery, the probability of diagnosing mild asphyxia (1.3 times) and respiratory distress syndrome (2 times) increases. With conservative management of childbirth against the background of ICI in newborns, the frequency of grade I cerebral ischemia increases significantly (by 5 times) (p < 0.001). Conclusion. The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.>< 0.001).Conclusion.The results of the study once again confirmed the significant importance of the ICI in the implementation of PB, which dictates the need for further study of this problem to improve the quality of care for pregnant women and improve perinatal outcomes.

Objective. To study the effect of fetal sexual dimorphism on the course of pregnancy and perinatal outcomes in preterm birth (PB). Patients and methods. The inclusion criterion was singleton PB at 22–36.6 weeks’ gestation (n = 1411) between 2014 and 2016 with male births (group 1, n = 789) and female births (group 2, n = 622). When analyzing medical histories of PB, the aspects of obstetrical and gynecological history, comorbidities, complications of the present pregnancy, date and methods of delivery were considered. Perinatal outcomes were assessed in terms of perinatal morbidity and mortality rates. Statistical analysis was performed using Statistica 7.0 software package. Results. The incidence of PB in mothers of boys increases 1.3-fold, increasing the likelihood of very early and early PB. The course of pregnancy in group 1 was found to be more often associated with anemia and acute respiratory viral infections and with threatened miscarriage, premature rupture of membranes, polyhydramnios, and pre-eclampsia. Patients in group 2 had an increased incidence of vulvovaginitis, pyelonephritis, gestational hypertension, and fetal growth restriction. Premature boys are more likely to develop intrauterine hypoxia, asphyxia, and respiratory distress syndrome. Conclusion. The results of the study indicate that further research in this area is needed to improve the quality of care for pregnant women, taking into account the sex of the fetus. Key words: pregnancy, pregnancy complications, perinatal morbidity, fetal sex, preterm birth

Introduction. Ectropion of the cervix (EC) is a condition when there is a cicatricial deformity of the uterine cervix (as a result of traumatic injuries) with visualization of the ectopic columnar epithelium on the vaginal part of it. The ectopia is currently classified as a variant of the normal histophysiological state of the cervix. This article discusses the features of the course and methods of treatment of complicated EC. Objective of the study is: to develop and evaluate the effectiveness of a new method of complex treatment of CE. Material and methods. In an open prospective study, 133 patients with CE (groups 1 and 2) and 56 healthy women (group 3) has taken part. In group 1 (n = 83), we have used a method for treating CE developed by us, which included two stages: stage I – elimination of microbial and viral pathogen in combination with immunomodulatory therapy, II – electrosurgical treatment (Leep biopsy) and treatment of the cervix with Galavit (100 mg of dry matter) dissolved in 5 ml of Miramistin (Patent for invention RU 2568768 C1). In group 2 (n = 50), surgical treatment of CE has been preceded by vaginal sanitation, empirical antibacterial and antiviral therapy. Diagnostic measures, in addition to standards, have included: determination of interleukins IL-1β, IL-6, IL-8, IL-10 in the discharge of the cervical canal, ultrasound diagnostics with Doppler measurements in the vessels of the central zone of the cervix. Statistica 7.0, SPSS 17 packages have been used for statistical processing. Results and discussion. Before the start of treatment, patients in groups 1 and 2 have been found to have a combination of CE with cervicitis (100%), ASCUS cytological picture (more than 60%), abnormal colposcopic signs (100%), imbalance of the local immune system with a predominance of Th1 cytokines (the content of IL-8 increased 2.6 times; IL-1b – 13 times; IL-6 – 20 times, and IL-10 – in 1.7 times) against the background of increased vascularization and cervical perfusion. The reparative process after Leep biopsy in group 1 has ended by the end of 3 weeks in 65.6% of patients, in group 2 – in 25.5%, after 5 weeks – in 100% and 57.4%, respectively, after 8 – in group 2, 91.5%. The average period of epithelialization of a wound on the cervix in group 1 was 27.4 ± 4.3 days, in group 2 – 39.5 ± 5.6 days (p = 0.01). After 2 years, the recurrence of cervical pathology has been recorded only in group 2 (34.0%). Conclusion. The use of the developed method of two-stage complex therapy for CE increases the effectiveness of treatment, prevents complications after Leep biopsy, accelerates epithelialization by 30.6% and avoids recurrence of the disease.

Introduction. Preterm birth (PR), complicated by premature rupture of the fetal membranes (PRPO), continues to be the focus of attention of obstetricians-gynecologists and neonatologists, due to high rates of perinatal morbidity and mortality.The purpose of the study: to identify the features of the course of puerperium in preterm birth with a long anhydrous interval.Material and methods. A single-stage cohort comparative study of the course and outcomes of PR complicated by PRPO and an anhydrous interval of more than 12 hours (group 1: n = 153) and spontaneous PR with an anhydrous interval of less than 12 hours (group 2: n = 408) has been conducted. Anamnestic data, peculiarities of pregnancy, childbirth, postpartum period, complications of puerperium and morbidity of newborns have been studied in detail.Results and discussion. Pregnancy in group 1 was significantly more likely to occur against the background of acute respiratory diseases (ARVI - 2 times), colpitis (2.6 times), more often complicated by threatening termination (1.3 times), the development of isthmic-cervical insufficiency (1.3 times) and chorioamnionitis (5.7 times). It has been found that in the group of patients with a long anhydrous interval, the risk of hyperthermia (2 times - up to 49.7%), subinvolution of the uterus (1.5 times - up to 25.5%), late hypotonic bleeding (13 times - up to 6.5%), endometritis (4 times - up to 3.9%) increased significantly in the postpartum period, increasing the probability of generalization of infection and hysterectomy to 1.3%.Conclusion. The results of the study once again have confirmed the negative impact of a long anhydrous interval on the incidence of newborns with PR. In addition, data have been obtained on an increased risk of purulent-septic infection in the puerperal period after PR, complicated by PRPO and a long anhydrous interval. All of the above indicates the need for further research in this area to develop a set of diagnostic and therapeutic measures to predict and prevent complications of puerperium during prolonged pregnancy complicated by PRPO.

Parvovirus (PV) is a widespread infection, despite the fact that this pathogen was discovered only recently. The therapeutic effect of PV, in particular its oncolytic activity, is being actively studied now. Notably, PVs causing infections in animals, such as rat PV H-1, caninae PV, and rodent protoparvovirus (minute virus of mice) suppress oncogenesis in these animals. There is an ex vivo evidence of rat glioblastoma and gliosarcoma sensitivity to PV. The affinity of PV B19 to P-antigen located primarily on the membranes of erythroid cells is crucial for the disease pathogenesis. The teratogenic effect of PV B19 is associated with its ability to infect placental cells (P-antigen is present on the cells of chorionic villi and surface of the trophoblast). PV infection can be acquired or congenital, typical or atypical. The outcome of intrauterine infection with PV B19 largely depends on the gestation age when the infection occurred. Women infected during the second trimester are at higher risk of vertical transmission and severe intrauterine pathology with a poor outcome than those infected during the third trimester. Constant contact with young children significantly increases the risk of PV B19 infection among pregnant women with no immunity to this virus. Serum is the most convenient biomaterial for detecting both PV DNA and virus-specific antibodies. One test for anti-PV IgG using enzyme-linked immunosorbent assay is sufficient to determine the immune status of a patient. Polymerase chain reaction with amniotic fluid is used to diagnose intrauterine infection with PV B19. Blood components and products should be checked for PV B19. High frequency of PV B19 detection in the blood of donors necessitates the development of special measures aimed at prevention of virus transmission. Key words: pregnant women, children, parvovirus B19, parvovirus infection

Objective. To assess the impact of endotoxicosis in pregnant women with acute pyelonephritis (AP) on the function of the utero-placental-fetal complex and gestational outcomes. Patients and methods. This study included 37 pregnant women with AP (Group 1) and 35 women with uncomplicated pregnancy (Group 2). Patients have undergone Doppler ultrasonography. In addition to that, we measured leukocyte intoxication index, total endotoxin, pregnancy-specific beta-1-glycoprotein (PSBG-1), and placental alpha microglobulin-1 (PAMG-1) in serum using enzyme-linked immunosorbent assay (ELISA). Results. AP during pregnancy led to placental dysfunction with desynchronization of pregnancy protein synthesis, endotoxicosis, and changes in hemodynamics in the uterine arteries, which, in case of standard treatment, increased the frequency of placental premature aging (43.2%), amniotic fluid disorders (32.4%), fetal growth retardation (27.8%), gestational hypertension (40.5%), preeclampsia (37.8%), preterm birth (27.8%), and caesarean section (32.4%). We found a correlation between the uterine artery resistance index and the level of endotoxicosis markers, as well as PSBG-1 and PAMG-1 levels. Conclusion. Our findings suggest the need for further studies in this area in order to develop a complex of therapeutic measures to increase the number of successful pregnancy outcomes after AP. Key words: pregnancy, acute pyelonephritis, placental dysfunction, endotoxicosis

The purpose of the research was to study the features of the clinical course of COVID-19 viral infection in pregnant women, depending on the gestational stage. Material and methods. Included the study of 67 pregnant women with COVID-19 at different periods of gestation. The age of women ranged from 16 to 41 years. All pregnant women were hospitalized to the infectious diseases departments of Saratov hospitals. During the period of hospitalization, the examination of women was carried out according to the methodological recommendations of the Ministry of Health of Russia for coronavirus infection in pregnant women. During virological examination of mucus from the pharynx and nose, using the reverse transcription polymerase chain reaction method, the RNA of the COVID-19 virus was found in all pregnant women. Results. COVID-19 most frequently infects primipara in the I (61,6%) and III (70,6%) trimester of gestation and multipara in the II (62,5%) trimester of gestation with burdened obstetrics-gynecological anamnesis (58,3%) and accompanying pathologies (41,5%). In pregnant women with COVID-19, mild and intermediate forms of the disease prevailed (31,3% and 47,8% respectiely). The frequency of coronavirus infection in the I (38,8%) and II (35,8%) trimesters of gestation increases the frequency of that in the III (25,3%) trimester. Among women with COVID-19, the following symptoms were observed: decrease in smell and taste in 66 (98,5%) cases, sore throat in 59 (85%) cases, increased body temperature in 61 (90,9%) cases. Lesions of lower respiratory tract was observed in all stages of gestation, pneumonias were less frequent in the I trimester. In all cases the COVID-19 course had a favorable outcome, with no lethality.

Pancreatitis ranks third in the structure of acute surgical diseases of the abdominal cavity. The development of this pathology during pregnancy is complicated by premature birth in 58% of cases, which directly affects the indicators of perinatal morbidity and mortality.Objective: to study the features of cytokine synthesis and their impact on the state of the fetoplacental system in acute pancreatitis in pregnant women, as well as to evaluate the effectiveness of the developed complex of therapeutic measures for the correction of violations and prevention of complications of gestation.Material and methods. The study included 127 pregnant women with acute pancreatitis. The main group consisted of 43 pregnant women, who were additionally included in the complex of therapeutic and preventive measures: discrete plasmapheresis for 1 and 3 days and micronized progesterone (patent for the invention № 2535108 from 08.10.2014). In the comparison group (n=84), standard therapy of acute pancreatitis was performed. The control group (n=30) was represented by healthy pregnant women. The examination was carried out in accordance with the standards, the content of cytokines (interleukins IL-1β, IL-4, interferon IFN-γ, tumor necrosis factor TNF-α), the marker of apoptosis of Fas-ligand, hemodynamic parameters in the uterine arteries, the concentration of trophoblastic beta-1-glycoprotein (TBG) and placentospecific alpha-1-microglobulin (PAMG-1) in serum were additionally studied blood pregnant.Research result. The combination of pregnancy with acute pancreatitis revealed increased levels of IFN-γ – 2.5-fold, IL-1β – 2.1 times, TNF-α – 2.5 times, IL-4 – 1.3 times in comparison with control data on the background of decrease in Fas-L – in 1,3 times and increase of indexes of peripheral resistance in the uterine artery in 1.3-1.4 times, which was accompanied by the exclusion of gravidarum synthesis of proteins: a decrease in TBG (1.3 times) and increase of PAMG-1 (1.9 times). Dynamic control of the studied parameters showed the preservation of high concentrations of cytokines and progression of uterine hemodynamic disorders in the standard treatment of the disease, which led to the appearance of signs of threatening termination of pregnancy on 7-10 days in 83.3% of women. In addition, the development of pancreatitis at different gestation periods increases the risk of spontaneous miscarriage to 11.9%, non – developing pregnancy – up to 29.8%, premature birth-up to 60.7%, as a result of the formation of chronic (78.9%) and acute (21.1%) placental insufficiency. The additional use of discrete plasmapheresis and progesterone drugs helped to restore the balance of Pro-and anti-inflammatory cytokines by the 3rd day of treatment, preventing their long-term negative impact on the structure and function of the utero-placental complex.Conclusion. The combination of pregnancy with acute pancreatitis is accompanied by dissociation of the immune response with predominance of Th1-cytokines against the background of apoptosis oppression and placental dysfunction development. The use of the developed method of complex treatment allows to reduce the frequency of threatening termination of pregnancy with the development of acute pancreatitis – 3 times, reduce the number of premature births – 13 times, and reduce pregnancy losses to zero.

1Кафедра акушерства и гинекологии педиатрического факультета (зав. — д.м.н. Н.Ф. Хворостухина) ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России, Саратов, Россия; 2Перинатальный центр ГУЗ «Саратовская городская клиническая больница No8» (главный врач — Ю.В. Максимов), Саратов, Россия; 3кафедра лучевой диагностики и лучевой терапии им. проф. Н.Е. Штерна (зав. — проф. М.Л. Чехонацкая) ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России, Саратов, Россия