The cardiovascular system during pregnancy undergoes a number of compensatory and adaptive changes, such as an increase in heart rate, cardiac output and total peripheral resistance, which causes an increase in the load on the myocardium. Peripartum cardiomyopathy is a serious polyetiological complication of pregnancy and the postpartum period, as well as an important cause of disability and mortality for both mother and fetus. The non-specificity of complaints and the paucity of clinical symptoms in the early stages of the disease lead to delayed diagnosis and significantly increase the frequency of unfavorable outcomes. In the article we present our own clinical observation of the acute development of severe peripartum cardiomyopathy in a multipregnant woman at 36 weeks of gestation, complicated by cardiogenic shock and antenatal fetal death.

The review article discusses the issues of studying occupational factors on the reproductive health of female flight attendants. The purpose of the study is to identify a correlation between reproductive health disorders of flight attendants and flight factors. Literature data from the Fundamental Library of the Military Medical Academy named after S.M. Kirov, online sci-hub library «CyberLeninka», e-library and PubMed was analyzed and systematized. Such professional factors as: ionizing radiation, physical stress in flight, work in a plantigrade position, disturbance of the regime of working, resting time and eating patterns, constant change of climatic zones, desynchronosis, – were identified. An analysis of the literature has shown that a number of issues related to flight factors and women's health remain poorly understood. It is advisable to study in detail the flight factors: vibration, noise, acceleration, hypoxia, pressure drops, and their impact on the reproductive system of female specialists working in aviation.

Preeclampsia is one of the so-called major obstetrical syndromes and a cause of maternal and neonatal morbidity worldwide. In addition, preeclampsia increases the risk of maternal and neonatal cardiovascular disorders and cerebrovascular diseases in the future. During pregnancy, the pregnant mother undergoes significant changes in the functions of various organ systems to accommodate the developing fetus. The onset of preeclampsia can cause dysfunction of multiple organs and systems, including the homeostasis system. Its dysfunction is associated with the most serious thrombohemorrhagic complications (premature detachment of normally situated placenta, thrombosis, embolism, and bleeding). It is important to understand the relationship between the maternal and fetal homeostasis system functioning. The homeostasis system functioning in the fetus and newborn infant has specific characteristics expressed not only in the quantitative composition and the level of activity of its main links, but also in the qualitastive composition, as well as in the functioning mechanisms which differ from those in adults. The above specific characteristics help to achieve an important balance in the homeostasis system functioning. Preeclampsia, associated conditions and complications can disturb the existing balance and homeostasis system functioning in the fetus and newborn infant with the development of thrombohemorrhagic complications. KEYWORDS: homeostasis system, newborn infants, preeclampsia, specific characteristics of functioning, preterm newborn infants, pregnancy. FOR CITATION: Yupatov E.Yu., Kurmanbaev T.E., Mustafin I.G. et al. Hemostasis functioning in neonates: normal condition and condition in preeclampsia (literature review). Russian Journal of Woman and Child Health. 2023;6(2):199–205 (in Russ.). DOI: 10.32364/2618-8430- 2023-6-2-199-205.

The article presents the links in the development history of two scientific schools of obstetrics and gynecology: the Imperial Medical and Surgical Academy and Kazan University. The history of training medical specialists is briefly described, starting from the 18th century and the opening of the first school of «Midwife Arts». Based on biographical data, the works of Professors A.Ya. Krassovsky, K.F. Slavyansky, V.M. Florinsky, V.S. Gruzdev and their colleagues were studied. Over the years of their medical work, a decrease in birth mortality and the number of complications during pregnancy and childbirth was achieved, and the number of successful caesarean sections increased. In addition to medical practice, their task was to develop the teaching of obstetrics and gynecology in higher educational institutions of Russia and to train highly qualified personnel. Thanks to the joint work of these scientists, the traditions and knowledge of the Saint Petersburg and Kazan schools were combined, methods of managing pregnant women, delivery and treatment of female diseases were developed, which to this day have not lost their relevance. The result of many years of their work is the preservation and enhancement of women’s health in Russia.

Thrombosis of the umbilical cord vessels is a rare complication of pregnancy, combined with a high level of perinatal morbidity and mortality. Anomalies of vascular attachment (velamentous attachment), pathology of the umbilical cord (hyperspiralization, short or long umbilical cord), intrauterine infections, maternal diabetes mellitus and preeclampsia as well as meconium found in the amniotic fluid are among the risk factors of developing thrombosis in the umbilical cord vessels. Here we present two clinical observations of umbilical vein thrombosis at full-term pregnancy. In both cases, during pregnancy and childbirth, no signs of umbilical cord pathology were found according to cardiotocography and Doppler ultrasound; despite this, the children were born in hypoxic state. Both newborns were transferred to the second stage of treatment due to suspected intrauterine pneumonia. Velamentous attachment, intrauterine infections as well as meconium found in the amniotic fluid were the risk factors of developing umbilical vein thrombosis described in case 1 and case 2, respectively. During pregnancy, both female patients suffered from clinically confirmed novel coronavirus infection (COVID-19) and contacted patients with COVID-19 in the third trimester of gestation. It is likely that endothelial damage caused by the novel coronavirus SARS-CoV-2 was one of the risk factors for the development of umbilical vein thrombosis, but this issue requires to be further explored.

Introduction. Hemostasis is an equilibrium system that performs 2 bidirectional tasks: on the one hand, it prevents bleeding development, whereas on the other hand, it counters thrombogenesis. Shifting the balance leads to development of various complications, and also serves as a key link in the pathogenesis of a number of diseases. Currently, the issue of changing the state of local endometrial hemostasis in various pathologies is of high priority. Unfortunately, publications available on this problem are limited.Aim: to conduct a literature search and systematize the data analysis to expand understanding regarding a role of local hemostasis disorders in formation of endometrial pathology.Materials and Methods. There has been performed a systematic analysis of full-text scientific reviews and original articles published in English and Russian in the modern literature. The review includes the 1995-2020 data published in the international abstract and bibliographic databases eLibrary, Google Scholar, Web of Science, Scopus and PubMed/MEDLINE.Results. Hemostatic changes in the endometrium that occur under the influence of estrogens and progesterone, and create a local hemostatic environment, which disturbance contributes to emergence of various endometrial pathologies, are described. It was found that for the physiological course of pregnancy, complex changes in the local hemostasis are necessary, which are aimed at facilitating the processes of chorionic invasion and maintaining metabolic processes in the mother-fetus interface, whereas alteration of the aforementioned processes contributes to development of abnormal chorionic invasion as the basis for development of insufficient placental function, preeclampsia (PE), and pregnancy termination. Moreover, there have been summarized the data on key changes in the state of local endometrial hemostasis that play a role in the pathogenesis of endometriosis, as well as underlying abnormal uterine bleeding (AUB).Conclusion. Current research publications provide sparse evidence that the state of the local hemostasis in the endometrium is an important aspect of the physiological course of the menstrual cycle, as well as formation of endometrial pathology. In this review, it is shown that local hemostasis is inextricably linked with the state of the systemic hemostasis, but at the same time, its functioning depends on the level of hormones estrogens and progesterone. Impaired function of local endometrial hemostasis is an important aspect of the pathogenesis of miscarriage, as well as conditions such as PE, endometriosis, AUB.

Introduction. Preeclampsia (PE) is a specific complication of pregnancy holding a lead place in maternal and perinatal morbidity and mortality worldwide. The development of PE in the maternal body is accompanied by severe hypercoagulation, disturbed anticoagulation and fibrinolytic systems. As a result, vascular microthrombosis in diverse organs with developing endothelial dysfunction, impaired utero-placental blood circulation emerge that leads to adverse perinatal outcomes.Aim: to study status of coagulation arm in pregnant women with moderate and severe PE, after delivery by cesarean section, to optimize management of the postoperative period.Materials and Methods. There were enrolled 50 pregnant women with PE: 16 with moderate and 34 with severe PE after surgical delivery. A status of coagulation arm was examined by evaluating major parameters in coagulogram (fibrinogen, activated partial thromboplastin time, prothrombin, international normalized ratio) as well as assay for early diagnostics of blood clotting disorders to reveal bleeding and thrombosis risks.Results. It was found that prior to surgery patients with severe PE had significantly increased clot growth rate (V) by 1.09-fold (p = 0.001), relative clot density (D) by 1.15-fold (p = 0.001), and time of spontaneous clot appearance (Tsp) was accelerated by 2-fold (p = 0.001) compared to moderate PE. After surgical delivery, patients from both groups had changes evidencing about activated coagulation system: increased V, D, as well as the Tsp. Upon that, all such parameters in patients with severe PE were significantly elevated: the V – by 1.25-fold (p = 0.005); the D – by 1.1-fold (p = 0.02); the Tsp was accelerated by 2-fold (p = 0.03) compared to patients with moderate PE. All parameters in both groups tended to normalize on day 5 after surgical delivery, but patients with severe PE were shown to have significantly increased the V – by 1.5-fold (p = 0.001); the D – by 1.14-fold (p = 0.001); the clot size – by 1.14-fold (p = 0.001); the Tsp – accelerated by 41 % (p = 0.001) compared to patients with moderate PE.Conclusion. Thus, patients with moderate and severe PE after surgical delivery by cesarean section were featured with markedly activated coagulation hemostasis, which may justify a prolonged use of low-molecular-weight heparins in the postoperative period, especially in patients with PE.

In December 2019, a new type of coronavirus was identified in China, called SARS-CoV-2 (COVID-19) that quickly spread not only within the People’s Republic of China, but also far beyond its borders. On March 11, 2020, the World Health Organization announced that the infection caused by novel coronavirus SARS-CoV-2 became a pandemic. Prior to this, two global epidemics were caused by pathogenic coronaviruses: in 2002 – by SARS-CoV that caused severe acute respiratory syndrome (SARS), and in 2012 – by MERSCoV that resulted in the Middle East respiratory syndrome (MERS). All coronavirus infections in humans are characterized by damage of lower respiratory tract with development of severe pneumonia and respiratory distress syndrome. According to reports, males become sick more often than females. It is known that due to developing immunological suppression pregnant women are at higher risk of contracting infectious diseases. However, the clinical course of SARS-CoV-2 infection during pregnancy, its effect on outcome of gestation, and the likelihood of vertical transmission to the fetus still remain unanswered. In this review, we present data on cases of SARS-CoV-2 disease during pregnancy published globally, its effect on outcome of gestation, as well as data on potential routes of infection for fetus and neonates. In addition, we also provide currently available clinical recommendations released by the Royal Society of Obstetricians and Gynecologists (UK), the American Society of Obstetricians and Gynecologists (USA), and the National Institute for Reproductive Health Research (India) on the management of pregnant patients infected with SARS-CoV-2.

The pandemic of the novel coronavirus disease 2019 (COVID-19) makes us to think about effective preventive methods in pregnant women, because the course of such infection is accompanied by a high risk of severe endotheliopathy, disseminated intravascular coagulation, septic shock, thromboembolic complications and maternal mortality. Undoubtedly, vaccination is the most effective method of protection during pandemic, which experience in some infections in pregnant women has been accumulated in the world practice and may be also used for the COVID-19 vaccine. Here we discuss the issues of vaccination for pregnant women to expand the view of medical doctors and eliminate prejudice against immunization of pregnant women.

Ectopic pregnancy is one of the most dangerous conditions and is the cause of maternal mortality in 4,9% of cases in developed countries, in 1,05% of cases in Russia. The purpose of the study is to study the risk factors of tubal pregnancy among residents and workers of industrial districts of Kazan (Kirovskiy, Aviastroitelnyy, Moskovskiy, Novo Savinovskiy). Materials and methods . The data of inpatient cards of women admitted with the diagnosis of «Ectopic pregnancy» and «Progressive pregnancy» to the City hospital № 11 of Kazan for the period 2017–2018 were used. The case-control study included data from 160 women with tubal pregnancy (study group) and 160 women with progressive pregnancy (comparison group). Results and conclusion. The following risk factors for tubal pregnancy were identified: number of sexual partners three or more people since the beginning of sexual life – the odds ratio OR 3,07 (95% confidence interval CI 1,56–6.02; p = 0,001); the presence of adhesions of the pelvic organs – OR 9,08 (95% CI 4,10–20,07; p < 0,00001); previous ectopic pregnancy – OR 3,85 (95% CI 1,69–8,76; p = 0,001).); miscarriages in history – OSH 9,88 (95% CI 1,61–60,66; p = 0,012); early sexual debut (15 years and younger) – OSH 14,0 (95%CI 1,80–106,53; p = 0,010); congenital malformations of the genital organs – OSH 15,0 (95% CI 1,29–169,33; p = 0,027).

It is known that during pregnancy, the hemostatic system, like the rest of the body's systems, undergoes certain changes: there is a gradual increase in the activity of coagulation unit of the hemostasis reaching a maximum before childbirth. However, if pregnancy is complicated by various hypertensive conditions, such as preeclampsia, an imbalance is observed in the hemostasis: against the background of an increase in the activity of coagulation link, depletion of anticoagulation factors and dysfunction of fibrinolytic system are observed. All these changes create a pathogenetic basis for the occurrence of severe thrombohemorrhagic complications that are fatal for both mother and fetus. Thus, the timely detection of these violations is an important task for modern obstetrics. Unfortunately, the applied screening methods for assessing the hemostasis system in practice provide extremely limited information: the tests have low sensitivity to hypercoagulation, as well as moderate to hypocoagulation, they do not allow to fully evaluate the dynamics of coagulation process in real time. In addition, when performing the same tests with reagents of different companies in the same patient, there may be a significant difference in the results. Disadvantages of screening tests became the reason for the search for a test to assess the functioning of the hemostatic system, which can reflect the complete picture of the state of blood coagulation system, and not of its individual links. Such tests are the so-called global tests for assessing the hemostatic system: thrombin generation test, thromboelastography, low-frequency piezothromboelastography and thrombodynamics. Each of the listed global tests has been successfully tested in obstetric and gynecological practice.

The article presents our own clinical observations of cases of abnormal uterine bleeding in postmenopausal women, where the main cause was the pathology of hemostasis: a patient after liver transplantation for cirrhosis with chronic viral hepatitis C, and a patient with primary idiopathic thrombocytopenic purpura which manifested at a later age. Among the most common causes of abnormal uterine bleeding in postmenopausal women are hyperplasia and endometrial cancer, leiomyoma, are adenomyosis are distinguished. Pathology of the hemostasis system as the main cause of abnormal uterine bleeding, prevails in the pubertal and reproductive period. In the literature available we did not find any publications concerning uterine bleeding in postmenopausal patients against the background of the pathology of the blood coagulation system. This article illustrates the significance of hemostasis disorders both secondary and primary in the origin of abnormal bleeding in postmenopausal period. Careful collection of anamnesis, an indication of the occurrence of petechial rash, gingival bleeding should alert the doctor. It should also be remembered that “suddenly arisen” immune cytopenias and late-onset thrombosis are often manifestations of the hematological paraneoplastic syndrome and require the exclusion of neoplasia, first of all, of the hematopoietic system. These clinical observations allow recommending a mandatory examination of the hemostatic system in patients with postmenopausal bleeding.

Разрыв матки - одно из редких и грозных осложнений беременности и родов. Наиболее часто он встречается в III триместре, однако есть публикации о случаях разрыва матки и во II триместре. В доступной нам отечественной литературе мы не обнаружили публикаций о случаях разрыва матки во II триместре по рубцу после предыдущего кесарева сечения; существующие публикации касались разрыва по рубцу после предшествующей миомэктомии. Частота кесарева сечения и в мире, и в России за последние годы резко возросла, а также появились данные о возможности пролонгирования беременности при разрыве матки по рубцу. Это побудило нас представить собственное клиническое наблюдение. Оно наглядно демонстрирует, что разрыв матки по рубцу на ранних сроках имеет достаточно стёртую картину и довольно часто клиницистами расценивается как угроза прерывания беременности. Необходимо помнить, что для угрозы прерывания беременности характерны укорочение и размягчение шейки матки, чего не происходит при угрожающем или свершившемся разрыве матки по рубцу. Поскольку основными предикторами в решении вопроса пролонгирования беременности в случае разрыва матки по рубцу бывают такие факторы, как время появления симптоматики разрыва матки, срок гестации, локализация плацентации, отсутствие вращения плаценты, жизнеспособность плода, размер имеющегося дефекта, а также характер разрыва, то наибольшее значение приобретает ранняя диагностика этого состояния.