V.F.Snegirev Archives of Obstetrics and Gynecology
ISSN (print): 2313-8726, ISSN (online): 2687-1386 Founder: Joint Stock Company "Publishing house "Medicina", Limited Liability Company "Eco-Vector" Editor-in-Chief: prof. Elena A. Sosnova, MD, Dr. Sci. (Med.) Frequency / Access: 4 issues per year / Hybrid Included in: Higher Attestation Commission List, RISC
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Snegirev Archives of Obstetricsand Gynecology” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “V. F. Snegirev Archives of Obstetricsand Gynecology” (further-the Journal) in accordance with the conditions stated below. I. 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Impact of bariatric surgery on reproductive health in women with obesity
The issue of obesity remains highly relevant both in Russia and worldwide, becoming increasingly acute each year. Bariatric surgery in women with obesity is associated with a number of positive effects, including improved fertility, a reduced risk of gestational diabetes and pre-eclampsia due to enhanced insulin sensitivity and normalization of glucose levels. However, the intrapartum and postpartum periods are associated with several challenges, including an increased risk of micronutrient deficiencies, development of dumping syndrome, anemia, and fetal growth retardation. Therefore, it is essential to develop individualized treatment plans for patients following bariatric surgery to prevent potential complications affecting both the mother and the fetus. Special attention should be paid to additional vitamin intake and individualized dietary planning, as these are important for the future child's health. Bariatric surgery is an effective treatment for obesity, but it should only be recommended when conservative approaches—such as dietary and lifestyle modifications, pharmacotherapy, and increased physical activity—fail to achieve sufficient weight loss. When choosing this method of obesity treatment, women should be informed about possible complications, postoperative metabolic peculiarities, and the necessity of their correction. It is also important to inform patients about postoperative rehabilitation and preconception care, which should last 12–18 months after surgery before planning a pregnancy. This review was based on a search in the PubMed database using the logical operator and a combination of the following keywords: pregnancy and bariatric procedures. This search yielded 111 results, 50 of which were relevant to the study topic. The types of publications included: article type, books and documents, clinical trial, meta-analysis, randomized controlled trial, review, and systematic review. An additional publication search was conducted using the eLibrary and PubMed databases, focusing on the following keywords: ожирение и репродуктивная система (obesity and reproductive system), ожирение и бесплодие (obesity and infertility), бариатрическая хирургия (bariatric surgery), осложнения бариатрической операции (bariatric surgery complications), морбидное ожирение (morbid obesity), and беременность после бариатрической операции (pregnancy after bariatric surgery). The review includes articles published over the past 10 years.
Modern technologies in the study of clinical heterogeneity and molecular subtypes of pre-eclampsia
This review focuses on modern technologies for investigating the pathogenic mechanisms of pre-eclampsia—a serious pregnancy complication that remains one of the leading causes of maternal and perinatal morbidity and mortality. Over the past decades, global scientific research has made significant advances in the study of pre-eclampsia, particularly its pathogenesis. Key roles have been identified for oxidative stress, endoplasmic reticulum stress, mitochondrial dysfunction, inflammation, and secondary endothelial dysfunction, as well as for angiogenic and anti-angiogenic factors, activation of the complement cascade, and the hemostatic system. Nevertheless, highly effective methods for predicting, preventing, and treating this pregnancy complication have not yet been developed. A possible reason, which has been receiving increasing attention in recent years, may lie in the existence of multiple subtypes of pre-eclampsia that differ in molecular mechanisms of development, severity and extent of lesions, as well as maternal and perinatal outcomes. In this regard, there is a need for deeper and more comprehensive exploration of the pathophysiology of pre-eclampsia using innovative high-throughput technologies that allow for simultaneous assessment of the full spectrum of systemic changes associated with pre-eclampsia. Such requirements are met by Big Data technologies utilizing various omics platforms, including epigenomics, genomics, transcriptomics, proteomics, metabolomics, and others. This article reviews the findings of published studies investigating the transcriptome, proteome, and peptidome of biological fluids and placental tissue in pregnant women with different clinical phenotypes of pre-eclampsia. When considered alongside clinical and anamnestic data and histological variants of placental changes, these findings allow for the identification of molecular subtypes of pre-eclampsia. The review demonstrates that the clinical heterogeneity of pre-eclampsia is driven by the wide variability of underlying molecular and genetic mechanisms. Special attention is given to studies employing a multi-omics approach. The analysis of publications in this review underscores the importance of accounting for identified molecular subtypes in the development of personalized management strategies for pregnant women, as well as individualized approaches to prediction and prevention of pre-eclampsia and evidence-based pregnancy prolongation or early delivery. The article also presents promising directions for further research into the pathophysiology of pre-eclampsia using omics technologies, the accumulation and analysis of which may contribute to improving the diagnosis, prevention, and treatment of this pregnancy complication through the development of potential biomarkers and molecular targets.
Current perspectives on premature ovarian failure
Premature ovarian failure is a complex and multifactorial condition, the main clinical sign of which is persistent or intermittent amenorrhea lasting for at least four months. This condition is diagnosed at an age of up to 40 years. The relevance of this article lies in a more detailed examination of the causes, pathogenesis, and key clinical symptoms of premature ovarian failure. Particular attention is given to early diagnosis in women of young and middle reproductive age in order to optimize management strategies in the context of reproductive goals, as well as to the current state of scientific research. The review highlights several emerging therapeutic approaches that have shown promising results, including platelet-rich plasma (PRP) therapy, exosome-based therapy, in vitro follicle activation, stem cell therapy, microRNA-based strategies, and mitochondrial-targeted therapy. These experimental treatment strategies aim to stimulate oogenesis and folliculogenesis by enhancing natural biochemical pathways (neo-oofolliculogenesis) and improving the ovarian microenvironment.
Breaking new ground: the role of molecular methods in detection of bacterial vaginosis
Bacterial vaginosis is one of the most common disturbances of the vaginal microbiota in women of reproductive age and is associated with an imbalance between lactobacilli and opportunistic microorganisms. Traditional diagnostic approaches based on clinical symptoms and laboratory methods—primarily microscopy or culture—are often insufficient in terms of sensitivity and specificity for detecting this condition, which may lead to diagnostic errors. In recent years, molecular methods, including polymerase chain reaction and metagenomic analysis, have become valuable tools for more accurate diagnosis of bacterial vaginosis in obstetric and gynecological practice. These technologies not only enable identification of pathogenic microorganisms but also allow for quantification of their relative abundance, thus significantly improving diagnostic accuracy. This article reviews current molecular approaches for the detection of bacterial vaginosis, their advantages and limitations, and their application in clinical settings. Recent studies are analyzed to illustrate how molecular diagnostics can contribute to more precise diagnosis and individualized treatment approach. The prospects for incorporating these technologies into routine clinical practice are also discussed, with the potential to improve women’s health and reduce the recurrences of bacterial vaginosis. Thus, molecular methods represent a significant breakthrough in the diagnosis of bacterial vaginosis, opening new opportunities for effective therapy and prevention.
Comprehensive weight management as a key factor in improving the effectiveness of endometrial cancer therapy with fertility preservation
Endometrial cancer is a prevalent oncological disease closely linked to obesity and disturbances in carbohydrate and lipid metabolism. Current approaches to conservative treatment of endometrial cancer in young women aim to preserve reproductive function and include high-dose progestin therapy, which may further contribute to weight gain. The relationship between obesity and treatment efficacy in endometrial cancer is multifactorial and involves hormonal changes, chronic inflammation, metabolic disturbances, and alterations in the tumor immune microenvironment. A comprehensive weight management approach—including dietary interventions (such as ketogenic diet, intermittent fasting, and caloric restriction), regular physical activity, and behavioral therapy—has demonstrated significant improvements in tumor remission rates and pregnancy achievement. This review highlights the key mechanisms by which obesity contributes to the development and progression of endometrial cancer, discusses current weight management strategies, and outlines future research directions, including the study of metabolites, the gut microbiome, neural appetite regulation mechanisms, and the implementation of personalized approaches using artificial intelligence and wearable devices. Comprehensive weight management is becoming a priority area for improving treatment effectiveness and outcomes in patients with endometrial cancer who aim to preserve their reproductive function.
Gestational diabetes mellitus in women after in vitro fertilization: prevalence, pathogenetic features, and risk factors
Background: The increasing number of infertile couples has led to the growing popularity of assisted reproductive technologies as a means of achieving desired pregnancy. It is known that assisted reproductive technologies are an independent risk factor for a serious pregnancy complication—gestational diabetes mellitus. The multifactorial and polygenic nature of gestational diabetes mellitus, as well as its high prevalence following in vitro fertilization, make this issue of particular interest for research. Aim: To investigate the prevalence of gestational diabetes mellitus in pregnancies achieved through in vitro fertilization, its pathogenetic features, and possible risk factors. Methods: Scientific publications from eLibrary and PubMed databases were analyzed, focusing on the prevalence, risk factors, and pathogenetic features of gestational diabetes mellitus after assisted reproductive technologies. Outpatient and inpatient medical records of 116 women with singleton pregnancies from 2018 to 2022 were analyzed retrospectively and prospectively. The main group included 77 (66%) patients with in vitro fertilization pregnancies and confirmed gestational diabetes mellitus; the reference group included 39 (34%) in vitro fertilization patients without gestational diabetes mellitus. Results: The prevalence of gestational diabetes mellitus among pregnant women after in vitro fertilization is significantly higher than in the general pregnant population and, according to various sources, reaches up to 12.6%. Gestational diabetes mellitus is a polygenic multifactorial disease, with epigenetic influences acting as triggers in the presence of specific gene polymorphism associations. A high pregestational body mass index was identified as a risk factor for gestational diabetes mellitus after in vitro fertilization, whereas the number of in vitro fertilization attempts and the follicle-stimulating hormone to luteinizing hormone ratio did not significantly affect its development in this cohort. The etiology of infertility may be a risk factor for gestational diabetes mellitus according to some data, but in our study, no statistically significant differences were found between groups based on infertility cause (p > 0.05). Conclusion: Understanding the pathogenetic features, identifying, and timely modifying potential risk factors for gestational diabetes mellitus among pregnant women following in vitro fertilization will allow for timely correction of carbohydrate metabolism disorders, as women with gestational diabetes mellitus are at high risk for pregnancy complications and the subsequent development of type 2 diabetes mellitus.
The role of brain natriuretic peptide in assessing fetal status and predicting perinatal outcomes in pregnant women with pre-eclampsia
Background: Assessing fetal status and predicting perinatal outcomes in pregnant women with pre-eclampsia is a pressing issue in contemporary obstetrics. The management of pregnant women with pre-eclampsia and fetal growth retardation primarily relies on instrumental diagnostic methods; however, an additional biomarker capable of predicting the progression of this pregnancy complication and fetal deterioration is highly relevant. Aim: To determine the prognostic value of brain natriuretic peptide (NT-proBNP) for perinatal outcomes in patients with pre-eclampsia. Methods: A prospective study was conducted involving 110 pregnant women at 22–40 weeks of gestation to improve perinatal outcomes and reduce neonatal morbidity and mortality. The main group included 80 patients with confirmed pre-eclampsia of varying severity. Two subgroups were identified: 40 (50%) patients with fetal growth retardation and impaired umbilical artery blood flow, and 40 (50%) patients with pre-eclampsia without fetal growth retardation. The control group consisted of 30 women with uncomplicated pregnancies. The study was conducted from November 2022 to July 2024. Serum NT-proBNP levels were measured using electrochemiluminescence immunoassay. Uteroplacental and fetal blood flow was assessed upon the patient’s admission to the hospital using a Siemens ultrasound machine. Results: All patients completed the study. A statistically significant association was found between elevated NT-proBNP levels and fetal growth retardation with impaired umbilical artery blood flow (p < 0.001). In the subgroup with fetal growth retardation and impaired umbilical artery blood flow, the NT-proBNP level was significantly higher compared with the subgroup without fetal growth retardation (227.25 vs. 79.50 pg/mL, respectively). Conclusion: Patients with pre-eclampsia of any severity who develop fetal growth retardation and impaired fetal circulation have NT-proBNP levels 2.8 times higher than those with pre-eclampsia without growth retardation. This supports the role of maternal cardiac maladaptation in pre-eclampsia. A threshold NT-proBNP value predictive of fetal growth retardation and impaired umbilical artery flow has been identified.
Key anthropometric parameters of newborns born to women with gestational diabetes mellitus under normoglycemic compensation
Background: Gestational diabetes mellitus increases the risk of adverse pregnancy outcomes for both mother and fetus. Hyperglycemia in gestational diabetes mellitus contributes to fetopathy, macrosomia, and increases the risk of type 2 diabetes, obesity, and hypertensive disorders. Lifestyle modifications in pregnant women with gestational diabetes mellitus can reduce these risks. Aim: To assess the height and weight parameters of newborns born to women with gestational diabetes mellitus who achieved normoglycemic compensation. Methods: A total of 119 newborns were assessed; they were born to mothers who had full-term, singleton pregnancies and delivered vaginally in cephalic presentation. To diagnose gestational diabetes mellitus, an oral glucose tolerance test was performed at 24–28 weeks of gestation. The pregnant women and their newborns were divided into two groups: the main group (n=31) with gestational diabetes mellitus confirmed by an endocrinologist based on reference venous plasma glucose levels, and the control group (n=88) with uncomplicated pregnancies and deliveries. To assess anthropometric conformity of newborns in the groups, INTERGROWTH-21st centile charts were used. Statistical analysis of the study results was performed using StatSoft software (Russia). Results: The pregnant women with gestational diabetes mellitus strictly followed dietary therapy and maintained physical activity, which enabled them to achieve normoglycemic compensation. Deliveries in women with gestational diabetes mellitus occurred at 39–40 weeks, with no significant difference compared with the control group (p >0.05). The mean length of the newborns was assessed in three subgroups (47–50 cm, 51–54 cm, and ≥55 cm). In the first subgroup, the mean length was 48.7 cm in the gestational diabetes mellitus group and 49.6 cm in the group without gestational diabetes mellitus (p >0.05); in the second subgroup, it was 52.1 cm in both groups (p >0.05); and in the third subgroup, it was 56.0 cm and 55.2 cm, respectively (>0.05). Newborn weight was assessed across four subgroups (≤3000 g, 3050–3500 g, 3550–3950 g, ≥4000 g). In the first subgroup, the mean weight was 2790 g (gestational diabetes mellitus) and 2850 g (without gestational diabetes mellitus) (p >0.05); in the second subgroup, it was 3330 g and 3260 g (p >0.05); in the third subgroup, it was 3690 g and 3770 g (p >0.05); and in the fourth subgroup, it was 4110 g and 4120 g (p >0.05), respectively. The head circumference of newborns was 35 [33; 36] cm in the gestational diabetes mellitus group and 34.7 [33; 37] cm in the group without gestational diabetes mellitus (p >0.05). Conclusion: Adherence to dietary therapy and moderate physical activity enabled normoglycemic compensation in pregnant women with gestational diabetes mellitus without using insulin. No differences were observed in the main anthropometric parameters of newborns from mothers with gestational diabetes mellitus compared with the control group representative of the general population. Term delivery and the absence of perinatal complications requiring early delivery indicate successful compensation of gestational diabetes mellitus.
Laser surgical treatment of intrauterine synechiae in patients with a complicated obstetric and gynecological history: a STROBE-based analysis
Background: Uterine factor accounts for up to 15% of female infertility cases, and the prevalence of intrauterine synechiae and Asherman syndrome is increasing due to the growing number of intrauterine procedures. Despite the availability of effective treatments, the risk of Asherman syndrome recurrence remains high, reaching 30%–66% after various surgical interventions. One of the current challenges in medicine is the development of more effective methods aimed at suppressing fibrosis, stimulating regeneration, and restoring functional endometrium. Aim: To evaluate the effectiveness of a comprehensive approach to the surgical treatment of patients with intrauterine synechiae and Asherman syndrome in the context of a compromised obstetric and gynecological history. Methods: A retrospective cohort study was conducted at the V.F. Snegirev Clinic of Obstetrics and Gynecology, Sechenov University. Medical records of 32 patients with uterine infertility due to intrauterine synechiae or Asherman syndrome treated between 2014 and 2021 were analyzed. The diagnosis was based on the results of pelvic ultrasound and office hysteroscopy. The study included patients with complicated obstetric and gynecological history, including pregnancy loss, multiple intrauterine interventions, complicated deliveries, and postpartum complications. Destruction of intrauterine synechiae was performed using laser energy, followed by intrauterine administration of an anti-adhesion gel. Follow-up office hysteroscopy was performed at 3 and 6 months postoperatively to assess treatment outcomes. Results: Long-term surgical outcomes were obtained in 294 (90.0%) patients. At 3- and 6-month follow-ups, isolated intrauterine adhesions were identified in 20 (6.7%) patients, 18 of which underwent repeat hysteroscopy with laser adhesiolysis and intrauterine gel administration, while two required a three-stage hysteroscopic laser adhesiolysis. No recurrence of synechiae was observed among patients who received intrauterine anti-adhesion gel. Of 178 patients with menstrual disorders, restoration of regular cycles was reported in 136 (76.0%), whereas 42 (24.0%) reported light but regular menstruation. Within one year, 300 patients planned pregnancy; follow-up data were obtained for 239, and 155 (65.0%) reported conception, with 132 resulting in childbirth. A total of 46 patients continued treatment at assisted reproductive technology clinics. Conclusion: Laser adhesiolysis followed by intrauterine anti-adhesion gel administration demonstrated high effectiveness (by reducing recurrence rates, restoring menstrual function, and increasing the likelihood of pregnancy). These findings highlight the importance of a comprehensive approach to timely diagnosis, treatment, and prevention of synechiae to improve the reproductive health of patients.
Assessment of current options for correction of stress urinary incontinence and pelvic organ prolapse without mesh implants
Background: Between 40% and 80% of women over the age of 50 experience pelvic organ prolapse of varying clinical severity, often accompanied by stress urinary incontinence. With a growing trend toward abandoning synthetic meshes in pelvic surgery, the search for alternative treatment methods has become a relevant issue. Aim: To assess the potential for correcting stress urinary incontinence and pelvic organ prolapse without using mesh implants. Methods: A prospective clinical study included 70 women with varying degrees of pelvic organ prolapse. Patients with stage I prolapse according to the POP-Q classification were included only if they had concomitant complaints of stress urinary incontinence. These patients formed Group 1 (n = 24). Group 2 included patients with stage II–IV pelvic organ prolapse by the POP-Q with mandatory apical compartment descent (n = 46). Patients from each group were divided into subgroups. Subgroup 1A received transurethral injections of fillers, whereas subgroup 1B underwent conventional TVT-O sling placement. In Group 2, two types of surgery were performed according to subgroup assignment: in subgroup 2A, laparoscopic promontofixation of the cervical stump was carried out using a mesh-less technique (native tissues and suture material); in subgroup 2B, conventional laparoscopic sacrocolpopexy with polypropylene mesh was performed. Results: In Group 1, 12 months after filler injection, clinical efficacy was sustained in 40% of patients, which was more than two times lower than in the mesh sling group (93%). With careful patient selection, fillers may reduce hospital workload by shifting a portion of stage I pelvic organ prolapse patients with stress urinary incontinence symptoms to outpatient care, while lowering the use of foreign implants. In Group 2, the anatomical success rate at 1 month was 92% in subgroup 2A (mesh-less) versus 90% in subgroup 2B (p = 0.265). Although 1-year recurrence rates were comparable between subgroups, long-term follow-up over 5–10 years is necessary for a comprehensive outcome assessment. Conclusion: Given the minor advantages of various mesh implants in pelvic surgery, their high cost and increasing rates of intra- and postoperative complications have led to a trend toward alternative surgical approaches using autologous tissues and non-surgical injectable therapies in cases of stress urinary incontinence.
Premature isolated adrenarche in a six-year-old girl
Premature isolated adrenarche is a diagnosis of exclusion that requires careful differential diagnosis and subsequent long-term follow-up to monitor for potential late complications (such as polycystic ovary syndrome, carbohydrate metabolism disorders, and cardiovascular diseases). Conditions that may mimic isolated adrenarche include central precocious puberty and congenital adrenal hyperplasia, both of which necessitate timely diagnosis and appropriate pharmacotherapy. However, in pediatric clinical practice, isolated forms of precocious puberty are more common and require ongoing monitoring to assess the risk of complications involving the carbohydrate metabolism, reproductive, and cardiovascular systems. This article presents a clinical case of isolated adrenarche in a six-year-old girl. Her parents sought medical attention due to the appearance of terminal hair in the axillary region. On physical examination, dark, coarse terminal hair was observed in the axillary, pubic, and perilabial areas, without signs of hirsutism. Laboratory examination revealed increased dehydroepiandrosterone sulfate, whereas markers of congenital adrenal hyperplasia and central precocious puberty were excluded. Based on the patient’s complaints, medical history, and laboratory and instrumental data, a diagnosis of isolated adrenarche was established. The condition was attributed to premature maturation of the adrenal zona reticularis. It was accompanied by increased dehydroepiandrosterone sulfate (as confirmed by laboratory tests), advancement of bone age by one calendar year, and clinical signs such as pubic and axillary hair growth. Comprehensive examination ruled out congenital adrenal hyperplasia, central precocious puberty, adrenal or gonadal tumors. No treatment was indicated in this case. However, regular follow-up is necessary, as scientific data indicate that girls with early adrenarche are at increased risk for developing certain conditions. Parents of children with this variant of precocious puberty should be counseled on the importance of long-term monitoring.
Clinical case of infertility treatment and pregnancy and delivery management following uterine artery embolization for uterine fibroids
Uterine artery embolization is a minimally invasive and effective method for treating symptomatic uterine fibroids; however, its impact on fertility, pregnancy course, and obstetric outcomes remains a topic of ongoing debate. This article presents a clinical case involving the management of a patient with infertility due to uterine factors following uterine artery embolization, which was complicated by non-target embolization of the ovarian vessels. After specialized laser spectral diagnostics of endometrial status and restorative treatment, the patient achieved a spontaneous pregnancy. The pregnancy was complicated by the threat of miscarriage, cervical insufficiency, premature detachment of a normally located placenta, and preterm delivery at 32–33 weeks, as well as prolonged postpartum vaginal bleeding. Additional studies are needed to investigate long-term reproductive outcomes in women following uterine artery embolization and to develop diagnostic and preventive approaches aimed at reducing the risk of complications. The results of this study may contribute to improving the management strategies for patients with similar complications and serve as a basis for developing treatment guidelines.