An interview with Professor Alla Vladimirovna Samoylova, Doctor of Medical Sciences, Head of the Federal Service for Surveillance in Healthcare. Alla Vladimirovna told us about the activities of the Federal Service for Surveillance in Healthcare regarding maternal and child health protection, plans for 2024, participation in the organisation of the National Project 'Healthcare' and other national and federal projects, the contribution of her organisation to the improvement of demographics in Russia, monitoring of measures to prevent abortions and violations in the circulation of medicines used for abortions. Mrs Samoylova emphasised that, in order to preserve and improve reproductive health in Russia, it is essential to have preventive examinations, screenings, preferably close to the place of residence, to develop and improve minimally invasive methods for reproductive disorder correction. During the interview, special attention was paid to the Perinatal Centre Development Program, introduction of the quality control system in obstetrical institutions and organisations using assisted reproductive technologies. The Head of the Federal Service for Surveillance in Healthcare appealed for the introduction of a quality management system in all inpatient obstetrical units.

Aim. To identify the clinical and anamnestic risk factors of preeclampsia (PE) in gestational diabetes mellitus (GDM).

Design. Open-label observational prospective study.

Materials and methods. The study enrolled 204 pregnant women with GDM, 70 of which had their pregnancy complicated with PE (study group) and 134 patients did not have PE (controls). In the study group, clinical and anamnestic risk factors were searched for by tracing data from primary medical records. The age of participants was 21 to 46 years old. Extragenital conditions were studied as possible risk factors of PE in GDM.

Results. It has been established that GDM with PE was more likely to be associated with chronic arterial hypertension (CAH) (χ² = 7.72, р = 0.006, odds ratio (OR) = 8.52, 95% confidence interval (CI): 1.76–41.29); a history of respiratory diseases — severe sore throat (χ² = 6.2, р = 0.01, OR = 3.98, 95% CI: 1.40–11.27), chronic tonsillitis (χ² = 12.84, р < 0.001, OR = 4.81, 95% CI: 2.03–11.40), acute bronchitis (χ² = 6.0, р = 0.02, OR = 7.33, 95% CI: 1.48–36.32) than GDM without PE.

Conclusion. Clinical and anamnestic risk factors of PE in women with GDM are CAH, a history of respiratory diseases (acute bronchitis, severe sore throat, chronic tonsillitis).

Aim. To identify immunological predictors of premature birth in women with isthmic-cervical insufficiency (ICN).

Design. A prospective comparative cohort study.

Materials and methods. The study included 58 pregnant women with ICN and 20 women without ICN. After completion of pregnancy, all women were divided into three groups: group 1 (main) — 23 patients with premature birth, group 2 (comparison) — 35 patients with timely delivery and group 3 (control) — 20 women with normal pregnancy without ICN. Indicators of innate immunity in cervical mucus were studied in all pregnant women. In patients with ICN, an immunological study was conducted at the time of this diagnosis. In participants without ICN, cervical mucus was collected 18–20 weeks after receiving the results of cervicometry.

Results. In the main group, the average number of leukocytes and neutrophil extracellular traps (NET), lysosomal activity of neutrophils, levels of macrophage inflammation protein-1β (MIP1β) and BOX1 protein of the high mobility protein group (HMGB1) in cervical mucus were statistically significantly higher than in the comparison group and the control group. Using ROC analysis, the prognostic value of these markers in relation to premature birth in women with ICN was studied. It was found that the amount of NET > 18%, the levels of MIP1β > 13.5 pg/ml and HMGB1 > 10 ng/ml in cervical mucus can be considered as predictors of premature birth in patients with ICN. At the same time, the HMGB1 index has the highest sensitivity (78.3%) and specificity (80%) as a prognostic marker of premature birth in ICN.

Conclusion. The proposed new approach to the prediction of premature birth in ICN is non-invasive and can be applied in the routine clinical practice of obstetricians and gynecologists.

Aim. To evaluate the implementation of the modern breastfeeding support principles into the practice of the maternity hospitals in Moscow.

Design. Observational cohort study.

Materials and methods. The study was conducted on the basis of two maternity hospitals in Moscow. With the help of a questionnaire specially developed by us, an anonymous survey of maternity patients was conducted at the time of discharge. A total of 614 mothers were interviewed from October 2020 to July 2021.

Results. In general, the clinical practice of breastfeeding support in the maternity hospitals has demonstrated its stability and compliance with the criteria recommended by WHO for monitoring the main clinical practices. The rate of exclusive breastfeeding at the time of discharge from the hospital was 83.9%. The majority of mothers were satisfied with the breastfeeding support provided to them (90.9%). Mothers highly appreciated the work of lactation consultants introduced into the staffing of hospitals. Nevertheless, shortcomings were also identified in the implemented practice of breastfeeding support that requires improvement.

Conclusion. The introduction of modern practice of breastfeeding support in maternity hospitals contributes to an increase in the level of breastfeeding among maternity hospitals, including exclusively breastfeeding from birth. To achieve the sustainability of this practice, it is necessary administration support, training of the medical staff, including lactation consultants, and monitoring of the breastfeeding practice.

Aim. А determination of predictors of early placental abruption (up to 34 weeks of pregnancy).

Design. Multicenter retrospective cohort study.

Materials and methods. The total number of cases of placental abruption — 1594, data from 22 medical centers in 16 constituent entities of the Russian Federation. The main group (n = 618) — patients with placental abruption at a gestation period of less than 34 weeks, comparison group (n = 976) — pregnant women with placental abruption at 34 weeks or more.

Results. Multivariate analysis carried out using the logistic regression method revealed a statistically significant effect of smoking, pregnancy number, the presence of a scar on the uterine abnormalities of its structure on the occurrence of early placental abruption.

Conclusion. Disentangling placental abruption into early and late phenotypes may provide insight into the causes of this obstetric condition and improve maternal and neonatal outcomes.

Aim. To evaluate the role of placenta growth factor (PlGF), vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in the pathogenesis of placental adherent and invasive pathology (PAIP).

Key points. sFlt-1 is an inhibitor of the angiogenic action of PLGF and VEGF.

The concentration of sFlt-1 in the blood serum of patients with PAIP was significantly lower than in women with physiological pregnancy in all the studies presented in this review. Only two studies have determined thresholds for serum markers for PAIP, but according to the results of the meta-analysis, they had large differences. Despite the known proangiogenic function of VEGF and PlGF, a significant correlation between their levels was not found either in serum by enzyme immunoassay or in expression on chorionic cells, decidual tissue and myometrium in abnormal placental invasion.

Conclusion. Further study of the role of VEFG, PlGF and sFlt-1 in the pathogenesis of PAIP is needed to find their threshold levels in the blood and use as a diagnostic markers.

Aim. Analysis of the possibilities of predicting gestational diabetes mellitus in early pregnancy in obese women.

Key points. The incidence of obesity and gestational diabetes mellitus among the female population in the world is steadily increasing. Obesity is an independent risk factor for gestational diabetes. Diabetes mellitus, which occurred during pregnancy, is associated with a number of complications for both the mother and the fetus. The presented literature review summarizes modern ideas about the prognosis of gestational diabetes mellitus in early pregnancy in obese women. Data on the effectiveness of various prognostic factors of gestational diabetes are presented.

Conclusion. To date, both clinical and laboratory predictors of gestational diabetes are known, but there are no regulated criteria for its diagnosis in the early stages of pregnancy. There is a need to conduct large-scale studies in order to select the most significant predictors of this disease in obese women and introduce them into the practical activities of an obstetrician-gynecologist.

Aim. To analyze laboratory diagnostic methods confirming the fact of alcohol consumption in order to determine the possibility of using the most effective methods in screening for the detection of alcohol in the blood of women of reproductive age and pregnant women.

Key points. The analysis of domestic and foreign scientific literature was carried out using the keywords: fetal alcohol syndrome, fetal alcohol spectrum disorder, pregnancy, biomarkers of alcohol consumption, phosphatidylethanol, blood test. The review was compiled according to the databases: Scopus, MedLine, The Cochrane Library, CyberLeninka, RSCI, etc. The material was collected on the basis of the literature data of review articles, the selection was carried out depending on the scientific value, with the formation of the final list of references according to the relevance of the analyzed material.

This review included 35 articles (36.4% of the total number of records found). All entries included were original articles, of which there were 15 prospective cohort studies, 20 observational-descriptive studies. The studies analyzed phosphatidylethanol (PEth), and other biomarkers in newborn blood in neonatal blood and in pregnant women. In 80% of the included articles, PEth was found to be a more sensitive diagnostic tool than other biomarkers of alcohol use.

Conclusion. Pregnant women tend to underreport their alcohol use, which creates a need for sensitive and specific biomarkers. Studies show that PEth has a high specificity in the diagnosis of alcohol use and provides the ability to determine the fact of alcohol consumption in the prenatal period in pregnant women and in the blood of a newborn. In general, the accumulated data allow us to consider the determination of PEth in the blood as a promising marker of episodic alcohol use, both in small and large doses, as well as chronic alcohol intoxication. An urgent task for further research is to study the sensitivity, specificity, threshold values of PEth for various regimens of alcohol consumption and alcoholization.

Aim. To study modern ideas about late premature spontaneous labor, identify unresolved issues and identify tasks for further research on this theme.

Key points. The problem of late premature labor occupies a leading position in modern obstetrics and perinatology. Currently, there is no single opinion and no identical approaches in predicting late premature spontaneous labor. This prevents the creation of a single algorithm of actions to prevent them. The article presents up-to-date information on the marker serum proteins and transcriptomic analysis of the placenta, as well as highlights some aspects of the pathogenesis of premature labor on the model of fetoplacental homeostasis disorders.

Conclusion. To reduce the risk of adverse outcomes of late premature spontaneous labor, it is necessary to create clear criteria for their prediction and early diagnosis, as well as timely implementation of organizational and therapeutic measures for this obstetric complication.

Aim. To provide clinicians with a systematic review of the available information regarding the use of menopausal hormone therapy in women with induced menopause due to combined treatment of ovarian cancer.

Key points. Ovarian cancer is the eighth most common and seventh leading cause of cancer death. Menopausal hormone therapy is effective in correcting menopausal disorders, but its safety for patients who have had ovarian cancer is questioned.

Conclusion. In patients with a history of ovarian cancer, menopausal hormone therapy is currently thought to improve overall survival and has little to no effect on progression-free survival. However, due to the lack of information, the reliability of the results obtained requires further research in this area.

Aim. To demonstrate a clinical case of HELLP syndrome with renal damage that required the use of therapeutic plasma exchange and to review the literature data on the treatment of this condition.

Key points. A clinical case of HELLP syndrome with renal dysfunction in a 19-year-old first-pregnant woman is described. The rapid development of the disease in the postpartum period required differential diagnosis of HELLP-syndrome with other types of thrombotic microangiopathy. Therapeutic plasma exchange was used in treatment.

Conclusion. Differential diagnosis of HELLP-syndrome and obstetric thrombotic microangiopathy attracts the interest of obstetriciangynecologists. In patient G. the differential diagnosis was carried out in full, according to the current clinical recommendations. Thus, effective therapy of HELLP-syndrome is possible with simultaneous influence on all pathogenetic links — activation of inflammation processes, endothelial dysfunction and coagulopathy.

Aim. To present the experience of using a thoracoamniotic bypass for the treatment of a fetus diagnosed with nonimmune fetal dropsy, against the background of cystic adenomatous lung malformation type I.

Key points. Congenital cystic adenomatous pulmonary malformation (CAPRL) is a benign lung lesion that appears before birth as a cyst or mass in the chest. The macrocystic form of this defect is associated with a significant risk of pulmonary hypoplasia, pleural effusion, and non-immune fetal hydrops. We present our own observation of a patient with type 1 CAPRL in the fetus and signs of non-immune hydrops.

Conclusion. The use of intrauterine thoraco-amniotic shunting can stop the manifestations of hydrops in type I CAPRL in the fetus.

Aim. To identify risk factors for recurrent intrauterine synechiae in women of reproductive age.

Design. A comparative prospective study.

Materials and methods. The study enrolled 89 female patients of reproductive age with confirmed intrauterine adhesions (IUA), according to hysteroscopy and morphology. Patients were divided into two groups depending on the course of IUA: main group (n = 45) — women with recurrent IUA (at least one episode during the year), and reference group (n = 44) — patients with IUA de novo. The mean age of patients in the main and reference groups was 36 ± 6 and 30 ± 3 years old, respectively.

Results. A history of emmeniopathy was statistically more common in patients with recurrent IUA (odd ratio (OR) = 4.5; 95% confidence interval (CI): 1.7–12.3) as compared to women with IUA de novo (p < 0.05), diffuse adenomyosis (OR = 5.4; 95% CI: 2.2–13.6) (p < 0.05). Patients with morphologically confirmed chronic endometritis had a high risk of recurrent IUA (OR = 4.0; 95% CI: 1.6–9.7) (p < 0.05). The risk is several times higher after surgeries: repeated curettage of uterine cavity due to abnormal uterine bleeding (OR = 17.3; 95% CI: 5.8–51.3) (p < 0.001), a history of myomectomy due to a submucous myomatous nodule (OR = 7.4; 95% CI: 2.9–18.8) (p < 0.001), hysteroresectoscopic adhesiolysis with monopolar energy (OR = 4.4; 95% CI: 1.7–11.3) (p < 0.001).

Conclusion. The mentioned risk factors of recurrent IUA make it possible to timely identify women with a high risk of the disease and undertake preventive measures.