The potential of extracellular microvesicles of mesenchymal stromal cells in obstetrics.

BACKGROUND: The rate of cesarean deliveries is steadily growing worldwide as a result of increasing maternal age at first delivery. Ensuring optimal recovery after surgery, specifically the development of a functionally competent uterine scar to facilitate vaginal birth after a cesarean delivery (VBAC), is one of the challenges in modern obstetrics. Extracellular microvesicles (EMVs) are secreted by multiple cell types and act as mediators of intercellular interaction during tissue reparation. The immunomodulatory and regenerative effects of EMVs of mesenchymal stromal cells (MSCs) have been studied shown in pre-clinical studies. AIM OF THE STUDY: To evaluate the safety profile of EMVs of mesenchymal stromal placental cells (MSPCs) injected during the cesarean delivery and the impact of this pilot approach on post-surgery recovery. MATERIALS AND METHODS: This pilot study included 53 women undergoing cesarean delivery with (n = 23) or without (n = 30) an injection of 500 µl of MSC EMVs after closing the uterine incision with a single continuous Vicryl suture. RESULTS: All study participants had uncomplicated post-surgery period. The mean inpatient stay duration in women receiving the EMV injection was 4.26 ± 0.09 days vs. 5.33 ± 0.38 in the control group (p<.05). There were no postpartum inflammatory complications in the study group compared with two cases (6.7%) by postpartum endometritis/myometrial infection and one case (3.3%) of lochiometra in the control group. SUMMARY: Intra-surgery injection of MSC EMVs was well-tolerated and associated with a lower rate of infectious post-partum complications in women undergoing cesarean delivery.

[Prophylaxis and treatment of severe bleeding in obstetrics (draft guidelines)].

The article represents draft guidelines on severe bleeding in obstetrics which is the major reason of maternal mortality throughout the world. Criteria of estimation the physiological, pathological and massive blood loss are given. Algorithms of conservative and surgical treatment are presented, as well as major indications for administration of anti-fibrinolythics, infusion and transfusion treatment.

[Comparative assessment of stress electrocardiographic and echocardiographic tests in the diagnosis of insufficiency of the coronary circulation]. / Sravnitel'naia otsenka nagruzochnykh élektrokardiograficheskikh i ékhokardiograficheskikh prob v diagnostike nedostatochnosti koronarnogo krovoobrashcheniia.

Altogether 29 patients (14 with a characteristic clinical picture of CHD, 6 with probable angina and 9 with nonischemic cardialgia) were investigated by methods of two-dimensional echocardiography (echoCG) at rest and in combination with isometric exercise and left atrial transesophageal pacing test (LATPT) as well as by electrocardiographic exercise tests (bicycle ergometry testing and LATPT). EchCG exercise tests were conducted in most of the examinees (96.6%) whereas bicycle ergometry results were obtained in 75.9% of the patients (p less than 0.05). A significantly higher frequency of positive results of echoCG exercise tests in patients with typical CHD as compared to electrocardiographic exercise tests, and significantly high correlation of the results of the combination of echoCG with isometric exercise and echoCG with a degree of the pain syndrome in the heart area were revealed. The results obtained made it possible to recommend echoCG exercise tests for the diagnosis of coronary insufficiency.