Ischemia-Modified Albumin and Antioxidant Protection in Newborns with Asphyxia of Varying Severity.

The content of ischemia-modified albumin (IMA), serum albumin, and antioxidant capacity of blood serum was studied in healthy newborns and in newborns with moderate and severe asphyxia on days 1-2 and 3-4 of the postnatal period. Changes in these indicators were found in both groups of newborns with birth asphyxia in comparison with the group of healthy newborns and were more pronounced in children with severe asphyxia. An increase in the IMA level (by 1.6 times; p<0.001) and antioxidant capacity of blood serum (by 2.4 times; p<0.001) and a decrease in serum albumin content (by 1.5 times; p<0.001) were found in severe asphyxia on days 1-2. Analysis of changes in these indicators by days 3-4 allows to talk about a decrease in the intensity of free-radical reactions in newborns with birth asphyxia during complex therapy.

Coronavirus Infection COVID-19 and Pregnancy.

The novel coronavirus infection SARS-CoV-2, which broke out in China in December 2019, has rapidly spread around the world. On March 11, 2020, the World Health Organization (WHO) assigned this infection pandemic status. Pregnant women and puerperae occupy a special place in the structure of the incidence of COVID-19. For more than a year and a half, the Lapino Clinical Hospital of the Mother and Child Group of Companies has accumulated significant experience in managing patients with COVID-19, including pregnant women and puerperae. This article presents the features of the course of the new coronavirus infection in pregnant women and puerperae during various periods of the pandemic, the experience of managing pregnancy and childbirth in the above group of patients, and methods of treatment.

[Development and practical implementation of organ preservation surgery in case of placenta accreta in patients with a scar on the uterus].

Comparative analysis of methods for preventing/stopping intraoperative hemorrhage during surgical delivery of patients with placenta accreta (temporary balloon-assisted occlusion of common iliac arteries, internal iliac artery ligation; uterine artery embolization - UAE) has shown that internal iliac artery ligation is not effective. UAE and especially balloon-assisted occlusion of common iliac arteries have demonstrated a significantly greater effect due to the temporary 'devascularization' of the uterine corpus. It has been proved that an innovative surgical technique - a lower segment Caesarean section (LSCS) significantly reduces intraoperative blood loss. The main purpose of an alternative uterus cut - anterior placenta previa preserving and bleeding absence before the child removal - has been achieved within all observations. LSCS has caused a significantly smaller (by 1.6 times) amount of intraoperative blood loss than the corporal one. Another innovative surgical technique is metroplasty. It entails removing placenta accreta areas from the uterus with subsequent restoration of the organ integrity. The authors have proved the necessity of autologous advance blood donation and hemodilution strategy, which was first implemented in Moscow Center for Family Planning and Reproduction, and after 2006 was used in all obstetric institutions in Moscow. This allowed reducing the number of blood donations up to 85% and additionally decreased transfusiological risks which is economically valuable as well. Improvement of diagnostic methods, operating techniques, hemostasis, blood volume redistribution and creating an algorithm on its basis has proved the possibility of implementing an organ-, life, health- and fertility preserving approach in cases of placenta accreta in patients with a scar on the uterus after cesarean section. The introduction of the enhanced principles of patient management with placenta accreta has significantly reduced the number of hysterectomies in Moscow (from 48 in 2007 to 8 in 2016), and during the last 2 years no patient with this complication has had a hysterectomy. 12 out of 85 patients who had deliveries in accordance with the developed algorithm, have realized their subsequent fertility.

[Complicated appendicitis during pregnancy]. / Oslozhnennye formy ostrogo appenditsita u beremennykh.

AIM: To analyze incidence, diagnosis and treatment of complicated appendicitis in pregnant women and to determine the optimal surgical approach. MATERIAL AND METHODS: Retrospective cohort analysis included 338 pregnant women who underwent appendectomy in 2012-2016. Complicated appendicitis (abscess, local or common peritonitis and their combinations) was diagnosed in 22 cases. The main perioperative variables (duration of the disease, time of surgery, length of hospital-stay, incidence of wound complications, etc.), clinical and laboratory symptoms, results of ultrasound diagnosis and pregnancy outcomes were analyzed. Statistical analysis was carried out in Stata 14.2. Fisher's exact test, Mann-Whitney-Wilcoxon's U-test and multivariate regression analysis were used to compare data. RESULTS: The incidence of complicated appendicitis in pregnant women was 6.51%. There are no clinical symptoms which would be significantly more common in complicated appendicitis during pregnancy. Complicated course prolongs surgery and hospital-stay, however duration of postoperative analgesia depends on surgical technique as a rule. There were 27% of laparoscopic interventions that is lower compared with women with uncomplicated appendicitis. The percentage of conversions was higher too. CONCLUSION: Clinical diagnosis of complicated appendicitis during pregnancy even by using of ultrasound is not satisfactory and requires the involvement of other objective methods, such as MRI. Laparoscopic intervention is not contraindicated in pregnant women with complicated appendicitis and determine better treatment outcomes than open surgery.

[Acute appendicitis during pregnancy]. / Ostryi appenditsit u beremennykh.

Acute appendicitis is the most frequent surgical disease complicating pregnancy. Accurate diagnosis is difficult due to atypical and misleading clinical manifestations. Surgeons frequently do not know about advantages and disadvantages of different diagnostic methods applied during pregnancy. Treatment of acute appendicitis in pregnant women remains the real challenge for surgeons. There are enough researches indicating on benefits and risks of both open and laparoscopic operations. The main risk is due to fetal loss after laparoscopic procedure. Safety of diagnostic techniques and laparoscopic procedures, surgical tactics and independent risk factors of pregnancy loss are touched in the article.

[Treatment for acute promyelocytic leukemia during pregnancy].

AIM: To study the experience in managing patients with acute promyelocytic leukemia (APL) diagnosed in different periods of pregnancy. SUBJECTS AND METHODS: Nine women with APL were treated in 1998-2013. When APL was diagnosed in the first trimester of pregnancy, the latter was terminated (n = 1); when its diagnosis was made in the second trimester, chemotherapy (CT) followed by delivery (D) was performed (n = 3); when it was done in the third trimester, D followed by CT was done in relation to gestational age (n = 2) or these were performed at a later gestational age (n = 1). APL was treated in 5 and 1 patients according to the AIDA protocol and the 7+3 plus ATRA one, respectively. RESULTS: All the patients with APL achieved remission after the first cycle of induction CT; 5 of the 6 patients did at the moment of delivery; one patient underwent emergency delivery during cytopenia after the cycle. The gestational age at delivery after CT was 34 (34-40) weeks. Spontaneous term labor occurred in 2 patients at an obstetric hospital. Cesarean section was made in 4 of the 6 patients. All babies were born alive, healthy, and without developmental abnormalities. Their age at the time of analyzing the results was 2.5 months to 15 years. Four of the 9 patients are presently alive. Late recurrences occurred in 3 (33%) patients. The median overall survival is 26 (0.25-128) months; the median relapse-free survival is 17.5 (0-127) months. CONCLUSION: APL treatment in pregnant women, which is aimed at saving two lives, is effective and reasonable.

[Status of steroid receptors in the uterus, placenta and fetal membranes]. / Sostoianie steroidnykh retseptorov v matke, platsente i plodovykh obolochkakh.

Receptors of the myometrium, placenta and fetal membranes have been examined during deliveries at different gestational ages. No direct correlation was seen between plasma levels of steroid hormones and steroid receptor concentrations in target organs.