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Barinov SV, Di Renzo GC. A new technique to preserve the uterus in patients with placenta accreta spectrum disorders. Am J Obstet Gynecol 2024; 230:S1107-S1115. [PMID: 37661498 DOI: 10.1016/j.ajog.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. OBJECTIVE This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until 2014. STUDY DESIGN This retrospective cohort study included 147 patients with placenta accreta spectrum disorders who were divided into 2 groups: the study group (n=95) is to undergo cesarean delivery using the combined approach, and the control group (n=52) is to undergo the surgical technique used until 2014, which included bilateral uterine artery ligation, which is the transfusion of plasma, red blood cells, platelets, and protease inhibitors. RESULTS The volume of blood loss was 1.5-fold lower (P=.0010), the number of blood transfusions was 5.1-fold lower (P=.026), and the rate of bladder injuries was 19-fold lower (P=.012) in the study group than that in the control group. The duration of hospital stay after delivery was 4 days lesser (P=.001) and the number of hysterectomies was 4.5-fold lower in the study group than in the control group (P=.023). The study groups did not differ in terms of placenta accreta spectrum type. CONCLUSION The combined approach during cesarean delivery proved to be more effective than the surgical technique used until 2014 in reducing the number of hysterectomies, blood loss volume, number of blood transfusions, and duration of hospital stay in patients with placenta accreta spectrum disorders.
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Affiliation(s)
- Sergey V Barinov
- Department of Obstetrics and Gynecology No.2, Omsk State Medical University, Omsk, Russia
| | - Gian Carlo Di Renzo
- Department of Medicine, Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.
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Barinov SV, Di Renzo GC, Tsibizova VI, Shifman EМ, Leont'eva NN, Arbuzov AB. Detoxification treatment in Gynecology using a modified molded sorbent. Best Pract Res Clin Obstet Gynaecol 2023:102346. [PMID: 37225639 DOI: 10.1016/j.bpobgyn.2023.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
Postpartum endometritis is a common complication of cesarean section, the progression of which often leads to the loss of the uterus and the patient's fertility. We evaluated a detoxification therapy for treating patients with postpartum endometritis using an intrauterine application of a modified molded sorbent containing polyvinylpyrrolidone. A retrospective, controlled study included 124 patients with postpartum endometritis. The study group, n = 63, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial therapy in combination with the intrauterine application of a molded modified sorbent containing polyvinylpyrrolidone (FSMP) for 24 h daily for 5 days. The control group, n = 61, was composed of puerperae with postpartum endometritis after cesarean section, receiving antibacterial treatment only. The uterine cavity was infected by coccal flora (Enterococcus faecalis (26.6%), Staphylococcus spp. (21.3%), E. faecium (14.3%), and Gram-negative Escherichia coli (9.6%). A combination of these microorganisms was present in 40.5% of crops. Antibiotic resistance was detected in 53.6%-68.3% of the cases. In the study group, we observed: a faster and higher decrease in neutrophils (p < 0.05); a lower uterine concentration of pro-inflammatory cytokines: interleukin-1 beta (IL-1β) and tumor necrosis factor α (TNFα) - 4.0 and 3.2 times, respectively, compared with the control group (p < 0.05); and a significant decrease in the uterus volume and cavity (M-echo). Using a newly modified sorbent associated with antibiotic treatment in patients with postpartum endometritis, compared with antibiotics alone, we showed a sharp reduction of inflammatory parameters, residual microorganism growth, and faster uterine volume involution. Moreover, the frequency of hysterectomy decreased by 14.4 times.
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Affiliation(s)
- S V Barinov
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russian Federation.
| | - G C Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy; Wayne State University Medical School and Perinatal Research Branch, NIH-NICHD, Detroit, MI, 48201, USA; PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy; Department of Obstetrics, Gynecology and Perinatal Medicine of the Clinical Institute of Children's Health Named After N.F. Filatov, I.M. Sechenov First State Medical University Under Ministry of Health of the Russian Federation, Moscow, Russian Federation.
| | - V I Tsibizova
- Institute of Perinatology and Pediatrics, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.
| | - E М Shifman
- Department of Anesthesiology and Сritical Care of Moscow Regional M.V. Vladimirsky Moscow`s Regional Research Clinical Institute, Moscow, Russian Federation.
| | - N N Leont'eva
- Center of New Chemical Technologies Boreskov Institute of Catalysis, Omsk, Russian Federation.
| | - A B Arbuzov
- Center of New Chemical Technologies Boreskov Institute of Catalysis, Omsk, Russian Federation.
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Barinov SV, Shmakov RG, Medyannikova IV, Tirskaya YI, Kadtsyna TV, Lazareva OV, Razdobedina IN, Neustroyeva TN, Stepanov SS. Efficacy of distal haemostasis during caesarean delivery in women with placenta accreta spectrum disorders. J Matern Fetal Neonatal Med 2021; 35:8778-8785. [PMID: 34794371 DOI: 10.1080/14767058.2021.2005019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta. The aim of our study was to identify the risk factors for placenta praevia associated with PAS disorders and the efficacy of distal haemostasis during Cesarean delivery. METHODS This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 (n = 52), patients underwent bilateral uterine artery ligation. In Group 2 (n = 33), we used the combined compression haemostasis approach including the placement of tourniquets and insertion of an intrauterine balloon for controlled tamponade. In Group 3 (n = 79), we used the combination of surgical haemostasis with the controlled intrauterine tamponade using the vaginal and intrauterine Zhukovsky balloon. RESULTS PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries (р = .001). According to the FIGO classification, 53.8% of women with placenta praevia observed during the Cesarean had РА1 and 46.2% PA2. With regards to the PAS disorders observed in 30.8% of patients, 38.4% had PAS3, 34.7% PAS4, 18.3% PAS5 and 8.5% PAS6. The histology analysis showed normal placental attachment in 42.9% of the total number of study participants, placenta accreta in 28.2%, placenta increta in 16.7%, and placenta percreta in 12.2%. In Group 1, we performed the resection of uterine wall with the attached portion of the placenta in 13.5% of women, in Group 2 in 30.3% women, and in Group 3 in 50.6% women. There was a significant 4.8-fold reduction in the number of hysterectomies in Group 3 versus Group 2 (р = .043) and a 4.4-fold reduction in Group 2 versus Group 1 (р = .003). In Group 2, the volume of blood loss was 1.3-fold lower and in Group 3 1.5-fold lower than in Group 1. Conclusion: The techniques of compression distal haemostasis evaluated in this study in women with PAS are efficacious in the reduction of adverse maternal outcomes and should be used more widely in clinical practice.
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Affiliation(s)
- S V Barinov
- Federal State Budget Institution of Higher Education "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - R G Shmakov
- Federal State Budget Institution National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - I V Medyannikova
- Federal State Budget Institution of Higher Education "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - Yu I Tirskaya
- Federal State Budget Institution of Higher Education "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - T V Kadtsyna
- Federal State Budget Institution of Higher Education "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - O V Lazareva
- Federal State Budget Institution of Higher Education "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - I N Razdobedina
- Perinatal Centre of Omsk Regional Clinical Hospital, Omsk, Russia
| | - T N Neustroyeva
- Perinatal Center of the State Autonomous Institution of the Republic of Sakha (Yakutia) Republican Hospital No. 1, Yakutsk, Russia
| | - S S Stepanov
- Federal State Budget Institution of Higher Education "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
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Barinov SV, Di Renzo GC, Belinina AA, Koliado OV, Remneva OV. Clinical and biochemical markers of spontaneous preterm birth in singleton and multiple pregnancies. J Matern Fetal Neonatal Med 2021; 35:5724-5729. [PMID: 33627033 DOI: 10.1080/14767058.2021.1892064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM The aim of this study was to compare the clinical characteristics of singleton and twin pregnancies that resulted in spontaneous preterm births (sPTB) and to evaluate the prognostic value of phosphorylated insulin-like growth factor binding protein-1 (phIGFB-1) and placental alpha macroglobulin-1(PAMG-1) for sPTB prediction in symptomatic women. PATIENTS AND METHODS The study included 420 women and included two parts. Firstly, we performed a retrospective cohort study comparing pregnancy and neonatal outcomes in 170 women with singleton pregnancies and spontaneous preterm birth before 37 weeks of gestation with 150 women with twin pregnancies who delivered at the same gestational age. In order to obtain the link between clinical and biochemical predictors of preterm labor we organized the second part of the research. The second part was a prospective observational study in 100 women with singleton and twin pregnancies between 24 and 33 + 6 weeks of gestation and symptoms of threatening preterm labor and intact membranes. We assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for phIGFBP-1 and PAMG-1 in terms of sPTB within 7 days and 14 days after testing. RESULTS The rate of preterm premature rupture of membranes was higher in singleton pregnancies (67.1 versus 42.8%, p = 0.034). Cervical shortening in multiples was diagnosed at an earlier mean gestational age than in singleton pregnancies (30.1 ± 4.3 versus 35.9 ± 3.1 weeks, p = 0.013). In the singleton pregnancies group, the rate of microbial cervical colonization and the rate of bacterial vaginosis were significantly higher than in twin pregnancies (49.4 versus 15.3%, p < 0.001; 32.9 versus 12.0%, p = 0.007, respectively). Premature twins had a longer oxygen dependency period, while the singletons were more predisposed to infectious morbidity. The study showed low sensitivity of phIGFBP-1 for sPTB, while the sensitivity of the PAMG-1 test was higher (sensitivity 60% and 90% within 7 days after testing and 50 versus 75% within 14 days after testing). Both tests showed a high NPV for sPTB (93.3% for phIGFBP-1 versus 98.9% for PAMG-1). The NPV for preterm labor in twins was also high for both tests (93% for phIGFBP-1 and 96% for PAMG-1). CONCLUSION Cervical shortening is the main risk factor of sPTB in women with twin pregnancies; sPTB among singletons is associated with ascendent infection, involving fetal membranes. The PAMG-1 test showed high PPV and NPV for sPTB in symptomatic women and could be a reliable prognostic tool in clinical obstetrics. High NPV was observed for phIGFBP-1 and PAMG-1 in twin pregnancies.
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Affiliation(s)
- Sergey V Barinov
- Federal State Budgetary Educational Institution for Higher Education, Omsk State Medical University Ministry of Public Health, Omsk, Russian Federation
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Olga V Koliado
- Altai Regional State Clinical Perinatal Centre, Barnaul, Russia
| | - Olga V Remneva
- Federal State Budgetary Educational Institution of Higher Education, Altai State Medical University of Ministry of Health of Russian Federation, Barnaul, Russia
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Barinov SV, Tirskaya YI, Lazareva OV, Kadcyna TV, Shamina IV, Medyannikova IV, Borisova AV, Frikel EA, Beznoshchenko GB. Pregnancy outcomes in women with large uterine fibroids. J Matern Fetal Neonatal Med 2021; 35:5369-5374. [PMID: 33522331 DOI: 10.1080/14767058.2021.1879044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
STUDY AIM To evaluate the effects of the combination of Arabin pessary or cervical cerclage with vaginal micronised progesterone versus micronised progesterone or no medical management on the outcomes of pregnancies in women with large uterine fibroids. MATERIALS AND METHODS This was a retrospective, observational, controlled study in 120 women aged 18-45 years with large uterine (≥8 cm) fibroids diagnosed in the first trimester, who underwent treatment in the regional perinatal center of the Omsk Regional Clinical Hospital between 2015 and 2019. Women in Group A (n = 90) were divided into two subgroups. In Subgroup А1 (n = 35), participants received the combination of a cervical procedure (Arabin pessary or cerclage) and micronised progesterone, and in Subgroup А2 (n = 55) all participants additionally underwent myomectomy. In Group B (n = 18), only micronised progesterone was used. In Group C (n = 12), no medical therapy was administered during pregnancy. RESULTS Large uterine fibroids in pregnancy were associated with a threatened pregnancy loss in 46.4% of women and pain in almost 40% of women. Myomectomy in pregnancy was performed in 55 women. The combination of Arabin pessary or cervical cerclage with micronized progesterone reduced the rates of preterm delivery by 2.2-fold versus the progesterone-only group and by 11.2-fold versus no medical management group (χ2 = 19.4; p = .0001). CONCLUSION The combination of Arabin pessary or cervical cerclage with micronized progesterone in our study helped achieve term deliveries in >90% of pregnant women with large fibroids.
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Affiliation(s)
- Sergey V Barinov
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
| | - Yuliya I Tirskaya
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
| | - Oksana V Lazareva
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
| | - Tatyana V Kadcyna
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
| | - Inna V Shamina
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
| | - Irina V Medyannikova
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
| | - Anna V Borisova
- Department of Obstetrics and Gynecology with the Course of Perinatology, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ekaterina A Frikel
- Perinatal Centre, Budget Healthcare Institution of the Omsk Region "Regional Clinical Hospital", Omsk, Russia
| | - Galina B Beznoshchenko
- Department of Obstetrics and Gynecology No. 2, Omsk State Medical University, Omsk, Russia
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Barinov SV, Tirskaya YI, Borisova AV, Pyanova LG, Di Renzo GC. The effectiveness of using a molded sorbent: Modified polyvinylpyrrolidone for the combined treatment of chronic endometritis. Int J Gynaecol Obstet 2021; 154:277-284. [PMID: 33471361 DOI: 10.1002/ijgo.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To improve the management of patients with chronic endometritis (CE) by using a molded sorbent-modified by polyvinylpyrrolidone (FSMP). METHODS This prospective study included 70 patients with CE divided into two groups: group 1 (n = 23) received traditional antibiotic therapy (from days 3 to 10 of the menstrual cycle); group 2 (n = 47), received antibiotics and FSMP was inserted from days 5 to 10. RESULTS At the end of therapy, group 1 had massive growth of pathogenic microflora in 21.7%, moderate growth in 69.6%, and no growth in 8.7% of cases. In group 2, after combined therapy, massive growth was observed in 4.3%, moderate growth in 44.7%, and no growth in 51.0%. In group 2 after 5 days, serum levels of interleukin-1β (IL-1β) were 1.9 times, of IL-6 were 7.0 times, and of IL-8 and IL-1 receptor antagonist were 1.3 times lower than in group 1. In uterine cavity aspirates, IL-1β decreased around 4.8 times, IL-6 by 11.8 times, IL-8 by 3.2 times, tumor necrosis factor-α by 3.9 times, and IL-1 receptor antagonist by 2.1 times in comparison to group 1. CONCLUSION Combined therapy of FSMP with antibiotics is more effective in treating CE, because it contributes to the almost complete elimination of pathogens and toxins from the uterine cavity, blocking the local pro-inflammatory cascade.
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Affiliation(s)
- Sergey V Barinov
- Department of Gynecology and Obstetrics No. 2, Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation, Omsk, Russia
| | - Yuliya I Tirskaya
- Department of Gynecology and Obstetrics No. 2, Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation, Omsk, Russia
| | - Anna V Borisova
- Peoples Friendship University of Russia (RUDN, Moscow, Russia
| | - Lidiya G Pyanova
- Laboratory of Synthesis of Functional Carbon Materials, Institute of Hydrocarbons Processing of the Siberian Branch of the Russian Academy of Sciences, Omsk, Russia
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Reproductive and Perinatal Medicine, University of Perugia, Perugia, Italy
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Barinov SV, Tirskaya YI, Kadsyna TV, Lazareva OV, Medyannikova IV, Tshulovski YI. Pregnancy and delivery in women with a high risk of infection in pregnancy. J Matern Fetal Neonatal Med 2020; 35:2122-2127. [PMID: 32576052 DOI: 10.1080/14767058.2020.1781810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Pregnant women with chronic genital and non-genital infections are at a high risk of infections complication during pregnancy and the postpartum period. Preterm birth is one of the leading causes of obstetric and neonatal complications and occurs in one in nine women. Forty per cent of preterm births are considered to be caused by the abnormal vaginal microbiome, and there is currently no consensus on the contribution of combined bacterial and viral infections.Aim: To assess the course of pregnancy and delivery in women with a high risk of chronic infections and the association with the presence of specific microorganisms in the genital microbiome.Materials and methods: We performed a prospective controlled observational study in 355 pregnant women with a high risk of chronic infections. The high risk was defined as presence acute or chronic genital or extragenital infections, reactivation of chronic infections/inflammatory diseases during current pregnancy and history of obstetric complications during previous pregnancies such as miscarriages, missed miscarriages, preterm deliveries, postpartum endometritis, and sepsis.Results: In women with a high risk of chronic infections, pregnancy was associated with recurrent threatened pregnancy loss (49.8%), preterm premature rupture of fetal membranes (64.3%), followed by prolonged oligohydramnios. Almost in one in two women (47.9%), pregnancy resulted in the delivery of preterm, low-birth-weight neonates. One in three women (30%) experienced uterine hypotony and bleeding after vaginal and cesarean delivery. Almost a third of women (32.1%) developed inflammatory complications postpartum, and more than half of complications (54.4%) was observed in women giving birth prematurely. Vaginal and cervical cultures in women who experienced preterm birth were dominated by non-obligate pathogens. We observed persistence of the Herpesviridae family both in the cervical canal and uterine cavity, specifically the Epstein-Barr virus (17.2%; 95% CI: 10%, 26.8%).Conclusions: Pregnancies in women with a high risk of chronic infections were associated with high rates of recurrent threatened pregnancy loss, preterm rupture of membranes and preterm delivery.
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Affiliation(s)
- S V Barinov
- Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation
| | - Y I Tirskaya
- Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation
| | - T V Kadsyna
- Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation
| | - O V Lazareva
- Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation
| | - I V Medyannikova
- Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation
| | - Yu I Tshulovski
- Federal State Funded Educational Institution for Higher Education Omsk State Medical University, Ministry of Public Health, Russian Federation
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Barinov SV, Tirskaya YI, Shamina IV, Ledovskikh IO, Atamanenko OJ. Placental blood flow and pregnancy outcomes in women with abnormal placental localization and absence of placental "migration". J Matern Fetal Neonatal Med 2019; 34:3496-3502. [PMID: 31736394 DOI: 10.1080/14767058.2019.1685973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: We investigated the arcuate artery blood flow in the region of the abnormally localized placenta in women who had undergone insertion of an obstetric pessary and were receiving micronized progesterone.Materials and methods: The study included 120 pregnant women with high perinatal risks and abnormal placental localization. The patients were randomized to receive the Arabin's pessary and vaginal micronized progesterone (Group A, n = 60) or vaginal micronized progesterone only (Group B, n = 60). Randomization was carried based on the order of hospital admission: odd patient numbers were allocated to Group A and even numbers to Group B. Patients underwent a series of ultrasound scans to evaluate the placental migration and presence of abnormal placental attachment. Depending on the results of the scan, study participants were divided into the following groups: (1) patients without placental migration: A1 (n = 23) and B1 (n = 42); and (2) patients with placental migration: A2 (n = 37) and B2 (n = 18). Women in subgroups A1 and B1 were further divided into the subgroups based on the presence of abnormal placental attachment: A1x (n = 5) and B1x (n = 12) with abnormal placental attachment; and A1O (n = 18) and B1O (n = 30) without the abnormal placental attachment.Conclusion: In patients with abnormal placental attachment, the resistance of blood flow in the arcuate arteries was significantly higher than in those with normal placental attachment. A significant increase in the blood flow resistance occurred between 24 and 28 weeks of gestation. The combined use of the obstetric pessary and vaginal micronized progesterone in women with abnormal placental localization helped maintain the resistivity index at low levels and reduce the rate of abnormal placental attachment by 1.3-fold (OR 0.694 (95% CI: 0.21-2.29)).
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Affiliation(s)
- S V Barinov
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - Y I Tirskaya
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - I V Shamina
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - I O Ledovskikh
- Perinatal Centre, Budget Healthcare Omsk Region Institution, Regional Clinical Hospital, Omsk, Russia
| | - O J Atamanenko
- Perinatal Centre, Budget Healthcare Omsk Region Institution, Regional Clinical Hospital, Omsk, Russia
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Barinov SV, Tirskaya YI, Shamina IV, Medyannikova IV, Kadcyna TV, Shkabarnya LL, Lazareva OV. The use of an osmotic dilator for induction of miscarriage in patients with the second trimester missed miscarriage. J Matern Fetal Neonatal Med 2019; 34:2778-2782. [PMID: 31570024 DOI: 10.1080/14767058.2019.1671331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to assess the outcomes of combined use of dilapan-S and pharmacological induction of miscarriage with mifepristone and misoprostol versus mifepristone and misoprostol only in patients with a second-trimester pregnancy loss. MATERIALS AND METHODS Our study included 74 patients with a second-trimester antenatal death who were randomized into two groups to receive pharmacological induction of miscarriage combined with intracervical insertion of dilapan-S (n = 37) or pharmacological induction of miscarriage only (n = 37). Efficacy endpoints included: blood loss volume, length of time between the procedure initiation and complete miscarriage, and the number of complications. RESULTS The use of dilapan-S together with mifepristone and misoprostol for induction of miscarriage in the second trimester in women with antenatal fetal death reduced the time from the start of the procedure to complete miscarriage by 1.98-fold. However, the use of dilapan-S did not significantly reduce the odds of such post-procedural complications as hematometra and retention of the products of conception in the uterus (p = .2501). CONCLUSIONS Combined management of antenatal pregnancy loss in the second trimester including intracervical insertion of dilapan-S and conventional induction with miscarriage may be considered a valuable clinical strategy. However, future studies should focus on ways to prevent postprocedural complications in this group of women.
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Affiliation(s)
- Sergey V Barinov
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Yuliya I Tirskaya
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Inna V Shamina
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Irina V Medyannikova
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Tatiana V Kadcyna
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | | | - Oksana V Lazareva
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
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Barinov SV, Artymuk NV, Novikova ON, Shamina IV, Tirskaya YI, Belinina AA, Lazareva OV, Kadcyna TV, Borisova AV, Stepanov SS, Di Renzo GC. Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth. J Matern Fetal Neonatal Med 2019; 34:2071-2079. [PMID: 31409178 DOI: 10.1080/14767058.2019.1656195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin's pessary with cervical cerclage in women at a high risk of pregnancy loss. MATERIALS AND METHODS This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin's pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. RESULTS Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p = .448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p = .011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin's pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. CONCLUSIONS Women with a high risk of pregnancy loss treated with Arabin's pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.
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Affiliation(s)
- S V Barinov
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - N V Artymuk
- Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia
| | - O N Novikova
- Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University, Kemerovo, Russia
| | - I V Shamina
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - Y I Tirskaya
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - A A Belinina
- Altai State Clinical Perinatal Centre, Barnaul, Russia
| | - O V Lazareva
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - T V Kadcyna
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - A V Borisova
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia.,Peoples Friendship University of Russia (RUDN) Moscow, Russian Federation
| | - S S Stepanov
- 2nd Department of Obstetrics and Gynaecology, Omsk State Medical University, Omsk, Russia
| | - G C Di Renzo
- Department of Obstetrics and Gynecology and Centre for Reproductive and Perinatal Medicine, The University of Perugia, Perugia, Italy
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Barinov SV, Shamina IV, Di Renzo GC, Lazareva OV, Tirskaya YI, Medjannikova IV, Ledovskikh IO, Klementyeva LL, Dudkova GV. The role of cervical pessary and progesterone therapy in the phenomenon of placenta previa migration. J Matern Fetal Neonatal Med 2019; 33:913-919. [PMID: 30081730 DOI: 10.1080/14767058.2018.1509068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This study aimed to evaluate the effects of combined management of placenta previa with the Arabin cervical pessary and progesterone.Study design: In this randomized controlled study, we followed up 217 patients with placenta previa and high risk of preterm birth. The main group (n = 81) underwent combined management with the Arabin cervical pessary and progesterone; the control group (n = 136) received progesterone only. Placental migration was monitored using Doppler scanning from 24 weeks of pregnancy onwards.Results: Patients receiving the combination of the Arabin cervical pessary and progesterone had a three-fold reduced rate of bleeding during pregnancy compared with patients in the control group (11.3% versus 33.1%; p = .006). Placental migration occurred 1.8 times more often in the pessary group (48.1% versus 26.4%; p = .037), and preterm labor <34 weeks occurred 2.7 times less often compared with the control group (p = .031). The use of the Arabin cervical pessary caused a change in the anterior cervico-uterine angle by 7.4 degrees, and reduction in the arcuate artery RI at 32-33 weeks of pregnancy compared with the control group.Conclusions: The use of the Arabin cervical pessary combined with progesterone in patients with placenta previa significantly reduced the rate of preterm delivery <34 weeks and bleeding during pregnancy.
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Affiliation(s)
- Sergey V Barinov
- Federal State Budget Educational Institution of Higher Education "Omsk State Medical University", Russian Ministry of Healthcare, Omsk, Russia
| | - Inna V Shamina
- Federal State Budget Educational Institution of Higher Education "Omsk State Medical University", Russian Ministry of Healthcare, Omsk, Russia
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Oksana V Lazareva
- Federal State Budget Educational Institution of Higher Education "Omsk State Medical University", Russian Ministry of Healthcare, Omsk, Russia
| | - Yuliya I Tirskaya
- Federal State Budget Educational Institution of Higher Education "Omsk State Medical University", Russian Ministry of Healthcare, Omsk, Russia
| | - Irina V Medjannikova
- Federal State Budget Educational Institution of Higher Education "Omsk State Medical University", Russian Ministry of Healthcare, Omsk, Russia
| | - Inna O Ledovskikh
- Perinatal center, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital", Omsk, Russia
| | | | - Galina V Dudkova
- Perinatal center, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital", Omsk, Russia
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Barinov SV, Medjannikova IV, Tirskaya YI, Chuprinin VD, Khilkevich EG, Savelyeva IV, Shamina IV, Borisova AV, Lazareva OV. The use of Zhukovsky vaginal and intrauterine balloons to improve the outcome of postpartum hysterectomies in patients with severe bleeding. J Matern Fetal Neonatal Med 2019; 33:2955-2960. [PMID: 30614315 DOI: 10.1080/14767058.2019.1566309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To assess the efficacy of a Zhukovsky obstetric double balloon for improving outcomes in women undergoing hysterectomy for postpartum hemorrhage.Materials and methods: This was a randomized controlled study. Participants were divided into two groups to undergo insertion of a Zhukovsky obstetric double balloon prior to hysterectomy (n = 16) or conventional hysterectomy (n = 25).Results: The main reasons for major obstetric hemorrhage were placenta accreta (53.6%), uterine atony (26.8%), uteroplacental apoplexy (14.6%), and amniotic fluid embolism (4.8%). The use of a Zhukovsky obstetric double balloon during postpartum hysterectomy was associated with a 1.7-fold reduction in blood loss and a 2.3-fold reduction in blood loss > 2000 ml compared with conventional hysterectomy.Conclusion: The use of a Zhukovsky obstetric double balloon represents a potent tool for improvement of immediate outcomes of hysterectomy in women with severe postpartum bleeding.
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Affiliation(s)
- Sergey V Barinov
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Irina V Medjannikova
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Yuliya I Tirskaya
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Vladimir D Chuprinin
- Ministry of Health of Russia, National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Elena G Khilkevich
- Ministry of Health of Russia, National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Irina V Savelyeva
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Inna V Shamina
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Anna V Borisova
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Oksana V Lazareva
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
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Barinov SV, Shamina IV, Lazareva OV, Tirskaya YI, Ralko VV, Shkabarnya LL, Dikke GB, Kochev DM, Klementyeva LL. Comparative assessment of arabin pessary, cervical cerclage and medical management for preterm birth prevention in high-risk pregnancies. J Matern Fetal Neonatal Med 2016; 30:1841-1846. [PMID: 27550418 DOI: 10.1080/14767058.2016.1228054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to compare the efficacy of combined use of Arabin pessary, cervical cerclage and progesterone with progesterone-only management of pregnant women at high risk of preterm birth. MATERIALS AND METHODS The study included 203 pregnant women at high risk of preterm birth who were randomised to receive Arabin pessary (Group 1, n = 82) and progesterone, circular cervical cerclage and progesterone (Group 2, n = 121) or progesterone treatment only (Group3, controls, n = 50). Patients in the pessary and cerclage group also received progesterone. RESULTS The use of Arabin pessary combined with progesterone resulted in a 2.5-fold decrease in the rate of vaginal dysbiosis in pregnancy (p = 0.015) and almost three-fold reduction in in the postpartum period (p = 0.037), combined with circular cervical cerclage and progesterone. Suture eruption was observed in 4.3% of women. In patients with abnormal placental location, placental migration was observed in 62.1% of patients in Group I, 52.1% in Group II and a significantly lower proportion of patients (14.0%) in Group III (p = 0.001). Bleeding during pregnancy was observed significantly more often in both comparison groups (p = 0.005). Incidence of intrapartum bleeding was 17.4% (p = 0.011) in Group II and 24.5% in Group III (p = 0.002). Intrapartum chorioamnionitis was observed in 4.3% of patients in Group II and 2.04% of patients in Group III. CONCLUSIONS The use of Arabin pessary compbined with progesterone reduces the rate of infectious complications and bleeding during pregnancy and the postpartum period.
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Affiliation(s)
- Sergey V Barinov
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Irina V Shamina
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Oksana V Lazareva
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Yuliya I Tirskaya
- a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia
| | - Vyacheslav V Ralko
- b Perinatal Centre, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital" , Omsk , Russia
| | - Lyudmila L Shkabarnya
- b Perinatal Centre, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital" , Omsk , Russia
| | - Galina B Dikke
- c Federal State Autonomous Educational Institution "Peoples' Friendship University of Russia" , Moscow , Russia
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Barinov SV, Zhukovsky YG, Dolgikh VT, Medyannikova IV. Novel combined strategy of obstetric haemorrhage management during caesarean section using intrauterine balloon tamponade. J Matern Fetal Neonatal Med 2016; 30:29-33. [PMID: 26625194 DOI: 10.3109/14767058.2015.1126242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this trial was to evaluate the performance of a combined strategy of postpartum haemorrhage management, based upon thromboelastographic (TEG) assessment of coagulation, early surgical haemostasis and mechanical compression of the uterine wall combined with uterine cavity draining, via intrauterine balloon tamponade (BT). METHODS We carried out an open controlled trial, which included 119 women with obstetric haemorrhage (main group - combined strategy: n = 90, control group - conventional strategy: n = 29). The combined strategy included three essential components: (1) early surgical haemostasis, (2) mechanical pressure upon the uterine wall and draining of the uterine cavity via BT and (3) treatment of blood coagulation disorders identified via TEG. RESULTS The combined haemorrhage management strategy resulted in significantly lower number of peripartum hysterectomies compared with standard management (4.44% versus 31.03%, respectively, p = 0.02). Blood loss of >2000 ml occurred significantly less common in the main group compared with the control group (16.2% versus 27.6%, respectively, p = 0.03). Mean total blood loss after combined management was significantly lower than after the standard approach (2502 ± 203 ml versus 1836 ± 108 ml, p = 0.04). CONCLUSIONS The proposed combined strategy of obstetric haemorrhage management represents a powerful tool for fertility-sparing treatment of this life-threatening condition.
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Abstract
BACKGROUND The aim of the study was the reduction of adverse pregnancy outcomes in women with gestational and genetically determined changes in the hemostatic system. PATIENTS AND METHODS The study group comprised 98 patients with obstetric complications on the background of changes in the parameters of coagulation screening. In 63 pregnant women, hemostatic disorders were not corrected, in 35 patients medical tactic defined clinical situation and the results of laboratory and instrumental studies of the hemostatic system. RESULTS Hereditary thrombophilia detected in 85% of patients with obstetric complications. Carriage of the rare allele of MTHFR-677 2-fold increased risk of adverse pregnancy outcomes; heterozygous carriers of polymorphism PAI-1 - 1.5 times more. The prognostic parameters thrombelastographic (sensitivity 80%, specificity 82%) were higher than in laboratory tests. To determine the most predictive of adverse pregnancy outcome has a density of fibrin clot--the maximum amplitude. CONCLUSIONS In women with obstetric complications associated with disturbances in the hemostatic system, medical diagnostic tactics using c thrombelastographic evaluates all stages of coagulation and fibrinolysis, allows you to select a reasonable pathogenetic anticoagulant therapy and reduce the number of adverse pregnancy outcomes.
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Dolgikh TI, Barinov SV, Kadtsyna TV. [The diagnostic value of antibodies to annexin and B2-glycoprotein for verification of active course of herpesviral infections of pregnant women]. Klin Lab Diagn 2014:44-46. [PMID: 25338463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article deals with results of analysis of hemostasiological and immunological alterations under reactivation of herpesviral infections during pregnancy. The formation of pathological thrombinemia, activation of intra-vascular blood clotting, increasing of factors resulted in damage of endothelium under active course of herpesviral infection and increasing risk of development of obstetric pathology are demonstrated. The antibodies to B2-glycoprotein class IgM and antibodies to annexin class IgM, IgG can be operated as diagnostic signs of activation of herpesviral infection during pregnancy.
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