Ukrainian Journal of Perinatology and Pediatrics

Placenta accreta spectrum disorder management: literature review and authors experience

Sat, 28 Sep 2024 00:00:00 +0300

Placenta accreta spectrum disorder (PSD) is a rare complication of pregnancy with extremely severe consequences, including hysterectomy, massive bleeding, and fetal asphyxia. The frequency of such disorders has been increasing over the past decades all over the world, which is primarily due to the higher frequency of cesarean sections and comorbidities, the older age of pregnant women. The experience of doctors worldwide in the treatment of patients with RSPA is limited and is limited to published descriptions of clinical cases or clinical case series.

The aim of this review is to analyze evidence-based medicine data on surgical treatment and intensive care approaches for patients with RSPA in the world, as well as to present our own experience of surgical treatment and intensive care for patients with placenta accreta (placenta increta).

According to the results of the literature review, the key points in the management of patients with RSPA are the strategies of adherence to Patient blood management: prevention and treatment of anemia in pregnant women, preparation of the blood bank for a possible massive hemotransfusion, adherence to protocols for the management of massive obstetric bleeding, in particular, the use of tranexamic acid and early hemotransfusion, objective calculation of blood loss, etc. The surgical technique of treatment is mainly hysterectomy with minimal blood loss (after suturing the incision on the uterus), however, in women who wish to preserve fertility, organ-sparing surgery using autohemotransfusion may be chosen in individual cases.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Bacterial vaginosis as a factor in pregnancy complications (literature review)

A.B. Рrуlutska, L.I. Martynova, О.L. Kisilenko, D.O. Govsieiev — Sat, 28 Sep 2024 00:00:00 +0300

Aim - to analyze the current literature on etiopathogenetic factors, diagnosis and treatment of bacterial vaginosis in cases of vaginosis and improve treatment methods for this pathology Changes in the size of the body due to the passage of vaginosis.

The article shows the relevance of the problem of bacterial vaginosis in the whole world. The etiopathogenetic factors that determine the cause of illness during pregnancy are examined. The emphasis is placed on complications caused by bacterial vaginosis in vaginal patients. The effectiveness of methods for diagnosing bacterial vaginosis in women has been analyzed. The prospects for the use of antibacterial drugs and antibiotics in pregnant women with bacterial vaginosis are examined. The tactics for preventing pregnant women with bacterial vaginosis have been assessed.

Conclusions. Despite modern diagnostics and pharmacological means, the problem of detecting and treating bacterial vaginosis in pregnant women remains difficult, as the morphological polymorphism, species diversity of pathogens complicates diagnosis, and the wide spread of drug-resistant strains reduces the effectiveness of treatment, leading to relapses of the disease. During pregnancy in patients with BV, only women with persistent symptoms are subject to observation and in cases where treatment is prescribed to reduce the risk of premature birth and other complications, re-diagnosis should be carried out after one month and further treatment should be offered in case of recurrence of bacterial vaginosis.

The authors declare no conflicts of interest.

Juvenile fibroadenoma: modern trends in diagnosis and treatment of multiple and recurrent forms of pathology (analytical review of the literature and own observation)

Sat, 28 Sep 2024 00:00:00 +0300

Neoplastic lesions of the mammary gland in children are mostly benign in nature, which is associated with the normal development of the mammary gland. Malignant neoplasms in childhood are very rare. The specific gravity of breast cancer in teenagers is no more than 0.1 % of all breast cancer cases and less than 1% of all cancer cases among children. The malignant potential of breast fibroadenoma is quite low and ranges from 0.125% to 0.02%.

The aim is to highlight modern approaches diagnosis and treatment of juvenile fibroadenoma according to literature sources and own experience.

The conducted analysis of the state of modern scientific research regarding the problem of fibroadenoma in general and especially their juvenile forms, taking into account a certain own experience in the treatment of this pathology, prompts, in our opinion, the expediency of considering the recurrent course of the disease in pediatric practice from the angle of possible "continued growth" in relation to the pathological condition in general. The phenomenon of "continued growth" should be specifically discussed only in those cases, in the process of primary removal of juvenile fibroadenomas in one and/or contralateral mammary gland, during clinical and instrumental examination, there are no signs of any additional neoplasms. Juvenile fibroadenoma in pediatric treatment remains an actual problem that requires further fundamental and multifaceted study and wider coverage among specialists of various specialties – pediatric surgeons, pediatric gynecologists, mammologists, pediatricians, family doctors. In the modern medical literature, studies regarding the recurrent course of juvenile fibroadenoma are insufficiently covered, which hinders the development of a modern strategy for the treatment of this pathological condition, including the determination of predictors of the disease and its stages, indications for surgical intervention. In the case of recurrent course of juvenile fibroadenoma, regardless of the size of the tumor, it is necessary to enucleate the tumor with its mandatory morphological verification.

The authors declare no conflict of interest.

Polycythemia syndrome in childhood (literature review)

N.H. Lotysh, T.Yu. Kravchenko, R.M. Papinko, M.V. Fedin — Sat, 28 Sep 2024 00:00:00 +0300

The relevance of polycythemia syndrome in pediatrics is related to the long-term consequences of hypoxia, especially for the brain, which to one degree or another causes the development of neurological consequences. Polycythemia is one of the many and quite complex in terms of choosing tactics for managing neonatal diseases. A number of conditions and nosologies characteristic of the perinatal period lead to the development of this pathology. A decrease in the perfusion of organs that develops against the background of polycythemia can be accompanied not only by their transient dysfunction, but also by a severe lesion that leads to a violation of the further development of the child, disability. A child may lag behind in psychomotor and physical development, suffer from social adaptation disorders, etc.

Aim - to review the current definition of polycythemia and the appropriate management that can be used to aid clinical decision making.

According to modern data, polycythemia (erythremia) is a condition characterized by an increase in the number of erythrocytes (more than 7.5 T/l), the level of hemoglobin (more than 180 g/l) and the total volume of erythrocytes (TBC) (more than 0.52 ). The term "polycythemia" is used only in relation to erythrocytes, without taking into account the number of leukocytes and platelets. When talking about an absolute increase in the number of erythrocytes, the term "erythrocytosis" is used. "Erythremia" is called "true polycythemia (polycythemiavera)", in which the number of leukocytes and platelets is increased. In newborns and children of early and older age, this condition can be caused by various factors, such as hypoxia, infections, damage to the cardiovascular system, perinatal complications, and others. According to the literature (domestic and international sources), the following forms of polycythemia are distinguished - true (primary) and relative (secondary). The mass of erythrocytes increases only with true polycythemia. The total volume of erythrocytes changes in true and secondary polycythemia.

An analysis of literary sources was carried out and information from many different researchers was provided regarding the factors of the development of polycythemia, etiopathogenesis, clinical and laboratory indicators, the basis for which are the anatomical and physiological features of the child’s body.

No conflict of interests was declared by the authors.

Herbal components in the complex therapy of acute cystitis in women: optimization of efficacy, prevention and safety

M.M. Kochuieva, I.I. Hrek, R.I. Tsapenko, H.I. Kochuiev, V.B. Kushnir — Sat, 28 Sep 2024 00:00:00 +0300

Aim - to study anti-inflammatory and antioxidant effects of phytochemicals in young women with acute cystitis.

Materials and methods. The study included 50 women with acute cystitis aged between 18 and 35 years. The patients were divided into two groups. The control group (n=25) received standard antibacterial therapy for 7 days, and patients in the intervention group (n=25) additionally took a combined herbal preparation at a dosage of 1 capsule twice a day for 30 days and then a further 60 days at a dosage of 1 capsule once a day. Follow-up visits were made 7 days, 1 month and 3 months after the start of treatment. During the study, the dynamics of the complaints, the results of the ACSS questionnaire, laboratory tests of urine and blood were evaluated, and the parameters of the oxidative stress-antioxidant status system were determined.

Results. After the course of etiotropic treatment, it was found that the average duration of acute cystitis` symptoms in the control group was 1.67 times longer than in the intervention group. After one month of taking the herbal combination drug, the antioxidant defence system was stabilized: the indicators of oxidative stress in the intervention group had a significantly greater positive dynamic than in the control group; the indicators of the antioxidant system reached normal levels and had significant differences compared to the control group. In the intervention group, there was a restoration of neutrophil membrane-associated pyridine nucleotide oxidase activity and an increase in the functional reserve of phagocytic cells, a significant increase in the number of cells capable of phagocytosis was noted, and the absorptive activity of neutrophils was also significantly higher than in the control group. During the 3-month prophylactic course of treatment with the herbal remedy, the absence of recurrent disease was observed in 96% of patients in the intervention group, in contrast to the control group, where the absence of reinfection was observed in only 72% of patients.

Conclusions. The use of a combined herbal preparation at a dosage of 1 capsule twice a day in addition to standard therapy for acute cystitis in women significantly reduces the duration of clinical symptoms and promotes faster clinical and laboratory recovery. After 30 days of use, oxidative stress, antioxidant protection and phagocytic activity of neutrophils are normalized. Complex therapy of acute cystitis with the inclusion of herbal medicine for 3 months is associated with a significantly lower number of cases of urinary tract reinfection compared with treatment without herbal medicine.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Analysis of complications of pregnancy, childbirth, the postpartum period and extragenital morbidity in pregnant women in Ukraine and forecasting the dynamics of selected indicators until 2026

Sat, 28 Sep 2024 00:00:00 +0300

Aim - evaluation of the quality of obstetric care in Ukraine and forecasting the dynamics of intranatal morbidity and complications of the postpartum period for the period until 2026.

Materials and methods. Statistical data of healthcare institutions of Ukraine for the period 2011-2022 were analyzed. One-factor linear regression models were used for mathematical modeling. Calculations by MedCalc® Statistical Software version 22.009.

Results. According to the data of the conducted analysis, the following stable trends were revealed: a decrease in the total number of births from 491,467 to 195,243; decrease in the share of physiological births from 68.6% to 61.6%; an increase in the number of multiple pregnancies (calculations per 1,000 pregnancies) from 10 to 13 per 1,000; number of pathological venous conditions from 25 to 50; number of gestational and pre-gestational diabetes from 1 to 10; the number of infections of the genitourinary system from 134 to 143. Pathologies of the circulatory system and diseases of the thyroid gland do not have a tendency to increase. The analysis of indicators related to childbirth revealed a significant increase in cesarean delivery from 16.17% to 27.43% with a further increase to 31.4% in 2026, an increase in the level of bleeding from 7.3 to 9.9 and the number of complicated births from 58 to 70 (the figures are calculated for 1000 births).

Conclusions. During the period of analysis, no significant deterioration in the quality of obstetric care was found, however, there are a number of negative trends, namely, an increase in the frequency of difficult childbirth and cesarean delivery. In the near future, we should expect a decrease in the total number of births, a decrease in the share of physiological births, an increase in the frequency of pre-existing somatic diseases and pregnancy complications, and an increase in the specific gravity of multiple pregnancies. The result will be a further increase in cesarean deliveries, and an increase in the frequency of abnormal placentation and associated heavy bleeding. The key approaches to managing the identified trends are the development and implementation of algorithms for timely detection of pregnant women at risk of developing perinatal and obstetric complications and optimal routing of pregnant women who are included in the formed risk groups for the occurrence of severe obstetric and perinatal pathology.

The authors declare no conflict of interest.

The role of assessment of provisional organs in the diagnosis of fetal pathology

Sat, 28 Sep 2024 00:00:00 +0300

Aim - to evaluate the potential of using data on provisional organs’ changes and fetal growth restriction (FGR) for the diagnosis of fetal pathology, including severe/sublethal pathology - multiple malformations and chromosomal abnormalities (CA).

Materials and methods. The results of complex prenatal examinations of 2954 high-risk pregnant women performed in 2020-2022 were analyzed. The rate of FGR, placenta, umbilical cord and amniotic fluid changes were compared depending on the presence of fetal pathology by Chi-Square (χ²) test and odds ratio (OR) calculation.

Results. 853 cases of fetal pathology (28.9%) were diagnosed, including cases of 658 anatomical malformations and 195 CA. 264 observations of multiple malformations and CA were allocated to the subgroup of severe pathology. The rates of provisional organs’ changes were significantly higher in presence of fetal pathology: FGR in the control group 2.0%, in the group of fetal pathology 19.5%, in the group of severe pathology 36.7%; single umbilical artery in 1.1%, 9.3% and 14.8%, respectively, velamentous/marginal cord insertion in 1.95%, 7.4% and 8.3%, respectively. OR of fetal pathology in presence of FGR was 11.6, in presence of single umbilical artery 9.2, in presence of FGR combined with polyhydramnios 97.9; for single umbilical artery combined with polyhydramnios 30, combined with oligohydramnios, combined with FGR 13.6. OR of severe pathology in presence of FGR was 27.8, for combination of FGR and polyhydramnios 172.1; in presence of single umbilical artery 15.7, its combination with polyhydramnios 57.2, with FGR 35.5. These markers had low sensitivity, high specificity and accuracy.

Conclusions. Early FGR, polyhydramnios, oligohydramnios, single umbilical artery, velamentous/marginal umbilical cord insertion, structural placenta changes are associated with the higher rate of fetal pathology. These findings must prompt women’s referral to tertiary prenatal diagnosis departments and may be an indication for prenatal invasive procedures.

No conflict of interests was declared by the authors.

Obstetric complications during pregnancy and childbirth in women with uterine leiomyoma

T.G. Rоmanenko, A.A. Suchanova, V.V. Konoplynko — Sat, 28 Sep 2024 00:00:00 +0300

Aim - to study the features of the clinical course of pregnancy and childbirth in women with uterine leiomyoma (LM) in order to improve the prevention of obstetric complications in these pregnant women.

Materials and methods. A prospective study was conducted to analyze the characteristics of the course of pregnancy and childbirth in 112 pregnant women with uterine leiomyoma (main group, MG). The control group (CG) consisted of 45 pregnant women without uterine LM and without pregnancy complications. Statistical analysis of the obtained data was performed using the SPSS Statistics software. Differences at p<0.05 are considered statistically significant.

Results. In the first half of pregnancy, retrochorionic haematoma was detected in 38 (33.9%) women in MG and 1 (2.2%) patient in CG; low placentation - in 6 (14.3%) and 1 (2.2%) woman, respectively; pulling pain in the lower abdomen and lower back - in 78 (69.6%) patients in MG, and slight bloody discharge from the genital tract - in 33 (29.5%) women in MG. In the second half of pregnancy, the threat of late spontaneous abortion was noted in 26 (23.2%) women in MG and 2 (4.4%) patients in CG; the threat of preterm birth - in 39 (34.8%) and 3 (6.7%) cases, respectively; placental insufficiency - in 27 (24.1%) and 2 (4.4%) patients, respectively; preterm birth - in 18 (16.1%) patients in MG; fetal distress in labour - in 12 (10.7%) women in MG and 2 (4.4%) patients in CG; moderate preeclampsia - in 24 (21.4%) and 4 (8.9%) women, respectively; severe preeclampsia - in 4 (3.5%) pregnant women in MG; fetal growth retardation syndrome - in 21 (18.7%) women in MG and 1 (2.2%) patient in CG; caesarean section - in 48 (42.9%) women in MG and 2 (4.4%) patients in CG.

Conclusions. In women with LM, pregnancy is complicated by the threat of miscarriage of various terms, the threat of premature birth, placental insufficiency with FGR syndrome, preeclampsia, which causes a high rate of caesarean sections.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Type of suture material for cervical cerclage: the lost puzzle piece of isthmic-cervical insufficiency treatment

V.V. Bila, V.O. Chernega — Sat, 28 Sep 2024 00:00:00 +0300

Every year, preterm birth (PTB) causes more than million deaths worldwide. Cervical insufficiency (CI) is a significant risk factor for PTB. Progesterone and cervical cerclage (CC) are used to manage such patients. In this study, the authors analyzed the effect of the type of suture material used for cerclage on the inflammatory status of the birth canal and pregnancy outcomes.

The aim of our study is to evaluate the effect of using braided and monofilament sutures on the results of microscopic and microbiological examination and the level of IL-6 and IL-8 in cervical-vaginal fluid (CVF).

Materials and methods. During 2021-2024, a prospective cohort study was conducted, which analyzed 51 patients with singleton pregnancy who underwent CC. The braided suture (BS) group included 27 patients, and the monofilament suture (MS) group included 24 patients. Participants were examined twice during the study: 3 weeks after suturing and at suture removal time.

Results. The microscopy results (12 vs. 4 patients) and bacteriological examination (15 vs. 6 patients) in the BS group were significantly worse. IL-6 level in the BS group was significantly higher at the time of suture removal than at the beginning (59.67±29.95 vs. 76.6±22.29). The increase of IL-6 levels in the BS group was 2.1, and in the MS group - 1.49. The type of suture material can affect the delivery timing (34.2±2.7 weeks in BS group versus 32.9±3.1 in MS group).

Conclusions. The data indicate that CC using BS is associated with vaginal dysbiosis – increase in the frequency of 3-4 grade smear and abnormal levels of opportunistic microflora, CVF IL-6 levels, and with an increased incidence of PTB.

The research was carried out in accordance with Helsinki Declaration principles. The study protocol was approved by participating institution’s Local Ethics Committee. The informed consent of the patients was obtained for conducting the studies.

Authors declare no conflict of interest.

Features of clinical symptoms and possibilities of early diagnosis of acute pancreatitis in pregnant women

Sat, 28 Sep 2024 00:00:00 +0300

Traditional methods of diagnosing acute pancreatitis (AP) in pregnant women do not differ from diagnostic criteria in the non-pregnant population. Instead, physiological changes during pregnancy and the similarity of clinical manifestations of the disease with typical pregnancy complications are associated with difficulties in diagnosis, late diagnosis, and deterioration of treatment results.

Аim - to analyze the diagnostic value of the criteria for diagnosing AP in pregnant women.

Materials and methods. 123 pregnant women aged 18 to 42 years with a gestation period of 12 to 37 weeks (on average - 21.95±8.81 weeks) with AP were examined: I (control) group - 62 pregnant women, using traditional methods of treatment and diagnosis, and II (main) group - 61 pregnant women, using the developed diagnostic and treatment algorithm. Statistical data processing was carried out using the SPSS 21 program.

Results. Our results show that the triad of clinical symptoms of AP (typical "pancreatic" pain, nausea and vomiting, paralytic intestinal obstruction) are found in only 29% of pregnant women. The frequency of painless forms of AP is 29.1%. The diagnostic sensitivity and specificity of blood leucocytosis for AP in pregnant women is 75.8% and 54.8%, an increase in the level of serum amylase 3 times about the upper limit of average - 74.2% and 68.7%, lipase - 77.4% and 90.3%, respectively. 48.4% of pregnant women had sonographic changes characteristic of AP within the first day from the moment of disease manifestation. In the group ІІ, when applying the diagnostic and treatment algorithm, 100% of patients had acute pancreatitis at an early stag

Conclusions. Our results indicate that early diagnosis of AP in pregnant women using generally accepted diagnostic criteria is possible in no more than 48.8% of cases, which suggests the need to improve early diagnosis of the disease in this category of patients.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

The quality of sexual life and general health of women with precancerous lesions of the vulva

V.V. Dunaevskaya — Sat, 28 Sep 2024 00:00:00 +0300

In recent decades, the number of young women with vulvar intraepithelial neoplasia has increased. The frequency of this pathology doubled in all age groups. These diseases are chronic and in many women significantly affect their physical, psychological and sexual health.

The aim was to study the general quality of life and sexual activity of women with precancerous vulva pathology.

Materials and methods. Were examined 258 women with lesions of the vulva (VHSIL; dVIN; Paget's disease of the vulva grade Ia; melanoma in situ of the vulva) aged from 25 to 70 years, as well as 60 gynecologically healthy women (30 women under 50 years old, 30 from 50 years old). The data was obtained from anamnesis and filling in by women of a specially developed questionnaire about their sexual life and behavior. In addition, quality of life was assessed using the SF-36 questionnaire.

Results. Was registered statistically significant decrease quality of life indicators according the SF-36 questionnaire in women with precancerous vulva diseases: physical functioning, role-related physical functioning, general health, social functioning, psychological health - by an average of 1.41 times; role emotional functioning - by 1.62 times. Were revealed statistically significant differences in the quality of sexual life: 21.84% of patients in the VHSIL group were never or rarely satisfied with it at this time; 42.21% of women with dVIN; 88.89% of patients with Paget's disease of the vulva; 50.00% of patients with melanoma in situ.

Conclusions. A characteristic feature of the quality of life of patients with precancerous lesions of the vulva is a significant decrease in the integral assessment of vitality, role-emotional functioning, and the psychological component of health. Compared to healthy women, women with precancerous lesions of the vulva have a reduced frequency of sexual life, satisfaction with current sexual activity, and less interest in sex.

The study was carried out in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Institution's Local Ethics Committee. Informed consent was obtained for the research.

The authors declare no conflict of interest.

Assessment of risk factors for chronic endometritis after early artificial abortion

Sat, 28 Sep 2024 00:00:00 +0300

The frequency of inflammatory postabortion diseases, which have turned into a chronic form, ranges from 14.6% to 19.2% and is often the cause of reproductive health disorders in young women.

Aim - to investigate risk factors for the development of chronic endometritis after early abortions.

Materials and methods. A cohort study was conducted, in which 119 women aged 18 to 45 years (on average - 29.63±5.75 years) took part: I group - 19 women with developed chronic endometritis after artificial abortion, II group - 100 women with the physiological course of the postabortion period. Analysis of anamnestic data, results of clinical laboratory and instrumental research was carried out. Statistical data processing was carried out using the SPSS 21 program.

Results. According to the results of multivariate regression analysis, significant risk factors for the development of chronic endometritis after artificial abortion in the early stages are: age ≥30 years, presence of obesity, anemia, previous abortion(s) in the anamnesis, III-IV degree of vaginal contents purity, due date abortion > 9 weeks, retention of fetal egg elements after termination of the current pregnancy.

Conclusions. On the basis of the identified clinical and anamnestic risk factors for chronic postabortion endometritis, it is advisable to single out a high-risk group in order to increase the effectiveness of treatment and preventive measures to avoid possible negative consequences for the reproductive women’s health after early termination of pregnancy.

No conflict of interest was declared by the authors.

Immediate and long-term results of two variants of sling surgery for surgical correction of stress urinary incontinence in women

Sat, 28 Sep 2024 00:00:00 +0300

The problem of urinary incontinence is one of the leading causes of deterioration of the quality of life of women of various age categories. Modern and effective surgical treatment of this pathology is sling surgery. Therefore, the search for the optimal variant of such an operation remains an actual direction in modern gynecology.

Aim - to compare the immediate and long-term results of two variants of sling operations for stress urinary incontinence.

Materials and methods. A comparative study of immediate and long-term outcomes after sling surgery for surgical correction of stress incontinence was conducted in 84 women who were divided into two groups. In the 1st group, plastic surgery with a free synthetic loop (TVT) was performed, in the 2nd group - an operation using a transobturator arrangement of a prolene loop (TVT-Obturator - TVT-О). All patients were comprehensively examined using clinical, instrumental and laboratory research methods. Statistical data processing was carried out using the SPSS 21 program.

Results. The analysis of sonographic indicators of the state of the urethrovesical segment in women of both groups established a significant decrease in the angle of inclination and the posterior urethrovesical angle. There were no significant differences in these parameters between the I and II groups, which proves the comparable effectiveness of TVT and TVT-O regarding the correction of the anatomical defect. Instead, it was established that the TVT technique allows to achieve a higher frequency of cases of complete urinary continence 2 years after the operation - 87.9% versus 67.9% in the TVT-O group, as well as a lower number of urges and episodes of urge incontinence after 1 year (p=0.047 and p=0.03, respectively) and 2 years (p=0.012 and p=0.02, respectively) after sling installation.Conclusions. The obtained data indicate the anatomical efficiency of both options of sling installation, however, the efficiency of the TVT operation, according to the evaluation of the functional results of the surgical intervention, is statistically significantly higher than the TVT-O operation.

No conflict of interest was declared by the authors.

Personal experience of simultaneous surgical treatment of patients with deep infiltrative endometriosis affecting the rectosigmoid sections of the large intestine

S.I. Savoliuk, O.Y. Shevaga, D.S. Zavertylenko — Sat, 28 Sep 2024 00:00:00 +0300

Endometriosis affects approximately 10% of women globally and can lead to infertility (30-50% of cases) and a significant decline in quality of life. One of the most severe forms of this disease is deep infiltrative endometriosis (DIE).

Аim - to evaluate the effectiveness of multidisciplinary surgical treatment for patients with DIE in the short term.

Materials and methods. The study included 18 patients with confirmed DIE and bowel involvement, treated. Laparoscopic surgical interventions were performed following Enhanced Recovery After Surgery principles. The parameters assessed included the duration of surgery, pain level, length of hospital stay, and early postoperative complications.

Results. The average duration of surgery was 145.83±15.3 minutes. Bowel involvement was localized to the anterior surface of the rectum in 7 cases and the rectosigmoid area in 4 cases. The average size of endometriotic lesions was 3.83±0.75 cm. All resections were performed with R0 margins, and no protective stoma was placed. Early postoperative complications included transient nausea and vomiting in 6 patients, managed conservatively. Pain levels, measured by the ACCS scale, were 57.51±10.51 points at 12 hours post-operation and 19.7±8.51 points after 24 hours. The average hospital stay was 3.66±0.81 days. After 3 months, 6 patients reported complete symptom relief, 6 noted significant symptom reduction, and 12 experienced improved quality of life.

Conclusions. Multidisciplinary laparoscopic surgical treatment of deep infiltrative endometriosis with bowel involvement is safe and effective in the short term. Patients show significant improvement in quality of life and reduction in pain. However, long-term evaluation of the condition is necessary.

No conflict of interest was declared by the authors.

Staffing of medical care for children in Ukraine in conditions of war and pandemic COVID-19

O.P. Volosovets, Yu.G. Antipkin — Sat, 28 Sep 2024 00:00:00 +0300

Most countries around the world report risks to children's health care due to a growing shortage of paediatricians.

Аim - to analyse the staffing of paediatric health care in Ukraine in the context of the ongoing war and the COVID-19 pandemic.

Materials and methods. The methods used were a systematic approach and comparative analysis of data from the state institution "Centre for Public Health of the Ministry of Health of Ukraine" for 2020-2023.

Results. During the years of the pandemic and full-scale aggression of the Russian Federation, the number of paediatricians in Ukraine decreased by 1006 people, which led to a corresponding decrease in the paediatric care coverage rate by 12.5% to 1.19 per 1000 children, which may affect the quality and accessibility of medical care for children, especially newborns. The largest staff losses during the pandemic and war have been in paediatric pathology, pulmonology, phthisiology, infectious diseases, immunology, dentistry, dermatology, neurology, gynaecology, gastroenterology and neonatology, which has already led to problems in the availability of specialised paediatric care for children and newborns, especially in the frontline and de-occupied areas. In such difficult conditions, pediatric doctors and the system of providing medical care to Ukrainian children in general have proven their viability and are still able to withstand the double pressure of war and the COVID-19 pandemic, preventing a significant increase in child morbidity and infant mortality.

Conclusions. In order to eliminate the shortage of personnel, it is urgent to increase the number of doctors trained at higher medical educational institutions in specialty 228 «Paediatrics» to 1,000 per year, to adjust the state order and admission conditions accordingly, and to introduce paediatric residencies in the most popular specialties.

No conflict of interests was declared by the authors.

Clinical and paraclinical characteristics of inflammatory bowel diseases with very early onset in children

Sat, 28 Sep 2024 00:00:00 +0300

Over recent decades, there has been a notable increase in the incidence of inflammatory bowel disease (IBD) among children under the age of six. The management of such patients is challenging due to the severe and treatment-resistant course of the disease, alongside atypical presentations.

Aim - examine the clinical and paraclinical features of IBD with an onset at a very young age.

Materials and methods. The study involved 10 young children diagnosed with IBD including 3 with Crohn's Disease (CD), 2 with Ulcerative Colitis (UC), and 5 with an unclassified form of IBD. Clinical, anamnestic, laboratory, endoscopic, and histopathological methods was employed to gather comprehensive data on each case.

Results. Six children experienced a severe course, while four had a moderate disease course. Identified triggers included COVID-19 or rotavirus infections, food allergies, and early artificial feeding. Three children had a family history of IBD. For 80% of children, IBD onset occurred within the first year of life following the escalation of war in Ukraine, with a severe, treatment-resistant progression. Symptoms and laboratory findings were similar in children with CD and UC. Endoscopic and histopathological findings revealed the chronic inflammation in the colon of 80% patients, with two CD patients showing terminal ileitis. In 50% of cases, endoscopic and histological features were ambiguous, presenting characteristics of both CD and UC (IBD- unclassified).

Conclusion. IBD in early childhood is marked by high inflammatory activity involving the entire colon, with overlapping clinical, endoscopic, and histopathological characteristics between CD and UC, complicating accurate diagnosis and expanding the group classified as IBD- unclassified.

The study adhered to the Helsinki Declaration principles, received ethical approval from local ethical committee, and obtained parental consent for child participation.

Authors report no conflicts of interest.

Clinical and immunological features of rotavirus infection in children infected with herpesviruses

M.Yu. Sliepchenko, O.M. Olkhovska, Ya.V. Kolesnyk, A.V. Gavrylov — Sat, 28 Sep 2024 00:00:00 +0300

The basis for conducting the study was the absence in the scientific literature of works devoted to the study of clinical and immunological features of rotavirus infection (RVI) in children against the background of the latent form of herpesvirus infection (lHVI) caused by cytomegalovirus (CMV) and human herpesvirus type 6 (HHV-6).

The aim - to identify clinical and immunological features of RVI in children with lHVI caused by CMV and HHV-6 that will contribute to the early diagnosis of lHVI in patients.

Materials and methods. A total of 81 children aged 12-36 months with RVI were examined. The Group 1 included 33 children who were not found to be infected with any of the herpesviruses. The Group 2 included 17 children who were suffering from RVI against the background of lHVI caused by CMV. The Group 3 included 31 children suffering from RVI against the background of lHVI caused by HHV-6 type. Statistical processing of the results was carried out using the IBM® SPSS® 25.0 program for Microsoft® Windows®.

The results. The presence of lHVI caused by CMV in the acute period (AP) of RVI leads to lower indicators of temperature reaction, lower frequency of vomiting, a decrease in the immunoregulatory index (IRI) against the background of an increase in the level of CD8+ T-lymphocytes. In addition to lower numbers of the temperature reaction, the level of IgA was increased in children with lHVI caused by HHV-6. During the convalescent period (CP), CMV is associated with an increase in the duration of fever and diarrhea, an increased content of CD8+ T-cell counts, and lower IRI, CD16+, CD22+ T-cells, and IgM scores. In patients with lHVI caused by HHV-6, fever, diarrhea, and catarrhal syndrome persisted longer against the background of reduced levels of IRI, CD22+ T cells, and IgM.

Conclusions. lHVI is caused by CMV and HHV-6, it has different effects on clinical and immune indicators in children with RVI.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution indicated in the work. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Prevention of pathological changes of eventerated organs in gastroschisis in fetuses and newborns

O.K. Sliepov, N.Y. Skripchenko, O.P. Ponomarenko, K.L. Znak — Sat, 28 Sep 2024 00:00:00 +0300

The primary cause of unsatisfactory outcomes in the treatment of gastroschisis (GS) is the pathological changes in eviscerated organs and their consequences. One preventive method against these pathological changes is the premature delivery of pregnant women with fetal GS, either by physiological means or cesarean section.

Aim - to analyze and develop preventive measures for pathological changes in eviscerated organs in GS by optimizing the delivery timing and method in pregnant women, to improve outcomes in fetuses and neonates.

Materials and methods. The study examined the impact of delivery timing and method on the condition of eviscerated organs in 118 neonates with isolated (uncomplicated) GS. Depending on the delivery method, patients were divided into two groups: Group I included 72 neonates born at the SI “Institute of Pediatrics, Obstetrics, and Gynecology named after Acad. O.M. Lukyanova of the NAMS of Ukraine” between 2006 and 2023 via cesarean section, with 80% of cases being premature (at 35-37 weeks gestation); Group II included 46 neonates delivered vaginally between 1987 and 2005, who were treated either at the Institute (n=23) or at the Mykolaiv Regional Children’s Clinical Hospital (n=23). Neonates with complicated GS forms were excluded from the study. According to the degree of pathological changes in the eviscerated organs, cases were classified as unchanged, moderately changed, or markedly changed.

Results. The implementation of planned premature cesarean delivery for pregnant women with fetal GS effectively reduced the occurrence of marked changes of eviscerated organs by 49.1%. At the same time, there was a significant increase (49.2%) in cases with unchanged and moderately changed organ conditions.

Conclusions. One of the preventive measures to reduce the frequency and degree of pathological changes in eviscerated organs in GS is planned premature cesarean delivery at 37 weeks gestation. This approach positively influences the condition of eviscerated organs in fetuses with GS, preventing marked pathological changes in two-thirds of cases and significantly increasing (by 49.2%) the occurrence of unchanged or moderately changed organs.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution's Local Ethics Committee, and informed consent was obtained from the patients.

Authors declare no conflict of interest.

The influence of environmental factors on the mineral profile of children and the immune response to citomegalovirus infection

Sat, 28 Sep 2024 00:00:00 +0300

Aim - determination of the mineral imbalance influence in children, who are living in areas of a large city with different environmental characteristics, on the immune response to cytomegalovirus infection (CMVI).

Materials and methods. 128 children with CMVI were examined and distributed depending on the environmental conditions of the residence area and the disease's activity: I group - 66 children, who lived in a conditionally clean district (CCD): I-a - 40 children with latent CMVI (lCMVI), I - b group - 26 children with active CMVI (aCMVI); II group - 62 children from a conditionally dirty district (CDD): II-a - 34 children with lCMVI and II-b group - 28 children with aCMVI. The indicators of the children's mineral profile were determined in the hair by the methods of X-ray fluorescence spectrometry and γ-activation analysis. The state of the cellular and humoral immunity, the levels of interleukins were studied in the blood serum. The obtained data were processed by the StatSoft Statistica 6.1 program.

Results. The children with lCMVI, who living in CDD, had a significant increase of the Sr, Cr, Pb, Ni, Zn levels, a decrease of Cu and Fe in hair samples and significantly higher indicators of IL-1β and TNF-α, which were determined in comparison with the indicators of children from CCD. The direct correlation was established between the content of Pb, Ni, Sr, Cr in hair samples and an increasing the levels of anti-inflammatory interleukins.

Conclusions. Living of children in conditionally polluted areas of a large city is a risk factor for the formation of macro- and microelement imbalance with the accumulation of conditionally toxic elements. It has been proven that an imbalance of the mineral profile negatively affects the immune response in children with lCMVI.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Features of the appearance of primary ossification centers in humans

T.V. Khmara, O.A. Koval, O.V. Tsyhykalo, T.V. Pankiv, I.I. Zamorskyi — Sat, 28 Sep 2024 00:00:00 +0300

Digital data of computer tomograms of primary centers of ossification in human fetuses can serve as age-normative intervals relevant for gynecologists, obstetricians, pediatricians, and diagnosticians during screening ultrasound examinations.

Aim - to clarify the timing of the emergence of primary centers of ossification and the dynamics of further development of human bone deposits for estimating fetal age and for ultrasound diagnosis of congenital malformations.

Materials and methods. The study was carried out on 32 series of consecutive sagittal, frontal, and horizontal sections of human embryos and pre-fetuses aged from 4 to 12 weeks of intrauterine development (IUD) 4.0-80.0 mm parietal-coccygeal length (TCL) and 54 preparations of human fetuses 4-7 months (81.0-270.0 mm TCL) using a microscopic method, computer tomography and creation of 3D-reconstruction models of pre-fetuses and human fetuses of various ages. Three-dimensional computer reconstruction was applied to study, the morphometry and densitometry of serial CT sections. The DICOM PACS standard series of images were processed in specialized computer programs RadiAnt Dicom Viewer (Medixant), and ImageJ (National Institutes of Health). Such programs automatically outline the contours of the bone model according to the gradients of the Hounsfield scale, which allows you to visualize and carry out morphometry of the entire bone model and the ossification centers.

Results. At the end of the 6th week of embryonic development, there is an accumulation of mesenchyme in the area of the future cartilaginous models of the skeleton, this is the pre-cartilaginous stage of osteogenesis, which is well expressed in the area of the future cartilaginous model of the spine. At the beginning of the 8th week of IUD, the cartilaginous structure of the ribs, limb bones, pelvis, and vertebral bodies was revealed. In the bodies of the vertebrae, there is a tendency towards the processes of ossification, which is expressed in the uneven staining of the intercellular substance, which acquires a dark color in places. In this age period, three points of bone tissue attachment appear, located in the area of the upper and lower jaws, and the clavicle. At the end of the 8th - at the beginning of the 9th week of IUD, the intensity of bone tissue deposits in the clavicle and jaws, especially the upper jaw, increases significantly. In 9-week-old human fetuses, the parts of the rib are clearly defined on a series of histological sections: head, neck, and body. In the area where the ribs join the vertebrae, there is a border between the bone part of the rib and its head. In 11-week-old human fetuses, numerous and diverse foci of ossification are determined in many bones of the skeleton. Taking into account the fact that the contraction of the muscles of the fetus begins from the 3rd month of intrauterine life, from this moment the contracting muscles affect the design of the details of the skeleton structure, namely, the processes of the arches and bodies of the vertebrae. In models of tubular bones of the lower and upper limbs, intensive concentric bone deposition is present, while in other ossification centers, bone deposition is mainly observed in the form of plates of various shapes and sizes, connected by thinner bone cords. In fetuses of 6-7 months, ossification of the pelvic bones is clearly expressed. The process of ossification almost completely covers the posterior parts of the ilium, except for its lower parts and cartilaginous areas adjacent to the iliac crest. Intensive deposition of bone mass is found in the area of the buttock.

Conclusions. For the first time, the primary centers of ossification in human embryos appear at the age of 1.5 months and are located in the clavicle and upper and lower jaws. In the future, the ossification process dynamically increases and becomes more complicated, proceeding specifically with certain features for each future bone. The deposition of bone masses of different shapes and sizes is expressed unevenly in individual parts of the skeleton.

No conflict of interests was declared by the authors.