Case of uterine scar rupture in the second trimester of pregnancy after preceding caesarean section

Uterine rupture is one of the rare and severe complications of pregnancy and childbirth. It most often occurs in the third trimester however there are publications on cases of uterine rupture in the second trimester. In the available Russian literature we were unable to find any publications regarding uterine scar rupture in the second trimester after preceding caesarean section; available publications focus on uterine scar rupture after preceding myomectomy. Prevalence of caesarean section has recently increased dramatically both in the world and in Russia, besides the data about possibility of pregnancy prolongation in case of uterine scar rupture appeared. It encouraged us to present clinical observation. It demonstrates that uterine scar rupture in the early stages of pregnancy is paucisymptomatic and is often considered as a threatening miscarriage. It is necessary to remember that threatening miscarriage is usually characterized by shortening and softening of the cervix which are not observed in case of threatening or accomplished uterine scar rupture. As such factors, as the time of uterine rupture symptoms occurence, gestational age, localization of placenta, absence of placenta rotation, fetal viability, size of the uterine scar and the characteristics of scar rupture are the main predictors for the decision of pregnancy prolongation in case of uterine scar rupture, so the early diagnosis of such condition is of great importance

A novel coronavirus infection COVID-19 in practice of obstetrician-gynecologist: a review of current data and guidelines

In December 2019, a new type of coronavirus was identified in China, called SARS-CoV-2 (COVID-19) that quickly spread not only within the People’s Republic of China, but also far beyond its borders. On March 11, 2020, the World Health Organization announced that the infection caused by novel coronavirus SARS-CoV-2 became a pandemic. Prior to this, two global epidemics were caused by pathogenic coronaviruses: in 2002 – by SARS-CoV that caused severe acute respiratory syndrome (SARS), and in 2012 – by MERSCoV that resulted in the Middle East respiratory syndrome (MERS). All coronavirus infections in humans are characterized by damage of lower respiratory tract with development of severe pneumonia and respiratory distress syndrome. According to reports, males become sick more often than females. It is known that due to developing immunological suppression pregnant women are at higher risk of contracting infectious diseases. However, the clinical course of SARS-CoV-2 infection during pregnancy, its effect on outcome of gestation, and the likelihood of vertical transmission to the fetus still remain unanswered. In this review, we present data on cases of SARS-CoV-2 disease during pregnancy published globally, its effect on outcome of gestation, as well as data on potential routes of infection for fetus and neonates. In addition, we also provide currently available clinical recommendations released by the Royal Society of Obstetricians and Gynecologists (UK), the American Society of Obstetricians and Gynecologists (USA), and the National Institute for Reproductive Health Research (India) on the management of pregnant patients infected with SARS-CoV-2

Hemostasis in pregnant, parturient and puerperal women with preeclampsia

Introduction. Preeclampsia (PE) is a specific complication of pregnancy holding a lead place in maternal and perinatal morbidity and mortality worldwide. The development of PE in the maternal body is accompanied by severe hypercoagulation, disturbed anticoagulation and fibrinolytic systems. As a result, vascular microthrombosis in diverse organs with developing endothelial dysfunction, impaired utero-placental blood circulation emerge that leads to adverse perinatal outcomes.Aim: to study status of coagulation arm in pregnant women with moderate and severe PE, after delivery by cesarean section, to optimize management of the postoperative period.Materials and Methods. There were enrolled 50 pregnant women with PE: 16 with moderate and 34 with severe PE after surgical delivery. A status of coagulation arm was examined by evaluating major parameters in coagulogram (fibrinogen, activated partial thromboplastin time, prothrombin, international normalized ratio) as well as assay for early diagnostics of blood clotting disorders to reveal bleeding and thrombosis risks.Results. It was found that prior to surgery patients with severe PE had significantly increased clot growth rate (V) by 1.09-fold (p = 0.001), relative clot density (D) by 1.15-fold (p = 0.001), and time of spontaneous clot appearance (Tsp) was accelerated by 2-fold (p = 0.001) compared to moderate PE. After surgical delivery, patients from both groups had changes evidencing about activated coagulation system: increased V, D, as well as the Tsp. Upon that, all such parameters in patients with severe PE were significantly elevated: the V – by 1.25-fold (p = 0.005); the D – by 1.1-fold (p = 0.02); the Tsp was accelerated by 2-fold (p = 0.03) compared to patients with moderate PE. All parameters in both groups tended to normalize on day 5 after surgical delivery, but patients with severe PE were shown to have significantly increased the V – by 1.5-fold (p = 0.001); the D – by 1.14-fold (p = 0.001); the clot size – by 1.14-fold (p = 0.001); the Tsp – accelerated by 41 % (p = 0.001) compared to patients with moderate PE.Conclusion. Thus, patients with moderate and severe PE after surgical delivery by cesarean section were featured with markedly activated coagulation hemostasis, which may justify a prolonged use of low-molecular-weight heparins in the postoperative period, especially in patients with PE

To the question on vaccination of pregnant women during COVID-19 pandemic

The pandemic of the novel coronavirus disease 2019 (COVID-19) makes us to think about effective preventive methods in pregnant women, because the course of such infection is accompanied by a high risk of severe endotheliopathy, disseminated intravascular coagulation, septic shock, thromboembolic complications and maternal mortality. Undoubtedly, vaccination is the most effective method of protection during pandemic, which experience in some infections in pregnant women has been accumulated in the world practice and may be also used for the COVID-19 vaccine. Here we discuss the issues of vaccination for pregnant women to expand the view of medical doctors and eliminate prejudice against immunization of pregnant women

Environmental Changes of the Aral Sea (Central Asia) in the Holocene: Major Trends

From the 20th International Radiocarbon Conference held in Kona, Hawaii, USA, May 31-June 3, 2009.Changes of the Aral Sea level have been observed in 3 sediment boreholes, 2 outcrops, and associated archaeological sites. The obtained results are supported by 25 radiocarbon dates. Major trends of lake-level changes have been reconstructed in some detail for the last 2000 yr, and additional data provide an outline of fluctuations throughout the Holocene. Several distinct changes are shown to precede the modern, human-induced regression of the Aral Sea. These include: 1) the latest maximum in the 16th-20th centuries AD (53 m asl); 2) a Medieval "Kerderi" minimum of the 12th-15th centuries AD (29 m asl); 3) the early Medieval maximum of the 4th-11th centuries AD (52 m asl); and 4) a near BC/AD lowstand, whose level is not well established. Since then, events are only inferred from sparse data. The studied cores contain several sandy layers representing the lowering of the lake level within the Holocene, including the buried shore-bar of ~4500 cal BP (38 m asl), and shallow-water sediments of ~5600 cal BP (44 m asl), 7200 cal BP (28 m asl), and 8000 cal BP (26.5 m asl).The Radiocarbon archives are made available by Radiocarbon and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform February 202