Monoclonal antibodies for coronavirus infection in pregnant and puerperal women

O.V. Polikarpova1, Yu.E. Dobrokhotova2, N.A. Shevchenko1, V.M. Grabovskiy1, M.A. Lysenko1 1City Clinical Hospital No. 52, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation Aim: to compare the efficacy of monoclonal antibodies for novel coronavirus infection treatment in pregnant women. Patients and Methods: a retrospective analysis of medical reports of 502 pregnant and puerperal women aged 18–49 years with mild-to-moderate novel coronavirus infection who received monoclonal antibodies was performed. Women were divided into two groups. Group 1 included 108 women who received sotrovimab. Group 2 included 394 women who received bamlanivimab plus etesevimab. The condition was evaluated over 14 days after administering drug(s) based on the data of the general condition survey and laboratory and instrumental tests on days 1, 3, and 7 of follow-up. Lung damage was detected using ultrasound. Results: the maximum number of patients with lung damage grades 1a and 2a was identified on day 3 after starting therapy, i.e., 34.6% in the sotrovimab group and 71.8% in the bamlanivimab plus etesevimab group. On day 14 after starting therapy, most women recovered. When comparing the efficacy of two treatments, sotrovimab was superior to bamlanivimab plus etesevimab (recovery was reported in 96% and 89%, respectively). No adverse events after sotrovimab administration were reported. No therapy-associated clinically significant events were detected using ultrasound during pregnancy and the postnatal period on days 3 and 7 after drug administration. Conclusion: treatment for mild-to-moderate novel coronavirus infection with monoclonal antibodies in pregnant women is effective and reduces the number of hospital admissions, complications, and maternal and perinatal mortality. Keywords: COVID-19, pregnancy, monoclonal antibodies, obstetric risk, efficacy. For citation: Polikarpova O.V., Dobrokhotova Yu.E., Shevchenko N.A., Grabovskiy V.M., Lysenko M.A. Monoclonal antibodies for coronavirus infection in pregnant and puerperal women. Russian Journal of Woman and Child Health. 2023;6(3):241–246 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-4. </p

Fertility preservation problem in oncohematological patients of reproductive age

Yu.E. Dobrokhotova1, M.A. Lysenko1,2, V.M. Grabovsky2, N.A. Shevchenko1,2, I.M. Grashchenko2 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2City Clinical Hospital No.52, Moscow, Russian Federation Modern advances in the early diagnosis and treatment of oncological, in particular oncohematological, diseases have led to an increase in the reproductive-aged life expectancy. The use of effective, but aggressive from the standpoint of gonadotoxic treatment, chemotherapy regimens in the treatment of female patients of reproductive age with hematologic malignancies can lead to iatrogenic premature ovarian insufficiency with reduced fertility. All female patients of reproductive age who are scheduled for chemotherapy courses should be informed in a timely manner about the possible ovarian insufficiency and consulted about modern methods of preserving fertility, taking into account both medical and social factors. Cryopreservation procedures (cryopreservation of oocytes, embryos, ovarian tissue) create a large financial burden, being a significant social problem. However, the accumulated experience of using a financially affordable medical method for preserving ovarian function (gonadotropin-releasing hormone agonist drugs) during chemotherapy allows to widely use it in everyday practice. Further trials are needed to study the use of combined oral contraceptives in oncohematological female patients, which include innovative components that provide minimal effect on the hemostatic system and a favorable safety profile for venous thromboembolism. Keywords: hematological malignancies, fertility preservation, gonadotropin-releasing hormone agonists, oocyte cryopreservation, embryo cryopreservation, ovarian tissue cryopreservation, assisted reproductive technologies. For citation: Dobrokhotova Yu.E., Lysenko M.A., Grabovsky V.M., Shevchenko N.A., Grashchenko I.M. Fertility preservation problem in oncohematological patients of reproductive age. Russian Journal of Woman and Child Health. 2023;6(4):362–367 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-6. <br

Solid organ transplantation and pregnancy

M.A. Lysenko1, P.V. Kozlov2, V.M. Grabovskiy1, I.Yu. Kokaya1, I.P. Osokin1 1City Clinical Hospital No. 52, Moscow, Russian Federation 2Pirogov Russian National Research Medical University, Moscow, Russian Federation This paper highlights the management of pregnancy, delivery, and the postpartum period after solid organ transplantation. First, statistical data on the prevalence and pattern of organ transplantation are addressed. The most relevant issues of pregnancy management in organ transplant recipients include identifying optimal criteria of transplant function monitoring, assessment of pregnancy and medication effects on the fetus, and pregnancy complication development. Next, the authors review major pharmacological classes of immunosuppressive therapy, pregnancy risks, complications, and outcomes associated with these medications, relevant pregnancy planning and management issues, and delivery in liver and kidney transplant recipients. Finally, the effect of breastfeeding (in the context of regular immunosuppressive therapy) on the postnatal period is discussed. Current data demonstrate that favorable pregnancy outcome after organ transplantation is most likely at least one year after transplantation in case of stable organ functioning, careful monitoring of recipient and transplant, adequate immunosuppressive therapy, diagnostic monitoring of fetus throughout pregnancy, and timely delivery. Keywords: pregnancy, transplantation, liver, kidney, immunosuppressive therapy, complications, breastfeeding. For citation: Lysenko M.A., Kozlov P.V., Grabovskiy V.M. et al. Solid organ transplantation and pregnancy. Russian Journal of Woman and Child Health. 2021;4(4):333–338 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-333-338. <br

Endometrial hyperplasia process in female patients with chronic kidney disease: the choice of treatment tactics

Yu.E. Dobrokhotova1, M.A. Lysenko2, V.M. Grabovsky2, N.A. Shevchenko1,2, N.P. Zapolskaya2 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2City Clinical Hospital No. 52, Moscow, Russian Federation This article provides a literature review demonstrating modern paradigms concerning etiology, pathogenesis and management of endometrial hyperplasia processes in female patients with chronic kidney disease (CKD). Endometrial hyperplasia (EH) is a pathological process with various phenotypic cell changes and a characteristic predominance of glands over the stromal and epithelial components in the endometrium. Untimely diagnosis and treatment of EH can cause the pathology progression and the development of endometrium malignant transformation. Endometrial cancer (EC) refers to one of the most common malignant tumor forms of the female reproductive system, and EH, as a rule, is its precursor. In the gynecological morbidity structure, EH is 10 to 55%, and its incidence is steadily increasing. EH occurs as a result of excessive estrogen stimulation, when it is not compensated by the progesterone action. In addition, patients with CKD develop "immunosuppressive states" due to the use of various types of renal replacement therapy (hemodialysis, peritoneal dialysis, taking immunosuppressive drugs in patients with kidney transplant). Every year there are more and more such female patients. Over the past decade, there has been no reference in the Russian literature concerning a systematic approach to the diagnosis and treatment of EH in female patients with CKD. Considering that these were female patients of the reproductive period to a greater extent, who wanted to perform the childbearing function in the future, therefore, this problem is very relevant for the world medical community. Keywords: endometrial hyperplasia, abnormal uterine bleeding, chronic kidney disease, hemodialysis, kidney transplant, peritoneal dialysis, immunosuppression. For citation: Dobrokhotova Yu.E., Lysenko M.A., Grabovsky V.M., Shevchenko N.A., Zapolskaya N.P. Endometrial hyperplasia process in female patients with chronic kidney disease: the choice of treatment tactics. Russian Journal of Woman and Child Health. 2023;6(4):380–384 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-9. </p

Successful pregnancy and delivery outcome after the surgical treatment of pituitary adenoma in the first trimester of pregnancy (a clinical case)

O.V. Barakina1, T.N. Markova1,2, S.G. Ismailova1, I.M. Godkov3,4, V.M. Grabovsky1, P.V. Kozlov4 1City Clinical Hospital No. 52, Moscow, Russian Federation 2A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation 3Moscow Multi-profile Clinical Center "Kommunarka," Moscow, Russian Federation 4Pirogov Russian National Research Medical University, Moscow, Russian Federation The authors present a clinical case of partial hypopituitarism developed in a 31-year-old patient during the first trimester of pregnancy after the surgical treatment of hemorrhagic pituitary adenoma. The onset of the diseases was recorded on the 12th week of pregnancy and was characterized by such specific clinical manifestations as severe headache, multiple spells of vomiting, diplopia and right-sided ptosis. The contrast-enhanced MRI revealed a pituitary adenoma with a "fresh" hemorrhage and the destruction of anterior wall and floor of the sella turcica, and the invasion into the sphenoid and right cavernous sinuses. The patient underwent emergency surgery – the endoscopic endonasal approach for total resection of pituitary adenoma. Hypopituitarism manifestations identified in the postoperative period were relieved by hormone replacement therapy. A timely diagnosis and prompt decision on the surgical treatment of pituitary adenoma, as well as a multidisciplinary team approach to patient care ensured the appropriate management of the underlying disease, successful pregnancy, childbirth outcome and high maternal quality of life. Keywords: pituitary adenoma, pregnancy, management practices, hemorrhage, pituitary apoplexy, hypopituitarism, surgical treatment. For citation: Barakina O.V., Markova T.N., Ismailova S.G. et al. Successful pregnancy and delivery outcome after the surgical treatment of pituitary adenoma in the first trimester of pregnancy (a clinical case). Russian Journal of Woman and Child Health. 2022;5(4):326–331 (in Russ.). DOI: 10.32364/2618-8430-2022-5-4-326-331. </p

Burkitt’s lymphoma and pregnancy. Advantages of today’s medicine

T.S.&nbsp;Kotomina, E.A.&nbsp;Baryakh, E.N.&nbsp;Misyurina, E.I.&nbsp;Zhelnova, I.Yu. Kokoya, V.M.&nbsp;Grabovskiy, M.A.&nbsp;Lysenko City Clinical Hospital No. 52, Moscow, Russian Federation Recent years have seen the increase in the rate of childbirth after the age of 30 years. This is associated with higher risks for a mother and a child as well as higher rate of cancers diagnosed during pregnancy including non-Hodgkin’s lymphoma (NHL). The data on pregnancy-associated NHLs are limited by individual case studies. This makes difficult to develop a therapeutic strategy for lymphoma and pregnancy management in women with hematologic malignancies. The paper addresses the case study of a rare combination of Burkitt’s lymphoma and pregnancy. At 20 weeks of the pregnancy, right ovarian tumor was identified by magnetic resonance imaging. Burkitt’s lymphoma was verified by the biopsy of the excised ovary. Progressive tumor growth required chemotherapy. R-DA-EPOCH chemotherapy program was successful and also allowed for pregnancy prolongation and led to favorable perinatal outcome. Keywords: pregnancy, Burkitt’s lymphoma, non-Hodgkin’s lymphoma, chemotherapy, remission, adnexectomy. For citation: Kotomina T.S., Baryakh E.A., Misyurina E.N. et al. Burkitt’s lymphoma and pregnancy. Advantages of today’s medicine. Russian Journal of Woman and Child Health. 2020;3(3):211–216. DOI: 10.32364/2618-8430-2020-3-3-211-216. <br