Наукові праці. Кафедра акушерства та гінекології № 3
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Publication Editorial: The repercussions of maternal inflammation in pre-eclampsia on fetal health and neurodevelopment(Frontiers, 2024-05-29) Lakhno, Igor; Reyes-Lagos, José Javier; Adam, Ishag; Brownfoot, Fiona C.Inflammation is a crucial and inevitable biological response in humans, playing an essential role in defense against infections and tissue repair. It is known as a basic pathological process. Inflammatory response is involved in the pathogenic scenario of several obstetrical syndromes. The main trigger for maternal inflammation is a disturbed placentation. HLA (Human Leukocyte Antigen) incompatibility between maternal and fetal tissues significantly influences the risk of preterm birth and pre-eclampsia. Therefore, immune-induced inflammation is a part of pre-eclampsia.Publication Maternal and fetal arrhythmia as a sign of hemodynamic deterioration: a case report(Медексперт, 2024-02-20) Lakhno, Igor; Sykal, Iryna; Korovai, Svitlana; Korotych, Valentina; Tkachov, AndriyThe co-existing maternal (MA) and fetal arrythmia (FA) are associated with maternal goiter disease, chorioamnionitis, or Ballantyne’s syndrome. The aim of the study — to determine theinvolvement of maternal arrhythmia and fetal arrhythmia in the pathogenic scenario of hemodynamic deterioration in Ballantyne’s syndrome. Clinical case. It is presented the case of sustained several weeks of MA and FA. A pregnant woman aged 36 years was admitted to the division of maternal and fetal medicine at 34 weeks of gestation. She was gravida 4 and para 3. She had complaints of rapid heartbeat, left-side chest discomfort, and lower extremities edema. The diagnosis of maternal sinus tachycardia was supported via electrocardiography. The indices of fetal, umbilical, and uteroplacental hemodynamics detected via Doppler ultrasound were appropriate. However, fetal heart rate was 209 beats/min. The transplacental attack of oral sotalol 80 mg thrice daily was prescribed. But maternal and fetal tachycardia persisted to stay. The tricuspid regurgitation was detected via Doppler ultrasound next day. The fetus was hydropic. The male baby of 2400 g, 46 cm length, 31 cm head circumference, and Apgar score 3→5 was delivered via caesarean. The newborn was discharged in 21 days. He was admitted again in one month for rehabilitation. Maternal heart rate reduced to 72 beats/min and edema regressed in three days after birth. Conclusions. MA and FA before fetal hydrops are supposed to be the early signs of mirror syndrome. This speculation needs further investigation.Publication VP24.04: The delayed fetal neurological maturation in women with threatened preterm labour(Wiley&sons, 2021-10-15) Vasyliva, Iryna; Lakhno, IgorObjectives The uterine activity separated from maternal abdominal signal could contribute to better diagnosing of threatened preterm birth. This signal is being obtained via equipment for fetal non-invasive electrocardiography. The detection of acceleration capacity (AC) and deceleration capacity (DC) variables reflects the fetal neurological development. Methods Totally examined 192 pregnant women. The US cervicometry was performed at 16 weeks of gestation. The patients with normal cervical length (> 30 mm) were enrolled in Group I (n = 34). The US investigation of cervical length and fetal AC/DC detection via transabdominal non-invasive electrocardiography at 26, 32, and 38 weeks of gestation were used in Group II (n = 84). The investigation of uterine activity was additionally performed in women in Group III (n = 74). Fetal cardio signals and maternal uterine activity were obtained via non-invasive fetal electrocardiography using Cardiolab Babycard equipment (the “KhAI Medica” Scientific Research centre, Ukraine). The monitoring of fetal AC/DC was also performed in Group I. The results were analysed with an ANOVA test. Results The level of AC/DC was minimal in all groups at 26 weeks. This fact reflects the immaturity of autonomic regulation. But later on, the decreased values of AC/DC were found in Group II and Group III at 32 and 38 weeks of gestation. Thus, the threatened preterm delivery has a negative projection on fetal neurodevelopment. The sensitivity and the specificity of the threatened preterm labour detection were in Group II and Group III respectively: 86.49% (95% CI – 76.55% to 93.32%) and 58.82% (95% CI – 40.70% to 75.35%); 98.46% (95% CI – 91.72% to 99.96%) and 90.91% (95 % CI – 58.72% to 99.77%). The use of uterine activity has improved the accuracy of threatened preterm labour diagnosing. Conclusions The application of uterine activity extracted from electrophysiological maternal abdominal signal contributed to better diagnosing of the threatened preterm labour. Fetal neurodevelopment is retarded in case of the threatened preterm birth.Publication The pathogenic pathways of cardiovascular disease in perimenopausal women(Termedia, 2023-06-05) Lakhno, Igor; Korovai, Sergei; Struk, Tetiana; Pak, SvitlanaIntroduction Menopause is associated with disturbed cardiovascular health. The objective of the study was to compare the effect of hormonal replacement therapy (HRT) and its combination with diet, L-arginine, and xylitol solutions on metabolic processes and cardiovascular health in perimenopausal women. Material and methods In total 106 women were enrolled in the cross-sectional study. The 36 patients of Group II received HRT. 35 women who had been prescribed additionally to HRT a diet, L-arginine, and also xylitol were included in Group III. 35 healthy reproductive-aged women were included in Group I (control). The variables body mass index (BMI), heart rate (HR), blood pressure (BP), lipid and carbohydrate metabolism and C-reactive protein, and menopausal Cooperman’s score were determined before and after the 3-month program. Results The obtained results showed the homogeneity of average age, BMI, HR, BP, and Cooperman’s score in Group II and Group III before inclusion in the study. But several variables changed significantly after a 3-month period. The study showed the effect of the 3-month program on BMI and Cooperman’s score. We also found the restoration of the lipid profiles in Group III. The patients of perimenopausal age featured elevated levels of insulin and C-RP (C-reactive protein). The restoration of levels of insulin and CRP occurred in the process of the 3-month program. Conclusions The use of a 3-month program including diet, xylitol, and L-arginine solutions contributed to the reduction of Cooperman’s score, chronic inflammation, and restoration of lipid and carbohydrate metabolism.Publication Tocilizumab is effective in preventing ovarian injury induced by ischemia- reperfusion in rats(Academia Brasileira de Ciências, 2023-05-15) Uzel, Kemine; Lakhno, Igor; Turkler, Can; Kuzucu, Mehmet; Naz, Gulce Yazici; Mammadov, Renad; Suleyman, Bahadir Ahadir; Kale, Ahmet; Suleyman, HalisOvarian torsion can be defined as the bending of the ovaries on the supporting ligament, disrupting both venous and arterial blood circulation. Insufficient blood flow causes ovarian tissue hypoxia and leads to ischemia. This study aimed to investigate whether tocilizumab has a protective effect on ischemia-reperfusion injury due to ovarian torsion in rats. Eighteen female Wistar albino rats were divided into three equal groups (Sham (SG), ischemia-reperfusion (OIR), and ischemia-reperfusion+tocilizumab (OIRT)). Degeneration, necrosis, vascular dilatation/congestion, interstitial edema, hemorrhage, and polymorphonuclear lymphocyte (PMNL) infiltration scores were significantly different between the groups (p=0.001 for all parameters). Moreover, the OIRT group had a significant improvement in these criteria compared to the OIR group (p<0.05). Additionally, there was a considerable difference between OIRT and OIR groups in the number of primordial, developing, and atretic follicles groups (p<0.05), while there was no difference in the number of corpus luteum (p=0.052). Stress markers or cytokines, such as MDA, tGSH, NF-κB, TNF-α, IL-1β, and IL-6, were significantly different between groups (p<0.05). Furthermore, a significant improvement was found in the measured variables when the OIRT group was compared with the OIR group (p<0.05). Tocilizumab may be an alternative option for treating ischemia-reperfusion injury due to ovarian torsion.Publication COVID-19 mimicked fetal hemolytic disease: a case report(Publishing House Professional Event, 2023-03-31) Lakhno, IgorThe pandemic of COVID-19 changed the traditional approaches to the management of gestational complications. Today there is still a lack of information about the impact of COVID-19 on the pregnancy course, in particular, about its role in relation to Rh-conflict during pregnancy. The paper focused on a rare presentation of Rh-conflict pregnancy and COVID-19. 32 years old G3 P2 pregnant women with Rh-negative had a third pregnancy. The injection of anti-D immunoglobulin after the first abortion was not performed. The second pregnancy finished with a term delivery and the birth of a fetus with hemolytic disease. During the third pregnancy, the woman fell ill with COVID-19 in the 26th week. The bilateral pneumonia was diagnosed. The treatment included antibiotics, antiviral, antithrombotic, and anti-inflammatory drugs. No signs of fetal hemolytic disease were found via ultrasonography. But the abnormal level of anti-D antibodies – 1:1024 was detected. From the 28th weeks of pregnancy till the delivery the test for anti-D antibodies was constant – 1:4. The variables of utero-placental, fetal (blood flow velocity in a middle cerebral artery), and umbilical hemodynamics were normal during the third trimester. But fetal moderate hepato- and splenomegaly were found at 36 weeks of gestation. The patient delivered at 38 weeks of gestation a female newborn 3100 g, 52 cm with a 7→8 Apgar score. The laboratory investigation detected a hemoglobin value of 202.6 mg/dL in a child. The blood analysis showed total bilirubin of 44.2 mg/dL, direct bilirubin of 1.0 mg/dL, and a negative result on the direct Coombs test. The baby received phototherapy for 3 days. Total bilirubin was decreased (15.2 mg/dL). The newborn was discharged from a hospital with the mother on the fifth day. COVID-19 could change the placental permeability and increase the titer of anti-D antibodies. But it did not contribute to fetal and newborn hemolytic disease.Publication Dysautonomia involvement in maternal cardiac arrhythmia(Balkan Medical Union, 2022-03-08) Lakhno, Igor; Kniazkova, Iryna; Lakhno, Olga; Uzel, KemineIntroduction. The role of autonomic imbalance in maternal cardiac arrhythmia (CA) is still debatable. The objective of the study was to assess the relationship between maternal autonomic tone and CA in pregnant women. Materials and methods. The cross-sectional study was carried out among pregnant women admitted to Kharkiv Municipal Perinatal Center between 1 December 2015 and 31 July 2020. 117 patients at 28-36 weeks of gestation were enrolled. 20 of them had sinus rhythm and were included in Group I (control). In Group II, 55 pregnant women with CA and cardiovascular comorbidity were observed. 42 patients with idiopathic CA were monitored in Group III. The daily electrocardiogram and heart rate variability (HRV) were obtained. The density of ectopic beats (DEB) was defined as the percentage of ectopic to total beats. Results. The investigation of the HRV revealed heterogeneity in the groups of study. The enhanced sympathetic activity was determined in women with CA and structural heart disease. Pregnant women with idiopathic CA demonstrated a parasympathetic pattern of autonomic nervous regulation. The revealed relations between DEB and sympathetic or parasympathetic regulation demonstrate an increased sympathetic tone in patients with structural heart disease. In women with idiopathic CA, parasympathetic regulation played a significant role in the scenario of cardiac ectopy. Conclusions. The idiopathic CA could be the result of abnormally elevated parasympathetic regulation in the second half of pregnancy.Publication Comparison of the effects of testosterone on pre- and posthysterectomy findings in transgender Individuals(Japan University of Health Sciences & Japan International Cultural Exchange Foundation, 2021-08-15) Uzel, Kemine; Lakhno, Igor; Eminli, ItibarObjective: This study aimed to investigate the effect of testosterone on complications and blood parameters in transgender individuals undergoing hysterectomy. Methods: This case-control study was carried out by examining the files and records in the hospital automation system of individuals who underwent laparoscopic hysterectomy and oophorectomy for a female to male transgender change in our hospital. To achieve normal male physiologic testosterone levels, transgender individuals (n = 12) were given intramuscular testosterone esters for two years before surgery. The drug dose was initially administered every three weeks, then adjusted according to the patients response. The control group (n=20) was selected from women who underwent hysterectomy and oophorectomy in the same hospital and study period. Results: When the research and control groups were compared concerning blood values, there was no significant difference in preoperative white blood cell (Z = 0.262, p = 0.795), neutrophil (Z = 0.384, p = 0.704), and lymphocyte levels (Z = 0.481, p = 0.634). However, a significant difference was found in the postoperative levels of the same measurements (Z = 2.457, p = 0.020; Z= 7.310, p = < 0.001; and Z = 6.586, p < 0.001, respectively). Regarding preoperative and postoperative measurements, leukocyte and neutrophil levels increased, while lymphocyte and hemoglobin levels decreased in both groups (p < 0.001). Besides, the study group had higher creatinine levels than the control group (Z = 3.817, p = 0.001). Conclusion: Testosterone has anti-inflammatory effects. Additionally, it substantially influences hemoglobin. Thus, testosterone can be considered as an option in selected cases. However, it's potentially harmful effect on the kidneys should always be kept in mind.Publication The role of endometrial thicknesses as risk factor in endometrial pathologies(ScopeMed Publishing, 2021-04-15) Uzel, Kemine; Lakhno, IgorAim: This study aimed to investigate the role of endometrial thickness in endometrial pathologies and compare transvaginal ultrasonography (TvUSG) and histopathological results in pre-and post-menopausal women with abnormal uterine bleeding. Methods: We retrospectively reviewed the records of 1882 women with abnormal uterine bleeding between 2018 and 2020. After exclusions, the final study population consisted of 1088 women. The primary variable was the endometrial thickness. Secondary variables examined were final diagnosis, age, gravidity, parity, and menopausal status. Results: Results for 653 women (60.0%) with normal endometrium, 26 women (2.4%) with endometrial carcinoma, and 409 women (37.6%) with other endometrial pathology were analyzed. The mean endometrial thickness of the women with normal endometrium was 11.38±5.80 mm (range: 3-45 mm), while the mean endometrial thickness of the women with other endometrial pathology and endometrial carcinoma were 12.27±5.15 mm (range: 3-33 mm), and 17.24±7.19 mm (range: 5-33 mm), respectively. A statistically significant difference was detected between the groups concerning endometrial thickness (F=15.464, p<0.001). On the other hand, logistic regression analysis was used to identify the risk factors for endometrial carcinoma. Age (p=0.003) and endometrial thickness (p=0.002) were the risk factors in predicting endometrial carcinoma. Conclusion: Women admitted to the hospital with pre-menopausal or post-menopausal bleeding should undergo a detailed gynaecological examination, and the endometrium should be evaluated with TvUSG. If an increased endometrial thickness is detected, an endometrial biopsy should be performed. Even TvUSG is not a definitive diagnostic method; it is a non-invasive, cost-effective, and guiding technique for endometrial pathologies.Publication The utility of phase rectified signal averaging in diagnosing fetal distress(John Wiley & Sons Ltd, 2020-10-15) Vasylieva, Iryna; Lakhno, IgorObjectives Fetal heart rate variability is known as a marker of fetal wellbeing. The variables of phase rectified signal averaging – acceleration capacity and deceleration capacity (AC/DC) – were found to have a significant prognostic value in fetal growth restriction (FGR). Methods A total of 168 pregnant women at 26–28 weeks were examined. The patients with AGA fetases (N = 36) were enrolled in group 1. eFGR without fetal distress (N = 64) were group 2. eFGR with fetal distress (N = 68) = group 3. We used Cardiolab Babycard equipment (the "KhAI Medica" Scientific Research Centre, Ukraine) to non-invasive fetal electrocardiography. Fetal distress was diagnosed via Doppler ultrasound in case of the RD UA, absent A-wave in the DV, and umbilical vein pulsations.The results thus obtained were analysed with an ANOVA test. The significance was set at p-value <0.05. The correlations coefficients were estimated with Spearman's test. Results The maximally decreased AC/DC values were in Group 3 (p < 0.05). The variables of phase rectified signal averaging were lower in Group 2 than in Group 1 (p < 0.05) but higher than in Group 3 (p < 0.05). Thus, the delayed neurological maturation and the autonomic malfunction could be the reasons for fetal distress in FGR. The considerable correlation was detected in the appropriate to gestational age fetuses (R = 0.64, p < 0.05). In Groups 2 and 3, the force of correlation was almost similar (respectively, R = 0.62, p < 0.05; R = 0.68, p < 0.05). Therefore, AC/DC is a prospective marker for the detection of fetal compromise. This result was supported by a significant correlation in the pair “AC/DC vs umbilical blood pH” in all groups. The coefficients of correlation were: R = 0.70, p < 0.05; R = 0.68, p < 0.05; R = 0.72, p < 0.05 in Group 1, 2 and 3, respectively. Conclusions Fetal AC/DC variable is a sensitive tool for the detection of fetal distress in FGR.