The history of 18 years follow-up of patient with androgen insensitivity syndrome is presented. Diagnostic and treatment aspects such as surgery and HRT are discussed. Beneficial effects of the possibility to be a mother due to assisted reproductive technologies on the psychological state of such patients is also emphasized in this article.
According to the world statistics, men are much more susceptible to infection with the new coronavirus than women. Nowadays, investigation of potential impact of COVID-19 on men’s reproductive health is a particularly relevant topic. Previous research has shown that more than 25 viruses, including herpes simplex virus and human immunodeficiency virus, can infect human sperm. It is currently not fully understood whether the novel coronavirus SARS-CoV-2 has a negative impact on sperm quality and whether the virus is sexually trans-mitted. Published data indicate decreased sperm quality and possible development of orchitis in patients with COVID-19. Moreover, severe stress and corticosteroid therapy may be risk factors for patients’ sexual dysfunction. Thus, further studies are needed to determine the effects of COVID-19 on men’s reproductive health, which will help to optimize the management and rehabilitation of these patients.
This review provides current information on safety and effectiveness of COVID-19 vaccines for pregnant and lactating patients. Various vaccine types as well as information regarding reproductive toxicology studies are described in the article. The review also reflects practice guidelines of international professional communities on the use of COVID-19 vaccines in pregnancy, including the World Health Organization, RCOG (Royal College of Obstetricians and Gynecologists), ACOG (American College of Obstetricians and Gyne-cologists), RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).
The aim of the study is to compare the pregnancy outcomes for the mother and the fetus during the COVID-19 pandemic in patients with a new coronavirus infection and in the general population. Materials and methods. A retrospective analysis of the operational information provided by the chief specialists in obstetrics and gynecology of the Far Eastern and Siberian Federal Districts (Far Eastern Federal District and Siberian Federal District) on the incidence of COVID-19 in pregnant women in comparison with the general population, maternal and perinatal outcomes during the COVID-19 pandemic from March 11 to December 25 was carried out Feb 2020. Results. During the COVID-19 epidemic in 2020, SARS-CoV-2 infection was identified in 8485 women in pregnancy, during labor and postpartum period in the Far Eastern Federal District and Siberian Federal District. The incidence of mothers was 3.0 times higher than the general population: 5933.2 vs 1960.8 per 100 thousand people (p<0.001). In women with COVID-19, compared to the general population, the incidence of preterm birth (18.3% vs 6.7%, p<0.001), caesarean section (42.0% vs 25.7%, p<0.001) and below is higher — operative vaginal delivery (vacuum extraction of the fetus, obstetric forceps) (0.2% vs 1.2%). The maternal mortality in SARS-CoV-2 infection was multiple times higher than the population one (505.69 vs 13.1 per 100 thousand live births, p<0.001); perinatal losses were also statistically significantly higher (1.54% vs 0.81%, p<0.001), mainly due to antenatal stillbirths (1.25% vs 0.61%). The SARS-CoV-2 virus was detected in the nasopharyngeal contents in 6.2% of newborns from mothers with COVID-19; virological studies were not carried out for children from non-sick mothers. Conclusion. During the 2020 pandemic, mothers with COVID-19 were higher than in the general population, indicators of maternal mortality (38.2 times), perinatal mortality (1.9 times), premature birth (2.7 times), delivery by cesarean section (1.6 times). SARS-CoV-2 infection was detected in 6.2% of newborns.
Obesity is one of the top 10 risk factors for death and is also an important risk factor for other chronic noncommunicable diseases (diabetes mellitus, hypertension, musculoskeletal disorders and some types of cancer). According to WHO forecasts, by 2025, up to 50% of women on the planet will be obese. As of the end of May 2021, there were more than 166 million confirmed cases of COVID-19 worldwide. The medical community is calling for obesity to be considered an independent risk factor for COVID-19. It is too early to draw conclusions about a definite causal and pathophysiological relationship between overweight/obesity and the severity of COVID-19 outcomes. However, it is clear that there are potential mechanisms for the more severe course of COVID-19 in obese patients. Possible causes of this phenomenon are discussed in this article. Epidemiological data indicate higher morbidity and mortality from COVID-19 coronavirus infection among men. There are several possible reasons for this gender difference: higher expression of angio-tensin-converting enzyme-2 in men than in women, immunological differences due to sex hormones and the X chromosome, and a higher prevalence of smoking among the male population. The COVID-19 pandemic has shown that obesity not only increases the risk of acute and long-term complications, but also increases the risk of severe outcomes of this infectious disease.
This review provides current information on safety and effectiveness of COVID-19 vaccines for pregnant and lactating patients. Various vaccine types, information regarding reproductive toxicology studies and vaccines efficacy against variants of concern are described in the article. The review also reflects practice guidelines of international professional communities on the use of COVID-19 vaccines in pregnancy, including the World Health Organization, RCOG (Royal College of Obstetricians and Gynecologists), ACOG (American College of Obstetricians and Gynecologists), RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists), etc. Currently, there is no evidence of a negative impact of COVID-19 vaccines on male and women’s reproductive health. On the other hand, the negative consequences of COVID-19 infection are well known both on the reproductive health of men and on the course and outcomes of pregnancy. Results of analysis of data on the course of pregnancy, childbirth, the postpartum period and the condition of newborns in 891 patients with coronavirus infection and in 1694 patients without coronavirus infection of the obstetric department of the Filatov City Clinical Hospital No. 15 for the period from January 1, 2020 to April 25, 2021. It was revealed that patients with coronavirus infection have a higher risk of preterm birth, a higher probability of having premature babies, and a higher percentage of operative delivery, than in patients without coronavirus infection. Newborn children in patients with coronavirus infection were more often admitted to the intensive care unit, than children of patients without coronavirus infection. Patients with coronavirus infection have a higher perinatal mortality rate than patients without coronavirus infection. No data has been received to support vertical transmission of the virus from a mother infected with COVID-19 to her fetus. There were no specific changes in placental tissue in patients with coronavirus infection. Based on the available results of clinical studies on the safety and efficacy of COVID-19 vaccines, all mentioned professional communities (WHO, CDC, ACOG, RCOG, RANZCOG, etc.) strongly recommend getting COVID-19 vaccine for women who are pregnant or breastfeeding.
Objective. To evaluate the effect of COVID-19 vaccine on molecular features of semen samples based on the gene expression analysis. Materials and methods. 10 men of reproductive age with no history of laboratory-confirmed COVID-19 were inlcuded in this study. Six men were planning to get vector-based COVID-19 vaccine «Gam-COVID-Vac» («Sputnik-V») of the National Research Center for Epidemiology and Microbiology named after N.F. Gamaleya, four men were included in the control group. Gene expression level in semen samples of men who received COVID-19 vaccine was analyzed using RNA-sequencing (semen samples were collected prior to the vaccination and 75 days after the administration of the second dose of the «Gam-COVID-Vac» vaccine). The semen samples, collected of men of the control group at the same time interval, were also analyzed using RNA-sequencing. Results. Comparative analysis of the gene expression level in the semen samples collected prior to and after getting COVID-19 vaccine did not reveal statistically significant changes in the intracellular molecular pathways functioning. Conclusion. Study results indicate the absence of an adverse effects of the «Gam-COVID-Vac» («Sputnik-V») vaccine on molecular features of semen samples.
Objective. To evaluate the effect of COVID-19 vaccine on molecular features of semen samples based on the gene expression analysis. Material and methods. 10 men of reproductive age with no history of laboratory-confirmed COVID-19 were inlcuded in this study. Six men were planning to get vector-based COVID-19 vaccine Gam-COVID-Vac (Sputnik V) of the Gamaleya National Research Center for Epidemiology and Microbiology, four men were included in the control group. Gene expression level in semen samples of men who received COVID-19 vaccine was analyzed using RNA-sequencing (semen samples were collected prior to the vaccination and 75 days after the administration of the second dose of the Gam-COVID-Vac vaccine). The semen samples, collected of men of the control group at the same time interval, were also analyzed using RNA-sequencing. Results. Comparative analysis of the gene expression level in the semen samples collected prior to and after getting COVID-19 vaccine did not reveal statistically significant changes in the intracellular molecular pathways functioning. Conclusion. Study results indicate the absence of an adverse effects of the Gam-COVID-Vac (Sputnik V) vaccine on molecular features of semen samples.
This review provides current information on the impact of the new coronavirus infection COVID-19 on the management of patients in obstetrics and gynecology. The article addresses various issues such as pregnancy and neonatal management, different aspects of gynecological surgery and the use of assisted reproductive technologies during the COVID-19 pandemic. The review reflects practice guidelines of international professional communities, including the World Health Organization, RCOG (Royal College of Obstetricians and Gynecologists), ACOG (American College of Obstetricians and Gynecologists), RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists), as well as Temporary guidelines of the Ministry of Health of the Russian Federation on the prevention, diagnosis, and treatment of new coronavirus infection.
The article provides information on the Post-COVID-19 syndrome that is relevant today. Post-COVID-19 syndrome is systemic in nature and is manifested, as a rule, by persistent asthenia and neurocognitive impairment in patients. Possible mechanisms of prolonged pro-longation or the occurrence of various multiple organ complications in patients undergoing COVID-19 are considered. The ways of supporting patients with Post-COVID-19 syndrome is proposed, including for reducing significant socio-economic consequences. The analysis of the world literature was carried out, the lack of studies with a comprehensive and objective assessment of the quality of life of pregnant women and those who gave birth with COVID-19 was revealed. In order to understand the immediate and long-term consequences of the transferred new coronavirus infection in 1510 patients of the obstetric department of the Filatov City Clinical Hospital No.15 a questionnaire has been drawn up, the collection and analysis of the data obtained is being carried out.
This review provides current information on the different aspects of restoration of reproductive health in women who recover from COVID-19. The article addresses various issues such as pregnancy management in women who recover from COVID-19, prevention of complications, recommendations for pregnancy planning, contraception and the use of assisted reproductive technologies in women who recover from COVID-19. The review reflects practice guidelines of international professional communities, including the RCOG (Royal College of Obstetricians and Gynecologists) and ESHRE (European Society of Human Reproduction and Embryology). The relationship between the psychological state of women who recover from COVID-19 and reproductive health is also considered.
Presented are two clinical cases of pregnancy, childbirth and the postpartum period in patients with a new coronavirus infection COVID-19 of the obstetric department of the Filatov City Clinical Hospital No.15. Despite the severe course of the disease, an extremely high risk of fatal complications, thanks to clear routing, a multidisciplinary approach and effective treatment tactics, it was possible to successfully solve the most difficult medical and diagnostic problems, save the lives and preserve the health of patients and newborns.
Objective of the study is to provide a comparative assessment of comorbid factors and the clinical course of the COVID-19 in pregnant women who died and survived a critical condition in the Siberian and Far Eastern Federal Districts of Russia.
Materials and methods. Design was a retrospective study. The analysis of the primary medical documentation of pregnant women and postpartum women with a severe course of COVID-19 from April 1, 2020 to May 25, 2021 was carried out. Mathematical analysis included methods of descriptive statistics, analysis of contingency tables, where the value of χ2 was estimated, the achieved level of significance (p); calculation of the odds ratio (OR) at a 95% confidence interval (CI).
Results. 10,842 cases of COVID-19 of pregnant women were registered in the Far Eastern Federal District and the Siberian Federal District. The incidence rate in pregnant women was 2.7 times higher than among the general population: 8833.5 vs 3289.1 per 100 thousand population (8.8% vs 3.2%, p<0.001). The proportion of deaths in pregnant women, women in labor and parturient women was 0.19%, among the population - 2.3% (p <0.001). The highest risk of maternal mortality is associated with obesity (OR = 80.3; 95% CI 9.34-690.19), slightly lower - with diabetes (OR = 11.3; 95% CI 2.0-63.27); chronic arterial hypertension (OR = 17.2; 95% CI 1.80-163.62); respiratory diseases (OR = 12.2; 95% CI 1.19-123.96); anemia (OR = 4.5; 95% CI 1.28-16.02). CT grade 3-4 lung damage on admission was associated with a 9-fold increase in the risk of death (OR = 9.1; 95% CI 3.03-27.14). The risk factors for MS were delay of antibacterial (OR = 4.6; 95% CI 11.24-16.87) and glucocorticoid (OR = 3.4; 95% CI 1.24-9.16) therapy. Anticoagulant therapy was prescribed statistically significantly later in the MS group (5.3 + 1.2 vs 3.5 + 1.1, p = 0.048).
Conclusion. The risk of maternal mortality in COVID-19 is associated with co-morbid factors - obesity, diabetes, chronic arterial hypertension, respiratory diseases, and anemia, delay of antibacterial and glucocorticoid therapy. Timely anticoagulant therapy and delivery are key factors to preventing maternal mortality. Cesarean section for obstetric indications does not increase the risk of poor outcome, while operative delivery with intractable respiratory failure and refractory septic shock is associated with a high risk of maternal death.
Key words: COVID-19, pregnancy, maternal mortality, near miss.
