Наукові праці. Кафедра акушерства та гінекології № 3
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Publication Non-invasive fetal electrocardiography ameliorates fetal outcome in chorioangioma: A case report(IOS Press, 2021-02-16) Lakhno, IgorChorioangioma is a rare vascular placental tumour. Large chorioangiomas are known to have many maternal and perinatal complications. The case of placental chorioangioma detected via ultrasound is presented. This paper is focused on non-invasive fetal electrocardiography (NI-FECG) clinical use for diagnosing fetal anemia in chorioangioma. A 22-year-old primigravida was admitted to the department of fetomaternal medicine at 30 weeks of gestation. She had threatened preterm labour, polyhydramnios, and breech presentation. The large echogenic mass of 77mm×66mm×83 mm, located in the uterine bottom, protruded into the amniotic cavity, and connected to the marginal sinus of the placenta was determined via ultrasound. The sinusoidal pattern of beat-to-beat variations was diagnosed via NI-FECG in spite of normal blood flow velocity in the fetal middle cerebral artery. Therefore, NI-FECG was superior in the detection of fetal anemia. The female baby weighing 1500 g and measuring 42 cm in length, with a head circumference of 30 cm and Apgar score 3−→5, was delivered by caesarean section. The baby had severe anemia and respiratory distress syndrome. NI-FECG was a good option for the clinician for the timely and accurate diagnosis of fetal anemia and fetal compromise in placental chorioangioma.Publication Dyslipidemia in Internally Displaced Middle-aged Women in Kharkiv During the War(Bucharest College of Physicians and the Romanian Academy of Medical Sciences, Media Med Publicis, 2024-12-19) Lakhno, IgorBackground. Kharkiv is a hub for internally displaced persons (IDPs). The impact of war on general health in perimenopausal women is still a challenging issue. The study was focused on the detection of possible relationships between metabolic disorders in IDPs and residents among perimenopausal women in Kharkiv. Methods. In total 82 patients were enrolled in the descriptive cross-sectional study. The number of Kharkiv’s residents was 42, and the IDP’s number was 40. The variables of body mass index (BMI) and menopausal Cooperman’s score were determined after inclusion in the study. All selected women were tested for serum lipids. The atherogenic index (AI), which is the logarithm of atherogenic (triglycerides) and antiatherogenic (high-density lipoprotein cholesterol) fractions of cholesterol, was also calculated. The levels of glycemia and insulin were detected with subsequent calculation of the HOMA index. C-reactive protein (C-RP) as a marker of chronic inflammation was investigated. Results. The values of BMI, Cooperman’s score, НОМА index, insulin, glucose, and C-RP did not reveal any statistical distinction between subgroups of the study population. Some variables of lipid metabolism differed between kharkovites and IDPs. The results of the multivariate regression model with IDP sign showed a statistically significant relationship with AI. Conclusion. The enhanced atherogenicity was typical for perimenopausal women among IDPs in Kharkiv. This peculiarity could be used as an initial stage in future research on advanced health programs during wartime.Publication Women’s Health Problems - A Global Perspective(IntechOpen, 2024) Russel Kabir; Ali Davod Parsa; Lakhno, IgorWomen’s health issues constitute a multifaceted global challenge, encompassing a wide range of complex problems that impact millions of women around the world. This edited volume, Women’s Health Problems – A Global Perspective, presents a comprehensive overview of the various health issues and societal challenges women face across different cultural, religious, and economic contexts. Our expert contributors, from diverse fields, offer in-depth analyses and evidencebased insights into topics including reproductive health and sexual health matters, menstruation, health service utilization, violence against women, and inequalities experienced by women. By examining these topics from a global perspective, this book underscores both the shared and distinct challenges women face in various regions. We aim for this collection to not only inform and educate but also to inspire further research and policy initiatives to enhance women’s health worldwide. This work is dedicated to all women, whose health and well-being are essential to the progress of our global society. The health of a woman throughout her life, from childhood to menopause, is a key focus of this volume. The holistic approach postulates that the function of the female reproductive system is critically dependent on general health. Ultrasound is of great significance in the medical visualization and diagnosis of diseases in women. Social and psychological adaptation depends on hormonal regulation. Premenstrual disorders can disrupt the daily activities of adult women. Testosterone is responsible for some adverse effects in women with polycystic ovarian syndrome or adrenal gland hyperplasia. Transgender individuals are the target population for prolonged testosterone administration. However, androgens play a beneficial role in sexual desire. Marriage is a considerable step towards childbirth. Multinational marriage is not only an ethical dilemma but also an instrument for improving genetic disturbances. Pregnancy is a period of maximal adaptive changes in the female reproductive system. The system of antenatal screening using biochemical and biophysical markers can contribute to the early diagnosis of chromosomal disorders, pre-eclampsia, preterm birth, and fetal growth restriction. Pre-eclampsia is one of the major obstetric syndromes that plays a crucial role in the programming of fetal and maternal health. There is no efficient treatment for pre-eclampsia, thus the emphasis is on prevention. Female endocrine regulation is an important part of homeostasis. Hypoestrogenicity is a trigger event for atherogenic vasculopathy. The activity of the ovaries impacts metabolic processes, vascular tone, and endothelial function. Hyperandrogenicity in polycystic ovarian disease is a trigger for adiposity, type 2 diabetes, and atherosclerosis. The increased level of testosterone persists even after menopause. Hormonal changes during menopause are discussed. Hormone replacement therapy has not shown an evident beneficial effect on the cardiovascular system. A possible therapeutic strategy for improved cardiovascular health during the transitional years of life is presented. The use of diet, L-arginine, and xylitol could be reasonable options for managing perimenopausal women. An alternative regimen of hormonal replacement therapy with herbal soy isoflavone extracts is presented as an efficient and safe option for women in their transitional years. This book includes a preface by the editors, followed by 12 chapters written by international experts, arranged in four sections. It is a useful resource for social workers, psychologists, general practitioners, endocrinologists, and gynecologists.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 Noninvasive fetal electrocardiography for the detection of fetal arrhythmias(John Wiley and Sons Ltd., 2019-01-02) Behar, Joachim; Bonnemains, Laurent; Shulgin, Vyacheslav; Oster, Julien; Ostras, Oleksii; Lakhno, IgorObjective: To assess whether noninvasive fetal electrocardiography (NI‐FECG) enables the diagnosis of fetal arrhythmias. Methods: A total of 500 echocardiography and NI‐FECG recordings were collected from pregnant women during a routine medical visit in this multicenter study. All the cases with fetal arrhythmias (n = 12) and a matching number of control (n = 14) were used. Two perinatal cardiologists analyzed the extracted NI‐FECG while blinded to the echocardiography. The NI‐FECG‐based diagnosis was compared with the reference fetal echocardiography diagnosis. Results: NI‐FECG and fetal echocardiography agreed on all cases (Ac = 100%) on the presence of an arrhythmia or not. However, in one case, the type of arrhythmia identified by the NI‐FECG was incorrect because of the low resolution of the extracted fetal P‐wave, which prevented resolving the mechanism (2:1 atrioventricular conduction) of the atrial tachycardia. Conclusion: It is possible to diagnose fetal arrhythmias using the NI‐FECG technique. However, this study identifies that improvement in algorithms for reconstructing the P‐wave is critical to systematically resolve the mechanisms underlying the arrhythmias. The elaboration of a NI‐FECG Holter device will offer new opportunities for fetal diagnosis and remote monitoring of problematic pregnancies because of its low‐cost, noninvasiveness, portability, and minimal setup requirements.