Features of stereoisomerism of uterine contraction in pregnant women with isthmic-cervical insufficiency and its clinical significance

Objective: to study the features of contractile activity of the right and left sides of the uterus in patients with isthmiccervical insufficiency and uncomplicated pregnancy and to assess the nature of the gestational processes and labor outcomes depending on the sex of the fetus. Materials and Methods: a total of 146 patients with the functional form of isthmic-cervical insufficiency and 138 with uncomplicated pregnancy were examined. To study the nature of uterine activity of the right and left sides of the uterus, mechanohysterography was performed in the II and III trimesters of pregnancy. Results: in isthmic-cervical insufficiency in pregnant women with male fetuses with a higher incidence of preterm labor, bilateral uterine contractions predominated, whereas in uncomplicated pregnancy (dominated in pregnant women with female fetuses), unilateral (mainly right-sided) uterine contractions were detected. Conclusion: isthmic-cervical insufficiency is characterized by the predominance of functional symmetry in the myometrium, predominant in the case of the male fetus and leading to an increase in intraamniotic pressure and to dynamics from the length of the cervix, whereas physiological pregnancy is characterized by functional asymmetry, causing the preservation of the lower segment and the length of the cervix and more pronounced when bearing female fetuses.

1. Beglov D.E., Artymuk N.V., Novikova O.N., Marochko K.V., Parfenova Ya.A. Risk factors for extremely preterm and very preterm birth. Fundamental and Clinical Medicine. 2022;7(4):8-17. (In Russ.) https://doi.org/10.23946/2500-0764-2022-7-4-8-17

2. Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, et al. Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol. 2017;50(5):569-577. https://doi.org/10.1002/uog.17457

3. Tetruashvili N.K., Agadzhanova A.A. Management of single and multiple pregnancy in women with habitual abortion. Obstetrics and Gynecology: News, Opinions, Training. 2018;(2):52–57. (In Russ.) https://doi.org/10.24411/2303-9698-2018-00015

4. Matei A, Saccone G, Vogel JP, Armson AB. Primary and secondary prevention of preterm birth: a review of systematic reviews and ongoing randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2019;236:224-239. https://doi.org/10.1016/j.ejogrb.2018.12.022

5. Radzinsky V.E., Botasheva T.L., Kotaysh G.A., eds. Fatness. Diabetes. Pregnancy. Versions and contraversions. Clinical practices. The prospects. Moscwo: GEOTAR-Media; 2020. (in Russ.)

6. Cataño Sabogal CP, Fonseca J, García-Perdomo HA. Validation of diagnostic tests for histologic chorioamnionitis: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;228:13-26. https://doi.org/10.1016/j.ejogrb.2018.05.043

7. Grabovac M, Karim JN, Isayama T, Liyanage SK, McDonald SD. What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses. BJOG. 2018;125(6):652-663. https://doi.org/10.1016/j.jogc.2018.03.059

8. Alyokhina A.G., Blesmanovich A.E., Petrov Yu.I. Increasing pregnancy after the isthmic-cervical insufficiency. Synergy of Sciences. 2018;19:900−998. (in Russ.). eLIBRARY ID: 32330409 EDN: YMTELK

9. Mönckeberg M, Valdés R, Kusanovic JP, Schepeler M, Nien JK, et al. Patients with acute cervical insufficiency without intraamniotic infection/inflammation treated with cerclage have a good prognosis. J Perinat Med. 2019;47(5):500-509. https://doi.org/10.1515/jpm-2018-0388

10. Radzinsky V.E., Orazmuradov A.A., Savenkova I.V., Damirova K.F., Haddad H. Preterm labour: an open problem in XXI century. Kuban Scientific Medical Bulletin. 2020;27(4):27-37. (In Russ.) https://doi.org/10.25207/1608-6228-2020-27-4-27-37

11. Anzhoeva P.G., Shamanova A.I., Sunsheva B.A., Bairamukova A.A., Vandisheva A. P. et al. An analysis of pregnancy and labour outcomes in cervical incompetence. International Research Journal. 2024;6(144). (in Russ.) https://doi.org/10.60797/IRJ.2024.144.165

12. Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658-1667. https://doi.org/10.1016/S0140-6736(21)00682-6

13. Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S. Current discourse on recurrent pregnancy loss (EshRE Protocol 2023, National clinical guidelines "Recurrent Pregnancy Loss" 2021, materials of the World congress of EshRE 2023). RMJ. Mother and child. 2023;6(3):219-225. (in Russ.) https://doi.org/10.32364/2618-8430-2023-6-3-1

14. Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022;6(2):106-115. Erratum in: Lancet Child Adolesc Health. 2022;6(1):e4. https://doi.org/10.1016/S2352-4642(21)00311-4.

15. Medley N, Poljak B, Mammarella S, Alfirevic Z. Clinical guidelines for prevention and management of preterm birth: a systematic review. BJOG. 2018;125(11):1361-1369. https://doi.org/10.1111/1471-0528.15173

16. FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: Prediction of preterm labor and preterm premature rupture of membranes. Int J Gynaecol Obstet. 2019;144(3):340-346. https://doi.org/10.1002/ijgo.12744

17. Gondarenko A.S., Galina T.V., Smirnova T.V., Kuznetsova O.A., Markaryan N.M., Obukang A. Scale for Assessing Risk of Extremely Preterm Birth. Doctor.ru. 2016;(7):53–56. (in Russ.) eLIBRARY ID: 26697332 EDN: WMFQYP

18. Dolgushina V.F., Alikhanova E.S., Kurnosenko I.V., Astashkina M.V., Smolnikova L.A. Immunological predictors of premature birth in isthmic-cervical insufficiency. Doctor.Ru. 2024;23(2):12–18. (in Russ.) https://doi.org/10.31550/1727-2378-2024-23-2-12-18

19. Keller O.V., Botasheva T.L., Rymashevsky A.N., Lebedenko E.Yu., Palieva N.V., et al. The role of some indicators of the antioxidant system and adipose tissue metabolism in predicting isthmic-cervical insufficiency. Medical Herald of the South of Russia. 2024;15(2):7-15. (In Russ.) https://doi.org/10.21886/2219-8075-2024-15-2-7-15

20. Kozlov L.A., Khanova A.M., Talipova R.R., Khasanova A.M., Galyaveeva A.R. Works by Professor V.S. Gruzdev and his disciples on uterine contractions (for the 150th anniversary of Professor V.S. Gruzdev). Practical Medicine. 2018;16(6):141- 150. (in Russ.) https://doi.org/10.32000/2072-1757-2018-16-6-141-150

21. Botasheva T.L., Kotieva I.M., Grigoryan A.K., Kudrin R.A., Klaucek S.V., et al. The principle of morpho-functional symmetry-asymmetry in the formation of contractile activity of the uterus during physiological and complicated pregnancy. Journal of Volgograd State Medical University. 2024;21(4):117- 124. (In Russ.) https://doi.org/10.19163/1994-9480-2024-21-4-117-124

22. Fabrikant A.D., Botasheva T.I., Rymashevsky A.N., Petrov Yu.A., Palieva N.V., et al. The fetus gender value in the structure of obstetric pathology in pregnant women with gestational diabetes mellitus. Medical Herald of the South of Russia. 2021;12(4):20-26. (In Russ.) https://doi.org/10.21886/2219-8075-2021-12-4-20-26

23. Lorente-Pozo S, Parra-Llorca A, Torres B, Torres-Cuevas I, Nuñez-Ramiro A, Cernada M, et al. Influence of Sex on Gestational Complications, Fetal-to-Neonatal Transition, and Postnatal Adaptation. Front Pediatr. 2018;6:63. https://doi.org/10.3389/fped.2018.00063

24. Bezirova L.H., Malyshkina А.I., Nazarova А.О., Loginova V.S., Nazarov S.B. Bioelectric parameters of contractile activity of the uterus in the III trimester of pregnancy. Bulletin of the Ivanovo Medical Academy. 2023;28(2):23-26.(in Russ.) eLIBRARY ID: 54893279 EDN: LAMTYS

25. Orlov R.S. Fundamentals of modern myometrial electrophysiology. Obstetrics and Gynecology. 1969;(1):3–10.(in Russ.).

26. Kovalev V.V., Tsyvyan P.B., Milyaeva N.M., Lukin O.N., Protsenko Yu.L. The degree of stretching of the myometrium is an important regulator of contractile activity of the uterus. Obstetrics and Gynecology. 2013;(2):62-67. (in Russ.). eLIBRARY ID: 18897228 EDN: PXNSUP

27. Teodorescu-Exarchu I., Dumitru I. Physiology and pathophysiology of human reproduction. Bucharest: Medical Publishing House; 1998. (In Russ.)