The cost-effectiveness of early induction of labour for suspected large-for-gestational-age foetuses to prevent shoulder dystocia is unknown. A within-trial economic evaluation of induction at 38 + 0 to 38 + 4 weeks' gestation for suspected large-for-gestational-age foetuses. Resource use and costs were measured to 6 months postpartum. We estimated incremental cost per case of shoulder dystocia prevented and incremental cost per maternal quality-adjusted life year (QALY) gained. We collected data for planned caesarean sections in a cohort study. Mean combined woman and infant costs in the induction arm were £89 (95% confidence interval (CI): -£79, £257) higher than the standard care arm, driven by increased neonatal costs. The incremental cost of preventing one case of shoulder dystocia was £11 879 and the incremental cost per maternal QALY gained was £39 518. The probability of early induction being cost-effective was 0.65 at a cost-effectiveness threshold of £20 000 per case of shoulder dystocia prevented, but 0.36 at a cost-effectiveness threshold of £20 000 per maternal QALY gained. The cohort study found the mean cost was £310 (95% CI: £74, £545) higher in the induction arm than in the planned caesarean group. Early induction of labour increased neonatal care costs. It is not a cost-effective approach when effects are restricted to maternal QALYs. Planned caesarean section might be cost-saving when compared to early induction, although we did not assess longer-term effects such as an increased risk of repeat caesarean sections. Assessments of long-term effects on the mother and infant should be incorporated into future studies. ISRCTN18229892.

The aim of the study. To determine the main trends and medical and organizational prerequisites for adjusting prevention programs at the population level in the Russian Federation based on a long-term epidemiological analysis of complications of childbirth and the postpartum period. Material and methods. The authors analyzed forms No. 32 «Information on medical care for pregnant women, women in labor and women in labor», data from the collection «Main indicators of maternal and child health, activities of the child protection and obstetric services in the Russian Federation» of «Central Research Institute for the Organization of Health Informatization» of the Ministry of Health of the Russian Federation. Statistical analysis was performed using the StatTech v. 3.0.9 program (OOO «Stattech», Russia). Results. A decrease in the number of normal births in the Russian Federation, except for the North Caucasian Federal District, was established. In the Central, Ural and Siberian Federal Districts, an increase in the incidence of hypertension, which complicated childbirth and the postpartum period, is noted. A decrease in the incidence of preeclampsia has been established in the North Caucasus Federal District, while in other territories an increase in this indicator is observed, as in the country as a whole. In Russia, an increase in the incidence of premature placental abruption and a decrease in the frequency of difficult labor are observed. The incidence of placenta previa with bleeding has decreased. The frequency of bleeding due to blood clotting disorders has increased in the Northwestern Federal District. An increase in the incidence of labor dysfunction has been established in the Urals Federal District. In Russia, an increase in the incidence of grade III-V perineal rupture, uterine rupture, obstetric sepsis, diffuse postpartum infection, venous complications, and diabetes mellitus is observed. Conclusion. The study allowed us to determine the incidence trends that can be used as a methodological basis for developing preventive programs.

DNA methylation patterns are inherited from the parental germline to the embryo. In mature sperm, the sites of unmethylated DNA are tightly coupled to sites of histone retention at gene regulatory elements that are implicated in paternal epigenetic inheritance. The timing and mechanism of site-specific DNA demethylation in the male germline currently remains unknown. Here, we perform genome-wide profiling of DNA methylation during spermatogenesis by capturing methylated DNA through interaction with a methyl-DNA binding protein domain (MBD). Our data demonstrate that there is a site-specific change in DNA methylation during the mitosis-to-meiosis transition. Importantly, the genomic sites that are demethylated during this transition predetermine nucleosome retention sites in spermatozoa. These results suggest that site-specific DNA demethylation during the mitosis-to-meiosis transition of spermatogenesis prepares embryonic gene expression after fertilization. We therefore propose DNA demethylation during spermatogenesis as a novel phase of epigenetic reprogramming that contributes to embryonic gene regulation.

DNA methylation patterns are inherited from the parental germline to the embryo. In mature sperm, the sites of unmethylated DNA are tightly coupled to sites of histone retention at gene regulatory elements that are implicated in paternal epigenetic inheritance. The timing and mechanism of site-specific DNA demethylation in the male germline currently remains unknown. Here, we perform genome-wide profiling of DNA methylation during spermatogenesis by capturing methylated DNA through interaction with a methyl-DNA binding protein domain (MBD). Our data demonstrate that there is a site-specific change in DNA methylation during the mitosis-to-meiosis transition. Importantly, the genomic sites that are demethylated during this transition predetermine nucleosome retention sites in spermatozoa. These results suggest that site-specific DNA demethylation during the mitosis-to-meiosis transition of spermatogenesis prepares embryonic gene expression after fertilization. We therefore propose DNA demethylation during spermatogenesis as a novel phase of epigenetic reprogramming that contributes to embryonic gene regulation.

Relevance. Maternity protection is an urgent area of health development, since the health of the expectant mother largely determines the health of the future child. The purpose of the study is to identify trends in complications of parturition and the postpartum period in the Republic of Mari El for 2010–2022. Materials and methods. The authors analyzed forms No. 32 “Information on medical care for pregnant women, women in labor and maternity women” using methods of epidemiological analysis and medical statistics. Results. A 49.3% decrease in normal labor was found (M ± SD 40 ± 7; 95% CI 36–44; p ˃ 0.05), an increase in the incidence of the studied cohort by 13% (M ± SD 600 ± 70; 95% CI 557–642; p ˃ 0.05), a decrease in the incidence of edema, proteinuria and hypertensive disorders by 14.3% (M ± SD 100 ± 17; 95% CI 89–110; p ˃ 0.05), since 2015 — a decrease in moderate preeclampsia by 19.8%, eclampsia by 22.5%, an increase in severe preeclampsia by 1.2%. A tendency to increase the incidence of diabetes mellitus has been established. There was a twofold increase in bleeding due to blood clotting disorders, a 30.4% decrease in labour disorders (M ± SD 105 ± 17; 95% CI 95–116; p ˃ 0.05), an increase in obstructed labour by 27.5% (M ± SD 66.54 ± 34.70; 95% CI 45.57–87.51; p ˃ 0,05). Anemia is the leader in the structure of diseases in 2010 and 2022 (45.67% and 30.32%), labour disorders (15.36%) in 2010 and diabetes mellitus (22.81%) in 2022 are in second place, edema, proteinuria and hypertensive disorders are in the third place in 2010 and 2022 (13.3% and 11.0%). Research limitations. the present study was limited to the data of diseases that complicated childbirth on the territory of the Republic of Mari El. Conclusion. There is a tendency to increase the incidence in pregnant women, severe preeclampsia, diabetes mellitus, the prevalence of bleeding due to blood clotting disorders, and difficult parturition. The results of this study allowed identifying trends in morbidity that can be taken into account when planning preventive programs.

Background. Group B streptococcus (Streptococcus agalactiae, SGV) remains the main cause of neonatal sepsis and meningitis, despite a marked decrease due to the use of intranatal antibiotic prophylaxis. At the same time, delays in the detection and treatment of neonatal infections can cause serious consequences and, in some cases, the death of a newborn, on the other hand, unnecessary use of antibiotics also has harmful consequences (changes in the normal microbiota of a newborn, the development of antimicrobial resistance, etc.). At the same time, laboratories are constantly faced with the task of improving diagnostic approaches for the rapid and correct identification of newborns with infection.The purpose of the study. To analyze the effectiveness, efficiency and timing of the results of bacteriological examination in neonatal sepsis and meningitis caused by Streptococcus agalactiae to determine the best diagnostic strategy.Material and methods. In the period from January to November 2024, the case histories of 10 newborns with positive hemoculture for Streptococcus agalactiae were analyzed. Blood samples were taken under aseptic conditions according to the standard protocol. The identification of microorganisms was carried out by 2 methods: 1 — by standard subcultivation on nutrient cups and 2 — directly from positive vials using MALDI-TOF MS technology on a Vitek MS analyzer (BioMerieux, France) using the in-house method.Results. The average time from the moment of sampling to placement in the hemocultivation device (A) was 13.1±7.4 hours, the average growth time of the microorganism, i.e., to a positive signal (B) was 6.7± 3.0, the average time for identification of the pathogen from a blood vial (C) was 20.2±13.1, the average sample turnover time in the laboratory (from the collection of the material to the issuance of the identification result to the clinician — D) was 42.0 ± 12.0 hours. When using the accelerated identification method directly from a positive vial, the average time C was 12.5 hours, D — 36.3 hours.Conclusions. The use of an accelerated technique for the cultural detection of OHS in hemocultures of newborn children allowed to reduce the time of identification of the pathogen in a positive blood culture by 17.5 hours from 30 hours to 12.5 (more than 2 times), and the total time from obtaining the biomaterial to making a decision by the attending physician was reduced by 14 hours (from 50 hours to 36), i.e. almost 1.5 times.

Pathologically invasive placenta has been a problem in obstetrics for several centuries. Recently, its importance has increased due to the growing number of women with a previously operated or compromised uterus, which is a direct risk factor for placenta accreta. In addition to the unpleasant development of events during childbirth for the obstetrician-gynecologist, this pathology is a danger to the mother's health. And this is not surprising, because even with quick action of the surgeon and prevention of massive blood loss after hysterectomy - a classic surgical procedure for implantation of the placenta - such women lose their reproductive organ, which can cause social and psychological discomfort. That is why organ-preserving operations are being developed today, the results of the evaluation of the effectiveness of one of them are given in this work. Aim: to compare the effectiveness of the proposed organ-preserving CLAP technique in women with placenta accreta spectrum compared to classic hysterectomy. Materials and methods: Women with placenta accreta spectrum underwent cesarean section and CLAP in the main group (n=19) and classical hysterectomy in the control group (n=18). Blood loss, neonatal outcome, and length of hospital stay were compared. Statistical analysis was performed using MedStat and Microsoft Excel software. Patients' rights were respected in accordance with the Declaration of Helsinki and the Universal Declaration of Bioethics and Human Rights (UNESCO). All pregnant women signed an informed consent form to participate in the study. Results: The two groups did not differ in terms of age, medical history and comorbidities. Statistically less blood loss was found in the main group (2377±322 ml vs. 3339±358 ml in the control group, p<0.001), while there was no difference in the condition of newborns, postpartum women, and length of hospital stay. Conclusions: The use of the CLAP technique in comparison with hysterectomy allows, in addition to the preservation of the female reproductive organ, to achieve less blood loss during surgical delivery of a pathologically invasive placenta, without changing the condition of the newborn, the postpartum woman, or the length of hospital stay. At the same time, in comparison with other organ-preserving techniques, CLAP does not require the use of special additional equipment and can be performed in any medical institution with sufficient qualifications of the surgeon.

prematurity and fetal growth retardation complicates in general one in five pregnancies. The combination of prematurity with severe growth retardation and hypoxia worsens the prognosis due to increase of periventricular hemorrhage incidence, and later coronary heart disease, hypertension, stroke, miscarriage and fetal growth retardation in own pregnancies in adulthood. The causes of impaired blood coagulation and fibrinolysis in retardated and premature newborns remain poorly understood. The goal of the study - to compare the parameters of blood acid-base and gases balance, coagulation and fibrinolysis in prematurity and growth retardation. Material and methods. Newborns of three clinical groups were examined. 24 full-term newborns with a postnatal diagnosis of I-II growth retardation stage constituted group I. 18 newborns of group II were born prematurely, corresponding to pregnancy term of 28-34 weeks. Control group III consisted of 20 full-term healthy infants. The birth took place without emergency interventions and without perinatal losses. Blood samples of the umbilical cord artery were obtained immediately after it was clamped. The parameters of blood acid-base and gas compositionof mothers and newborns blood and the fetal kinetic characteristics of blood coagulation and fibrinolysis were compared. Results. Newborns of group I had a pH of 7.27±0.012, in group II - 7.33±0.022, in group III - 7.30±0.024, which corresponded to the difference between maternal and fetal values of 0.10; 0.07 and 0.13. The pH difference in growth retarded fetuses is higher than in premature fetuses, closely to that of full-term fetuses, despite the lowest pH. Parameters of pO2 and pCO2 in labor do not have an indicative difference in newborns of all groups. Thromboelastometric parameters of the premature infants blood indicate low density and accelerated clot lysis, but while growth retarded fetuses accelerated formation and incomplete clot lysis. That is because of notable predominance of endothelial origin procoagulant factors in growth retarded fetuses. Indicators of acid-base and gas balance in newborns with growth retardation are shifted towards acidosis, in contrast to anthropometrically similar premature infants, whose indicators are higher than full-term fetuses ones.