No 4 (2008)

Objective: to study the regulatory and adaptive processes in the maternal-placental-fetal system in gestosis. Setting: Obstetric Clinic, Kemerovo State Medical Academy. Design: a prospective study. Subjects: 237 pregnant women at gestational weeks 28-40 were examined. A study group included 102 pregnant with mild gestosis (n = 28), moderate gestosis (n = 23), and severe gestosis (n = 51). A control group consisted of 135 women with physiological pregnancy. Methods: routine clinical study, ultrasound fetometry and piacentometry, Doppler study of blood flow in the maternai-placentak-fetal system, and feta I cardiotocography. The maternal and fetal autonomic nervous systems (ANS) were studied, by analysing cardiac rhythm variability by cardiointervahgraphy (C1G). Maternal cardiointervals were recorded by the photofrequency; awakening fetal C1G was made by the procedure described by G. A. Ushakova and Yu. V. Rets. The calculations of a mode, its amplitude, a variability range, and a tension index are given. The results were compared using the Mann-Whitney U-test; Pearson’s correlation coefficient was used to analyze the relation of variables. Results: in physiological pregnancy there was a preponderance of the LVF component of a spectrum in the ranges of 26-130 and 2-30 msec 2/Hz in 85.9 and 88.1% in the mother and fetus, respectively; baroreceptive (LF) and parasympathetic (HF) components were 10-30% of the power spectral density of VLF, which suggested that there was a functional balance of centra! and autonomic regulatory circuits. In mild gestosis, maternal and fetal ANS regulation was at the state of equilibrium in 64.2 and 71.4%, respectively; however, 39.2% of the females were found to have a moderate activation of a trophotropic regulation component. Neonatal adaptation was satisfactory in 82.2% of cases. Only 17.8% of cases were diagnosed as having metabolic disorders, which piomoted the formation of groups at risk for central nervous system (CNS) diseases and endocrinopathies and required a follow-up. In moderate gestosis, 82.5 of the mothers and 100% of the fetuses were observed to have abnormal cardiac rhythm regulation types with significant sympathetic regulation tension or exhaustion. In early neonatality, 26.1% of the neonatal infants were diagnosed as having hypoxic-ischemic encephalopathy with the signs of CNS excitation; 8.9% had intracranial hypertension. The posthypoxic syndrome of cardiovascular dysadaptation was recorded in 13.1% of cases, which was mainly characterized by functional systolic murmur in the presence of patent fenestra ovalis with right-to-left shunting. In severe gestosis, the above trends progressed, which was indicative of maternal-fetal system maladjustment and autonomic functioning, and clinically manifested by worsening gestosis and fetal hypoxia, which required emergency delivery. The early neonatal manifestations of dysadaptation were acute mild and severity asphyxia in 17.6% of cases (2.3%; p = 0.002), hypoxic-ischemic encephalopathy with the significant signs of CNS inhibition and (he presence of convulsions. In 5.9% of cases experienced hypoxia led to a dysrythmie type of cardiovascular dysadaptation syndrome appearing as sinus tachycardia, sinus arrhythmia. Conclusion: CIG determination of ANS function evaluates the state of metabolic processes and autonomic nervous regulation of maternal and fetal cardiac rhythm, which makes it possible in gestosis to detect and timely correct abnormalities in the maternal-placental-and-fetal system, to decide the time and method of delivery and to improve labor outcomes.

Objective: to determine ways of reducing perinatal mortality and morbidity among full-term infants and the significance of cesarean section (CS). Setting: Department of Obstetrics and Gynecology, Pediatric Faculty, Russian State Medical University, Moscow. Design: a retrospective study. Material and methods: 292 case histories of term labors, the babies after which required intensive care, in different Moscow obstetric institutions were analyzed. Infants with congenital or hereditary diseases were excluded from the study. Results: analysis of the causes of fetal sufferings during pregnancy and labor suggests that it is necessary to expand indications for CS in third-degree growth retardation, advanced pregnancy, severe gestosis, large fetal dimensions exceeding 4500 g during the first labor, and stillbirth in the history. In addition, aggressive labor management contributes to the grave condition of babies at birth. Conclusion: perinatal outcomes in full-term infants without malformations should be continuously compared with the methods of management of pregnancy and labor, which promotes the choice of the most optimal methods of them.

Objective: to reveal the level of chromosomal aberrations in the embryos of patients with Robertsonian translocations in the karyotype. Setting: V. I. Kulagin Research Center of Obstetrics, Gynecology, and Perinatology, Russian Agency for Medical Technologies, Moscow Subjects: males with chromosomal changes in the karyotype, who were included into the assisted procreation (AP) programme and who needed an intraplasma oocystic cytoplamic spermatozoon injection (ICSI) procedure, as well as embryos of two married couples in whom the male karyotype was presented as 45,XY, der(13/l4)(q10;q10). Methods: molecular cytogenetic study. Results: in one married couple, embryonic genetic study revealed in two cycles 62% of embryos suitable for transfer by genetic criteria; trisomy in 38% by the study chromosomes. The other had no embryos suitable for transfer in two AP programs. Chromosomal aneuploidies were exhibited by the following abnormalities: monosomy of chromosome 13 or 14 (37.5%) and trisomy of chromosome 13 or 14 (62.5%). Singleton pregnancy occurred in the first married couple in the second cycle of AP. Conclusion: the high frequency of embryonic genetic abnormalities in patients with karyotypic translocations shows it unadvisable to transfer embryos without their genetic study and necessary to make preimplantation genetic diagnosis in patients with chromosomal aberrations.

Objective: to study the effects of sulfide-sludge muds and iodide-bromine waters on the clinical pathogenetic mechanisms of chronic small pelvic inflammatory diseases (CSPID) complicated by the pelvic pain syndrome. Setting: Research Center of Obstetrics, Gynecology, and Perinatology, Russian Agency for Medical Technologies, Moscow; Tinaki Rehabilitation Center, Astrakhan. Subjects: 108 pregnant women with CSPID. Methods; physical, hematological, ultrasound, radioimmune, psychological, laser Doppler flowmetry. Results; the use of snlfide-sludge muds and iodide-bromine waters of the Tinaki Rehabilitation Center in the treatment of patients with pelvic pain syndrome-complicated CSP/D promotes a rapid relief of pain, by preventing its chronic pattern, enhances nonspecific resistance of the body due to its adaptive capacities, positively affects the hormonal status, and improves peripheral hemodynamics, which makes in the aggregate the prediction of CSPID better. Conclusion: non-drug treatments in female patients with CSPID are highly effective.