No 3 (2009)

The overview presents data on the role of components of the rennin-angiotensin and immune systems in the pathogenesis of ovarian overstimulation syndrome. Particular attention is given to interleukins, vascular endothelial growth factor, tumor necrosis factor-a and adhesion molecules. A small section is devoted to the impact of the syndrome on the course of pregnancy.

The causes of maternal deaths are analyzed in the Russian Federation and Moscow. Particular emphasis is placed on hypotonic hemorrhages, gestoses, presentation and preterm detachment of the normally located placenta, by showing by the experience gained in Moscow. The application of compression sutures to the uterus, ligation of the internal iliac arteries, and the use of Novo-Seven are appraised.

The paper deals with different aspects of septic shock in preterm labor. The etiological factors and the clinical picture of the disease are described in detail. The prognostic and diagnostic criteria for the development of pyoseptic complications are considered in pregnant women, parturients, and puerperas. The case in point is the microbial flora, the volume of amniotic fluid, clinical laboratory markers, including the concentration of total inflammatory phase proteins. The basic principles in the rendering emergency care are detailed in septic shock. Data on the susceptibility of primarily detected microorganisms are given.

The paper deals with the cardinal problem of the diagnosis and treatment of perinatal infections and ways of their solution. It underlines the necessity of standardization of approaches to managing pregnant women with infections potentially dangerous to the fetus and newborn, by developing and introducing a national guideline for the diagnosis and treatment of perinatal infections.

The authors studied variations in the levels of vascular endothelial growth factor receptor-1 (VEGFR-1) and placental growth factor (PlGF) during physiological and abnormal pregnancy in women with chronic venous insufficiency (CVI) and determined their prognostic value for early diagnostic of gestational complications. One hundred and two (98) pregnant patients, including 42 women with CVI and normal pregnancy, 33 with CVI and complicated pregnancy (pregnancy being complicated in 10 of them), 10 with placental insufficiency (PI), and 9 with fetal growth retardation (FGR) were examined. A control group comprised 27 healthy pregnant women. Blood was taken from the ulnar vein of the patients during the first, second, and third trimesters of pregnancy. Serum angiogenic markers were measured in pg/ml by ELISA; PlGF was assayed using test systems/kits (R&D Systems Quintikine, Minneapolis, USA). VEGFR-1 was determined by the kits manufactured by Bender Medsystems (USA). In the patients with CVI in PI and in those with FGR, and preeclampsia, the mean level of VEGFR-1 was established to be significantly increased throughout pregnancy as compared with that in healthy women. The concentration of PlGF was higher in patients with PI or FGR while the level of this growth factor in women with preeclampsia was significantly lower than that in healthy pregnant women from the first trimester. With a VEGFR-1 level of above 3700 pg/ml, there was an increased risk for FGR (RR 1.97; 95% CI 1.98-4.94; p = 0.043); with a PlGF concentration of below 178 pg/ml, there was a high risk for preeclampsia (RR 2.57; 95% CI 1.21-5.46; p = 0.024). This abnormal course of pregnancy was ascertained to be accompanied by a statistically significant increase in VEGFR-1/PlGF ratio. Abnormal pregnancy was marked by impaired balance between pro- and antiangiogenic growth factors, in this connection the determination of the levels of VEGFR-1 and PlGF, their ratio in particular, at first trimester is of great importance for the prediction of pregnancy complications, such as PI, FGR, and preeclampsia in pregnant women with CVI.

A considerable number of women with abnormally low ( < 1 nmol/l) total testosterone levels were detected among infertile patients with external genital endometriosis (EGE). Surgical treatment for the latter resulted in a lower proportion of patients with this abnormality. The fact that the total testosterone value of < 1 nmol/l remains after surgical treatment for EGE is an essential risk factor that negatively affects the likelihood of spontaneous pregnancy in the postoperative period.

Three hundred and twenty four patients aged less than 35 years in different pregnancy periods were examined to establish the incidence and pattern of impaired urination during pregnancy and to assess significant risk factors in pregnant women with symptoms of urinary incontinence. The questionnaire "The specific urination during pregnancy" and uroflowmetry on an ELLIPS-4 apparatus (ANDROMEDA, Germany) were used during the study. Impaired urination was found to occur in 146 (48.7%) pregnant women. Of them, there were imperative urinary disorders in 83 (56.8%) patients, stress urinary incontinence in 30 (20.5%), the mixed form in 33 (22.7%) women. Pregnancy and labor are referred to as risk factors of urinary incontinence. The women with increased body mass index and a history of labor complications (maternal passage soft tissue tears, perineo- and episiotomy, and large fetus delivery) form a special risk group.

An early physical contact of the newborn with his/her mother, by placing the baby on the puerperas abdomen, was studied. Sixty puerpera-neonate pairs were examined. The contact was ascertained to have a crucial role in the formation of microbiocenosis in the infant.

The assessment of information on the basic characteristics of metronidazole and clindamycin has indicated that their co-administration enhances therapeutic effectiveness in treating bacterial vaginosis.

The paper concisely describes an algorithm of diagnosis (tests, hormonal study, ultrasonography) and treatment (gestagens, estrogen gestagens, and antiandrogens) of polycystic ovary syndrome.