No 5 (2009)

The review deals with the evaluation of the uterine scar after cesarean section. The general characteristics of the problem and its practical significance are presented. Methods for evaluating the scar, such ultrasonography, magnetic resonance imaging, transvesical myometrial biopsy, are described. Particular emphasis is laid on the role of connective tissue dysplasia and hereditary collagenopathies.

The study was performed in 64 married couples with habitual pregnancy loss in the first trimester, who had compatibility of 3 HLA antigens or more, the rate of which in the structure of miscarriage is 24.6%. The poor predictors of early reproductive loss may be a homozygous genotype in women for the DQA1 locus, genotype 0301/0301 for the DQB1 locus, genotype 0501/0501, DQA1 and/or DQB1 0201 allele in men. Both the specific features of a HLA genotype in each husband/wife and compatibility for these antigens in the married couple were ascertained to affect the course of pregnancy in the early periods.

The study was performed in 84 women at 4-7-week gestational age. A study group included 64 patients with abnormal pregnancy (non-developing pregnancy, spontaneous miscarriage, anembryony, threatening miscarriage); a control group consisted of 20 women with physiological pregnancy. The levels of progesterone (PG) IgG and IgM antibodies, estradiol, PG, testosterone, T3, and T4 were measured. In complicated pregnancy, the frequency and the mean level of PG autoantibodies were 1.5-2 times higher than the physiological normal values. The risk of pregnancy loss significantly increases with the PG antibody level of more than 30 U/ml, particularly when a combination of IgM and IgG antibodies is detected. It is expedient to test for PG autoantibodies when repeat pregnant women with a history of abortion plan to conceive. The use of gestagens in complex therapy makes it possible to prevent threatening miscarriage.

The expediency and informative value of using the indices of neuroautonomic adaptation (NAA) to predict complications after cesarean section were determined, by examining 95 pregnant women who gave birth to a baby via cesarean section. Adaptation break and overstrain were revealed in 54.7% of the pregnant women before cesarean section, which enabled them to be referred to as a high complication risk group. A higher significance of prediction was found from the autonomic homeostatic parameters. The risk unwarrantedly increased in 29% of the pregnant women with high compensatory-adaptive capacities. It is suggested that it is more expedient to assess the risk before surgical delivery, by keeping in mind the time course of autonomic homeostatic changes.

The structural and functional characteristics of iron-binding proteins and their contribution to the formation of oxidant stress in genital endometriosis were examined, by studying plasma samples from 22 patients, peritoneal fluid from 12 patients and plasma from 8 apparently healthy women. Electron paramagnetic resonance spectroscopy was used to determine the active centers of the major iron-binding proteins ceruloplasmin (CP) and transferrin (TF) and their ratio as a criterion for evaluating the plasma antioxidant status and to study the blood TF and lactoferrin in the perineal fluid. The ratio of the active CL/TF centers was found to be statistically significantly higher in endometriosis. Wide signal spectra of iron complexes were recorded in 76% and changes in the signal waveform of lactoferrin were observed in all cases. The revealed changes support the impaired mechanisms of antioxidative defense with the development of oxidative stress at the systemic and local levels. The findings confirm the important implication of oxidant stress in the pathogenesis of genital endometriosis and substantiate new therapeutic and pharmacological strategies, by using antioxidants and anti-inflammatory agents in the combined treatment of the disease.

The paper presents a retrospective analysis of 305 case histories of female patients (mean age 61.25+7.65 years; mean postmenopausal duration 10.99±7.74 years) who have undergone mini-invasive surgical intervention for endometrial polyps (EP). The follow-up lasted 4 to 7 years. Diagnostic hysteroscopy (HS) was re-made in 120 patients. Small pelvic ultrasonography was performed to diagnose intrauterine pathology. HS was carried out with a hysteroscope. In 22 patients, mini-invasive surgical intervention for postmenopausal EP is regarded as ineffective if genital bloody discharges are seen in the presence of postmenopause and/or the availability of ultrasound data suggesting the recurrent endometrial proliferative processes. The cure rate of hysteroscopic resection treatment was 92.31 and 100% after endometrial ablation and local EP hysteroscopic removal. Electric surgical destruction of EP and/or endometrium is the treatment of choice in postmenopausal patients.

Seventy-one cases of maternal death caused by complications from anesthesia and resuscitation in the Russian Federation (RF) in 2005-2007 and on-line data on the organization of resuscitative care to pregnant women, parturients, and puerparas in 82 subjects of the RF are analyzed. The frequency of anesthesia and resuscitation has been ascertained to be 6.7% of the maternal death cases. Eight women died after less than 28-week pregnancy interruption, 5 during pregnancy, 12 at delivery, 41 in the postpartum period, and 5 after extrauterine pregnancy. The causes of female death were complications from general anesthesia (43.7%), anaphylactic shock in response to anesthetics (33.8%), complications from epidural anesthesia (8.5%), and complications from subclavian vein catheterization (7.0%). Outpatient care defects were revealed in 46.7% of the examinees and inpatient care ones were found in 74.6% of the dead women. In 2007, the RF obstetric facilities employed 3.500 anesthetists-resuscitators, 415 transfusiologists, had 1832 resuscitation beds, of them 560 beds were in regional (territorial, republican) perinatal centers (maternity hospitals). Remote obstetric resuscitation advisory centers with traveling resuscitative teams operate in 52 subjects of the RF. To reduce maternal mortality due to complications from anesthesia and resuscitation, it is necessary to set up a round-the-clock anesthetic service in the obstetric facilities, as well as obstetric resuscitative advisory centers, to extensively apply regional anesthetic modes, and to soundly use drugs, to introduce the health care standards, to upgrade the quality of training of medical personnel, and to develop telemedical technologies.

The efficiency of combined (topical clindamycin cream and oral trichopol) and topical (clindamycin cream) therapies for bacterial vaginosis was studied in 39 patients aged 7-22 years (mean age 14.5 years). The study comprised vaginal smear bacterioscopy, vaginoscopy, vaginal discharge pH-metry, inoculation of the vaginal contents, by identifying microorganisms to exclude nonspecific vulvovaginitis and vaginal candidiasis. In bacterial vaginosis, the microbial flora showed a preponderance of bacteroids in puberty-age girls and gardnerellae in adolescents with established menstrual function. The efficiency of combined and topical therapies against the opportunistic anaerobic microflora was high (95 and 88%, respectively. The agents are recommended for the treatment of bacterial vaginosis in childhood and adolescence. The combined therapy should be regarded as a preferred treatment.

The paper gives data on the effectiveness and safety of Depantol (Nizhfarm, Russia) as vaginal suppositories in 50 women (mean age 29±2 years) who have incomplete epithelization of the cervix uteri after laser vaporization for a lesion. The highest efficacy of the agent was seen when used twice daily (in the morning and in the evening) for 10 days.

The case histories of 150 patients operated on for acute surgical and gynecological diseases were retrospectively analyzed. It is shown that elective and emergency operations should be made jointly by a surgeon and a gynecologist. This will enable one to perform organ-preserving treatment, in reproductive-age women in particular.