No 2 (2010)

The review considers the role of oxidative stress in the physiological and pathological course of pregnancy and postpartum. It underlines the importance of oxidative balance for the normal course of pregnancy, the development of an embryo, and the monitoring of inflammatory cytokines. Impaired placentation makes a considerable contribution to the pathogenesis of miscarriages and preeclampsia. Placental tissue oxidative stress induced by the excessive production of active oxygen forms (AOF) is a common pathophysiological mechanism in early pregnancy loss of varying etiologies. It is considered to be a key intermediate step in the pathogenesis of preeclampsia. The presence of proinflammatory cytokines and AOF at high concentrations leads to the degradation of lipids, proteins, and nucleic acids. Modified proteins change their antigenicity and are involved in the immune reactions resulting in inflammatory and/or autoimmune lesions. Postpartum is accompanied by lower oxidative stress than is pregnancy. Postpartum infectious complications are associated with the significant activation of leukocytes and the increases in the production of proinflammatory cytokines and in the generation of AOF by puerperal cells.

The review gives brief information on the role of growth factors and cytokines in the development of adenomyosis. The case in point is fibroblast growth factor, epidermal growth factor, vascular endothelial growth factor, etc. The role of cytokines, such as interleukins 1, 6, 8, and 10 and tumor necrosis factor-α, is described. The issue calls for careful further investigation.

The specific features of cerebral blood flow in gestosis were assessed to specify its severity. A study was made in 32 healthy pregnant women, 80 patients with varying gestosis, and 20 nonpregnant women. All the women underwent transcranial Doppler study in the arteries of the circle of Willis. The objective criteria for progressive gestosis were found to be evident spasm of the basilar artery in the presence of dilation of other arteries of the circle of Willis and arterioles of the brain, which was accompanied by elevated cerebral perfusion pressure and higher hydrodynamic resistance index. Severe gestosis is characterized by total dilation of all cerebral vessels and by cerebral blood flow autoregulation system derangement that appears as the relationship of cerebral perfusion pressure to the changes in systemic blood pressure, which results in brain edema and is attended by the clinical picture of preeclampsia. The authors consider transcranial Doppler study to be a safe, non-invasive, and informative technique for the objective evaluation of cerebral hemodynamics in gestosis, the determination of the degree of its severity, and the choice of the optimal management of pregnancy and labor.

Thirty-one women with multiple pregnancy (22 women in the first trimester and 9 in the second trimester) and 22 randomly selected women with singleton pregnancy (a comparison for the first trimester) were examined, by using ultrasound study, biochemical screening, computer-assisted analysis, chorionic villus biopsy, amnio- or cardocentesis to determine the embryonic/fetal karyotype. In the first trimester, 14 of the 22 women were found to be at high risk for birth of a baby with chromosomal abnormalities with increasing female age and with a larger embryonic nuchal region. The values of serum markers did not affect the risk degree. The level of the beta-subunit of human chorionic gonadotropin was similar in multiple and singleton pregnancy and that of pregnancy-associated plasma protein A significantly increased in multiple pregnancy. Chromosomal abnormality (Down and Edwards syndromes) was diagnosed in 2 embryos with a cervical fold. Their reduction was made. In the second trimester, the basic criteria for evaluating the fetal status were ultrasound findings when screening programs were used. In 64 embryos/fetuses (in 31 women), pathology was diagnosed in 7 (10.9%), including the karyotype in 3.1% (2/64) and the phenotype in 16.1% (5/64). The results of the study support the expediency of using the whole package of prenatal diagnostic techniques, preferably as early in pregnancy as possible. The results of ultrasound study and karyotyping are of the greatest informative value for this group of women.

One hundred and twelve patients with uterine myoma complicated by chronic posthemorrhagic anemia and 19 with uterine myoma without anemia were studied. Three groups of anemia severity were identified. These included 1) mild (Hb, 90-110 g/l); 2) moderate (Hb, 70-89 g/l); 3) severe (Hb, less than 70 g/l).

The purpose of the investigation was to study the specific features of the genotype of the married couples included into the assisted reproductive technology (ART) program. Malformations, monogenic diseases, and heterozygous carriage of mutant genes were found in 177 (9.3%) of 1898 patients. By taking into account chromosome changes in peripheral lymphocytes, the rate of genetic changes in the patients involved in the ART program increased up to 12.8%. Heterozygous carriage of CYP21B gene mutation was found in 41 (38%) of 108 patients. Of all the detected mutations in the men and women of both groups, the rates of CYP21B gene deletion and duplication were 70.7 and 24.4%, respectively. Mutations of CFTR genes at the AZF locus of chromosome Y in males having abnormal spermogram readings were found in 12.9% of cases. The total rate of 5T allele was 40.5% of the revealed CFTR gene changes. F508del mutation was the second most frequent type. Del sY1192 was the most common microdeletion at the AZF locus of chromosome Y. Medicogenetic counseling with the interpretation of transmitted information may permit timely measures to prevent the birth of a baby with genetic disorders.

Two hundred and eleven women aged 18 to 35 years during different pregnancy terms were examined. During a prolonged study, temperamental traits were studied in 12 women before, during, and after pregnancy, by using the formally dynamic individuality trait (FDIT) questionnaire developed by V. M. Rusalov. Normal pregnancy was shown to be accompanied by a reduction in the energy component of behavioral reactions both in the subject activity sphere and especially intellectual and communicative spheres, as well as a decrease emotionality levels on making any activity, except for communicative one. The above changes in the manifestation of temperamental traits are individual, and depending on the degree of occurring abnormalities, may (not) lead to a change in the FDIT type characteristic of a woman before the occurrence of pregnancy. Temperamental traits returned to the baseline values in not all women within a month after labor.

A study was conducted in 49 women with chronic cervicitis and/or complicated by ectopy of the cervix uteri, associated with Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma urealyticum, including in combinations with fungi of the genus Candida and the anaerobic microflora. Group 1 included 23 women receiving azithromycin (in a 1-g single dose) in combination with metronidazole (500 mg thrice daily for 7 days) and fluconazole (in a 150-mg single dose). Group 2 comprised 26 women taking Safocid (as a 4-tablet blister per course). Both drug therapy regimens demonstrated a high clinical efficacy, positive cervical colposcopic changes, and equal antimicrobial activity against C. trachomatis and M. genitalium. Safocid proved to be more effective in eliminating Gardnerella vaginalis in women having microbial associations. At the same time none of the treatment regimens was sufficiently ineffective in eradicating U. urealyticum and Mycoplasma hominis. Safocid showed a good tolerability and a high compliance.

The types of marriage were comparatively analyzed in the families with miscarriage. A group of 532 families with miscarriages that had happened in the first 12 weeks of pregnancy was divided into 3 subgroups: 1) 249 families with one miscarriage; 2) 210 families with two miscarriages; and 3) 73 families with three miscarriages or more. The second sample included 862 families in whom spontaneous abortions had occurred in the first 28 weeks (these families had live-birth children, abdominal pregnancies, and medical abortions). This group was divided into 2 subgroups: 1) 391 families with one miscarriage and 2) 471 families with two miscarriages or more. A control group consisted of 272 families without a history of miscarriage. The findings suggest that the families with a history of three miscarriages or more in the first 12 weeks of pregnancy were found to have inbreeding phenomena that might, with preserved pregnancy, result in an increase in the birth rate of infants with genetic abnormalities.