No 3 (2010)

Hereditary thrombophilias were studied in miscarriage, gestosis, premature detachment of the normally located placenta, cesarean section. The biochip method was used to study thrombophilic polymorphisms. In addition, blood coagulation tests were carried out by 12 indices; D-dimer, homocysteine, and von Willebrand factor were determined. The higher rate of multigenic thrombophilia was found in the abnormalities under study. Based on the data obtained, the authors developed principles in the assessment of the risk for complications in thrombophilic polymorphisms and an algorithm for diagnostic and medical measures (the use of antiaggregants and anticoagulants). The determination of the risk for obstetric complications in relation to the results of an examination for hereditary thrombophilia, as well as medical measures could reduce perinatal losses and prevent severe obstetric complications (severe gestosis, placental insufficiency, coagulopathic hemorrhage, fetal growth retardation, premature detachment of the normally located placenta).

The review presents the data available in the literature on the incidence of Mycoplasma infection in the female urogenital organs, its impact on the course of pregnancy, labor, and fetal status. Information on the pathogenetic mechanisms of Mycoplasma exposure is briefly given.

Seventy-nine women with early miscarriage and antiphospholipid syndrome (APS) were studied. Immunocytotherapy (ICT) used in the pregravid preparation of women with above pathology was found to contribute to elimination of Chlamydia infection and led to the enhanced differentiation of T helper cells towards Th2-dependent immune response. Thus, ICT used in the pregravid preparation of women with early miscarriage and APS is warranted and effective. The findings suggest that ICT has an advantage over traditional treatment for APS.

In 90 women aged 18 to 40 years who had a post-cesarean section uterine scar, its morphological and immunohistochemical features were studied, by identifying the possible molecular genetic predictors of its consistency as estrogen receptor-α gene polymorphism. The morphological substrate of scar inconsistency in undifferentiated connective tissue dysplasia (uCTD) is the progressive connective tissue disorganization to fibrinoid necrosis, which is characterized by the impaired levels of laminin and collagen type IV; moreover, the cause of tissue disorganization is likely to be relative microcirculatory bed inconsistency. The post-cesarean section formation of an inconsistent uterine scar in uCTD is genetically determined, which determines a predisposition to connective tissue disorganization in the scar with the ESR1:-397 T > C (Pvull) and -351G > A (Xbal) gene polymorphisms.

Sixty-two puerperas with iron deficiency were studied after labor and cesarean section. Group 1 included 32 puerperas who were given recombinant erythropoietin in combination with iron preparations; Group 2 comprised 30 puerperas who took iron preparations only. During therapy, there was an increase in hematological parameters in the puerperas from both groups. To objectify the evaluation of therapeutic effectiveness in both groups, the authors calculated a percent increment in the parameter with reference to the baseline value. During therapy, there were increases in hemoglobin levels by 40.7 and 18.7%, in packed cell volume by 34.8 and 6.9%, and red blood cells by 34.8 and 13.8% in Groups 1 and 2, respectively. Thus, the efficiency of treatment with iron preparation in combination with recombinant erythropoietin in puerperas with iron deficiency was twice as high as that with iron preparations only.

The use of a complex of methods (rapid culture method, polymerase chain reaction (PCR), in situ PCR) has revealed that the detection rate for herpes simplex virus (HSV) in the fraction of mobile spermatozoa is higher in patients with impaired fertility (20.4-26.4%) than in apparently healthy men (2.6-6.1%). An average of 1.5% of the mobile spermatozoa isolated from an infected ejaculate contains viral DNA. When assisted reproductive technologies are applied, the gradient centrifugation of the whole ejaculate makes it possible to wash the ejaculate from HSV or to reduce a viral load in 60% of cases. The development of an experimental model of herpetic infection in the murine testicular organ culture has ascertained that early spermatogenic cells, i.e. spermatogonia and spermatocytes, are susceptible to viral infestation.

Clinical laboratory examination was made in 74 women with singleton and multiple pregnancy occurring after in vitro fertilization (IVF) and embryo transfer (ET). Following IVF, the level of progesterone in women with pregnancy complicated and uncomplicated by bleeding was 5-6 times greater than the physiological parameters. These changes impair the protective-adaptive mechanisms of hemostasis and cause thrombophilic changes and, as a result of these diseases, chorionic detachment and formation of retrochorial hematomas, and the development of primary placental insufficiency. An algorithm for treatment is given in relation to the cause of bleeding (embryo reduction, chorionic detachment, chorionic presentation).

Fifty women with the neuropsychic form of premenstrual syndrome (PMS), including 15 patients with premenstrual disphoric disorder, were studied. Yarina containing ethynylestradiol 30 μg and drospirenone 3 mg was used to treat this condition. In PMS, the blood content of serotonin was found to be less than that in healthy women; in its severe form (0.26 μM/l), it was less than in its mild form. After treatment serotonin levels was increased by approximately by 3 times. Most patients were observed to have a significant reduction in the symptoms of PMS, including in the severe form of the disease. Low blood serotonin concentrations may serve as a prognostic sign of the insufficient efficiency of drospirenone therapy.

The clinical efficiency of focused ultrasound use under guidance of magnetic resonance imaging (FSU-MRI) was evaluated. Retrospective and prospective studies were made in 1087 patients aged 20 to 55 years. A total of 645 RSU-MRI procedures were performed on an ExAblate-2000 unit under guidance of MRI 1.5 Tesla in March 2006 to March 2009. There were two groups: 1) a randomized option; 2) option in accordance with the developed criteria. Their follow-up lasted 3.5 years. The standard and specifying methods were employed. FSU coagulation results in a blood flow reduction in the node and regression of major clinical manifestations. Its clinical effect and remission duration depend on the volume of FSU destruction and the type of uterine myoma. The technique is effective in treating the symptomatic myoma meeting the selection criteria, in preventing the clinical manifestations of the diseases, and in preparing for myomectomy.