No 4 (2010)

The investigation was undertaken to evaluate the efficacy of recombinant activated factor VII (rFVIIa), the drug NovoSevenR, used in massive obstetric hemorrhage (MOH) during pregnancy, labor, and the early postpartum period depending on the cause of bleeding, the volume of blood loss, and the trend in the development of hemostatic disorders. Fifty-two women with MOH were followed up during pregnancy, labor, and in the postpartum period. The investigation used physical examination and hematological and hemostasiological studies. The optimal hemostatic effect of rFVIIa was found in women with massive hypotonic hemorrhage. Its use allowed hysterectomy to be avoided in 80.6% of the women. The administration of rFVIIa was less efficient in patients with MOH and multiple organ dysfunction. rFVIIa is a highly effective hemostatic agent in the treatment of MOH women who are refractory to traditional hemostatic therapy.

The review gives the data available in the literature on Ehlers-Danlos syndrome. It briefly considers its pathogenesis, classification, and clinical picture. Pregnancy and labor management tactics in this pathology, as well as complications are described.

The paper reviews the Russian and foreign literature on stress-induced female urinary incontinence and an association of this pathology with connective tissue dysplasia. It outlines different aspects of connective tissue structural impairments that are directly related to the development of urinary incontinence. The impact of polymorphism of genes in connective tissue and a change in their expression on the development of stress-induced urinary incontinence are considered. Determination of gene polymorphism in women with stress-induced urinary incontinence will favor the timely identification of its risk group and its adequate prevention in young women, which is particularly important in pregnant women who have risk factors for stress-induced postpartum urinary incontinence.

The purpose of the study was to determine criteria for predicting the development of pregnancy and labor and perinatal outcomes in acute gestational pyelonephritis, by determining genetic markers (GPIIIα gene) and immunological predictors (ELI-P-Test). One hundred and twenty women with acute gestational pyelonephritis first diagnosed at 7-27 weeks of gestation were examined. The course of pregnancy and labor and fetal status were retrospectively assessed without using the prognostic criteria in 60 control patients (Group 1); prediction was made on the basis of immunogenetic studies in 60 pregnant women (Group 2). In the latter group, the frequency of obstetric complications was higher in the GP IIIα gene PL-AII allele carriers who were hyperreactive at the ELI-P-Test than that in the PL-AI allele ones. The greater the deviations from the normal ELI-P-Test values were, the severer acute gestational pyelonephritis was. In acute gestational pyelonephritis, there was a clear correlation between the frequency of pregnancy complications and the severity of the disease, the allele affiliation by the GPIIIα gene and the serum autoantibody levels as evidenced by the ELI-P-Test.

The aim of the study was to evaluate the efficiency of plasmapheresis used in puerperas with severe postpartum endometritis (PE). Sixty-one puerperas with severe PE were followed up. Of them, 31 patients received therapeutic plasmapheresis sessions (a study group) and 30 patients had traditional therapy for PE (a control group). Peripheral blood parameters, hemostatic state, and the levels of proinflammatory cytokines (IL-1β, IL-6, TNF-α) and C-reactive protein were determined. Incorporation of plasmapheresis into multimodality therapy for PE normalized the general condition of puerperas, reduced the count of white blood cells, and stab neutrophils, activated lymphocytes, and decreased platelet aggregability. The levels of the proinflammatory cytokines and C-reactive protein were significantly decreased in the study group patients. Plasmapheresis as part of multimodality therapy for PE makes it possible to achieve a considerable improvement in laboratory parameters and to favor a reduction in the degree of clinical manifestations of the disease and a more rapid cessation of its major symptoms.

The paper presents autopsy data from 37 children and 8 spontaneous abortions due to generalized intrauterine infection. The latter has been found to affect the frequency and structure of reproductive losses. It is stated that the less severity and shorter duration of the infectious process, the prediction and early diagnosis of chronic placental insufficiency of infectious genesis, and timely therapeutic and preventive measures may serve as an additional tool to decrease reproductive losses.

Preimplantation diagnosis (PD) using the molecular cytogenetic FISH technique was made in 37 married couples with infertility in the 41st superovulation induction cycle. The rate of aneuploidy for chromosomes 13, 21 in embryos was 38,2%; that for chromosomes X, Y, and 21 was 30.4%. In simultaneous aneuploidy for different chromosomes, the discordance in morphological structure differs more frequently than in aneuploidy for one chromosome: from 37.5% (in the study of chromosomes X, Y, 21) to 40% (in the study of chromosomes 13, 21) versus 16.7 and 35%, respectively. The PD technique is highly effective in preventing the birth of a genetically ill offspring.

Twenty-six pregnant women diagnosed as having bacterial vaginosis (BV) in the second and third trimesters were treated with metronidazole. The drug was administered in a daily dose of 0.5 g orally twice daily and 500 mg vaginally overnight. The treatment was proven to be highly effective and safe. Clinical and microbiological recovery occurred in all the pregnant women. Metronidazole turned out to be highly active against obligate anaerobic bacteria and Gardnerella, at the same time it failed to suppress the growth of lactobacilla, which promoted a rapid recovery of the normal concentrations of the lactoflora. There was no complication related to the treatment for BV as nonspecific vaginitis caused by facultative anaerobes. However, 3 pregnant women were observed to have signs of Candida vaginitis after treatment. The side effects (nausea, vomiting, oral metallic taste, etc.) characteristic for metronidazole were absent. The findings allow one to recommend this BV treatment regimen in the second and third trimesters of pregnancy.

The paper comparatively analyzes the fungicidal activity of drugs containing fluconasole as an active ingredient on test strains of 3 yeast species of the Candida genus: C. albicans, C. parapsilosis, and C. glabrata in vitro. This was a double-blind study that used the original fluconasole-containing drug diflucan and its 5 generics. The yeasts were seeded in Saburo and peptone-glucose-yeast extract media. The well-diffusion method was used in the study. The drugs as capsules were tested in suspensions at 2 concentrations: 150 and 2 mg/ml. Intravenous diflucan served as a control. Experiments were thrice carried out in 15-fold replicas. The results were estimated from the yeast growth inhibition area (mm). Comparative study of the fluconasole-containing drugs revealed that diflucan showed the highest statistically significant fungicidal activity on all three model yeast strains when given at the maximum (150 mg/ml) and minimum (2 mg/ml) concentrations. The fungicidal activity of diflucan as a capsule (2 mg/ml) and as a liquid for intravenous injection (2 mg/ml) against both C. albicans and C. parapsilosis did not differ statistically significantly. C. albicans and C. parapsilosis turned out to be most susceptible to diflucan. The latter suppressed C. glabrata growth statistically more significantly than did other test fluconasole-containing drugs.

One hundred and thirty-four patients aged 12 to 18 years with various menstrual dysfunctions and verified hyperprolactinemia were examined. Group 1 included 17 girls with proven pituitary microadenoma and drastically increased prolactin secretion; Group 2 comprised 117 girls with moderate hyperprolactinemia without organic pituitary changes. The clinical picture of hyperprolactinemia was more evident in Group 1. Most patients were observed to have amenorrhea, galactorrhea, and internal genital hypoplasia. Impairments were characterized by polymorphism and were less pronounced in Group 2 patients. Oligomenorrhea (64.9%), abnormal hair growth of various intensity (61.5%), and ovarian polycystosis (50.7%) were most common in this group. Fifty-five of the 134 patients were found to have clinical manifestations of the pubertal hypothalamic syndrome. Examining the secretion of prolactin, gonadotropins, and estradiol revealed considerable shifts in hypothalamic-pituitary-ovarian relationships. An inverse proportional relationship was established between the levels of secretion of prolactin, gonadotropin, and estradiol. The found high incidence of hyperprolactinemia without manifest symptoms (galactorrhea-amenorrhea) characteristic of the hyperprolactinemia syndrome shows it expedient to determine the level of prolactin in all cases of impaired formation of the reproductive system, in dysmenorrhea in particular.

A double-blind placebo-controlled multicenter study of Sagenit was conducted in menopausal patients. Thirty-four women received the drug as a tablet (0.1 g) daily. Therapy was performed for 9 months. Placebo was also given to 36 patients during the same period. Sagenit turned out to be highly effective in abolishing neurovegetative and psychoemotional symptoms. Even when used long continuously for 9 months, the agent caused no adverse reactions, such as endometrial proliferation, and had no effect on the breast. Thus, the use of sagenit may be an alternative to hormonal replacement therapy.