No 1 (2011)

The paper gives data on the impact of the maternal status on further development of a baby of the first year of life. It describes risk factors for psychosomatic and psychoautonomic disorders and defines the prognostic role of genetic or biological, organic cerebral, and psychosocial risk factors in the development of psychosomatic disorders in the baby. The functions of the mother-child system are examined in detail; different impairment stages in its development are presented. The basic principles of a psychoprophylactic service, its purposes, and tasks are outlined.

Objective. To evaluate the impact of overweight and obesity on hemostasis and the course of pregnancy and labor. Subjects and methods. 248, 134, and 118 normal weight, overweight, and obese pregnant women, respectively, were examined. Clinical and statistical methods were used; coagulative, thrombocytic, and fibrinolytic hemostases were studied over time by trimesters. Results. In obese and overweight women, pregnancy was significantly more frequently complicated by gestosis, chronic placental insufficiency, and premature labor. The neonates from the mothers in these groups had lower weight and height values than those from normal weight women. The most pronounced thrombogenic shifts in coagulative and fibrinolytic hemostases were observed in obese and overweight pregnant women in the first and second trimesters, respectively. Body mass index, a history of premature labor, concomitant gestosis, and fibrinogen levels during the second trimester are the most important factors independently associated with premature birth. Conclusion. Prepregnancy body mass index (Quetelet index) should be borne in mind in pregnant women to identify overweight and obesity groups. The women in these groups are in need for hemostasis monitoring to assess a thrombotic risk and to elaborate an antithrombotic correction program. Body mass index, a history of premature labor, gestosis, and fibrinogen levels during the second trimester should be taken into account when predicting the risk of preterm birth.

Objective. To compare the efficiency of different doses of recombinant human erythropoietin (rhEPO) and the frequency of its use for the treatment of anemias in pregnant women. Subjects and methods. Fifty women who were treated at the pregnancy pathology units of the maternity hospitals and who were followed up at the antenatal clinics of Ryazan were divided into 3 groups. The patients’ mean age was 23.8±2.42 years; the mean gestational age was 29.2±8.54 weeks. In Group 1 pregnant patients (n = 15), rhEPO was administered subcutaneously in a dose of 75 IU/kg thrice weekly; Group 2 (n = 21) received the agent in a dose of 100 IU/kg thrice weekly; Group 3 (n = 14) had it in a dose of 120 IU/kg twice a week. The therapy duration was 2 weeks. All the pregnant women were additionally given oral ferrous sulfate (Fe 2+) 200 mg daily. Hemogram parameters, including hemoglobin (Hb), reticulocytes (Rt), red blood cells, and platelets, were estimated by using a Systex 2000i hematology analyzer (Japan) before, every three weeks during, and after rhEPO therapy. Results. In Group 1, a significant increase in Hb and Rt levels was achieved only in 6 (40%) of the 15 women (the total weekly dose of rhEPO was 225 IU/kg). In Group 2, the goal Hb level was seen in 16 (76.5%) of the 21 women (p < 0.05 vs Group 1); the total weekly dose of rhEPO was 300 IU/kg). The administration of rhEPO (the total weekly dose was 240 IU/kg) resulted in a significant increase in hematological parameters in 7 (50%) of the 14 pregnant women in Group 3. Conclusion. The subcutaneous administration of rhEPO in a dose of 100 IU/kg thrice weekly is an optimal rhEPO therapy regimen for anemias in pregnancy.

Objective. To study the clinical and morphological characteristics of neonatal sacrococcygeal teratomas (SCT). Subjects and methods. Sixteen newborn infants (10 girls and 6 boys) were operated on for SCT in 2005 to 2010. Results. All the cases of SCT were shown to be ultrasonographically diagnosed at 14-35 weeks (mean 24.4 weeks) of gestation. Labor occurred at 29-39 weeks (mean 36.6 weeks) of gestation, 15 of them underwent cesarean section. SCT sizes varied from 4 to 20 cm. Among the study teratomas, types 1 and 2 were diagnosed in 8 and 6 patients, respectively; type 3 was found in 1 case and type 4 in 1. A morphological study revealed mature teratomas in 15 cases and an immature benign teratoma in 1. Conclusion. The paper underlines the need for an adequate SCT morphological study that defines the specific features of postoperative patient management.

Academician V. I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia, Moscow Objective. To study the profile of cytokine mRNA gene expression in the vaginal smears by the real-time reverse transcription polymerase chain reaction technique. Subjects and methods. Seventy-six women of reproductive age were examined; of them 34 had verified chronic recurrent vulvovaginal candidiasis (CRVC). The indicator cycle comparison method (AACq method) adjusted for 5 reference genes was used to quantify mRNA gene expression. Results. CRVC was shown to be accompanied by the increased mRNA expression of proinflammatory cytokines (TNF-α, IL-lβ, IL-6, IL-8, and IFN-γ) and IL-10 and the decreased mRNA gene expression of IL-18 and IL-12α/p35. Conclusion. The findings suggest that the cytokines IL-1β, TNF-α, IL-8, IL-18, IL-12α/p35, IL-10, IFN-γ, and CD45 play a significant role in the development of an inflammatory process in CRVC.

Objective. To evaluate vaginal biocenosis in reproductive-age women, by using a real-time polymerase chain reaction (RT-PCR) technique. Material and methods. The composition of vaginal biocenosis was quantified in 684 non-pregnant women of reproductive age. Results. It has been found that an intermediate-type smear, whether clinical manifestations are present, and a normal-type one in the presence of the clinical manifestations of vaginal abnormality require an in-depth vaginal biocenosis study comprising the qualitative RT-PCR of the composition of the microbiota.

Objective. To study rational methods for diagnosis and therapy in patients with chronic inflammatory reproductive system diseases after early miscarriage. Subjects and methods. Ninety-seven patients who had had spontaneous miscarriage at 13—21 weeks of gestation were examined. The authors used clinical, bacterioscopic, bacteriological, and laparoscopic studies, enzyme immunoassay, and polymerase chain reaction to study the epithelial cells of the vagina and cervical canal of the uterus, and endometrium, as well as ultrasound study. The results of the study were statistically processed. Results. A morphological study of placental tissue and clinical and laboratory diagnostic examinations confirmed that the patients had chronic endometritis and salpyngoophoritis. Conclusion. Rational antimicrobial therapy for chronic inflammatory processes in the small pelvic reproductive organs, which promotes the elimination of infectious agents, is an important factor of pregravid preparation of patients with early miscarriage. Its use must be combined with that of agents having an antimycotic effect and those enhancing the induction of interferons.

Objective. To determine the effect of zoledronic acid on bone metabolism markers in women with postmenopausal osteoporosis. Subjects and methods. Thirty women with postmenopausal osteoporosis treated with zoledronic acid in dose 5 mg once a year were followed up. The investigators assessed clinical and medical history data, evaluated the gynecological and somatic statuses, and made laboratory and instrumental studies: clinical and biochemical blood tests, general urinalysis, determination of serum bone metabolism markers (B-Crosslaps, osteocalcin), electrocardiography and a therapist’s examination if needed, as well as osteodensitometry. Results. Therapy with zoledronic acid 5 mg once a year was followed by a significant reduction in resorption markers (B-Crosslaps) just following a month, by reaching the lowest values after 3 months and gradually increasing up to the premonopausal level 12 months later. Formation markers decreased to a lesser degree, which was indicative of preserved positive bone-remodeling balance during the therapy. A weak response to therapy was found in 13% of the patients. Conclusion. Zoledronic acid therapy exerts a rapid and potent effect on bone metabolism, mainly by inhibiting the resorption processes. Determination of biochemical markers of bone remodeling permits assessment of an individual patient response to antiresorptive therapy just in the first months after infusion.

Objective. To study the efficacy of safocid in patients with sexually transmitted infections (urogenital trichomoniasis, chlamydial infection, Mycoplasma genitalium-associated urogenital diseases), nonspecific urogenital infectious diseases (bacterial vaginosis, urogenital candidiasis) and in their sexual partners. Subjects and methods. The study enrolled 50 patients (25 married couples) aged 18 to 45 years. All the patients received therapy with safocid given in a single oral dose of all 4 tablets contained in a blister pack. Results. The performed therapy could eradicate pathogenic and opportunistic agents in 98 and 96% of cases, respectively. Monitoring of vital functions revealed no clinically important abnormalities in any of the examinees. Conclusion. Safocid (a set of tablets) may be recommended for therapy of urogenital infectious diseases since it is a highly effective and easy-to-use drug showing a low frequency of side effects.

Objective. To study the regional aspects of stillbirth from its rates and causes as a basis for elaborating measures for its reduction. Material and methods. The 2008 official statistical data in the Russian Federation (RF) and its areas were studied. An aggregate of RF’s subjects was divided according to the rate, by applying the percentile distribution. Results. The study indicated that stillbirth rates were at the 2nd percentile (5.25‰) in the bulk of RF areas (n = 36 or 43.4%). Stillbirth rates at the 3rd percentile (6.375‰) were noted in 20 (24.1%) areas and those at the 1st percentile (less than 4.125‰) were in 16 (19.3%) areas and those at the 4th percentile (as high as 7.5‰) in 11 (13.2%) areas. The presented data clearly demonstrate that there were differences in percentile distribution of stillbirth rates by the federal districts of the Russian Federation. The areas at the 1st percentile (less than 4.125‰) ranged from 33.4% in the Siberian Federal District (SiFD) to 5.6% in the Central Federal District (CFD). Those with stillbirth rates at the 2nd percentile did from 61.5% in the South Federal District to 28.6% in the Volga Federal District (VFD). The areas with stillbirth rates at the 3rd percentile varied from 42.8% in the VFD to 7.7% in the SoFD. Those with as high as 7.5‰ rate did from 8.3% in SiFD to 27.8% in the CFD. Conclusion. When elaborating the measures to reduce stillbirth rates, one should use the experience in organizing an obstetric service of the areas with low rates that could be obtained, by decreasing causes, such as birth injury, birth asphyxia, and congenital malformations.