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No 3 (2011)

Articles

MANAGEMENT OF PHYSIOLOGICAL AND COMPLICATED LABOR

SAVELYEVA G.M., KURTSER M.A., KARAGANOVA E.Y., BREUSENKO L.E., TRETYAKOVA M.V.

Abstract

Principles in the management of physiological and complicated labor are presented on the basis of the data available in the Russian and foreign literature, statistic records of the obstetric facilities of the Moscow Healthcare Department and the Center of Family Planning and Reproduction. The factors presently influencing the course of pregnancy and labor are identified. The necessity to revise the concept of normal labor is substantiated. The paper presents the current tactics of a physician in frequently encountered labor complications: premature amniotic sac rupture, advanced pregnancy, breech presentation. It shows it necessary to expand, if any conditions, indications for operative vaginal delivery.
Obstetrics and Gynecology. 2011;(3):4-10
pages 4-10 views

FETOPLACENTAL ANGIOGENESIS DURING NORMAL PREGNANCY: A ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR

PAVLOV K.A., DUBOVA E.A., SHCHEGOLEV A.I.

Abstract

The paper gives the data available in the literature on fetoplacental angiogenesis during normal pregnancy. The processes of placental villous vascularization in different periods of pregnancy are considered in detail. The role of vascular endothelial growth factor and its receptors in placental angiogenesis and vasculogenesis is followed. It is shown that there may be adequate angiogenesis and vasculogenesis in the placenta if the interaction of angiogenic factors is balanced.
Obstetrics and Gynecology. 2011;(3):11-16
pages 11-16 views

OPTIMIZATION OF ANTIRESORPTIVE THERAPY WITH BISPHOSPHONATES

YURENEVA S.V., YAKUSHEVSKAYA O.V.

Abstract

One third of a woman’s life is postmenopausal, i.e. the time of accelerated bone loss, which results in a considerable reduction in bone mineral density and an increase in bone fragility. The first-line drugs for therapy for postmenopausal osteoporosis (PMO) are bisphosphonates (graded validity A). The mean duration of the therapy for PMO is 3 to 5 years. The major problem in treating this disease is low therapy adherence. The design of drugs with the least administrations shows promise for enhancing the adherence to PMO therapy and its effectiveness.
Obstetrics and Gynecology. 2011;(3):17-22
pages 17-22 views

RENAL IMMUNOMORPHOLOGY AFTER PRIOR PREECLAMPSIA

MURASHKO L.E., ILYINSKY I.M.

Abstract

Twenty women with a history of preeclampsia and perinatal losses were examined. Renal biopsy specimens were studied in 17 women at 8 days to 1.5 years after pregnancy completion. Their histological study revealed morphological changes in 7(41.2%) women, which allowed one to think that they had chronic kidney diseases that had been previously unrecognized and erroneously taken as preeclampsia. Fifteen (88.2%) of the 17 women with a history of preeclampsia were found to have the major immunoglobulin classes G, M, A, and complement component C3 in the kidney, which confirms one of the main points of the development of preeclampsia, according to which circulating immune complexes are deposited in the vital organs and exert damaging effects on the latter.
Obstetrics and Gynecology. 2011;(3):23-26
pages 23-26 views

INHERITED AND ACQUIRED THROMBOTIC RISK FACTORS IN WOMEN WITH A HISTORY OF OBSTETRIC PATHOLOGY

DOLGUSHINA V.F., VEREINA N.K.

Abstract

Objective: to study the detection rate of genetic polymorphisms associated with thrombophilia, as well as the structure of thrombotic risk factors and the pattern of chronic somatic diseases in women with a history of obstetric complications. Subjects and methods. One hundred and five women whose mean age was 30.5±5.1 years were examined. The inclusion criteria were a history of recurrent miscarriage; more than 1 loss at 10 weeks or more gestational age; early fetal death; severe preeclampsia; placental insufficiency; premature detachment of a normally situated placenta; two unsuccessful IVF attempts or more. The exclusion criteria were fetal chromosomal abnormalities with reproductive loss; a patient’s refusal to participate in the study. The investigators performed clinical examination, molecular genetic testing for Factor V Leiden (FVL), F II G20210A, C677T MTHFR, Fgb 455 G>A, Leu33Pro GP IIb/IIIa, PAI-1 675 5G>4G and determined lupus anticoagulant, IgM and IgG anticardiolipin antibodies, β2-glycoprotein 1 antibodies, and made quantitative assay of antithrombin III activity. Results. Inherited thrombophilias were found in 102 (97%) cases; of them 85% women had mixed thrombophilias. Antiphospholipid antibodies were detected in 23% of patients, their association with polymorphisms to thrombotic diseases being observed in 21% of cases. The rate of the detected antiphospholipid syndrome was 3.8%. Other risk factors were encountered with a high frequency; these were chronic endometritis (51%), overweight and obesity (40%), and use of combination oral contraceptives (44%). More than one third of the women had a combination of a few risk factors and chronic extragenital diseases.
Obstetrics and Gynecology. 2011;(3):27-31
pages 27-31 views

IGG SUBCLASSES DISTRIBUTION AND PATHOGENETIC ACTIVITY OF AUTOANTIBODIES TO HUMAN CHORIONIC GONADOTROPIN N WOMEN WITH A HISTORY OF REPRODUCTIVE FAILURE

MENZHINSKAYA I.V.

Abstract

Objective. To study the IgG subclass distribution and avidity of anti-human chorionic gonadotropin autoantibodies (anti-hCG) in women with reproductive failure in order to evaluate their pathogenetic activity. Subjects and methods. A study group included 83 women with anti-hCG IgG, of them there were 46 (55.4%) and 25 (30.1%) with a history of miscarriage and infertility, respectively. Their sera were tested for IgG subclasses (1—4) of anti-hCG, as well as circulating immune complexes (CIC) (CIC-C1q, CIC-C3d) by enzyme-linked immunosorbent assay. Results. IgG1, IgG2 and IgG4 subclasses of anti-hCG with a high avidity index were most common in the study group; different spectra of IgG subclasses were observed. There was a preponderance of IgG1 — the latter was seen in 66 (79.5%). Highly avid IgG1 and/or IgG2 were detected significantly more frequently in women with first-trimester spontaneous or threatened abortion after use of assisted reproductive technology for infertility. The mechanisms responsible for immunopathogenesis in the production of anti-hCG are assumed to comprise the activation of the complement system and effector cells. Conclusion. Estimation of the pathogenetic activity of anti-hCG, by determining avidity and IgG subclasses may be of practical significance in the prediction of the course of pregnancy and the development of reproductive failure.
Obstetrics and Gynecology. 2011;(3):32-36
pages 32-36 views

CLINICAL VALUE OF COMPREHENSIVE EVALUATION OF THE ENDOMETRIAL RECEPTOR STATUS IN ENDOMETRIAL POLYPS

KLINYSHKOVA T.V., FROLOVA N.B., MOZGOVOY S.I.

Abstract

Objective. to optimize treatment in patients with endometrial polyps (EP) on the basis of comprehensive evaluation of the clinical and morphological signs of the disease at reproductive age, by examining steroid hormone receptor expression, proliferative activity, and apoptosis in the polyp and adjacent endometrial tissues. Subjects and methods. Transvaginal ultrasound study, hysteroscopy, separate diagnostic curettage, histological and immunohistochemical study of the expression of α-estrogen and progesterone receptors (ER and PR), Ki-67, and bcl-2 in the glands and stroma of polyps and adjacent endometrium were performed in 43 reproductive-age women with EP and 10 control patients. Statistical processing used the Mann-Whitney test, χ 2 test, and Spearman correlation test, by employing a package of applied Statistica 6.0 programs. Results. Chronic endometritis was identified in 60% of the patients with EP. There were the following differences in the receptor apparatus of the adjacent endometrium versus the normal endometrium: ER deficiency with a relative preponderance of PR; unilateral expression of hormone receptors in the polyp and endometrial tissues; a correlation between the proliferative activity and expression of hormone receptors in both the polyp and the endometrium; a correlation of chronic endometritis with apoptosis. Conclusion. Imbalance has been found in the expression of hormone receptors in the adjacent endometrium after polypectomy that correlates with proliferation and apoptosis, which serves as a guide to anti-inflammatory rather than hormone therapy and a basis for the prevention of recurrent EP.
Obstetrics and Gynecology. 2011;(3):37-41
pages 37-41 views

REPRODUCIBILITY OF THE DIAGNOSES OF ENDOMETRIAL HYPERPLASIA ACCORDING TO THE WHO CLASSIFICATION AND THE MODIFIED (BINARY) CLASSIFICATION

KONDRIKOV N.I., ASATUROVA A.V., MOGIREVSKAYA O.A., BARINOVA I.V., ANDREYEV A.I., NAZHIMOV V.P.

Abstract

Objective. to study of the reproducibility of the diagnoses of endometrial hyperplasia (EH) by the leading gynecological pathologists of Moscow on the basis of the WHO classification (2003) and the modified (binary) classification that proposes two types of EH instead of four ones. Materials and methods. The study included 60 histological endometrial scraping specimens with diagnosed different types of EH, low-grade adenocarcinoma of the endometrium and the corpus uteri mucosa at the stage of proliferation and secretion. Results. There was a coincidence of the WHO classification-based diagnoses among the pathologists when examining endometrial scrapes in 31 of the 60 women; the other cases showed a discrepancy in the diagnoses. The к index in the diagnosis of the intact and abnormally altered endometrium averaged 0.59 (0.91 to 0.61). With the binary system for the diagnoses of endometrial pathological changes being used, there was a coincidence in histological conclusions made by the pathologists in 48 (80%) cases. The к index in the diagnosis of low- and high-grade EH averaged 0.72 (0.68 to 0.74). Conclusion. When the binary system is applied, the reproducibility rate for the diagnoses of EH is higher than that when the WHO classification is used, which permits the authors to recommend the binary classification to improve the diagnosis of EH. The reproducibility of its diagnoses can be also enhanced using immunohistochemical markers, among which the tumor suppressor PTEN, the proliferative marker Ki-67, the apoptotic marker Bcl-2, as well as steroid hormone receptors, insulin-like growth factors, and their receptors are most important.
Obstetrics and Gynecology. 2011;(3):42-46
pages 42-46 views

POTENTIAL SERUM PROTEOMIC MARKERS OF BENIGN UTERINE DISEASES

SOROKINA A.V., RADZINSKY V.E., SOKHOVA Z.M., KOSIKOVA T.A., ZIGANSHIN R.K., ARAPIDI G.P., GOVORUN V.M.

Abstract

Objective. To detect potential peptide markers in the female serum, which are suited for the diagnosis of benign uterine diseases, by applying the functionalized magnetic beads. Materials and methods. Proteomic profiling of sera from apparently healthy women (n=133; mean age 40 years) and female patients with the verified diagnoses of adenomyosis (n=63; mean age 40 years), uterine myoma (n=48; mean age 42 years), and endometrial hyperplastic processes (n=24; mean age 41 years) by means of MB-WCX magnetic beads with weak cation exchange surface enables the authors to build up classification models with the sensitivity and specificity being close to 100%, by employing a genetic algorithm and a controlled neuronic network. Results. Analysis of the statistical area variation diagrams incorporated into the classification models of mass spectrometric peaks between different groups of samples could reveal 3 peaks for adenomyosis and 3 for uterine myoma. No statistically significant peaks were found for uterine hyperplastic processes. Conclusion. Identification of the proteins specific for adenomyosis and uterine myoma makes it possible to develop innovation methods for the diagnosis, prediction, and treatment of these diseases and to give a better insight into the mechanism of their development, and to substantiate prospects for their treatment.
Obstetrics and Gynecology. 2011;(3):47-51
pages 47-51 views

REGIONAL ASPECTS OF EARLY NEONATAL MORTALITY

PALENAYA I.I., TSYMLYAKOVA L.M., FROLOVA O.G., SHUVALOVA M.P.

Abstract

Objective. To present the regional aspects of early neonatal mortality (ENM) by the index level and causes as a basis for elaborating measures to reduce death rates among live-birth infants during the first week of life. Material and methods. The 2005—2009 official statistical data in the Russian Federation and its areas were analyzed. An aggregate of the areas was divided according to the ENM rate, by applying the percentile distribution. Results. There was a steady reduction in the ENM rate in both the Russian Federation as a whole and in its federal districts. In the period 2005 to 2009, the mean reduction in ENM was 31.4%; with the maximum (46.5%) in the North-Western Federal District and the minimum (16.5%) in the South Federal District. In 2008, 62 (74.7%) areas of the Russian Federation had the 1st percentile (less than 3.9‰); 18 (21.7%) areas had the 2nd percentile (as high as 6.5‰); 2 (2.4%) areas had the 3rd percentile (as high as 9.1‰); and 1 (1.2%) area had the 4th percentile. There were also differences in the causes of both maternal and fetal death in the areas with different ENM rates. Conclusion. When elaborating the measures to reduce ENM, one should use the experience in organizing obstetric and neonatal services of the areas with low rates that could be obtained, by excluding or decreasing the rates of causes, such as birth injury, birth asphyxia, and congenital fetal malformations and maternal pregnancy complications.
Obstetrics and Gynecology. 2011;(3):52-56
pages 52-56 views

CLINICAL AND PATHOGENETIC RATIONALE FOR THE USE OF MAGNESIUM PREPARATIONS IN PREGNANT WOMEN WITH ISTHMIC CERVICAL INSUFFICIENCY AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA

KHODZHAYEVA Z.S., GURBANOVA S.R.

Abstract

Objective. To provide a clinical and pathogenetic rationale for obstetric management tactics for pregnant women with isthmic cervical insufficiency (ICI) and undifferentiated connective tissue dysplasia (UCTD) on the basis of complex studies, including molecular biological ones. Subjects and methods. A retrospective analysis of delivery records was made in 532 women and a prospective series of studies was conducted in 140 women with ICI of varying genesis. Genotyping was carried out using polymerase chain reaction; a biochemical study of the levels of magnesium was made in peripheral blood and saliva; the peripheral blood concentrations of matrix metalloproteinases were measured by enzyme immunoassay. Results. The most common markers of UCTD were tall stature, varicosity, mitral valve prolapse, myopia, and neurocirculatory dystonia. Various gestational complications, poor pregnancy outcomes, complicated labor, and birth of premature babies were more frequently noted in groups of pregnant women with functional ICI and those with ICI of mixed genesis. The clinical and laboratory patterns of magnesium deficiency were found in all groups of the examinees, the most pronounced magnesium deficiency being in the pregnant women with ICI of functional genesis. Study of HLA class I showed that the frequency of HLA-B35 antigen was significantly increased as compared to the general population. The significantly higher frequency of the A allele of the ESR-2014 G > A gene (OR 6.57, 95% CI 1.96—22.02), detected in pregnant women with the prolapsed fetal bladder, suggests that carriage of the A allele of the ESR-2014 G>A gene is a risk factor for threatening premature labor. Conclusion. A detailed analysis of the data obtained on ICI-UCTD relationships could confirm the contribution of UCTD to the development of a variety of obstetric complications and define ICI as a visceral marker of UCTD. The findings will promote obstetric alertness and rational management tactics for pregnant women with UCTD.
Obstetrics and Gynecology. 2011;(3):57-63
pages 57-63 views

THE DIAGNOSIS AND TREATMENT OF FUNCTIONAL CONSTIPATION IN PREGNANT WOMEN

CHUKHAREVA N.A., USHKALOVA E.A., BEVZ A.Y.

Abstract

The paper considers criteria for the diagnosis of functional constipations and principles in their treatment during pregnancy. Great attention is given to the choice of drug therapy in the context of its safety for a fetus and its impact on the course of pregnancy. The data by Russian and foreign authors are given, which support the efficacy and safety of lactulose during pregnancy. The results of interviews of 1082 physicians participating in the management of pregnant women are presented, which show that about 40% of the specialists prefer effective and safe lactulose preparations.
Obstetrics and Gynecology. 2011;(3):64-68
pages 64-68 views

TREATMENT USING «АМО-АТОС-Э» AND «АВИМ-1» APPARATUSES IN WOMEN WITH PELVIC PAIN SYNDROME

SALOV I.A., TKACHENKO L.V., RAIGORODSKY Y.M., TARASENKO Y.N., TIKHAYEVA K.Y., KURUSHINA O.V.

Abstract

Objective. To demonstrate the feasibility of combined use of local and central physiotherapy techniques. Subjects and methods. Ninety-eight women with pelvic pain syndrome of varying etiology (inflammatory diseases of small pelvic organs, pain after surgery, dysmenorrhea, ovulation syndrome) were examined. Vibration and a magnetic field were locally applied to the perineal area, by using the «АВИМ-1» apparatus. A central exposure included a combination of transcranial magnet therapy and electrostimulation, by employing the «АМО-АТОС-Э» device. Results. The concurrent use of local and central physiotherapy techniques in combination with drug therapy, if indicated, could reduce pain syndrome by 64.6%, autonomic dysfunction by 30%, and cerebral circulatory disorders by 18% and improve the basic parameters of microcirculation by 1.5—2 times, as compared with the control group. At the same time, systemic resistance increased in 72% of the women, by providing a higher reproductive potential to emerge pregnancy.
Obstetrics and Gynecology. 2011;(3):69-73
pages 69-73 views

A PROBLEM IN THE UNREGULATED USE OF INTRAVENOUS IMMUNOGLOBULIN IN OBSTETRICS

USHKALOVA E.A., SHIFMAN E.M.

Abstract

Intravenous immunoglobulin belongs to the drugs most frequently used for unregistered indications, including obstetric ones. A review of published clinical trials and meta-analyses does not make it possible to recommend its use in women with recurrent miscarriage of unknown etiology and in pregnant women with antiphospholipid syndrome and to improve the results of in-vitro fertilization in those with a history of unsuccessful implantation. The use of intravenous immunoglobulin for these indications is considered by experts as investigatory and recommended only within the framework of randomized clinical trials.
Obstetrics and Gynecology. 2011;(3):74-80
pages 74-80 views

ANTENATAL PREVENTION OF NEONATAL RESPIRATORY DISTRESS SYNDROME

PAVLOVICH S.V.

Abstract

The paper describes approaches to the antenatal prevention of neonatal respiratory distress syndrome. It analyzes the feasibility of using antenatal corticosteroid therapy in different pregnancy periods and discusses the efficiency of repeated courses of drugs and the expediency of their administration. Methods to estimate fetal lung maturity are presented.
Obstetrics and Gynecology. 2011;(3):81-85
pages 81-85 views

PREGNANCY AND LYMPHOMAS: MANAGEMENT TACTICS, PRINCIPLES IN DIAGNOSIS AND TREATMENT

SHMAKOV R.G.

Abstract

Based on foreign investigators’ data and his findings, the author has developed and summarized indications for and contraindications to pregnancy prolongation, as well as pregnancy management tactics in women with lymphomas. An analysis of children’s physical development and the rate of congenital and acquired diseases in newborn infants born to mothers who fell ill with hemoblastoses during pregnancy or sustained this disease and gave birth in complete remission showed no significant differences from those in the general population. Pregnancy and its maintenance at any stage of the disease fail to affect therapeutic efficiency and life span in patients with lymphomas.
Obstetrics and Gynecology. 2011;(3):86-92
pages 86-92 views

Professor M.M. Shekhtman

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Obstetrics and Gynecology. 2011;(3):93-94
pages 93-94 views

In memory of academician V.I. Grishchenko

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Obstetrics and Gynecology. 2011;(3):95-96
pages 95-96 views

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