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No 4 (2011)

Articles

CLINICAL VALUE OF MOLECULAR MARKERS IN PAPILLOMAVIRUS INFECTION

ROGOVSKAYA S.I., TROFIMOV D.Y., KOGAN E.A., SABDULAYEVA E.K.

Abstract

The paper briefly reviews methods for diagnosing human papillomavirus-associated lesions of the cervix uteri. It gives an update on the role of molecular markers as potential screening tests for detecting the early precursors of cancer of the cervix uteri and for predicting the course of the infection.
Obstetrics and Gynecology. 2011;(4):4-10
pages 4-10 views

CAN THE FMR1 GENE BE CONSIDERED AS A PREDICTOR OF EARLY OVARIAN AGING?

SHAMILOVA N.N., MARCHENKO L.A.

Abstract

The review considers the role of various genetic causes of premature ovarian aging with considerable attention given to the FMR1 gene located on the X chromosome long arm at Xg27.3. It has been ascertained that the CGG repeat length of the FMR1 gene may be one of the early objective predictors that indicate the risk of premature ovarian failure and may serve as a new test for predicting ovarian functional activity.
Obstetrics and Gynecology. 2011;(4):11-15
pages 11-15 views

ENDOMETRIAL HYPERPLASTIC PROCESSES: ETIOPATHOGENESIS, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

SHESHUKOVA N.A., MAKAROV I.O., FOMINA M.N.

Abstract

The review presents the currently available literature data on different aspects of endometrial hyperplastic processes. It considers some concepts of this pathology development and gives data on the risk of malignization of different types of endometrial hyperplastic processes and on basic treatment methods.
Obstetrics and Gynecology. 2011;(4):16-21
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NORMAL 3D/4D-ECHOGRAPHIC ANATOMY OF THE EMBRYONIC AND FETAL CENTRAL NERVOUS SYSTEM IN THE FIRST TRIMESTER OF PREGNANCY

VOYEVODIN S.M.

Abstract

Subjects objective. To investigate the capabilities of current 3D/4D echography in studying the normally developing structures of the embryonic and fetal brain in the first trimester of pregnancy. Material and methods. The experience in using transabdominal and transvaginal 3D/4D echography in 114 healthy pregnant women at 5—14 weeks gestational age served as a material. The parietococcygeal length in the embryos and fetuses varied from 3 to 75 mm. After birth, all the babies were found to have no neurological symptoms. Results. The quantitative changes in the echographic image of certain brain structures in the first trimester of pregnancy allowed 9 stages to be identified in the ontogenetic development of the brain. The use of 3D/4D echography permits visualization of brain structures irrespective of the location of an embryo in the uterine cavity. Conclusion. 3D/4D ultrasound has been shown to be of high informative value in identifying certain embryonic and fetal brain structures at 7 weeks of gestation, which forms the basis for the early detection of central nervous system malformations.
Obstetrics and Gynecology. 2011;(4):22-25
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ROLE OF ARGININE IMBALANCE IN THE DEVELOPMENT OF PLACENTAL INSUFFICIENCY

LINDE V.A., POGORELOVA T.N., DRUKKER N.A., KRUKIER I.I., GUNKO V.O.

Abstract

Objective. To study the metabolic features of arginine and the placental production of its derivatives during physiological pregnancy and placental insufficiency. Subjects and methods. The study was conducted in 36 women with placental insufficiency, who were divided into 2 groups depending on the term of labor (36—37 and 39— 40 weeks of gestation) and in 20 females with uncomplicated pregnancy and labor (a control group). Biochemical methods and electron paramagnetic resonance spectrometry were applied. Results. Significant changes were found in the levels of arginine and proline, the activity of arginase and nitric oxide synthase, and the rate of production of nitric oxide, peroxynitrite, nitrosothyrosine, and nitrosoglutathione in the placenta in its insufficiency. The degree of modification of the metabolites under examination was more pronounced in the placenta of women with complicated pregnancy during preterm labor than in that of women with full-term labor. There were relationships between the activity of enzymatic processes and the level of substrates and end products of respective biochemical reactions.
Obstetrics and Gynecology. 2011;(4):26-30
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THROMBOPHILIA AND PREGNANCY: PREDICTION OF PERINATAL COMPLICATIONS AND OPTIMIZATION OF MANAGEMENT TACTICS

PUTILOVA N.V.

Abstract

Objective. To study the role of endogenous intoxication syndrome (EIS) in the pathogenesis of thrombophilic complications during pregnancy and to provide a rationale for incorporation of a carbon hemosorption (CHS) technique into a complex of antithrombotic therapy. Subjects and methods. Ninety-six non-pregnant women with thrombophilia, 249 pregnant women with thrombophilia, 34 apparently healthy non-pregnant women, and 78 apparently healthy pregnant women were examined. The optical density of protein-free extracts of plasma and red blood cells was studied to detect low- and medium-weight molecules (LWM and MWM); the count of circulating endotheliocytes, the adhesive activity of platelets, and their aggregatory function were determined. Results. As compared with the controls, the thrombophilic patients showed significant endotoxicogram differences that were indicative of varying degree of EIS outside pregnancy and during its progression. EIS leads to the development of endothelial dysfunction attended by increases in the count of endotheliocytes and in the rate and degree of platelet aggregation. After CHS, there was a marked decrease in both the plasma and red blood cell levels of LWM and MWM and a significant reduction in integral coagulation index. Normalization of uteroplacental and fetoplacental blood flows was achieved in 76.4%. Conclusion. The detection of EIS and early signs of systemic endotheliosis may serve as an important diagnostic and prognostic criterion in the comprehensive evaluation of maternal and fetal status. The CHS shows a high efficiency in affecting the main components of the pathogenesis of thromboses, considerably improves the performance of the fetoplacental unit, and causes an increase in good perinatal outcomes.
Obstetrics and Gynecology. 2011;(4):31-35
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CESAREAN SECTION IN THE UNFORMED LOWER UTERINE SEGMENT

KRAMARSKY V.A., DUDAKOVA V.N., SVERKUNOVA N.L.

Abstract

Objective. To determine the optimum technology for cesarean section in pregnant women with the unformed lower uterine segment. Subjects and methods. Eighty-eight puerperas were examined after cesarean section carried out in the presence of the unformed lower uterine segment. A transverse semilunar incision was made in 30 cases; an isthmic cervical incision was done using the Shmiden method and separate knotty sutures in 32; the modified Stark’s procedure applying a double-row suture was performed in 26, as described by Reverden. The nature of reparative processes at the site of the uterine incision was assessed from suture involution index, protein coefficient, and trends in the cytological pattern of uterine cavity aspirate. Results. The least good healing occurred after use of an isthmic cervical incision. The best healing was observed when the modified Stark’s procedure (a semilunar diagonal incision and Reverden suturing) was applied. This is indicated by the higher suture area evolution index and the time course of changes in cytological parameters and in the levels of immunoglobulins in the metroaspirate. Conclusion. The findings enable one to recommend this surgical technique in women with the unformed lower uterine segment.
Obstetrics and Gynecology. 2011;(4):36-39
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ROLE OF ESTROGEN RECEPTOR-ALPHA (ESR1) GENE POLYMORPHISM IN INADEQUATE UTERINE SCAR FORMATION AFTER CESAREAN SECTION

SUKHIKH G.T., KESOVA M.I., DONNIKOV A.E., KAN N.E., BOLOTOVA O.V., KOGAN E.A., DEMURA T.A., KLIMANTSEV I.V., AMIRASLANOV E.Y., SANNIKOVA M.V., ABRAMOV D.D., KADOCHNIKOVA V.V., ORDZHONIKIDZE N.V., TRIFONOV D.Y.

Abstract

Objective. To search for associations of ESR1 gene polymorphism with the morphological and clinical signs of uterine scar inadequacy after previous cesarean section. Subjects and methods. One hundred and sixty patients with post-cesarean uterine scar were examined. According to biopsy specimen morphological evidence, the authors identified 2 groups: 1) 80 patients with inadequate scars and 2) 80 patients with adequate ones. ESR1 gene polymorphisms, such as Ser10Ser 30A>G (rs2077647/ rs17847075), Pvull -397 T>C (rs2234693), Xbal -351G>A, (rs9340799), Thr594Thr 2014G>A (rs2228480), and 1029C>T(rs3798577), were defined. Results. Analysis of individual ESR1 gene loci revealed no statistically significant association between the status of a scar and the genotype distribution of the study polymorphisms. However, an analysis of the linkage of the chosen polymorphisms showed its most significant disequilibrium between the polymorphisms -397 T>C (Pvull) and -351 G>A (Xbal) D’=0.991 (0.95—1.00), LOD=16.98. The frequency of the CA haplotype was substantially higher in women with the signs of scar tissue inflammation (17.2 versus 5.4%; p=0.046). The odds ratio for scar inadequacy in carriage of this haplotype was 3.7 (1.0—14.0). Conclusion. According to the ESR1 polymorphisms -397 T>C (Pvull) and -351 G>A (Xbal), CA haplotype carriage is a risk factor for inadequate scar formation after cesarean section.
Obstetrics and Gynecology. 2011;(4):40-44
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ENDOCRINE AND METABOLIC FEATURES IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

SUKHIKH G.T., BIRYUKOVA A.M., NAZARENKO T.A., DURINYAN E.R.

Abstract

Objective. To specify the diagnostic criteria and endocrine and metabolic disturbances, which are characteristic of polycystic ovary syndrome (PCOS). Subjects and methods. A single-stage direct prospective study was conducted. A study group comprised 98 patients with PCOS, whose mean age was 27.7±4.2 years; a control group included 62 patients without PCOS, whose mean age was 28.4±3.2 years. Conventional clinical anamnestic, hormonal, echographic, and biochemical studies were performed. Results. Anovulation, menstrual irregularities, and ultrasound signs of polycystic ovaries were absolute symptoms of PCOS. More than half of the patients with PCOS had higher luteinizing hormone levels and biochemical hyperandogenism. Obesity, insulin resistance, glucose intolerance, and dyslipidemia are not pathognomonic signs of PCOS. Overweight is of basic value in developing metabolic disturbances; and impaired carbohydrate and lipid metabolisms worsened in the presence of endocrine changes that are characteristic of PCOS. Conclusion. Routine general clinical examinations and conventional laboratory tests have demonstrated no direct associations of PCOS with metabolic disturbances. In this connection, an attempt to reveal any genetic markers predisposing to the development of both the very PCOS and its clinical symptoms is promising.
Obstetrics and Gynecology. 2011;(4):45-49
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PROGNOSTIC CRITERIA FOR SUCCESSFUL OVULATION INDUCTION N PATIENTS WITH PREMATURE OVARIAN FAILURE

ZHAKHUR N.A., MARCHENKO L.A., BUTAREVA L.B., KUZMICHEV L.N., KINDAROVA L.B.

Abstract

Objective. To search for possible prognostic criteria for successful ovulation induction in patients with premature ovarian failure (POF). Subjects and methods. The results of ovulation induction were retrospectively analyzed in 35 patients with POF. All the patients had previously undergone a full clinical and laboratory examination. According to their treatment response, the patients were divided into 3 groups: A) 23 patients without activation of folliculogenesis; B) 6 patients with growth of follicles greater than 10 mm, but their subsequent atresia, and C) 6 patients with verified ovulation. Results. Comparison of women with ovulation and without follicular growth revealed statistically significant differences in the following indicators: mean age at amenorrhea onset (26.8±6.2 and 32.0±3.35 years, respectively; p=0.036); rate of the familial form of the disease (33.3 and 3.4%, respectively; p=0.017), autoimmune comorbidity (0 and 48.3%, respectively p = 0.008); mean blood testosterone levels (1.07±0.5 and 0.69±0.1 nmol/l, respectively; p=0.03); detection rate for perioophoritis (0 and 35.3%, respectively; p=0.037). The relative risk of a poor ovarian response to stimulation showed 7- and 3.6-fold increases in autoimmune comorbidity and in the detection of perioophoritis, respectively. No statistically significant differences were found between the groups in baseline blood anti-Müllerian hormone (AMH) levels and ovarian volume. Conclusion. Later onset irrespective of the duration of amenorrhea, its family form, no autoimmune comorbidity, and higher blood total testosterone concentrations (more than 1 nmol/l) may be good predictors of ovulation induction in patients with POF. The generally accepted criteria for predicting ovarian response in patients with preserved menstrual function (serum AMH level, ultrasonographic ovarian volumes) in patients with POF cannot be regarded as significant.
Obstetrics and Gynecology. 2011;(4):50-55
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INTRAUTERINE EFFECTS OF LEVONORGESTREL IN ENDOMETRIAL HYPERPLASIA: CLINICAL AND MORPHOLOGICAL ASPECTS

CHERNUKHA G.E., MOGIREVSKAYA O.A., SHIGOREVA T.V., GRIBANOVA N.D.

Abstract

Objective. To clinically and morphologically evaluate the intrauterine effects of levonorgestrel in different forms of endometrial hyperplasia (EH). Subjects and methods. One hundred and twenty-eight patients with EH were followed up. After histological verification of the diagnosis, the Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) was inserted in all the patients. Clinical and laboratory indicators were monitored at baseline and after LNG-IUS insertion: the authors assessed hormonal and echographic parameters at a 3-month interval and endometrial morphology and immunohistochemical evidence at a 6-month interval. Results. After 6 months of LNG-IUS use, 118 (95.2%) patients had no morphological signs of EH, 6 (4.8%) preserved hyperplastic endometrial foci classified as simple EH. Therapeutic efficiency was found to be determined by the signs of endometrial glandular cellular atypia rather than a patient’s age. Thus, a complete morphological effect was achieved in all patients with simple and complex EH and only in 76.2% of those with atypical EH. Conclusion. The results obtained during the study enable one to consider it justifiable to use intrauterine LNG as a highly effective procedure for the treatment of simple and complex EH and as an alternative to that of atypical EH in reproductive-age women who are interested in becoming pregnant and to regard LNG-IUS as a method for the secondary prevention of EH.
Obstetrics and Gynecology. 2011;(4):56-62
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ENDOMETRIAL HYPERPLASTIC PROCESSES AT DIFFERENT AGES: STUDY OF CYTOKINE STATUS AND SFAS LIGAND LEVELS

LYSENKO O.V., ZANKO S.N.

Abstract

Objective. To study the local and systemic levels of cytokines and sFas ligand in endometrial hyperplastic processes and polyps at reproductive and premenopausal ages. Subjects and methods. One hundred and thirty-one women were examined. The patients were divided into 6 groups according to their age and histological findings. The patients’ uterine cavity aspiration specimens and sera were used to measure the concentrations of interleukin-2, intereukin-4, tumor necrosis factor-α, and sFas ligand by solid-phase enzyme immunoassay. A p value < 0.05 was regarded as significant. Results. Significant differences were found in the concentrations of cytokines and sFas ligand in the uterine aspiration specimens from the patients with endometrial hyperplasia and polyps versus the controls of reproductive and premenopausal ages. All the groups showed signif icant differences in the uterine aspiration specimens and serum concentrations of cytokines and sFas ligand. Their concentrations were significantly higher in the uterine cavity aspiration specimens than those in the sera. There were no differences in the serum levels of cytokines and sFas in all the groups. Conclusion. Prior inflammatory diseases, intrauterine interventions, or intrauterine contraception may be a cause of local immunity dysfunction and Fas-dependent apoptosis in endometrial pathology. The determination of cytokines and sFas ligand in the uterine cavity aspiration specimens may be a useful diagnostic marker of endometrial hyperplasia and polyps.
Obstetrics and Gynecology. 2011;(4):63-68
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PREVALENCE OF VARIOUS HUMAN PAPILLOMAVIRUS GENOTYPES IN CERVIX UTERI DISEASE

DOLGUSHINA V.F., ABRAMOVSKIKH O.S.

Abstract

Objective. To study the incidence of high-risk human papillomavirus (HPV), its genotype spectrum, and load. Subjects and methods. Molecular biologically studies of cervical canal scrapes were conducted in 773 female outpatients. Results. High-risk HPV was identified in 58.2% of the women. Whether clinical cervix uteri changes were present or absent, HPV type 16 held the lead. HPV type 31 was second most frequent in women without clinical and morphological changes in the cervix uteri, in those with chronic cervicitis and cervical intraepithelial neoplasia (CIN) grade I; and all other detectable high-risk HPV types were encountered in different percentage of cases. In patients with CIN grades II-III, HPV type 33 ranked second. HPV types 51 and 59 were undetectable in CIN grade II and III, respectively. In patients with chronic cervicitis and CIN grade I, the viral load exceeded the progression threshold. As morphological changes worsened, the viral load reduced and was in the upper range of significant concentration in patients with CIN grades II-III.
Obstetrics and Gynecology. 2011;(4):69-74
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IMPACT OF CHRONIC INTRAUTERINE DISTRESS ON THE HEALTH STATUS IN BABIES OF THE FIRST YEAR OF LIFE

BAIBARINA E.N., KHODZHAYEVA Z.S., SHATIRYAN L.A.

Abstract

Objective. To study the health status of babies of the first year of life from women with a history of recurrent miscarriage in relation to the severity of the babies’ experienced intrauterine hypoxia as evidenced by antenatal cardiotocography (CTG). Subjects and methods. One hundred and ten babies of the first year of life, who had been delivered via cesarean section due to the worsening in the fetal status at 37—40 weeks gestation, were examined. The babies were divided into 3 subgroups in relation to the CTG fetal index (FI). A control group comprised 11 babies from mothers with a history of recurrent miscarriage and with no episode of intrauterine fetal impairment (with normal FI values of 0 to 1, as shown by CTG). The parameters of the babies’ physical development, somatic and neurologic status, neurobehavioral reactions, and psychomotor development were estimated. Results. Postnatal adaptive problems were minimal in Subgroup 1 babies (FI, 1.1-2.0). Subgroup 3 infants (FI, more than 3) sustained acute hypoxia and their urgent delivery contributed to rapid compensation and further favorable adaptation. The most evident abnormalities as various manifestations of impaired postnatal adaptation were noted in Subgroup 2 babies (FI, 2.1-3.0), the state was compensated in the babies delivered within 5 days unlike the infants of the same group who had been longer (over 5 days) exposed to chronic hypoxia and accordingly later deliveries (postnatal difficult adaptation was noted in 85.4% of cases and autonomic and visceral dysfunction and other malformations were in 90.3%). Conclusion. The wait-and-see tactics, by monitoring the fetal status and fetoplacental system, is recommended if the IF is less than 2.0. If only the later becomes higher, delivery is indicated; if FI is greater than 3.0, urgent delivery must be done. It is inexpedient to prolong pregnancy if the IF is within the range of 2.1 to 3.0 for more than 5 days.
Obstetrics and Gynecology. 2011;(4):75-78
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WAYS TO IMPROVE THE QUALITY OF MEDICAL CARE FOR CONGENITAL MALFORMATIONS

KHAMATKHANOVA E.M., KUCHEROV Y.I., FROLOVA O.G., DEGTYAREV D.N., DEMIDOV V.N., MOROZOV D.A., PODUROVSKAYA Y.L., DOROFEYEVA E.I., PIMENOVA E.S., MASHINETS N.V., USHAKOVA I.A.

Abstract

The paper deals with the topical problem of medical tactics in the antenatal diagnosis of congenital malformations. It analyzes the experience of the prenatal council of perinatal center physicians and assesses whether a recommendation to interrupt pregnancy is reasonable in the antenatal diagnosis of surgically correctable fetal congenital malformations. New approaches to organizing medical care at the moment of the intrauterine diagnosis of fetal congenital malformations are given, by using the experience of the Academician VI. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia, as an example.
Obstetrics and Gynecology. 2011;(4):79-84
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COMPARATIVE ANALYSIS OF ABORTIONS IN THE RUSSIAN FEDERATION AND ITS REGIONS

SHUVALOVA M.P., VOLGINA V.F., PROTOPOPOVA T.A., CHAUSOV A.A., SUKHANOVA L.P.

Abstract

Objective. To comparatively analyze the trend in abortions and their patterns in the country as a whole and its regions from their rates per 1000 women of reproductive age and per 100 live and still births. Material and methods. The official statistical data of the Ministry of Health and Social Development of Russia on abortions in the Russian Federation (RF) and its regions in 2005—2008 were used; the trend in abortion rates was analyzed in this period; an aggregate of the areas was divided according to the abortion rates, by applying the quartile distribution. Results. The number of abortions per 1000 women of reproductive age and 100 live and still births dropped in both the country as a whole and in its all federal districts. The vast majority (93.5%) of abortions were performed at less than 12 weeks gestation. According to the quartile distribution of the number of abortions, this indicator exceeded the mean rate (32.9%) in most RF subjects. Conclusion. For a further reduction in the number of abortions, it is necessary to improve preventive measures against abortions, mainly medical (legal) ones, and to introduce the positive experience accumulated in the regions.
Obstetrics and Gynecology. 2011;(4):85-88
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EVALUATION OF THE CLINICAL EFFICACY OF A VITAMIN-AND-MINERAL COMPLEX FOR THE PREVENTION OF PREGNANCY COMPLICATIONS

MOZGOVAYA E.V., PROKOPENKO V.M., OPARINA T.I., NOVIKOVA T.D.

Abstract

Objective. To evaluate the efficacy of elevit pronatal in the prevention of iron-deficiency anemia (IDA) and gestosis during pregnancy. Subjects and methods. The study enrolled 60 pregnant women treated in the first trimester for threatening miscarriage or for the need for invasive prenatal diagnosis at the Antenatal Department, D. O. Ott Research Institute of Obstetrics and Gynecology. These women were later observed in the first, second, and third trimesters of pregnancy. Their clinical and laboratory examination (before and 1 month after the use of the test drug) included clinical and biochemical (serum iron, ferritin, transferrin, homocysteine, total protein, and the electrolytes Ca, K, Na, Mg) blood analyses and determination of blood total antioxidative and total antiradical activities (AOA and ARA). The course of pregnancy and labor outcomes were estimated. Results. Prior to the use of elevit prenatal, the first trimester was marked by the enhanced total AOA that was 0.795±0.051 relative units. With the drug use, the patients showed a significant increase in serum iron levels within the physiological range; there was normalization of total AOA up to 0.731±0.043 relative units (p > 0.05). Before start of therapy, serum total ARA was in the lower normal range, which was 783.0±31.6 μmole. In the third trimester, 3 (5.5%) patients with multiple pregnancy were found to have gestosis that was mild (up to 7 scores). The rate of gestosis was much lower than the average population one (25-30%) in Russia. Conclusion. In the second trimester of pregnancy, the use of elevit pronatal enhanced ARA up to 870.3±37.0 μmole. There was a significant, more than 2-fold, reduction in blood homocysteine levels from 9.4±2.1 to 4.6±0.8 μmol/l (p<0.05). Gestosis was not a cause of preterm or surgical delivery in any of the examinees.
Obstetrics and Gynecology. 2011;(4):89-94
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PRINCIPLES OF THERAPY FOR SYMPHYSIOPATHY IN THE THIRD TRIMESTER OF PREGNANCY

KUCHERENKO M.A., MOZGOVAYA E.V., GZGZYAN A.M.

Abstract

Objective. To evaluate the efficiency of multimodality treatment including calcium preparations and local ultraviolet radiation (UVR) for symphysiopathy in the second and third trimesters of pregnancy. Subjects and methods. Fifty pregnant women with symphysiopathy were examined. According to treatment options, the investigators identified 2 patient groups: 1) 30 pregnant women who received Calcemin and UVR and 2) 20 who took Calcemin only. The efficiency of the therapy performed was evaluated from the time course of changes in bone metabolic parameters: the bone formation marker osteocalcin, the bone resorption marker β-isomer of C-terminal telopeptide of type 1 collagen, and plasma vitamin D levels. Results. The vast majority (more than 80%) of pregnant women with symphysiopathy accompanied by evolving pelvic bone pain syndrome, convulsions and parasthesias in the limbs, and pubic symphysis diastasis were found to have urinary tract infections that were both chronic and first detected during pregnancy. The clinical symptoms of symphysiopathy were associated with changes in bone remodeling: lower vitamin D3 levels, inhibited osteosynthesis, and, in severe cases, suppressed bone resorption. Conclusion. Multimodality therapy with currently available calcium preparations and local UVR causes not only a reduction in the clinical symptoms of symphysiopathy, but also improves bone metabolic processes.
Obstetrics and Gynecology. 2011;(4):95-99
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CHRONIC ENDOMETRITIS AS A CAUSE OF RECURRENT CYSTITIS COMPLICATED BY PELVIC PAIN SYNDROME IN REPRODUCTIVE-AGE WOMEN

NEIMARK A.I., SHELKOVNIKOVA N.V.

Abstract

Objective. To substantiate the need for one-stage combination treatment of chronic endometritis and chronic cystitis complicated by chronic pelvic pain syndrome. Subjects and methods. One hundred reproductive-age women with chronic endometritis and chronic cystitis complicated by pelvic pain syndrome underwent comprehensive examination and treatment. The authors evaluated symptoms and quality of life, filled in an urination diary, made physical, external genital, and vaginal examinations, and small pelvic ultrasonography, and studied the microflora in the vagina, cervical canal, and urethra by polymerase chain reaction, and laser Doppler flowmetry 4 weeks and within a year after the termination of treatment. The latter included antibiotic (safocid), immunomodulatory (lavomax), local (urocystic and uterine instillations, vaginal sanitation), resorption (longidase) therapies, phytotherapy, and physiotherapy. Results. After treatment, the signs of chronic endometritis and chronic cystitis disappeared in 68 and 72 patients, respectively. 76% of patients achieved a positive effect of combination treatment. Conclusion. The proved association of chronic endometritis with recurrent cystitis necessitates combination treatment (use of combined antibiotics to treat inflammatory processes in the genitals and urinary bladder, local intrauterine and intravesical instillations, resorption therapy, application of physical factors with further courses of immunomodulation, vitamin therapy, and, if possible, sanatorium-spa rehabilitation).
Obstetrics and Gynecology. 2011;(4):100-103
pages 100-103 views

THE ROLE OF ADJUVANT IMMUNOTHERAPY IN THE SOLUTION OF PROBLEMS OF HPV-ASSOCIATED MUCOSAL AND SKIN LESIONS

ELISEYEVA M.Y., MYNBAYEV O.A.

Abstract

Subjects and methods. The efficiency of using IP and its side effects were analyzed in 5367 patients with HPV-associated mucosal and skin lesions by examining 19 papers. IP was given to 5033 women in all sources, combined IP and traditional treatments to 3408 patients in 17 studies, and IP alone to 1625 women in 12 ones. Comprehensive analysis of using IP alone and its combination with traditional treatments was done comparing these results with those obtained in patients treated by traditional methods as well as placebo treatment in 253, 495, 273, and 61 patients respectively. Statistical analysis was done by one way ANOVA and p value was obtained by Tukey’s multiple comparison tests. Results. The results of individual sources suggest that beneficial effects became higher after combined immunotherapy in most of the papers irrespectively of study design and the type of both mucosal and skin HPV manifestations. Comprehensive analysis of average values demonstrated that the efficiency of placebo treatment was 29.3% with the lower and upper limits of 95% confidence intervals (CI) from — 27.0 to 85.6% and that of traditional treatments was 59.9% (CI 45.8-74.0). In most studies the efficiency of IP was evaluated depending on its regimen. According to this analysis there were better clinical and laboratory results after combined IP and traditional treatments in 87.4% of cases (CI 83.7-91.1) in contrast with conflicting results of IP used alone in 64.9% (CI 43.5 — 86.4). Conclusion. The promising results of adjuvant immunotherapy used in combination with traditional treatments in these sources of literature allow us to conclude that it is reasonable to use inosine pranobex in combination with routine treatments of HPV-associated mucosal and skin lesions. However efficiency of immunotherapy used in HPV-associated mucosal and skin lesions needs further clinical investigations in terms of evidence-based medicine.
Obstetrics and Gynecology. 2011;(4):104-111
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THE FIRST ALL-RUSSIAN PHARMACOEPIDEMIOLOGICAL STUDY «EPIDEMIOLOGY OF DRUG USE IN PREGNANT WOMEN»: BASIC RESULTS

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

Abstract

Objective. To study drug-prescribing tactics for pregnant women in different regions of Russia. Subjects and methods. A one-stage multicenter pharmacoepidemiological study was conducted. Questionnaire surveys were made among 1286 physicians of different specialties and 2324 pregnant women and puerperas. Results. Most physicians have been shown to be inadequately aware of the processes of organogenesis. It has been ascertained that the physicians prescribe a wide range of drugs to pregnant women and recommend drugs with unstudied safety to a fetus and those that are contraindicated in pregnancy. The pregnant women show a low adherence to the prescribed therapy and a high self-treatment rate. Subjects and methods. A one-stage multicenter pharmacoepidemiological study was conducted. Questionnaire surveys were made among 1286 physicians of different specialties and 2324 pregnant women and puerperas. Conclusion. It is necessary to update branch standards and to introduce pregnancy management protocols according to the data of evidence-based medicine, to adjust drug use instructions in accordance with updated clinical recommendations, to elaborate educational programs for the therapy of somatic diseases in pregnancy for physicians of different specialties, to set up an effectively operating pharmacovigilance system to monitor adverse reactions occurring with drug use in pregnancy, and to initiate the creation and maintenance of registers for using drugs in pregnant women.
Obstetrics and Gynecology. 2011;(4):112-117
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TRUE PLACENTA ACCRETA: MEDICAL TREATMENT

KURTSER M.A., BRESLAV I.Y., LUKASHINA M.V., SHTABNITSKY A.M., ALEKSEYEVA T.V., PLATITSYN I.V., ZEMLYANSKAYA E.A.

Abstract

The paper describes a case of the successful medical treatment of 2 female patients with true placenta accreta. Both patients had placental presentation and a uterine scar after cesarean section. Echography and magnetic resonance imaging diagnosed placenta accreta during pregnancy. By taking into account the diagnosis, it has been decided to make bottom cesarean section, followed by uterine artery embolization. The placenta was left in situ. Delayed uterine artery reembolization was carried out in the postoperative period. After partial expulsion of the placenta, its remnants were removed by curettage and hysteroscopy. The patients completely recovered menstrual function during a follow-up.
Obstetrics and Gynecology. 2011;(4):118-122
pages 118-122 views

A CASE OF SUCCESSFUL ANESTHESIA DURING SURGICAL DELIVERY IN A PATIENT WITH UNDIAGNOSED SEVERE PRIMARY HYPERPARATHYROIDISM

CHIGIRKOV N.A., SOKOLOGORSKY S.V., SHIFMAN E.M.

Abstract

Primary hyperparathyroidism occurs very rarely in fertile women and, when concurrent with full-term pregnancy, these cases are sporadic. A history of hypercalcemia concurrent with pathological fractures may be indicative of primary hyperparathyroidism, which requires that parathyroid hormone concentrations be additionally determined. General anesthesia is the method of choice when these patients undergo surgical delivery. This paper considers a case of successful anesthesia during delivery in a pregnant woman with primary hyperparathyroidism.
Obstetrics and Gynecology. 2011;(4):123-125
pages 123-125 views

THE CLINICAL AND DIAGNOSTIC VALUE OF VASCULAR ENDO-THELIAL GROWTH FACTOR ON IVF ATTEMPS

VOLKOVA L.V., ALYAUTDINA O.S.

Abstract

Objective. To study the serum levels of vascular endothelial growth factor (VEGF) in women included into an IVF program and to define its clinical value. Subjects and methods. Eighty-six women aged 28 to 43 years (mean age 35.5±7.5 years) who had a history of failed IVF were examined. The patients made up the following clinical groups: 1) 44 patients with infertility of unclear genesis, including 34 patients with grade 1 infertility (21 had IVF failures) and 10 with grade 2 infertility and IVF failures; 2) 27 women who had become pregnant after IVF, 24 of them had a history of IVF failures; 3) 15 healthy nonpregnant women. The investigators performed small pelvic ultrasonography, examined for them sexually transmitted infections, determined hormonal and hemostatic states, made a molecular genetic analysis of risk factors for thrombophilia, immunological and genetic (karyotype determination in married couples) studies, identified a marker of local hemostasis of VEGF on 20 to 24 days of their menstrual cycle, and estimated VEGF concentrations in pg/ml by enzyme immunoassay, by applying a kit of commercial reagents (eBioscience Human FEFF-A, Austria). Results. Elevated serum VEGF levels in the women included into the IVF program may be a major predisposing factor for failed IVF attempts. An algorithm for the management of these patients was compiled. The IVF preparation program involved corrective therapy with vitamin B groups, folates, and anticoagulants. Conclusion. Thirty-eight (44.1%) women with a history of failed IVF became pregnant due to the performed therapy.
Obstetrics and Gynecology. 2011;(4):126-129
pages 126-129 views

RATIONAL THERAPY FOR VULVOVAGINAL CANDIDIASIS IN PREGNANT WOMEN

TSVETKOVA T.P.

Abstract

Objective. To evaluate the efficacy and tolerability of livarol used to treat acute vulvovaginal candidiasis (VVC) in pregnant women. Subjects and methods. Sixty-two pregnant women with VVC were followed up. Thirty-two patients received livarol (a study group) and 30 took pimafucin (a control group). Examinations were made before, 1 week and 2 months after the termination of treatment, and 6 weeks after delivery. The vaginal microflora was examined by microscopic and culture techniques. Results. After 2 months of livarol therapy, the clinical symptoms of VVC completely disappeared and the vaginal microbial environment became normal in 96.9% of the patients in the study group while only 66.7% of the control patients achieved a positive result (p<0.005). Recurrent VVC was observed in 3.1 and 33.3% in the study and control groups, respectively. The timely use of livarol made it possible to avoid the early development of neonatal upper airway diseases; and no recurrences — just 2 months after delivery — enabled the use of coils. Conclusion. Livarol is effective and safe for the treatment of VVC in pregnant women.
Obstetrics and Gynecology. 2011;(4):130-133
pages 130-133 views

ESCORT THERAPY IN GONADOTROPIN-RELEASING HORMONE AGONIST TREATMENT FOR ENDOMETRIOSIS

KHOVRINA E.A., KIRPIKOV A.S., KUZNETSOVA I.V.

Abstract

Escort therapy is used to increase the acceptability of gonadotropin-releasing hormone (GnRH) agonist therapy to perform an effective course and to prevent hypoestrogenic adverse effects. Escort therapy aids in reducing the frequency and degree of adverse reactions associated with the use of GnRH agonists, without affecting their efficacy. To minimize bone loss and to eliminate hot flushes and vaginal dryness, by preserving the efficiency of treatment for the underlying disease, the investigators propose the following modes of drug exposures: progestin monotherapy, progestins and organic bisphosphonates, the low doses of progestins and estrogens, as well as tibolone, the pulsating parathyroid hormone. The development of new escort therapy schemes and regimens can improve the outcome of treatment for proliferative hormone-dependent diseases.
Obstetrics and Gynecology. 2011;(4):134-139
pages 134-139 views

HORMONAL INTRAUTERINE SYSTEM: ISSUES OF ITS ACCEPTABILITY AND SAFETY

IVANOVA E.V., SASUNOVA R.A., LETUNOVSKAYA A.B., PRILEPSKAYA V.N., MEZHEVITINOVA E.A., TAGIYEVA A.V.

Abstract

The paper considers current criteria for the acceptability and safety of using the Mirena hormonal intrauterine system depending on the woman’s health status or disease, by analyzing clinical and epidemiological studies in this area.
Obstetrics and Gynecology. 2011;(4):140-144
pages 140-144 views

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