No 6 (2011)

Objective. To assess pregnancy outcomes from the results of an analysis of new augmented statistical forms. Material and methods. The official statistical data on the birth and death of extremely low birth weight (ELBW) infants in the Russian Federation, its federal districts, and subjects in 2009 were analyzed. Results. There was a reduction in mortality rates among infants weighing 750—999 g and a lesser decrease among those weighing 500—749 g. Conclusion. Based on the time course of changes in the obtained values, the authors found it important to develop new statistical registration forms for monitoring and improving medical care during delivery and nursing ELBW infants and to universally introduce them into the health care facilities of the Russian Federation.

The paper presents data on the possibilities for early prediction of preeclampsia (PE). It considers the parameters reflecting the characteristics of hemodynamics and impaired vascular resistance, endocrine dysfunction of the fetoplacental unit, and renal dysfunction, and those characterizing endothelial dysfunction and oxidative stress. Analysis of the results of the performed studies dealing with the prediction of PE indicates that Doppler study, angiogenic and fetoplacental unit dysfunction factors hold the greatest promise for its early prediction.

Ministry of Health and Social Development of Russia, Moscow The author has examined the data currently available in the literature on labor management tactics for the prevention of afterbirth and early postpartum hemorrhage. Wait-to-see policy envisages the natural process of labor and early postpartum. Active policy is distinguished by the use of uterotonic agents and umbilical ligation and crossing within 1 minute after childbirth and by the implementation of measures for rapid birth of the placenta with further uterine massage. The results of systematic reviews of randomized clinical trials have strongly demonstrated that the active management tactic, primarily the use of uterotonic drugs, assists in reducing blood loss, the rate of postpartum hemorrhages, and the duration of the third stage of labor. In the literature there is now no agreement regarding the benefits of administration of an uterotonic agent before or after birth of the placenta and the optimal time for umbilical ligation to prevent hemorrhage. The active management tactic may be accompanied by a number of side effects and complications. However, the frequency of complications is low and the degree of side effects is generally of no significant clinical value. The active management tactic is an effective method for reducing afterbirth and early postpartum blood loss.

Objective. To evaluate the androgen-receptor (AR) gene in ovarian tissues and its association with the production of androgens themselves and to analyze the length of CAG-repeat in the AR gene in patients with premature ovarian failure (POF) and in healthy women. Subjects and methods. One hundred and eighteen women with POF were examined. Twenty intraoperative ovarian biopsy specimens from patients with POF served as a material for fluorescence in situ hybridization (FISH) analysis. Ten ovarian tissue specimens from women who had died during emergencies at less than 40 years of age (mean 28.4±6.3 years) were used as a control. DNA samples from 83 healthy women living in the European part of Russia were analyzed as a population control of AR gene CAG repeat length. Nine reproductive-age healthy women with preserved menstrual rhythm were a control group to estimate the levels of testosterone-estradiol binding globulin, testosterone, and free androgen index. Results. There was a clear tendency for shorter AR gene CAG repeat lengths in patients with POF. The FISH analysis of the ovarian biopsy specimens from the patients with POF showed a change (amplif ication) in the AR gene in almost every three (30%) women with POF while no changes were found in the ovarian biopsy specimens from the women with preserved ovarian function (a control group). Conclusion. The AR gene amplification detected in ovarian tissues in almost every three patients with POF allows one to consider that along with other molecular genetic, autoimmune, and infectious causes, increased AR expression in the presence of a hypoandrogenic state plays a certain role in the basis of this pathology. Our findings permit premature ovarian failure to be considered to result from impaired androgen signaling.

Objective. To evaluate the efficiency of various labor activation methods, the specific features of the course of labor, and the factors influencing the success of induction in patients with prolonged and advanced pregnancy. Subjects and methods. Seventy-one women with singleton pregnancy of 40 weeks and 2 days or more and cephalic presentation were examined. According to the method of labor induction, the women were divided into three groups: 1) amniotomy; 2) sequential use of dinoprostone and amniotomy; 3) intravenous dropwise injection of dinoprost in the presence of the whole gestational sac. Group 4 (control) comprised women with spontaneous initiation of delivery in the same gestation period. The data were statistically processed using risk ratios, odds ratio, and Wilcoxon test. Results. The efficiency of labor induction in patients who tended to have advanced pregnancy was high and amounted to 80% during labor induction via amniotomy, 86.7% via a combination of PGE 2 analogues and amniotomy, and 100% by that of dinoprost. The characteristic feature of the course of labor during advanced pregnancy is the high rate of abnormal delivery; at the same time labor induction does not increase the risk for the development of this pathology. The basic factor influencing the success of labor activation is the state of the cervix uteri; thus, labor must be induced only unless its maturation is achieved. The number of complications following induction of labor increases with the gestational period of more than 41 weeks, so the latter of 40—41 weeks is optimal for cervix uteri preparation and labor induction.

Objective. To optimize obstetric tactics for varying severity of fetal distress in women with a history of recurrent miscarriage, by studying the fetoplacental system and following up infants of the first year of life. Subjects and methods. The investigation involved an analysis of the course of pregnancy in female patients with chronic fetal distress and at least two early pregnancy losses in the history, by conducting a retrospective study of 53 labor histories and a prospective observational study of 57 pregnant women. According to the fetal status (FS), the study group was divided into 3 subgroups: 1) 18 patients from a prospective series and 19 patients from a retrospective one, who had a FS value of 1.1-2.0; 2) 22 and 19 patients, respectively, whose FS value ranged 2.1 to 3.0; and 3) 17 and 15 patients, respectively, who had a FS value of above 3.0. The control group comprised 11 women with a history of recurrent miscarriage who had delivered babies via cesarean section due to the presence of a somatic disease with none episode of impaired fetal status (with a normal FS value of 0 to 1). Results. Analysis of the hormonal and biochemical parameters of peripheral blood from pregnant women before delivery revealed that the markers of fetoplacental dysfunction were thiobarbituric acid reactive substances, alpha-fetoprotein, cortisol, and ß-microglobulin. A cardiotocographic study of the health status of infants of the first year of life in relation to FS values indicated that the most evident abnormalities as different manifestations of postnatal maladaptation were observed in infants with a FS value of 2 to 3 during the first year of life, which may be suggestive of experienced chronic antenatal hypoxia. Conclusion. Detailed individual intragroup analysis of the health status of Subgroup 2 babies with a FS value of 2.1 to 3.0 established that during delivery within 5 days of the appearance of the signs of intrauterine suffering at over 37 weeks gestational age, the infants with lower values had abnormalities in their physical development and health status as compared to those from the same group, who had sustained longer (over 5 days) chronic hypoxia and had been born accordingly in later periods after the emergence of the cardiotocographic signs of fetal distress.

Objective. To study sex chromosomes in the interphase nuclei of gonadal cells in patients with premature ovarian failure (POF) and gonadal dysgenesis. Subjects and methods. A study group comprised 29 patients with POF and a normal karyotype in lymphocytes; a comparison group included 2 patients with POF and abnormal (47,XXY and 45,Х/46,ХХ) karyotypes in lymphocytes and 3 patients with gonadal dysgenesis (2 had a normal karyotype and 1 had a full form of 45,X). A control group consisted of 10 ovarian tissue autopsy specimens from young women. Fluorescence in-situ hybridization was used. Results. Different types of gonadal sex chromosome mosaicism were found in 21 (72.4%) of the 29 patients of the study POF group, in 1 (50%) in the comparison POF group, and in all 3 patients with gonadal dysgenesis. Among the 10 control ovaries, tissue mosaicism was detected only in 2 (20%) cases, which was statistically significantly less than that in patients with ovarian failure (p < 0.003). Ovarian tissues showed 2 to 50% of Y chromosome cells that were not found in the lymphocytes in 1 (3.4%) patient with POF and in 2 (66.6%) patients with gonadal dysgenesis. Conclusion. Occult gonadal sex chromosome mosaicism may be a mechanism of premature exhaustion of the follicular pool in patients with POF as in those with different forms of gonadal dysgenesis.

The paper describes the experience of the interaction of the V. N. Gorodkov Ivanovo Research Institute of Maternity and Childhood, Ministry of Health and Social Development of the Russian Federation, and the regional delivery services of the Central Federal District’s subjects, which are to be supervised by an order of the Ministry of Health of Russia. Data are summarized on developed and tested medical organizational technologies for the joint improved controlling of the regionalization of perinatal care under the conditions of a supervised regional operating systems complex. Evidence is provided for the efficiency of combined elective and emergency obstetric counseling at a set-up interregional consulting obstetric center.

Objective. to evaluate the efficacy of VENOTEKS compression knitted fabric used to prevent the development and/or progression of lower limb venous insufficiency and thromboembolic events during pregnancy, labor, and postpartum. Subjects and methods. The study enrolled 30 pregnant women aged 30—45 years during the second trimester (at 25 weeks) of pregnancy with signs of chronic lower limb venous insuff iciency (CEAP C2 to C4). General clinical studies, including determination of soluble fibrin-monomer complexes, D-dimer, and platelet aggregability, and ultrasound examination of lower limb venous blood flow. Results. The mean time for usage of the compression knitted fabric was 104.7+17.9 days. Of them, VENOTEKS Clinic 2 tights, code number 206, were used for an average of 98.53+18.06 days; VENOTEKS HOSPITAL ANTIEMBOLISM stockings, code number 401, were worn for 6.2+0.71 days. There was a reduction in the objective and subjective symptoms of chronic venous insufficiency in virtually 100% of cases. The antithrombotic effect of the medical compression knitted fabric is most likely to be associated with decreased blood stasis and enhanced lower limb venous circulation. There is no strong data suggesting that the compression knitted fabric has an impact on the hemostatic system, which is reasonable without using specific pharmacotherapy. No thrombotic events even in patients with a complicated medical history are indicative of the efficiency of using the VENOTEKS HOSPITAL ANTIEMBOLISM compression knitted fabric, code number 401, during labor and in immediate postpartum.

Objective. To evaluate the eff icacy and tolerance of hexicon used for the pregravid preparation of women with nonspecific inflammatory processes of external genitals. Subjects and methods. Sixty women with nonspecif ic inflammatory processes of external genitals were followed up. Group 1 included 30 patients who were found to have less than 50 leukocytes through microscopic study of the vaginal contents. Group 2 comprised 30 patients who had microscopically more than 50 leukocytes in the smears. All the patients used hexicon vaginal suppositories 16 mg twice daily for 10 days. Examinations were made before treatment, on day 5 of its initiation, and 3 and 30 days after its termination. The vaginal microflora was microscopically and culturally examined. Results. The investigation showed a significant normalization of white blood cell count in the vaginal and cervical secretions and local immunity parameters in the women of the two groups after treatment performed. Conclusion. Hexicon is effective and safe at the stage of pre-conceptional preparation for desired pregnancy. At the same time, the result of treatment does not depend on the pretreatment level of leukocytosis in the vaginal smear.

Objective: to study the efficacy of a lower-dose topical estradiol-containing agent (ovestin) in patients with urogenital atrophy on the basis of objective criteria. Subjects and methods. The study included 120 postmenopausal patients with symptoms of vaginal atrophy. Group 1 patients (n=60) were given the topical dosage form of hormonal replacement therapy — intravaginal ovestin cream in the standard therapeutic dosage of 0.5 mg once daily every day. In Group 2 patients (n=60), ovestin cream was intravaginally applied in a dosage of 0.5 mg once daily on alternate days. The course of therapy was 3 months. The studies comprised determination of the pH of the vaginal contents and the value of vaginal epithelial maturity; colposcopy; a comprehensive microbiological study of vaginal discharge; and a 5-point Barlow scale to estimate the intensity of symptoms of vaginal atrophy. Results. The use of an estradiol topical formulation (ovestin cream) in the standard therapeutic dose and its double reduction was equally effective in patients with urogenital atrophy, as confirmed by a number of objective criteria and allows prevention of possible adverse events.

Based of the data available in the Russian and foreign literature and statistical data, the author considers the issues of preservation of reproductive health in the population and those of increasing birth rate. Reasons for high abortion rates in the country are identif ied. There is evidence for the use of combined oral contraceptives as a main tool to reduce abortions. The paper shows it necessary to introduce counseling when prescribing hormonal contraceptive agents. Basic counseling steps are disclosed.

The authors describe two cases of intracardiac thrombi in newborn infants with hereditary hematogenic thrombophilia.