No 7-1 (2011)

The paper reviews the literature on the evaluation of fetal functional status during pregnancy and labor. It considers invasive and noninvasive methods for the diagnosis of the fetal status, their specificity, sensitivity, and reproducibility. Particular emphasis is laid on new approaches to diagnosing the discredited fetal status, on fetal echocardiography in particular. The efficiency, advantages, disadvantages, and possible perspectives in the use of pregnancy and labor are estimated.

The review gives the data available in the literature on experience with peri- and transurethral injections of current volume-forming agents used in stress urinary incontinence as a certain alternative if surgical treatment is impossible. Although the efficiency of surgical treatment is statistically significantly higher, the use of volume-forming agents is associated with the lower frequency of complications. The efficacy of peri- and transurethral injections remains about a year. Reinjections are necessary to maintain the effect of urinary continence.

Material and methods. Three hundred and thirty case histories of patients with EP (Group 1) were retrospectively analyzed and 350 women with this condition (Group 2) were prospectively studied. General clinical, laboratory, echographic, morphological, endoscopic, and statistical studies were performed. Results. When EP is less than 3-4 weeks, serum monitoring for ß-subunit of chorionic gonadotropin (ß-CG) in combination with transvaginal ultrasound scanning (TVUSS) is of the greatest informative value (98.3%) and laparoscopy is no of high diagnostic value (65.4%). When EP is more than 4 weeks, combined monitoring of ß-CG and TVUSS remains its high diagnostic value (99.5%), the value of TVUSS and laparoscopy increases from 68.6 to 97.1% and from 65.3 to 97.4%, respectively. Conclusion. The criteria for hospitalization in case of 10-14 days delayed for a menstrual period are a less than 50% increase in serum ß-CG within 48 hours and no ovum in the uterus. In case of more than 14 days delayed, the sufficient ground for hospital admission is no ovum in the uterus and positive serum ß-CG or positive urine pregnancy test.

Objective. To reveal the major risk factors of ovarian follicular depletion in women with Hodgkin’s lymphoma (HL) before antitumor therapy and to evaluate the efficiency of ovarian protection with combined oral contraceptives (COC) and gonadotropin-releasing hormone (GnRH) agonists. Subjects and methods. In 236 reproductive-age women with HL, ovarian function was evaluated by anamnestic, hormonal, and ultrasound studies prior to polychemotherapy (PCT) and 4-6 months after its termination. For ovarian protection, 52 and 24 women took COC and the GnRH agonist zoladex, respectively. Results. The preservation of a menstrual cycle after PCT depended on women’s age (p=0.000001), the symptoms of intoxication (p=0.04), the stage of disease (p=0.00004), a patient’s general condition (p=0.002), the presence of anemia (p=0.04) and albuminemia (p=0.008), and radiation of inguinal and iliac lymph nodes (p=0.003). Hypoestrogenia and decreased inhibin levels were found to be of prognostic value for the development of postchemotherapeutic amenorrhea; threshold values were determined for these hormones. In the group of women receiving high-dose cyclophosphan therapy, hormonal ovarian protection reduced the rate of amenorrhea by 2.5-fold (p=0.007). The rate of preservation of normal menstrual function was statistically higher in the group of women taking a GnRH analogue (р<0.001).

Objective. To define the common components of measures to control the quality of medical care delivered to women during pregnancy and labor at the level of a health care facility (self-control). Material and methods. The current normative legal acts regulating requirements for a procedure to render medical aid to women during pregnancy and labor are analyzed. Results. The individual components of control of the quality of medical care given to women during pregnancy and labor were identified. Conclusion. The common components of control of the quality of medical care to women during pregnancy and labor at the level of a health care facility are to evaluate the clinical and economic efficiency of rendered medical care in terms of the quality criteria, requirements, and standards established by the current legislation, to monitor patients’ satisfaction via polls, to make a patient feedback, and to establish a priority of work with complaints and applications.

Objective. To evaluate the efficiency of combined use of a running magnetic field in a rehabilitation program for women after an exacerbation of chronic salpingo-oophoritis (CSO). Subjects and methods. Ninety-six women aged 19—32 years, who had been treated for CSO, were examined. The patients were divided into 3 groups. Group 1 (n=32) was treated with the standard regimen (antibiotics, nonsteroidal anti-inflammatory drugs, rheolytic agents). In addition to the standard treatment, Group 2 (n=32) ОБМЕН ОПЫТОМ received a course of local magnetic therapy in the projection of the ovaries with a running magnetic field, by using an AMO-ATOS-E apparatus. In Group 3 patients (n=32), local magnetic field exposure was interchanged with transcranial magnetic stimulation. The course consisted of 10—12 sessions. The intensity of pain syndrome, the time course of changes in complications, the rate of recurrences, and the hormonal profile were studied before and 36 months after therapy. Results. Group 3 showed better results for all the study indicators. In this group there were reductions in pain intensity by more than twice, the rate of an abnormal ovarian and menstrual cycle by 2.5 times, dysmenorrhea by 3.5 times, and polymenorrhea by 4 times, as compared to Group 1 (a control group). Functional ovarian cysts were not revealed in Group 3 patients. According to the phase of a cycle, the levels of luteinizing andfollicle-stimulating hormones increased by 30-50% of the baseline values. The concentration of estradiol decreased by 25-26% and that of progesterone increased by 33.2% versus 9.2% in the control. During a 12-month follow-up, the rate of recurrent CSO exacerbations was 2.06±0.02 in Group 3 versus 4.4±1.05 in the control. Reproductive function improved after treatment. Conclusion. The high eff iciency of combined exposure to the magnetic f ield both in the projection of the ovaries and transcranially is associated with the normalization of pituitary-ovarian ratios and allows one to recommend transcranial magnetic therapy in the rehabilitation program for women with small pelvic inflammatory diseases and reproductive dysfunction.

Objective. To evaluate the efficacy and safety of livarol in the treatment of urogenital candidiasis in pregnant women. Subjects and methods. Thirty-two pregnant women in their second and third trimesters were followed up. All the patients received livarol, one suppository once daily, for 5 days. They were examined before and 7 days and 1 month after termination of therapy. The vaginal microflora was examined by microscopic and culture techniques. Results. The efficiency of the proposed livarol therapy following 7 days was 90.6 %. A month after termination of livarol therapy, 93.8% of the patients showed a complete clinical resolution: there were neither complaints nor objective clinical and laboratory signs of vaginal candidiasis. Conclusion. Livarol is effective and safe in treating urogenital candidiasis in pregnant women.

The paper describes a case of a 27-week pregnant woman with severe concomitant extragenital pathology, such as a posterior cranial fossa tumor (cerebellar hemangiopericytoma) that caused occlusive hydrocephalus. Due to adequate diagnosis, the pregnant woman was admitted to a specialized neurosurgery hospital and successfully operated on and gave birth to a virtually full-term baby via cesarean section at an obstetric hospital.

Objective. to evaluate the safety and clinical efficacy of VENOTEKS compression knitted fabric (tights for pregnant women and antiembolic stockings for patients with varicosity) and a high patient compience versus those of elastic bandages. Subjects and methods. An open comparative randomized prospective clinical trial was conducted in 45 pregnant women with chronic venous insufficiency at the V.F. Snegirev Clinic of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University. Clinical, laboratory, and instrumental studies were performed. Results: During a follow-up, the patients using the compression knitted fabric were found to have a significant regression of symptoms, such as severity, pain, and cramps in the calf, parasthesias, edema, and fatigability as compared to the baseline level. As compared to therapy with elastic bandages, that with compression knitted fabric caused no statistically significant leg volume increase during the study. Ultrasound angioscanning with Doppler study showed a significant decrease in the diameter of the greater saphenous vein during compression knitted fabric therapy. There was no convincing evidence for hemostatic changes when compression products were worn. No thrombotic or thromboembolic events were detected in any of the cases, there were no adverse reactions or undesirable events either. Conclusion. The study showed the high clinical efficacy and safety of compression knitted fabric and high compliance when the patients used it in the treatment of chronic venous insufficiency and in the prevention of thrombotic events in pregnancy and postpartum.

Objective. To evaluate the efficiency of drug treatment with the Russian oral antibiotic safocid for grades 1 and 2 pelvic prolapse complicated by chronic trigonitis and pelvic pain syndrome. Subjects and methods. Fifty patients with grades 1 and 2 pelvic prolapse complicated by chronic trigonitis and pelvic pain syndrome, which had been caused by a congestive inflammatory process in the bladder, parametrium, and descent vaginal walls, were examined. The study comprised medical history data collection, gynecological examination, transvaginal ultrasonography, combined urodynamic examination (CUDE), and cystoscopy. Results. All the patients had varying clinical manifestations. According to uroflowmetric evidence, there was a preponderance of obstructive urination. Cystomanometry showed the signs of the overactive bladder. Combination therapy included the use of safocid by the scheme: a single dose of 4 tablets 1 hour before or 2 hours after a meal on days 1, 7, and 14 of treatment; intravesical instillations of different uroseptics, vitamins B 1, B 6, and B 12, and nonsteroidal anti-inflammatory drugs. The findings suggest that safocid is highly effective in the combination drug treatment of dysuria, pelvic pain, and urge incontinence in the early stages of genital prolapse. After the treatment performed, all the patients reported pain and discomfort disappearance during voiding, the cystoscopic pattern became normal, and the signs of obstructive urination and overactivity diminished, as shown by CUDE. Dyspareunia and episodes of urinary incontinence disappeared in 13 and 47 patients, respectively. Conclusion. Thus, combination treatment with the broad-spectrum combined drug safocid in patients with early-stage prolapse complicated by chronic trigonitis makes it possible not only to eliminate an inflammatory process in the trigone region of the bladder, but also to reduce or stop urinary incontinence episodes and chronic pelvic pain syndrome.

The investigation was undertaken to evaluate the eff icacy, tolerability, and safety of soya isoflavonoids for the treatment of the vasomotor, emotional, and autonomic manifestations of the menopausal syndrome (MS), by studying the effect of isoflavones on the blood lipid spectrum. Forty women with MS were given the preparation containing 40 mg of soya isoflavones twice daily for 3 months. The efficacy of the drug was 62.5 and 85% according to diaries and subjective patient assessments, respectively, in the absence of serious adverse reactions. Analysis of the serum lipid spectrum indicated a decline in the levels of cholesterol and low-density lipoproteins, an increase in high-density lipoproteins, and a slight reduction in the atherogenicity index. Thus, soya isoflavonoids are effective, acceptable, and safe medicines to treat MS.