No 7-2 (2011)

The paper analyzes the history of the emergence and evolution of the concept «endometrial receptivity». The term «receptivity» is defined. The key biological (genetic, molecular, cellular, and tissue) regulations and their respective markers of the receptivity are considered. The role of different pathological processes that are able to affect endometrial receptivity is discussed.

Objective. To study whether it is expedient to make noninvasive monitoring, by determining the time course of changes in serum markers in pregnant women. Subjects and methods. Three hundred and nine women in the first and second trimesters of pregnancy were examined, by using ultrasonography, by measuring the level of serum markers, such as free β-subunit of human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein A in the first trimester, human chorionic gonadotropin, alpha-fetoprotein, estriol (E3) in the second trimester, by making a computer analysis using Life Cycle programs in the first trimester and PRISCA in the second one, and by applying invasive prenatal diagnostic methods. The data were statistically processed employing the McNemar, chi-square, and Fletcher tests. Results. Risk-group pregnant women diagnosed as having a baby with Down syndrome in their first trimester in 100% of cases were identified. The test specificity was 66.3%; the rate of false-positive results was 32.7%. In the second trimester, the changes in the levels of serum markers were unnatural and, in most cases, associated with obstetric pathology or age. In this trimester, specificity and false-positive rates were 24.0 and 72.8%, respectively. The high false-positive rates were mainly due to the elevated levels of β-hCG and E3. No relationship could be found between medical history data, the course of pregnancy, the levels of serum markers, and the risk for a baby to be born with a chromosomal abnormality; a karyotype abnormality was absent. Conclusion. If there is a risk for a baby to be born with a chromosomal abnormality, embryonic karyotyping should be carried out in the first trimester of pregnancy, without waiting for the results of the second trimester. Second-trimester examination should be done if it is absent in early periods.

Objective.To study the clinical and diagnostic characteristics of isthmic-cervical incompetence (ICI) and to evaluate the efficiency of different methods for its correction. Subjects and methods. A study group comprised 296 pregnant women aged 18 to 40 years, who were diagnosed as having ICI; a control group included 20 pregnant women without ICI. The study was retrospective and prospective. It involved vaginal, ultrasound, Doppler, hormonal (testosterone, dehydroepiandrosterone sulfate) studies and examinations for urogenital infections and connective tissue dysplasia (CTD). Results. The risk factors for ICI are polymenorrhea (14.3%), changes in the menstrual cycle before antecedent pregnancy (18%), sexually transmitted infections (52.4%), miscarriages (17.9%), complicated previous pregnancies (55.8%), and CTD (42.2%) (p<0.05). Structural changes in the cervix uteri, such as its shortening, softening, centralization along the pelvis axis, or cervical dilation, which are characteristic for ICI, occur most frequently (52%) at 16-20 weeks’ gestation. Pregnancy after surgical correction of CI is more often accompanied by threatening miscarriage (87.9%) and that after medical correction is followed by the development of colpitis (26.7%) (p<0.05). The full-term baby birth rate after both correction methods for ICI is 93.3%.

Objective. To study the morphological characteristics of structural features in the superficial epithelium and the receptor status of the endometrium in patients with repeated implantation failures in the assisted reproductive technology programs, to elaborate prognostic criteria for the occurrence of pregnancy in them, and to identify groups of patients who are to have cyclic hormonal therapy as endometrial preparation for the following in-vitro fertilization (IVF) cycle. Subjects and methods. The study enrolled 97 reproductive-age patients with tuboperitoneal infertility and a history of 2 IVF failures or more. At its f irst stage, 2 comparison groups were formed in accordance with the efficiency of IVF procedures: 1) 15 patients in whom pregnancy had occurred; 2) 47 negative-pregnant women. These patients underwent Pipelle endometrial biopsy in the cycle before superovulatory induction on days 7-8 postovulation. At the second stage, Group 3 consisting of 35 patients with lower steroid receptivity was formed in accordance with the data of immunohistochemical studies. They were given hormonal therapy as preparation for the following procedure of IVF and embryo transfer. Group 3 patients treated with hormone drugs also underwent control biopsy on days 21-24 of a menstrual cycle. A control group included 15 fertile women without gynecologic pathology in whom the endometrial structure was examined. While studying the histological specimens, the percentage of superficial epithelial cells with pinopodia was calculated using a light microscopy at x400. A histology H-score was used to analyze immunohistochemical findings. The expression of estrogen receptor-α (ER-α) and progesterone receptor (PR) was estimated in scores. The data were statistically processed using the Statistica for Windows (version 7.0) software package (StatSoft Inc.). Results. The major favorable prognostic criteria for IVF pregnancy is the PR/ER-α ratio that is concordant with the endometrial morphological structure and superficial endometrial cells with pinopodia (≥50%) in the endometrium and the most unfavorable prognostic marker is persistent ER-α hyperexpression in the midluteal phase of the menstrual cycle. Conclusion. Cyclic hormonal therapy with natural estradiol and natural micronized progesterone in patients with the lower receptor status can normalize the structural and functional status of the endometrium and the formation of adequate morphological reactions of the superf icial epithelium, by enhancing the expression of PR and ER-α.

Objective. To evaluate the efficiency of pelvic floor myoelectrostimulation using a BioBravo apparatus in patients with decreased pelvic floor muscle tone concurrent with and without moderate and mild stress urinary incontinence (UI). Subjects and methods. Pelvic floor myoelectrostimulation was performed in 28 women aged 28 to 52 years. Group 1 comprised 16 women with decreased pelvic floor muscle tone and symptoms of mild and moderate UI, who complained about urine loss during different types of exercise. In 12 women included into Group 2, lower pelvic floor muscle tone was not accompanied by the symptoms of UI. Objectivization of complaints, rating of symptoms, and monitoring the efficiency of performed therapy were done, by analyzing the voiding diaries filled out by each patient within 3 days before and after therapy and by carrying out an hour pad test. Quality of life in patients with UI was assessed using an Incontinence Quality of Life questionnaire, the Patient Global Impression of Severity Scale, and the Patient Global Impression of Improvement Scale. Results. An increase in the indices by more than 50% of the baseline level was noted in 14 (87.5%) and 12 (100%) women in Groups 1 and 2, respectively. The vast majority of the patients showed improvement 4-5 weeks posttherapy. Conclusion. The ease to use this treatment modality, the absence of its complications, and its low cost make it possible to regard it as the most promising method for a certain group of patients with UI and to recommend the use of portable electrostimulators in the outpatient setting and their self-use.

Objective. To define whether antiseptics (fluomizin) may be used for the reduction of the frequency of postabortion complications and for further rehabilitation and to provide evidence that the lactobacteria- and estriol-containing drug gynoflor E should be given to restore normal vaginal biocenosis in the postabortion period. Subjects and methods. The study covered 100 women (mean age 28.9±0.4 years) who had sought medical advice for artificial pregnancy termination (APT) at 5 to 9 weeks’ gestation. At the first stage of the study after having been examined for vaginal biocenosis, 31 patients diagnosed as having bacterial vaginosis and nonspecif ic vulvovaginitis underwent vaginal sanitation with f luomizin for 6 days prior to APT. At the second stage the women who had used fluomizin to be prepared for APT were given gynoflor E for 6 days after APT (regardless of the used technology) to restore normal vaginal biocenosis. All the pregnant women underwent a conventional clinical and laboratory study involving microscopic examination of vaginal discharge and an additional study of vaginal biocenosis by real-time PCR. Results. The paper gives the results of treatment for nonspecific bacterial vaginal infections, by using a two-step treatment regimen in the pre- and postoperative management of patients during APT. The broad-spectrum drug fluomizin (dequalinium chloride) was found to be effective in treating nonspecific bacterial vaginal infections. Evidence was provided that gynoflor E containing lactobacteria and estriol should be used to restore normal vaginal biocenosis in the postabortion period.

Objective. To examine and treat 30 women with urogenital disorders (UGD) after surgical menopause. Subjects and methods. Along with the symptoms of vaginal atrophy, different forms of urinary incontinence (UI) were observed in the majority (n = 18) of the 30 patients: there was stress UI in 7 patients and its mixed form in 11. If normocenosis and vaginal atrophy were present, ovestin was recommended according to the following scheme: one suppository daily for 4 weeks, then one suppository twice weekly for 22 weeks as maintenance therapy. Soption combination therapy was performed in patients with bacterial vaginosis, nonspecific vaginitis, and Candida vaginitis. Moreover, the organic silicone sorbent oral enterosgel and hydrogel of this agent for intravaginal use with probiotics (bifidum, lactobacteria, acilactum, zhlemic) were used for 7-10 days. Ovestin suppositories were applied after vaginal sanitation. Results. Intravaginal ovestin used in patients with UGD after surgical menopause makes it possible to eliminate genital disorders and stress UI and the use of tolterodine promotes the abolishment of urge incontinence.

The paper describes pulmonary sequestration with signs of type II cystic adenomatoid transformation in the retroperitoneal space of a neonatal boy and gives the data available in the literature on the clinical and morphological features of such malformations. It also underlines difficulties in preoperative clinical and instrumental diagnosis.

The paper presents data on the etiology, pathogenesis, clinical presentation, diagnosis, and current principles of prevention and treatment of nonspecific vaginitis.