编号 1 (2012)

The paper deals with the topical problem of modern obstetrics — surgical delivery. The reasons for the increasing annual rate of cesarean section and indications for abdominal delivery under the present-day conditions are analyzed. The authors propose alternative delivery methods, such as vaginal surgical delivery, for pregnant women with extragenital diseases and delivery per vias naturalis for those with a uterine scar after cesarean section. They give an objective assessment of these deliveries and their advantages over cesarean section for mother and fetus.

The data of a study of blood flow in the ophthalmic basin vessels in pregnancy complicated by preeclampsia and eclampsia are given as an analytical review. The latter presents the results of examining hemodynamic parameters in the direct sinus and basal veins of Rosenthal in arterial hypertension. It is concluded that Doppler ultrasound studies can assist in determining the stage of preeclampsia, predicting its course, and evaluating the therapeutic action of medicaments.

This paper considers the major components of the gene network of osteoporosis. As of now, the conventional study of the risk factors for postmenopausal osteoporosis (PMO) deals with a search for the gene mutations associated with bone mineral density (BMD) and PMO. Papers on the association between VDR, LRP-5, RANK, RANKL, ОPG, ESR1, and ESR2 gene polymorphisms and decreased BMD and fractures are analyzed. The given analysis of the data available in the literature suggests that the complex analysis considering the pathomorphological, pathophysioloical, and phenotypic changes in bone tissue with the allelic features of the genes associated with BMD and PMO, the combined effect of a few polymorphisms, gene-gene interactions, and population peculiarities must be a promising area of a genetic study.

Objective. To analyze the authors’ results obtained over 10 years and to evaluate the efficiency of the introduced current methods for the prenatal diagnosis and treatment of hemolytic disease (HD) of the fetus. Subjects and methods. The study enrolled 358 pregnant women who were divided into 4 groups according to treatment policy: conservative management and intrauterine blood transfusion (IUBT) to the fetus, as well as to the used algorithm (in 1999—2005 when their medical history, antibodies, the presence of fetal dropsy were kept in mind and in 2006—2009 when the maximal blood flow velocity (MBFV) in the middle cerebral artery (MCA) becomes the basis of mon itoring. Results. Introduction of fetal monitoring based on MCA MBFV measurements could optimize obstetric tactics and significantly reduce the number of invasive diagnostic interventions (p < 0.001). There was evidence that IUBT was highly effective in the treatment of the severest edematous form of HD of the fetus. Isoserological examination using gel technologies makes it possible to diagnose rare forms of conflicts and to select a donor on an individual basis. Conclusion. Fetal MCA MBFV measurements permit fetal anemia to be predicted. The edematous form of fetal HD is a curable condition that calls for fetal emergency care: IUBT is an effective treatment for fetal HD. The gel method is optimal in performing an isoserological study.

Objective. To establish the role of toll-like receptors (TLR) 1, 2, 4, and 5 in the pathogenesis of postpartum endometritis. Subjects and methods. Forty-eight patients with signs of postpartum endometritis and 56 women with a normal postpartum period were examined. Epithelial cells taken from the cervical canal at 3—4 days postpartum were the material to be estimated for TLR expression. The latter was assessed using the quantitative polymerase chain reaction (PCR). Results. The patients with postpartum endometritis showed a significant reduction in the levels of TLR4 and TLR5, as well as the TLR signaling pathway proteins MyD88 and NF-kB. The expression of TLR1 and TLR2 did not significantly change. Lower NF-kB expression resulted in a reduction in the elaboration of proinflammatory cytokines and antimicrobial peptides onto the mucosal surface, which may promote the invasion of a pathogen even if the latter was modest. Conclusion. The reduced expression of TLR4 and TLR5 in the female genital tract epithelium may play a considerable role in the pathogenesis of postpartum endometritis as this favors the activation of the opportunistic flora due to diminished local immunological responsiveness.

Objective. To def ine age-related changes in the clinical picture of polycystic ovary syndrome (POS). Subjects and methods. The study enrolled 60 POS patients aged over 40 years (38 patients at a late reproductive age and 22 in postmenopause). A control group comprised 197 women (mean age 52.8±7.2 years). All the patients underwent a clinical laboratory examination involving hormonal and biochemical (lipid fractions) studies and an oral glucose tolerance test. Results. TThe POS patients over aged 40 years were not found to have biochemical hyperandrogenism both at a late reproductive age and in menopause; type 2 diabetes mellitus (type 2 DM) and glucose tolerance were detected in a third (n=18) and every five (n=13) of patients, respectively; which is substantially higher than that in the comparison group stratified by body mass index and age. Obesity in POS makes an additional contribution, by increasing the risk of type 2 DM: odds ratio 5.58 (95% confidence interval 1.33-32.69). Conclusion. POS may be considered to be a powerful risk factor for carbohydrate metabolic disturbances. Obesity in POS is an additional risk factor and generally aggravates the course of the disease.

Objective. To study the efficacy and tolerance of an extract from the plant Vitex agnus castus in the treatment of moderate and severe premenstrual syndrome (PMS) in reproductive-aged women. Subjects and methods. One hundred and twenty-one women with PMS were followed up for 6 months, during which the patients f illed out their health assessment diaries every day and also the tested psychological questionnaire thrice. They took agnucaston (cyclodynon) that contained 40 mg of the Vitex agnus castus extract as one tablet daily immediately after awakening during 3 menstrual cycles. Results. A significant improvement occurred in 67.8% of the patients (according to the diary entries) and in 59.3% of the women (according to the questionnaire data). A subjective improvement was reported by 86.4 and 96.2% of the women according to the data of their diaries and questionnaires, respectively. The side effects associated with the use of the drug were noted in 13 (10.7%) women. Serious adverse reactions occurred in none patient. Conclusion. Agnucaston is an effective and acceptable drug to treat PMS.

Objective. To evaluate the macro- and microrheological properties of blood in pregnant women with placental insuff iciency (PI) after in vitro fertilization (IVF) and embryo transfer (ET). Subjects and methods. Clinical laboratory tests were carried out in 47 patients who were divided into 3 groups. A study group comprised 14 pregnant women after IVF and ET. A comparison group included 18 patients with chronic PI, in whom pregnancy occurred spontaneously. A control group consisted of 15 women with physiological pregnancy. Blood rheological parameters were estimated by macrorheological (asymptomatic blood viscosity, plasma viscosity, packed cell volume, and plasma total fibrinogen concentration) and microrheologic (spontaneous red blood cell aggregation and disaggregation) parameters. Results. After IVF, the pregnant women with PI were found to have blood macro- and microrheological changes; among other things, there were impairments in red blood cell aggregation and disaggregation processes and deformation. In PI, hyperaggregation and impaired blood rheology after IVF were ascertained to be mainly associated with the increased rate of formation of linear aggregates of red blood cells, their enhanced rigidity and lowered deformation. Conclusion. After IVF, the mechanism of hyperaggregation in PI is associated with considerable blood rheological changes which consist in the decreased disaggregation rate of large aggregates, the higher rigidity index of red blood cells, and their reduced deformation capacity. This requires timely diagnosis, correction of blood rheological parameters, and development of treatment regimens to improve the gas transport function of red blood cells in the microcirculatory bed of the fetoplacental unit, which positively affects perinatal outcomes.

Objective. To study perinatal outcomes in women with multiple pregnancy achieved by different methods. Subjects and methods. A retrospective continuous clinicostatistical analysis of primary medical records was made in 94 puerperas with multiple births (including 5 triple ones) given in the obstetric departments of the Center in 2008. According to the multiple pregnancy-achieving methods, the women were divided into 3 groups: 1) 34 (36.2%) women with spontaneous pregnancy, 2) 50 (53.2%) with pregnancy achieved by assisted reproductive technologies; 3) 10 (10.6%) with pregnancy due to ovulation induction. Results. Statistically significant differences were found between the groups in a number of gynecological diseases: infertility, oligomenorrhea, endometriosis, or polycystic ovary syndrome. The leading obstetric complications were threatening miscarriage, isthmic-cervical insufficiency, early toxicosis, and preeclampsia. Abdominal delivery occurred in 76.5, 98.0, and 80.0% in Groups 1, 2, and 3, respectively. The group rate of preterm labors was 55.9, 64.0, and 70%, respectively. There were 184 (96.3%) and 9 (4.7%) live and still births, respectively, including 58 (61.7%) and 36 (38.3%) same- and different-sex twin pairs, respectively, among the twin births and 2 and 3 same- and different-sex triple pairs among the triple births. Mild, moderate, and severe asphyxia was noted in 49.2, 9.3, and 7.8%, respectively. Stillbirth rates were 26.3%; early neonatal and perinatal mortality rates were 5.4% and 31.7%, respectively. Conclusion. The main cause of fetal and neonatal deaths is extreme immaturity and intragatric hemorrhages. The high rates of perinatal mortality and its components are associated with preterm labor and prematurity. The onrush of neonatal intensive care in the past decade has determined the substantial reduction of early neonatal mortality.

Objective. To optimize the results of treatment for urinary tract infections (UTI) in pregnant women, by using lactose (normaze) in their combination therapy. Subjects and methods. A study group consisted of 50 pregnant women with UTI who received normaze in addition to conventional therapy; a comparison group included 30 pregnant women with this condition who did not take normaze; a control group comprised 25 pregnant women without UTI. The magnitude of subjective questionnaire complaints was estimated; bacteriological study of the urogenital tract was conducted; ultrasonography of the pubic symphysis was performed in patients with symphysiopathy. The blood levels of magnesium and total and ionized calcium and the daily urinary excretion of magnesium and calcium were estimated. Results. There was a considerable improvement in stools, alleviated symptoms of mineral metabolic disturbances in pregnant women with UTI and a more significant correction of genital tract biocenosis in the patients receiving lactulose as part of combination treatment. Conclusion. Incorporation of normaze into the algorithm of treatment for pregnant women with UTI substantially affects the efficiency of the performed therapy due to its many-sided pathogenetic action on the symptom complex peculiar to patients with UTI during pregnancy.

The paper describes an ultrasound case of congenital diaphragmatic hernia concurrent with duodenal atresia in a fetus at 25 weeks. Fetal chest scanning determined heart displacement to the right, left lung hypoplasia due to the dislocation of the intestine, stomach, and spleen to the chest, as well as dilated duodenum, enlarged stomach, and polyhydramnios. In this term, the fetal stomach was located in the chest and its duodenum was in the abdomen. Reexamination of the fetus at 36 weeks showed a shift of the duodenum to the chest. Surgical treatment of diaphragmatic hernia and duodenal atresia was performed after birth. The diagnosis was intraoperatively verified.

The paper gives current views of the role of immune mechanisms, particularly innate immunity factors that contribute to the formation and development of normal pregnancy and participate in the pathogenesis of pregnancy complications. Based on the data available in the literature and their own studies, the authors consider the immunological aspects of pregnancy complications, such as recurrent miscarriage and preeclampsia, and those associated with infectious and autoimmune processes. Whether immunological assays can be used to diagnose and predict impairments in normal pregnancy is analyzed.

Pregnancy and labor are leading risk factors for developing the symptoms of female urinary incontinence. Great attention is now given to elective cesarean section in women at risk for developing the symptoms of impaired urination. Only behavioral therapy among the methods for treating and preventing urinary incontinence during pregnancy can be used.