No 3 (2012)

Vitamin D deficiency is one of the most common hypovitaminoses worldwide. The paper gives the data available in the literature on that in postmenopause there is almost a four-fold decrease in the capacity of the skin to produce vitamin D; in this connection elderly subjects are at increased risk for fall-related fractures. Vitamin D is a component of combination therapy for postmenopausal osteoporosis as its deficiency negatively affects the results of antiresorptive therapy: the patients with low vitamin D levels at baseline were observed to have a low increment during bisphosphonate therapy. At present there is no agreement on the required daily vitamin D dose for elderly subjects and there are no uniform standards for blood vitamin D concentration either.

Objective. To develop a standardized approach to evaluating the severity of chronic placental insufficiency (PI), which is based on a complex diagnostic point scale. Subjects and methods. Diagnostic criteria with chronic PI scores of 0 to 3 were identif ied in 359 pregnant women; in two clinical groups, each included 200 pregnant women, the diagnosis of chronic PI, by applying a developed clinical classification and a clinical classification involving division into compensated, subcompensated, and decompensated PI (DPI), was compared with the morphological estimation of PI severity and perinatal outcomes. Clinical, instrumental, laboratory, and statistical studies were employed. Results. The severity of chronic PI may be evaluated using the complex point scale with a scoring system for the following diagnostic criteria: the discrepancy between ultrasound (US) fetometric data and fetal gestational age; evaluation of PI, by using the diagnostic scale (an US component and laboratory testing), the degree of impaired blood flow, integral fetal state index, and fetal cardiovascular reaction. The complex scale outcome indicator from 1 to 3 scores diagnoses grade 1 chronic PI (placental dysfunction); that from 4 to 9 scores shows grade 2 chronic PI (DPI), from 10 to 13 scores, grade 3 chronic PI (progressive DPI); and 14 scores or more, grade 4 chronic PI (critical PI). Conclusion. Standardization of the diagnosis of chronic PI, using the complex point scale to calculate the outcome indicator of the severity of chronic PI and its based clinical classification increase accuracy in assessing the severity of chronic PI, optimize obstetric tactics, and improve perinatal outcomes.

Objective. To study the level of interleukin (IL)-6, IL-8, and tumor necrosis factor-а (TNF-а) in the serum and amniotic fluid of patients with early amniorrhea (EA) while pursuing an active wait-and-see policy. Subjects and methods. A study group comprised 68 patients with EA and full-term pregnancy, without severe obstetric and somatic abnormalities; a control group consisted of 29 patients with full-term pregnancy and timely amniorrhea. The serum and amniotic fluid levels of IL-6, IL-8, and TNF-а were once measured in the patients of both groups during their delivery. Results. As compared to the control group, the study group was found to have a statistically signif icant increase in the peripheral blood serum levels of IL-8 and TNF-а. No IL-6 concentration changes were observed in the compared groups. At the same time there was a correlation between the amniotic fluid levels of IL-8 and TNF-а in the study group women while it was essentially slighter in the control group. The peripheral blood serum showed the reverse. Conclusion. The cytokines play an important role in the mechanisms of pathogenesis of EA. The equal concentration of IL-6 in the peripheral blood serum and amniotic fluids in the compared groups may suggest that there is no risk for pyoseptic complications when pursuing the active wait-and-see policy proposed by the authors for EA in the women selected in accordance with the above criteria.

Objective. To evaluate the efficiency of oxygen use to reduce the incidence and severity of intraoperative nausea and vomiting (IONV) in patients who had spinal anesthesia (SA) during cesarean section (CS). Subjects and methods. A sample of two hundred 18-to-40-year-old preg-nant women at 38— 42 weeks gestational age without comorbidity who had been electively operated on and who had standardized neuroaxial anesthesia was formed. All the patients were randomized into two groups. The exclusion criteria were vomiting one hour before CS; the use of antiemetic drugs 24 hours before surgery; hemoglobin oxygen saturation below 90%; persistent systolic hypoten-sion below 100 mm Hg or 20% of the baseline blood pressure after twice ad-ministration of vasopressors; transition to general anesthesia; considerable sur-gical design changes or any study protocol breaches made by an anesthesiolo-gist in the interest of the patient. The degree of nausea was rated by the patients as mild (grade 1), moderate (grade 2), or severe (grade 3). Vomiting was regarded as mild (grade 4) if there were 1—2 episodes and as a severe (grade 5) if there were more than 2 episodes throughout the study. The statistical analysis of the findings comprised descrip-tive statistics for each examined indicator and the testing of the hypothesis for the statistical significance of the difference for the mean between two groups, by using the Student’s t-test at a significance of level of 0.05. The frequency characteristics of samples were calculated to compare the frequencies of com-plications. The whole processing of the data was made using the software pack-ages Microsoft Office Excel 2007 and STATISTICA 5.0. Results. The examined groups were statistically homogeneous in terms of age-related, anthropometric, and obstetric characteristics. Surgery and anesthesia were accompanied without complications. All the patients achieved an adequate level of anesthesia; the development of sensory block was within Th4—Th6. In the non-oxygen group, the incidence of mild nausea was 3 times more common than in the oxygen group. Mild vomiting was seen more frequently in Group 1. The rate of severe vomiting was identical at each time interval in both groups. A large number of cases without IONV episodes were noted in Group 2. The low-est rate of IONV was observed in a group of patients who inhaled moistened oxygen in a volume of 5 liters per minute as compared with the non-oxygen group. Conclusion. Additional oxygen inhalation during CS under SA reduces the rate and severity of intraoperative nausea or vomiting.

Objective. To determine the most common technical errors of electrosurgical conization, which worsen the diagnostic and therapeutic capacities of surgery in patients with cervical intraepithelial neoplasia (CIN) III and microinvasive carcinoma of the cervix uteri (CCU). Subjects and methods. The study enrolled 474 patients with CIN III and microinvasive CCU who had undergone conization at the Russian Cancer Research Center and 85 patients after conization in other institutions. Histological specimens were reconsidered; the removed cone, resection margins, and scrapes were evaluated. The reasons for incomplete removal of the neoplastic epithelium (positive resection margins) were analyzed. Results. The positive endocervical resection margin was more common in women over 35 years of age and particularly common in postmenopause, which is associated with the inadequate choice of a «sail» and with its incomplete insertion due to canal stenosis. In patients with postpartum ruptures, inadequate excision was associated with the impossibility of placing an electrode in the deformed patulous canal and an incision along the neoplastic epithelium of crypta. The most common reasons for hampered interpretation of the degree of neoplasia and resection margins by the material of conization were carbonization and coagulation of cone margins (5.2%), non-fulf illment of curettage of the endocervical canal (4.5%) or its curettage up to conization (4.1%), as well as cone fragmentation (2.9%). The inadequate sequence of manipulations — curettage up to conization — makes it impossible to evaluate the endocervical margin in patients with signs of neoplasia in their scrapes. Conclusion. To avoid the artifacts of a cone, the “sail” electrode in postpartum cervical deformities should be pressed against the patulous canal wall on the side of incision. For postmenopausal patients, it is necessary to bougie the stenotic canal for the adequate insertion of the “sail” and the latter should be chosen, by orienting to the size of the cervix rather than the outlines of lesions visible on the ectocervix. When the altered epithelium of the ectocervix is located in close proximity to the cone margin, additional excisions of the ectocervical margin reduce the likelihood of obtaining the positive resection margins. Radiosurgical conization should be preferred to diathermoconization and the incision mode to the coagulation mode. Conization must necessarily be supplemented by cervical canal curettage, by performing it after cone removal, which will provide a precise evaluation of the endocervical margin status.

Objective. To estimate the rate of neonatal infectious and inflammatory diseases in placental insufficiency (PI) of infectious genesis. Subjects and methods. 1500 case histories were retrospectively analyzed; of which 500 showed infectious and inflammatory diseases. Two hundred and eighty-two cases diagnosed as having PI during pregnancy were selected. Moreover, complex prevention and therapy of PI were performed in 187 women and 95 patients were untreated. The babies were divided into 3 groups: 1) 85 neonatal infants diagnosed as having pneumonia (P23; P24); 2) 107 babies diagnosed as having omphalitis (P38), conjunctivitis (P39.1), and rhinitis (P28.8); 3) 90 newborn infants diagnosed as having other infectious diseases specif ic to the perinatal period (P39). Results. Infectious and inflammatory diseases ran much more severely in babies born to mothers with decompensated PI. Pneumonia was predominant in the structure of the diseases. At the same time the detection of markers for systemic inflammatory reaction not always reflected the presence of infectious and inflammatory disease in the newborns. Furthermore, there was a direct relationship between the manifestation of infectious and inflammatory diseases in neonatal infants and the correction of PI in their mothers (all untreated women gave birth to babies with infectious diseases). Conclusion. The findings suggest that maternal infection plays a role not only in causing pregnancy complications, premature labor, fetal growth retardation, etc., but also in developing intrauterine infection and in showing the infection in neonatality.

Objective. To study the efficiency of a current package of methods for the prenatal diagnosis of congenital malformations (CM) and chromosomal abnormalities (CA). Subjects and methods. In the period 2006 to 2010, a total of 72,514 ultrasound studies (US) were conducted in 34,523 pregnant women in different gestation periods and biochemical screening was carried out in 26,275 women in the first-second trimesters of pregnancy. Invasive diagnosis was made in 3248 pregnant women in terms of found US and biochemical markers. Results. US revealed 2794 CMs in the fetuses. Invasive studies could diagnose CA in 181 fetuses. Biochemical screening was found to be of diagnostic value in anterior abdominal wall defects and fetal neural tube defects and to be of low informative value in Down syndrome (DS). The prenatal diagnosis of DS in the Republic of Bashkortostan in the above period was 30.6%. Conclusion. A comprehensive approach to examining pregnant women, involving US and biochemical screening in the first trimester, as well as invasive diagnosis permit the increase in the number of diagnosed CMs and CMs. Combined prenatal screening was ascertained to have signif icant sociomedical and high economic eff iciencies.

Objective. To optimize therapy for bacterial vaginosis associated with Atopobium vaginae (A. vaginae). Subjects and methods. The study enrolled 60 women who received therapy with one of the drugs (metronidazole gel, 0.75%, clindamycin cream 2%, hexicon suppositories). To evaluate the efficiency of therapy, the authors made a clinical laboratory examination, assessed the symptoms of bacterial vaginosis according the Amsel criteria, estimated the lactobacillus component of the vaginal microflora, and identified A. vaginae. Results. Therapy with vaginal hexicon suppositories demonstrated a high clinical laboratory efficiency (95%) that was comparable with that of clindamycin and greater than that of metronidazole.

Young women with undifferentiated connective tissue dysplasia commonly manifest cardiac arrhythmias in pregnancy. The causes of progressive arrhythmias may be gestational hormonal, autonomic, and hemodynamic features. The authors discuss the implication of magnesium def iciency in the pathogenesis of undifferentiated connective tissue dysplasia and its related conditions. Magnesium deficiency is associated with a wide range of pregnancy and labor complications. Magnesium preparations are successfully used in pregnancy to treat hypertension, autonomic dysfunction, fetoplacental insufficiency and the aptness of discoordinated labor. The antiarrhythmic effect of magnesium preparations in pregnant women needs to be additionally evaluated.