Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

No 6 (2012)

Articles

DETERMINATION OF FREE EMBRYONIC DNA IN THE PLASMA OF PREGNANT WOMEN FOR NONINVASIVE PRENATAL GENETIC DIAGNOSIS

TETRUASHVILI N.K., FEDOROVA N.I., FAIZULLIN L.Z., KARNAUKHOV V.N.

Abstract

The need for timely diagnosis with the minimum risk to mother and fetus determines whether it is urgent to make a noninvasive prenatal diagnosis. The detection of free (extracellular) embryonic DNA circulating in the maternal plasma has opened up fresh opportunities for the noninvasive genetic diagnosis of the fetus and the state of pregnancy. Embryonic DNA may be detected at 5—6 weeks’ gestation and promptly disappears after childbirth. Current molecular biological technologies to investigate this DNA make it possible to predict pregnancy complications, to define fetal sex and rhesus, and to diagnose gene and chromosomal mutations.
Obstetrics and Gynecology. 2012;(6):4-8
pages 4-8 views

FREE EMBRYONIC DNA IN PLASMA AS A PREDICTOR OF SPONTANEOUS PREGNANCY LOSSES IN WOMEN WITH RECURRENT MISCARRIAGE

FEDOROVA N.I., TETRUASHVILI N.K., FAIZULLIN L.Z., KARNAUKHOV V.N., SUKHIKH G.T.

Abstract

Objective. To reveal an association between the plasma levels of free embryonic DNA (feDNA) in the first trimester of pregnancy and recurrent miscarriage before 22 weeks’ gestation. Subjects and methods. A study group included 122 women with recurrent miscarriage and a control group comprised 103 pregnant women without obstetric and gynecological histories. The levels of feDNA (SRY and DYS-14 genes) were determined in the first trimester of pregnancy by real-time polymerase chain reaction. In 44 patients, the study was conducted over time at 6 to 20 weeks’ gestation at a 2-week interval. Results. There was a significant excess of feDNA levels in the women with recurrent miscarriage as compared to those with uncomplicated pregnancy (DYS-14, 1021.0±660.6 versus 172.4±56.8 copies/ml; p<0.01; SRY, 124.4±48.3 versus 45.3±21.6 copies/ml;p<0.01). The women with recurrent miscarriage were found to have the rise in DYS-14 and SRY levels at 6 to 20 weeks’ gestation, which was greater than those in the control group (p<0.05). Comparison of feDNA DYS-14 levels in the women whose pregnancy ended in spontaneous abortion before 22 weeks’ gestation versus in those who gave birth to full-term babies showed significant differences (1697.5±980.7 and 841.8±394.8 copies/ml, respectively; р<0.0001). The similar indicators for the SRY gene were 174.077±49.616 and 108.2±37.8 copies/ml (р<0.0001). Conclusion. In the pregnant woman, the plasma feDNA release up to the levels much greater than those in physiological pregnancy can serve as a predictor of spontaneous abortion before 22 weeks’ gestation.
Obstetrics and Gynecology. 2012;(6):9-14
pages 9-14 views

CURRENT PRINCIPLES IN THE MANAGEMENT OF PATIENTS WITH THROMBOPHILIA IN THE CONTEXT OF EVIDENCE-BASED MEDICINE

PUTILOVA N.V., BASHMAKOVA N.V.

Abstract

Objective. To choose an optimal package of therapeutic and diagnostic measures for patients with thrombophilia, by keeping in mind the pattern of hemostasiological disorders and the priority role of endogenous intoxication syndrome in the pathogenesis of gestational thrombogenic complications. Subjects and methods. A randomized study was conducted in 671 patients diagnosed as having thrombophilia of different genesis and associated hemostasiological disorders detected using the integral coagulation index (ICI) that reflected total coagulopathic changes in all the components of the hemostatic system in this contingent of patients. The efficiency and tolerability of therapy were evaluated from the changes in the clinical and laboratory manifestations of thrombophilia: the state of the hemostatic system (ICI) and the pattern of circulation in the mother-placenta-fetus system, which were monitored before and 2—3 weeks after treatment. The pattern and severity of gestational complications were assessed during pregnancy. Results. A combination of heparinoids and carbohemosorption is the optimal multimodality therapy option, which makes it possible not only to substantially reduce the proportion of complications of gestation, but also to prolong its time at delivery. Conclusion. The findings permitted the authors to write clinical management protocols for patients during both pregravid and pregnancy.
Obstetrics and Gynecology. 2012;(6):15-20
pages 15-20 views

CURRENT APPROACHES TO DIAGNOSIS AND PREGNANCY MANAGEMENT TACTICS IN CONGENITAL OBSTRUCTIVE UROPATHIES IN THE FETUS

GUS A.I., KOSTYUKOV K.V., KUCHEROV Y.I., PODUROVSKAYA Y.L.

Abstract

Objective. To define the value of prenatal echography in the detection of congenital obstructive uropathies in the fetus and pregnancy management tactics. Material and methods. One hundred and nine cases of obstructive urinary tract abnormalities found in the antenatal period were retrospectively analyzed. Echographic studies were performed antenatally and postnatally. The complex neonatal examination included the following studies: clinical blood analysis, biochemical blood and urine analysis, bacteriological urinalysis, echography, nephroscintigraphy, and contrast-enhanced magnetic resonance imaging of the urinary tract. All cases were divided into 4 groups according to the degree of urinary tract obstruction, as recommended by the Society of Neonatal Urologists, and analyzed in detail. Results. Thirty-three (30.3%) neonatal infants were found to have spontaneous hydronephrosis resolution with insignificant pyelocaliceal complex dilation in the first month after birth. The mean values of the anteroposterior dimensions of the renal pelvis (APDRP) significantly differed in 4 comparison groups. Retrospective analysis showed that surgical interventions were more frequently performed in infants whose APDRP was more than 19 mm at the echography carried out in the third trimester of pregnancy.
Obstetrics and Gynecology. 2012;(6):21-27
pages 21-27 views

THE COMPARATIVE LEVELS OF REGULATORY TRANSPORT PROTEINS, CYTOKINES, AND SPECIFIC IMMUNE COMPLEXES IN THE BLOOD, PERITONEAL FLUID, AND CYSTIC CONTENTS OF WOMEN WITH EXTERNAL ENDOMETRIOSIS

ZORINA V.N., TRETYAKOVA T.V., ZORINA R.M., BAZHENOVA L.G., RYABICHEVA T.G., ZORIN N.A.

Abstract

Objective. To comparatively study the blood, peritoneal fluid (PF), and cystic contents (CC) levels of a number of cytokines (IL-6, IL-8, TNF-α), alpha2-macroglobulin (a2-MG), pregnancy-associated alpha2-glycoprotein (a2-PAG), lactoferrin (LF), and alphal-antitrypsin (a1-AT), as well as the concentrations of circulating immune complexes of class G antibodies with a2-MG and a2-PAG in Stage III external genital endometriosis to specify their role in the pathogenesis of the disease and the possibility of their use in differential diagnosis. Subjects and methods. A group of 48 women (33.2±1.8 years of age) diagnosed as having Stage III external genital endometriosis was examined. Sera from 35 apparently healthy women (38.20±2.06 years of age) selected according to the results of planned prophylactic medical examination and sera, PF, and CC from 10 women (41.9±6.5 years of age) with simple ovarian serous cysts (SOSC) were studied as control and comparison groups, respectively. The content of a2-MG, a2-PAG, and al-AT was measured by quantitative rocket immunoelectrophoresis. The levels of IL-6, TNF-a, IL-8, LF, a2-MG-IgG, and a2-PAG-IgG were examined using solid-phase enzyme immunoassay (EIA). Results. The patients with endometriosis were found to have higher levels of the immune complexes of a2-PA G-IgG, LF, al-AT, and TNF-a and a lower concentration of a2-MG than did the healthy individuals (only the a2-MG concentration was decreased in ovarian retention cyst (ORC). In endometriosis, PF showed higher a2-PAG-IgG and IL-6 levels and a lower LF concentration than in ORS. In this condition, CC exhibited increases in all the study indicators as compared with ORS. Conclusion. The found changes are indicative of the more magnitude of alterations in humoral immunity and more aggressive processes in endometriosis and may be used as additional diagnostic and prognostic criteria in the clinical practice of an obstetrician/gynecologist.
Obstetrics and Gynecology. 2012;(6):28-32
pages 28-32 views

ROLE OF NONRANDOM X-CHROMOSOME INACTIVATION AND ANDROGEN RECEPTOR POLYMORPHISM IN POLYCYSTIC OVARY SYNDROME

CHERNUKHA G.E., BLINOVA I.V., NEMOVA Y.I., RUDENKO V.V.

Abstract

Objective. To study the presentation of nonrandom X-chromosome inactivation and androgen receptor (AR) gene CAG repeat polymorphism in patients with polycystic ovary syndrome (POS). Subjects and methods. The study enrolled 53 patients with POS and 64 healthy women with regular menstrual cycles. Nonrandom X-chromosome inactivation was detected by differential methylation of active and inactive X chromosome, followed by AR gene exon 1 CAG repeat polymorphism analysis, by applying the methyl-sensitive polymerase chain reaction. Results. In the POS group, nonrandom X-chromosome inactivation was found in 54% (27/50) of cases, which was 3.4 times as often as that in the control group — 16.1% (9/56) (p<0.0001). A study of AR CAG repeat lengths indicated that the alleles with a repeat length of 23 (CAG) and 19 (CAG) were most common in 13% (14/106) and 18.8% (24/128) in the POS and control groups, respectively. The mean sum of the two alleles (SBM) did not differ between the groups and were 22.02±2.77 and 21.42±2.26, respectively (р>0.05). There was a relationship of the clinical manifestations of POS to the genotype of the patients: more severe impairments in the menstrual cycle were observed in the patients with random X-chromosome inactivation. This group of patients showed a relationship of AR gene CAG repeat lengths to the level of androgens. In the patients with long repeat length alleles for AR (GAC repeats ≥22) and its low activity, the mean level of free testosterone was 3 times as high as that in those with short repeat length alleles (7.49±5.79 versus 2.27±1.81pg/ml; р=0.0017). Conclusion. Every two patients with POS were found to have nonrandom X-chromosome inactivation associated with more pronounced ovarian dysfunction. There were no differences in AR CAG repeat lengths between the control and POS groups; however, the nonrandom X-chromosome inactivation group displayed a relationship of long repeat length alleles to the high levels of free testosterone. This may be considered as one of the mechanisms for the development of hyperandrogenism in POS.
Obstetrics and Gynecology. 2012;(6):33-39
pages 33-39 views

CLINICAL VALUE OF STUDY OF MATRIX METALLOPROTEINASES AND THEIR INHIBITORS IN PATIENTS WITH OVARIAN CANCER

GERSHTEIN E.S., LEVKINA N.V., KUSHLINSKY D.N., ERMILOVA V.D., NOSOV V.B., MAKSIMOVA Y.V., LAKTIONOV K.P., ADAMYAN L.V.

Abstract

Objective: by using quantitative enzyme immunoassays, to comparatively estimate the content of matrix metalloproteinases (MMP)-2, -7, and -9 and their type 1 and 2 tissue inhibitors (TIMP) in the tumors and sera of patients with cancer, benign, or borderline neoplasms of the ovary and to analyze the relationship between these indicators and the major clinical and morphological features of ovarian cancer. Subjects and methods. Eighty-four patients with primary ovarian tumors (49, 11, and 24 patients with malignant, borderline, and benign tumors, respectively) were examined. A control group included 30 apparently healthy women. Out of the 49 patients with malignant ovarian tumors, 43 were found to have serous ovarian carcinoma; 3, mucinous carcinoma; and 3, endometrioid carcinoma. Serous tumors were identified in 19 cases of the 24 benign ovarian neoplasms. The levels of the study proteins were determined in the sera and tumor lysates [12], by applying the standard enzyme immunoassay kits, Human/ Mouse/Rat MMP-2 (total), Human MMP-7 (total), Human MMP-9 (total), Human TIMP-1, and Human TIMP-2 (Quantikine®, R&D Systems, USA). The concentration of the study indicators was expressed as nanograms per ml (ng/ml) for serum and as nanograms per ml total protein (ng/mg protein) for tissues. The data were processed using the software Statistica 7.0. Nonparametric methods, such as Mann-Whitney U test, Kruskal—Wallis H test, and Spearman’s rank order correlation coefficient (R), were used to compare values and to analyze their relationships. The differences and correlations were considered significant at p<0.05. Results. Analysis of the serum content of MMP and TIMP indicated that the most promising marker for the differential diagnosis of borderline, benign, and malignant ovarian neoplasms was MMP-7. The level of this MMP was above the control one only in the patients with ovarian cancer. The level exceeding the upper limit of the reference range (95% of the control values — less than 4.67 ng/ml) was noted in 38 of the 49 primary patients with cancer, i.e. its sensitivity relative to the controls at 95% specificity was 78%. The sensitivity of this test was 37.5 and 64% for benign and borderline neoplasms, respectively. MMP-7 proved to be the most important marker in analyzing the relationship between the serum values and the clinical and morphological features of ovarian cancer. Its level was significantly positively correlated with the key indicators of the extent of ovarian cancer: the stage of the disease as a whole, the size of a primary tumor, as evidenced by ultrasound study, the presence and pattern of peritoneal dissemination and metastases in the greater omentum, and the presence and amount of ascites. The concentration of MMP-7 in the serum was also correlated with that in the ascitic fluid (R=0.53; p=0.008). Furthermore, only the level of MMP-7 was positively associated with that of the classical serum ovarian cancer marker CA-125 (R=0.32; p=0.003). Conclusion. Enzyme immunoassay of MMP-2, MMP-7, and MMP-9 and TIMP-1 and TIMP-2 levels in the tumor tissue and serum of patients with cancer, borderline, or benign neoplasms of the ovary showed a coordinated increase in the tissue expression and serum concentration of MMP-7 in ovarian cancer. The changes opposite in opposite magnitude were found for MMP-2. Those in the levels of MMP-9, TIMP-1, and TIMP-2 were less marked. MMP-7 should be regarded as the most important serological marker for ovarian cancer.
Obstetrics and Gynecology. 2012;(6):40-46
pages 40-46 views

PERINATAL MORTALITY IN THE RUSSIAN FEDERATION: POSSIBLE WAYS OF ITS REDUCTION

FROLOVA O.G., SHUVALOVA M.P., GREBENNIK T.K., DOLGUSHINA N.V.

Abstract

Objective. To analyze perinatal mortality in Russia and its regions and to establish the specific features of its causes in the regions with its different rates. Material and methods. The 2006—2010 official statistical data were used. Statistical and analytical methods were employed. Results. In the Russian Federation, the leading cause of perinatal mortality was infant asphyxia (412.5 per 100 000 live and stillborn births), then respiratory disorders (107.8), congenital anomalies (71.4), endocrine disorders (45.3), and infections (35.9). The causes of perinatal mortality in 2010 were detailed in detail in two Russian Federation’s subjects having its different rates. The incidence of an abnormality as a cause of perinatal mortality was ascertained to vary with its rate. Conclusion. Analysis of the regional aspects of perinatal mortality gives the chance to develop an effective system of measures for further reduction of perinatal losses.
Obstetrics and Gynecology. 2012;(6):47-51
pages 47-51 views

THE EXPEDIENCY OF ANTIBIOTIC PROHYLAXIS DURING CEASAREAN SECTION IN PREGNANT WOMEN AT LOW RISK FOR INFECTION

BALUSHKINA A.A., TYUTYUNNIK V.L., SHIFMAN E.M.

Abstract

Objective. To analyze the pattern and frequency of pyoinflammatory complications in puerperas at low risk of infections after cesarean section according to whether or not antibiotic prophylaxis is performed. Subjects and methods. 3549 history records were retrospectively studied in women who had delivered by cesarean section at the Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology over 3 years from 2008 to 2010 inclusive. The authors selected a total of 170 cases, including 85 puerperas who had received antibiotic prophylaxis for cesarean section (Group 1 (a study group) and 85 pregnant women who had single-dose perioperative antibiotic prophylaxis with inhibitor-dependent penicillins (Group 2, a comparison group). Results. It is reasonable to refuse antibiotic prophylaxis in women at low risk for infectious complications after cesarean section if the risk of infection is correctly estimated, local infection is timely sanitized, the duration of surgery is reduced to 30 minutes, and the aseptic and antiseptic rules are observed.
Obstetrics and Gynecology. 2012;(6):52-57
pages 52-57 views

CORRECTION OF VAGINAL MICROBIOCENOSIS IN WOMEN WITH GESTATIONAL DIABETES MELLITUS

ARZHANOVA O.N., KAPUSTIN R.V.

Abstract

Objective. To assess the efficacy of vaginorm-C for the correction of vaginal microbiocenosis in women with gestational diabetes mellitus (GDM). Subjects and methods: The study included 45 pregnant women who formed two comparison groups: 1) 30 pregnant women with dietarily compensated GDM; 2) 15 pregnant women with insulin-compensated GDM. The examination standard included clinical and laboratory studies, determination of vaginal acidity (pH) using Careplan VpH test gloves before and after the study, bacterioscopy, molecular biology (PCR), culture (vaginal smear tests for lactobacteria before and after therapy, study of lactobacteria, and evaluation of perinatal outcomes. Results: Within the first days of use of vaginorm-C, more than half (56%) of the patients of the study groups had objective improvement and reduced clinical symptoms of bacterial vaginosis. The vaginal pH value measured by the Careplan VpH system decreased to normal values (<4.5) in about all (93.4%) women included into the protocol. After treatment, the microflora of vaginal secretions became physiological. Virtually all the pregnant women had term deliveries; all babies were born with Apgar scores of 7—8. There were no postpartum infectious complications in the puerperas. Conclusions: The use of vaginorm-C is a safe and effective method to correct vaginal microbiocenosis in women with gestational diabetes and may be used to treat bacterial vaginosis and to prevent postpartum infections in pregnant women with this pathology.
Obstetrics and Gynecology. 2012;(6):58-62
pages 58-62 views

CONSEQUENCES OF SEVERE UTERINE CONTUSION IN PREGNANT WOMEN

KARIMOV Z.D., ZHABBAROV U.U., KHUSANKHODZHAYEVA M.T., ABDIKULOV B.S., PAKHOMOVA Z.E.

Abstract

Objective. To make a comprehensive analysis of the pattern and nature of different damages among pregnant women with severe injury. Subjects and methods. In the past 11 years, the authors have followed up 158 pregnant women; the study enrolled only patients with severe injury who were admitted to the head center of Tashkent and its regional branches. The severest injuries characterized as polytrauma were noted in 18 (11.4%) pregnant women who had been admitted after traffic accidents (TA) and catatrauma and their mortality rate was 55.6% (10 of the 18 women died). Overall maternal death rate was 13.3% (21 of the 158 women were dead). The pregnant women’s age ranged from 18 to 35 years. The victims comprised 59 (37.3%) primigravidas and 99 (62.6%) secundiparas. The gestational age of the victims ranged from 8 to 40 weeks. Results. Damages to the locomotor apparatus and extragenital internal organs were present in 93 (58.9%) and 86 (54.4%) pregnant women, respectively. Mixed shock developed in 125 (79.1%) pregnant women. Eighty-six pregnant women with TA and catatrauma were found to have upper and lower limb fractures in 86(100.0%) cases, neurotrauma in 78 (90.7%), splenic rupture in 24 (27.9%), extensive retroperitoneal hematoma in 19 (22.1%), pelvic fracture in 18 (20.9%), rupture of the kidney in 16 (18.6%) and that of the liver in 11 (12.8%), pneumo-and hemothorax in 8 (9.3%), costal fractures in 6 (7.0%), lung ruptures in 6 (7.0%), spinal fracture in 2 (2.3%), urinary bladder rupture in 2 (2.3%), urethral detachment in 2 (2.3%), and leg detachment in 1 (1.2%) victim. At the same time, the volume of total blood loss in the victims was below 1000 ml in 9 (10.5%) pregnant women, from 1200 to 2000ml in 31 (36.0%), from 2200 ml or more in 46 (53.5%). Damages to the uterine-placental unit in 137 victims (those with burn injury being excluded) included uterine atony and areflexia in 25 (18.2%) pregnant women, premature detachment of the normally located placenta in 25 (18.2%), and incomplete uterine rupture in 1 (0.7%) case. Conclusion. The performed studies allowed us to formulate new propositions that characterize severe contusion of the pregnant uterus and to recommend a number of clinical guidelines at the stages of hospitalization.
Obstetrics and Gynecology. 2012;(6):63-68
pages 63-68 views

OPTIMIZATION OF APPROACHES TO USING MIFEPRISTONE TO PREPARE FOR LABOR

BAYEV O.R., RUMYANTSEVA V.P.

Abstract

Objective. To optimize approaches to preparing the cervix uteri for labor with mifepristone in patients tending to prolong pregnancy and to define their management tactics after inadequately ineffective initial preparation with th is drug. Subjects and methods. One hundred and twenty-two patients at 256—298 days gestation were examined. Mifepristone alone was used to prepare 90 women (Group 1) for labor; if the agent was inadequately effective, the following labor preparation stage or labor induction was made in 32 women (Group 2) Results. After the use of mifepristone, regular labor activity developed during preinduction in 84.2% before 287 days gestation and in 61.4% at >287 days. The risk for labor abnormalities showed a 1.7-fold increase with advancing gestational age at which preinduction was initiated (p=0.02). Moreover, at 42 weeks or more gestation, the need to continue preinduction was generated 2.5 times more frequently (p=0.015). The outcomes of preinduction were comparatively analyzed to determine whether it was reasonable to continue preparation for labor if mifepristone was inadequately effective. The active phase of labor was achieved in 90 and 68.8% of Groups 1 and 2 women, respectively (p=0.03). The latter group was also characterized by the high rate of abnormalities in labor activity (34.4% versus 18.9%;p=0.009) and abdominal delivery (40.6% versus 25.5%;р=0.09) Conclusion. 1. The optimal gestational age at which mifepristone preinduction is the maximum effective is 40 weeks 4 days to 40 weeks 5 days. 2. It is reasonable to continue preparation for labor if mifepristone is inadequately effective in certain clinical situations; however, account must be taken of the reduced efficiency of the used methods and the increased risk of cesarean delivery.
Obstetrics and Gynecology. 2012;(6):69-73
pages 69-73 views

CURRENT ASPECTS OF NUTRITIONAL SUPPORT FOR VERY LOW AND EXTREMELY LOW BIRTH WEIGHT INFANTS IN THE NEONATAL PERIOD

LENYUSHKINA A.A., ANTONOV A.G., BAIBARINA E.N., GROSHEVA E.V., KRYUCHKO D.S., IONOV O.V.

Abstract

Objective. To evaluate the efficiency of a procedure for the early forced dotation of essential nutrients versus the traditional tactics in very low and extremely low birth weight (VLBW and ELBW) infants. Subjects and methods. According to the time of dietary protein intake and the rates of its dose increment, all the infants were divided into 2 groups. Group 1 with forced protein donation comprised 52 premature neonates who began receiving protein not later than on the second day of life; moreover, protein donation was increased up to >3 g/kg/day on day 5 of life. Group 2 with traditional protein donation included 36 premature newborn babies who were given protein < 3 g/kg/day on day 5 of life. The amount of the dotated plastic substrate was estimated by adding the parenterally and enterally administered protein (amino acids). The results of clinical and laboratory studies were assessed until the babies were less than 37 weeks post-conceptual age or until they were discharged from hospital if it occurred earlier. Results. Within the first week of life, the daily total protein intake in Group 1 babies averaged 2.48 g/kg/day, which was 47.17% higher than that in Group 2 infants who had received a protein level of 1.17g/kg/day; within the second week of life, the mean protein intake was 3.96 versus 3.12g/kg/day, which was 21.2 % greater than that in Group 1. No differences were found in the administered protein doses during the succeeding weeks of life. The energy supply from carbohydrate and fat components was similar in the compared groups. In Groups 1 and 2, the maximum postnatal weight loss was noted on 4±1.6 and 6±2 days of life, respectively (p < 0.05). Positive weight changes or start of weight gain was seen on 5.37 and 7.14 days of life in Groups 1 and 2, respectively. There was less weight loss in Group 1 than in Group 2 (8.24 versus 9.18%). The postnatal weight loss of > 15% of the baseline birth weight, which was abnormal in premature babies, was observed in 3 and 10 infants from Groups 1 and 2, respectively (6% versus 28%;p < 0.05). In Groups 1 and 2, weight was restored to the baseline birth values on 11±4.5 and 14±4.2 days, respectively (p < 0.05). The rate of daily weight gain after weight restoration was 18.37 and 17.13 g/kg/day in Groups 1 and 2, respectively. Conclusion. In the VLBW and ELBW groups, early forced parenteral protein administration improved the time course of changes in the levels of restoration of primary loss of weight and its further gain in the neonatal period, which can promote better nursing results, a shorter hospital stay, and lower treatment cost.
Obstetrics and Gynecology. 2012;(6):74-80
pages 74-80 views

MACROMASTIA OF PREGNANCY: CLINICAL CASES OF BILATERAL MASTECTOMY AND A GOOD OUTCOME

TYUTYUNNIK V.L., SHIFMAN E.M., PARAKONNAYA A.A., BALUSHKINA A.A.

Abstract

The paper describes clinical observations of two patients at 22—24 weeks’ gestation with bilateral macromastia concurrent with myasthenia in one of the cases. Owing to the adequate diagnosis, the pregnant women were admitted to a core hospital, successfully operated on and then transferred to an obstetric unit to prolong pregnancy. Both clinical cases ended with the birth of full-term live babies.
Obstetrics and Gynecology. 2012;(6):81-84
pages 81-84 views

VERMIFORM APPENDIX MUCOCELE MIMICKING AN ADNEXAL MASS

MISHINA A.E., ROJNOVEANU G.A., MISHIN I.V.

Abstract

The paper describes a case of vermiform appendix mucocele mimicking an adnexal cystic mass in a 54-year-old female patient.
Obstetrics and Gynecology. 2012;(6):85-86
pages 85-86 views

AN EXAMINATION AND PREGESTATIONAL PREPARATION PROGRAM FOR PATIENTS WITH RECURRENT MISCARRIAGE (A CLINICAL LECTURE)

TETRUASHVILI N.K., AGADZHANOVA A.A.

Abstract

Recurrent miscarriage is a polyetiological problem requiring examination and preparation before planned pregnancy. The paper gives an improved examination program for non-pregnant patients and describes the causal factors of recurrent miscarriage in 230 married couples. It also outlines the results of a randomized trial evaluating the efficacy of actovegin incorporated into a pregestational preparation program for women with recurrent miscarriage and chronic endometritis.
Obstetrics and Gynecology. 2012;(6):87-91
pages 87-91 views

PREGNANCY MANAGEMENT IN WOMEN WITH CANCER: 10 YEARS' EXPERIENCE

VOLOCHAYEVA M.V., POLUSHKINA E.S., SHMAKOV R.G., SHETIKOVA O.V.

Abstract

Recent epidemiological data suggest that there is both a true rise in the prevalence of cancer and an increase in the number of young women in whom current specific therapy leads to recovery from the disease, which has made the problem of their reproductive function realization urgent. Based on foreign investigators’ and their data, the authors developed indications for and contraindications to prolonged pregnancy, as well as pregnancy management tactics in women with lymphoma, breast cancer, or chronic myeloproliferative diseases. Analysis of the physical development of infants and the rate of congenital and acquired diseases in neonates born to mothers with these cancers showed no significant difference in these indicators from those in newborns from the general population. Pregnancy and its maintenance at any stage of the disease do not affect the efficiency of treatment and survival rates in patients with these cancers.
Obstetrics and Gynecology. 2012;(6):92-98
pages 92-98 views

SIMPLE HYSTERECTOMY USING THE DA VINCI S ROBOTIC SYSTEM FOR BENIGN UTERINE TUMORS

KIRA E.F., POLITOVA A.K., ALEKPEROVA A.F., KHAIKINA V.Y.

Abstract

Objective. To make a primary analysis of robot-assisted simple laparoscopic hysterectomies using the da Vinci S. robotic complex. Subjects and methods. In March 2009 to August 2011, the Clinic of Female Diseases and Reproductive Health, N.I. Pirogov Research Medical and Surgical Center, Ministry of Health and Social Development of Russia, followed up 33 women aged 38 to 63 years (mean age 46.3±5.8 years) with benign uterine and ovarian tumors. The patients’ weight was 48.4 to 106.43 kg (mean 77.4±2.7 кг); body mass index was 21.9 to 33.25 kg/m 2 (mean 26.07±0.4 kg/m 2). All the 33 patients underwent 27 simple hysterectomies and 6 supravaginal uterine amputations, by applying the da Vinci S robotic system. Uterine myoma was concurrent with adenomyosis in 3 patients, with benign ovarian neoplasms and fallopian tube abnormalities in 9, and endometrial hyperplasia in 4. The uterus varied 7 to 16 weeks’ gestational size (mean 12.4±2.6 weeks). Criteria, such as the time of surgical intervention, a surgeon’s console work, and anesthesia, the volume of blood loss, and intraoperative and postoperative (up to 6 weeks) complications, were estimated. Results. The robotic expansion and set-up time averaged 17.8±2.09 min (range 20.4—180.6 min). The duration of skin-to-skin (i.e. first-to-last incision) surgery was 184.7±10.2 min (range 78.5—215.9 min). The mean surgical duration (the time of a surgeon’s console work) was 156.34±54.36 min. Intraoperative blood loss averaged 97.0±65.43 ml (range 50.3—150.2 ml). There were no intraoperative or early postoperative complications. In one case, there was a conversion switch from robot-assisted laparoscopy to conventional one because of the uterus being enlarged 16-18 weeks’ gestational size and two myomatous nodules being located low, which limited to a greater extent the feasibility of abdominal manipulations. The surgery was completed laparoscopically. Conclusion. A great breakthrough has been made during 200 years of gynecological operations, simple hysterectomies in particular. Technological progress has contributed to the enormous improvement and promotion of simple hysterectomies from the laparotomy developed by E. McDowell to the robotic system.
Obstetrics and Gynecology. 2012;(6):99-103
pages 99-103 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies