No 7 (2012)

Objective. To characterize the specific features of peripheral blood phagocyte function in pregnant women and their newborn infants in intrauterine infection (IUI). Subjects and methods. Subjects and methods. One hundred and eighteen pregnant women delivered by cesarean section were examined and divided into groups: 1) 30 patients had placental insufficiency (PI) without bacterial or viral infection during pregnancy; 2) 30 had bacterial or viral infection during pregnancy without PI; 3) 30 had PI and bacterial or viral infection during pregnancy; 4) 28 apparently healthy women. According to the neonatal status, the authors identified the following groups: 1) 15 women having a high infection risk who gave birth to babies with the signs of hypotrophy; 2) 18 women having a high infection risk who had neonates with IUI; 3) 25 women having a high infection risk, whose neonatal babies had noninfectious complications; 4) 32 women having a high infection risk who gave birth to apparently healthy infants; 5) a control group comprising 28 apparently healthy women and their babies. The phagocytic activity of neutrophil granulocytes was determined by a flow cytometric technique; the generation of reactive oxygen species (ROS) was estimated by luminol-dependent chemiluminescence. The spontaneous and opsonized zymosan-induced production of ROS was determined in the samples of nonfractionated maternal venous blood and neonatal umbilical cord blood. The expression of activation markers on the granulocytes of venous blood from pregnant women before childbirth and neonatal umbilical cord blood, such as CD16 (Fc receptor type III), CD11b (complement receptor (CR3)), CD95 (Fas/ APO1) (a proapoptotic marker (Fas-receptor)), was investigated. Results. No statistically significant group differences were found in the levels of white blood cells in the venous blood of pregnant women just before childbirth and in the umbilical cord blood of their infants. Absorbable function evaluation revealed significantly reduced phagocytic activity in the blood of pregnant women with a high infection risk and their newborn infants. Determination of blood granulocyte functional activity showed no great differences in the spontaneous generation of ROS between the pregnant women having a high infection risk and their neonates (p=0.437), but differences in the control group (p<0.05). The induced production of ROS was, on the contrary, more intensive in the pregnant women having a high infection risk than that in the control group women. Conclusion. Decreased granulocyte functional activity was noted in the neonatal infants born to the mothers having a high infection risk and enhanced immune system activation, particularly in early neonatal IUI. The high level of induced ROS production in the maternal blood and its low level in the umbilical cord blood may serve as one of the predictors for a high probability of IUI.

Objective. To establish a relationship of serum placental growth factor levels in the early gestational period (at 8—9 weeks) in pregnant women with metabolic syndrome (MS) to the clinical picture of preeclampsia and placental insufficiency (PI) and to placental morphological features. Subjects and methods. Eighty-nine pregnant women with MS (Group 1) were examined. A control group consisted of 25 healthy pregnant women (Group 2). Serum human placental grow factor levels (PlGF, pg/ml) were measured and placentas were morphologically studied in all the patients. Results. In the pregnant women with MS, the level of PlGF was ascertained to be slightly lower than that in the control group (р<0.01). The critical level of PlGF in the prognosis of development of PI is its value below 100 pg/ ml. A morphological study of placentas from the puerperas with metabolic syndrome suggests that placental immaturity is much more common with the low level of PlGF. Conclusion. The low level of PlGF may be used as a prognostic criterion for the development of PI and preeclampsia. The lower level of PlGF is in the f irst trimester of pregnancy, the earlier a package of measures should be launched to prevent severe gestational complications.

Objective. To comparatively evaluate the efficiency of internal iliac artery (IIA) ligation and uterine artery embolization (UAE) for hypotonic bleeding. Material and methods. Seventy-four childbirth history cases were analyzed in patients with hypotonic bleeding, who gave birth in 2002 to 2011. In 39 puerperas (Group 1), IIA ligation was performed in combination with measures to stop bleeding in the placental and postpartum periods. UAE was made in 35 patients (group 2). The two groups were comparatively analyzed; the obtained data were statistically processed by variation statistical methods using the Mann-Whitney test. Results. In all the puerperas, hysterectomy could be avoided by organ-saving surgery. After IIA ligation 56.4% of the patients additionally lost up to 300 ml of blood. After UAE, additional blood loss not exceeding 300 ml was recorded in 85.7% of the examinees. Conclusion. IIA ligation, as well as UAE, is an effective way to arrest postpartum hemorrhage. UAE should be considered to be the method of choice in promoting safe and prompt hemostasis. Vascular ligation may be undertaken if embolization is ineffective or the hospital lacks equipment.

Objective. To evaluate the fimbrial segment of the fallopian tubes in reproductive-aged women with benign tumors and cysts of the ovaries, by using electron microscopy. Subjects and methods. The study enrolled 25 fertile-aged patients with a benign ovarian abnormality. The biopsy specimens of the fimbrial segment of the fallopian tubes, obtained at surgery for the above abnormality, were investigated. Epithelial fragments after respective preparation were looked through an electron microscope. Results. Six patients with unrealized reproductive function were found to have atypical cilia with multiple axonemes and structural abnormalities of the ciliary transit area. Conclusion. It was proposed that the found ultrastructural abnormalities are involved in reproductive dysfunction in the patients. Whether molecular biological diagnostic techniques for ciliopathic infertility may be developed is discussed.

Objective. To study the efficacy and safety of lactic acid (femilex) alone and in combination with chlorhexidine (hexicon) versus ascorbic acid (vaginorm—C) and clindamycin (dalacin) in the therapy of bacterial vaginosis. Subjects and methods. In the period May 2010 to July 2011, the N.I. Pirogov National Medical and Surgical Center, Ministry of Health and Social Development of Russia (Moscow), and the Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia (Moscow) conducted a randomized, multicenter, comparative trial of the efficacy and safety of vaginal suppositories containing lactic acid and its combination with vaginal suppositories with chlorhexidine versus vaginal tablets with ascorbic acid and vaginal suppositories with clindamycin in 114 patients diagnosed as having bacterial vaginosis (BV). All the patients were divided into 4 groups according to the therapy used: 1) 33 women patients who were treated for BV with monotherapy with femilex as a vaginal suppository daily for 10 days; 2) 26 women who received daily monotherapy with vaginorm-C as a vaginal tablet for 6 days; 3) 28 patients who were daily treated with hexicone as a vaginal suppository in combination with femilex as a vaginal suppository for 10 days; 4) 27 patients who daily received dalacin as a vaginal suppository for 7 days. All the women underwent a set of clinical and laboratory studies including collection of their complaints, an objective gynecological examination, evaluation of vaginal biocenosis, PCR diagnosis of sexually transmitted infections. Results. The total recovery and improvement rates regarded by the patients as a positive treatment result were 93.9% in the femilex group, 73% in the vaginorm group, 96.5% in the femilex+hexicon group, and 59.2% in the dalacin group (Fisher’s exact test, p<0.01). It was the investigators’ opinion that the effectiveness rates in the groups were 90.9, 69.2, 96.4, and 55.5%, respectively. Evaluation of the safety and tolerability of the drugs in all the study groups showed no serious adverse reactions due to their use, which would worsen the patients’ health. However, undesirable events were recorded in the vaginorm-C (in 6(23.1%) of the 26 cases) and dalacin (in 4 (14.8%) of the 27 cases) groups. Conclusion. The given results of BV therapy with femilex alone and in combination with hexicon indicated the high efficiency and safety of both therapy regimens, which was comparable and even superior to conventional clindamycin therapy. Ascorbic acid (vaginorm-C) versus femilex, femilex + hexicon, and dalacin proved to be ineffective as an independent treatment option for BV. The findings suggest that femilex alone and in combination with hexicon may be recommended to treat BV and concomitant infectious and inflammatory diseases of the vagina.

Objective. To improve the quality of medical care to neonatal infants with infectious and inflammatory diseases (IID), by elaborating a clinical audit system and introducing rational etiotropic and pathogenetic therapy into neonatal practice. Material and methods. The 2006—2011 medical records of newborn infants were retrospectively analyzed. The medical records from 4 Federal Districts of the Russian Federation (3227 neonates, of them there were 1862 patients with the most common neonatal IIDs (congenital and acquired pneumonia, omphalitis, rhinitis, conjunctivitis, sepsis) were analyzed. Results. A neonatal IID audit model was determined. The used model was shown to be highly effective in diagnosing neonatal IID and reducing systemic antibacterial therapy and immunotherapy by 2.2 and 6.8 times, respectively. Conclusion. The use of a definite audit model makes it possible to avoid the hyperdiagnosis of neonatal IIDs and the baseless use of antimicrobial therapy. The application of an audit spiral enables the introduction of scientifically grounded measures to improve the quality of medical care to neonatal infants and to reduce economic costs.

Objective. To evaluate the clinical and microbiological efficacy and safety of fenticonazole (lomexin) used in women with vulvovaginal candidiasis (VVC). Subjects and methods. Thirty women of reproductive age (18—45 years old) with the verified diagnosis of VVC were examined using a general clinical study, microscopy of gram-stained smears, a cultural study of vaginal discharge, polymerase chain reaction, and expanded colposcopy. Lomexin was used in a daily dose of 600 mg as vaginal capsules twice at an interval of 3 days. A control examination was made 7—10 days and 1 month after its administration. Results. The eff iciency of Lomexin use was 96.7%. All the patients (100%) reported considerable positive changes just on days 2—3 of therapy. Manifestations, such as itch, burning, discomfort, and dysuria, were most rapidly relieved. A colposcopic re-examination revealed a positive effect in 22 (73.3%) of the 30 patients with varying degrees of exocervicitis after the therapy performed. No drug-related adverse reactions were observed in any case. Conclusion. Lomexin is an effective agent to treat VVC, well tolerated, easy-to-use, and highly acceptable.

Objective. To study the efficiency of combined central and local physiotherapeutic procedures in correcting neuroendocrine and cerebral disorders in puberty girls with obesity. Subjects and methods. Eighty-seven puberty girls, including 67 with varying degrees of obesity and 20 apparently healthy girls without obesity, were examined. Their hormonal profile, lipidogram, and fasting reactive insulin and glucose levels were studied. Body mass index (BMI) and waist and hip circumferences were determined. The functional status of the central nervous system was examined by electroencephalography. The parameters of the autonomic nervous system were estimated by cardiointervalography. The obese girls were divided into two groups: a study group (n=40) and a control one (n=27). The study group patients received transcranial magnetotherapy using the bitemporal procedure in combination with transcranial electrostimulation employing the frontomastoid procedure, as well as myoelectrostimulation of the anterior abdominal wall, by transferring the stimulation zone from the right hypochondrium to the left one. The course consisted of 10—15 daily sessions. The control girls had placebo physiotherapeutic procedures (with disconnected electrodes). An AMO-ATOS-E apparatus was used for central physiotherapeutic exposures; a MIOVOLNA (MYOWAVE) device made in Russia was applied for local exposures. All the girls received a low-calorie diet and studied at weight control school. Results. Six months after treatment initiation, BMI decreased by an average of 5.9 and 2.5 kg/m 2 in the study and comparison groups, respectively. In the study group, CNS and UNS improvements were noted in 55% of the children (in 3.7% in the comparison group), the menstrual cycle was recovered in 25 of 30 girls with its impairment in the study group and in 1 of 22 girls in the comparison group. The hormonal profile (LH/FSH ratio) significantly improved by 26% in the study group and remained unchanged in the comparison one. Conclusion. The high efficiency of combined (central and local) physiotherapy procedures is likely to be associated with normalization of pituitary-ovarian relationships and allows the proposed methods to be recommended in a rehabilitation program for puberty girls with obesity and reproductive abnormalities.