No 1 (2013)

The review presents large-scale worldwide researches on using of androgens in patients with different stages of ovarian aging. Current understandings of pathogenic mechanisms lead to successful outcomes of these hormones use are explained.

Increasing number of patients with overactive bladder was observed over the past few years. The prevalence of OAB rises with age, and significantly affects the patients' quality of life. Large-scale epidemiological studies have reported on the prevalence of AOB, which was 15—20% in adult women and about 6% in younger women (15— 20 years old). The evidence of infectious nature of AOB is cumulated last years. Many manuals and guidelines, like NICE, recommend screening for uncomplicated urinary tract infections in patients with AOB and administer antimicrobial therapy when it's revealed. Deficiency in this glycosaminoglycan layer of the bladder is thought to be one of the main cause of cystitis recurring why is the researches on replacement therapy with hyaluronic acid were conducted. It is known that some cytokines and urinary nerve growth factor, detected in the urinary, are biomarkers for inflammatory, and correlate with intensity of urgency. However, all currently known biomarkers demand further investigations, prognostic value and their role in clinical practice assessment.

Objective. To increase effectiveness of uterine scar assessment after previous C-section using methods of complex mathematical modeling. Methods. Patients with history of uterine scar from previous C-section ages 18-40 years of age were enrolled in the study: 80 pregnant patients comprised a group with non-viable uterine scar, while another 80 patients had viable uterine scar. In terms of clinical end-point we used method of mathematical modeling when looking for evidence of non-viable uterine scar. Assessment of scar viability was conducted intraoperatively with follow up of morphological studies of scar tissue and adherent myometrium. Molecular and genetic methods for scar assessment were accomplished by using single nucleotide polymorphism (SNP) associated with inadequate homeostasis of connective tissue. Results. We propose low sensitivity of diagnostic ultrasound (37.5%) with moderate specificity (82.5%). As an alternative, a mathematical model was developed to assess scar viability based on genetic predictors allowing us to increase sensitivity of ultrasound screening to 46%. Using complex modeling that included results of diagnostic ultrasounds and genotypes MMP2: -735 C>A, VEGFA: -634 (-94) G>C, VEGFA: 936 CA (Thr594Thr) allowed us to increase sensitivity to 59.3% with specificity of 89.2%. Discussion. Using molecular and genetic screening methods in combination with traditional diagnostic standards allowed for a more accurate assessment of uterine scar after previous C-section in determination for the best mode of delivery.

Objective. Optimization of complex placental insufficiency treatment by using of both extracorporeal blood purification techniques and medical ozone. Methods. 127 pregnant women with placental insufficiency were divided into 2 groups depending on used therapeutic methods. Pre-conceptional status, pregnancy course, labor, postpartum period, newborns were assessed. Group 1 (study group) composed 58 pregnant women with placental insufficiency in which extracorporeal blood purification techniques and medical ozone treatment were included in complex therapy. Group 2 (comparison group) composed of 69 women with standard methods of placental insufficiency treatment. Results. The pregnancy complicated by placental insufficiency creates negative impact on adequate production and functioning of growth factors. Using traditional therapeutic methods in patients with placental insufficiency has led to considerable decrease in PGF level and increase in VEGF level during pregnancy compared to study group. It could be explained with higher therapeutic efficiency in the study group. Using extracorporeal blood purification techniques and medical ozone treatment in the study group resulted in significant reduction of complication rates during the labor and postpartum period, so as to more favorable perinatal outcomes. Conclusion. Thus, the current research has shown high-potency of extracorporeal blood purification techniques in complex therapy of placental insufficiency.

Objective. To determine pathogenetic mechanisms for realization of heritable and nonheritable risk factors for development of gestational complications by detecting of polymorphisms associations of genes involved in homocysteine metabolism and parameters of early pregnancy endothelial function. Materials and methods. 187 women in first trimester of pregnancy were enrolled in the study: 54 women with subcompensated placental insufficiency, resulting in fetal growth restriction (first study group), 22 pregnancies resulting in early pregnancy losses (before 12 weeks of gestation, second study group) and 111 women without complications who delivered healthy full-term infants. The assessment of genetic polymorphism associated with homocestein metabolic imbalance (MTHFR: 677 С>Т, 1298 A>C; MTRR: 66 A>G; MTR: 2756 A>G) was done be using real-time PCR. Serum Homocestein, endothelin, big-endothelin and metabolites of stable nitrous oxides concentrations were detected by IFA, immunofluorescent assay. Results. It was found that common pathogenic mechanisms for placental insufficiency development and early pregnancy losses may be associated with increased frequency of low functional allele 2756G gene MTR, which is associated with increased level of homocestein and endothelial dysfunction characterized like misbalance in vasoconstrictors and vasodilatotors system in pressor effect. At the same time early pregnancy losses associated with some polymorphisms of genes involved in homocysteine metabolism. Conclusion. Increased homocestein level due to expression of polymorphisms of genes involved in folate metabolism can lead to endothelial dysfunction. That results in placental insufficiency and early pregnancy losses if the pregnancy maintenance mechanisms are lacking.

Objective. To assess cognitive performance in outpatient postmenopausal women with arterial hypertension. Methods. 58 women ages 44 to 88 with arterial hypertension took part in investigations. Clinical investigation, blood chemistries, echocardiographic tests were performed for all of them. 24-hour blood pressure monitoring and treadmill tests were performed in 39 women. Depression and anxiety were assessed by using Hospital Anxiety and Depression Scale in all women and psycho-emotional status were assessed by using Mini-mental State Examination in 49 women. Results. Among women with hypertension during postmenopausal period cognitive dysfunction were revealed in 40, 8%: 24, 8% mild stage, 8, 2% moderate stage and in 6, 1% dementia was developed mild and moderate severity. Decreasing of cognitive status was associated with early menopausal age (р=0,001, r=-0, 77), obesity (р<0,001, r=0, 95), depression (р<0,001, r=-0, 55). Strong correlation was found among systolic blood pressure and severity of cognitive impairment (р<0,001, r=-0, 95). Decrease of left ventricular ejection fraction (р=0,001, OR 0, 22, 95% CI0, 09-0, 52) and left atrial enlargement according to ECHO (р=0,013, OR 11, 6, 95% CI 1, 67-79, 8) was independent risk factors for cognitive status reduction. Cognitive impairment was associated with obesity (р=0,004, OR 0,09, 95% CI 0,02-0,47), hyperlipidemia (р<0,001, OR 0,03, 95% CI 0,01-0,22), elevated blood urea nitrogen (р=0,001, OR 0,06, 95% CI 0,01 0,29) elevated blood glucose level (р=0,012, OR 6,3, 95% CI 1,5-25,9). Conclusion. Decline of cognitive status in women with AH is associated with early age of menopausal onset, obesity, depression, and dysfunctional lipid and carbohydrate metabolisms. Timely diagnosis of cognitive impairment is critical at early stages to maximize the greatest success of therapy.

In the frame work of performing state assignment in providing High-Tech Medical Care to citizens of the Russian Federation, subsidiary federal funds had been allocated to the leading Research Center for Obstetrics, Gynecology and Perinatology where close to 2000 programs are being implemented in Assisted Reproductive Technology yearly. Current clinico-scientific analysis is a vivid example of organizational work and medical aspects of various programs conducted by 11 physicians and 3 embryologists of the department for Assisted Reproductive Technology (ART) at the Research Center. The leading methods employed for women undergoing superovulation: were short with antagonists -67%, with that including “soft” protocols in patients with high risk of developing Ovarian Hyperstimulation Syndrome (OHSS), short with antagonists of GnRH- 15%, long with antagonists of GnRH- 18%. The effectiveness of IVF program in 2011 with regard to transfer of embryos was equal to -31.5%. Out of these: after successful IVF pregnancy was established in 31.5% of cases; with intro-cytoplasmic sperm injection (ICSI) method- 32.2% of cases. Diagnosis of twin pregnancy was observed in 11.2% cases, which added extra confidence about good quality of embryo transfer and adequate readiness of endometrium achieved by the team. Despite excellent results achieved with IVF program, we are often faced with difficulties in patients receiving treatment through HTM having lack of communication between federal Center and Regional centers; inability to receive consultation directly with the export; inaccurate or missing records for IVF contraindications in patient’s discharge paperwork; lack of prior preparation of a patient which leads to decrease effectiveness of treatment. Therefore, an adequately organized help to patients suffering from infertility and highly advanced technological treatment options are one of main factors today that will serve as a successful foundation for treatment of infertility. Together with the Assisted Reproductive Technologies we can count on our reserve of giving birth to long desired pregnancies and perspective increase in higher reproductive potential of the nation.

Objective. To reveal taurine's effects on metabolism, menstrual and reproductive function in women with PCOS. Methods. A total of 44 women with PCOS were included in the study with ages ranging from 18 to 44. Patients were randomized into two groups: 1) «Dibicor» group, n=30; 2) «Placebo» group, n=14. Thirty patients received dibicor 500 mg twice a day, fourteen patients received placebo 500 mg twice a day. Duration of the therapy was 3 months. Anthropometric measurements, content of adipose tissue, blood pressure, pulse rate, lipid levels, 3-hours oral glucose tolerance test (OGTT, 75 gr glucose), ultrasound uterine and ovarian investigations were done both before and after the therapy. Results. In the study group systolic and diastolic blood pressures were decreased. Heart rate was decreased, while serum HDL cholesterol was significantly increased (p=0,03). Changes in glucose metabolism characterized with metabolic clearance improvement in peripheral tissue («MRCSTUM», p=0,017) due to increasing of insulin sensitivity and beta cell function («1-st Phase», p=0,072; «2-nd Phase», p=0,049). Modulation of metabolism with taurine was accompanied by ovarian function enhancement, normalization of menstrual cycle (p=0,079), formation of dominate follicle in 20% of women with previous history of anovulation. Conclusion. Administration of dibicor in women with PCOS modulates metabolic dysfunction and improves reproductive prognosis, and also has protective effects against diabetes and cardiovascular diseases.

The most common and severe complications during pregnancy, labor, and postpartum period are caused by changes in the hemostatic system: recurrent miscarriage, early-onset severe preeclampsia, placental abruption, placental insufficiency, and thromboembolic events. In gynecological practice, the hemostatic system should be studied before and during hormonal contraception, hormone replacement therapy, during tumor processes, and in the perioperative period. As of now, the range of hemostasiological studies is wide, but the expediency and interpretation of the findings frequently present problems for obstetricians and gynecologists. Due to the above fact, an algorithm that can optimize hemostasiological examination and adequate correction of found disorders has been elaborated.