No 3 (2013)

The paper formulates a new pregnancy management concept that envisages the need for primary prevention of gestational hypertensive and metabolic disorders. Hypertension during pregnancy is one of the major causes of maternal death and neonatal losses and it is associated with a poor long-term cardiovascular prognosis. Fat and carbohydrate metabolic disturbances also deteriorate the course of pregnancy, labor, and delivery and gives rise to fetal hypoxia, macrosomia, fetopathy, as well as obesity and diabetes mellitus (DM) in further years of a woman’s life. At the same time, the prevalence of gestational DM (GDM) is increasing all over the world. In 2012, Russia has adopted the national consensus on gestational diabetes mellitus: diagnosis, management, and postpartum follow-up, which is the generally accepted opinion of the experts of the Russian Association of Endocrinologists and those of the Russian Society of Obstetricians/Gynecologists about diagnostic criteria for GDM and other carbohydrate metabolic disturbances during pregnancy. The basic provisions of the national GDM consensus are given in the paper; strict compliance with its recommendations will be able to prevent many maternal and fetal complications.

This review presents an update on the role of vascular endothelial (VE) growth factor (VEGF) in the pathogenesis of ovarian hyperstimulation syndrome (OHSS). The paper shows the pathophysiological bases for the development of this iatrogenic complication: hypovolemia, hemoconcentration, dysproteinemia. VEGF receptor-1 (Flt-1) and VEGF receptor-2 (KDR), VE cadherins are considered to be involved in the development of OHSS. Particular attention is given to the effect of dopamine D2-receptor agonists on the basic pathophysiological mechanism of OHSS - vascular permeability. Data on the efficacy of this group of agents in the prevention of this complication are given. It is emphasized that the use of dopamine D2-receptor agonists needs further investigation in order to define their ultimate place in the prevention of OHSS.

The review gives literature update on different aspects of hyper- and neoplastic processes in the endometrium. The results of investigations into the prevalence, risk factors, and diagnosis of endometrial hyperplasia, including the possibilities of using immunohistochemical and molecular genetic studies, are presented. The efficiency of different hormone therapy options is shown.

Objective. To investigate the blocking effect (BE) of autologous sera on the activation of lymphocytes from women with a history of recurrent miscarriage (RM) in their preparation for pregnancy and during the latter. Subjects and methods. The BE of the sera was determined by flow cytometry in 31 women with RM and 11 fertile women Results. After pregestation preparation using immunocytotherapy (ICT), pregnancy ended in the birth of a live baby in 17 women with RM and a miscarriage occurred in 5. During the current pregnancy, BE was minimal at 8-9 weeks gestation and then increased by the end of the second trimester and in the third trimester. Conclusion. The assessment of the blocking activity of peripheral blood serum is seemingly promising for use as one of the laboratory criteria for the efficiency of pregestation preparation using ICT and as one of the indicators of threatened miscarriage in the women with RM at 8-9 weeks gestation.

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow Objective. To reduce premature birth rates, by optimizing the management tactics for pregnant women at high risk, and to subsequently assess maternal and fetal outcomes. Subject and methods. A retrospective group included 137 women with premature birth, who had been followed up in the Kaliningrad women’s health clinics in 2004 to 2009. A prospective group consisted of 143 women at high risk for premature birth, who had been followed up since early pregnancy at Maternity Home One, Kaliningrad Region. Results. The causes of premature birth were retrospectively analyzed; their outcomes in the period 2004-2009 were assessed. By using the findings, the authors formed a prospective group of pregnant women at high risk for premature birth. They developed a pregnancy management plan in terms of the diagnostic criteria: the efficiency of vaginal pH-metry, actim partus and actim prom test systems in diagnosing premature labor premature rupture of membranes, respectively. Detection rates for hereditary thrombophilias -hemostatic system gene mutations -were estimated; efferent (plasmapheresis), disaggregant, and anticoagulant therapies were used. The efficiency of different tocolytic therapy options in preventing threatened preterm labor was evaluated, by taking into account the period of pregnancy and the necessity of preventing neonatal respiratory distress syndrome. Based on the findings, the authors elaborated a package of medical and diagnostic measures to prevent premature birth at Maternity Home One, Kaliningrad Region. Conclusion. The intensive follow-up of pregnant women since the early periods, the timely recovery of vaginal normocenosis, the use of preventive antithrombotic therapy in cases of diagnosed hereditary thrombophilia, the prevention of fetal distress syndrome, and the prescription ofmicronized natural progesterone in the early stages of pregnancy in high-risk group women allow pregnancy management tactics to be optimized. The timely application of a package of the elaborated medical measures makes it possible to reduce preterm birth rates and to have a higher percentage of live full-term babies.

Objective. To study the association of polymorphisms in the blood pressure regulatory genes with hypertensive complications of pregnancy in patients with gestational diabetes mellitus (GDM). Subjects and methods. 108 pregnant women with GDM, of whom 63 women were found to have gestational hypertension (group 1) and 45 pregnant women had normal blood pressure (group 2) were examined. A molecular genetic study of polymorphisms in the blood pressure regulatory genes by using a real-time PCR assay was studied in all the women. Results. There was an association between 704TS genotype in the angiotensinogen (AGT) gene and the risk of hypertensive disorders in women with GDM (OR = 3.28; 95% CI, 1.64-6.59; p = 0.003). The AGT gene 704S allele in the genotype (704TS + SS) increased the risk of hypertensive disorders in the presence of GDM by 3.87 times (OR = 3.87; 95% CI, 1.60-9.35; p = 0.002). On the contrary, the 704TT genotype had a protective effect against the development of this disease (OR = 0.26; 95% CI, 0.62-0.11; p = 0.002). Conclusion. The findings suggest that there is an association of the AGT gene 704TS and 704SS genotypes with the risk of hypertensive disorders in the presence of GDM.

Objective. To analyze the risk of congenital fetal malformations (CFM) in the carriers of balanced chromosome rearrangements after different conception procedures. Subjects and methods. The rate and pattern of reproductive outcomes, including cases of fetal CFM and/or life-compatible fetal chromosome anomalies, were studied in 109 married couples in which one of the spouses was a carrier of balanced chromosome arrangement after natural conception and assisted reproductive technologies (ART) using preimplantation genetic diagnosis (PGD) by fluorescence in situ hybridization. Results. Out of 226 pregnancies in 109 women, 21 pregnancies were complicated by CFM in 15 women: they all occurred naturally. There were no cases of CFM in both ART groups. The cases of CFM were sporadic in 11 women and recurrent in 4. Thus, the married couples with CFM were 13.76% (15/109) of the total number of the couples, those with recurrent cases of CFM were 3.67% (4/109) of the total number of the couples with chromosome arrangements, and 26.67% (4/15) of the number of the couples having CFM and/or life-compatible fetal chromosome anomalies in the history. Conclusion. PGD of embryonic chromosome anomalies in the carries of balanced chromosome rearrangements may be considered as a means to prevent sporadic and recurrent cases of CFM of chromosome etiology. Due to the high risk of recurrent cases, PGD of embryonic chromosome anomalies is indicated for married couples who are carriers of balanced chromosome arrangements and have a history of CFM in pregnancy.

Objective. To estimate colposcopic indices (CI) in patients with human papillomavirus (HPV-associated) cervical intraepithelial neoplasias (CIN) versus uninfected patients with CIN and the correlation of CI with р16, Ki-67, and E7 expression. Subjects and methods. 150 patients with verified CIN who formed two study groups (1 and 2) of HPV-infected patients and two comparison groups (3 and 4) of uninfected patients with CIN I and CIN II-III were examined. Their comprehensive study involved colposcopic, cytological, and histological examinations, HPV typing by PCR, ELISA determination of HPV Е7 oncoprotein, and immunocytochemical determination of p16ink4 and Ki-67 in the cervical samples. Results. There were statistically significant correlations between CI (according to R. Reid and M. Shafi and Nazeer) and E7 oncoprotein, between the immunocytochemical biomarkers p16ink4 and Ki-67 and the CIs in the patients with HPV-associated CIN versus HPV-uninfected patients with CIN. Conclusion. The patients with HPV-associated CIN II-III showed higher CIs (р < 0.05) than those uninfected with HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 while in CIN I, the impact of HPV infection on the magnitude of colposcopic signs was not established. CI was found to correlate with р16, Ki-67, and Е7 in contrast to the noninfected patients (р<0.05).

The paper considers the problems associated with the protection of maternity, paternity, and childhood, which are urgent to all the countries of the Commonwealth of Independent States (CIS). The legislation regulating reproductive health care in the CIS countries is analyzed; structural changes, by developing and adopting the national laws and state policy aimed at observing the population’s reproductive rights, are highlighted. The main stages and content of the concept of the Model Law on the Protection of Reproductive Health and Rights in the CIS countries, which will be the basis for shaping the internal legislation on reproductive health care in the citizens of the CIS countries, are considered.

Objective. To comparatively estimate the informative value of testing the biological material from the cervix uteri and vagina for the diagnosis of vulvovaginal and cervical infection in pregnant women. Subjects and methods. The investigation enrolled 677 pregnant women. The biological material taken from the cervical canal and vagina was examined using a real-time PCR assay. Results. C. trachomatis was identified in the two loci in 100% of cases. Mycoplasma genitalium was detected only in the patients’ vagina. Ureaplasma parvum, Ureaplasma urealyticum, and Mycoplasma hominis were more frequently found in the vaginal samples. Conclusion. The findings demonstrate that the biological material obtained from the vagina is of greater informative value than that from the cervical canal during examination of pregnant women for genital infections.

Objective. To determine the medical and social characteristics of women undergoing termination of pregnancy earlier than 6 weeks and to comparatively evaluate the efficacy and safety of different mifepristone doses for medical abortion (МА). Subjects and methods. A prospective comparative study of the efficacy of different mifepristone doses (600 and 200 mg) for a MA regimen was conducted in 337 and 130 women undergoing termination pregnancy less than 6 weeks’ gestation, respectively. Sonography, vaginal smear bacterioscopy, and in some cases, if indicated, vacuum aspiration, pathomorphological examination of the uterine material were performed. Results. The medico-social portrait of women preferring a reduced mifepristone dose is presented with their late reproductive age (35-43 years), blue-collarjobs, unemployed, mainly legally married women, and parous women who had fewer artificial abortions and a history of MA. Previous genital inflammatory diseases and reproductive losses were determinants in women who are a group at high-risk for post-abortion infectious complications (incomplete abortion and endo-metritis), However, the frequency of complications of MA did not depend on the used dose of mifepristone. The low frequency of complications of MA was ascertained to be associated with a package of preventive measures, such as sanitation of the lower genital tract, ultrasound monitoring of the quality of an abortion.