No 4 (2013)

The paper provides a rationale for the identif ication of two clinical and morphological types of adenomyosis -active and inactive. The identification of the clinical and morphological forms of adenomyosis is of fundamental importance in elaborating a differentiated, pathogenetically sound approach to therapy. Active adenomyosis is generally an indication for surgical treatment while the detection of inactive adenomyosis necessitates medical therapy, whose basis is hormonal correction.

Objective. To elucidate risk factors for pathological weight gain during pregnancy. Subject and methods. A cohort study was conducted in 518 women with full-term singleton pregnancies without evidence of diabetes mellitus and severe somatic disease. It comprised conventional clinical and laboratory studies, additionally questionnairing in each trimester of pregnancy, and biochemical and hormonal blood tests (determination of a lipidogram, glucose and insulin levels, and Homeostasis Model Assessment (HOMA) index). Results. The risk for pathological weigh gains significantly increases in baseline lipid metabolic disturbances (p=0.000), secundiparas (p=0.018), incomplete weight reduction after previous delivery (p=0.026), ex-smokers (p=0.038), and gross violation of healthy nutrition standards. The physical activity in pregnancy is unrelated to gestational weight gain (p>0.05). An analysis has shown that the patients are unaware of a recommended weight gain, in this connection they do not always adhere to the normal values. The results of biochemical and hormonal examinations are indicative of the secondary pattern of metabolic changes in abnormal weigh gains. Conclusion. Pathological weight gain during pregnancy is mainly due to women’s inadequate eating behaviors. Preventive measures must be to normalize pregravid weight, to adequately lose weight after previous delivery, to inform a pregnant woman about the physiological weight gain value and the necessity of quitting smoking as soon as possible, and to compulsorily correct her eating behavior during pregnancy.

Objective. To evaluate the efficiency of diagnosis of acute pyelonephritis in pregnant women, the possibility of differential diagnosis of its serous and purulent forms, and the effectiveness of their treatment. Subjects and methods. Cases of acute pyelonephritis were analyzed in 150 pregnant women over the past 5 years. Results. The authors specified risk factors for pyelonephritis and analyzed operations performed in case of ineffective medical therapy and pyodestructive inflammation: nephrectomy in 10.7% of the patients; renal carbunclectomy in 24.7%, and ureteral stenting to recover impaired urine passage in 39.5%. Conclusion. It is important to timely diagnose and treat asymptomatic bacteriuria for the prevention of complications and, in case of acute pyelonephritis, to timely perform surgical treatment for its pyodestructive forms.

Objective. To study the presentation of nonrandom X chromosome inactivation and androgen receptor (AR) gene CAG repeat polymorphism in patients with different phenotypes of polycystic ovary syndrome (PCOS). Subject and methods. The investigation enrolled 56 patients (mean age 27.3±5.74 years; body mass index (BMI) 24.2±5.47kg/m2) with PCOS and 64 healthy women (mean age 25.6±4.28 years; BMI 22.4±0.11kg/m2). The Rotterdam criteria were used to determine the reproductive phenotypes of PCOS, according to which the patients were divided into subgroups. Nonrandom X chromosome inactivation was revealed by differential methylation of active and inactive X chromosomes, followed by an analysis of CAG repeat polymorphism in the first exon of androgen receptor (AR), by applying methyl-sensitive PCR assay. Results. The rate of nonrandom X chromosome inactivation in phenotypes A and B was 61% (16/25) and 47% (8/16), respectively, which were significantly higher than the reference values 16.1% (9/56) (р<0.05). There were no differences between phenotype D [30% (3/9)] and the control group (р=0.3490). The prevalence rate of genotypes with both short alleles in the AR gene (VMTR/CAG) (n<22/<22) among the patients with phenotype D (non-androgenic) was 60% (6/10), this was 5-6 times greater than that in phenotypes A and B and among the healthy women (p<0.05). In short alleles of AR (CAG repeats < 22) and its presumptively high activity in both groups with phenotype D, the mean level of total testosterone was some 2 times lower than that in a group of patients with long alleles - phenotype A and B (1.99±0.16 pg/ml versus 3.5±0.37 and 3.32±0.19 pg/ml, respectively; р<0.05). Conclusion. The f indings suggest that there are genetic differences between the phenotypes of PCOS in the presentation rate of nonrandom X chromosome inactivation and androgen receptor gene polymorphism. In phenotype D, nonrandom X chromosome inactivation and short alleles in the AR gene were 2-fold less. This may contribute to the excess effect of androgens at their normal serum concentrations and point to the specific features of mechanisms for the formation of non-androgenic and androgenic phenotypes of PCOS.

Objective. To show trends in and regional features of the provision of obstetric prof ile personnel for the female population in Russia. Subject and methods. The 2005-2011 official statistical data of the Ministry of Health of Russia were analyzed. Results. The provision of obstetricians/gynecologists for the female population remained the same nationwide, but that of midwives decreased. There is a staff shortage in central European Russia. In a number of regions, the low provision of obstetricians/gynecologists is aggravated by a large proportion of unqualified specialists. Main approaches to calculating the subjects’ needs for obstetricians/gynecologists are given. Conclusion. Personnel planning should be based on the determination of needs for and distribution of medical staff in the regions. Efforts to improve the quality of obstetrical/gynecological care call for the serious attention of healthcare administrators and policy-makers to the provision of personnel and the level of its qualification. Regional staff policy programs are to be developed, by attracting educational and research institutions.

Objective. To study the clinical efficacy of duphalac in pregnant women with constipation. Subject and methods. Examinations were made in 63 pregnant women in the first, second, and third trimesters and in the postpartum period: 28 pregnant women with constipation that had first occurred during pregnancy and 35 pregnant women with constipation that had occurred before pregnancy. All the pregnant women received duphalac in a dose of 10-40 ml/day for 15 days. Results. Intestinal transit was restored in 100% of cases. Premature birth occurred in 1 patient at 34-35 weeks gestation; the baby was alive. Sixty-two full-term healthy babies were born, who were discharged on days 3-5. There were no pyoseptic complications during the postpartum period. Conclusion. Duphalac not only effectively restores the transit of intestinal contents, but also promotes recovery of the normal vaginal biotope and no pyoseptic complications in the postpartum period.

Ministry of Health of Russia, Moscow The new types of urogynecological pessaries designed by the authors were made from high-grade silicone of definite elasticity and density, specially chosen for optimal pessary use. The distinctive property of the new pessaries is the presence of two or four half-round cuts on the outer surface of the ring with symmetric arrangements. The advantage of the new models of urogynecological pessaries over the existing ones is as follows: 1. There is additional fixation of the pessary in the vagina owing to the external cuts and there is no pessary displacement and descent during exercises, coughing, sneezing, or straining. 2. The ease and simplicity of vaginal compressibility of the pessary are increased when inserted into the vagina. 3. The possibility of developing bedsores and ulcers on the vaginal mucosa is decreased due to the reduced area of pessary contact with the vaginal wall. 4. The vaginal outflow tracts are enlarged. 5. The antimicrobial coating of the pessary contributes to the prevention of bacterial vaginal complications. 6. There are no allergic complications. 7. There is easy and painless pessary removal from the vagina.

Objective. To show the importance of physical identification of connective tissue dysplasia (CTD) by the phenotypic criteria in obstetrics and gynecology, their set and variability with regard to age. Subject and methods. 614 women with the classified and unclassified forms of CTD were examined. Group 1 consisted of 268 primigravidas (mean age 24.8±3.46 years); Group 2 included 346 women (mean age 44.5±10 years) with gynecological disorders. General clinical and laboratory studies, ECG, ultrasonography, EchoCG, radiological examination, comprehensive urodynamic study, and magnetic resonance imaging were used. Results. The manifestations of DST were absent in newborn infants. In the adults, the persistent and prognostically significant manifestations were the arm length being greater than stature (> 1.05), hand length, hand and foot length-to-stature ratios, middle finger length, upper-to-lower body segment ratio (< 0.86), a positive thumb test in 29.1-29.5% of the patients, joint hypermobility in 54.6-64.6%, talpes in 44- 65.3%, scoliosis, postural disorders in 49.8-76.8%, osteochondrosis in 34.1%, heart valve prolapse, involvement of a few valves in 25%, myxomatous degeneration in 15%, anterior abdominal wall hernias in 19.4%, visceral ptosis in 10.2%, cardiac rhythm and conduction disturbances in 33%, varicosity in 39.5%. Conclusion. The working diagnostic criteria for DCT are variable throughout an individual’s life and determined by the form of DCT, age, degree of involutional processes, and rate of manifestation. The diagnostic criteria for DCT in women over 40 years of age cannot be applied to young patients.

The paper describes the role of an elevated homocysteine level in the development of endothelial dysfunction and thrombophilic states, which are key factors for the development of fetal depletion syndrome in different gestational periods. It shows the main metabolism of folates and homocysteine, methods for correcting hyperhomocysteinemia, and the prevention of neural tube defects.