No 6 (2013)

The term «fetal allograft» reflects the immunological status of fetal tissues in the maternal organism. Impaired tolerance formation processes lead to the development of pregnancy pathology, which are characterized by activation of the cellular and humoral components of the immune system with the development of clinical manifestations of varying rejection. It is suggested that there are parallels between acute graft rejection and fetal rejection in miscarriage, as well as between chronic rejection and preeclampsia. Today the cellular mechanisms of allogeneic or semi-allogeneic graft rejection are better known than the humoral ones. However, all types of rejection are shown to occur with the antibodies of different nature being involved. The purpose of this review is to analyze updates on the role of humoral rejection in the pathogenesis of pregnancy pathology.

Despite the high prevalence and proven malignization potential of endometrial polys, their etiology and pathogenesis are not yet clear. With the advance of molecular medicine, an investigation of the underlying mechanisms in the development of postmenopausal endometrial polyps may elucidate their pathogenesis. Russian and foreign studies of the molecular aspects of the pathogenesis of postmenopausal endometrial polyps are overviewed.

The given review considers an update on the epidemiology, clinical presentation, prevention, and treatment of neonatal infectious and inflammatory diseases caused by group B streptococcus. It is shown that despite their reduced incidence and the proven eff icacy of prophylactic antibiotics in the mother during labor, the problem does not lose its relevance. At the present time, there is a need to develop national guidelines based on current diagnostic techniques, including molecular biological studies, and on the analysis the efficiency of therapy regimens used to reduce adverse obstetric and perinatal outcomes.

Objective. To estimate tactics for the management of very early preterm labor and the perinatal outcomes of extremely low birth weight (ELBW) babies. Subject and methods. The investigation included all infants born with an ELBW of less than 1000 g in 2012. In this period, a total of 64 ELBW babies were born. They were conventionally divided into 2 groups: 1) 44 survivors; 2) 20 dead infants. Maternal age, parity, duration of pregnancy at delivery, babies’ birthweight, causes of preterm labor, mode of delivery, fetal presentation, the number of fetuses, and type of chorionicity in multiple pregnancy were analyzed. Results. The investigation indicated that Group 2 mothers had a history of obstetric and gynecological diseases in 90% of cases. The babies weighing less than 500 g had the highest mortality rates (66.7%). The main cause of preterm labor was decompensated chronic fetoplacental insufficiency in Group 1 (38.6%) and premature amniorrhea and chorioamnionitis in Group 2 (55%). The critical period for survival of ELBW babies was 26 weeks’ gestational age. 85% of the ELBW babies with a gestational age of less than 26 weeks died; on the contrary, 86.4% of the neonates born more than 26 weeks gestation survived. In Group 1, the babies born from singleton pregnancy were prevalent (61.4%); in Group 2, there were no signif icant differences in the number of fetuses. Among the multiple births in Group 1, the proportion of bichorial and monochorial twins was approximately equal and, in Group 2, the monochorial twins were predominant (72.7%). Group 1 had high cesarean section rates (95.5%); in Group 2, only 45% of the women delivered abdominally. Conclusion. The best survival was observed in ELBW infants born at 26 weeks gestation or; moreover, abdominal delivery was preferred. At less than 26 weeks gestation, the mode of delivery and fetal presentation did not increase the likelihood of a favorable outcome.

Objective. To evaluate the efficiency of using hydroxyethyl starch (HES) 130/0.4 (Voluven 6%) versus physiologic saline (PS) as an initial agent for the therapy of arterial hypotension in the early neonatal period. Subject and methods. A prospective randomized open-label study was conducted from January 2010 to September 2011. The study included all neonates admitted to a neonatal intensive care unit (NICU) regardless of diagnosis and gestational age who were diagnosed with arterial hypotension in the first 24 hours of life. The exclusion criterion was acute bleeding in neonates. In all the neonatal infants enrolled in the trial, the vital parameters were routinely monitored including blood pressure (BP), heart rate, and diuresis. Before and after therapy, the investigators determined blood pH, pCO 2, pO 2 glucose, and lactate, performed echocardiography, and studied regional hemodynamics in the anterior cerebral artery, renal artery, and upper mesenteric artery. HES 130/0.4 (Voluven 6%) and PS were used as a volume-replacement solution. After using the solutions, the examination protocol involved a hemostatic study and biochemical and clinical blood tests. BP normalization time and therapeutic effect duration were also recorded. Case history data were used to estimate the length of a hypotensive episode, the total one- and 7-day dose of cardiotonic agents, and the duration of their use. Results. PS and HES 130/0.4 infusions normalized regional blood flow. What is more, there was a significant rise in diuresis after infusion of both agents. Pre- and postinfusion measurements of pH and lactate levels showed a significant increase in pH after using both solutions. A significant drop in lactate levels to the normal values was recorded only after Voluven 6% infusion; there was no elevation of serum sodium concentrations after use of both agents. No differences were found in liver enzymes and protein C levels and prothrombin index. In-depth analysis revealed that the administration of Voluven 6% in extremely low birth weight babies elevated blood creatinine levels, prolonged activated partial thromboplastin time, and increased the rate of intraventricular hemorrhage. At the same time, the described complications were not characteristic of neonates weighing 1000 g or more. Evaluation of therapeutic effectiveness in relation to birth weight indicated that Voluven had some advantage over PS in decreasing the needs for cardiotonic support only in the patients weighing 1000 g or more. Conclusion. Voluven 6% is more effective than PS in increasing cardiac output (CO), myocardial contractility, daily diuresis, maintaining normal fluid balance, resolving tissue hypoxia (normalizing lactate level), decreasing the need for a subsequent infusion of dopamine, reducing its dose and cardiotonic support time. Voluven may be recommended for the therapy of arterial hypotension in neonatal infants weighing more than 1000 g along with PS particularly in the situations when besides BP normalization, there was a need for promptly and effectively increased CO and normalized microcirculation in shock states.

The need for surgical correction of acquired heart disease in reproductive-aged women who plan future pregnancy requires a weighted assessment in choosing an implantable device in terms of the known advantages and disadvantages of different types of prosthetic heart valves. The use of biological prosthetic heart valves in this case is most preferred in spite of their limited functional lifespan since this makes it possible to refuse life-long anticoagulant therapy and to bear a healthy baby. In addition, bioprosthetic heart valve implantation in women of childbearing age requires no close monitoring of hemocoagulation parameters during pregnancy and labor or is not followed by an increased risk of uterine bleeding. A case of KemCor biological prosthesis implantation in a young woman with two previous pregnancies and deliveries is considered.

The paper gives a clinician’s historical view of the problem of using heparin in obstetric practice. The authors propose a scale for assessing thrombogenic risk factors. The pathogenetically substantiated regimens recommended for obstetric care to use unfractionated and low-molecular-weight heparins are described.