No 9 (2013)

Objective. To assess the role of early screening for gestational diabetes mellitus (GDM) in optimizing perinatal outcomes. Subject and methods. A prospective comparatively study was conducted in 2 groups of pregnant women with GDM. The time for detection of GDM was 14.5±7.5 and 27.2±7.6 weeks in Groups 1 (n=44) and 2 (n=97), respectively. In both groups, the diagnosis of GDM was verified using the WHO criteria (1999). There were no differences between the groups in treatment policies for GDM. Results. The early diagnosis of GDM was accompanied 1.8-, 3.1-, and 2-fold less frequently by fetoplacental insufficiency, macrosomia, and cesarean section, respectively. There were no cases of preterm delivery and neonatal hypoglycemia in Group 1 whereas Group 2 showed these conditions in 20.6 and 11.3% of cases, respectively. Analyzing our results according to the new criteria for GDM (Russian National Consensus, 2012) revealed a fasting venous plasma glucose level of ≥5.1 mmol/l in 88.6% of the patients who were found to have GDM according to the WHO criteria and oral glucose tolerance test (OGTT). Conclusion. The early detection of GDM and hence the timely correction of carbohydrate metabolic disturbances permit the optimization of perinatal outcomes. The GDM diagnostic criteria recommended by the Russian National Consensus allow an early screening in all pregnant women without being divided into risk groups and a first-trimester diagnosis of the disease without carrying out an OGTT in most patients.

Objective. To study the efficiency of using argon plasma coagulation (APC) versus bipolar coagulation (BC) in patients with benign ovarian tumors (BOT). Subject and methods. The prospective study enrolled 110 patients with BOT surgically treated by BC or APC. The diagnostic value of clinical criteria (motor activity; recovery of urination and intestinal motility; temperature and pain responses; blood clinical test; C-reactive protein) and biochemical specific markers (middle-weight molecules; acid-soluble fractions of nuclei acids; active products of interaction with thiobarbituric acid) was studied to evaluate the severity of a surgical intervention. Results. A scale was constructed to rate traumaticity of surgical intervention using BC and APC for BOT. Significant differences in the clinical criteria and biochemical markers of surgical intervention were found in patients surgically treated using different types of energy. APC in patients with benign ovarian tumors showed low and moderate traumaticity in 27 (45%) and 33 (55%) cases, respectively (p<0.05). When BC was applied, these were in 14 (28%) and 36 (72%) cases, respectively (p<0.05). Thus, after APC there were 1.6 times more and 1.3 times fewer patients with low and moderate traumaticity than those following BC. Conclusion. Analyzing the traumaticity of laparoscopic intervention in patients with benign ovarian tumors, by applying the constructed scale has indicated that when the protocol is optimally used, APC is less traumatic (aggressive) than BC.

Objective. To study endometrial morphological and molecular biological features in patients with infertility and Stage 1—2 external genital endometriosis (EGE) during the implantation window. Subject and methods. Seventy-two infertile patients, including 23 with Stage 1-2 EGE and 32 with tuboperitoneal factor (TPF) infertility, and 17 with male factor (MF) infertility were examined. All the patients underwent pipelle (aspiration) endometrial biopsy at 6-8 weeks after ovulation, followed by histological and immunohistochemical examinations. The number of pinopodia, the expression of estrogen receptor-α (ER-α) and progesterone receptor A (PR-A) in the endometrial stroma and epithelium, as well as stromal PR/ER-а ratio were determined. Results and discussion. The patents with Stage 1-2 EGE were found to have a significant increase in the expression of ER-α in both the endometrial stroma and epithelium (p=0.031 and p=0.027). In all the groups, the endometrial stromal and epithelial level of PR-A was decreased in relation to the phase of endometrial development (p = 0.013; p = 0.032); but was statistically indifferent between the groups (p=0.186; p=0.503). The mean number of pinopodia in the endometrium of the patients with Stage 1-2 EGE and TPF was significantly lower than in those with MF (p = 0.02). Conclusion. The findings suggest that in patients with infertility concurrent with Stage 1-2 EGE, impaired endometrial receptivity occurs during the implantation window which manifests itself as lower pinopodium count and impaired hormone receptor balance. The significantly higher epithelial and stromal ER-α levels are the peculiarity of endometrial changes during the implantation window in Stage 1-2 EGE. This, in turn, may be one of the leading causes of infertility and the lower efficiency of an LVF program in patients with this disease.

Objective. To define the role of three-dimensional echography in estimating the degree of renal lesion in congenital fetal obstructive uropathies (OU). Subject and methods. A prospective case-control analysis was made in 45 fetuses with obstructive defects of the urinary tract and in 45 fetuses without any malformations at 20 to 40 weeks of gestation, in whom the dilatation of the calycopelvic system (CPS), renal volume parenchyma, and CPS, which were obtained by three-dimensional scanning, were analyzed. Results. Three-dimensional echography (a VOCAL mode) makes it possible to measure, to a high accuracy, the volume of a kidney in obstructive uropathies in the antenatal period. In the above pathology, the CPS volume calculated using the SonoAVC mode may be used as a new marker of the status of urinary tract organs. It can be clinically used to predict a postnatal outcome, namely: a need for postpartum follow-up and treatment. Conclusion. Three-dimensional echography in OU can yield new valuable information that affects pregnancy management tactics, contributes to the making a decision on antepartum radical intervention, and thus reduces the risk of further severe complications and disability in the infant.

Objective. To monitor Pseudomonas aeruginosa at obstetric hospitals, by taking into account the antibiotic resistance and genetic relationship of its strains. Subject and methods. The microorganisms were isolated from healthy neonatal infants (colonization) and in case of pyoseptic infections (PSI) in the period January 2006 to October 2012. The relationship of the isolated microorganisms was identif ied applying molecular genetic methods. Results. The mean annual infection rate over 5 years was 7.9±5.8 years per 1000 examinees. P. aeruginosae was most common in the meconium and gastric juice samples from newborn infants in case of colonization and in their expectorations in case of PSI. The infection most frequently occurs as exogenous, induced by nosocomial strains and, with due regard to the vulnerability of a contingent, shows an outbreak pattern. This assumption is evidenced by the antibiotic resistance of the isolated microorganisms and by blaOXA-50 gene sequencing. Conclusion. P. aeruginosa may be most important only in respiratory tract infection. The established uniformity of blaOXA-50 genes could suggest the formation of an epidemically significant clone in the closed circuit: an obstetric hospital — neonatal units of a children’s clinic.

Objective. To provide a rationale for intraoperative therapy aimed at reducing the rate and magnitude of small pelvic adhesions in patients with tubal pregnancy. Subject and methods. Laparoscopy was carried out in 121 women with tubal pregnancy (a study group) and 24 patients with infertility (a comparison group). PCR diagnosis of biopsy specimens of the cervix uteri and fallopian tubes from the patients with tubal pregnancy was made to identify Chlamydia trachomatis, Neisseria spp. and gonorrhoeae, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and Trichomonas vaginalis. In Subgroup 1 (n=28) of the study group, sumamed (azithromycin) was given intraoperatively and postoperatively to create conditions for intraoperative hydroflotation. Subgroup 2 (n=26) received Interacoat gel intraabdominally in addition to sumamed. In Subgroup 3 (n=37), ceftriaxone was used intraoperatively to produce the effect of hydroflotation. In Subgroup 4 (n=30), the gel was injected into the abdomen in addition to cefrriaxone. Following 6-12 weeks, endoscopic resurgery was performed in 17, 13, 33, and 15 patients from Subgroups 1, 2, 3, and 4, respectively. The study group patients had immunoglobulins (IgG), IgA, and IgM to Chlamydia trachomatis, IgG to major outer membrane protein (MOMP), and IgG to heat shock protein 60. Statistical processing was carried out using AtteStat 7.3, MedCalc, Microsoft Excel 2003, Statistica 6.0packages. Results. Ureaplasma urealyticum was most common (up to 27.27%). Mycoplasma hominis was the second most frequently diagnosed pathogen (up to 4.96% in the abdominal cavity). The other isolated pathogens were 0 to 5.79%. In the patients with tubal pregnancy, MOMP and Pgp3 antibodies were the most commonly diagnosed anti-Chlamydia trachomatis ones (73.55%) and IgA and IgG were less significant (63.64% and 51.24%). Tubal pregnancy was characterized by a combination of IgA antibodies to both MOMP and Pgp3 (63.64%). After second-look laparoscopy, the degree of an adhesive process was 7 (5-10), 4 (4-5), 18 (15-21), and 14 (12-18.5) in Subgroups 1, 2, 3, and 4, respectively. The differences between the subgroups other than Subgroups 3 and 4 were statistically significant (p < 0.01). Conclusion. It is inexpedient to take material to be tested using PCR assay for different infectious organisms in the upper portions of the genital tract during surgery for tubal pregnancy. Intraoperative intravenous sumamed administration with abdominal Interacoat gel injection is effective in preventing adhesive disease after surgery for tubal pregnancy, which gives rise to a reduced adhesive process from 18 to 4 scores (P < 0.01) after cephalosporin hydroflotation, as shown by the adnexal adhesion scale developed by the American Fertility Society, and may contribute to the maintenance of reproductive function in patients.

Objective. To identify the specific features of the incidence of cancer of female reproductive organs in the Primorye Territory over time in 1992-2011 and to estimate prognosis till 2017. Subject and methods. Information was obtained from the data bank on new cases of reproductive organ cancer in the women of the Primorye Territory, which had been created at the Research Institute of Oncology, Siberian Branch, Russian Academy of Medical Sciences (Tomsk), on the basis of medical records from the oncology dispensaries of Siberia and Far East — these were a total of 6812 cases. The mathematical statistical methods recommended by the Ministry of Health of Russia and other adequate epidemiological methods were used. Results. In the structure of female cancer morbidity in the Primorye Territory, cancer of reproductive organs (breast, cervix uteri, corpus uteri, and ovary) affects occupies more than one third of all sites. During the study, its morbidity rose by 59.1%. This increase was mainly due to elderly patients. It has been predicted that with he identified trends being maintained, the morbidity rates will be able to rise by further 10.8-25.8% in 2017 as compared to 2007-2011. As a result, the exception is cancer of the corpus uteri, the standardized index of which may achieve the rate of the Russian Federation in 2011; the other sites in this group exceed it. Conclusion. The trend in the incidence of reproductive organ cancer in the female population of the Primorye Territory is indicative of its rather negative pattern and the need to monitor this process for the future and to make corrections in the planning of therapeutic and prophylactic measures.

Uterine myoma is the most common cause of hysterectomy, but contemporary patients prefer to avoid removal of the womb and to preserve fertility and femininity that they associate this organ with. In recent decade, the proved role of progesterone in stimulating the growth of uterine leiomyoma has aroused interest in the study of a possibility for the treatment of this disease with selective progesterone receptor modulators. The decrease in the sizes of uterine myoma, regardless of its baseline dimensions, due to performed therapy with ulipristal acetate maintains for at least 6 months after completing a course of treatment. Menstrual blood loss reduces from profuse bleeding with clots to moderate one and to the point of amenorrhea. At this stage, the indication for the use of ulipristal acetate 5 mg daily is preoperative therapy for the moderate and severe symptoms of uterine myoma in adult reproductive-aged women above 18 years of age with the investigated treatment duration of not more 3 months. This review gives the results of studying the efficacy and safety of ulipristal acetate in the treatment of uterine myoma and describes new possible prospects for use of ulipristal acetate in gynecology.

Objective. To evaluate experience with the combination phytotherapeutic drug Canephron N in pregnant women Design. This was a multicenter retrospective observational study. Subjects and methods. The study enrolled 550 patients whose pregnancy ended in a delivery. Group 1 included 480 women who used Canephron N in different periods of pregnancy (a study group) and Group 2 consisted of 70 women who did not take the drug (a comparison group). Their medical records were analyzed just on pregnancy completion. The pregnant women were given Canephron N prophylactically and as part of combination therapy for different types of kidney and urinary tract infections. Canephron N tablets and drops were used in 402 and 51 pregnant women, respectively; 27 patients received tablets and drops sequentially. All the patients underwent comprehensive clinical and laboratory examination including full blood and urine tests, Nechiporenko urinalysis, kidney ultrasound, and urine bacteriological study. The fetal status was assessed using dynamic ultrasound biometry, Doppler blood flow study in the uterine, placental, and umbilical cord vessels, and cardiac monitoring. Results. Effective Canephron N treatment without antibiotic use was performed in 12 of 32 women with asymptomatic bacteriuria (a study group). There was no relapsing bacteriuria. Thirty patients with acute cystitis and 48 women with an exacerbation of recurrent cystitis took Canephron N together with antimicrobial agents. Canephron N treatment reduced the symptoms of an exacerbation of cystitis in all the patients; moreover, the results suggest that there is a significant (p < 0.05) reduction in reinfection rates and an increase in interrecurrence periods. Even if recurrences occurred, they were taking their milder course with the use of Canephron N. Fifty-six pregnant women with gestational pyelonephritis and 132 women with an exacerbation of chronic pyelonephritis received Canephron N (a study group) together with antibiotic therapy. Incorporation of Canephron N into pyelonephritis therapy in pregnant women substantially enhanced its efficiency: the prompter the exacerbations abated, the fewer number of recurrences was. This could reduce the number of repeat courses of antibacterial therapy during pregnancy and, possibly, the rate of renal infection chronization after prior gestational pyelonephritis. The study also evaluated the safety of Canephron N to the fetus and newborn infant. The rate of developmental anomalies of the babies born to the mothers who had taken Canephron N proved to be slightly lower than that in the population. Conclusion. This study has revealed no signs of the fetotoxic effect of Canephron N, which makes possible the use of the drug in all pregnancy periods. The total effects of Canephron (in improving renal blood flow and enhancing glomerular filtration, positively affecting urodynamics, antibacterial and anti-inflammatory properties, and stimulating restorative processes in the renal epithelium) along with its high safety permits the use of Canephron N in pregnant women for the treatment and prevention of relapses of chronic and acute urinary system infections.

Background. Thrombocytopenia may complicate the course of up to 10% of pregnancies. Above 70% of the first detected thrombocytopenia cases are directly related to pregnancy. Glucocorticoid therapy in average daily therapeutic doses of 0.5-0.7 mg/kg is a basic treatment during pregnancy and for immune thrombocytopenia. Splenectomy is the basis for second-line therapy during pregnancy. Description. The paper describes two clinical cases of pregnant women with thrombocytopenia who underwent laparoscopic splenectomy after cesarean section. Both patients preoperatively received prednisolone and human immunoglobulin. In the first 24 hours after surgery, there was an increase in platelets from 28,000 to 111,000 in one woman and from 9х10 9 to 13х10 9/l in the other. The latter underwent cesarean section and laparoscopic splenectomy during reinfusion of autoerythrocytes and transfusion of 1000 ml of fresh frozen plasma and 8 doses of platelet concentrate. Outpatient romiplostim therapy that could maintain partial remission for 14 months was additionally performed. Conclusion. Simultaneous laparoscopic splenectomy during surgical delivery in pregnant women with severe refractory immune thrombocytopenia is effective and maximally safe due to its low invasiveness, less expected blood loss, and rapidest postoperative recovery as compared to an open access.