No 11 (2013)

Preeclampsia is one of the most severe pregnancy complications, leading to maternal and perinatal morbidity and mortality. In recent years, there has have been an increase in the number of investigations of the association of preeclampsia with the processes of trophoblast invasion. There is also evidence that the processes of trophoblast invasion and tumor progression are similar. The review gives the last decade’s data on impaired trophoblast invasion processes and their impact on the occurrence of complications, such as preeclampsia, as well as the possibility of its timely diagnosis and pathogenetic treatment.

Osteoporosis is a systemic skeletal disease characterized by reduced bone mass and microarchitectural impairment of bone tissue, which result in increased bone fragility. Drugs of varying antiresorptive potency from a class of bisphosphonates have been designed today. The need for the long-term (3-5-year) and regulatory use of the drugs to ensure the adequate efficiency of therapy is associated with its low compliance. Intravenous bisphosphonate formulations (ibandronate, zoledronic acid) that can reduce the frequency of use to once 3-12 months have been designed to enhance therapy compliance. Adverse events (the symptoms of an acute phase response) occurring after intravenous administration of antiresorptive drugs promotes any patient alertness and unwillingness to further use bisphosphonates. Recent international studies have provided a more insight into the pleiotropic mechanism of bisphosphonates and disclosed pathogenetic mechanisms for the development of the symptoms of an acute phase response to these drugs in the treatment of osteoporosis.

Objective. To reveal the structure of placentas from pregnant women operated on for congenital malformations of the heart and vessels during preterm labor at 33-36 weeks’ gestation. Subject and methods. Forty-three placentas from pregnancies resulting in live birth in patients operated on for congenital malformations of the heart and vessels at 33-36 weeks’ gestation were examined. These included 16 (37.2%) placentas from women operated on for acyanotic heart disease, 18 from puerperants for cyanotic heart disease, and 9 (20.9%) from patients for heart defects with an obstacle to blood flow. ere examined. A study group consisted of 56 women operated on for CMHV. A control group comprised 20 patients without congenital heart disease who were matched for parity, age, and social class. The study group patients were divided into three subgroups: 1) 22 (39.3%) pregnant women operated on for acyanotic heart disease; 2) 18 (32.1 %) women operated on for cyanotic heart disease; 3) 16 (28.6%) patients with operated heart defects with an obstacle to blood flow. Results. The findings were compared with those described in the literature on placentas of the same period during physiological pregnancy. The macro- and microscopic features of the structure of placentas from women operated on for congenital malformations of the heart and vessels were revealed. Major changes were noted in the villous chorion and intervillous lacuna. The development of the villous tree was marked by the preponderance of chorionic villus angiogenesis that was inadequate to the period of pregnancy, as well as accelerated collagenization of the stroma of villi that led to the narrowing of intervillous lacunas. In turn, the impairment of maternal blood rheological properties in the intervillous lacuna, which was accompanied by vascular stases, infarction, thrombosis, and excessive intervillous fibrinoid deposition in the presence of maternal hemodynamic disorders, resulted in hemodynamic impairments at the level of the structures of the placental barrier. Conclusion. The found structures suggest that chronic placental insufficiency in the patients operated on for congenital malformations of the heart and vessels results from inadequate inflow of maternal blood with the predominance of two variants: impaired and normal maturity of the villous tree.

This study provides evidence for the invalidity of a number of Intrauterine interventions on the basis of ultrasonographic evidence. Objective. To estimate the disadvantages of two-dimensional transvaginal ultrasonography and the advantages of Pipell endometrial biopsy in the diagnosis of endometrial hyperplastic processes and to calculate correlations between the above techniques and histological findings. Subject and methods. A retrospective analysis was made using the case histories of reproductive-aged women with endometrial hyperplastic processes from Vitebsk gynecology un its in the past 10 years, as well as 128 ultrasound and postmortem reports. The data were statistically processed using the Statistica 6.0 software package. The value of p < 0.05 was regarded as significant. Results and conclusion. The paper gives data on the high informative value of endometrial aspiration biopsy in the concurrent use of cytological and histological studies of its specimens. It presents the developed algorithm for the diagnosis of endometrial hyperplastic processes using Pipell biopsy.

Objective. To assess the implication of the autonomic nervous system (ANS) in the pathogenesis of diffuse dyshormonal breast dysplasia and the possibilities of mastodynon correction of autonomic dysfunction. Subject and methods. Twenty hundred and five women with diffuse dyshormonal breast dysplasia and 45 healthy women underwent comprehensive evaluation of ANS by questioning, cardiac intervalography, and autonomic testing along with hormone analysis. Results. The reduced total power spectrum of neurohumoral modulation and activated humoral, metabolic, and sympathetic effects on heart rate regulation were established for each form of mastopathy. The high efficiency of therapy with mastodynon is determined by not only the normalization of prolactin levels, but also by the arrest of autonomic dysfunction. Conclusion. The f indings can optimize therapy for diffuse dyshormonal breast dysplasia, by affecting the ANS, which is a pathogenetic component of the occurrence and progression of the disease.

Objective. To study the specific features of carbohydrate metabolism, by using an oral glucose tolerance test (OGTT), in women with polycystic ovary syndrome (PCOS) and in healthy women and to evaluate the abilities of taurine to correct found metabolic dysfunctions in PCOS. Subject and methods. The study included 109 women aged 18 to 45 years, including 94 women diagnosed with PCOS and 15 apparently healthy women (a control group). A taurine treatment group consisted of 30 women with PCOS who took the taurine (Dibikor) in a dose of 500 mg b.i.d. for 3 months. At baseline, all the women underwent anthropometric measurements and a 3-hour 75-gram OGTT. These were repeated in the taurine-treated women following 3 months of treatment. Beta-cell function and insulin sensitivity were determined using the mathematical models: 1-st Phase, 2-nd Phase, ISISTUM, and MRCSTUM. Results. In all the women with PCOS, beta-cell dysfunction was a characteristic metabolic disturbance with its degree being variable. The most adequate insulin secretion in the early phase was in the PCOS group with peak glucose and insulin concentrations at 30 minutes during OGTT and the severest beta-cell dysfunction in the same group with peak insulin levels at 120 minutes of OGTT. Virtually ideal beta-cell function was seen in the comparison group of healthy women with peak insulin concentrations at 30 minutes of OGTT. The other control women also showed beta-cell dysfunction, but insulin secretion was more adequate in the first phase in this group than in the PCOS group. The degree of beta-cell dysfunction was evaluated using the mathematical models determining the sensitivity of peripheral tissues to insulin and the metabolic clearance rate of glucose and insulin levels were estimated using a mathematical model in the first phase. The ratio of these two components for each group was compared with the hyperbola reflecting the ideal beta-cell function, which corresponded exactly to peripheral tissue insulin sensitivity and which was unique to healthy individuals, indicated by a respective symbol for each group. The symbols of the comparison groups with different time of achieving the peaks of glucose and insulin (healthy women) were closer to the line of the distribution index hyperbola than those with the same time of the peak of insulin in the PCOS groups. The distribution index in the group of treatment with dibikor 1000 mg in the Taurine group after 3 months of its use came to be closer to the hyperbola line, which was proof that it was effective in improving beta-cell function in this group. Conclusion. Deciding metabolic dysfunction in PCOS is the individual inconsistency between the secretory function of beta-cells and the reduction in the sensitivity of peripheral tissue to insulin. The action of taurine (dibikor) is achieved by the modulating effect on the ratio of peripheral tissue insulin sensitivity to beta-cell function.

Successful in vitro fertilization (IVF) and embryo transfer into the uterine cavity do not always result in desired pregnancy. Novel methods for enhancing the efficiency of IVF are mainly sought among high technologies. However, the success of ongoing medical studies and maneuvers frequently depends not only on the application of high technologies, but also on that of simple methods and procedures, which are to be studied and used in practice. The authors developed and tested a new procedure to increase the possibility of successful embryo implantation to the uterine cavity (patent for invention No. 2444315) and an embryo implanter (patent for useful model No. 106521). According to the authors’ procedure, the technical result in improving the implantation of blastocysts to the endometrium is achieved by creating the minimal air pressure in the uterine cavity by means of a gas mixture (CO 2 + N), which gives rise to the closest contact with and adhesion of blastocysts to the endometrium, and to subsequent implantation. In the initial phase of the investigation, it was very interesting for the authors to test the effect of a gas mixture of 6% CO 2 and 94% N on oocyte viability. For this, the immature oocytes of 30 patients, which were unfit for fertilization and should be disposed, were examined. The findings showed that the viability of oocytes exposed to the gas mixture of CO 2 and N remained unchanged in all cases. The gas mixture was concurrently examined for its effect on sperm motility and viability. The total motility (a + b%) of fast progressive and slow progressively spermatozoids in the ejaculate samples incubated in IVF medium in a thermostat, by adding the experimental gas mixture (CO 2 + N) was ascertained to increase by 8.3 and 7.3%, respectively, as compared in the samples incubated under the same conditions, but without adding the gas mixture 5.5 and 3.7%).

Little attention is now given to investigations of intestinal diseases in pregnant women despite the fact that they are a common condition. One of them is constipation during pregnancy. The cause of intestinal dysfunction during pregnancy is multifactorial and may be associated with the hormonal and mechanical changes that occur in the pregnant woman. There are four main types of laxatives: bulk-forming, osmotic, stimulant, and stool softener ones. The paper presents data on the safety and efficiency of using the laxatives during pregnancy.

The paper describes a clinical case of the course of two pregnancies in a woman with systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome (APS). The investigation was undertaken to assess pregnancy outcomes in a patient with secondary APS in the presence of SLE in relation to management tactics. This observation shows that the concurrence of severe abnormalities, such as SLE and APS, substantially worsens obstetric outcomes. However, timely detection of APS in women with SLE, the occurrence of pregnancy in remission of the underlying disease, adequately chosen therapy, and an interdisciplinary observation of such patients allow achievement of favorable outcomes of pregnancy.