No 12 (2013)

The results of implementation of health care modernization programs in the subjects of the Russian Federation in 2011-2012, in the part of improvement of obstetric/gynecologic care, were analyzed. It was shown that the implementation of regional modernization programs could strengthen the material and technical basis of obstetric facilities, optimize obstetric bedspace, begin to promote current information technologies, introduce medical care procedures, and start stepwise transition to rending medical care in accordance with the standards. Obstetric service modernization resulted in an increase in the availability and quality of medical care for women and children and a reduction in maternal mortality in the Russian Federation. The purposes, tasks, and basic areas of further improvement of obstetric care service in the Russian Federation were defined.

Premature ovarian failure (POF) is a symptom complex involving amenorrhea in less than 40-year-old patients with high levels of gonadotropins and low values of sex hormones. The precise nature of this pathology remains still vague and determined by genetic, chromosomal, autoimmune, infectious, toxic, and psychogenic factors, as well as defects in the structure of gonadotropins. The pathogenetic basis for the development of POF is the diminished total ovarian reserve that is nonphysiologic for a woman’s age, presumably due to an accelerated apoptotic process. The existing concepts of timely and premature ovarian aging have been recently reconsidered. Studying the role of mitochondrial dysfunction not only in the genesis of apoptosis, but also as a main trigger in the development of POF will be able to further elaborate new therapeutic approaches to treating this relatively rare, but quite mysterious abnormality.

The distinguishing feature of present-day surgical obstetrics is the rising number of cesarean resections, the indication for which is an inconsistent uterine scar in more than 70% of cases. Objective. To analyze the outcomes of cesarean section (CS) at different postoperative stages. Subject and methods. A retrospective analysis was made in 479 patients after CS: in 52 puerperas after CS in the postpartum period (within 70 postoperative days), in 42 patients with a postcesarean section uterine scar when planning a next pregnancy, and in 385 pregnant women with a uterine scar after postcesarean section CS during full-term pregnancy. The uterine scar was evaluated from clinical and echoscopic findings. Results. The CS procedure, in particular a method for suturing the incision on the uterus, plays an important role in its scar formation. When individual musculomucosal sutures were used after the Eltsov-Strelkov method, the frequency of inconsistent scars was 38.5% (35/91); when individual musculomucosal sutures and an uninterrupted suture were applied to the uterine fascia proper, it was 13.2% (10/76); when the uterine incision was closed with one-two-layer uninterrupted sutures, inconsistent scars occurred in 95.4% of cases (105/110) and when uterine closure was done using a Reverden uninterrupted suture, they did in 95% (19/20). Conclusion. For the prevention of additional injury, the Gusakov-Zanchenko uterotomy should not be employed especially in CS during labor and delivery. To create the optimal conditions for forming a uterine suture/scar, it is expedient to close the incision with individual sutures, by using an absorbable synthetic suture material.

Objective. To study the intergenic interactions of gene markers for thrombophilia, impairments in homocysteine metabolism and blood pressure regulators in women with bad obstetric history. Subject and methods. The investigation enrolled two groups of women. A study group included 200 women with bad obstetric history (spontaneous abortions, preterm births, and non-developing pregnancy). A control group consisted of 200 women with good obstetric history. Molecular genetic testing of 21 allelic polymorphisms in the genes (MTHFR, MTR, MTRR, FGB, F2, F5, F7, F13, ITGA2, ITGB3, PAI-1, ADD1, AGT, AGTR1, AGTR2, CYP, GNB, and NOS3) was carried out. Results. Univariate analysis revealed no statistically significant differences in the frequency of alternative genotypes in the study genes. However, the higher frequency of a definite combination of genotypes (AGT 704CC, NOS3 894GT, and MTRR 66AG) was found in the bad obstetric history group. Conclusion. The definite combination of the genes in obstetric complication susceptibility genes (the hemostatic factors, homocysteine metabolism, blood pressure control and vascular tone control genes) can supposedly affect the lability of compensatory and adaptive responses.

Objective. To study the specific features of the clinical presentation and diagnosis of urinary tract endometriosis. Subject and methods. Data on the patients examined and operated on in the period February 2010 to January 2013 were considered. The patients’ complaints, the data of physical and instrumental studies (transvaginal ultrasound, renal and bladder ultrasonography (USG), small pelvic and renal magnetic resonance imaging (MRI), cystoscopy), intraoperative findings, and histological examination were analyzed. Results. Thirty-four patients were diagnosed with endometriosis in the bladder (n = 17 (50%), in the ureters (n=12 (35.3%), and in the bladder and ureters (n = 5 (14.7%). Urologic symptoms were noted in 8 (17%) patients with bladder endometriosis and in 4 (12%) patients with ureteric involvement. Insignificant cyclic dysuresis was characteristic. USG was of informative value in 4 and 5 cases of bladder and ureteric endometriosis, respectively. MRI revealed bladder endometroid infiltrates 1 cm in diameter in 6 patients and ureteric ones in 12 women, including 5 with hydronephrotic renal changes. Cystoscopy demonstrated bladder endometroid infiltrate in 6 patients and ureteric stenting in 5. Conclusion. Analysis of the findings may suggest that the absence of symptoms is not an indicator for that of the disease and their magnitude is not indicator for disease activity. The timely diagnosis of infiltrative urinary tract endometriosis requires the work congruence of three components: 1) physician and patient awareness; 2) interaction between specialists (a gynecologist, an urologist); 3) targeted examination.

Objective. To compare two therapeutic procedures (volemic saline loading and the use of dopamine without volemic preload) for hypotension in extremely low birth weight (ELBW) infants. Subject and methods. The investigation included newborn infants with birth weights of less than 1000 g who were recorded to have hypotension. Neonates with congenital malformations and those with obvious signs of hypovolemia and shock were excluded from the investigation. When included into the investigation, all the neonates received adequate respiratory therapy. After randomized, 18 and 21 infants were included into the saline and dopamine groups, respectively. The following indicators, such as the efficacy of an agent in normalizing blood pressure (BP) (achieving the mean BP being equal or greater than that for gestational age per week, diuresis before and after the intervention, 24-hour diuresis, needs of dopamine and its effective dose, weekly cumulative dose, total duration of inotropic support, were thereafter estimated:. Before the intervention and 30 minutes after initiation of therapy, all the newborn infants underwent echocardiography (cardiac output, ejection fraction, fractional shortening, the presence and diameter of patent ductus arteriosus (PDA), heart rate, and blood flow in the anterior cerebral, renal, and superior mesenteric arteries). Acid-base balance and blood lactate concentrations were estimated prior to and following the intervention. The frequency of PDA, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, periventricular leukomalacia, pre-discharge death, the duration of mechanical ventilation (MV), and the length of intensive care unit (ICU) follow-up were assessed as outcome measures. Results. Antihypotensive therapy with dopamine and no rapid saline administration showed a high efficiency in normalizing mean BP in the ELBW infants. Dopamine was more effective than a saline bolus in increasing left ventricular ejection fraction while saline was more effective in raising cardiac output, however, without elevating BP. Dopamine and saline were equally effective in normalizing blood flow in the anterior cerebral, mesenteric, and renal arteries. The incidence of severe BPD was significantly higher in the group receiving saline as antihypotensive therapy. The diameter of PDA was also larger in this neonatal group. The patients having a volemic load were significantly longer on MV and needed ICU treatment. Conclusion. Based on the findings, refusal of volemic loading may be recommended as initial antihypotensive treatment in favor of dopamine infusion in ELBW neonates without clinical signs of shock.

Objective. To evaluate the efficiency of long-term use of a glycyrrizic acid preparation (Epigen-Intim spray) in the treatment of women with benign changes in the cervix uteri and signs of genital infections. Subject and methods. The study enrolled 69 sexually active women aged 18-25 years. Their study involved examination, colposcopy, screening for sexually transmitted infections (STI), HPV testing, and microbiocenosis study. The criterion for group selection was cervix uteri changes interpreted as ectopy and a transformation area. Results. The long-term use of the glycyrrizic acid preparation resulted in a considerable reduction in clinical complaints and in the magnitude of atypical colposcopic changes unassociated with HPV infection. Conclusion. This study proves it necessary to use an agent, such as glycyrrizic acid, (along with barrier methods of birth control) for the prevention of STI and virus-associated diseases in young women. There is also evidence that the long-term use of this agent is effective in preventing a recurrence after etiotropic therapy for an infectious process in the lower genital tract, particularly when benign cervical changes are found in a patient.

The paper substantiates the theories of the occurrence, pathogenesis, and clinical and morphological manifestations of adenomyosis. It considers its organ-sparing treatment that involves hormone (gonadotropin-releasing hormone antagonists, combined oral contraceptives, anti-gonadotropins, anti-progestagens, progestagens) and combination therapy. The combination therapy of adenomyosis encompasses a stepwise combination of surgical and medical treatments. Laser drilling of the corpus uteri occupies a special place, followed by hormone therapy.

Objective. To study the current features of reproductive behavior and reproductive choice of young people of both sexes and the impact of current social relations on them. Subject and methods. The problems under the conditions of society transformation were comprehensively considered; the information from the questionnaires obtained from 585 students (68.7% girls and 31.3% boys at the age of 16 to 19 years (mean age 17.0±1.1 and 17.6±1.5 years, respectively) from the Moscow State Pedagogical University were analyzed. Results. Russia’s current socioeconomic state substantially affects the young people’s priorities, the vector of which is mainly aimed at enhancing their material welfare and does not coincide with family creation and child birth. The gender relations of young people are chiefly determined by their sexual satisfaction with the use of currently available contraceptives at a low level and inadequate sexual education.

Objective. To assess the knowledge of reproductive possibilities among female medical university students and to reveal their awareness of Chlamydia infection. Subject and methods. A total of 1391 first-to-fifth-year female medical students were examined for their reproductive health. In addition, 100 first-to-second-year students were tested for Chlamydia trachomatis, by using two nucleic acid amplification methods (polymerase chain reaction and transcription-mediated amplification). Results. The medical university students turned out to be unaware of contraception, sexually transmitted infections, and abortion complications. The detection rate of urogenital chlamydiasis among early-year students was 12%, which was higher than the respective rate in other countries. Conclusion. The main directions of enhancing the reproductive potential of the students are to optimize sexual and reproductive behavior, by preventing abortions and urogenital infections, and to extensively introduce diagnostic, therapeutic, and preventive measures for reduction of gynecological morbidity in students.