No 2 (2014)

The paper presents the history of the Research Center of Obstetrics, Gynecology, and Perinatology that will be 70 years old. The given data are suggestive of the uniqueness of this leading institution where highly qualified world-renowned scientists work to develop scientific, therapeutic, and educational processes in preserving the nation’s reproductive health. New promising areas of the Center, namely the development of basic (physiological, immunological, genetic, etc.) researches, are considered.

The paper discusses the mechanisms responsible for the impact of superovulation induction on endometrial receptivity in in-vitro fertilization programs. It presents the morphological characteristics of the endometrium in stimulated cycles. The specific features of the expression of estrogen receptors and progesterone receptors and other endometrial receptivity markers (pinopodia, leukemia inhibitory factor, integrins) in natural and stimulated cycles are described. Changes in the endometrial gene expression profile in the stimulated cycles are shown.

Objective. To study the pharmacogenetics of tocolytic therapy with a ß 2-adrenomimetic (hexoprenaline sulfate), by investigating cytokine and β-adrenergic receptor gene polymorphisms. Subject and methods. One hundred and three patients with threatened preterm labor who received tocolytic therapy with the selective ß 2-adrenomimetic hexoprenaline sulfate (gynipral) at 22-33 weeks’ gestation were examined. Polymerase chain reaction and a melting curve analysis were used to investigate 11 genes and 13 polymorphic gene loci. Results. The predictors of conception less than 7 days after acute tocolysis at 22-33 weeks’ gestation are the T/T genotype of the BSG 3800 gene (p=0.03, OR=5.18 (1.01-26.61) and IL10-592 A allele (р=0.05, OR=3.12 (0.88-11.06)). The T/T genotype of the IL1R1-15858C>T gene was associated with the possibility of prolonging a pregnancy > 34 weeks after acute tocolysis (OR=4.62 (1.17-18.20), p=0.02). The IL1RN: 390 C/C and VEGFA:936 С/С genotypes are predictors of conception less than 7 days after acute tocolysis at 22-27 weeks while after acute tocolysis at 28-33 weeks they exert no substantial impact on the possibility of prolonging a pregnancy > 34 weeks. Conclusion. There is a decrease in the role of infection in preterm labor in the third trimester of pregnancy and hence there is a reduction in the significance of genetic susceptibility to infectious agents. An infection-initiated tendency to activate an inflammatory cytokine cascade seems to be the main mechanism of the low efficiency of tocolytic therapy at 22-27 weeks in pregnancy prolongation, which is associated with the cytokine BSG 3800C>T, IL10.-592A>C, IL1R1-158580T, IL1RN: 390 C/C and VEGFA:936 С/Сgenes.

Objective. To study the serum concentrations of pregnancy-associated a-glycoprotein (a 2PAG), a-macroglobulin (a^MG), trophoblast-specific β-globulin (Tß }G), and lactoferrin (LF) in women with in vitro fertilization (IVF) pregnancy versus those with physiological pregnancy during the early stages of gestation and before delivery. Subject and methods. The investigators determined the serum concentrations of a 2PAG and a 2MG (by quantitative rocket immunoelectrophoresis), LF and Tß 1G (by enzyme immunoassay) in 37 women undergoing IVF (20 women before superovulation and on 15 days after embryo transfer and 17 women prior to delivery) and in 65 physiologically pregnant women (15 women who were 3-5 weeks pregnant and 50 full-term pregnant women before labor). Results. The patients entering the IVF programs were observed to have decreased a 2PAG levels than healthy women and lower serum concentrations of Tß 1G and higher levels of a 2PAG were found in early induced pregnancy than in physiological one. However, the concentrations of the above proteins in full-term pregnancy did not differ in the IVF and control groups. Conclusion. The found differences in study results in the patients undergoing IVF (those before entering the program and those at 3-5 weeks pregnancy), healthy nonpregnant women, and physiologically pregnant women are suggestive of residual manifestations of inflammatory processes and syncytiotrophoblast functional incompetence in early IVF pregnancy. However, when the program outcome is positive, these changes are completely compensated by labor.

Objective. To assess a combination of surgery and drug, antirecurrent therapy for severe genital endometriosis. Subject and methods. Fifty-nine patients with severe genital endometriosis were examined. Group 1 included 33 women whose surgical treatment used argon plasma coagulation (APC) in combination with dienogest 2 mg as antirecurrent therapy; Group 2 comprised 11 patients who received APC during surgery and antirecurrent therapy with gonadotropin-releasing hormone (GnRH) agonists; Group 3 consisted of women operated on by conventional procedures without APC, followed by therapy with GnRH agonists. Results. Groups 1 and 2, as compared to Group 3, exhibited a significant reduction in pain syndrome and in the postoperative adhesion formation process verified by relaparoscopy. Conclusion. With APC, followed by therapy with dienogest (visanne), the conception rate is 1.5-fold higher than that with standard energies, followed by therapy with GnRH agonists.

Objective. To study the expression of estrogen and progesterone receptors (ER and PR) in the epithelial and stromal cells of endometrial polyps and their adjacent endometrium in postmenopausal women. Subject and methods. Clinical and laboratory studies were performed in 96 patients with endometrial polyps. Three groups were selected for immunohistochemical examination. Group 1 comprised 11 patients with adenomatous polyps; Group 2 consisted of 17 patients with fibroglandular polyps; a comparison group included 18patients with the non-polypoid atrophic endometrium. An immunohistochemical technique was used to estimate ER and PR expressions in the epithelial and stromal cells of a polyp and its adjacent endometrium and those of the control endometrium. Results. There were higher ER and PR expressions in the epithelium and stroma of endometrial polyps than in those of the adjacent endometrium. Adenomatous and fibroglandular endometrial polyps were found to differ not only in their morphological structure, but also in the expression of sex hormone receptors in their stromal and epithelial components. There was also a substantial difference between the endometria surrounding each of these histotypes of polyps, which are in turn distinct from the control endometrium in their higher ER and PR expressions. Conclusion. The higher steroid receptor expression in the epithelia of polyps than that in the adjacent endometrium suggests that these steroid hormone structures are more highly sensitive, which determines the chance of their increase with the low local estrogen levels and in the surrounding atrophic endometrium. An understanding of the role of steroid receptors in the pathogenesis of different types of polyps may improve a differentiated approach when choosing treatment policy and the volume of endometrial destruction in this pathology.

Objective. To analyze perinatal outcomes in patients whose pregnancy is complicated by early amniorrhea in preterm pregnancy. Subject and methods. Sixty-four pregnant women with early amniorrhea at 22-34 weeks’ gestation, whose pregnancy had been prolonged by an average of 10.8±2.4 days during antibiotic and tocolytic therapy underwent clinical and laboratory examination at the Perinatal Center of the Saratov Region. Results. Pregnancy prolongation at 24-34 weeks’ gestation in the presence of early amniorrhea assists in reducing the rate and severity of respiratory disorders, the incidence and degree of intraventricular hemorrhage in premature infants, by decreasing the rate of disability in this group of infants. Conclusion. It is expedient to use expectant management tactics for preterm pregnancy complicated by early amniorrhea.

Uterine and vaginal malformations are a rather complex abnormality observed in 6.5% of the girls with different gynecological diseases. Atresia of the hymen is the most common type of these diseases. Thirty-five girls with this abnormality treated at the Izmailovo Children’s City Clinical Hospital in 2000 to 2008 were examined. The clinical picture of atresia of the hymen accompanied by menstrual outflow impairment shows evident symptoms of the acute abdomen, which requires its prompt differential diagnosis. Despite the apparent simplicity of this pathology, its diagnostic errors were noted in 23% of the girls. Its treatment consisted of hymenotomy using a crucial or semilunar incision in the most scanty vessel areas, as well as evacuation of the hematocolpos. Laparoscopy was performed to reduce postoperative complications, to evaluate the uterus and fallopian tubes, and to detect hematosalpinx and other abnormality undetectable during preexamination. A clinical case is described in the paper.