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No 2 (2014)


The Research Center of Obstetrics and Gynecology is 70 years old

Sukhikh G.T., Serov V.N., Baranov I.I.


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.
Obstetrics and Gynecology. 2014;(2):3-8
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The course of pregnancy in obese women

Chukhareva N.A., Runikhina N.K., Dudinskaya E.N.


The increasing prevalence of obesity and its related diseases is one of the major health problems, which assumes particular significance in a group of reproductive-aged women. Prepregnancy obesity and overweight are an important risk factor for pregnancy, labor, postpartum complications and poor perinatal outcomes.
Obstetrics and Gynecology. 2014;(2):9-13
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Endometrial receptivity in an in-vitro fertilization program

Mityurina E.V., Perminova S.G., Demura T.A., Gallyamova E.M.


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.
Obstetrics and Gynecology. 2014;(2):14-20
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Vaginal atrophy

Glazunova A.V., Yureneva S.V., Ermakova E.I.


Postmenopausal estrogen deficiency leads to vaginal atrophy in a number of women. The review gives recent data on the pathogenesis, clinical characteristics, and therapy of this condition.
Obstetrics and Gynecology. 2014;(2):21-26
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Molecular genetic predictors of the efficiency of tocolytic therapy in pregnancy prolongation in threatened preterm labor

Sukhikh G.T., Khodzhaeva Z.S., Donnikov A.E., Trofimov D.Y., Olenev A.S., Fedotovskaya O.I.


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.
Obstetrics and Gynecology. 2014;(2):27-34
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The clinical and morphological features of earlyand late-onset preeclampsia

Vodneva D.N., Romanova V.V., Dubova E.A., Pavlov K.A., Shmakov R.G., Shchegolev A.I.


Objective. To study the specif ic features of labor and placental changes in early- and late-onset preeclampsia in pregnant women with sleep apnea syndrome. Subject and methods. The study enrolled 36 patients aged 20 to 41 years who were divided into 2 groups according to the onset of preeclampsia. Polysomnography and placental morphological examinations were performed. The f indings were processed using a Statistica 6.0 program. Results. Early-onset preeclampsia differs significantly from late-onset one with regard to the time of pregnancy prolongation. Sleep apnea is much more common in late-onset preeclampsia (88.9%) than in its early onset (5.5%). The placentas obtained from the women with early-onset preeclampsia display lower VEGF and VEGFR-2 expressions while the VEGF expression in late-onset preeclampsia is not distinct from that in the control group. Conclusion. The findings may suggest that the main cause of early-onset preeclampsia is impaired trophoblast invasion processes; late-onset preeclampsia may be linked to pathogenetic mechanisms, such as nocturnal intermittent hypoxia in sleep apnea, which leads to endothelial dysfunction, systemic inflammatory response, and oxidative stress.
Obstetrics and Gynecology. 2014;(2):35-40
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Serum levels of immunoregulatory proteins in pregnant women after in vitro fertilization

Markina L.A., Zorina V.N., Gusyatina G.N., Renge L.V., Zorina R.M., Bazhenova L.G., Zorin N.A.


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.
Obstetrics and Gynecology. 2014;(2):41-45
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Reference ranges for von Willebrand factor and ADAMTS-13 metalloproteinase levels and activity and platelet activity in physiological pregnancy

Momot A.P., Kiryushchenkov P.A., Trukhina D.A., Taranenko I.A., Tomilina O.P., Pykhteeva M.V., Fadeeva N.I., Tsyvkina L.P., Serdyuk G.V., Belozerov D.Y., Romanov V.V.


Objective. To establish allowable ranges for platelet aggregation and von Willebrand factor (vWF) and ADAMTS-13 metalloproteinase activity and levels in physiological pregnancy. Subject and methods. Examinations were performed in 301 females who were nonpregnant or physiologically pregnant at different stages and 2-3 days after spontaneous labor. Aggregatometry and enzyme immunoassay were used to study platelet function and vWF and ADAMTS-13 levels and activity. Results. The pregnant women showed an increased platelet susceptibility to ADP (0.1 μΜ), which was associated with 1.19 and 1.42-fold vWF ristocetin cofactor activity increases relative to the baseline values at 22-24 and 34-36 weeks’ gestation, respectively. The most noticeable change in vWF antigen levels was observed at 12-13 weeks’ gestation. The levels of the activity and antigen of ADAMTS-13 at 6 to 13 weeks’ gestation were similar to those in the nonpregnant women. Subsequently, at 22 weeks to late periods of pregnancy, there was a decrease in this enzyme - in its activity and antigen by 26.4-39.2 and 28.7-31.7%, respectively, as compared to those seen in the nonpregnant women. The investigations indicated that in physiological pregnancy and postpartum, the Spearman correlation coefficient between the activities of vWF and the enzyme ADAMTS-13 was -27 (P < 0.001) and that between the antigens of vWF and ADAMTS-13 was equal to -0.32 (P < 0.001). Conclusion. There was a progressive increase in vWF activity and levels (at 12-13 weeks of physiological pregnancy) along with decreases in ADAMTS-13 activity and levels. The given data specify the mechanisms of platelet activation and may be used as estimated values while studying the hemostatic system in pregnant women and forming groups at risk for bleeding and thrombosis.
Obstetrics and Gynecology. 2014;(2):46-52
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Possibilities of argon plasma coagulation in the combination therapy of severe endometriosis

Glukhov E.Y., Oboskalova T.A., Urakov A.V.


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.
Obstetrics and Gynecology. 2014;(2):53-56
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Immunological aspects of the pathogenesis of chronic endocervicitis in the presence of cicatricial deformity of the cervix uteri

Molochkov A.V., Bagramova G.E., Murakov S.V., Maikov O.A., Seregina P.E., Veredchenko A.V., Popkov S.A.


Objective. To study the immunological aspects of the pathogenesis of chronic endocervicitis and to evaluate the efficiency of its surgical treatment in the presence of cicatricial deformity of the cervix uteri. Subject and methods. Clinical observations covered 100 patients with chronic nonspecific endocervicitis in the presence of cicatricial deformity of the cervix uteri. Plastic operations via dissection were used as a surgical technique. The clinical efficiency of the technique and changes in the cytokine profile of the cervical mucus plug were evaluated. Results. Prior to treatment, all the patients were found to have pronounced changes in the levels of inflammatory cytokines. Postoperative clinical convalescence was achieved in 75 of the 100 patients. Six months after treatment, the endocervical mucin level of inflammatory cytokines corresponded to the normal values in the majority of patients. Conclusion. Reconstructive plastic surgery via dissection promotes recovery of cervical functional adequacy, normalization of the vaginal microflora, and restoration of antiinfectious resistance of the reproductive tract, which can recommend it for the treatment of chronic endocervicitis in the presence of cicatricial deformity of the cervix uteri.
Obstetrics and Gynecology. 2014;(2):57-59
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The receptor status of endometrial polyps in postmenopausal women

Kogan Y.A., Sattarov S.N., Sarkisov S.E., Boiko M.A., Mamikonyan I.O.


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.
Obstetrics and Gynecology. 2014;(2):60-66
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Introduction of current methods for pregnancy termination in Russian practice

Dikke G.B., Yarotskaya C.L., Erofeeva L.V.


Objective. To estimate the current introduction and quality of medical care for women with unwanted pregnancy in health care facilities. Subject and methods. The 2008-2013 statistics of the Ministry of Health of the Russian Federation; the data of periodicals and speeches of regional leaders at the conferences during 2010-2013; anonymous testing of specialists (24 obstetricians/gynecologists in Yekaterinburg), and questionnaires of 161 women seeking medical advice before abortion were analyzed. Results. The introduction of the current pregnancy termination methods in health care facilities, which are recommended by the WHO experts and the normative documents of the Ministry of Health of the Russian Federation, shows a positive tendency, but insufficiently rapid rates. The application of safe technologies aids in significantly reducing complications in the absence of maternal deaths.
Obstetrics and Gynecology. 2014;(2):67-73
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Our experience in managing pregnancy complicated by early amniorrhea in preterm pregnancy

Mikhailov A.V., Dyatlova L.I., Rogozhina I.Y., Glukhova T.N., Panina O.S.


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.
Obstetrics and Gynecology. 2014;(2):74-79
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Use of immunomodulators in the therapy of cervicitis

Kuznetsova I.V., Suleimanova N.S.


There is now a global trend in the higher prevalence of chronic urogenital inflammatory diseases. This is due to many circumstances, including ineffective antibacterial therapy. The evolving resistance of microorganisms to existing antibiotics, a protracted pause in the emergence of novel antibacterial agents, the atypical clinical picture of acute inflammation, late diagnosis, and inadequate treatment guidelines - all in turn increases the likelihood of pathogen persistence and an abnormal inflammatory response. There are several ways to solve the problem of enhancing the eff iciency of therapy for infectious and inflammatory diseases. One of them is to prudently use immunomodulators. Tilorone, an interferon inducer, takes its rightful place among the drugs of this group. The gained experience with tilorone used in different f ields of medicine recommends its wide use in gynecological practice.
Obstetrics and Gynecology. 2014;(2):80-85
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The clinical presentation, diagnosis, and treatment of atresia of the hymen in girls

Baran N.M., Adamyan L.V., Bogdanova Y.A., Glybina T.M.


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.
Obstetrics and Gynecology. 2014;(2):86-90
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Alexander Kiter

Kira E.F.
Obstetrics and Gynecology. 2014;(2):91-94
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In remembrance of Ya.E. Krivitskiy

- -.
Obstetrics and Gynecology. 2014;(2):95-95
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