No 5 (2014)

The data available in the literature on the female reproductive system in Wilson-Konovalov disease (hepatocerebral dystrophy) are analyzed. The low incidence of the disease and its frequent onset with extrahepatic manifestations (hemolytic crises, dysmenorrhea, and kidney injury) are reported to frequently give rise to the untimely diagnosis of the underlying disease and associated inefficiency of late treatment initiation. There are few reports by a number of authors on successful pregnancy in Wilson-Konovalov disease, which suggest that timely therapy substantially improves quality of life and disease prognosis in patients; at the same time the women with hepatocerebral dystrophy tolerate satisfactorily pregnancy. It is concluded that it is necessary to conduct in-depth studies to improve a system of therapeutic and preventive measures in pregnant women with Wilson-Konovalov disease.

The review deals with the history of studies of one of the most common abnormalities - neonatal hypoglycemia and its etiology and pathogenesis. Its urgency is determined by difficulties in diagnosing this condition and its impact on neurological outcome in the neonatal period.

Objective. To study perinatal outcomes in patients whose pregnancy was complicated by premature rupture of membranes at 22-35 weeks’ gestation when applying medical expectant pregnancy management strategies. Subject and methods. Eighty-four case histories of deliveries at 22-37 weeks’ gestation, occurring in the Petrozavodsk Republican Perinatal Center in 2009-2012, which were complicated by preterm amniorrhea (PA) and a long dry interval, were analyzed. PA was diagnosed using the AmniSure tests. Results. The investigation has indicated that the medical wait-and-see strategy for PA promote accelerated fetal lung maturation, by increasing the incidence of severe forms of fetal respiratory distress syndrome and reducing the rate of disability in infants in this group. Conclusion. The use of antibiotics could prevent clinically significant infectious complications in the mother and decrease morbidity rates in the newborn infant. The application of current methods for childbirth preparation can reduce the rate of surgical delivery.

Objective. To evaluate the clinical efficiency of intravenous laser blood irradiation (ILBI) in the prevention of infectious and IICs in puerperas after cesarean section. Subject and methods. A study group consisted of 126 puerperas after cesarean section. All the puerperas received antibiotic prophylaxis with amoxiclav 1.2 g intravenously 15 minutes before skin incision. After surgery, the puerperas were divided into 2 groups: 1) 65 puerperas who, beginning from postoperative day 1, underwent daily ILBI using a Solaris device (Russia) with helium-neon laser at a wavelength of 0.63 nm during 15 minutes for 5 days (a study group); 2) 61 puerperas who had antibiotic prophylaxis only (a comparison group). From the first operative days, all the puerperas daily underwent thermometry, assessment of pain intensity according to a visual analogue scale, the breast, and fundal height, ultrasonographic examination of the postpartum uterus, and determination of peripheral blood parameters and C-reactive protein (CRP) levels. The pattern of postoperative complications and the number of hospital bed days were analyzed. Results. The mean age of the puerperas in the study and comparison groups were 31.2±5.4 and 30.5±5.1 years, respectively (р?0.05). All the women had a poor obstetric history and a complicated current pregnancy. The risk factors of postoperative IICs were identified. Prophylactic postoperative ILBI promptly normalized the total count of white blood cells, lowered erythrocyte sedimentation rate, increased lymphocyte and hemoglobin levels, and significantly decreased SRP; postoperative pains were more rapidly relieved and body temperature became normal. Lactation was noted on days 3.8±0.8 and 4.2±0.4 in Groups 1 and 2, respectively. Lactostasis was observed in 5 (8.2%) puerperas in the comparison group and in none in the study group. The babies of the study group puerperas were on breastfeeding in 83.1% of cases and on mixed feeding in 16.9%. In the comparison group, 62.3% of the babies were breastfed, 22.9% and 14.7% were on mixed and formula feeding, respectively. In the postpartum period, Groups 1 and 2 showed physiological puerperium in 95.4 and 86.9% of cases, respectively. Both groups had complications in 4.6 and 13.1%, respectively; moreover, complications, such as wound infection and endometritis, were absent in the study group, which provides an explanation for the larger number of bed days in the comparison group. Group 1 spent fewer (5.8±0.74) postoperative bed days, Group 2 did 6.5±1.3 days. ILBI caused no complications in the puerperas. Conclusion. ILBI was shown to be highly effective and safe in puerperas at risk for postoperative IICs. The absence of adverse reactions caused by ILBI and its safety can recommend the technique to use as part of preventive measures to prevent IICs after cesarean section.

The ovarian hyperstimulation syndrome (OHSS) results from enhanced vascular permeability, from activated endothelial vascular growth factor (VEGF). The selective dopamine receptor type 2 agonist cabergoline inactivates VEGF receptor 2 (VEGFR2), by blocking the further functions of VEGF, and prevents higher vascular permeability. Objective. To evaluate the effect of cabergoline on vascular permeability markers (VEGF, VEGF receptor 1 (VEGFR1), and VEGFR2 in the serum of women at risk for OHSS. Subject and methods. One hundred and sixty-eight women included in the IVF program were examined. Group 1 included 65 women at risk for OHSS who were given, for the prevention of this condition, oral cabergoline in a daily dose of 0.5 mg on the following day after transvaginal puncture for 5 days before the embryo transfer (ET) day. Group 2 consisted of 63 similar patients who did not take the drug. According to the development of OHSS, the patients were divided into subgroups: 1a (n = 38) and 2a (n = 30) without the syndrome being developed; 1b (n = 7) and 2b (n = 15) with OHSS. Group 3 comprised 40 women who had no risk factors OHSS (a control group). ELISA was used to measure the serum levels of VEGF, VEGFR1, and VEGFR2 in 90 high-risk patients and 40 control women. Results. On day 5 after cabergoline intake, Subgroup 1a women were found to have higher levels of soluble forms of VEGFR1 (p < 0.0007) and VEGFR2 (p < 0.0049) than the patients who did not take the drug. By the ET day, the OHSS subgroups versus the non-OHSS ones demonstrated a manifestation of the syndrome with lower VEGF1 and VEGF2 levels (p < 0.05). The administration of cabergoline could reduce the absolute risk of OHSS by 19% (95% confidence interval, 5-33%). Conclusion. The preventive effect of the selective dopamine receptor type 2 agonist cabergoline in the women at risk for OHSS shows itself as an increase in the serum levels of soluble VEGF1 and VEGF2 forms, which favors the optimal balance between these indicators and the maintenance of the physiological mechanism for vascular permeability.

The current contraception is well studied, reliable, and available. Adolescents, the most vulnerable group regarding unwanted pregnancy, use low effective contraceptive methods or do not at all. In addition to available contraceptives, effective counselling is needed. In Russia, there is a high pent-up demand for contraception; traditional and low effective methods are mainly used. This fact and a lack of motivation to go to a doctor to choose a method of birth control explain high unintended pregnancy and abortion rates in Russia. The latest-generation progestagen combined oral contraceptives, such as dimia, are the method of choice for young people. Progestagen-containing lactinet tablets may be recommended for those who have contraindications and nursing mothers; it is continuously used every day. Besides planned birth control methods, a condom is required to prevent sexually transmitted/HIV infections. Young people need emergency contraceptive pills, such as single-dose postinor and escapelle, not later than 72 hours after sexual contact. Effective family planning programs ensuring main human rights to choose current contraceptives and skills to use them may deepen young people’s knowledge about reproductive health and improve its quality situation.

Objective. To evaluate the efficiency of using gynestril (mifepristone, 50 mg) in the medical treatment of patients with uterine myoma. Subject and methods. Seventy-three women aged 25 to 40 years who were seeking organ-sparing treatment for uterine myoma as they planned childbirth in the future were followed up. During their primary examination and follow-up, all the patients underwent comprehensive studies involving evaluation of general health status, gynecological examination, small pelvic and breast ultrasonography, office hysteroscopy and histological examination of pipelle endometrial biopsy specimens. Results. The authors present their data on the prevalence of uterine myoma in women from different age groups, as well in those with infertility, miscarriage, and other internal genital diseases. There are data on the detection rate of concomitant somatic and gynecological diseases in patients with uterine myoma. There is also evidence for the use of mifepristone (50 mg) for the medical therapy of women with uterine myoma. Conclusion. The antigestagenic monotherapy caused the most pronounced reduction in myomatous nodules of baseline small sizes.