No 6 (2014)

The review sets forth current views on the role of free embryonic DNA (feDNA) in the prediction of pregnancy complications and outcomes. It describes the procedures that could determine feDNA in the blood of pregnant women regardless of the sex and rhesus factor of a fetus. The trial data suggesting that there is an association between elevated feDNA levels in spontaneous miscarriage, preterm births, preeclampsia, and fetal growth retardation are outlined. There are also results of predicting complications and diagnosing aneuploidies in the noninvasive fashion. The possibilities of clinically using these techniques in both risk-group pregnant women and as screening tools are described.

Vaginal birth after cesarean section is becoming more and more common. The once said phrase “once a cesarean section always” is presently criticized by leading obstetricians/gynecologists. The paper shows current trends in choosing the route of delivery in women with previous cesarean section, positive moments of vaginal birth in patients with a uterine scar.

Background. No multicenter studies to assess the prevalence of Magnesium (Mg) deficiency in the general population, particularly among pregnant women have been previously conducted in Russia before previous study, where significant prevalence of magnesium deficiency (81,2%) in pregnant women was revealed. This study is the second wave of the program to confirm the findings of first wave in other populations leaving across the Russian Federation, with increased sample size. Objectives: the primary objective of this registry was to evaluate the incidence of the Mg deficiency in a pregnant population monitored in Russian polyclinics. Subject and methods. Pregnant women (at any trimester) aged over 18 years with clinical manifestations suggestive of Mg deficiency, such as uterine hypertonus, leg cramps, hestosis, neurasthenia and having signed the informed consent were included. Mg deficiency due to any other concomitant condition and participation to other concomitant clinical research were exclusion criteria. Data coming from medical records were collected at Visit 1 and visit 2 (1 month +/- 1 week): complete medical history; diagnosis of Mg deficiency confirmed by serum Mg level (<0.7mmol/l) routine laboratory tests performed in the course of current practice (blood count, Mg plasma determination and urinalysis) and evaluation of total score (superior ≥ 30) using a structured 28 questions self-administrated Magnesium Deficiency Questionnaire (MDQ). Spontaneous reports of adverse reactions were collected. The statistical tests were applied according to type of variable distribution and the estimation of equality of variances. Results. 2117 pregnant women, mean age 28,1±5,1 years were included in 200 sites in Russia. 2097 were receiving Mg and data of 2087 of them were analyzed (10 patients were excluded). The prevalence of Mg deficiency in pregnant women according to the blood plasma levels (<0.7 mmol) and MDQ was 58.4% (436/747) and 78.4% (1660/2117), respectively. Combining both criteria, the estimated prevalence of Mg deficiency was 80.9% (1713/2117). It was observed that physicians commonly prescribe different organic Mg salts to pregnant women with Mg deficiency as a routine practice. Conclusion. Thus, Mg was prescribed to 2097 pregnant women: 90.3% received Mg Citrate (1894/2097) and 9.7% (203/2097) Mg lactate. It was observed that organic Mg salts are commonly prescribed by physicians to pregnant women with established Mg deficiency and even if the study was not designed to evaluate efficacy of the prescribed treatments, statistically significant improvement in Mg deficiency signs in pregnant women receiving organic Mg salts was observed.

Postpartum pyoinflammatory and thromboembolic events continue to remain important causes of maternal morbidity and mortality in developed countries. A search for effective treatments in surgical patients has led to the elaboration of the multimodal program Fast track surgery (FTS) or Enhanced Recovery After Surgery» (ERAS), that has been recently used in obstetrics and gynecology. Objective. To evaluate the clinical efficiency of postpartum and postoperative management protocols based on the current FTS and evidence-based medicine principles. Subject and methods. The specific features of pregnancy, labor, and postpartum period were traced in 5614 women retro- and prospectively followed up and delivered at the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in May 1, 2011 to April 30, 2013. Of them, 2631 women delivered before introduction of the protocols (May 1, 2011 to April 30, 2012): Group 1a (n = 1196) delivered via cesarean delivery; Group 1b (n = 1435) had spontaneous delivery. After introduction of the protocols (May 1, 2012 to April 30, 2013), 2983 pregnant women delivered, of them 1252 women (Group 2a) did via cesarean section; 1731 (Group 2b) had spontaneous delivery. The frequency of postpartum and postoperative complications, including thromboembolic, infectious and inflammatory, and postinfection ones, was analyzed. Statistical data processing was done using the mass market Winpepi 10.7 software. The odds ratio (OR) was given with 95% confidence interval (CI). Results. This trial showed considerably reduced antibiotic therapy after protocol introduction: from 72.4 to 23.6% (OR 8.02 (95% CI, 1.9 to 2.2)) after surgical delivery (p = 0.05) and from 9.6% to 0.5% (OR 20.1 (95% CI, 9.8 to 47.7)) after spontaneous delivery (p = 0.05). Revision of criteria for the uterine subinvolution diagnosis caused a decrease in its rate (from 9.2 to 1.6% (OR 29.1 (95% CI, 17.2 to 52.9)) after spontaneous delivery (p = 0.05), from 20.3 to 0.87% (OR 6.3 (95% CI, 3.9 to 10.8)) after cesarean section (p = 0.05); from 4.4 to 0.6% (OR 6.3 (95% CI, 3.3 to 13.3)) prior to and following protocol introduction, respectively and, hence, vacuum aspiration of the uterine cavity contents after spontaneous delivery (p = 0.05); from 3.3 to 1.4% (OR 2.8 (95% CI, 1.5 to 5.3)) after cesarean section (p = 0.05). The introduction of the FTS program could reduce the frequency of postoperative complications: enteroparesis by 3.5 times from 0.8 to 0.2% (OR 3.5 (95% CI, 0.89 to 19.82)) and urinary tract infection by 6 times from 2.4 to 0.4%, [OR 6.6 (95% CI, 2.53 to 21.96)). Prevention of pyoinflammatory and thromboembolic events, by using the scale of risk factors for thrombotic events could reduce their frequencies, the unreasonable use of low molecular-weight heparins, and hemostasiogram examinations. Conclusion. Decreased unreasonable antibiotic therapy during surgical intervention, optimization of thrombus prevention, use of current postoperative management principles reduced postpartum and postoperative complications.

Objective. To optimize the diagnosis of external genital endometriosis (EGE) in reproductive-aged patients, by determining the production of lipids and cytokines. Subject and methods. Ninety-six patients were examined and divided into 3 clinical groups: 1) 28 patients with Stages I-II EGE according to the r-AFS classification (1985); 2) 46 patients with Stages III-IV EGE; 3) a control group of 22 patients without endometriosis. All the patients underwent laparoscopy using the conventional procedure. The levels of lipoproteins, growth factors, CA-125, the endogenous level of NO as nitrite anion, and the activity of NOS were determined in their sera and peritoneal fluid. Results. The patients with different stages of EGE were found to have changes in molecular-cellular relationships at both systemic (serum) and local (peritoneal fluid) levels. Conclusion. The detected changes in the association of the lipid spectrum, growth factors, and angiogenic compounds are a theoretical ground for additional therapeutic measures to normalize metabolic processes in EGE.

The paper gives the results of a comparative statistical analysis of the FSM reporting forms No. 32 “Information on medical care for pregnant women, parturients, and puerperas” from 16 subjects of the Central Federal District of the Russian Federation (other than the city of Moscow and the Moscow Region) in 2012, which can characterize the organization of medical care during very early preterm births. The findings suggest that there are regional differences in the organization of perinatal care during early termination of pregnancy. The proposed methodical approaches during preterm births allow a comparative analysis at the district level in order to elaborate exposure control measures.

Objective. To evaluate the efficiency of peloid therapy in the rehabilitation of reproductive function in patients after hemorrhagic ovarian apoplexy. Subject and methods. An open-label prospective trial was conducted to study reproductive function in 112 patients who had received peloid therapy 1.5-2 months after surgery. Results. The ovulation phase of the menstrual cycle recovered in 91.5% of cases; ovarian artery blood flow improved, and the periovulatory endometrial structure restored. Conclusion. Having an ability to improve microcirculation and an estrogen-like effect, peloid therapy is an effective method for postoperative rehabilitation of the female reproductive system.

Objective. To study the efficacy, safety, and tolerability of the combined drug safocid (secnidazole, azithromycin, fluconazole) in the therapy of associated urogenital infections. Subject and methods. The study enrolled 50 patients with uncomplicated associated urogenital infections (urogenital trichomoniasis, chlamydial genitourinary infection, urethritis, and/or cervicitis caused by M. genitalium, bacterial vaginosis, and urogenital candidiasis). N. gonorrhoeae, T. vaginalis, and opportunistic microorganisms were identified by a culture method; C. trachomatis and M. genitalium were by a polymerase chain reaction assay. Bacterial vaginosis was diagnosed using the Amsel criterion. Results. Eradication of the causative agents of sexually transmitted infections, such as T. vaginalis, С. trachomatis, and M. genitalium, was achieved in 98% of the examinees. The efficiency of therapy for urogenital candidiasis and bacterial vaginosis was 97.3 and 95.3%, respectively. Therapy compliance was noted in 100% of the patients. Adverse drug reactions were recorded in 2% of the patients. Conclusion. Safocid is an effective and safe drug to treat patients with uncomplicated associated urogenital infections, including those with low compliance to treatment.