No 7 (2014)

What happens to reproduction, demography, and natural selection in the modern world? This question agitates scientists, physicians, psychologists, sociologists, demographers, and politicians today. Low birth rates are a global public health problem; there are a rapidly growing number of countries with aging population and the conscious choice of people themselves rather than infertility increasingly leads to childlessness. Sexuality, the closest intimate aspect of human life, becomes the subject of close investigation and the World Health Organization has declared the provision of the population’s sexual and reproductive health to be one of the most important goals of millennium development.

This paper presents an update on the molecular genetic and epigenetic mechanisms of the pathogenesis of infiltrative endometriosis. It gives the morphological characteristics of endometriosis.

Objective. To analyze the association of the presence of anti-annexin V antibodies with reproductive failures in women with recurrent miscarriage. Subject and methods. One hundred and fifty-five pregnant women, including 119 ones diagnosed as having recurrent miscarriage and 34 women with physiological pregnancy, were examined. The level of the antibodies was determined using enzyme immunoassay kits (Orgentec, Germany). Results. The detection rate of anti-annexin V antibodies was increased in the women with recurrent miscarriage as compared to the control group of those with physiological pregnancy. In the recurrent miscarriage group, the frequency of anti-annexin V antibodies was higher than that of anti-phospholipid and anti-ß2 glycoprotein antibodies. Conclusion. Anti-annexin V antibodies are an independent risk factor identified in women with recurrent miscarriage and confirm the need for their determination in routine practice for the examination of women with recurrent miscarriage.

Previous investigations have shown that the existing classifications of undifferentiated connective tissue dysplasia (UCTD) are inadequately efficient in obstetrics, as well as those in the prediction of obstetric complications. Objective. To optimize an UCTD rating scale for increasing its ability to predict a risk for obstetric complications and to create a model for predicting preterm labor. Subject and methods. A prospective study was conducted in 150 pregnant women. The degree of UCTD was evaluated in all the patients, by applying the following classifications: that developed by T.Yu. Smolnova, a rating table for the screening diagnosis of CTD by A.S. Kalmykova, and a table of the significance of clinical markers in the evaluation of the degree of UCTD by T.I. Kadurina. At the second stage, the authors performed a prospective study of280patients and created a model for predicting preterm labor to evaluate the efficiency of the proposed rating scale. Results. A modified UCTD rating scale containing 26 signs was developed for obstetric patients. A mathematical model was created to determine the risk of preterm labor. Conclusion. The modified UCTD rating scale was proposed to identify a group of patients having more than 10 scores that were associated with the risk of obstetric complications and the model was created to predict preterm labor.

Objective. To study the statistics of extremely low birth weight (ELBW) births and extremely preterm births (EPB) in the Ural Federal District and to define who to improve perinatal outcomes. Subject and methods. A comparative analysis of the statistics of EPB and perinatal outcomes in ELBW infants (n=2019) in the areas of the district during 2012-2013; direct audit of 8 leading perinatal centers. Results. In the past 2 years of introduction of new live birth criteria, the proportion of ELBW babies in the district has increased from 0.49 to 0.62%; however, EPB is being registered irregularly. There is a 17% decrease in the proportion of stillborn infants and a 14.5% increase in that of survivors among the live ELBW births. Conclusion. The survival rates of ELBW infants increase up to 70% or higher in the areas where 80% of EPB are done at Level III perinatal centers.

Objective. To evaluate the efficiency of using ultrasound uterine cavitation irrigation to restore the endometrium in women after termination of regressing pregnancy. Subject and methods. Thirty-eight women who had undergone a session of uterine cavitation irrigation comprised Group 1. Thirty-two patients who had not received intrauterine irrigations for their treatment made up Group 2. A control group included 8 apparently healthy women. On day 3 after termination of regressing pregnancy, the uterus was irrigated by means of an AK 100 Fotec device (5 sessions for 3-5-minutes). Histological and immunohistochemical examinations of pipelle endometrial biopsy specimens were made on days 7-10 of the next menstrual cycle. Results. The endometrial histological pattern corresponding to the early phase of proliferation without stromal lymphoid infiltration was observed in 66.7% of the women in Group 1 and in only 25.2% of those in Group 2. The pattern of chronic endometritis was revealed in 56.3% of the women in Group 2. The expression of estrogen receptor-α in the endometrial glands was 188.54±1.97 and 177.01±5.29 in Groups 1 and 2, respectively (p < 0.05); that in the endometrial stroma was not significantly dissimilar in the observation groups, but was below the reference values. The expression of progesterone receptor in the stroma was 159.09±4.82 in Group 1 and 143.01±8.19 in Group 2 (p < 0.05); that in the glands was 196.18±1.94 and 181.66±3.18, respectively (p < 0.01). The expression of Ki-67 in the stroma was 107.45±2.93 in Group 1 and 115.66±3.86 in Group 2 (p < 0.05); that in the glands was 145.63±5.43 and 168.33±14.59, which was far above the reference values of 132.51±4.25, respectively (p < 0.01). Conclusion. Ultrasound uterine cavitation irrigation following termination of regressing pregnancy is an effective technology for rehabilitation of an endometrial receptive field.

Objective. To evaluate the efficiency of interferon-a2b correction of an infectious factor in reproductive-aged women at the stage of preparation and during pregnancy. Subject and methods. In nonpregnant women, the infectious factor of “bacterial vaginosis” was corrected with vagiferon vaginal suppositories (Group 1, n = 40), that of “bacterial and viral vaginitis” with vagiferon in combination with wilprafen (Group 1, n = 40) and vagiferon (Group 2, n = 40) under clinical and instrumental control, and that of “influenza and other acute respiratory viral infections” (ARVI) with grippferon nasal drops in 80pregnant women. Results. During topical therapy for bacterial vaginosis with vagiferon vaginal suppositories, there was a marked early clinical effect and neither recurrence within 2 weeks after drug use termination nor need at Stage 2 of vaginal biotope restoration, and during this therapy for bacterial and viral vagititis, there was a pronounced early clinical effect and a practical coincidence of the efficiency of vagiferon monotherapy and combined therapy. During topical therapy for ARVI and influenza with grippferon nasal drops there was a statistically significant reduction in the intensity and frequency of symptoms in early periods and neither disease complications nor additional use of antibiotics and antibacterial chemopreparations. Conclusion. The proven high activity of vagiferon vaginal suppositories in the therapy of nonspecific and mixed infection-induced bacterial vaginosis and vaginitis in nonpregnant women and that of grippferon nasal drops in the therapy of influenza and ARVI in pregnant women permit them to be recommended in the correction of an infectious factor.

Objective. To study fertility after completing the use of reversible hormonal contraceptive methods: combined oral contraception and levonorgestrel-releasing intrauterine system (IUS). Subject and methods. The authors made a retrospective analysis of 120 outpatient cards of patients who used hormonal contraception and sought medical advice after discontinuation of the method to plan pregnancy. The f indings were compared with published data from 17 prospective trials. Results and conclusion. The performed comparative analysis has led to the conclusion that hormonal contraception (combined oral contraception and levonorgestrel-releasing IUS) has no negative impact on fertility, the course of pregnancy, labor, delivery, and fetal status. The duration of using the above methods does not affect the time of fertility restoration.