No 8 (2014)

Current nutritional support of a gestation period is one of the most important obstetric problems since adequate provision with essential nutrients during pregnancy can prevent fetal malformations and guarantee a healthy baby. To prevent and treat folate deficiency-associated abnormalities during pregnancy, it is advisable to use vitamin/ mineral complexes containing metafolin, an active form of folates with high bioavailability.

Objective. To analyze the expression of the tumor necrosis factor-а (TNF-а) gene in blood mononuclear cells and the production of cytokines (TNF-а, interferon-а (IFN-а), and transforming growth factor в 1 (TGF-fi 1)) in the serum of patients with herpesvirus infection and a history of recurrent miscarriage, who underwent chemosensitized blood photomodification (BPM). Subject and methods. Comprehensive examination and treatment were performed in 74 patients with herpesvirus infection, including 36 women with no history of recurrent miscarriage (Group 1) and 38 with a history of this condition (Group 2). TNF-а gene expression, cytokine profile, and a change in specific antibody titers against herpes simplex virus (HSV) type 2 and cytomegalovirus were estimated in all the patients before, during, and after therapy. Results. Examination of TNF-а gene expression revealed that 100% of Group 1 patients showed a significant downward trend in this indicator during therapy. Lower TNF-а production was noted in 60% of the patients in Group 1. In Group 2, there was a significant trend in declining TNF-а gene expression and a reduction in TNF-а production 10 days after treatment initiation was detected in 62.5% of the patients. There was a significant increase in the level of TGF-Pj in Group 1 patients during therapy. In Group 2, there was a mediated elevation in TGF-fi 1 levels by the completion of an 18-20-day therapy cycle, which is a positive effect and promotes suppressed HSV replication. BPM failed to affect serum IFN-а levels; no changes in specific antibody titers were found in the examined groups. Conclusion. Thus, chemosensitzed BPM has a positive impact in all the patients of the examined groups: the mechanisms of the body’s antiviral protection activate, which will be able further to increase the rates of conception and a favorable pregnancy outcome in women with recurrent miscarriage of infection genesis.

Objective. To estimate the diagnostic value of ultrasound studies in the differential diagnosis of ovarian tumors and tumoroids in pregnant women. Subject and methods. Three hundred and forty-nine pregnant women with ovarian tumors/tumoroids were examined. Group 1 included 123 women who had undergone surgical treatment during their pregnancy at 8 to 28 weeks; Group 2 comprised 142 women in whom the tumor had been removed during cesarean section; and Group 3 consisted of 84 women who had been surgically treated 6 days to 7months after spontaneous delivery. All the patients underwent ultrasonography during their first referral for medical help, in the screening periods, in the presence of indications during pregnancy, prior to surgery, in the postoperative period, and in the presence of signs of threatened miscarriage. Ultrasonography encompassed color Doppler mapping and Doppler metry in addition to echography. All removed ovarian tumors/tumoroids were histologically verified. The data were compared to determine the diagnostic value (sensitivity and specificity) of comprehensive ultrasonography in the diagnosis of ovarian tumors/tumoroids in pregnant women. Results. The sensitivity and specificity of ultrasound studies in the diagnosis of benign epithelial tumors, including serous, seropapillary, mucinous cystadenomas were 71.4 and 94.9%, those of mature cystic teratomas were 91.7 and 98.7%, and those of endometriod cysts were 83.9 and 97.4%, respectively. The accuracy of the diagnosis of borderline and malignant ovarian tumors was highest and accounted for 90.9 and 99.1%, respectively. The diagnosis of tumoroids (paraovarian, follicular, corpus luteum, simple, lining epithelium-free, inclusion, or thecalutein cysts) showed the least accuracy (sensitivity, 76.1%; specificity, 88.1%. Conclusion. The echographic pattern of ovarian tumors/tumoroids exhibits a number of features in pregnant women. To make a decision about surgical treatment during pregnancy, ultrasonography in pregnant women with ovarian tumor/tumoroids should be of expert nature and made by the most experienced specialists in a specialized health facility where possible.

Objective. To study the morphological and molecular substrate of impaired endometrial receptivity in fertile patients with external genital endometriosis who enter an assisted reproductive technology program. Subject and methods. One hundred andforty-eight infertile patients, including 50 women with grade 1-2 external genital endometriosis (a study group), 44 with endometrioid ovarian cysts (a comparison group), and 54 with tuboperitoneal factor of infertility (control group) were examined. All the patients underwent aspiration pipelle endometrial biopsy on 6-8 days following ovulation. Serial paraffin-embedded sections were used to determine the count of pinopodia and the expression of leukemia inhibitory factor (LIF), H0XA10, glycodelin A, integrin a в 3, and aromatase in the superficial epithelium, glandular epithelium, and endometrial stroma. Results. The patients with external genital endometriosis (the study and comparison groups) versus the control group had significantly lowerpinopodium counts (p<0.05) and a decreased expression of LIF, H0XA10, integrin а в and glycodelin A in the superficial epithelium and a significantly increased expression of aromatase in the superficial epithelium, glands, and endometrial stroma (p<0.05). The highest expression of aromatase was seen in patients with endometrioid ovarian cysts. Conclusion. In the patients with infertility concurrent with external genital endometriosis, the endometrium displays a reduction in the levels of pinopodia, LIF, H0XA10, glycodelin A, and integrin ав 3, and an increase in aromatase. At the same time, the magnitude of these changes correlates with the severity of external genital endometriosis. Thus, changed endometrial receptivity may be one of the leading causes of infertility and lower efficiency of the assisted reproductive technology program in patients with external genital endometriosis.

The prevalence of low bone mineral density (BMD) in patients with amenorrhea amounts to as much as 52%. Moreover, osteodensitometry is accessible only in large medical centers. Objective. To develop a widely accessible non-instrumental screening methodfor low BMD in women with secondary amenorrhea. Subject and methods. One hundred and nine women (55 patients with premature ovarian failure and 54 with functional hypothalamic amenorrhea) were examined. Basic physical, hormonal, biochemical, and instrumental examinations, including osteodensitometry, were performed. Results. A model was proposed to estimate the probability (P) of low BMD: Р = 1/(1+е -у), where у = 2.67 + 0.22 x DA - 0.29 x BMI + 0.74 x AC (AD is the duration of amenorrhea (years); BMI is the body mass index; AC is the atherogenic coefficient). Conclusion. The proposed formula is a theoretically and clinically grounded screening method for low BMD in patients with secondary amenorrhea, which can identify risk groups to choose the tactics of further examination and combination treatment.

Objective. To study the clinical and morphological pathogenic features of an evolving adhesive process in patients with uterine myoma after myomectomy. Subject and methods. One hundred and ten patients with uterine myoma were examined. The patients were divided into 2 groups. Group 1 included 34 patients with an adhesive process. Group 2 consisted of 76 patients without this process. Clinical anamnestic, morphological, immunohistochemical examinations and determination of the expression of the markers Ki-67, C-KIT, VEGF, MMP-2, TIMP-2, and collagen types I and III were made. Results. Group 1 showed more myomas with dystrophic changes and growth areas; the commissural fiber displayed the increased expression of the markers of proliferative activity, intercellular interaction, and angiogenesis. The commissural f iber was morphologically characterized by the presence of fatty tissue and cells with the signs of stemness. Conclusion. In women with uterine leiomyoma, peritoneal commissures were clinically and morphologically characterized by the presence of more significant pain syndrome, higher infertility rates, and lower parity. The cells with the signs of stemness, which are located in fatty tissue, are involved in the formation of commissures in women with uterine myoma.

Objective. To analyze maternal mortality rates and to characterize women who died from preeclampsia and eclampsia in 2010-2012 in the Russian Federation. Subject and methods. The investigation analyzed the 2010-2012records of maternal deaths, including those from preeclampsia and eclampsia. It provided the sociomedical and clinical organizational characteristics of maternal losses from preeclampsia and eclampsia and also compared the parameters of this group with the general group of maternal deaths from other causes. Results. The sociomedical characteristics of women who had died from preeclampsia/eclampsia and those of women who had other causes did not differ significantly. Comparison of both groups revealed differences in gestational ages in the final stage of pregnancy, parity, and at the onset of a fetal outcome. The gestational age of 29-36 weeks was shown to be the most critical periodfor primigravidas with evolving preeclampsia/eclampsia. Conclusion. Despite the fact that maternal mortality is a population result of the interaction of different factors, the maternal death from preeclampsia and eclampsia is associated with the quality of medical care.

The paper gives indications, contraindications, specific methods of using different preformed physical factors in patients after less than 12-week pregnancy termination using different techniques. Physical factors are used in all patients to prevent possible complications and to treat already occurred complications in women with poor somatic and gynecological histories in conjunction with drug therapy. The differential use of therapeutic factors is indicated depending on the age of patients, parity, the method of abortion, an individual response to physiotherapy.

Objective. To compare the parameters of coagulation hemostasis and fibrinolysis and the levels of fetoplacental unit hormones in young women in early pregnancy in relation to the degree of hereditary connective tissue disorders and thrombosis prophylaxis. Subject and methods. The parameters of coagulation hemostasis and fibrinolysis and the levels of fetoplacental unit hormones were studied and correlations between vascular resistance indices in the uteroplacental unit and hemostatic system parameters were determined in 418 patients with hereditary connective tissue disorders and in 313 pregnant women without these conditions. Results. The use of low-molecular-weight heparins in combination with dydrogesterone was found to improve the indicators of uteroplacental unit hormones in the patients with hereditary connective tissue disorders. Conclusion. Thrombosis prophylaxis and dydrogesterone therapy in early periods in patients with hereditary connective tissue disorders can improve uteroplacental unit parameters.

Objective. To present the frequency, pattern, and causes of complications after surgical correction of genital prolapse and stress urinary incontinence (SUI) with synthetic prostheses. Subject and methods. Among 310 operated women, complications requiring surgical correction were diagnosed in 31 (10.0±1.7%) cases during the first day to 3 years after surgery. Results and discussion. Resurgery consisted in excising the implanted prosthesis partially or entirely and in surgically recorrecting SUI. Conclusion. Errors of surgical techniques are the main cause of postoperative complications. Reoperations after interventions using synthetic prostheses are accompanied by an increased risk for damage to the bladder and urethra and must be performed by experienced surgeons.

The review presents the data currently available in the literature, including the authors’ publications, regarding the pathogenetic aspects of vaginal dysbiosis. It discusses the role of gram-negative bacterial lipopolysaccharides in the development of bacterial vaginosis. The paper provides a rationale for the pathogenetic correction of vaginal dysbiosis through the local and oral use of probiotic L. crispatus, L. brevis, and L. acidophilus strains.

Iron-deficiency anemia is one of the most common pregnancy complications, which may cause conditions, such as fetal growth retardation and lower birth weight, have a negative impact on placentation, increase the risk of premature birth, placental abruption, and bleeding during delivery. To rule out other causes of anemia is a key moment in its diagnosis and a promise for therapeutic effectiveness. Oral iron preparations are first-line therapy for iron deficiency. In case of inadequate efficacy, side effects, or very low hemoglobin, intravenous ferric carboxymaltosate is a preferred alternative. Timely diagnosis and adequate therapy can correct iron exchange changes in the shortest possible time and improve pregnancy outcomes.