No 10 (2014)

The paper presents the results of an analysis of Russian and foreign studies of the relationship between fetal malformations and folic acid provision. It gives the epidemiological data showing that multivitamin support including folic acid is effective in preventing placental detachment. It is concluded that it is necessary to include recommendations for the dietary intake of a multivitamin/mineral/folate supplement in the algorithm of standard counseling to prevent obstetric and perinatal complications and to form the basis for the development of healthy generations.

Objective. To create a mathematical model for the prediction of fetal growth retardation in patients with undifferentiated connective tissue dysplasia (USTD). Subject and methods. A prospective cohort study was conducted in 201 pregnant women. According to the Fenton percentile growth chart, all the patients were divided into two groups. A study group consisted of 63 women whose babies were rated to be in the 3 rd to 10 lh percentiles. A comparison group included 138 patients whose babies were assigned to the 10 th or more percentile range. The magnitude of dysplasia was determined by the modified growth chart. Results. The investigators determined the clinical and molecular genetic predictors of fetal growth retardation, such as the magnitude of USTD, threatened miscarriage in the second trimester, an exacerbation of chronic urinary tract diseases, and threatened preterm labor during ultrasound study, as well as VEGFA gene polymorphisms: -634 G>C and VEGFA: 936 C>T. Conclusion. A mathematical model including the clinical anamnestic and molecular genetic parameters was developed to predict fetal growth retardation in patients with USTD.

Objective. To give the results of meta-analysis for evaluation of efficiency of drugs based on citrate, lactate, magnesium pidolate on pregnancy outcomes, mothers and newborns health. Subject and methods. 11 randomized clinical trials using citrate, lactate, magnesium pidolate in combination with pyridoxine (registered under the trade name Magne B/Magne B 6 Forte in the Russian Federation) per os during pregnancy (n = 2130) were analyzed. Results. Meta-analysis showed that nutritional support of pregnancy with magnesium preparations was associated with a lower risk of miscarriage (6 trials, OR 0.49; 95% CI, 0.34...0.71, Р = 0.00015), placental insufficiency (6 trials, OR 0.33; 95% CI 0.22...0.50; Р = 1.1*10- 7), threatened miscarriage (3 trials; OR 0.39; 95% CI 0.25...0.62; Р = 4.1х10- 5), preeclampsia (9 trials; OR 0.35; 95% CI, 0.26...0.48; Р = 1.6*10- 8), preterm delivery (5 trials; OR 0.34; 95% CI0.21...0.55; Р=7.1*10 -6), cesarean delivery, (6 trials; OR 0.26; 95% CI0.17...0.41; Р=1.9x10- 6), maternal hospitalization (2 trials; OR 0.47; 95% CI 0.26...0.87; Р = 0.014), fetal growth retardation (6 trials; OR 0.44; 95% CI0.28...0.69; Р=0.0003). Conclusion. Nutritional support of pregnancy with magnesium preparations based on organic salts, such as citrate, lactate, and pidolate, in combination with pyridoxine favorably affects the course and outcomes of pregnancy with a high safety level and no adverse reactions.

Objective. To study the possibility of using uterine artery embolization (UAE) to treat uterine myoma with submucosal nodules. Subject and methods. A total of 1610 reproductive- and premenopausal-aged patients diagnosed as having uterine myoma who had been treated by UAE were examined. The examinees’ age ranged from 21 to 56 years (mean age 40.8±0.7 years). The examination involved the consultations of a gynecologist and an interventional radiologist, small pelvic ultrasound study determining the Doppler readings of blood flow in the uterine arteries, their branches, and perifibroid plexus vessels, biochemical and clinical blood tests, smears to define purity grade and flora, and a test to detect urogenital infection. To evaluate the endometrium, the investigators performed aspiration and, if indicated, hysteroscopy and separate curettage of the uterine cavity. Results. UAE was carried out in 1003 (62.3%) patients with solitary submucosal or multiple myoma; one of its nodules displayed submucosal growth. Myoma belonged to type 0 in 17 (1.7%) of the patients, type 1 in 361 (36%), and type 2 in 625 (62.3%). 334 (33.3%) women were observed to have either myolysis or expulsion of uterine nodules and their generation or vaginal removal in the period 2 weeks to 1 year after UAE. Spontaneous generation of nodules occurred in 71 (7.1%) patients. Long-standing nodules in the cervical canal were noted in 15 (1.5%) patients. A nodule was surgically removed by the traditional procedure. Bleeding occurred in 5 patients at 2 months postembolization, which required emergency admission and transvaginal myomectomy. None of these cases needed any radical surgical intervention. Postmyomectomy small pelvic ultrasonography demonstrated complete recovery of the topography of the uterine cavity without any additional surgical interventions. Conclusion. UAE alone and as a treatment stage may be used to treat uterine myoma with the submucosal arrangement of a nodule in any size of a myomatous nodule, at any patient age. It may be carried out in patients with submucosal uterine myoma as an alternative to hysterectomy and when transcervical myomectomy is impossible. UAE is the method of choice in the treatment of this pathology in high risk surgical/anesthetic patients.

Objective. To evaluate the specific features of the subpopulation composition and functional activity of white blood cells in premature infants at birth and in the early neonatal period depending on gestational age and the presence of congenital infectious pathology. Subject and methods. This prospective study was performed using the umbilical cord blood samples obtained from 43 premature infants, 24 of whom were found to have symptoms of congenital infectious disease; a control group consisted of 8 healthy full-term infants. The white blood cells were phenotyped by flow cytofluorometry applying monoclonal antibodies to the markers CD95, CD45, CD14, CD11b, CD16, cD64, CD38, and HLA-DR. The rate of reactive oxygen species (ROS) generation by whole blood cells was estimated by luminol-dependent chemiluminescence. Results. There was a correlation of the levels of activated phagocytes and their ability to produce ROS depending on gestational age. The presence of infectious disease does not reflect on the expression of the differentiated phagocytes detectable with the markers; yet it affects the functional activity of ROS-producing umbilical cord blood cells. The early neonatal period is characterized by the higher rate of expression of activated markers on granulocytes and by enhanced cell functional activity. The innate immunity of premature infants with intrauterine infection was shown to develop more rapidly than that of non-infected babies; moreover, there was monocyte pool exhaustion with the activated mechanisms of immune defense in the neonates exposed to pathogens in utero.

Background. Cadmium (Cd) and lead (Pb) are toxic metals and may have effects on babies’ birth weight. Glutathione-S-transferases (GST) are involved in the detoxification of many heavy metals by glutathione conjugation. Objective. To reveal a relationship between prenatal Pb and Cd exposure, GST Ml (GSTM1) and GST T1 (GSTT1) gene deletions, and newborn birth weight. Subject and methods. The population-based cross-sectional study included 166 puerperas randomly selected from a population of Chita pregnant women. The inclusion criteria were age of 20 to 40 years and at least 5-year residence in the region. Women with fetal malformations, multiple pregnancy, diabetes mellitus, or preeclampsia/eclampsia were not included in the study. The urinary concentrations of Pb and Cd in the mother-infant pairs were tested using atomic absorption spectrometry. Commercial PCR test systems (Research-and-Production Association “DNA-Technology”, Russia) were used to determine the genotypes of GST(GSTM1 and GSTT1). Results. Birth weight was found to be inversely correlated with urinary Cd and Pb levels in the puerperas and neonatal infants in both the absence of and the presence of GSTM1 and GSTT1 gene deletion (p < 0.0001) and in the presence of concomitant variants of the latter. The groups with lower and higher Cd and Pb levels showed no significant difference in neonatal body weight in relation to GSTM1 gene deletion whereas GSTT1 gene deletion was associated with a considerable decrease in the weight of infants who were more exposed to Cd and Pb. Conclusion. Prenatal exposure to Pb and Cd may have impact on a newborn baby’s weight in relation to the presence of GSTT1 gene deletion.

To paper gives the recent European Guidelines for the management of patients with small pelvic inflammatory diseases, which became available at the website of the International Union against Sexually Transmitted Infections in late 2012. Thus, these are today’s most recent guidelines on this topic, the basis for which are the principles of evidence-based medicine.

It is important to develop more effective methods for diagnosis and combination therapy, which are aimed at accelerating the processes of cervical epithelial regeneration and at preventing cancer of the cervix uteri (CCU) in the presence of human papillomavirus (HPV) infection. Objective: to study the therapeutic efficacy of the immunomodulator lavomax and depantol vaginal suppositories, which stimulate tissue epithelialization after damage, in order to improve management tactics for women with HPV-associated genital lesions and for those with the symptoms of cervicitis in the presence of cervical ectopy. Subjects and methods. The comparative randomized investigation enrolled 80 patients aged 18 to 50 years; their follow-up lasted 6 months. Clinical, laboratory, and instrumental findings and evaluated the efficiency and safety of treatment with above mentioned agents versus the conventional clinical tactics were analyzed. Results. Incorporation of lavomax and depantol into the combination therapy of papillomavirus-associated diseases of the cervix uteri in combination of destruction of the abnormal epithelium significantly exceeds therapeutic effectiveness versus monoablation. Depantol therapy for chronic cervicitis in the presence of ectopy and immature metaplasia significantly improves its clinical picture as evidenced by colposcopy, cytology, subjective complaints versus passive follow-up tactics. Conclusion. The traditional treatment regimens for patients with HPV-associated cervical diseases should include lavomax (7 days before cervical destruction: as a 125-mg tablet once daily in the first two days, after a one-day interval at the same dosage: a course dosage of 125-mg tablets once daily for 20 days, also after two weeks: one depantol suppository twice daily for 10 days. Women with chronic slowly progressive cervicitis in the presence of ectopy and an extensive transformation area with no signs of dysplasia should use depantol by the scheme: one suppository twice daily for 20 days.

The paper describes the role of iron and its metabolism in the body and the causes of iron deficiency states. It presents the clinical picture of iron deficiency anemia, its diagnostic criteria and treatment principles in patients with gynecological disease. The results of treatment with iron polymaltose complex (37 patients) versus ferrous sulfate (30 patients) are given. There is evidence for the high efficacy and safety of maltofer.