No 12 (2014)

Placental insufficiency (PI) as one of the major causes of perinatal morbidity and mortality is a relevant problem not only from a medical standpoint, but also from a social one, every baby born is of value not only to his family, but also to the state as a whole. The rate of PI is rather great and accounts for 20 to 45%, reaching 46- 77% in the risk groups, and would not tend to decrease. It is known now that PI has a multifactorial nature and it is a main cause of intrauterine hypoxia, growth retardation in a fetus, and its birth traumas. The review gives data on the role of genetic markers responsible for endothelial injuries and genetic forms of thrombophilia and shows a role of maternal and fetal thrombophilia in the development of PI.

To date, no one doubts that there is a need for pregravid preparation even in healthy young women. Nutrient deficiency that characterizes current nutrition may be a cause of the unfavorable course of pregnancy and poor perinatal outcomes. In addition, vitamin and trace element deficiencies can decrease fertility and give rise to infertility. But the composition of vitamin-mineral complexes may vary widely and the choice of one or another agent becomes a very urgent problem. Since many known biologically active substances are involved in impaired fertility, the pregravid preparation of infertile women must consider this factor and include the vitamins, micro- and microelements, the likelihood of whose deficiencies is highest, and the active ingredients that ensure nervous system adaptation, hormonal homeostasis, and optimal reproductive organ status prior to conception.

Lactic acid is the most important biological substrate in maintaining the optimum biological homeostasis of the vaginal microecosystem and femilex as vaginal suppositories containing 100 mg of lactic acid restores pH, promotes glycogen accumulation, and has microbicidal and immunomodulatory properties; the drug is used to treat hypo- and anacidic disorders in the vaginal environment.

The problem of birth control is particularly relevant in Russia where the level of induced abortion remains high, having a negative impact on women’s health. The prevalence of hormonal contraception is hampered by poor awareness about the potential benefit of hormonal agents among both women and physicians and by an inability to correctly choose among a broad range of contraceptives offered on the pharmaceutical market. Combined oral contraceptives are being continuously improved, but the emergence of new medications should not make the agents of previous generations be automatically discontinued. It should be remembered that progestins, the basis of hormonal contraception, are significantly different in the characteristics of partial effects and it is precisely these pharmacological features that determine the possibility of individually choosing a contraceptive. Gestodene-containing oral contraceptives show good tolerability and optimal menstrual cycle control, which allows them to be widely recommended as the first choice of drug in a wide female population.

Subjects and methods. One hundred patients and their newborn infants were examined. Group 1 (a study group) consisted of 65 pregnant women with urogenital infection (UGI), including 24 with preterm birth (PB) and intrauterine infection (IUI) (Subgroup 1a), 15 with PB without IUI (Subgroup 1b), and 26 with term birth (Subgroup 1c). Group 2 (a control group) comprised 20 patients without IGI in whom pregnancy resulted in term birth. Group 3 (a comparison group) included 15 non-pregnant women. Cytokine gene expression in the peripheral cell mononuclear cells was determined using reverse-transcription polymerase chain reaction. A biological method was used to determine the elaboration of interferons (IFN) and the sensitivity of peripheral blood leukocytes (PBL) to IFN preparations. A patient was considered to be susceptible to IFN-α and IFN-γ if her PBLs responded by producing the higher levels of IFN during priming with at least one of the interferons. Results. The capacity to induce IFN-α production in the cultured leukocytes of pregnant women with PB was higher than that in healthy pregnant women (35.5±11.6 U/ml versus 25.5±5.4 U/ml). That to produce IFN-γ in the pregnant women with PB was, on the contrary, diminished (5.1±2.4 U/ml and 14.9±1.6 U/ml, respectively; р < 0.05). In pregnant women who gave birth prematurely, the ratio of induced IFN-α/IFN-γ production averaged 9.7±3.2 versus 3.2±1.4 in those who gave birth at term (p < 0.05). The induced IFN-α/IFN-γ production ratio more than 5 may be a prognostic factor for PB and fetal IUI. The positive prognostic value of this factor is 69%; its negative prognostic value is 85.7%; the sensitivity and specificity are 90 and 60%, respectively. In the pregnant women with PB, the high gene expression of IFN-α (82.3%) matches with its high elaboration in the cultured leukocytes (35.5±11.6 U/ml); however, with the high gene expression of IFN-γ (91.0%), its production is lowered (5.1±2.4 U/ml), suggesting impaired IFN-γ synthesis. PBLs in pregnant women with PB of infection genesis were noted to be highly sensitive to IFN preparations: Roferon A (82.0%) and Intron A (82.0%); in this case the sensitivity of cultured leukocytes to Gammaferon was found only in 20.5% of cases (p < 0.05). Conclusion. The risk factors of PB and fetal and neonatal IUI are UGI during pregnancy concurrent with chronic inflammatory diseases of small pelvic organs or chronic extragenital diseases. In the pregnant women with PB and high gene expression levels of IFN-γ, its production is lowered in the cultured leukocytes, which suggests impaired IFN-γ production at the post-transcriptional level. The induced PBL IFN-α/IFN-γ production ratio by 5 or more times allows PB to be predicted with a high degree of accuracy. The highest susceptibility (82.0%) to IFN-α preparations (Roferon A, Intron A) is shown by the leukocytes from pregnant women in the UGI and PB group, i.e. with the most pronounced changes in the interferon status.

Objective. To examine the maternal placental cytotrophoblast layer and to reveal the contractile capacities of its cells. Subjects and methods. Seven placentas from 25-30-year-old women with uncomplicated pregnancy and labor were examined. Fluorescent immunohistochemical staining of the maternal placenta was carried out. Anticytokeratin 7 and anti-alpha smooth muscle actin antibodies were used. Results. The apical surface of the placenta was shown to be covered with the myofibroblast network limiting the cytotrophoblast layer. Conclusion. The competence and activity of the myofibroblast network located in the apical portion of the cytotrophoblast layer can determine the normal separation of the placenta from the uterus during labor.

The paper considers the concept of treatment adherence and compliance in patients with papillomavirus infection. Using the performed two-step study as an example, the author demonstrates the possibilities to enhance the efficiency of the performed therapy, by incorporating a motivational component as a stimulator for the adherence of patients’ to treatment regimen.

The symptoms similar in the manifestations of climacteric syndrome may be observed in patients over 30 years of age. It is relevant to study prolactin levels at any age if there are hot flashes or night sweats. The choice of drugs for the treatment of climacteric disorders depends on the pathogenetic form of climacteric syndrome.

The correct choice of an effective and safe contraceptive in a cohort of overweight women should be based on the understanding of the mechanism of overweight and the effects of a hormonal contraceptive on the key components of eating behavior and lipogenesis.

According to the data available in the literature on benign tumors resembling typical leiomyomas with their atypical location and aggressive growth are a diagnostic dilemma and though have common structural features when different imaging techniques are used. The paper presents two clinical cases of disseminated peritoneal leiomyomatosis in the patients who were operated on at the Department of Surgery, V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation. When disseminated peritoneal leiomyomatosis is suspected, surgical policy should be assessed at the individual level, by taking into account a patient’s wish to preserve her reproductive function and by considering the severity of the disease.