No 1 (2015)

Objective. To reveal clinical and pathogenetic differences in early and late preeclampsia (PE), by comprehensively examining pregnant women with regard to the morphological and immunohistochemical characteristics of the placental bed. Subjects and methods. The investigation enrolled 150 patients aged 18 to 43 years, who were divided into 3 groups (pregnant women with early and late severe PE and controls). Placental bed tissues were morphologically and immunohistochemically examined. Results. The differences were found in the clinical picture, morphological and immunohistochemical features of the placental bed in early and late PE, which reinforced the heterogeneity of this multisystem disorder and defined various pathogenetic ways and different pregnancy outcomes in early and late PE. Conclusion. The data of this investigation lend support to the need and rationale for dividing PE into early and late forms because of different clinical and pathogenetic mechanisms of development, therefore different pregnancy outcomes for mother and fetus and for searching for the diagnostic markers of the disease and personified therapeutic approaches.

Objective. To compare the diagnostic value of peripheral blood lymphocyte phenotyping tests in women with recurrent miscarriage. Subjects and methods. The phenotype of lymphocytes was determined on 18-20 days of the menstrual cycle in 70 patients with recurrent miscarriage and in 15 fertile women. Results. The count of the cells with the CD4 +CD25 highCD127 low/-phenotype was significantly lower and that with the CD3 -CD8 +, CD56 +, CD3 +CD56,16 +, CD3 -CD56,16 +, SCD56,16 +, CD200 +phenotype and the ratio of cells with the CD200 + and CD4 +CD25 highCD127 low/-phenotypes were higher in the women with recurrent miscarriage. The sensitivity and specificity of the tests for these indicators were estimated. Conclusion. The tests for the relative and absolute counts of regulatory T cells (T reg) and the test for the ratio of the relative count of cells with the CD200 + phenotype and T reg have the best characteristics of diagnostic value: an equally high specificity (92.9%) and a high sensitivity (86.6, 83.3, and 90.9%, respectively). Further investigations are to study the value of these tests as markers for the efficiency of performed immunotherapy for recurrent miscarriage.

Objective. To evaluate the efficiency of a test system determining placental α-microglobulin-1 (PAMG-1) in the vaginal discharge as compared to the traditional techniques for the diagnosis of premature rupture of the membranes (PROM). Subjects and methods. One hundred and nine pregnant women with suspected PROM at 28-38 weeks’ gestation were examined. All the women underwent an Amnisure ROM test to determine PAMG-1 in the vaginal discharge and a set of traditional methods used to diagnose PROM (mirror examination, nitrazine pH test, and vaginal bacterioscopy to identify the arborization phenomenon). The final diagnosis was established on the basis of a follow-up of patients during pregnancy and labor. Results. The sensitivity of a rapid test based on the determination of PAMG-1 in the vaginal discharge was 96.5% versus 91.3% in a set of traditional methods (р = 0.1102); the specificity was 98% versus 84.3% (р = 0.0004); the accuracy was 97.2% versus 88.1% (p = 0.0124); the prognostic value of a positive result was 98.2% versus 86.8% (р = 0.0023), and that of a negative result was 96.2% versus 89.6% (р = 0.084), respectively. Conclusion. The f indings have given proof to the efficiency of the Amnisure ROM test versus a set of diagnostic techniques traditionally used in suspected PROM.

Subjects and methods. The investigation included 65 reproductive-aged patients with primary or secondary infertility and the thin endometrium that was untreatable by other therapies and unresponsive to hormonal stimulation conducted in cycles 3-4 months before the investigation. Study group patents (n = 35) underwent endometrial irrigation with the gas mixture (CO 2 and N 2) thrice on days 7, 9, and 11 of the menstrual cycle; control women (n = 30) did not. The gas mixture at 1.3 atmospheres in a volume of 5-6 cm 3 was administered using the transfer embryo catheters attached to a gas cylinder. Ultrasonography was performed on days 7, 9, 11, and 14 days of the menstrual cycle in the study group and on days 7 and 14 in the control group. Results. After administering the gas mixture thrice, there was a significant increase in the endometrial thickness in the study group as compared to the control one (mean endometrial thickness 9.18±1.23 and 5.98±0.66 mm, respectively; p < 0.05). In none case of gas mixture administration, the patients felt unpleasant sensations in the area of small pelvic organs and had adverse reactions. Conclusion. In women with the thin endometrium, the latter’s thickness can be substantially increased by gas mixture irrigation during one menstrual cycle. This procedure may be recommended to prepare the endometrium for further embryo transfers in patients with failed IVF attempts, whose cause was impaired implantation due to the thin endometrium.

Objective. To elaborate an algorithm for choosing the size of embolic material for uterine artery embolization (UAE) in patients with uterine myoma. Subjects and methods. The investigation included 63 patients. All the patients underwent bolus contrast-enhanced magnetic resonance imaging (MRI) and further estimation of the contrast medium in the myomatous nodules. According to the type of a kinetic curve for the contrast agent in relation to the intact myometrium, all myomatous nodules were classified into three types: I) a hypovascular nodule; II) a nodule with moderate vascularization; III) a hypervascular nodule. According to the size of the embolic material used, the patients were randomized into two groups of those who received calibrated polyvinyl microspheres 500-700 or 700-900 μm in size. In all the cases, bilateral UAE was performed through right-sided transfemoral approach, followed by MRI evaluation of the efficiency of the procedure. Results. All the patents underwent technically successful bilateral UAEs. Preoperative MRI assigned 188 (57%) of 330 detected myomatous nodules to type I, 73 (22.1%) to type II, and 69 (20.9%) to type III. The type distribution of myomatous nodules was 107, 33, and 41 in Group 1; and it was 81, 40, and 28 in Group 2. According to MRI data, the direct efficiency of UAE was 96.7 and 88.6% in Group 1 and 2, respectively. In accordance with the perfusion types (I, II, and III) of myomatous nodules, the efficiency of embolization was 99.1, 93.9, and 92.7% in Group 1 and 96.3, 95, and 57.1% in Group 2. In Groups 1 and 2, the severity of pain syndrome averaged 4.1±2.1 and 3.1±3.0 scores, respectively. In these groups, the need for narcotic analgesics in the first 24 hours postsurgery was 28.1 and 12.9%, respectively. The amount of spent embolic material averaged 7.8±1.9 and 5.4±2.8 ml in Groups 1 and 2, respectively. Conclusion. The calibrated spherical embolic material 700-900 μm in size versus that 500-700 μm in size showed a low efficacy in type III myomatous nodules. Embolic material with smaller embolic particles should be used in patents with type III (hypervascular) myomatous nodules found preoperatively by MRI. That with larger particles should be applied to patients without myomatous nodules to reduce the intensity of pain syndrome.

Objective. To develop methodological approaches to preventing human papillomavirus (HPV)-associated cervical precancer and cancer. Subjects and methods. The basis for the investigation was the results of treatment in 195 women infected with high-risk HPV genotypes, of whom there were 25 who were diagnosed with grade II dysplasia, 120 with grade III dysplasia, and 50 with cancer in situ. The terms grades II and III dysplasia accepted in the Russian literature, which the foreign literature denotes as CIN II-III, where CIN III encompasses grade III dysplasia and cancer in situ were used to characterize atypical changes in the cervical epithelium. A session of laser irradiation of the cervical canal was performed along its whole length, by applying a flexible quartz single-fiber light guide with a 3-cm-long cylindrical diffuser that gave a 360-degree light matrix. The vaginal portion of the cervix uteri was remotely irradiated using the light guide with a 1.-1.5-mm-diameter lens, which was perpendicularly brought to the organ. The investigators used a multipositional procedure for photodynamic exposure to a light spot from 1.5 to 1.5 cm in diameter when one-field irradiation was initiated from the mouth of the womb, by successively transferring the light spot along the entire surface of the cervix to overlap the neighboring fields by 0.3-0.4 cm and to capture intact tissues by 0.3-0.5 cm. Analysis of the immediate results of photodynamic therapy (PDT) with photosens (0.3 mg/kg, 24-hour exposure, a 100-J/cm 2 light dose) for grade II HPV-associated cervical dysplasia indicated that all clinical cases had been cured, regardless of the location of abnormal cervical epithelial changes. A complete regression of precancer was achieved in 92.5% of the women with grade III HPV-associated dysplasia who received PDT with photoheme (3.0 mg/kg, 72-hour exposure, a 150-J/cm 2-light dose) and photosens (0.3 mg/kg, 24-hour exposure, a 150-J/cm 2-light dose). The therapeutic effectiveness was found to be high in involvement of the exocervix (96.8%) and slightly beneath the exo-endocervix (90%). 200- and 250-J/cm 2 light doses were used in PDT with photoheme (3.0 mg/kg) and photosens (0.3 mg/kg) to treat cases of cancer in situ. A complete regression was achieved in 80.7% of the women; initial tumor changes were most commonly located in the exocervix (93.9%). Sporadic ineffective treatment cases were diagnosed predominantly when carcinoma in situ was present in the endocervix. Conclusion. Thus, PDT with the Russian agents photosens and photoheme is the minimal organ-sparing treatment for grades II and III HPV-associated dysplasia and precancer of the cervix uteri, which is similar to conventional therapies. The findings of the antiviral efficiency of PDT are of great interest in the context of the proven etiological role of HPV in the development of cervical cancer.

Objective. To study the expression of magnesium channels in the uterine scar after cesarean section in patients with undifferentiated connective tissue dysplasia (USTD). Subjects and methods. A study included 80 patients with uterine scar after cesarean section, who were divided into 2 groups: 1) 40 patients with USTD (a study group) and 2) 40 pregnant women without its signs (a comparison group). Clinical, general laboratory, ultrasound, morphological, and immunohistochemical studies were used. Results. Adequate uterine scars were represented by young connective tissue rich in various f ibroblastic elements located among the plethoric capillaries and small vessels. Inadequate uterine scars were characterized by atrophy and thinning with the formation of a fine fibrous film that covered a uterine wall defect. In the study group, the uterine scars exhibited a lower magnesium channel expression that resulted in increased matrix metalloproteinase (MMP) activity, which, with the reduced activity of tissue inhibitors of metalloproteinases (TIMP), led to enhanced extracellular matrix degradation. Having the normal expression of magnesium channels, the comparison group showed a balanced and unidirectional MMP-9 and TIMP-1 increase that led to more adequate reparations. Conclusion. The lower level of magnesium channels in the smooth muscle cells and fibroblasts is accompanied by the increased activity of MMPs that enhance degradation of collagen fibers, giving rise to connective tissue disorganization and hence an inadequate uterine scar in USTD.

Objective. To analyze maternal mortality and to provide the characteristics of women who have died from extragenital diseases (EGD). Subject and method. The 2010-2012 reporting schedules on maternal deaths from EGD were analyzed. The sociomedical and clinicoorganizational characteristics of maternal losses from EGD were given; and the rates in this group were also compared with those in the entire group of maternal deaths from other causes. Results. Circulatory system diseases (37.7%) rated first in the causes of maternal losses from EGD. There was a difference in the sociomedical characteristics of women who had died from EGD or other causes, except for bad habits that had been 1.5 times more common among those who had died from the former. Every three maternal deaths due to EGD occurred during pregnancy. More than half of the maternal deaths from EGD were recognized to be unavoidable. Conclusion. To solve the problem associated with the reduction of maternal losses from EGD, it is necessary to elaborate measures to improve the quality of an antenatal follow-up and to expand a multidisciplinary interaction.

Objective. To evaluate the efficacy of drotaverine (no-spa) in routine clinical practice for spasmodic abdominal pain caused by diseases of the gastrointestinal, biliary, and urinary tracts and dysmenorrhea. Subjects and methods. The M-ASAP trial is a multicenter, prospective crossover and long-term noninterventional registry-based study of the drug (3 visits), which was conducted in Mexico, Kazakhstan, and Russia. The study included a crossover (prescribed registration (PR)) phase and a prolonged (long-term registration (LREG)) one. Data on 25 consecutive patients with spasmodic abdominal pain who were eligible for the trial were documented in the PR phase and during a further observation 5 days (+3) later versus those on the first 5 consecutive eligible patients taking no-spa in the LREG phase. Pain was assessed using the numeric pain rating scale and the visual analog scale. Only spontaneous reports on adverse drug reactions were recorded. Results. The trial covered 208 physicians and 5507 patients. 75% of the patients received No-Spa®. The treatment was initiated mainly as monotherapy (72%). A total of 1116patients were included in the LREGphase (881 patients in the population in accordance with the protocol). Their mean age was 34.2±12.5 years; 86% were female. The majority (53%) of the women suffered from dysmenorrhea. They took no-spa for 5.7±4 days. 89% of the patients responded to the therapy. In the patients with dysmenorrhea, the results were statistically significant as compared to their first assessment (p < 0.0001). Conclusion. Examining the real practice of using no-spa showed that the latter rapidly relived pain in patients with spasmodic abdominal pain. The results permit the incorporation of drotaverine into national guidelines for the treatment of patients with dysmenorrhea to be recommended.