No 2 (2015)

The literature review gives data on the history of the discovery of the Notch signaling pathway, its molecular structure, cell localization, and functions of its major components, as well as those on the canonical and noncanonical pathways of their interaction, by specifying the basic steps in activating the structural components of the pathway. Particular emphasis is placed on the specific features of Notch signaling pathway functioning in the human placenta during physiological pregnancy; the specific features of the temporary and spatial expression of receptors and ligands in the placental Notch system, as well as its role in the course of placentation are described. The functions of the Notch signaling system in the structures of villous and extravillous trophoblasts are detailed; data on its role in the processes of trophoblast invasion, proliferation, and differentiation, as well as placental vasculogenesis and angiogenesis are given. The specific features of Notch system functioning in some pregnancy complications, mainly in preeclampsia, are depicted and the possible mechanisms by which the components of this system are involved in the development of pregnancy complications are also given.

Objective. to study pregnant outcomes and delivery modes in relation to the degree of hypertensive disorders and gestational ages. Subjects and methods. One hundred and fifty women with hypertensive states caused by current pregnancy at above 20 week’s gestation (a study group) and 50 women with normal pregnancy without hypertensive disorders in the same gestational periods (a control group) were examined. The outcomes of pregnancy, the time and methods of delivery were studied in relation to the severity of hypertensive disorders. Pearson’s x 2test was used to assess the relationship between qualitative indicators. Results. In gestational hypertensive disorders, pregnancy ends in term, preterm, and immature births in 26.7, 54.7, and 18.6% of the examinees, respectively. Reproductive losses in hypertensive disorders are 22.7%. Hypertensive disorders are characterized by a high rate of operative deliveries (70.7%). Gestational age affects the rate of a delivery mode - operative deliveries prevail over vaginal ones before 34 weeks’ gestation; the reverse is observed after 34 weeks. The rate of cesarean delivery in hypertension depended on the degree of the disease and considerably increased (8.6-fold) in its severe forms. Conclusion. Pregnancy-induced hypertensive disorders every so often give rise to poor outcomes for both the mother and fetus. The treatment of this disease, its severe forms in particular, is ineffective. The only correct and effective way to overcome this problem is timely delivery and prevention of the severe forms of the disease.

Objective. To make a comparative analysis of the peripheral blood levels of free embryonic DNA (fe-DNA) in women with threatened recurrent miscarriage and healthy pregnant women at 6 to 22 weeks’ gestation. Subjects and methods. A prospective cohort study was conducted in 57 pregnant women, including 33 women with recurrent miscarriage and 24 with an uncompromised obstetric and gynecological history. Regardless of fetal gender, fe-DNA was determined by a real-time polymerase chain reaction assay at a 2-week interval. Results. The clinical manifestations of threatened and incipient abortion were found to be related to high fe-DNA levels without regard to a patient’s history. In the women with recurrent miscarriage and an uncomplicated course of the first half of pregnancy, the levels of fe-DNA were established to be significantly higher than those in healthy pregnant women, which may predispose to placenta-related gestational complications. Conclusion. This data should be further analyzed to clarify the role of these changes in the implementation of the later gestational complications and possibilities of their use in clinical practice.

Objective. To study the impaired expression of the proteins 0-6-methylguanine-DNA methyltransferase (MGMT) and ezrin in different forms of endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN), and low-grade endometrioid adenocarcinoma (EAC) in perimenopausal women. Subjects and methods. Thirty-five perimenopausal patients, including 12 with simple EH (SHE) without atypia (Group 1), 9 with complex EH (CEH) without atypia (Group 2), 5 with CEH with atypia (CEHA) (Group 3), 5 with EIN (Group 4), and 4 with low-grade EAC (Group 5), which were histologically and immunohistochemically verified using Ki67 and PTEN, were examined. Nine removed uteri and 22 endometrial scrapes were explored. The results of an immunohistochemical examination of ezrin expression and data on the level of MGMT protein expression in endometrial tissues were presented. Results. The level of MGMTprotein expression increases in SHE and CEH, peaks at the stages of CEHA and EIN, and decreases in EAC. The specific features of ezrin expression are associated with that, as the disease progresses from simple HE to EAC, there is a loss of its apical specific localization, as well as free cell cytoplasmic accumulation. Conclusion. The obtained results of clinicoanamnestic, diagnostic, and immunohistochemical studies in the above patient groups can substantiate a differentiated approach to choosing a treatment policy for patients with different forms of EH.

Objective. To establish the distribution of allelic variants of the immune response genes associated with a predisposition to vaginitis in reproductive-aged women. Subjects and methods. A polymerase chain reaction (PCR) assay was used to investigate 22 allelic variants of the immune response genes in 96 women with vaginitis. A comparison group consisted of 60 apparently healthy women without signs of genital tract inflammatory diseases. Peripheral blood samples were examined. Results. The distribution of 22 allelic alleles of the immune response genes was established in the apparently healthy women and in the patients with vaginitis. The allelic variants of TNF (rs361525) and TGFB1 (rs1800469) polymorphisms, which were associated with the development of vaginitis, were ascertained. Both allelic variants result in the decreased TNF and TGFB1 mRNA expression, they are more common in the population, which can also cause the high prevalence of this gynecological disease. Conclusion. There was a positive association of the C allele of the TGFB1-509 C>T locus (OR =1.8; CI: 1.12.9) and a negative association of the A allele of the TNF-238 G>A locus (OR = 0.21; CI: 0.07-0.68) with a predisposition to inflammatory diseases of the lower female genital tract.

Subjects and methods. The paper presents treatment results in 59 gynecological cancer patients, 24 of them were laparoscopically operated on. Results. During laparoscopy, no significant differences were found in the volume of removed tissues and in the number of lymph nodes, but blood loss and hospital stay length considerably reduced. Conclusion. The development and use of operative laparoscopy is a promising area in gynecological oncology; the technique may be used as a surgical stage for the treatment of cancers of the female reproductive system.

Objective. To study the impact of autoimmune thyroiditis (AIT) in pregnant women on their infants’ health indicators in the early neonatal period and within the first year of life. Subjects and methods. A group of 72 pregnant women with AIT was examined. The investigators studied pregnancy outcomes and their babies’ health indicators: anthropometric data, neonatality features, perinatal central nervous system (CNS) lesion, intrauterine infection and somatic diseases, the incidence of acute diseases during the first year of life, and thyroid ultrasound findings in infants aged 1 year. Results. The significant rate of hypotrophic intrauterine growth restriction (IUGR) was noted in full-term neonatal babies born to mothers with AIT, which correlated with antithyroid antibodies and the presence of hypothyroidism during pregnancy. There was a high prevalence of intrauterine infection among the babies of mothers with AIT. Comparison of groups of AIT patients who had undergone early and late iodine prevention established the higher rate of thyroid structural changes in the infants whose mothers had received late iodine prevention during pregnancy. Conclusion. AIT in pregnant women has no significant impact on the anthropometric parameters of neonates, the rate of perinatal CNS lesion and somatic diseases in babies when hypothyroidism is adequately corrected during pregnancy. The high level of maternal blood antithyroid antibodies is a risk factor for hypotrophic IUGR. The babies born to mothers with AIT are a group at high risk for intrauterine infection and belong to a category of frequently ill children. Inadequate iodine prevention in pregnant women with AIT negatively affects the thyroid in their children, which is shown by the heterogeneous echostructure and enhanced vascularization of the thyroid parenchyma at echographic study.

Objective. To assess the PartoSure test and cervicometry used to define the risk of preterm birth. Subjects and methods. A test for PAMG-1 and cervicometry were performed in 49 patients with threatened preterm birth. Time to delivery (TTD) intervals was estimated if labor occurred. Results. The test was positive (+) in 100% of cases if the cervical canal length (L) was 4 1.5 cm (6% of the patients); at the same time, preterm births occurred in 75% (TTD=18 and 44 hours). When L was 1.5 to 3 cm, the positive (+) test was seen in only 1 case (85%) (TTD=140 hours). The relationship between the results of the test and cervicometry, their diagnostic sensitivity, specificity, the prognostic value of positive and negative results were determined. Conclusion. The PartoSure test in conjunction with cervicometry is a technique to determine whether threatened preterm birth may be managed in an outpatient setting.

Objective. To analyze a case of uterine arteriovenous malformation, a rare abnormality of small pelvic organs, in a 29-year-oldprimiparous multigravida at 23-24 weeks’ gestation. Subjects and methods. A 29-year-old primiparous multigravida at 2324 weeks’ gestation diagnosed with cervical varices was examined at the Department of Ultrasound Diagnosis, Chelyabinsk Regional Perinatal Center. Ultrasonography was performed using a Voluson E6 apparatus (General Electric, USA) having transabdominal and transvaginal transducers with color Doppler flow mapping and pulsed wave Doppler. Results. Ultrasonography showed that the fetal size corresponded to a gestational age of 23-24 weeks; no fetal anomalies were detected; the placenta was located at the anterior uterine wall, failed to block the internal uterine mouth area, it was thickened up to 52 mm; there was expansion of intervillous spaces with slow blood circulation and subamniotic cysts of up to 37 mm, oligohydramnios, and small pelvic varices. The anterior wall of the uterus mainly in its lower third displayed myometrial varices of up to 10-12 mm and a cystic structural focus of up to 28 mm; local hypervascularization with mosaic staining; the parametrial veins were dilated up to 17 mm. The uterine cervix was enlarged, 94 x 90 x 95 mm in size, had a barrel-like shape with well-defined even contours, a heterogeneous wide-meshed structure with multiple anechogenic inclusions. Conclusion. Objectively, there were vascular changes: uniform cervical hypervascularization with the mosaic staining characteristic of turbulent blood flow. Pulsed wave Doppler revealed a high hyporesistant vascular blood flow velocity of up to 25-40 cm/sec, wh ich depended on the diameter of vessels; the resistance index was 0.42.