No 4 (2015)

Objective. To study the therapeutic and diagnostic tactics for the management of pregnant women, parturients, and puerperas who have died from the severe forms of preeclampsia, eclampsia, and their complications in Russia in 2013. Subjects and methods. Thirty-four blind copies of primary medical records (outpatient cards, pregnant woman’s cards, puerpera’s cards, labor histories, inpatient’s cards, postmortem examination protocols) for the 2013 maternal deaths from preeclampsia and eclampsia were retrospectively analyzed. Results. Maternal mortality from severe preeclampsia and eclampsia was more frequently associated with the development of multiple organ dysfunction, brain edema, acute disseminated intravascular coagulation and massive hemorrhage, septic complications, and extragenital comorbidities. The physicians’ most common errors continue to be underestimation of the severity of disease and untimely labor and delivery in the presence of atypical severe preeclampsia (critical hypertension (^ 180/120 mm Hg) occurred in 41.7% (95% CI 24.6-59.3) of the dead, generalized edema in 64.2% (95% CI 46.5-80.3), high-grade proteinuria in 45.8% (95% CI 29.8- 64.9). At the same time, terminology, classification, and a set of laboratory and functional studies used in the majority of obstetric facilities have not virtually changed in recent years. Maternal death was preventable and arbitrarily preventable in 85.3% (95% CI 68.9-95.0). Conclusion. To reduce maternal mortality from preeclampsia/eclampsia requires universal compliance with the unified current terminology, classification, diagnostic criteria, and severity evaluation, which are approved by the ICD-10, the procedures, standards, and protocols of the Ministry of Health of the Russian Federation, the Fifth Congress of Obstetricians/Gynecologists; introduction of evidence-based scientific advances into obstetric practice.

Objective. To reveal clinical and morphological parallels in early and late preeclampsia (PE), by comprehensively examining pregnant women with regard to the morphological and immunohistochemical characteristics of the placenta and placental bed. Subjects and methods. The investigation enrolled 150patients aged 18 to 43 years, who were divided into 3 groups (pregnant women with early and late severe PE and a control group). The tissues of the placental bed and placenta were also morphologically and immunohistochemically examined. Results. The differences were found in the clinical picture, morphological and immunohistochemical features of the placental bed and placenta in early and late PE, which reinforced the heterogeneity of this multisystem disorder and defined various pathogenetic ways of development 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 study the time course of changes in the percentage and absolute values of peripheral blood lymphocyte subpopulations, including the subpopulations of killer cells with different phenotypes, natural regulatory T cells, and CD200 molecule-expressing cells, in women with recurrent miscarriage of alloimmune genesis in the pregravid preparation using immunocytotherapy (ICT). Subjects and methods. Two weeks after immunization (on days 18-20 of the menstrual cycle), the phenotype of peripheral blood lymphocytes was determined in 52 non-pregnant women with a history of recurrent miscarriage and in 15 fertile women in the control group. Results. There were changes in the count of lymphocytes with killing function and the CD56+, CD3 -CD56,16+, CD56,16+, CD3+CD16+ phenotypes, as well as an increase in the absolute values of lymphocytes with the CD5+CD19+phenotype during two ICT cycles. No changes were found in the levels of the major subpopulations of lymphocytes (CD4+, CD8+, CD19+), CD200 molecule-expressing cells, and regulatory Tcells. Conclusion. Prospects for future research related to the study of the activation state of lymphocyte markers of different subpopulations.

Objective. To estimate the clinical signif icance of the expression prof ile of vaginal mucosal cells as a predictor of the outcome of an in vitro fertilization (IVF) program. Subjects and methods. The investigation enrolled 67patients with tuboperitoneal factor infertility. According to the outcomes of the IVF program, the patients were divided into two groups: 1) 30 women in whom biochemical pregnancy (implantation) had occurred; 2) 37 patients with a negative result. Biological material sampling (vaginal mucosal discharge scraping) was carried out on the day of embryo transfer into the uterine cavity. The expression of mRNA of 13 genes, including 6 cytokines (IL-1P, IL-8, IL-10, IL-18, TNF-a, and TGF-P1), 3 transcriptional markers (TBX21, GATA3, and RORC2), 2-toll-like receptors (TLR2, TLR4), and 2 immune system cell surface markers (CD45, CD68), was analyzed. Results. The patients in whom implantation had occurred were statistically significantly less often observed to have the expression profile corresponding to local inflammation (16.7% versus 43.2%). For successful implantation, the odds ratio was 0.26 (0.08-0.82; p = 0.02) in the presence of molecular genetic signs of local inflammation. Conclusion. The local inflammatory response is a poor prognostic criterion for implantation in the IVF program. Investigation of the expression profile of the cytokine genes in the vaginal mucosa is a promising area ofnoninvasive diagnosis and may be used to individualize patient management tactics in the IVF program.

The paper analyzes some aspects of the etiopathogenesis of preterm birth, which are associated with the inadequate biological effects of progesterone. It gives current evidence for the use of progestagens for pregravid preparation and pregnancy support and discusses criteria for choosing progestagens.

Older women are more often prone to menopausal urogenital disorders caused by estrogen deficiency. In postmenopausal women, urogenital disorders do not generally belong to infectious diseases. The basis for their pathogenesis is the reduced production of female sex hormones. Local administration of estriol as ovestin vaginal cream and suppositories is recognized to be one of the safest treatments. With the treatment cycle completed, switching to maintenance therapy is indicated. Thus, therapy with the local ovestin formulations is a highly effective method for the treatment and prevention of lower urogenital tract diseases caused by age-related estrogen deficiency.

The purpose of the study was to analyze the results of the International Symposium on Human Chlamydial Infection. Molecular biology and genomics, cell biology, diagnosis, immunology, and responses to chlamydial infection, as well as sexually transmitted infections were the major matters considered at the congress.

Objective. To preserve reproductive health in a patient with the rare ectopic pregnancy - cervical pregnancy (CP). Material and methods. The paper reports a CP patient managed with current organ-sparing treatment options: selective uterine artery embolization and hysteroresectoscopy. Results. A 27-year-old patient with the clinical diagnosis of CP underwent organ-sparing surgery using selective uterine artery embolization and hysteroresectoscopy. Conclusion. Selective uterine artery embolization, followed by egg removal under guidance of cervicoscopy and by implantation site electrocoagulation with a hysteroresectoscope, is one of the possible treatment options for early-stage CP. This treatment allows for egg retrieval with minimal blood loss and for reproduction function preservation.