No 7 (2015)

The paper gives the present-day views on labor management tactics in patients with a uterine scar after cesarean section. It analyzes the frequency of maternal and perinatal complications in relation to the choice of delivery mode. It discusses criteria for the choice of delivery methods in patients with a uterine scar after cesarean section and the perspectives for further study areas.

The review gives the data of international studies of brain structures by neurosonography (NSG) in very preterm infants. It lends support to the importance of its use in this category of babies as a noninvasive high-tech technique that allows the differential diagnosis of different brain abnormalities just in the first days of life, by predicting further neurological development. The authors point out that there is a need to introduce 3D/4D HSG for the evaluation of postnatal neuroontogenesis in very preterm neonates in order to qualitatively monitor the therapy performed during resuscitation.

Persistent infertility is a leading complaint in women with premature ovarian failure (POF) after disease manifestation. This paper analyzes 3 systematic reviews that discuss different therapeutic approaches applied to this category of patients, as well as an innovative technique to overcome infertility in patients with POF. The current concept of timely and premature ovarian aging provides a new possibility for developing effective and safe treatments for infertility in this category of patients.

Objective. To evaluate the efficacy of carbetocin for the prevention of postpartum bleeding (PPB) during spontaneous labor. Subjects and methods. In July 2013 to September 2014, the obstetric hospitals of the Mother and Baby Perinatal Medical Center administered carbetocin to 229 high-risk parturients for the prevention of PPB during spontaneous labor. A comparison group included 200 patients who had taken oxytocin for this purpose. The indication for the use of the above drugs was the presence of at least one risk factor for hemorrhage. The parturients in both groups were matched for age, parity, and weight and height characteristics. All the pregnancies were singleton; the gestation age was more than 36 weeks. Results. The proportion of patients with physiological blood loss was higher in Group 1 [n = 215 (93.3%)] than in Group 2 [n = 181 (90.5%)]; the average amount of blood lost in these patients was 344.6±79.5 and 363.6±72.3 ml, respectively. In 12 (5.2%) patients in the study group and in 16 (8.0%) in the control group, the volume of blood loss was more than 0.5% of body weight (not more than 1 liter), averaging 678.8±106.5 and 695.3±127.5 ml in Groups 1 and 2, respectively. Early PPB occurred an average of 25±13 minutes after placental removal and required external uterine massage and administration of an additional oxytocin dose during 2-3 hours in all the patients with hemorrhage, as well as manual uterine examination and external and internal uterine compression with a fist in 12 (5.2%) patients in the study group and in 16 (8.0%) parturients in Group 2. A blood loss of more than 1 liter occurred in 2 (0.9%)parturients in Group 1 (a blood loss of 1000 and 1200 ml) in 3 (1.5%) in Group 2 (a blood loss of 1100 to 1500 ml). Analysis of adverse reactions to carbetocin and oxytocin revealed that the proportion of the above complications was higher in the parturients receiving oxytocin [n = 44 (22.0%)]. The adverse reactions of carbetocin occurred in 40 (17.0%) patients. Conclusion. The investigation has shown the high efficacy of both carbetocin and oxytocin for the prevention of obstetric hemorrhage in high-risk patients. The distinctive feature of carbetocin is the rapidity and prolongation of its action after single administration.

Subjects and methods. A randomized controlled clinical trial was conducted in 207 patients with tuboperitoneal, male, or mixed factor infertility. Ovarian function was stimulated according to a fixed-dose GnRH antagonists (GnRH-ant) protocol using recombinant follicle-stimulating gonadotropins. According to a LP support regimen in the stimulated cycle, the patients were divided into 2 groups: 1) 92 patients received micronized progesterone (P) in a dose of 600 mg/day on day 1 after transvaginal puncture (TVP) of ovaries and triptorelin in a single subcutaneous dose of 0.1 mg on day 6 after fertilization; 2) 115 had micronized P only in a dose of 600 mg/day on day 1 after TVP. Dynamic monitoring of the levels of Е2, Р, luteinizing hormone (LH), and chorionic gonadotropin β-subunit (CG-β) was made on days 5, 7, and 15 after fertilization. The rate of biochemical pregnancy, implantation, clinical pregnancy, and progressive pregnancy was estimated as criteria for the efficiency of the IVF program. Results. Analysis of the results of hormonal monitoring on day 5 following fertilization revealed no significant difference between the groups in LH, P, and E2 concentrations (p > 0.05). In patents with pregnancy, the concentrations of CG-β were not statistically significantly different on days 5 and 7 after fertilization in both examined groups (p = 0.66) and p = 0.763). On day 7 following fertilization, those of E2 (median 5126 and 3501 pmol/l; p = 0,002, Р (median 335 and 170 nmol/l; р = 0.0001), and LH (median 13.9 and 0.1 IU/l; р = 0.0001) were substantially higher in Group 1. On day 15 after fertilization, the concentrations of LH (median 0.3 and 0.1 IU/l; р = 0.003) and Р (median 206 and 108 nmol/l; р = 0.043) were also significantly higher in Group 1. On the same day following fertilization, in the patients with pregnancy showed higher level of CG-β in the GnRH-a group than that in the control group (p = 0.0001). On day 15 after fertilization, the patients with single and double pregnancy had also much higher CG-β concentrations in Group 1 (p < 0.05). In the latter group, the rate of biochemical pregnancy, implantation, and clinical pregnancy was significantly higher than that in the control group (51.1 and 34.8%; р = 0.018), (30.6 and 16.6%; р < 0.05), and (40.2 and 27%; р = 0.044). That of progressive pregnancy was higher in the GnRH-a group (37 and 21%), but the difference was not statistically significant (p = 0.349). No significant group difference was found in abortion rates (8.1 and 22.5%; p = 0.309). The rate of multiple pregnancy was also significantly higher in the GnRH-a group (35.1 and 12.9%;p = 0.049). Conclusion. The use of GnRH-a for LP support has a favorable impact on the clinical outcomes of IVF programs in the GnRH-ant protocols.

The paper deals with the legal consequences of pregnancy and delivery in minors the practicing obstetricians/ gynecologists face when working with this challenging category of patients. It describes the key elements of the Russian Federation’s legislation in relation to the issues of termination of pregnancy, a follow-up during pregnancy, delivery, and typical situations occurring postpartum (child abandonment at maternity hospital, adoption, deprivation of parental rights) while working with under-aged women.

The transportability of a premature neonatal infant is determined using the Clinical Assessment Seale for Premature Infants (Patent No. 2318444). Transportation to a high-level care hospital is possible only when the baby’ general condition is not more than 8 scores. The total score of 9 to 14 scores is a contraindication to transportation because the latter can lead to death. To improve the outcome of disease, it is advisable to continue the treatment of the infant at home until his/her health assessment is not greater than 8 scores.

The paper provides a clinical appraisal of the data of the U.S. Woman’s Health Initiative (WHI) study that has played a negative role in the fate of hormone replacement therapy (HRT). More than 10 years of intensive analysis, reanalysis of the data of the WHI and new randomized clinical trials have elapsed. This could create concepts of the role of a temporal factor in the use and efficiency of HRT and confirm the notion of its exposure window. The findings are a guide to create a global consensus on menopausal hormone therapy with the participation of 6 leading medical associations. The paper gives the main points of the consensus and their interpretation.

In the past decades, the number of patients with cervix uteri cancer has increased in geometric progression worldwide. The WHO confirms this and sounds the alarm - this abnormality has recently begun affecting young women of the earliest reproductive age. This information makes the medical community look more intently at this problem and search for new ways of improving treatment. A study of the pathogenetic role of human papillomavirus (HPV) in the occurrence of this disease, early diagnosis, current treatment options, and prevention absolutely yield certain results - five-year survival rates have reached a rather high level. But unfortunately there is a category of patients whom we cannot help. To update a program for population screening and that for vaccination of HPV-infected women are herewith promising areas.

A malformation of the lymphatic system underlies the development of lymphangioma, a benign tumor composed of dilated lymph vessels. The most common location is the mucosa of the mouth and tongue and the skin of the hands and trunk. Vulvar lymphangioma occurs rather rarely. The paper describes a clinical case of cystic lymphangioma of the vulva, which was primarily diagnosed as herpesvirus and papillomavirus infection. The early diagnosis of anogenital skin neoplasms allows timely and the most effective therapy to be performed.