№ 8 (2015)

Renal injury in preeclampsia (PE) remains an urgent problem in modern obstetrics and nephrology, which is due to its high prevalence (2-14% of all pregnancies) and outcome unpredictability. The pathogenesis of renal injury in PE, like a balance of pro- and antiangiogenic factors that are today considered to be one of the major pathogenetic mechanisms of PE, has not been practically investigated. The paper presents an update on the pathogenesis of renal injury in PE and shows the impact of a soluble fms-like tyrosine kinase-1/vascular endothelial growth factor system imbalance on the clinical manifestations of nephropathy in PE.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of ch ildbearing age, which affects 5-7% of the population and is associated with a broad spectrum of diseases: hypertension, dyslipidemia (DL), atherosclerosis, type 2 diabetes mellitus (T2DM), and gestational diabetes, increased risk of myocardial infarction, stroke, and higher cardiovascular and overall mortality rates. Inflammation, insulin resistance (IR), and hyperinsulinemia are permanent components of the pathogenesis of PCOS in obese women and in the majority of normal weight women due to the presence of a multitude of factors initiating systemic inflammation (SI) and IR. Metformin (MF) and pioglitasone (PG) are the only drugs that reduce SI and IR in different ways, which themselves used alone or in combination with hormonal agents make it possible to restore ovulation, fertility, and pregnancy carrying in 90% of the women, by minimizing the need for surgical intervention, as well as to prevent, stop, and ensure the regression of T2DM, dyslipidemia, non-alcoholic fatty liver disease, atherosclerosis, and hypertension. The administration of MF is completely safe and limited only by an individual’s intolerance that is mainly associated with gastrointestinal disorders. PG treatment requires monitoring the state of the bladder, eyeground, and bone mineral density due to rare changes in these organs and tissues.

Endometriosis is one of the rather common gynecological diseases and diagnosed in 10% of reproductive-aged women. The problem of endometriosis is assuming an increasing sociomedical importance, which is due to the severe clinical manifestations and recurrent course of the disease, which have a negative impact on quality of life and working ability in women. The review discusses the high rate and unpredictability of recurrences of deep infiltrating endometriosis after surgical treatment. Adequate postoperative drug therapy is important for the prevention of recurrent pelvic pain and endometriotic foci and can reduce poor health consequences for women when repeated and more radical surgical interventions are needed.

Uterine myoma is one of the most commonly diagnosed benign tumors among gynecological diseases. The optimal choice of a suture material favoring the formation of a qualitative uterine scar after nodular enucleation is one of the basic points during laparoscopic myomectomy. The objective of this paper is to review the data available in the literature on the application of different types of suture materials used in laparoscopic myomectomy.The literature data-based conclusion is that monofilament, absorbable, self-locking, nodeless suture materials are most effective.

Objective. To evaluate the efficiency of a noninvasive prenatal test in the identification of trisomies 21, 18, and 13 and sex chromosome aneuploidies in maternal blood samples. Patients and methods. Results of an analysis of fetal DNA in maternal blood were obtained in 2010 pregnant women. Preparation of samples involved PCR amplification, sequencing, and information analysis of the results of sequencing that could separate fetal and maternal genomic DNA. Results. SNP-based investigation of fetal extracellular DNA in the serum of a pregnant woman correctly identif ied all cases of autosomal trisomies 13, 18, and 21, Turner’s syndrome, Klmefelter’s syndrome, polyploidy and determined the sex of a fetus in all cases. In our investigation, the Panorama test for Down’s syndrome achieved a sensitivity of 100 at 0.05% false-positive rates. Conclusion. The noninvasive prenatal test is an exact method to detect fetal trisomies 21, 18, and 13 and sex chromosome aneuploidy and may be recommended as a highly effective prenatal screening test in pregnant women at 9 weeks’ gestation.

Objective. To evaluate the clinical symptoms of deep infiltrating endometriosis and its surgical treatment in women with this condition. Subjects and methods. Fifty-two patients with deep infiltrating endometriosis were followed up in 2010 to 2013 and allocated into groups according to their age: 1) 4 (4.7%) women of early reproductive age; 2) 33 (63.5%) women of middle reproductive age; 3) 11 (21.15%) women of late reproductive age; 4) 4 (7.7%) women aged 46 years or older. All the patients underwent clinical, laboratory, and instrumental examination involving ultrasonography, magnetic resonance imaging, colonoscopy with biopsy, as well as surgical treatment. The diagnosis was verified by histological examination. After testing for the normality of data distribution, Spearman’s rank correlation coefficient was calculated to determine a relationship (correlation) between the variables. The data were statistically processed using the freely distributed software product WINPEPI version 9.7 (Abramson J.H. WINPEPI (PEPI-for-Windows): computer programs for epidemiologists. Epidemiologic Perspectives & Innovations 2004, 1: 6), Statsoft Statistica 8.0.725, IBM SPSS Statistics 19.0 for Windows. Results. The volume of surgical treatment depended on the site and depth of injury. The investigators excised and coagulated endometriotic foci, resected the vaginal wall and ovaries, and carried out segmental bowel resection. After performing surgical treatment, pain syndrome and dyspareunia were absent in 14 (27%) and 8 (15.4%) patients and remained only in 8 (15.4%) and 2 (3.8%) patients, respectively. Reproductive function was recovered in 14 (27%) patients; 12 (23%) women reported to have persistent infertility. Twenty (38.5%) patients pointed to the recovery of their menstrual cycle; menstrual dysfunction persisted in 10 (19%). After surgical treatment, all the patients who had previously complained of dyschezia, cyclic intestinal bleeding, diarrhea, and abdominal distension pointed out that these symptoms were absent. Complaints of blood and mucus in the stool were retained in 1 (1.9%) woman. Those of hematuria and dysuria were absent after treatment for urinary tract endometriosis. Pregnancy occurred in 21 women; delivery took place in 12 women. The correlation analysis revealed a weak positive correlation (p = 0.35822) between the older age of patients and the volume of surgical intervention (sigmoid colon resection). Conclusion. Our findings have indicated that single treatment with its maximum volume improves the results of surgery.

Objective. To optimize the efficiency and safety of bacterial vaginosis (BV) therapy with combinations of metronidazole or ornidazole and a drug containing lactic acid and glycogen. Subjects and methods. An open-label multicenter randomized trial was conducted to study the efficiency and safety of vaginal ornidazole and its combination with lactagel versus oral metronidazole and its combination with lactagel. Four representative groups were made up from 142 reproductive-age patients (18-45 years old) included into the trial. These were: 1) oral metronidazole (n = 39); 2) vaginal ornidazole (n = 34); 3) oral metronidazole + vaginal lactagel (n = 35); 4) vaginal ornidazole + vaginal lactagel (n = 34). The investigators made objective gynecological examination, pH-metry, vaginal smear microscopy using the Nugent scoring system, key cell detection, an amino test (Amsel’s criteria), and PCR: florocenosis for diagnosing BV and AmpliSens-NCMT for detecting C. trachomatis, N. gonorrhoeae, M. genitalium, and T. vaginalis. The findings were statistically analyzed. Results. There were positive vaginal pH changes in all the groups, but they were signif icantly fewer in Groups 3 and 4. After a month of treatment completion, this indicator remained stable (<4.5) in the majority of women in Groups 2, 3, and 4 whereas Group 1 exhibited its increase >4.5. There was a similar tendency in the detection rate for key cells in the smears and in the amino test. By analyzing the eff iciency of treatment according Amsel’s criteria, the investigators could not reveal statistically significant differences (p = 0.544): 95, 94, 97, and 100% in Groups 1, 2, 3, and 4, respectively. At visit 2, the Nugent scores were significantly lower in Groups 3 and 4; a score of > 8 (BV) was seen only in Groups 1 and 2. The posttreatment Nugent scores were significantly lower in Groups 3 and 4. Prior to treatment, all the groups were matched for the levels of Gardnerella vaginalis detected at equally high concentrations (= 109 GE/ml) in all the patients. Following treatment, the concentration of G. vaginalis was decreased in all the groups, but it was significantly lower in groups 3 and 4 (p = 0.022). On the contrary, there was a consecutive rise in the number of lactobacilli during treatment. After treatment, the concentration of lactobacilli was significantly higher in Groups 3 and 4. In Groups 1 and 2, lactobacilli levels were also increased but to a lesser extent. Adverse reactions occurred in each group; however, they were not a reason for medication discontinuation in any of the cases or for exclusion of the patients from the trial. Conclusion. There is evidence that two-component treatment using metronidazole and ornidazole with lactic acid is more effective in treating BV than monotherapy with 5-nitroimidazole drugs.

Objective. To familiarize practitioners with diagnosis and treatment policy in patients with dissecting aortic aneurysm during pregnancy, labor, delivery, and the postpartum period. Subjects and methods. Two clinical cases of dissecting aortic aneurysm during pregnancy, labor, delivery, and the postpartum period were analyzed. Results. The paper analyzes 2 clinical cases of dissecting aortic aneurysm in the pregnant women and puerperas, one of which had a tragic end. It considers the urgency of the problem in pregnant women: its incidence is 0.6%; 4.5-6 and 20% of the cases are for Marfan syndrome and Loeys-Dierz syndrome, respectively. In urgent disease development, the survival rates are not greater than 9-13%. Follow-up prenatal visits according to the current order No. 572-н and clinical recommendations in the specialized health care facilities (HCF) will be able to prevent maternal mortality. Recommendations for diagnosis, management and treatment are given. Conclusion. The stages of examination and management of patients with cardiovascular diseases (in the context of connective tissue syndromes in this case), moreover, in the specialized HCF, guarantee successful management and prevention of fatal outcomes.

Objective. To improve the immediate and late results of treatment in patients with acute pyoinflammatory diseases. Subject and methods. The basis for the investigation was 16-year archival paper and electron data, surgery journals, case reports, clinical observations, and investigations of the urban emergency gynecological service in the 0.5-million city. Results. In the past 8 years, in addition to single exhaustive operations, 94 programmed endoscopic sanitizations of the small pelvis have been performed in 38 patients, from 2 to 6 sanitations made in each 24-36 hours later. Re-entry technology did not involve leaving the ports; an entrance was made through the earlier puncture sites. The best result was obtained by programmed relaparotomies for disseminated peritonitis. Conclusion. The novel approach improved not only the results of treatment for genital inflammatory processes, but also reproductive function.

The review deals with the state-of-the-art of vulvovaginal candidiasis. It gives data on the role of fungi of the Candida genus in biofilm formation, their substantial impact on the state of local anti-infection protective factors in non-pregnant and pregnant women. The issues of management tactics in patients with chronic recurrent vulvovaginal candidiasis are considered in accordance with basic orders and clinical guidelines.