No 9 (2015)

Objective. To estimate the current attitude towards the impact of obesity on reproductive function from the data available in the literature. Subject and methods. Literature sources dedicated to estimates of the prevalence of obesity in different countries of the world, to the current view on the mechanism by which obesity affects fertility, and to approaches to treating obesity are reviewed. Results. The present-day literature data favor experts’ predictions that obesity rate will keep rising. The close relationship between obesity and reproductive dysfunction determines the relevance of the problem. Current drug therapy assists in achieving weight management goals, but does not completely rule out abnormal eating behaviors. Conclusion. Sibutramine havingpleiotropic effects is the drug of choice in controlling body weight. The drug can affect energy balance and correct eating behavior. These can expect a high therapeutic effect and patient compliance.

The review considers the role of microRNA in precancer and cancer of the cervix uteri (CCU). Today there are a lot of studies showing the increased or decreased expression of certain microRNAs in the body’s pathological processes, including in benign and malignant cell and tissue hyperplasias. Neoplastic transformation of normal tissues of the cervix uteri to cervical neoplasia of various grades and CCU is accompanied by a change in the expression profile of more than 50 microRNAs that control the processes of cell proliferation, apoptosis, invasion, migration, and local angiogenesis. Estimation of the expression level of individual microRNAs in the affected tissue can highly effectively differentiate the early stages of cervical neoplasia from normal tissue and cervical cancer from precancer states; quantification of microRNA in the cervical canal scrapes or blood can characterize disease severity, CCU progression to a metastasis stage, an aggressive disease course, and poor survival prognosis. The expression level of certain microRNAs may serve as a marker for the efficiency of disease therapy. That of microRNA allows evaluation of the efficacy of novel drugs in treating CCU; synthetic microRNA-based molecules open up new possibilities of targeted therapy for both precancers and cancers.

Objective. To define the diagnostic and prognostic value of the major morphometric parameters of the umbilical cord and placenta for full-term neonates. Subjects and methods. The investigation enrolled 123 full-term newborn infants. The length and diameter of the umbilical cord, the maximum and minimum diameters of the placenta, its weight and umbilical cord blood volume were measured immediately after delivery of the placenta. Results. The morphometric parameters of the umbilical cord and placenta during full-term pregnancy were found to show a rather wide range of values. One cm of the umbilical cord contained an average of 0.5 ml of blood and its amount sequestered in the entire umbilical cord averaged 29.97%, amounting to 9.52% of the neonatal circulating blood volume. The length of the umbilical cord was shown to be directly related to all major anthropometric parameters at birth: weight, height, head and chest circumferences. Its diameter was correlated with the specific features of the early neonatal period. Conclusion. The standards and values of placental and umbilical cord morphometric parameters were determined to predict the course of an early neonatal period. Calculating the amount of blood sequestered in the umbilical cord allows blood transfusion volume from the umbilical cord to a baby to be estimated immediately after birth.

Background. Different oocyte dysmorphisms in women are associated with the higher level of aneuploidy in the sex cells and hence with the increased risk of embryonic aneuploidy. Objective: to compare the clinical and economic efficiency of in vitro fertilization (IVF) with further prenatal genetic diagnosis and that of IVF with preimplantation genetic screening (IVF/PGS), by applying a fluorescence in situ hybridization (FISH) assay, to prevent the birth of babies with aneuploidies in couples with different types of dysmorphisms in women. Design. A decision-making analysis was used to compare IVF and IVF/PGS by a FISH assay to search for the cheapest and most effective procedure (the birth of a healthy = euploid baby). Subjects. Infertile couples with cytoplasmic dysmorphisms and extracytoplasmic oocyte dysmorphisms. Methods. IVF or IVF/PGS using a FISH assay. Primary endpoint. This is the cost of the birth of a healthy (euploid) newborn infant. Results. The application of a cost-probability estimation model indicated that the likelihood of the birth of a euploid baby in the infertile couples with extracytoplasmic oocyte dysmorphisms in women was 28 and 15% when treated with IVF and IVF/PGS using a FISH assay, respectively. In the infertile couples with cytoplasmic oocyte dysmorphisms in women, the likelihood of the birth of a euploid baby was 15 and 21% when treated with IVF and IVF/PGS, respectively. IVF/PGS would become a dominating strategy if the likelihood increased up to 26% versus a baseline likelihood of 21% and its costs decreased to 126,238rubles versus baseline 188,909 rubles. Conclusion. IVF is a more clinically and economically effective treatment for infertility in married couples with oocyte dysmorphisms in women. In couples with cytoplasmic dysmorphisms, IVF/PGS using a FISH assay may become more economically sound if the cost of PGS is lower.

Objective. To assess the diagnostic importance of HPV testing performed by RT-RCR, liquid-based cytology with the PAP test in HPV-associated cervical diseases in patients aged less than 30years or older. Subjects and methods. Cytological, biopsy, and cytological materials were examined in 91 patients, including 35 women aged less than 30 years and 56patients over 30 years of age. The methods of RT-PCR, liquid-based cytology, histology, andp16 INK4A/Ki-67immunohistochemistry were used. Results. The efficiency of detecting CIN2+ in the HPV DNA test in patients aged less than 30 years and in those older than 30 years of age was the following: a sensitivity of 81.8 and 90.5% and a specificity of 30.4 and 47.2%, respectively; that of the PAP test was as follows: a sensitivity of 45.5 and 71.4% and a specificity of 100.0 and 97.2%, respectively. Conclusion. Early diagnosis of HPV-associated diseases of the cervix uteri should be based on a set of the cytological technique and HPV DNA testing irrespective of age.

Objective. To improve high-frequency hysteroresectoscopic electrosurgical (300 kHz) coagulant ablation of the endometrium, by comparatively assessing the use of monopolar ablation in dielectric medium and that of bipolar technology in saline solution. Subjects and methods. The investigation enrolled 100 postmenopausal women aged 50 to 71 years with uterine bleeding who had repeatedly undergone separately diagnostic dilatation and curettage. Endometrial pathology in the presence of atrophy was a criterion for inclusion into study groups. All the patients underwent laboratory, clinical, and gynecological examinations using a package of special diagnostic measures (ultrasonography, diagnostic hysteroscopy, and separately diagnostic dilatation and curettage and then a morphological examination of the removed material). They were subdivided into 2 groups according to monopolar or bipolar electrosurgical endometrial destruction. With monopolar technology, 5% glucose solution was used as an expansion medium (Group 1, n=50). Bipolar technology and 0.9% NaCl as an expansion medium were employed in Group 2 (n=50). Out of them, 8% had a cardiac pacemaker and 8% had metallic prostheses in the small pelvis. The endometrium was ablated using a 26Fr rigid two-way (continuous-flow) hysteroresectoscope (Olympus, Japan) with changeable mono- and bipolar passive working elements and roll electrodes in a coagulation mode. Surgery was performed under intravenous anesthesia with diprivan orfentanyl. The investigators intraoperatively estimated the levels of potassium, sodium, chlorine, intravasation, blood loss, and gas formation and the duration of intervention. All the patients received 5-day antibiotic therapy. They underwent small pelvic ultrasonography on days 1 and 5 postsurgery. Results. Both study groups showed no differences in the level of intravasation. Comparison of the levels the blood electrolytes potassium, sodium, and chlorine revealed that their values were in the normal range and the difference in their pre- and postoperative values was statistically insignificant. Conclusion. Monopolar (in 5% glucose) and bipolar (in saline solution - 0.9% NaCl) endometrial ablations were comparatively analyzed in postmenopausal women. Unlike the monopolar technology, the bipolar technology required the high output of an electricity generator and endometrial destruction was accompanied by high gas formation within the uterine cavity.

Background. Physicians’ inadequate awareness of the safe induced-abortion technologies recommended by the WHO, no practical skills in first-trimester abortion by vacuum aspiration (VA), and administrative restrictions on the use of VA at less than 6 weeks of gestation are responsible for the application of outdated procedures (dilatation and curettage). Objective: to evaluate the impact of an education course on safe pregnancy termination on the introduction and quality of medical care to women; to comparatively assess two types of introducing VA into the practical activity of a healthcare facility: to conduct education courses and to use an administrative method (Ministry of Health of the Sverdlovsk Region Order No. 1229-п dated 29 October 2012). Subjects and methods. The investigation covered 24 obstetricians/gynecologists from 6 outpatient and inpatient facilities of Yekaterinburg and Sverdlovsk Region, half of whom had attended an education course on safe methods of abortion. The results were assessed determining the level of the physicians’ knowledge and the statistical indicators of the participating facilities. Results. In the inpatient facilities, the personnel of which had been trained, the rate of VA use was 23%, reaching 100%; and in those where the physicians had not, the rate was only 7.5%, reaching 85%. In the outpatient facilities, the rate of applying safe pregnancy termination technologies was 44.5% in both groups, reaching 100%. The physicians who had been trained started using VA 6 months earlier than those who had not. The educational course contributed to the better quality of medical care to women because of abortion, by considerably reducing the number of complications (by 20 times in the outpatient facilities and by 5 times in the inpatient facilities), hospital admissions for complications (by 5 times), and instrumental revisions of the uterine cavity. Conclusion. The administrative methods for introducing the up-to-date abortion techniques are insufficient to upgrade the quality of medical care to women with undesirable pregnancy and must be accompanied by the goal-oriented training of healthcare workers.

The most frequent sequela of obstetrical perineal traumas is the pelvic prolapse, a condition that highly affects the quality of life of women by causing sexual disorders and dysfunction of pelvic floor leading to the social disadaptation. Recently, an importance has been given to minimally invasive conservative interventions that facilitate the restoration and preservation of normal pelvic anatomy and allows the patients to come back to an active lifestyle. In this paper, we present one of the perspective minimally invasive methods of the perineovaginal lifting with the use of the special ribbed threads, which is a new solution in the treatment of genital prolapse and sexual disorders in women.

The paper gives the results of clinically using an algorithm for managing women with isthmicocervical insufficiency (ICI) complicated by amniotic sac prolapse into the cervical canal or the upper third of the vagina at 24-26 weeks’ gestation. After taking into account all contraindications, in 17 cases atosiban tocolysis and antibiotic therapy were initiated, after which surgical correction of ICI was made, by tucking the amniotic sac behind the internal cervical os. Atosiban tocolysis was continued for 48 hours; fetal respiratory distress syndrome was prevented. In 14 (82.4%) of the 17 cases, pregnancy ended in timely deliveries at 37-39 weeks’ gestation. In 3 cases, preterm delivery occurred at 29, 32, and 34 weeks; the babies underwent a cycle of treatment and rehabilitation. The use of atosiban in the combination treatment of complicated ICI at 24-26 weeks’ gestation may become one of the options to prevent very early preterm delivery.