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No 12 (2015)

Articles

ROLE OF GENE IMPRINTING IN INTRAUTERINE GROWTH RESTRICTION

Degtyareva E.I., Grigoryan O.R., Volevodz N.N., Andreeva E.N., Klimenchenko N.I., Melnichenko G.A., Dedov I.I., Sukhikh G.T.

Abstract

Objective. To analyze the data available in the literature on the impact of epigenetic changes in particular genome imprinting that is of great importance in the development and function of the placenta and in the regulation of fetal growth and development. Subject and methods. The data published in the past 30 years on the impact of epigenetic changes on the regulation of fetal growth were sought in NSBI Pub Med. Results. The paper describes the imprinting mechanisms of genes, the distinctive feature of which is their expression only of one allele; it may be both paternally and maternally inherited. Conclusion. The mechanism of expression can supposedly control the stream of nutrients from mother to fetus, both increasing and decreasing it. This dysregulation may give rise to fetal malformations. Animal testing of reproductive technologies have shown that the changes in the epigenome of an embryo at its early development stage result in imprinting, which may both provoke and constrain intrauterine growth restriction.
Obstetrics and Gynecology. 2015;(12):5-10
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PATHOGENETIC ASPECTS OF PREECLAMPSIA

Boris D.A., Kan N.E., Tyutyunnik V.L., Khovkhaeva P.A.

Abstract

Objective. To provide an update on pathogenetic mechanisms for the development of preeclampsia. Material and methods. Literature sources published in the Medline, Pubmed, and other databases were sought. A total of 277 sources on the study of the pathogenesis of preeclampsia at the ultrastructural level were found; 49 of them were included in this review. Results. The preclinical phase of preeclampsia is associated with immunological, molecular, and epigenetic disorders causing structural and functional changes at the cellular and subcellular levels. The study of the problem at the ultrastructural level will be able to diagnose the pathological process at an early stage, to effectively perform prophylaxis, and to reduce maternal and perinatal morbidity rates associated with preeclampsia. Conclusion. The early diagnosis of preeclampsia has not been fully studied. There is a need for further investigation in this area.
Obstetrics and Gynecology. 2015;(12):11-15
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RHESUS SENSITIZATION, HEMOLYTIC DISEASE OF THE FETUS AND NEWBORN: CURRENT TRENDS AND PROSPECTS

Ozhereleva M.A., Kravchenko E.N., Kuklina L.V.

Abstract

Objective. To analyze current available data in the foreign and Russian literature on the epidemiology, diagnosis, treatment, and prevention of hemolytic disease of the fetus and newborn with rhesus immunization, as well as the guidelines of the British Committee for Standards in Haematology and to define main approaches to managing rhesus-immunized pregnant women in the Russian Federation and to treating fetal hemolytic disease. Subject and methods. The review includes the past decade data of foreign and Russian authors, which have been found in Pubmed and eLIBRARY on this topic. Results. The paper presents current approaches to diagnosing and treating fetal hemolytic disease and to managing rhesus-immunized pregnant women; a need for preventive measures with regard to the volume of fetomaternal hemorrhage. It notes that there can be preimplantation genetic diagnosis of a blastomere prior to an vitro fertilization procedure, as well as a RHC/c, RHE/e, KEL, Ph(D) genotyping procedure in the fetus. Conclusion. The issues of etiopathogenetic therapy for hemolytic disease of the fetus and newborn remain fully unexplored. A differential approach to implementing preventive measures (in a planned order and potentially sensitizing events) in terms of fetomaternal hemorrhage volume is stated.
Obstetrics and Gynecology. 2015;(12):16-20
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PROSPECTS FOR STUDYING CUMULUS CELL MARKERS TO ASSESS THE QUALITY OF OOCYTES AND EMBRYOS IN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS

Safronova N.A., Kalinina E.A., Donnikov A.E., Bourmenskaya O.V., Makarova N.P., Kulakova E.V., Alieva K.U.

Abstract

Objective. To make a systematic analysis of the data available in the modern literature on the role of cumulus cells in the physiology of the female reproductive system, on the impact of cumulus cell gene expression on embryological characteristics and results of in vitro fertilization (IVF) programs in order to identify biomarkers for the assessment of the quality of oocytes and developing embryos in the assisted reproductive technology technologies programs. Subject and methods. The review includes the past decade data of foreign and Russian articles found in Pubmed on this topic. Results. Recent studies prove that the expression of potentially significant genes in the cumulus cells correlates with the indicators of oocyte quality, the development of embryos, the rate of conception, and the birth of live children. The paper gives the data of the study of the cumulus cell genes that the latter correlate to the possible identification with chromosomal abnormalities by preimplantation genetic diagnosis. Conclusion. The results of the performed investigations confirm the prospects for studying the profile of cumulus cell gene expression, which will be able to more precisely choose embryos to be transferred and, in doing so, to enhance the effectiveness of IVF programs as a whole. Assessment of cumulus cell transcriptome may become a new alternative noninvasive method for diagnosing fetal chromosomal abnormalities.
Obstetrics and Gynecology. 2015;(12):21-25
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ROLE OF WEIGHT LOSS IN THE TREATMENT OF REPRODUCTIVE DISORDERS IN WOMEN

Kuznetsova I.V., Uspenskaya Y.B., Vedzizheva E.R., Vasilyeva I.V.

Abstract

Objective. To analyze current scientific data on the impact of adipose tissue on female reproductive function in obesity. Subject and methods. Scientific sources dealing with the pathogenesis of metabolic disorders associated with obesity and the role of overweight in the development of menstrual and reproductive dysfunctions were reviewed. Results. The current scientific sources describe the theoretical and clinical aspects confirming the relationship between adipose tissue metabolism and hormonal disorders. Anti-obesity medication is shown to be needed in women at the pregnancy preparation stage. Conclusion. Prior to therapy directly aimed at achieving pregnancy, it is absolutely necessary to correct weight and metabolic parameters. The co-use of sibutramine and metformin to treat obesity and to reduce insulin resistance can enhance the efficiency of therapy aimed at recovering reproductive function.
Obstetrics and Gynecology. 2015;(12):26-30
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ENHANCING THE EFFICIENCY OF TREATMENT IN WOMEN WITH REPRODUCTIVE DYSFUNCTION IN THE USE OF DEAD SEA MEDICINAL MUDS UNDER EXTRA-RESORT CONDITIONS

Dikke G.B.

Abstract

Objective. To analyze the Russian investigations conducted in the past 5 years among women with reproduction dysfunction, whose restorative treatment and rehabilitation incorporating Dead Sea medicinal muds (DSMM) and to evaluate their clinical efficacy, therapeutic effects, and mechanisms of action. Subject and methods. Eight clinical trials meeting the preset criteria were selected for analysis. There were a total of 826 cases, including 455 patients who had been treated with DSMM, 237 patients received another treatment (a comparison group), 60 took placebo (a control group); 74 untreated patients (a control group). Results. Spontaneous pregnancy could be achieved in 40-60% of the patients with tuboperitoneal infertility concurrent with other conditions (chronic endometritis, luteal phase deficiency, post-reconstructive-plastic conditions), which was 4 times more than those who had received or rejected another physiotherapeutic treatment. Better IVF success rates were noted in 20-40% of the DSMM-treated patients. Conclusion. By taking into account the results and limitations of the analyzed trials, it can be with high probability argued that DSMM used in the restorative treatment and rehabilitation programs for women with reproductive dysfunction is effective and helps overcome infertility and improve IVF outcomes. However, there is a need for additional randomized clinical trials with sufficient number of cases.
Obstetrics and Gynecology. 2015;(12):31-38
pages 31-38 views

CURRENT TREATMENTS IN PATIENTS WITH CHRONIC ENDOMETRITIS

Gombolevskaya N.A., Marchenko L.A., Muraveva V.V.

Abstract

Objective. To study the efficiency of current treatments in patients with chronic endometritis (CE). Subject and methods. The currently available publications on current methods for the diagnosis and treatment of patients with CE were reviewed. Results. The opinion that it is expedient to perform two-stage combination therapy for CE has formed now. In the view of some specialists, the empirical use of antibacterial agents is justified; however, a number of authors believe that the species and quantitative composition of microorganisms detectable in the endometrial biopsy specimens should be kept in mind when prescribing the agents. Conclusion. Most modern-day investigations demonstrating different treatments for CE and analyzing the efficiency of its therapy are aimed at alleviating the clinical symptoms of the disease and at normalizing the endometrial ultrasound pattern. However, the latter should be examined pre- and postoperatively in order to adequately assess the therapy performed. The efficiency of etiotropic therapy for CE is largely determined by the accurate identification of its pathogen in the uterine mucosal biopsy specimens. Despite the great variety of proposed therapy options for CE, its treatment involves considerable methodic and practical problems. By taking into account the components of the pathogenesis of CE and new diagnostic possibilities, there must be a further search for innovative comprehensive approaches to treating CE.
Obstetrics and Gynecology. 2015;(12):39-45
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PROLACTIN AND THE BREAST: NEW DATA OF RANDOMIZED TRIALS

Podzolkova N.M., Sumyatina L.V., Mokhova Y.A.

Abstract

Objective. To make a systemic analysis of the data available in the current literature on the synthesis of prolactin, its mechanism of action and its effect on the risk of breast cancer. Subject and methods. The review includes the data of foreign and Russia articles that were found in Pubmed on th is topic and published manly in the past 10 years. Results. The prolactin level increase up to more than 8.3 ng/ml less than 10 years before the identification of neoplasias was shown to correlate with the development of invasive estrogen-receptor-positive (ER+) breast cancer. Conclusion. There is a need for further studies to assess the risk of breast cancer in the presence of higher prolactin concentrations. Acting on prolactin and its signaling pathways may be considered as a promising way to treat and possibly to prevent breast cancer.
Obstetrics and Gynecology. 2015;(12):46-50
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IMPAIRED IMMUNE MECHANISMS DUE TO PERINATAL STRESS: EXPERIMENTAL AND CLINICAL FINDINGS

Khudaverdyan A.D., Torgomyan A.L., Khudaverdyan D.N.

Abstract

The stress reaction becomes a nonspecific cause of many pathological conditions in which the impaired immune protection mechanisms are of fundamental importance. Objective. To analyze the data available in the literature on studies of immune disorders due to the prenatal stress experienced.ц Subject and methods. The key words, such stress, glucocorticoids, immunity, adrenals, were used to search for data in international and Russian databases. A total of 39 sources on suitable themes were selected. Results. The mechanisms of adaptive responses are interlinked in a complex manner and may be multidirectional with the possibility of changing from protective to destructive ones. They become a basis for the development of pathological processes that depend on the number, intensity, and duration of stress factors and on the specific features of the body and its predisposition to different pathological processes. Conclusion. Impaired immune protection mechanisms are of prime importance in the development of these complications.
Obstetrics and Gynecology. 2015;(12):51-56
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CLINICAL FEATURES OF PREGNANCY COURSE AND OUTCOMES IN WOMEN WITH OBESITY AND EXCESSIVE WEIGHT GAIN DURING PREGNANCY

Timoshina I.V., Komissarova L.M., Timofeyeva L.A., Ilyasova N.A., Burlev V.A., Khodjaeva Z.S.

Abstract

Objective. To show the impact of excessive weight gain (WG) on the course of pregnancy, labor, and postpartum period in normal-weight, overweight, and obese patients. Subject and methods. The investigation enrolled 170 patients: Group 1 included 46 women with normal weight and overweight (body mass index (BMI) 18.5-29.9 kg/m 2) and normal WG (11.5-16 kgfor normal weight; 7.0-11.5 kg for overweight) during pregnancy; Group 2 consisted of 52 women with a BMI of 18.5-29.9 kg/m 2 and excessive WG (>16 kg for normal weight and >11.5 kg for overweight) during pregnancy; Group 3 comprised 30 patients with pre-pregnancy obesity (BMI > 30 kg/m 2) and normal WG (from 5 to 9 kg) during pregnancy; Group 4 included 42 pregnant women with obesity (BMI >30 kg/m 2) and excessive WG (>9 kg). Results. Pregnancy in the women who are obese is much more often complicated by gestational diabetes mellitus than in those with normal-weight and overweight and the concurrence of obesity and excessive WG substantially increases the risk of moderate preeclampsia and the birth of a big baby. The postpartum period in the obese patients is more frequently accompanied by complications; among which endometritis and disseminated intravascular coagulation are most common. Lactation disorders most commonly accompany the postpartum period in the group of obese and overweight pregnant women. Conclusion. Obese pregnant women belong to a group at high risk for pregnancy, labor, and postpartum complications. The incidence and magnitude of the complications depends not only on the baseline obesity, but also on excessive pregnancy WG. In pregnant women with baseline normal weight or overweight and excessive WG, the complications of pregnancy, labor, and postpartum occur significantly more rarely than in those with baseline obesity and excessive WG.
Obstetrics and Gynecology. 2015;(12):57-63
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ASSOCIATION OF CTLA-4 AND PTPN-22 GENE POLYMORPHISMS WITH THE DEVELOPMENT OF HYPOTHYROIDISM IN RUSSIAN PREGNANT WOMEN

Faizullin L.Z., Klimenchenko N.I., Fedorova E.V., Karnauhov V.N., Kolodko V.G., Trofimov D.Y.

Abstract

Objective. To study an association of polymorphisms in the immunoregulatory genes of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and protein tyrosine phosphatase, nonreceptor 22 (PTPN-22) with hypothyroidism in Russian pregnant women. Subject and methods. The investigation included 179 women with single pregnancy who were divided into 2 groups: 1) 66 with subclinical or overt hypothyroidism (a study group) and 2) 113 without severe extragenital disease, endocrinopathy, obstetric and gynecological complications (a control group). Hypothyroidism was diagnosed on the basis of measurement of thyroid-stimulating hormone levels (more than 2.5 IU/l) at the end of the first trimester to the beginning of the second trimester (10-16 weeks). The polymorphisms of the CTLA-4 (A49G) and PTPN-22 (C1858T) were determined by allele-specific polymerase chain reaction (PCR) using a fluorescence-labelled oligonucleotide probe and melting curve analysis. Results. Examinations of the levels of thyroid tissue antibodies revealed the latter to thyroid peroxidase and thyroglobulin more frequently in the study group (in 73.9 and 75.4%, respectively) than in the control one (in 8.9 and 9.7%, respectively), which suggested the probable autoimmune pattern of the disease. Genotyping in the examined groups indicated that pregnant women with CTLA-4 GG or GA genotype were more often identified in the study group than in the control one. On the contrary, AA genotype carriage was associated with the lower risk of hypothyroidism in the pregnant women (OR = 0.3; 95% CI, 0.12-0.68). At the same time, the examined groups were similar in the rate of PTPN22 C1858Tpolymorphism. Conclusion. The investigations demonstrated that the pregnant women may develop autoimmune hypothyroidism due to the G allele of the A49G CTLA-4 polymorphism.
Obstetrics and Gynecology. 2015;(12):64-68
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ABNORMAL HYPERMETHYLATION OF HOXA10 AND HOXA11 GENES IN CHRONIC ENDOMETRITIS-RELATED INFERTILITY

Sukhikh G.T., Osipyants A.I., Maltseva L.I., Smolina G.R., Poloznikov A.A., Muyzhnek E.L., Kiselev V.I.

Abstract

The HOXA10 and HOXA11 genes and their encoded protein products are now considered to be one of the key regulators of endometrial receptivity during embryo implantation, which determine fertility as a whole. It is known that patients with endometriosis-related infertility exhibit lower levels of HOXA and HOXA11 proteins in endometrial tissue because of hypermethylation within the promoter regions encoding these protein genes. Objective. To investigate the methylation in the promoter regions of the HOXA10 and HIXA11 genes in the endometrium of reproductive-aged women with infertility in the presence of chronic endometritis. Subject and methods. The bisulfite sequencing method was used to study the level of promoter methylation of the HOXA10 and HOXA11 genes in 25 eutopic endometrial biopsy specimens obtained from reproductive-aged women with infertility in the presence of chronic endometritis. Results. It was established that hypermethylation of the HOXA11 and HOXA10 genes was observed in 64 and 84% of the biopsy specimens, respectively. At the same time, promoter methylation of the HOXA10 gene correlated with the duration of infertility. Conclusion. The findings agree well with the data previously obtained by other authors and allow the methylation of the HOXA10 and HOXA11 genes to be considered as a potential molecular marker for infertility associated with gynecological diseases.
Obstetrics and Gynecology. 2015;(12):69-74
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THE SOCIAL AND CLINICAL CHARACTERISTICS OF WOMEN WITH INFERTILITY ASSOCIATED AND UNASSOCIATED WITH GENITAL TUBERCULOSIS

Mordyk A.V., Yakovleva A.A., Leontiev V.V., LEONTYEV V.V.

Abstract

Objective. To identify social and clinical factors in female patients with infertility associated with genital tuberculosis to improve the diagnosis of the specific process. Subject and methods. The authors conducted a prospective study, by selecting 170 patients: 65 infertile women diagnosed with genital tuberculosis and 106 infertile patients without the tuberculosis. Results. The infertile patients with genital tuberculosis were maturely reproductive aged, had a compromised epidemiological history, complaints of subfebrile temperature, intoxication symptoms, and pain, gynecological inflammatory diseases with frequent exacerbations, ineffective treatment, and high rates of small pelvic organ operations. Conclusion. Consideration of the identified social and clinical factors will be able to accelerate the diagnosis of genital tuberculosis in infertile patients, by building mathematical prognostic models.
Obstetrics and Gynecology. 2015;(12):75-80
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ROLE OF TOLL-LIKE RECEPTORS 2, 4, 9 IN THE ENDOMETRIUM IN CHRONIC ENDOMETRITIS

Kogan E.A., Gombolevskaya N.A., Demura T.A., Marchenko L.A., Burmenskaya O.V., Fayzullina N.M., Muraveva V.V.

Abstract

Objective. To study the expression of Toll-like receptors (TLRs) 2, 4, 9 in the endometrium in chronic endometritis (CE). Subject and methods. The investigation included 60 reproductive-aged patients (mean age 32.1±5.2 years). All the patients underwent morphological and microbiological examinations of endometrial biopsy specimens. The expression of TLRs 2, 4, 9 was investigated by immunohistochemistry (IHC) and real-time reverse transcription PCR (RT-PCR). According to the endometrial morphological findings, the patients were divided into 2 groups: 1) 45 women with morphologically verified CE; 2) 2) 15 apparently healthy women (proliferative-phase endometrium). Mann-Whitney U-test and Spearman’s correlation test were applied for statistical processing. The values of p < 0.05 were considered statistically significant for all the tests. Results. Group 1 showed a significantly increase in the expression of TLRs in the endometrium as compared to Group 2 (p < 0.05). Comparative analysis revealed no statistical difference in TLR expression in the women with CE in the presence and absence of infective agents in their endometrial biopsy specimens. There were weak direct correlations: TLR2 expression between the endometrial epithelial cells by IHC and the endometrium as a whole by RT-PCR (r = 0.3; p = 0.024); TLR9 expression between endometrial stromal cells, vessels by IHC and the endometrium as a whole by RT-PCR (r = 0.3;p = 0.028; r = 0.3;p = 0.023, respectively). Conclusion. Examination of the expression of TLRs 2, 4, 9 in the endometrium could specify that to prevent the chronization of an endometrial inflammatory process, it was necessary to rapidly eliminate the pathogen, to prevent its persistence, to restore the normal architectonics of the uterine mucosa, and to suppress TLR overexpression predisposing to the creation of the vicious pathogenetic circle.
Obstetrics and Gynecology. 2015;(12):81-88
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PREVALENCE OF ANOGENITAL HPV TYPES IN PATIENTS WITH HPV-ASSOCIATED DISEASES OF THE CERVIX UTERI

Nazarova N.M., Bourmenskaya O.V., Sulamanidze L.A., Prilepskaya V.N., Pavlovich S.V., Trofimov D.Y.

Abstract

Objective. To study the prevalence of different anogenital HPV types in patients with varying severity of HPV-associated cervical intraepithelial neoplasia. Subject and methods. Clinical studies, extended colposcopy; high-resolution anoscopy; cytological examination; target biopsy of the cervix uteri; histological examination of biopsy specimens; HPV typing and qualitative assessment. Results. A total of 159 women (mean age 30±12 years) were examined. Five groups were formed according to the examination results: 1) 38 (23.9%) patients with CIN I-III at that moment; 2) 41 (25.8%) with a history of CIN I-III; 3) 35 (22. 0%) with anogenital condylomas; 4) 29 (18.2%) with HPV carriage; 5) 16 (10.1%) healthy women. Cervical and anal HPV was detected in 79 (49.7%) and 65 (40.9%) patients. HPV group A9 was significantly more common in the cervical canal (OR = 2.8 (1.3-5.9), p = 0.005) whereas HPV group 10 was in the anus (OR = 2.5 (1.1-5.6), p = 0.025). The most common HPV types were 16 (41.7%), 31 (15.1%), 44, 33 (12.6%), and 52, 68 (11.3%) in the cervix and 16 (29.2%), 53 (21.5%), 66 and 44 (16.9%), 31 (13.8%), 56 and 39(12.3%), and 6(10.7%) in the anal canal. In Groups 1, 2, 3, and 4, the cervix was detected to have HPV 16 in 52.6, 4.9, 8.6, and 27.6% of cases; HPV 33 in 7.9, 2.4, 0, and 20.7%; the anal canal more frequently contained HPV 16 in 23.7, 4.8, 8.6, and 17.2%; HPV 31 in 5.3, 0, 5.7, and 17.2% of cases; HPV 66 in 2.6, 4.8, 11.4, and 13.8%; HPV 56 in 15.8, 0, 2.9, and 3.4%; HPV 53 in 13.2, 7.3, 5.7, and 13.8%. Conclusion. In the patients with HPV-associated anogenital diseases, HPV types were ascertained to be different in the cervical canal and anal area. HPV group A9 was significantly more often encountered in the epithelium of the cervical canal than in the anus of patients with CIN, which allows consideration of the presence of CIN as a risk factor for the anal area to be infected with these types of the virus.
Obstetrics and Gynecology. 2015;(12):89-96
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VULVOVAGINAL ATROPHY: SYMPTOMS, IMPACT ON EMOTIONAL WELL-BEING, QUALITY, AND SEXUAL FUNCTION

Glazunova A.V., Yureneva S.V., Yezhova L.S.

Abstract

Background. Vulvovaginal atrophy (VVA) at menopause is a complex of symptoms associated with the development of atrophic and dystrophic processes in estrogen-dependent vaginal tissues. VVA symptoms, such as vaginal dryness, itching, burning, and dyspareunia, are observed in 40-57% of postmenopausal women. Objective: to study the impact of the symptoms of VVA on emotional well-being, quality of life, and sexual function in postmenopausal women. Subjects and methods. The survey covered 100 women aged 40 to 75 years with a postmenopausal duration of 1 to 35 years. A study group consisted of 63 patients with diagnostically verified vulvovaginal atrophy (Group 1); a control group comprised 37 patients (Group 2). The survey involved questionnaire interviewing and laboratory diagnosis. All the patients underwent cytological examination of the vaginal wall, followed by estimation of the epithelial maturation index and vaginal pH. Results. VVA symptoms were present in two groups and statistically similar. The most common complaint was dryness reported by 60% of the respondents. As in previously conducted surveys, our respondents felt embarrassed because of vaginal discomfort (41.3 and 54.1% in Groups 1 and 2, respectively; p = 0.218), which had in turn a negative impact on the women’s emotional status. Some patients noted a decreased desire to interact with others (9.5 and 13.5 in Groups 1 and 2; p = 0.540) and deterioration of daily activity due to the presence of VVA symptoms (30 and 20% in Groups 1 and 2; p=0.218). When analyzing the quality of their sexual life, the investigators considered the indicators of only the women who were married or those who reported to have a sexual partner (Subgroups 1a and 2a). The patients of these two subgroups were age-matched (53±3.3 and 53±7.0; p = 0.749). In both the first and second subgroups, the women experienced discomfort during sexual intercourses: pain, dryness, and postcoital bleeding. During sexual intercourses, Subgroup 1a women significantly more frequently observed pain and dryness (p = 0.021 and p = 0.046). Because of this, it was possible that the patients of this subgroup were less sexually active. Among them, only 21 (44.68%) patients continued to lead a sex life; among the patients without VVA (Subgroup 2a), 24 (74.41%) women had a regular sex life (p = 0.002). More than half of the patients in Subgroup 1a reported that the symptoms of VVA were a reason for refusing to enter into intimate relationship (p = 0.021), as well as decreased libido, which in turn negatively affected interpersonal relations between the partners. Conclusion. Vaginal dryness, itching, burning, and dyspareunia frequently bother postmenopausal women, irrespective of whether they have VVA. The presence of these symptoms upsets women and causes embarrassment, which has a negative impact on their emotional status and self-rating. Vaginal discomfort deteriorates daily activity in postmenopausal women and decreases a desire to interact with others. Pain and dryness during sexual intercourses are significantly more common in women with laboratorily verified VVA, which was a reason for refusing to enter into intimate relationship and negatively affected interpersonal relations between the partners. The women with VVA had a regular sex life twice less than those in the control group.
Obstetrics and Gynecology. 2015;(12):97-102
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RESULTS OF MEDICAL THERAPY IN PATIENTS WITH CERVICAL INTRAEPITHELIAL NEOPLASIA I-II (CIN I-II)

Ashrafyan L.A., Kiselev V.I., Aleshikova O.I., Ponomareva Y.V., Kuznetsov I.N., Vashakmadze S.L.

Abstract

Objective. To evaluate the efficiency of medical treatment incorporating promisan in patients with histologically verified cervical intraepithelial neoplasia (CIN) I-II. Subjects and methods. The investigation enrolled 90 reproductive-aged patients who were randomized into three groups. A study group (Group 1) took 2 promisan capsules twice daily during cycle therapy with eubiotics; Group 2 patients underwent radiowave surgery; Group 3 was followed up (a control group). The therapy lasted 12 months. Results. The findings of the clinical trial support the efficiency of promisan therapy. The therapeutic efficiency is proven by the results of cytological monitoring, colposcopy, and polymerase chain reaction. The trial shows that the efficiency of this treatment option can be most adequately evaluated following 12-month therapy. Conclusion. The current treatment policy for CIN I-II in reproductive-aged patients at Stage 1 should be directed at medical treatment incorporating promisan as an effective multitarget agent and at normalization of vaginal biocenosis.
Obstetrics and Gynecology. 2015;(12):103-109
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INTERNATIONAL PRACTICE OF THE TERRITORIAL DISTRIBUTION OF PERINATAL CENTERS: HEALTHCARE VOLUMES AND PUBLIC TRANSPORT ACCESSIBILITY

Shuvalova M.P., Pismenskaya T.V., Yarotskaya E.L.

Abstract

Objective. To show international practice of the territorial distribution of top-level specialized healthcare facilities for women during pregnancy, labor, postpartum period and for newborn infants. Subject and method. Third-level obstetric facilities were compared according to indicators, such as transport accessibility, healthcare volumes in the facilities, and neonatal mortality rates. Results. Analysis of world practice could lead to the conclusion that there were considerable differences in third-level obstetric care. In accordance of the WHO guidelines, there must be at least five emergency obstetric care facilities, including one highly specialized obstetric care one, per 500,000 population. At the same time their geographical distribution should ensure that time basic emergency obstetric care should be accessible during two hours and, when the occasion requires, highly specialized obstetric care should be rendered within a maximum of 12 hours. Conclusion. The territorial and time top-level obstetric care accessibility may have an impact on treatment outcomes. The rational distribution of obstetric service infrastructure objects facilitates a free access of the population to health care and enhances chances of preserve life and health if complications develop.
Obstetrics and Gynecology. 2015;(12):110-115
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THE NATIONAL REGISTER OF ASSISTED REPRODUCTIVE TECHNOLOGIES: REALITIES AND PROMISES

Shakhova M.A., Lebedev G.S., Kholin A.M., Malyarenko O.L.

Abstract

Background. To solve the problems of female and male infertility is an important and urgent task in the context of declining birth rates and the worsening demographic situation in Russia during a number of years. Objective. To develop a set of mathematical models and algorithms for evaluating the efficiency of assisted reproductive technologies (ART) (in vitro fertilization) in medical centers on the basis of an analysis of data from the prospective register. The investigation is concerned with assisted reproductive technologies permitted to use in the healthcare system in the established procedure. Data on the efficiency, safety, and economic appropriateness of ART in the medical organizations of different forms of property are the subject of investigation. Subject and methods. The data were sought for using key words in electronic databases, databases of systematic reviews and those of ART assessment reports. Results. On the basis of the performed analysis, 132 most significant indicators that characterize the following sectors of the register: official data, health status data on a couple, the causes of its infertility, epidemiological data on infertile couples, attempt characteristics, specific features of the course of pregnancy and labor, and information on a child’s status, may be recommended as parameters of the prospective register of ART programs after their implementation. The structure of the register and the procedure for its use are described. Conclusion. The development of a set of mathematical models and software tools is aimed at being used by all the interested specialized medical centers to enhance the efficiency of ART through preliminary and subsequent risk calculations and correction of plans for treatment and use of drugs that have proven their efficacy. To evaluate the efficiency of ART programs is one of the most important tools to solve the problems facing health administrators in demography.
Obstetrics and Gynecology. 2015;(12):116-121
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PHARMACOLOGICAL CORRECTION OF IRON-DEFICIENCY ANEMIA DURING PREGNANCY

Batishcheva G.A., Mubarakshina O.A., Somova M.N., Mubarakshin E.A., Barbashina K.V.

Abstract

Objective. To carry out a systematic analysis of the data available in the current literature on the specific features of pharmacotherapy for iron-deficiency anemia during pregnancy. Subject and methods. The review includes the data of foreign and Russia articles that were found in Pubmed on th is topic and published in the past 10 years Results. The paper describes the relevant problem of iron-deficiency anemia in pregnant women, possible consequences of this complication, and areas of its pharmacological correction. It presents ways to enhance the efficiency and safety of therapy with iron preparations, as well as by adding vitamins, designing the formulations with modified release and improved pharmacokinetic characteristics. Conclusion. It is necessary to conduct further investigations into the design and clinical use of the most effective and safe drugs to correct iron-deficiency anemia in women during pregnancy and lactation.
Obstetrics and Gynecology. 2015;(12):122-126
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METABOLIC THERAPY IN THE COMBINATION TREATMENT OF VOMITING IN PREGNANT WOMEN

Spiridonova N.V., Kaganova M.A., Solovova L.D.

Abstract

Objective. To evaluate the efficacy of corylip used in the combination of moderate and severe vomiting in pregnant women. Subject and methods. Seventy pregnant women with moderate and severe vomiting were examined. Group 1 included 40 pregnant women who received metabolic therapy with corylip in addition to standard treatment (a study group); Group consisted of 30 pregnant women who underwent standard treatment only (a control group). The efficiency of the therapy performed was evaluated using the Pregnancy-Unique Quantification of Emesis (PUQE) scale and the 36-item short form (SF-36) scale and changes in the indicators of ketoacidosis. Results. The administration of corylip results in a more rapid relief of the clinical symptoms of toxicosis according to the PUQE scale, improvements in general health, role and emotional performances by the SF-36 scale and from laboratory parameters of ketoacidosis in the group.
Obstetrics and Gynecology. 2015;(12):127-132
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CURRENT POSSIBILITIES FOR THE PHARMACOTHERAPY OF HEARTBURN DURING PREGNANCY

Kartseva V.S., Esayan R.M., Chukhareva N.A.

Abstract

Objective. To provide a review of the data available in the current literature on the pathogenesis of heartburn during pregnancy and therapeutic possibilities of using alginates. Subject and methods. The review includes the data of foreign and Russia articles that were found in Pubmed and eLIBRARY.RU on this topic and published in the past 20 years. Results. The paper describes the physiological and pathological mechanisms of heartburn during pregnancy and the data of investigating gaviscon forte in the treatment of heartburn during pregnancy. Conclusion. Along with lifestyle and dietary modifications, the use of gaviscon forte that has demonstrated its efficacy and safety in trials covering more than 50 pregnant women is pathogenetically sound in mild and moderate heartburn.
Obstetrics and Gynecology. 2015;(12):133-136
pages 133-136 views

EFFICIENCY OF ALTERNATIVE THERAPY FOR MENOPAUSAL SYNDROME

Egorova A.T., Kiseleva E.Y., Bazina M.I., Zhirova N.V.

Abstract

Objective. To investigate the efficiency of alternative therapy with genistein synthesized in an active form for menopausal syndrome (MS). Subject and methods. A prospective cohort study was conducted. Examined groups comprised women aged 45 to 60 years: a study group included 30 women with mild and moderate MS; a control group consisted of women without this condition. Basic and special studies were performed; the severity of MS was evaluated by the modified Kupperman-Uvarova menopausal index (MMI) and quality of life in the women of the examined groups was assessed using the international unified SF-36 Health Status Surgery questionnaire. The study group was treated with an active form of genistein (menoryl) in a dose of 30 mg twice daily for 3 months. Then all the aboveenumerated parameters were reestimated in the women of the examined group and compared with the baseline level in the study group and the indicators in the control group. Results. The women with mild and moderate MS showed a reduction in both the physical and psychic heath components of quality of life. The total MMI proved significantly higher in the study group women. Their detailed examination revealed the highest rate of neuroautonomic symptoms among the women with MS. During therapy with active genistein (menoryl), there was a decrease in MMI: from the signs of moderate MS to those of mild MS in the use of phytoestrogens. Menoryl therapy was noted to lead to better quality-of-life indicators in both physical and (predominantly) psychic component.
Obstetrics and Gynecology. 2015;(12):137-142
pages 137-142 views

CURRENT PRINCIPLES OF THERAPY FOR PAPILLOMAVIRUS INFECTION

Kurchakova T.A., Balushkina A.A., Kan N.E., Tyutyunnik V.L.

Abstract

Objective. To provide an update on therapy for papillomavirus infection (PVI). Materials and methods. The literature data published were sought in Pubmed and elibrary. A total of 128 sources on PVI and its treatment options, out of which 25 were included in this review, were found. Results. The following treatments for PVI have been currently proposed. These include destruction of papilloma foci in this or that manner, activation of an antiviral immune response or a combination of these approaches. Russian and foreign authors show that the use of immune response modulators makes it possible to enhance the efficiency of treatment and to reduce the rate of relapses. Conclusion. It is expedient to perform combination treatment involving not only exposure of altered tissues, but also nonspecific antiviral and immunomodulatory therapy, resulting in significant elimination of human papillomavirus.
Obstetrics and Gynecology. 2015;(12):143-147
pages 143-147 views

GENITAL TRACT BLEEDING IN PRESCHOOL GIRLS. RHABDOMYOSARCOMA OF THE VAGINA

Batyrova Z.K., Uvarova E.V., Kogan E.A., Kumykova Z.H.

Abstract

Background. Soft tissue rhabdomyosarcoma is the most common malignant tumor of the lower genital tract in children younger than 15 years of age. According to the data of investigators, the proportion of rhabdomyosarcoma is 8% of all cancers in children. Description. The paper describes a clinical case of vaginal tumor in a prepubertant girl in terms of the importance of timely identification of the cause of vaginal bleeding in girls. Conclusion. Bloody spotting in prepubertant girls requires special attention; its timely diagnosis and implementation of respective therapeutic measures will be able to preserve the girls’ health and life.
Obstetrics and Gynecology. 2015;(12):148-151
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PRAVILA DLYa AVTOROV

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Obstetrics and Gynecology. 2015;(12):152-152
pages 152-152 views

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