No 5 (2016)

Objective. To study the role of abnormal weight gain (AWG) during pregnancy as a risk factor for gestational diabetes mellitus (GDM), by performing a meta-analysis. Materials and methods. To solve the set problem, literature data from the leading bibliographic sources MEDLINE, Cochrane col., and EMBASE were analyzed. The WHO guidelines and the revised criteria of the Institute of Medicine (IOM, 2009) were used to estimate body mass index (BMI) and normal weight gain during pregnancy. The incidence of GDM was separately assessed for each of three groups of BMI indicators in terms of normal weight gain. The indicators were estimated by performing a meta-analysis using the Review Manager 5.3 (Cochrane col.). Results. 13 investigations meeting the search criteria were selected for analysis. A total of 85,559 pregnant women were examined. The odds ratiofor a GDMrisk in AWGfor the normal BMIgroup was established to be 1.67(95% CI, 1.28-2.18) (χ2 = 32.1; р = 0.001), that for the baseline overweight group was 2.13 (95% CI, 1.47-3.11) (χ2 = 24.9; р = 0.009), and that for the obesity group was 2.0 (95% CI, 1.53-2.63). Conclusion. A WG during pregnancy is an importantfactor in the development of GDM. The performed investigation allows pregnant women with AWG to be identified as a group at high risk for carbohydrate metabolic disturbances. Timely detecting AWG and more carefully following the balanced diet and exercise recommendations in such patients will be able to reduce the incidence of GDM and related perinatal complications.

Objective. To carry out a systematic analysis of the data available in the current literature on the nonreproductive (neurobiological) effects of progesterone in obstetrics and perinatology and on the prospects of replacement therapy with progesterone in premature neonatal infants with neurologic deficits. Material and methods. The review includes the data of foreign and Russian articles published on this topic in the past 10-15 years and found in the databases Pubmed and Medline. Results. The paper describes the role of the major progesterone neurometabolite allopregnenalone on the development of the fetal central nervous system, myelination and remyelination, and fetal sexual differentiation. It provides evidence that maternal progesterone deficiency may be associated with the development of congenital neurological diseases in newborns. Conclusion. The growing interest in the role of neurosteroids in the production of healthy descendants, as well as experimental and clinical studies in neuroendocrinology open up prospects for translational medicine and for the revision of the traditional views on miscarriage and prevention of preterm birth as a perinatal and obstetric problem.

Objective. To summarize available data on different superovulation stimulation protocols in assisted reproductive technology programs, on their currently available modifications, and on indications for their use. Material and methods. Respective sources were sought for in the systems Medline, Cochrane Library, and Elibrary; these included publications from January 2005 to October 2015. Thirty of the found 807 investigations were used to write a systematic review. Results. Today there are different controlled ovarian stimulation (COS) protocols; but the most common protocols among them in clinical practice are a “long” protocol with gonadotropin-releasing hormone agonists, a protocol with gonadotropin-releasing hormone antagonists, and its different modifications. Meticulous attention is given to the elaboration of regimens for the replacement of an ovulation trigger as a method to prevent ovarian hyperstimulation syndrome. The choice of a superovulation stimulation regimen should be individual and depend on many factors. Conclusion. Today there is a rich variety of modified COS protocols; experience has been accumulated regarding some indications for the use of one or other stimulation protocol in relation to the clinic-anamnestic and embryologic characteristics of patients; however, contradictory and ambiguous data on their efficiency call for further investigations in this area.

Objective. To study the impact of infiltrating endometriosis on quality of life in women according to the data available in Russian and foreign literature. Material and methods. The key words “quality of life”, “health-related quality of life” “quality of life assessment”, and “infiltrating endometriosis” were used to search for literature sources in the Russian and foreign databases: Elibrary, Medline/PubMed, Embase, and CINAHL. Forty sources were selected. Results. Women with infiltrating endometriosis have a low quality of life. Various drug and non-drug treatments positively affect its level. A lot of trials compare the efficacy of pharmaceuticals, in which progestins and gonadotropin-releasing hormone agonists with add-back therapy occupy leading places. Such trials are conducted at the second stage of treatment for infiltrating endometriosis (after surgery). Conclusion. Infiltrating endometriosis is a common disease among fertile-aged women with gynecological disease and considerably affects health-related quality of life. Comparative evaluation of the efficiency of isolated surgical and medical treatments is given in some publications. The quality of life in patients with infiltrating endometriosis after different surgical volumes is also inadequately depicted. Therefore, there is a need for further investigations into this topic.

Objective. To determine the specific features of the course of labor and delivery in patents with excessive gestational weight gain (EGWG). Subjects and methods. The investigation enrolled 110 primigravidae with EGWG and 115 with recommended one, as well as their neonatal infants. The intrapartum and postpartum complications, the frequency of aids and operations in the intrapartum period, neonatal weight, and their assessment using the Apgar scale were analyzed. Results. Within-group comparison revealed that in patients with normal pregravid weight, its excessive weight increment increases the rate of uterine inertia (27.3 and 15.7%), clinical incompatibility (11.8 and 4.3%), the need for labor induction (26.4 and 15.7%), labor augmentation (34.5 and 19.1%), and cesarean section (23.6 and 11.3%) (p < 0.05). The rate of fetal macrosomia in the presence of EGWG ((10.9 and 3.5%) was significantly higher than that during the recommended one (p < 0.05). Conclusion. EGWG impairs the mechanisms responsible for triggering and maintaining delivery and assists in increasing the risk of intrapartum clinical incompatibility. There is more often a need for labor induction or emergency cesarean section, which allows patients with EGWG to be referred to as a group at high risk for complicated labor.

Objective. To evaluate the cytoprotective effect of intravenous immunoglobulins (IVIGs) against endothelial cells. Subjects and methods. The cytotoxic effects of the sera obtained from 45 pregnant women against the endothelial cells treated with IVIGs were investigated using culture, an enzyme immunoassay, and flow cytometry. Results. After treatment of endothelial cells with IVIGs, there was a reduction in the cytotoxic effect of the sera obtained from the women with recurrent miscarriage against endothelial cells. Conclusion. IVIGs are effective cytoprotectors that are able to prevent abnormalities associated with endothelial damage and dysfunction.

Objective. To optimize the results of surgical treatment and rehabilitation in patients with congenital uterine and vaginal malformations concurrent with external genital endometriosis. Subjects and methods. A total of 198 patients with uterine and vaginal abnormalities were operated on at the Department of Operative Gynecology, V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in 2013 to 2015. According to the presence or absence of foci of external genital endometriosis, two groups were formed: 1) 105 patients with uterine and vaginal abnormalities and concurrent external genital endometriosis; 2) 93 patients with uterine and vaginal abnormalities without concurrent endometriosis. Results. The indicators for surgical treatment were primary infertility (41.5%), secondary infertility (18.6%), recurrent miscarriage (26.2%), dysmenorrhea (45.4%), menorrhagia (23.2%), pain syndrome (17.2%), and dyspareunia (8.1 %). The rate of external genital endometriosis was 53.0%. No significant differences were found in the rate of endometriosis between the patients with and without menstrual blood outflow. Conclusion. The implantation theory cannot explain all cases of endometriosis developed in patients with uterine and vaginal defects. Consequently, all pathogenetic mechanisms should be borne in mind when studying the possible ways how endometriosis develops in congenital anomalies of the female genitalia.

The aim of this study was to analyze the quality of primary care in Latvia. We took into account the main principles of family medicine - continuity, coordination, community orientation, and comprehensiveness of care. Objectives. Analyze access to Latvian General Practitioner services and patient satisfaction with the work of General Practitioner practices. Subject and methods. Data were collected as a part of a larger international study entitled Quality and Costs of Primary Care in Europe (QUALICOPC) that took place in 2012 and 2013. A cross-sectional survey of 1,937 patients who had just visited general practitioners in 218 family doctor practices was done. We used random sampling of GP practices in Latvia. Results. Most Highly Rated Latvian Patient Values. Patients of 218 physicians across Latvia completed the patient value scale indicating his/her perceived importance of primary care aspects before, during and after consultation with their family doctor. This first section highlights the aspects of primary care that patients most frequently rated as being very important to them. Patient Values and Experiences in Four Dimensions of Primary Care. The second results section of this report summarizes patient experience responses with a particular focus on those aspects of primary care rated as most important to patient respondents. Conclusion. By analyzing the data obtained, we can conclude that the organization and accessibility of most general practices in Latvian are in compliance of the principles outlined in the World Health Organization (WHO) and in accordance with Latvian laws and regulations. Key message: The organization of general practices and their accessibility in Latvia is ensured. There are separate GP practices where performance indicators should be improved, regarding the principles of work organization in order to improve accessibility ratios, improved communication with patients. These are the basic principles of family medicine.

Objective. To evaluate the efficiency and safety of using the dietary supplement amberen in relieving vasomotor and psychosomatic disorders in perimenopausal and postmenopausal women. Subjects and methods. A randomized double-blind placebo-controlled trial was conducted among 42-60-year-old women with vasomotor and psychosomatic symptoms of menopause. Physical examination and questionnaire survey using Green’s test and Spielberger-Hanin test were done; the plasma levels of gonadotropins, estradiol, leptin, and apolipoproteins were determined. Results. The investigation enrolled 104 women who were randomized into 2 groups. The Green test revealed a statistically significant (p < 0.05) improvement in patients who took amberen in terms of 13 of 21 menopause symptoms. During and after its use, the levels of estradiol, gonadotropins, and leptin were significantly changed, the mean values of weight and waist circumference decreased in the patients. The Spielberger-Hanin test showed that amberen could stabilize the patients’ mental status with significantly reduced anxiety, enhanced resistance to stress, and improved adaptability. Comparative analysis of the measurements of vital signs and blood and urine tests revealed that amberen had a negative effect on the patients. Conclusion. The perimenopausal and postmenopausal use of amberen may be considered to be the method of choice in relieving the symptoms of menopause for women who have contraindications or who do not desire hormone therapy.

Objective. To present basic clinical research data based on the current evidence about peri- and postmenopausal anatomic and physiological changes in the urogenital tract and on the principles of management of patients with genitourinary syndrome of menopause. Material and methods. Russian and foreign sources dealing with the prevalence, current diagnosis, and treatments of vaginal atrophy were reviewed. Results. The present clinical guidelines give current terminology and data on the etiopathogenesis, clinical presentation, diagnosis, and treatments of vulvovaginal atrophy or urinary discomfort in peri- and postmenopausal women. Conclusion. Genitourinary syndrome of menopause is a common disorder in peri- and postmenopausal women. The knowledge of the current aspects of its diagnosis, treatment, and prevention will be able to render timely aid to patents and to improve their quality of life.

Background. The prediction of a risk for ovarian hyperstimulation syndrome (OHSS) is relevant, as in spite of the assessment of clinical and laboratory indicators (age, body mass index (BMI), baseline follicle-stimulating hormone levels; anti-Müllerian hormone, number of antral follicles) and the implementation of early and late prevention measures, some patients develop OHSS, which presumes that genetic factors are involved in its development. Description. The paper describes a clinical case of severe OHSS in a patient with a normal ovarian response and shows that the development of this complication is associated with the OHSS risk genotypes detected during a pilot study. Conclusion. The clinical and laboratory markers used in routine practice to assess the risk of OHSS are inadequately objective and require confirmation by more specific methods. The determination of the genotypes of an OHSS risk is able to complement a panel of conventional procedures for predicting an ovarian response. Genetic testing is a highly specific procedure that can individually select an optimal ovarian stimulation protocol and minimize the risks associated with the development of OHSS.