Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

No 6 (2016)

Articles

Prognostic value of a ratio of soluble fms-like tyrokinase1 to placental growth factor in pregnant women with preeclampsia

Serov V.N., Kan N.E., Tyutyunik V.L.

Abstract

Objective. To predict preeclampsia in pregnant women, by determining a ratio of soluble fms-like tyrokinase-1 (sFlt-1) to placental growth factor (PlGF). For validation, 550 women were additionally examined. Subjects and methods. The sFlt-1:PlGF ratio threshold point that is of great importance was determined on a cohort of 500 women. Results. The sFlt-1:PlGF ratio threshold point equal to 38 was of great importance for the development of preeclampsia. The sFlt-1:PlGFratio of 38 or lower has negative prognostic value (i.e. the absence of preeclampsia in the following week) in 99.3% (95% confidence interval (CI), 97.9 to 99.9) with a sensitivity of 80.0% (95% CI, 51.9 to 95.7) and a specificity of 78.3% (95% CI, 74.6 to 81.7). The positive prognostic value of the sFlt-1:PlGF ratio of higher than 38 predetermined the development of preeclampsia during 4 weeks and accounted for 36.7% (95% CI, 28.4 to 45.7) with a sensitivity of 66.2% (95% CI, 54.0 to 77.0) and a specificity of 83.1% (95% CI, 79.4 to 86.3). The foregoing confirmed the diagnostic value of the proposed threshold point. Conclusion. The sFlt-1:PlGF ratio may be regarded as a noninvasive diagnostic marker of preeclampsia. However, a search is continuing for predictors of this abnormality with the maximum sensitivity and specif icity at the present developmental stage of science.
Obstetrics and Gynecology. 2016;(6):5-10
pages 5-10 views

Efficiency of assisted reproductive technology programs in stimulated-cycle embryo transfer versus cryopreserved-thawed embryo transfer

Naimi Z.M., Kalinina E.A., Donnikov A.E., Alieva K.U., Dudarova A.K., Tukhvatullina Y.A.

Abstract

Objective. To carry out a systems analysis of the data available in the current literature on the efficiency of unstimulated-cycle cryopreserved-thawed embryo transfer versus stimulated-cycle native embryo transfer in the assisted reproductive technology (ART) programs. Material and methods. The review included the data of randomized clinical trials comparing the results obtained in the IVF cycles during native and cryopreserved/thawed embryo transfer, which have been found in the Medline, Embase, and Cochrane Library and published in the past 10 years. Results. Analysis of the data has shown that in the unstimulated superovulation cycle cryopreserved-thawed embryo transfer, the clinical pregnancy rate is higher and pregnancy outcomes are also better than those in the stimulated-cycle native embryo transfer. This may be associated with a more precise hit into the implantation window and with the optimal level of inflammation in the endometrium for embryo implantation. Conclusion. The findings give grounds to revise standard tactics for implementing an ART program in favor of cryopreservation of embryos for natural-cycle transfer.
Obstetrics and Gynecology. 2016;(6):11-17
pages 11-17 views

Obesity and female reproductive health

Aganezova N.V., Aganezov S.S.

Abstract

Objective. To analyze the medical and civilized social aspects of obesity and its significance for the development and aggravation of impairments in the female reproductive system. Material and methods. Scientific information sources on the pathogenesis of metabolic disturbances associated with obesity and its impact on the female reproductive system are reviewed; current approaches to hormone therapy in obese women were considered. Results. The theoretical and clinical aspects confirming the relationship between adipose tissue metabolism and impairments in the female reproductive system are described. Weight-loss recommendations (regimens and drug therapy) are given. Conclusion. Weight reduction regimens and drug therapy provide a means of using the protective effects of estrogen-gestagen contraceptives and reducing the risk of cardiovascular events.
Obstetrics and Gynecology. 2016;(6):18-25
pages 18-25 views

Genital prolapse: Genetic aspects

Lukyanova D.M., Smolnova T.Y., Adamyan L.V.

Abstract

Objective. To investigate the impact of the polymorphisms and expression of genes governing the synthesis of components of the connective tissue intercellular matrix and sex hormone receptors on the development of genital prolapse (GP). Material and methods. The data available in the literature on the etiological factors and pathogenetic (including molecular genetic) mechanisms of GP development were analyzed. Results. The paper gives data on the influence of a number of genetic determinants on predisposition to GP. It describes molecular genetic mechanisms in the development of this disease in the presence of single and combined polymorphisms and expression of the genes of connective tissue intercellular matrix components and sex hormone receptors, as well as those regulating the cell cycle and apoptosis. Conclusion. GP is a multietiological disease with an unspecified developmental mechanism. At this moment most found genetic variants are not specific to this disease. In this connection, identification of molecular genetic markers for predisposition to GP in the context of initial manifestations of connective tissue incompetence and pelvic floor laxity weakness and relaxation is of particular relevance in predicting the outcomes of treatment and further progression of GP.
Obstetrics and Gynecology. 2016;(6):26-31
pages 26-31 views

Alternative methods for the treatment of vasomotor symptoms in postmenopausal women

Yureneva S.V., Ilyina L.M., Ebzieva Z.H.

Abstract

Objective. To analyze data on the efficiency and safety of alternative treatments for vasomotor symptoms in postmenopausal women, by leaning on recent documentary data. Material and methods. The review presents the data of randomized controlled studies, systematic reviews, and meta-analyses in the past five years, as well as the consensus opinion of the experts of international menopause societies, which is given in the 2015-2016 guidance documents. Results. There is evidence on the efficiency and safety of lifestyle modification, dietary supplements, alternative non-drug treatments, herbal remedies, and neuroactive agents for the treatment of postmenopausal vasomotor symptoms. There are also results of two large surveys reflecting the extent of use of these treatment options, their advantages and disadvantages in the view of women themselves. Conclusion. A clinician must be aware of the level of evidence regarding the efficiency and safety of alternative means in order preclude the insufficient use of effective treatment options for postmenopausal vasomotor symptoms, and conversely, the use of treatments that are ineffective or inappropriate in specific clinical situations.
Obstetrics and Gynecology. 2016;(6):32-38
pages 32-38 views

Clinical and anamnestic risk factors for preeclampsia in pregnant women

Kan N.E., Bednyagin L.A., Dolgushina N.V., Tyutyunnik V.L., Khovkhaeva P.A., Sergunina O.A., Tyutyunnik N.V., Amiraslanov E.Y.

Abstract

Objective. To build a prognostic mathematical model to calculate an individual risk for preeclampsia (PE) on the basis of clinical and anamnestic data. Subjects and methods. A retrospective case-control study covering 320 women was conducted. A study group consisted of 160 patients with PE. A control group was formed using the pair matching method in accordance with 2 signs: domicile (urban/area area) and social status (income level), which also comprised 160 women. The investigators analyzed the anamnestic risk factors of PE as a whole and also early PE (occurring before 34 weeks of pregnancy) and late PE (occurring at 34 weeks’ gestation) separately. Multivariate analysis (logistic regression) was used to construct a PE prognostic model and to calculate an individual risk. Results. The risk factors of PE are patient age and chronic hypertension. In this case, the only proven predictor for early PE is chronic hypertension (by 3.7 times more frequently) and that for late PE was a female age more than 36 years (by 2 times more commonly). A model to measure the individual risk of PE was built on the basis of clinical and anamnestic data. Conclusion. Different risk factors for various forms of PE may be suggestive of the different genesis of these conditions. Early PE is characterized by early vascular bed lesion, which proves the great risk of its occurrence in patients with vascular disease (hypertension). Late PE may show secondary impairment in placental blood flow at a late gestational age. The possible trigger of late PE is immunological intolerance, causing a systemic inflammatory response. The compromised somatic and obstetric risk associated with old patient age can make a tangible contribution to the development of these pathological processes.
Obstetrics and Gynecology. 2016;(6):39-45
pages 39-45 views

Association of pregnancy outcomes with fetal amino acid metabolism and maternal obesity

Bashmakova N.V., Tsyvyan P.B., Pestryaeva L.A.

Abstract

Objective. To compare the blood concentrations of essential amino acids in mothers and newborn infants during normal pregnancy (a control group; n = 28) and in two study groups of obese women who had given birth to normal (Group 1; n = 46) and low (Group 2; n = 44) birth weight babies. Material and methods. The concentrations of amino acids were measured using an automatic amino acid T339M analyzer (Czechia); biochemical examinations were made on a Sapphire-400 analyzer (Japan). Results. The mean weight of babies in Group 2 was significantly lower than that of those in the control group and Control 1. Cholesterol and lipoproteins were considerably elevated in the obese women, particularly in Group 2. The concentrations of the majority of amino acids and the fetal-maternal concentration gradients were lower in obese women, especially in Group 2. Conclusion. There was a substantial reduction in the amino acid transport-and-concentration function of the placenta in obese women, particularly in those who had given birth to low-birth weight infants, which agrees with the fetal programmed theory of diseases.
Obstetrics and Gynecology. 2016;(6):46-53
pages 46-53 views

Estimation of forming uteroplacental blood flow in patients with threatened miscarriage in the presence of progesterone deficiency in the first trimester of pregnancy

Dobrokhotova J.E., Zubarev A.R., Zalesskaya S.A., Zubareva E.A., Saprykina L.V., Demidova A.K.

Abstract

Objective. To define the relationship of forming uteroplacental blood flow in first-trimester threatened miscarriage in the presence of normal and low blood progesterone levels. Subjects and methods. The investigation enrolled 91 primigravidas at 8-12 weeks’ gestation. 64 pregnant patients with threatened miscarriage formed Group 1; 27 with uncomplicated pregnancy were included in Group 2. Blood progesterone levels were determined in both groups. According to the findings, Group 1 was divided into two subgroups: 1A) 21 patients with a blood progesterone level lower than the 25th percentile; 1B) 43 with normal (from the 25th to 75th percentile) and elevated (more than the 75th percentile) blood progesterone levels. To estimate uteroplacental blood flow, all the patients underwent real-time three-dimensional transvaginal Doppler ultrasonography. Results. In the presence of blood progesterone def iciency versus blood flow ultrasound parameters and curve values, the patients with normal progesterone levels were recorded to have a significant increase in the blood flow curve values in the spiral arteries (p=0.0001) and corpus luteum vessels (0.0001). There was also a decrease in chorionic volume (p=0.026) and vascularization index (0.028), and corpus luteum volume (p=0.025). The groups showed no differences in the blood flow curve values in the uterine and ovarian arteries. Conclusion. The status of the mother-placenta-fetus system is determined by the blood flow curve indicators (resistance index, pulsatility index) of the spiral and corpus luteum arteries, and by chorionic volume and vascularization and corpus lutetium volume. The blood flow that is impaired in the spiral arteries and altered in the yolk sac artery may be considered to be a major Doppler sign of threatened miscarriage and possible complications of a gestational process in later periods.
Obstetrics and Gynecology. 2016;(6):54-61
pages 54-61 views

Echographic predictors for fetal critical condition

Voevodin S.M., Shemanaeva T.V., Shchegolev A.I.

Abstract

Objective. To identify the initial echographic markers of placental dysfunction in pregnant women with subsequent antenatal fetal death. Subjects and methods. Thirty-eight women in whom the course of pregnancy was complicated by antenatal fetal at 24-36 weeks’ gestation (a study group) were retrospectively analyzed. A control group was formed from 28 women with physiological pregnancy. The data of medical history, clinical, laboratory, and echographic studies in the pregnant women and morphological examination of the placenta were analyzed. Results. The main pregnancy complications that led to antenatal fetal death in the second trimester were severe preeclampsia and infectious lesions of the fetus and placenta. The clinical manifestations of preeclampsia were recorded in 12 (31.6%) patients in the study group. 34.2% of the women were found to have echographic signs of placental dysfunction as evolving fetal growth retardation. Moreover, the latter that developed in the second and third trimesters of pregnancy was found in 10.5 and 23.7%, respectively. Conclusion. The most informative echographic markers of a fetal critical condition are oligohydramnios, specific placental changes, fetal growth retardation, and abnormal blood flow values in the fetoplacental unit.
Obstetrics and Gynecology. 2016;(6):62-66
pages 62-66 views

Pharmacotherapy for heartburn during pregnancy: Safety of reserve drugs

Chukhareva N.A., Kartseva V.S., Esayan R.M., Ushkalova E.A., Tkacheva O.N., Bevz A.Y., Povetkin S.V., Chizhova G.V., Panova I.A., Bontsevich R.A., Vinogradova N.G., Pribytkova O.V., Feoktistova Y.V.

Abstract

Trials conducted in foreign countries have indicated that histamine H2 blockers (H2B) and proton pump inhibitors (PPIs) are used rarely in pregnancy, even if indicated. Objective. To determine how frequently physicians prescribe H2B and PPIs to pregnant women in the Russian Federation (RF). To analyze regulatory documents for the use of drugs in this group in the RF and to make a systems analysis of the data available in the current literature on their safety during pregnancy. Subjects and methods. 332 therapists and 734 obstetricians/gynecologists were interrogated; the information contained in the Russian clinical guidelines, current manuals for obstetricians/gynecologists, Order No. 572н issued by the Ministry of Health of Russia, and medical use instructions were analyzed. Foreign and Russian articles published in the past decade and found in Pubmed on this topic were reviewed. Results. In heartburn, antacids, PPIs, and H2B are prescribed by 75.4, 6.7, and 6.2%, of physicians, respectively. Russian guidelines draw little attention to the safety of reserve drugs used to treat heartburn. The analysis of the instructions has shown that some manufacturers do not allow use of the drugs of this group during pregnancy. Conclusion. The results of recent trials enable one to consider H2B and PPIs to be rather safe agents during pregnancy; however, their clinical application in the RF is limited by the lack of clear clinical recommendations and inconsistency available in different manufacturers’ instructions.
Obstetrics and Gynecology. 2016;(6):67-72
pages 67-72 views

Experience with oxytocin receptor antagonist for incipient preterm labor

Fatkullin I.F., Fatkullin F.I., Munavirova A.A., Islamova L.H., Akhmetgaliev A.R., Shaikhetdinova A.T.

Abstract

Objective. To present the results of analyzing 40 cases of use of the oxytocin receptor antagonist atosiban in incipient preterm labor. Material and methods. A group included 40 pregnant women with incipient preterm labor at 24-33 weeks’ gestation. Results. Pregnancy could be prolonged by a minimum of 7 days in 97.5% of the pregnant women with incipient preterm labor, which could perform a full prevention cycle for fetal respiratory distress syndrome. Following 48 hours, one half (21/40) of the women needed additional tocolysis using drugs from other groups. 90% of the women could prolong their pregnancy to full-term.
Obstetrics and Gynecology. 2016;(6):73-77
pages 73-77 views

Infiltrating endometriosis of the urinary tract: Mechanisms of growth and progression. Clinical, morphological, and immunohistochemical examinations

Khachatryan A.M., Kogan E.A., Chuprynin V.D., Paramonova N.B., Adamyan L.V., Khilkevich E.G., Yazykova O.I.

Abstract

Objective: to reveal the clinical, morphological, and immunohistochemical features of infiltrating endometriosis of the urinary tract, as well as the role of cells with the signs of stemness in its pathogenesis. Subjects and methods. The investigation enrolled 62 patients who had been examined and treated at the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology for infiltrating endometriosis involving the urinary tract in the period February 2010 to May 2015. The patients were divided into two groups. Group 1 consisted of patients with infiltrating endometriosis of the urinary tract who had sought medical advice for this disease for the first time. Group 2 included patients with infiltrating endometriosis of the urinary tract who had been previously treated for endometriosis. A control group (Group 3) was made up for immunohistochemical examination. Groups 1 and 2 patients underwent physical examination and all necessary clinical, laboratory, and instrumental studies (ultrasonography, magnetic resonance imaging, computed tomography, coloscopy, and cystoscopy) for specifying the diagnosis and preparing for surgical treatment. The latter was performed in 61 patients; 1 patient was discharged home prior to surgery due to family circumstances. The normal endometrium during the proliferative phase, which had been taken from 10 women (surrogate mothers), was examined in the control group (Group 3). Histological examination was performed in 61 patients. Immunohistochemical examination was done in 25 patients: 5 from Group 1, 10 from Group 2, and in 10 from the control group. Results. In recurrent endometriosis of the urinary tract, the intestine was more commonly involved in the endometrioid process. In Group 2, double endometrioid infiltrations of various intestinal portions were also encountered in the same patient. Morphological examination showed that the endometrioid foci possessed the properties of active foci. The recurrent foci more frequently displayed cystically transformed glands with polypoid proliferations of the epithelium and fibrosis of the adjacent tissues. Studying the results of immunohistochemical reactions discovered the specific features of the expression of epithelial and mesenchymal differentiation markers (CKWw, Cld3, and Vimentin), and those of stemness markers (PTEN, CD15, ALDH1, Musashi, and SOX2) in the endometrioid heterotopies and autologous endometrium. Conclusion. The endometrioid heterotopies differ from the autologous endometrium not only in their structure, but also in the degree of maturity of cells and their molecular arrangement according to Vimentin-у, Musashi, ALDH1, CD15, and SOX2. The endometrioid heterotopies have higher expression of the stemness markers, suggesting their relative immaturity, which manifests itself as higher active proliferation and infiltrative growth.
Obstetrics and Gynecology. 2016;(6):78-86
pages 78-86 views

The specific features of uterine hemodynamics and hemostatic system in myoma complicated by hemorrhagic syndrome

Khvorostukhina N.F., Ostrovskaya A.E., Rogozhina I.E., Novichkov D.A., Stepanova N.N.

Abstract

Objective. To study the specific features of uterine hemodynamics and hemostatic system in uterine myoma complicated by hemorrhagic system. Subjects and methods. The paper provides a detailed comparative analysis of the results of examination of 76 women with uterine myoma; out of them 43 patients with clinical presentation of hemorrhagic syndrome during hormone therapy formed a study group; a comparison group comprised 33 patients who were observed to have no complications due to hormone treatment for uterine myoma. A control group included 27 apparently healthy women. A complex Doppler ultrasound scanning was carried out using a HITACHI-5500 apparatus. The hemostatic system (platelet component, coagulation hemostasis, and fibrinolysis) was investigated by conventional procedures. An enzyme immunoassay was used to identify IgG and IgM antibodies to the pathogens of urogenital infections. Results. It was found that there was a preponderance of a hypervascular tumor (90.7%; n = 39) in uterine myoma complicated by hemorrhagic syndrome during hormone therapy with increases in systolic blood flow in the uterine arteries (by 1.8 times) and resistance index (by 1.6 times) and a decrease in diastolic blood flow (by 2.5 times). The occurrence of hemorrhagic syndrome during hormone therapy for uterine myoma is associated with the exacerbation of chronic urogenital infections, which gives rise to the impaired blood hemostatic potential (hypercoagulation, decreased platelet number and their aggregability, suppressed fibrinolysis, and increased paracoagulation products. Conclusion. The findings necessitate a more detailed examination of women in order to improve medical treatments for uterine myoma and to reduce the frequency of complications due to hormone therapy.
Obstetrics and Gynecology. 2016;(6):87-93
pages 87-93 views

Clinical and morphological features of leiomyoma of the uterine corpus in reproductive-aged women after previously undergone uterine artery embolization, MRI-guided focused ultrasound ablation, and myomectomy

Porotikova I.E., Demura T.A., Adamyan L.V., Gavrilova T.Y.

Abstract

Due to the introduction of new treatment options, such as uterine artery embolization (UAE), MRI-guided focused ultrasound (MRIgFU) ablation of myoma, in order to evaluate their efficiency, investigators are interested in the impact of the above procedures on the structural and molecular biological features of myomatous nodules. Objective. To investigate the clinical, morphological, and immunohistochemical features of leiomyoma of the uterine corpus in reproductive-aged women after previously undergone UAE, MRIgFU ablation of myoma, and myomectomy. Subjects and methods. The investigation enrolled 85 reproductive-aged women with uterine myoma who needed surgical treatment. Material was obtained from 29 patients after previously undergone UAE (Group 1), 26 patients after previously undergone MRIgFU ablation (Group 2), and 30 patients after previously undergone myomectomy (Group 3). The age range for the women in the compared groups was 22 to 45 years; their mean age was 36.2±5.2 years. Histological and immunohistochemical examinations were performed using the intraoperative myomatous nodule samples obtained during organ-sparing myomectomies in the phase of secretion. The expression of the markers VEGF, HIF-1, IGFR-1, Casp3, and Ki67 was estimated. Results. In Group 1, the expression of VEGF was 2.7 scores in the endothelium and 1.7 scores in the smooth muscle cells; in Groups 2 and 3, this was 1.8 and 0.3 scores and 3.5 and 2.0 scores, respectively. In our investigation, the expression of HIF-1 was much higher in the post-UAE group (10.1%), moderate in the post-myomectomy group (5.0%); and very low in thepost-MRIgFUablation group (0.26%), which was statistically significant (p < 0.05). IGFR-1 was detected in the cytoplasm of smooth muscle cells in the leiomyocytes; In Groups 1, 2, and 3, the expression of IGFR-1 was 1.5, 3.6, and 2.7 scores, respectively (p < 0.05). Its maximum expression was revealed in Group 2. The values of Ki-67 expression as a proliferative process were comparable with the level of apoptosis in the cells, as shown by the obtained date on Casp3, which can judge a relative balance between proliferative and apoptotic processes. Conclusion. Our clinical and morphological evaluation of the leiomyoma after treatment using UAE, MRIgFU ablation, and myomectomy is suggestive of certain molecular biological mechanisms for the development of myoma, as well as the expression of growth factors in the leiomyocytes in relation to the previously performed treatment option. In addition, the inferred causes of myomatous nodular growth could be established.
Obstetrics and Gynecology. 2016;(6):94-101
pages 94-101 views

Transforming growth factor-p expression in the ectocervical epithelial cells in cervical intraepithelial neoplasia and HPV infection

Samodelkin Y.I., Kosareva P.V., Vetelina V.V.

Abstract

Objective. To investigate cell-cycle regulation in the ectocervical epithelium in infection with HPV and in the development of cervical intraepithelial neoplasia (CIN) by studying the expression of transforming growth factor-beta (TGFbs). Materials and methods. The subject of the investigation was cervical biopsy specimens from 105 women, including 39, 24, and 12 patients with CIN I, II, and III, respectively (a study group); A comparison group included 30 HPV-infectedpatients without CIN. Immunohistochemical examinations were made in accordance with standard protocols using Diagnostic BioSystems reagents (USA). Results. The expression of TGFbs was found in the ectocervical basal cells of patients in the comparison group and in the cells of basal, parabasal, and intermediate layers in the CIN I group, in the basal and parabasal layers in the CIN II group; TGFbs expression was absent in the majority of patients in the CIN III group. Quantification of TGFBs expression established that the latter in the ectocervical basal, parabasal, and intermediate layers was statistically significantly more pronounced in the HPV infection minus CIN group and the CIN I and CIN II groups than in the CIN III group. Conclusion. As CIN progresses, the expression of TGFbs in the ectocervical epithelium at first increases and then decreases to the point of complete disappearance, which apparently suggest that the antiproliferative activity of the epithelium reduces by autocrine regulation.
Obstetrics and Gynecology. 2016;(6):102-107
pages 102-107 views

Metabolic effects of combined hormonal contraception and a risk for thrombotic events

Kuznetsova I.V.

Abstract

Objective. To make a systematic review of the data available in the literature on the effect of combined oral contraceptives with different progestogenic components on the risk of venous and arterial thrombosis. Material and methods. For analysis, foreign and Russian publications were sought in the international system Pubmed over the past 15 years. Results. Risk factors for thrombotic events in women are described; differences in the influence of risk factors for venous or arterial thrombosis are analyzed. The data available in the literature on the role of progestin as part of combined hormonal contraceptives are discussed in the context of the occurrence of arterial or venous thrombosis. Progestins that have demonstrated the most favorable safety profile as part of combined contraceptives are mentioned. Conclusion. The need for a differentiated approach to identifying a risk for arterial and venous thrombosis in women using combined hormonal contraceptives is emphasized.
Obstetrics and Gynecology. 2016;(6):108-114
pages 108-114 views

A case of successful delivery in a patient with a complete uterine rupture in previous pregnancy after laparoscopic myomectomy and hysteroresectoscopy

Tskhai V.B., Makarenko T.A., Ulyanova I.O., Nikiforova D.E.

Abstract

Background. Current gynecological practice shows a steady increase in the number of endoscopic surgeries for uterine myoma in reproductive-aged women. So the number of women with the operated uterus is increasing everywhere. In future, this will inevitably present a problem of uterine scar competence during pregnancy and labor. Description of clinical case. This clinical example shows that women who have sustained a uterine rupture during previous pregnancy may have a favorable course of subsequent pregnancy and a favorable labor outcome. In the given case, the cause of the complete uterine rupture accompanied by severe hemorrhagic shock and antenatal fetal death was postoperative uterine scar incompetence. The patient has a history of a large number of uterine myoma surgeries (hysteroresectoscopy, laparoscopic myomectomy, and uterine artery embolization). Conclusion. Organ-sparing surgery for uterine rupture during pregnancy and labor is the method of choice particularly in young women who have not realized their reproductive function. Pregnancy management in these patients should contemplate careful antenatal care, automatic check of the uterine scar, and planned delivery at third-level hospitals.
Obstetrics and Gynecology. 2016;(6):115-119
pages 115-119 views

Peripartum cardiomyopathy: A clinical case

Shkyaev A.E., Kotelnikova O.V., Tveritnev P.M.

Abstract

Background. Among the somatic causes of maternal death, acute heart failure poses a particular threat. Its development in pregnant women in the absence of other causes is associated with peripartum cardiomyopathy characterized by high death rates. Case description. The paper describes a case of a 32-year-old woman with peripartum cardiomyopathy with an onset of pulmonary edema in the early postpartum period. The predisposing factors were anemia, as well as acute respiratory disease in pregnancy. The timely diagnosis and adequate therapy could achieve a favorable outcome. Conclusion. The lack of clarity in the understanding of the etiology of peripartum cardiomyopathy and clear therapeutic approach in this condition predetermines the need to continue to collect clinical cases in order to elaborate an optimal therapeutic and diagnostic algorithm for this disease.
Obstetrics and Gynecology. 2016;(6):120-123
pages 120-123 views
pages 124-128 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies