No 8 (2016)

Objective. To highlight the problem of iron def iciency anemia in obstetric and gynecological practice. Material and methods. The review included the data of foreign and Russian articles on this topic and those of guidelines and orders for the treatment of patients with iron deficiency anemia. Results. Approaches to treating patients with this pathology are described in relation to the severity of the condition, by using current agents. Conclusion. Search for novel pathogenetically sound treatments and wide introduction of current blood-sparing technologies during obstetric and gynecological surgery will be able to reduce the rate of complications, such as anemia, and to improve quality of life in patients and perinatal indicators.

Objective. To evaluate the efficiency of a noninvasive prenatal test (NIPT) to identify chromosomal anomalies in maternal blood samples. Material and methods. The review included the data of foreign and Russian articles published in the past 15 years and found in Pubmed on this topic. Results. This review gives the results of recent studies determining the sensitivity, specificity, and accuracy of the noninvasive prenatal DNA test versus conventional screening techniques for pregnant women. It sets forth leading obstetric societies’ viewpoints about the place of this screening technique in prenatal testing. Conclusion. NIPT is a promising prenatal screening technique for its clinical introduction, by complying with the legal norms.

Objective. To improve obstetric outcomes by reducing the rates of preterm birth (before 34.0 weeks of gestation) through the prophylactic use of natural progesterone at a dose of 200 mg daily vaginally at 19-34 weeks’ gestation in women at high risk for preterm birth compared with its population-based rate in this category of pregnant women. To improve neonatal outcomes and to correspondingly reduce total neonatal mortality and morbidity rates compared to population-based rates. Subjects and methods. The international multicenter open-label clinical trial was conducted to study the efficacy of vaginal progesterone in the prevention of preterm birth (Phase III), by involving asymptomatic women, women with singleton pregnancy, with ultrasound signs of cervical shortening (10 to 25 mm) at 18-236/7 weeks’ gestation (Group I; n = 110) and/or having a history of preterm birth (Group II; n = 110). The women were daily given vaginal Utrogestan from 18-236/7 to 336/7 weeks’ gestation or spontaneous termination of pregnancy. Results. The study demonstrated a statistically significant reduction in preterm birth rates at < 34 weeks’ gestation to 5.5% (95 CI 2.6-11.5) (P = 0.003) in women with a sonographic short cervix uteri and to 6.4% (95% CI3.1-12.6) (P = 0.0028) in pregnant women with a history of preterm birth - 5.9% (95% CI 3.5-9.9) (P = 0.000013) as compared to the rates given in the literature. Conclusion. The findings have led to the conclusion that 200-mg micronized vaginal progesterone capsules are effective in reducing the risk of miscarriage at less than 34 weeks of gestation in pregnant women with no clinical signs of threatened abortion, but with premature birth or preterm amniorrhea before 37 weeks of pregnancy in their history or with a short cervix identified by transvaginal ultrasound at 18-20 weeks.

Objective. To determine the serum concentrations of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and soluble VEGF receptor 1 (sVEGF-R1) in pregnant women with physiological pregnancy. Subjects and methods. A prospective cohort study was conducted in 114 women with physiological pregnancy. The factors were controlled at 11-13, 22-24, and 32-34 weeks’ gestation. The levels of VEGF was determined by an enzyme immunoassay and those of sVEGF-R1 by an electrochemiluminiscence immunoassay. Results. There was a rise in the concentration of PlGF with longer gestation. The level of PlGF was 51.9±7.2 and 481.3±27.3 pg/ml at 11-13 and 32-34 weeks’ gestation, respectively. That of VEGF increased from the first to the second trimester of pregnancy and decreased by 32-34 weeks’ gestation. The concentration of sVEGF-R1 remained relatively stable in the first and the second trimester of pregnancy (1991.6±30.7and 1980.7±27.7 pg/ml, respectively). At 32-34 weeks’ gestation, there was an increase in the indicator up to 2266.5±51.3pg/ml. Conclusion. The findings demonstrate the process of physiological angiogenesis and the investigation used in our descriptive study should be regarded as a diagnostic procedure in the examination of women at risk for vascular events.

Objective. To comparatively analyze the miRNA expression profile in the placental and peripheral plasma samples from pregnant women with physiological pregnancy and preeclampsia. Material and methods. The investigators used a miRNA deep sequencing technique (HiSeq 2000, Illumina) in the placental and plasma samples from apparently healthy women and pregnant women with early and late preeclampsia and then validated the findings by a real-time quantitative PCR assay (StepOnePlus™). Results. There was a significant decrease in the expression of hsa-miR-532-5p, -423-5p, -127-3p, -376a-5p, -539-5p, and -519a-3p in the placenta and a significant increase in that of hsa-miR-423-5p and -519a-3p in the plasma of pregnant women with preeclampsia by more than twice. An association was first found between the change in the expression of the above miRNAs and the presence of preeclampsia in pregnant women, exclusive of miR-519a-3p, the changed transcriptional profile of which had been already demonstrated in preeclampsia. The application of the logistic regression model constructed using the data of the investigations showed that the risk of early preeclampsia increased with higher miR-423-5p expression levels in the plasma of pregnant women. This observation may become the basis for the testing system through screening pregnant women for the early diagnosis of preeclampsia until the disease shows its clinical manifestation. Conclusion. The found miRNAs are potentially regulators of the signaling pathways that are involved in ovarian folliculogenesis and steroidogenesis; in antigen processing and presentation; in endometrial decidualization and maintenance of early pregnancy; in graft-versus-host disease; in the development of an autoimmune disease; in cell migration and invasion, in focal adhesion and regulation of the actin cytoskeleton; in intracellular calcium transport and calcium-dependent reactions; in complement activation and blood coagulation; in aldosterone-regulated sodium reabsorption; in the renin-angiotensin system, as well as in p53- and prohibitin-mediated cellular apoptosis, which is as a whole within the general notion that these signaling pathways are implicated in the pathogenesis of preeclampsia.

Objective. To investigate changes in the tissues of a scar and uterus in rats and to establish whether there may be spontaneous labor after ligation of the uterine horns, followed by the administration of multicomponent mesenchymal stromal cells ((MSCs) into these areas in order to prove the principal possibility of improving scar repair and the feasibility of reducing the rate of cesarean section in patients with the uterus operated on. Material and methods. The investigators determined whether pregnancy and delivery might occur in 66 laboratory Wistar rats with a myometrial scar and also explored tissue changes after use of multicomponent MSCs with the GFP transgene when simulating hydrometra in 170 inbred Wag rats. Results. After injecting multicomponent MSCs into the uterine scar, the latter showed a larger number of de novo formed vessels with the participation of the administered cells. Multicomponent MSCs were used to construct entire vascular walls or their individual elements. After application of multicomponent MSCs, the animals began to parturiate by 2 estrous cycles earlier; the proportion of parturient rats in this group was higher; they had more both a total number of broods and the maximal number of infant rats than the animals that had not received cell technologies. The animal mortality after use of multicomponent MSCs was, on the contrary, lower. Conclusion. Following administration of muticomponent MSCs, there is a clear trend towards acceleration of reparative processes in the rat uterus with a change in its scar.

Objective. To investigate the effect of blood vitamin D levels on embryo implantation and efficiency of assisted reproductive technology (ART) programs. Subjects and methods. The investigation enrolled 201 patients who met the inclusion criteria. The women were divided into 2 groups according to treatment options: A) 201 patients who had been treated by in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) and superovulation and embryo transfer in this cycle; B) 111 patients in whom pregnancy had not occurred in the stimulated cycle and they continued to be treated with cryopreserved/thawed embryo transfer. Serum 25-hydroxyvitamin D (25-OH D) levels were determined in all the patients. According to vitamin D levels, the women were divided into 3 subgroups: 1) blood vitamin D deficiency (< 10 ng/ml); 2) inadequate blood levels of vitamin D (10-29 ng/ml); 3) its normal blood levels (30-100 ng/ml). Results. In stimulated cycles, embryo implantation and clinical pregnancy occurred in 10 (35.7%) patients in Subgroup 1 with 25-OH D deficiency, in 41 (29.7%) in Subgroup 2, and in 9 (25.7%) in Subgroup 3. In natural-cycle cryopreserved-thawed embryo transfer, pregnancy occurred in 5 (38.5%) patients in Subgroup 1, in 40 (53.3%) in Subgroup 2, and in 17 (73.9%) in Subgroup 3. In unstimulated-cycle cryopreserved-thawed embryo transfer, there was a direct correlation of normal blood vitamin D levels with the higher efficiency in ART programs, i.e. the highest clinical pregnancy rate was observed in the normal vitamin D level group. Conclusion. In unstimulated-cycle cryopreserved-thawed embryo transfer, the normal blood vitamin D level was associated with successful implantation and higher clinical pregnancy rates.

Objective. To investigate the rate and pattern of chromosome abnormalities in embryos from married couples with male factor infertility and mutation in AZF locus of the Y chromosome; to comparatively evaluate the efficiency of assisted reproductive technologies (ART) in this group of patients with and without preimplantation genetic diagnosis (PGD). Subjects and methods. The prospective clinical trial included 46 married couples with mutations in AZF locus of the Y chromosome in men and with normal karyotypes of couples who needed an in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) program. A study group consisted of 24 married couples who underwent 41 IVF/ICSI cycles with PGD of embryos. A comparison group comprised 22 married couples who underwent 39 IVF/ICSI cycles without PGD. Preimplantation genetic analysis was carried out by a fluorescent in situ hybridization (FISH) technique (using probes (Abbott) for chromosomes X, Y, 13, 18, and 21) on day 3 of embryo culture. In the study group, female embryos without abnormalities in the study chromosomes were selected to be transferred to the uterus. Nonparametric methods (Mann-Whitney test) and chi-square test were used for the statistical analysis of the data. Results. The results of PGD in married couples with mutation in AZF locus of the Y chromosome showed that the level of aneuploidy in the embryo blastomere nuclei was 59.7%. Gonosomal aneuploidies (43.4%) and chromosome 18 pathology (32.1%) were most common. Comparative analysis of IVF/ICSI programs in the study groups revealed no statistically significant differences in implantation rate and clinical pregnancy rate per stimulated cycle and per embryo transfer. However, the rate of reproductive losses in the non-PGD group was 7 times higher than that in the PGD group, accounting for 88.9% versus 12.5% (p = 0.007). The live birth rate per embryo transfer cycle was 8 times greater in the PGD group than that in the non-PGD group, amounting to 22.6 and 2.9%, respectively (p = 0.014). Conclusion. The married couples with male factor infertility and mutation in AZF locus of the Y chromosome in men form a group at risk of having a miscarriage and giving birth to babies with chromosome abnormalities, which needs treatment strategies for infertility to be individualized in these patients. To enhance the efficiency of ART programs in this patient group, it is expedient to make a preimplantation genetic screening and an analysis of the full spectrum of chromosomes in embryos.

Background. As of now, progress in therapy has frequently made it possible to plan pregnancy and safe childbirth in women with different hematological diseases. Myelodysplastic syndrome (MDS) is a group of severe clonal hematopoietic diseases that are most common in the old age group. Pregnancy in patients with MDS is extremely rare and associated with an increased risk of both maternal and fetal complications. Case report. The paper describes a case of successful pregnancy and childbirth in a 30-year-old patient with partial remission of refractory anemia with excess of blasts. Conclusion. Adequate initial therapy for the underlying disease, planning, and careful interdisciplinary follow-up throughout the gestation has promoted a favorable pregnancy outcome.

Background. According to the world and Russian literature, the detection rate of an intravaginal foreign body (IVFB) among patients with long-term abnormal vaginal discharge is 4-10%. There are single reports on a longstanding INFB in girls. Case report. The paper describes a clinical case of a 12-year-old girl with a 9-year history of IVFB unrecognized during multiple local examinations. Thepreclinical diagnosis was established when the girl attended the Research Center of Obstetrics, Gynecology, and Perinatology on the basis on the data of objective examination, small pelvic ultrasonography, and retrospective analysis of presented magnetic resonance mage findings. A foreign body (a felt-tip pen cap) was removed in the inpatient setting. Conclusion. Recurrent, intractable purulent or bloody vaginal discharge in prepubescent girls requires that vaginoscopy should rule out an IVFB.