No 11 (2016)

Objective. To provide an update on the relationship between the inherited characteristics of energy metabolism and the development of placental insufficiency with an outcome to intrauterine growth restriction (IUGR). Material and methods. Available literature sources published in the databases Medline, PubMed, and others were sought. 70 sources dealing with the study of a relationship between the gene polymorphisms of energy metabolism and the development of IUGR were found; 35 of them were included in this review. Results. The concepts of the role of mitochondrial DNA, as well as the polymorphisms of nuclear steroid receptors of the peroxisome proliferator-activated receptor (PPAR) family, which are responsible for energy metabolism in the development of IUGR were outlined. The data on a mitochondrial dysfunction biomarker and chronic tissue hypoxia were given. The major subtypes of nuclear steroid receptors of the family PPAR:PPARA-α (alpha), PPAR-δ (delta) or -β (beta), PPARG-γ (gamma) and their importance in the development of the placental complex were also presented. Conclusion. Further studies of inherited risk factors may give a key to understanding the primary cause of IUGR. To identify patients with genetically determined anomalies of cellular metabolism will be able to predict placental insufficiency with an outcome to IUGR during early gestational periods. All will ultimately lead to better perinatal outcomes.

Objective. To carry out a literature review on the use of elastography in obstetrics to investigate the capabilities of this technique for uterine scar evaluation. Material and methods. A systematic review of the literature published in 2011 to 2016 was carried out searching with the use of key words. Results. Among 25 publications dealing with elastography used in obstetric and gynecologic practice, there was one publication on the assessment of tissues in the uterine scar region after cesarean section in the second trimester of pregnancy, one publication on the study of myometrial elasticity during labor, and 19 publications on the examination of the elastic properties of cervical tissues. Conclusion. This technique may be useful in estimating the functional capacity of tissues in the uterine scar region after cesarean section; however, more extensive investigations are required.

Objective. To carry out a systematic analysis of the data available in modern literature on the causes of repeated implantation failures in an in vitro fertilization (IVF) program and terminology definitions. Material and methods. The review included the data of foreign and Russian papers published in the past 10 years and found through Pubmed on this topic. Results. The possible causes of repeated implantation failures in an IVF program and terminology definitions were described. Conclusion. The molecular biology of gametes and embryos and the mRNA gene expression of endometrial receptivity markers in patients with repeated implantation failures require further investigations. To adopt a uniform terminology and to clarify the prognostic role of each factor (gametes, embryos, and endometrium) will determine tactics to overcome repeated implantation failures in the ART cycles.

Objective. To analyze the data available in the literature on the role of endometriosis in the development and progression of tumors. Material and methods. There is information on the incidence of malignant tumors in women with endometriosis and on the detection rate of the latter in ovarian cancer. Results. The presence of endometriotic foci increases the risk of malignant tumors at various sites, mainly in the ovaries. There are data on the risk of various histological forms of ovarian cancer in patients with endometriosis and the latter is shown to cause clear-cell and endometrioid carcinomas. The major pathways for malignant transformation of endometriotic foci are noted to be genomic disorders, gene mutations, and changes in the expression of growth factors, as well as impaired cell proliferation and apoptosis. Conclusion. Most investigators support the concept of the pro-oncogenic effect of endometriosis.

Objective. To investigate the degree of abnormalities, by analyzing the course of pregnancy, delivery, and perinatal outcomes in women with accelerated labor. Subjects and methods. The investigation enrolled 180 women whose pregnancy had ended with a nonsurgical term delivery at 37- 41 weeks of gestation. 140 patients whose labor had been accelerated formed a study group (Group I). The other 40 women had a normal duration of childbirth and were assigned to a comparison group (Group II). According to the presence of perinatal complications, Group 1 women were divided into two subgroups IA and IB. Subgroup IA included women without complications seen in the mother and fetus (n = 56). The inclusion criteria in Subgroup IB (n = 84) were excessive blood loss during childbirth, acute intrapartum hypoxia, soft tissue injuries of the maternal passages, and postpartum and early neonatal complications of any origin. Questionnaires were used to study the characteristics of personal and family histories. The maturity of the cervix uteri was estimated using the scale described by Bishop in 1964. The characteristics of uterine contractility were assessed by singlechannel hysterography on an Avalon FM-300 machine (Phillips); a signal was recorded in real time. The WHO partograph (1987) was employed to monitor labor and cervical dilation. The neonatal status was assessed on the basis of clinical observations and instrumental and laboratory findings. Results. The women in study group had a high incidence of cardiovascular and gastrointestinal diseases. In the women from the study group there was a set of several signs of a nondifferential connective tissue dysplasia (NCTD) in 72% (12,5% - in comparison group) and the severity of this abnormality was significantly higher than that in the comparison group. The women in the comparison group had a set of several signs of NCTD only in 12.5% of cases and the severity of symptoms was quite low. In the study group, their family histories were characterized by the high rate of accelerated labor in the relatives in a matrilineal line. The current pregnancy in the study group women was complicated by many and different diseases. In the pattern of the diseases, there was a predominance of infectious diseases mainly in the lower genital tract. In 98.6% of the cases the labor activity was not hyperergic, accelerated labor was due to the high cervical dilation rate. The high frequency of occurrence of maternal passage soft tissue damages and uterine subinvolution was noted among the postpartum complications. The early neonatal diseases were mainly cerebral disorders and hemorrhagic syndrome. Conclusion. In 98% of cases, accelerated labor was caused by rapid cervical dilation in the presence of normergic uterine contractions. Abnormal maternal and fetal outcomes are not related to the nature of labor, but are due to infectious diseases in the mother, which complicate her medical history and current pregnancy.

Objective. To study the pattern of expression of heparanase-1 (HPSE-1) and its substrate heparan sulfate (HSP) in the eutopic and heterotopic endometrium of reproductive-aged women with adenomyosis and leiomyomatosis in relation to the volume of the corpus uteri. Subjects and methods. An immunohistochemical study of the expression of HPSE-1 and HSP in the intraoperative specimens obtained from 48patients was performed. Results. If the volume of the corpus uteri was less or more than 12 weeks, the eutopic endometrium during the proliferative phase of the cycle showed a minimal HPSE expression level in single stromal cells. In the foci of adenomyosis, HPSE-1 was expressed in the epithelium and subepithelial microvessels, negatively correlating with the expression of HSP; in the patients with a uterine corpus volume of more than 12 weeks, the expression of HPSE-1 was much higher than in the patients with that of less than 12 weeks (p < 0.001). Conclusion. Enhanced HPSE-1 activity in the heterotopic endometrium was combined with progressive leimyomatosis and may facilitate endometrial invasion into the myometrium to develop adenomyosis.

Objective. To investigate associations of NOS3 and ESR1 gene polymorphisms in girls born with intrauterine growth restriction (IUGR) who suffer from abnormal uterine bleeding of puberty (AUBP). Subjects and methods. Examinations were made in 96 adolescent girls suffering from menarche in AUBP, including 32 girls born at term with IUGR, 37girls born with normal weight, and 27 healthy girls. A real-time PCR assay was used to study the single-allele polymorphisms NOS3 786T>C, 894G>T and ESR1351A>G, and 397T>C. Results. The girls suffering from AUBP born with IUGR were more often found to be carriers of the polymorphic C allele of NOS3 786T>C (OR = 2.03; 95% CI, 1.12-3.68 for homozygotes; p = 0.04; OR = 1.68; 95% CI, 1.09-2.60;p = 0.046for heterozygotes) and ESR1 Pvull CCgenotype (OR = 4. 58; 95% CI, 0.97-21.68;p = 0.04). Conclusion. Intrauterinally programmable endothelial dysfunction syndrome may be of importance in developing AUBP in girls born with IUGR.

Objective. To analyze the data available in the literature on sanatorium-spa treatment in women with high-risk pregnancy. Material and methods. A search was made in the database PubMed containing open-access Russian publications in the past 15 years. Results. The article analyzes the interim results of sanatorium-spa treatment in women with high-risk pregnancy in 2006-2009, the present state of this issue, indications for and contraindications to sanatorium-spa treatment and possibilities for using natural and preformed physical factors in pregnant women. Conclusion. The paper shows the expediency of the therapeutic and prophylactic activities of sanatoria intended to work with pregnant women and the importance of this treatment in preserving the health of future mothers and their offspring.

Objective. To improve the quality of informing and counselling patients before pregnancy termination and to assess physicians’ satisfaction with the content of audio-video presentations on standard questions given prior to abortion. Subjects and methods. This was a multicenter prospective simple cohort controlled study. Information on test questions was collected using specially designed 20-item questionnaires for physicians. The investigators analyzed 92 questionnaires, including 62 ones that contained information on patients who had listened to the audio-video before pregnancy termination (a study group) and 30 ones having on those who had obtained only oral information from a physician. Results. 40% (12/30) of the patients who had obtained only a physician’s oral information prior to abortion called their physician between the administration of mifepristone and the control visit versus 3.2% (2/62) of those who had listened to the audio-video did this 12 times less frequently (p < 0.001). An additional visit was made by 13.3% (4/30) of the patients on their own initiative without having any evidence for this (only two of them had any complications) and by 3.2% (2/62) of those in the study group (by 4 times less frequently). On the contrary, the number of patients who had not made a control visit on the scheduled day was 23.3% (7/30) and 9.7% (6/62), respectively; that was 2.4 times less frequently (p < 0.005). Regardless of its form, counselling prior to abortion caused a high frequency of contraception choice (96.8% (60/62) in the study group and 86.7% (26/30) in the control group). Conclusion. The quality of pre-abortion information with the use of audio-video presentations on modern gadgets corresponds to the high assessments by physicians and allows them to improve the consultation process, which is accompanied by the optimization of working time, by reducing the latter to provide the information and decreasing the number of phone calls and unscheduled visits.

Objective. To investigate the efficacy of clindacin B prolong used to treat bacterial vaginosis (BV) concurrent with vulvovaginal candidiasis in nonpregnant reproductive-aged women. Subjects and methods. The investigation enrolled 30 patients aged 18 to 50years (mean age, 27.9±1.6 years) with BV concurrent with vulvovaginal candidiasis. After the disease was verified, all the patients received antibacterial therapy with clindacin B prolong at an intravaginal dose of 5.0 g overnight for 3 days. Results. Most of the women had a history of gynecological infectious diseases. The main complaints of the patients were white or gray vaginal discharge often with unpleasant odor. The vaginal pH value rose above 4.5 in all the cases. A total of 74 strains of strict anaerobic and aerobic microorganisms were isolated. 28 (93.3%) patients achieved clinical and etiological cure after treatment. Conclusion. The clinical efficacy of clindacin B prolong used to treat BV concurrent with vulvovaginal candidiasis in nonpregnant reproductive-aged women was 93.3%.

Objective. To carry out a systematic analysis of the data available in modern literature on the choice of hormonal contraception, by taking into account the safety and individual needs of women. Material and methods. The review included the data of foreign and Russian papers published in the past 15years and found in Pubmed on this topic. Results. The paper presents an update on the reasoned choice of hormonal contraception for reproductive-aged and premenopausal women. Conclusion. When choosing a contraceptive, one must take into account not only its safety and efficacy, but also individual needs and additional benefits.