No 12 (2016)

Objective. To carry out a systematic analysis of the data available in the current literature on states that can imitate preeclampsia, in the genesis of which pregnancy will play not a major role, but a trigger one. Material and methods. The review included the data of foreign and Russian papers published in the past 5 years and found in Pubmed on this topic. Results. The paper describes a differential diagnostic search between the different types of thrombotic microangiopathy (TMA), which can be induced by pregnancy since a correct diagnosis frequently affects life expectancy primarily in a mother and her child. Thrombotic thrombocytopenic purpura and atypical hemolytic-uremic syndrome are life-threatening conditions during pregnancy and require timely adequate treatment and further follow-up. HELLP-syndrome and preeclampsia have similar clinical characteristics. Conclusion. The main differences between preeclampsia and HELLP syndrome, on the one hand, and life-threatening conditions, such as atypical hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, and catastrophic antiphospholipid syndrome, on the other hand, are considered. An algorithm of diagnostic search for pregnancy-associated TMA is proposed, key differences determined, and therapeutic approaches approached.

Objective. To carry out a systematic analysis of the data available in the current literature on rhesus hemolytic disease of the fetus, the incidence and degree of the abnormality in relation to the Rh blood group of the mother and her intrauterine fetus and on treatments for this pathology. Material and methods. The review included the data of foreign and Russian papers published in the past 5-7 years and found in Pubmed on this topic. Results. The etiology and incidence of hemolytic disease of the fetus over the past years and its current treatments were described. Conclusion. It is necessary to conduct further investigations in the study of hemolytic disease of the fetus in immunology and gas homeostasis, in which answers to the existing questions can be concealed.

Objective. To carry out a systematic analysis of the data available in the literature on the problem of menstrual cycle disorders arising from psychological stress. Material and methods. For the analysis, foreign and Russian papers published in the past 15 years were sought in the international citation system Pubmed. Results. The current theories of the mechanism of psychogenic menstrual irregularities and the features of the latter developing due to psychological stress are described. Conclusion. The data of the studies demonstrating different stress sensitivity and characteristics of the personality structure in women who responded to stress as menstrual dysfunction were analyzed.

Objective. To study the expression of plasma microRNAs (has-mir-29b-3P, has-mir-34a-5p, has-mir-141-3p, and miR-376c) in preeclampsia (PE). Material and methods. 36 pregnant women were examined, by analyzing their clinical characteristics and investigating the expression of plasma microRNA. Results. There was a significant increase in the expression of three microRNAs: has-mir-29b-3p, has-mir-34a-5p, and has-mir-141-3p in the plasma of pregnant women with PE as compared to the control group. There were differences in the expression of miR-376c, but there was a high degree of variation in the expression level in the groups. The highest diagnostic accuracy ( 76.7%) was achieved with the simultaneous assessment of the expression level of the three m icroRNAs. Conclusion. The changes in the expression level of the investigated microRNAs are closely correlated with the development of PE. The quantification of plasma microRNA expression in the period after 30 weeks allows for the identification of pregnant women with PE with high accuracy.

Objective. To provide a rationale for the need for an individual approach to anticoagulant therapy (with low-molecular-weight heparins (LMWHs) in combination and without acetylsalicylic acid (ASA) and its laboratory monitoring in pregnant women with a complicated obstetric history to improve a pregnancy outcome. Subjects and methods. This investigation enrolled 58 patients with a complicated obstetric history. The patients were divided into 4 subgroups: 1) patients with a history of infertility; 2) those having a history of early miscarriage before 12 weeks’ gestation; 3) those with a history of late miscarriage at 12 to 22 weeks’ gestation; 4) those with a history of preterm birth at 22 to 36 weeks. At their inclusion in the investigation, all the patients were examined involving their genetic passport (thrombophilia, cardiac risk assessment), extended coagulogram, and thrombodynamics assay. The hemostastic system was monitored every 2 weeks. Results. ITGA2, ITGB3, and PAI-1 polymorphisms were found to be of high significance for pregnancy losses at different stages. Analysis of hemostatic parameters revealed that the late miscarriage group had signif icantly higher Vst in the thrombodynamics assay and the highest rate (33.3%) of spontaneous thrombosis, indicating a hypercoagulable state. The summing up of the results showed that there was successful birth in 24 (41.3%) patients and no pregnancy loss. Conclusion. The decision regarding antithrombotic therapy with LMWHs with or without ASA in the identification of a prothrombotic state should be individualized on the basis of a patient’s medical history (a personal obstetric or family history of thrombosis) and be guided by global hemostatic tests.

Objective. To determine the efficiency and possibility of temporary balloon occlusion of the common iliac arteries during organ-sparing surgery in patients with placenta accreta. Material and methods. The retrospective study analyzed the data available in the labor and delivery records of 34 patients with the placenta grown into the uterine scar after cesarean section. During delivery, all the patients underwent temporary balloon occlusion of the common iliac arteries after fetal expulsion. Results. The use of up-to-date technologies, such as temporary balloon occlusion of the common iliac arteries and instrumental autoerythrocyte reinfusion, allowed for organ-sparing surgery in all the examinees. The mean intraoperative blood loss was 1656±1042 ml; 20.6% of thepuerperas were recorded to have a minimal blood loss of400-700 ml. Postoperative complications were observed in 8.8% and were unassociated with angiosurgery. Conclusion. Temporary balloon occlusion of the common iliac arteries is an effective procedure to reduce blood loss during delivery in patients with placenta accreta and post-cesarean section uterine scar, permitting organ-sparing surgery. It can be recommended for use at third-level hospitals.

Objective. To analyze the possibilities of ultrasound diagnosis of placenta increta, to develop its reliable echographic signs in women with placenta previa, and to compare our obtained results with the data published in the literature. Subjects and methods. A total of 162 women with placenta previa and no placental migration were identified. All the pregnant women underwent an in-depth study using transabdominal, transvaginal echography and color Doppler mapping. The echography was performed at 7 to 39 weeks’ gestation once every 4 weeks and a study group was selected after only 28 weeks of pregnancy. Results. The echographic signs suggestive of placenta increta were established. Conclusion. Ultrasound examination in patients with placenta previa is a valuable tool and, in most cases, may not only suggest that placental tissue grows into the myometrium, but also exclude this abnormality.

Subject. Comparison of physico-chemical and biomedical properties of test specimens of mesh implants based on polydioxanone and polyglycolide, looking for application in gynecology and general surgery. Material and methods. In vitro evaluation of cytotoxicity of samples was performed using the MTT assay. Assessment of in vivo biocompatibility prosthesis was performed on outbred rats by simulating polnosloynogo defect of the anterior abdominal wall, which is sutured to the edges of polydioxanone and polyglycolic prosthesis. As a comparison group using the prosthesis on the basis of detsellyulyarizirovannoy dermis (Permacol). The animals were taken from the experiment 3, 10, 30 and 60 days after surgery. Was conducted macroscopic, tenziometricheskoe, morphometric, immunohistochemical and western blot studies. Results. The test prostheses do not possess cytotoxic properties, but in an in vivo experiment showed different intensity of adhesions, the speed and efficiency of integration with the surrounding tissues, preservation of the biomechanical properties of the severity of the inflammatory response. Conclusion. For some indicators of biocompatibility and efficacy of polydioxanone prosthesis was significantly better than prosthesis from polyglycolide and detsellyulyarizirovannoy dermis

Objective. To determine the factors influencing the colonization of a central venous catheter (CVC) and the clinical status of intensive care unit neonates, whose CVC is colonized with microorganisms. Subjects and methods. The neonates were divided into two groups: 1) neonates, whose catheter was colonized with opportunistic microorganisms and 2) those whose catheter after its removal showed no growth of microorganisms. The investigation assessed whether CVC colonization was present or absent and microbial species were identified. Results. 165 results of CVC cultures were analyzed in 112 newborns. The investigation has indicated that the most critical factor in increasing the risk for contamination of a CVC is the time of its insertion. The use of a CVC during a week or longer does not increase the rate of microbial colonization. Conclusion. The findings may lead to the conclusion that the prevention of catheter-related infections in neonates should lie in the selection of an adequate antiseptic for the processing of a surgical field, its adequate exposure and technique for aseptic CVC insertion by a medical staff.

Objective. To evaluate the efficiency of anti-anemia therapy in the prevention of placental insufficiency (PI) in the second trimester of pregnancy. Subjects and methods. The results of prevention and treatment of perinatal complications were analyzed in 40 pregnant women with anemia. The pathogenetically substantiated package of measures at 17-24 weeks of gestation included drug correction of fetoplacental homeostastic disorders in conjunction with anti-anemia treatment. Results. During treatment, Sideral Forte caused a significant (p < 0.001) increase in the level of hemoglobin from 80.3±1.3 to 114.3±1.8g/l and red blood cells from 3.2±0.41012/l to 4.1±0.31012/l. There was a significant rise in serum iron levels (from 12.5±1.5 to 17.4±1.3 μmol/l) and a substantial ferritin increment that is only possible at the least speed of hemoglobin increases. Thus, the assessment of iron depots by serum ferritin concentrations ascertained that the administration of Sideral Forte increased iron stores. The treatment-induced increment in serum ferritin levels tended to exceed from 32.3±1.2 to 34.5±1.5 μg/l. Conclusion. The high frequency of pregnancy complications makes the early diagnosis and prediction of iron deficiency anemia (IDA), its timely and efficient prevention and treatment extremely relevant. The use of Sideral Forte at a dose of one capsule (30 mg of iron) per day for the treatment of IDA in the complex correction of PI allows achievng not only normalization of iron levels and improvement of quality of life in pregnant women, but also a reducton in the incidence of obstetric and perinatal complications.

Objective. To determine the detection rate of M. hominis, U. urealyticum, and U. parvum in patients with clinical and/or laboratory signs of inflammatory processes in the urogenital tract and in clinically healthy individuals; to study the indicators of antibiotic susceptibility of genital mycoplasma isolates. Subjects and methods. 409 patients, in whom a polymerase chain reaction and culture identified genital mycoplasmas, were examined. The susceptibility of the isolates to doxycycline, josamycin, tetracycline, ofloxacin, clindamycin, azithromycin, and erythromycin was studied. Results. U. urealyticum as monoinfection (n = 78; 39.6%) and association with U. parvum (n = 43; 21.8%) and M. hominis (n = 32; 16.2%) was significantly more frequently found in the patients with inflammatory diseases of the urogenital system than in the clinically healthy individuals (n = 10; 4.7%, n = 20; 9.4%, and n = 12; 5.7%, respectively). In male patients, the infectious inflammatory process manifested as urethritis; the pattern of genital mycoplasmas was characterized by a preponderance of U. urealyticum (46.9%), including that in association with U. parvum (31.25%). In female patients, U. urealyticum significantly prevailed over the other Mycoplasma species and were detected in 37.5% of patients with vaginitis, in 47.6% of those with cervicitis, and in 37.2% of those with vaginitis concurrent with urethritis or cervicitis (p<0.05). Infection with U. urealyticum, including that in association with U. parvum was more commonly accompanied by a high leukocyte reaction (52.4-74.3%; p < 0.05) than infection with M. hominis and U. parvum. Ureaplasma and M. hominis demonstrated a low level of antimicrobial resistance to doxycycline (2.8% and 3.4%, respectively), josamycin (7.8% and 5.1%), tetracycline (9.2% and 5.1%) and a high rate of resistance to erythromycin (75.2% and 71.4%, respectively), azithromycin (64.2% and 62.8%) and clindamycin (70.2% and 69.1%). Conclusion. In this study, U. urealyticum as monoinfection and in association with U. parvum was the most clinically significant etiologic agent in the development of infectious inflammatory diseases of the genitourinary system. The high susceptibility of genital mycoplasmas to doxycycline, josamycin, and tetracycline determines the possibility of their use in the therapy of urogen ital tract diseases caused by genital mycoplasmas.

Background. When describing the etiological factors of the development of endometrial hyperplastic processes (EHP), the authors emphasize the importance of various viral infections. In this regard, the data on EHP in patients with chronic hepatitis C (CHC) are interesting. Description. The paper gives a clinical case of recurrent EHP in a reproductive-aged patient with CHC. The specific feature of the case is the detection of hepatitis C virus genome in endometrial tissue in moderate viremia. Virological study of endometrial tissue was performed by PCR using the Russian reagent kits: AmpliSens HCV/ HBV/HIV-FL, AmpliSens HCV-monitor-FL, and AmpliSens HIV-monitor-FRT. Antiviral therapy (AVT) normalized the endometrial structure. Conclusion. Virological examination of the endometrium and AVT should be performed in reproductive-aged patients with recurrent EHP in the presence of CHC.