No 4 (2017)

Objective. The review highlights the issues associated with a study of the role of genetic components in recurrent miscarriage (RM) susceptibility through generalized quantitative analysis of data. Material and methods. The review includes the results of foreign and Russian meta-analyses published in the past 10 years and found in the Pubmed database on this topic. Results. The data obtained from the meta-analyses of studies of an association of allelic variants of candidate genes with RM were generalized and the functional signif icance of a number of associated polymorphic markers was characterized. Consideration of the ethnicity of individuals was shown to be important in studying the role of genetic factors in the development of this disease, as well as gene-gene and gene-environmental interactions. Conclusion. Creation of a future database including the results of associative studies with a detailed description of their design (detailed clinical characteristics of the examinees; criteria for group formations; patient ethnicity) will provide statistically significant evidence for the role of genetic components in the structure of RM susceptibility.

Objective. To carry out a systematic analysis of the data available in the current Russian and foreign literature on a change in the level of various autoantibodies (autoAb) in the development of preeclampsia and on the possibility of its diagnostic use. Material and methods. The investigations included data from the Russian and foreign publications appearing during the past 15 years. Results. The results of clinical and immunological analyses suggest that one of the direct pathogenetic factors in the development of preeclampsia may be an abnormal decrease in the production of many autoAbs. Thus, the study of autoAbs is an additional reliable method to diagnose preeclampsia. Conclusion. Further immunological investigations are needed to understand the significance of autoAbs in the pathogenesis of preeclampsia.

Objective. To formulate the management concept for deeply infiltrating endometriosis. Material and methods. The literature data available in the Pubmed search database and the results of the authors’ own clinical observations during 2010-2016 were analyzed. Results. The paper shows a general surgeon’s role in the surgical treatment of infiltrating endometriosis. It highlights the clinical manifestations of common forms of endometriosis; preoperative examination to detect visceral lesions; surgical access and volume in view of a multidisciplinary approach; and types of possible postoperative complications. Conclusion. Involvement of multidisciplinary groups in the examination and surgical treatment is justified by clinical and economic results and will provide a way to use radical and least invasive techniques in combination with an individual approach.

Objective. To determine diagnostic significance of combined evaluation of malondialdehyde level and catalase activity in the blood of pregnant women with threat and/or onset of preterm labor. Subject and methods. The study involved 112 women 18 to 40 years old. Group I - 36 pregnant women with delivery between 22 to 36 weeks of gestation and within 7days after the examination. Group II included 42 women with threatened preterm labor and subsequent delivery at term. Group III - 34 generally healthy pregnant women delivered at term. Spectrophotometric method was used to measure level of malondialdehyde (MDA) as a marker of lipid peroxidation and catalase enzymatic activity in maternal peripheral blood. Results. It was shown that the enzymatic activity of catalase in plasma of women with realized preterm labor and women with threatedpreterm delivery with subsequent pregnancy retention was increased in comparison to control group. The same time at 28-32 weeks of gestation the quantity of women with catalase activity higher than 150 U/ ml was significantly higher in group of women with threated preterm delivery with subsequent pregnancy retention then in early delivered women. The concentration of MDA in plasma of women with realized preterm labor at 22-27 weeks of gestation was significantly higher in comparison with control group. At term of 28-32 weeks the same tendency was observed but the difference was not significant. No significant difference in MDA level was observed between women with threated preterm delivery and subsequent delivery at term and control group. Conclusion. The main finding of the study is that in pregnant women there are some systemic compensatory reactions intended to decrease the level of reactive oxygen species production by catalase in the situation of threated preliminary labor. Catalase activity reduction in the blood of pregnant women with realized preliminary labor can indicate the disturbances in reactive oxygen species production system as a result of mother and placenta adaptive resources attenuation. Thus, elevated level of MDA at 22-27 weeks of gestation and decreased activity of catalase at 28-32 weeks of gestation may be negative prognostic factors in the case of preterm labor threat.

Objective. To justify the diagnostic and prognostic value of the serum levels of placental growth factor (PIGF), platelet-derived growth factor (PDGF-BB), and vascular endothelial growth factor (VEGF-A) in women with infertility and/or miscarriage due to chronic endometritis. Subjects and methods. A comprehensive examination was made in 88 women who were divided into the following clinical groups: 1) 28 women with recurrent pregnancy loss and morphologically and immunohistochemically confirmed chronic endometritis; 2) 36 infertile patients with chronic endometritis; 3) 24 women with male factor infertility and unchanged endometrial structure (a control group). The investigators performed clinical (history data collection, general and gynecological examinations) and ultrasound studies on days 15-22 of the menstrual cycle, aspiration and Pipelle biopsies of the endometrium on days 7-11 of the menstrual cycle, and enzyme immunoassay of serum PlGF, PDGF-BB, and VEGF-A levels. Results. PlGF and VEGF were increased and PDGF-BB was decreased in the serum of the women in Groups 1 and 2. Conclusion. The above results can be used in clinical practice. The determination of PIGF and VEGF-A levels is one of the promising methods for evaluating the endometrium.

Objective. To determine changes of the cervicovaginal fluid proteomic composition for assessment of the severity of HPV-associated cervical lesions among women of reproductive age. Subject and methods. The study involved 30 volunteers with various forms of HPV-associated cervical lesions (ASCUS, LSIL and HSIL). All samples of cervicovaginal fluid were prepared for further proteomic analysis by tandem mass spectrometry (HPLC-MS/MS). Semi-quantitative data analysis including identification and annotation of proteins was carried out using the software package MaxQuant and Perseus. Results. The protein panels specific to the various forms of HPV-associated cervical lesions (ASCUS, LSIL and HSIL) were identified. The first group of proteins (P4HB, HSPA8, C4BPA and others) characterized the early changes associated with HPV infection and cervical epithelium lesion, including viruspenetration into the cell and its transcription, impaired function of the complement system. The second group of proteins (PRDX5, YWHAE, LRG1 and others) were directly involved in the development and progression of cervical neoplasia and characterized late changes, in particular, reduced apoptosis, impaired differentiation and maturation of the epithelium, and the transformation of atypical cells. Conclusion. The analysis of the proteome of the CVH allows to study the molecular mechanisms of the pathogenesis of HPV-associated cervical diseases and to differentiate epithelial changes at early stages of development.

Objective. To investigate the efficiency of neoadjuvant chemotherapy in combination with laparoscopic radical hysterectomy in the combination treatment of patients with locally advanced cervical cancer. Subjects and methods. The results of examining 81 patients with locally advanced cervical cancer who had received combination treatment involving neoadjuvant chemotherapy and surgical treatment are given. Results. Following neoadjuvant chemotherapy, radical hysterectomy was performed in 75 (92.6%) patients. The surgical interventions via laparoscopic and laparotomic accesses were comparatively analyzed and yielded the similar results.

Objective. To rationalize the diagnosis of acute salpingoophoritis by the informative indicators of oxidative and antioxidative systems. Subjects and methods. These indicators were investigated using appropriate methods in 132 patients with acute salpingoophoritis and in 117healthy women; and their informative value was calculated according to V.M. Gubler. Results. The highest informative value was established for malondialdehyde, diene conjugates, superoxide dismutase, and glutathione peroxidase. Conclusion. The determination of the above indicators allows one to more rationally diagnose acute salpingoophoritis.

Objective. To determine the frequency of aerobic vaginitis and the etiological pattern of vaginal biotope impairments in reproductive-aged women. Subjects and methods. A retrospective study included an analysis of medical records in 122 outpatients aged 18-48 years, who had sought medical advice for lower genital tract biocenosis at the Medical Center, Peoples’ Friendship University of Russia, in 2011 to 2016. After sexually transmitted infections and acute viral infections were ruled out in the women, a comprehensive microbiological study of vaginal discharge encompassing microscopy of its Gram-stained smears, parallel inoculation onto culture media, such as blood agar, Endo agar, Saburo agar, etc. (University Medical Center Laboratory), and a PCR assay (Independent Laboratory, Moscow) was conducted to characterize the vaginal microbiota. Results. Aerobic vaginitis as a nosological entity with signs of a vaginal inflammatory process and a high bacterial pathogen titer was identified in 63 (51.9%) women of reproductive age. Normal biocenosis was found in 17(13.9%) women; bacterial vaginosis in 34 (27.9%). Fungi of the genus Candida were described in 36 (29.5%) smears of all the specimens and in more than one third (n = 24 (38.1%)) of the vaginal smears with aerobic vaginitis; isolated vulvovaginal candidiasis was seen in 8 (6.6%) women. There was aerobic vaginitis only in 19 (15.6%) women or that concurrent with bacterial vaginosis in 20 (16.4%) or with vulvovaginal candidiasis in 19 (15.6%). Conclusion. This investigation made it possible to concretize the etiological pattern of impaired vaginal biocenosis in reproductive-aged women, to clarify the role of aerobic and facultative anaerobic bacteria, and to determine the frequency of mixed infections. By taking into account the data available in the literature on complex, not fully understood mechanisms for a relationship between causative agents, which are frequently underestimated and lead to a recurrent course, it is appropriate to perform etiotropic therapy of both anaerobes and aerobes, their combination (Clindamycin) and other mixed infections: aerobes/anaerobes and fungi of the genus Candida (Clindamycin + Butoconazole).

Objective. To determine the level of emergency contraception awareness among physicians of different specialties. Subjects and methods. A specially designed questionnaire was given to medical students trained in their specialty and according to training programs and placed on social network sites on the specialized portal “Doctors of the Russian Federation”. The group is a simple random sample. 375 physicians (obstetricians/gynecologists, therapists, and surgeons) (305 women, 70 men) participated in the investigation. Results. Among the survey participants, every two (49%) women used emergency contraception; two-thirds (63%) of them had it repeatedly. 84% of the physicians do not object to the use of postcoital contraceptive pills; almost all (about 95%) women are familiar with levonorgestrel-containing drugs and their regimens. No more than two-thirds of the specialists in various disciplines are well informed of the efficiency of emergency contraception. Only one-third of the practicing obstetricians/gynecologists have sufficient knowledge of the safe use of postcoital contraceptive pills. Overall, nearly two-thirds of the obstetricians/gynecologists and about 85-90% of the physicians of other specialties have insufficient knowledge about emergency contraception. Conclusion. It is necessary to train physicians of different specialties to enhance the level of knowledge about emergency contraception.

Objective. To make a critical review of international and federal clinical guidelines for the diagnosis and treatment of hyperprolactinemia. Subjects and methods. The recent clinical guidelines of the American Society of Endocrinology and the Russian Association of Endocrinologists, as well as the data of foreign and Russian articles on hyperprolactinemia, published in the past 7years and found in Pubmed, were used. Results. Indications to rule out pathological hyperprolactinemia were formulated and specific recommendations described for a practicing obstetrician/gynecologist. Conclusion. It is necessary to strictly follow all mandatory international and federal clinical guidelines, which will allow the practitioner to enhance the effectiveness of medical care.