No 3 (2017)

Objective. To carry out a systematic analysis of the data which is available in modern literature, concerning prevalence, etiology, pathogenesis, diagnostics and treatment of cesarean scar pregnancy (CSP) and possible complications. Subject and methods. The review included foreign and Russian publications which entered the Pub med database on this subject. Length of search covered 15 years. Results. Modern data on prevalence, etiology and pathogenesis of CSP are submitted. Value of risk factors is reflected in the development of CSP and its complications. Value of transvaginal scanning in combination with dopplerometry is specified at early diagnostics of BRM as rather reliable method. Efficiency and low number of complications at the use of combined treatment methods is demonstrated: systemic application of Methotrexate, carrying out a laparoscopy together with a hysteroresektoskopy. Conclusion. Frequency of CSP grows together with the frequency of operation of Cesarean section. The effective organosafe treatment provides fertility, and decreases a number of serious complications and critical situations perhaps only at timely diagnostics on early term of gestation. The comparative assessment of efficiency of the combined surgical and medication treatment is presented in separate publications. However, almost total absence of information on CSP in domestic special literature, absence of uniform algorithm of diagnostics and treatment, can lead to mistakes of obstetricians-gynecologists both in diagnostics, and in tactics of maintaining pregnant women with this pathology.

Objective. To evaluate the efficiency of echographic diagnostic techniques in in vitro fertilization programs. Material and methods. The review includes data from foreign and Russian articles found in Pubmed on this topic. Results. SonoAVC makes it possible to save the time of ultrasound study and to obtain reliable data by physicians, regardless of their experience; it is more convenient for patients. Conclusion. There is a need for further investigations to evaluate the efficiency of 3D echographic diagnostic techniques for the assessment of ovarian function in the IVF program.

Objective. To conduct a systematic analysis of the data available in the current literature on the role of lipids in carcinogenesis and the importance of lipid markers in the diagnosis of HPV-associated cervical diseases and to provide perspectives on the lipidomic analysis of cervical tissue in predicting the course of cervical neoplastic processes. Material and methods. The review includes data from 46 foreign articles published in the past 5 years and found in Pubmed and Scopus on this topic. Results. The paper describes a number of lipid markers of tissues in different organs for the early diagnosis of precancerous and cancerous lesions, by estimating the degree of diagnostic significance. Conclusion. It is necessary to conduct further studies aimed at identifying specif ic lipid markers for the early diagnosis and prognosis of human papillomavirus-associated cervical diseases.

Objective. To study of the serum levels of Interleukin-6 (IL-6), soluble IL-6 and vascular endothelial growth factor (VEGF) receptors in women during delivery at term, threatened preterm labor, and in preeclampsia. Subjects and methods. A total of 85 pregnant women who were divided into 4 groups were examined. Group 1 included 35 women with physiological delivery; Group 2 consisted of 11 with threatened preterm labor; Group 3 comprised 23 with preeclampsia; Group 4 (a control group) included 16 with physiological pregnancy. A solidphase enzyme-linked immunoabsorbent assay was used to determine the serum levels of IL-6, soluble IL-6 and VEGF receptors. Results. The level of IL-6 was shown to increase dramatically in women with physiological delivery while the level in those with threatened preterm labor was approximately the same as that in the controls. The content of soluble IL-6 receptor was opposite to that of IL-6. The level of soluble VEGF receptor 1 reduced in threatened preterm labor and increases in physiological delivery and preeclampsia.

Objective. To assess the role of gene polymorphisms of the hemostatic system and folate cycle enzymes in the development of retrochorial hematoma (RCH). Subjects and methods. The investigation enrolled 305pregnant women who were examined and treated at the Rostov Regional Perinatal Center. All the pregnant women were divided into 2 groups: 1) 238pregnant women with RCH; 2) (a control group) 67 pregnant women with clinically normal pregnancy without RCH, as evidenced by first-trimester ultrasound. To identify genetic markers determining the development of chorion detachment, the pregnant women in the first-trimester underwent genotyping of four polymorphic loci of the folate cycle genes (MTHFR C677T, MTHFR A1298C, MTR А2756G, and MTRR А66С) and eight hemostatic genes (F2 G20210A, F5 G1691A, G10976A F7, F13 G103T, FGB G-455А, C807TITGA2, ITGB3 Т1565С, and SERPINE1-675 5G/4G). Results. Significant differences were obtained in a study of the distribution of the alleles G10976A of the F7 gene, G103T of the F13 gene, and G-455A of the FGB gene in a group of pregnant women with RCH versus that of pregnant women with clinically normal pregnancy. The A allele of F7 G10976A, the T allele F13 G103T, and the A allele of FGB G-455A were found to be associated with a high risk for RCH. Conclusion. The F7 gene (proconvertin, CF VII) polymorphism G10976A (rs 6046), the F13 gene (Fibrinase, CF XIII) G103T polymorphism (rs 5985), and the FGB gene (fibrinogen β-chain) polymorphism G-455A (rs 1800790) are associated with the risk of RCH.

Objective. To analyze the laboratory and clinical outcomes of IVF-DO programs using embryos from vitrified donor oocytes and to compare them with the results of those with native and thawed embryos derived from native donor oocytes. Material and methods. The results of IVF-DO programs using vitrified oocytes (29 oocyte thaw cycles), native embryos (115 embryo transfer (ET) cycles), and thawed embryos derived from native oocytes (56 ET cycles) were compared. The survival and fertilization rates of thawed vitrified oocytes were clarified in assessing the results. When the clinical outcomes of the IVF-DO programs compared were assessed, the rates of ET discontinuation, pregnancy per ET, implantation, multiple pregnancy, and early reproductive losses were analyzed. Results. The survival and fertilization rates of vitrified oocytes were ascertained to be 88.7 and 67%, respectively. The clinical outcomes of IVF-DO using the embryos derived from vitrified oocytes were substantially inferior to those with native or thawed embryos obtained from native oocytes in terms of all the most important indicators. Treatment results in view of pregnancy rates in the IVF-DO programs with vitrified oocytes can be improved only by increasing the number of transferred embryos to three; however, there is a dramatic increase in multiple pregnancy risk that is much greater than in the alternative IVF-DO programs with native or thawed embryos derived from freshly isolated oocytes. Conclusion. In all situations when the use of donor oocytes is required to overcome infertility, it is advisable to give priority to IVF-DO programs using just native or thawed embryos obtained from native oocytes.

Objective. To evaluate the efficiency of using a V-Loc 180self-locking thread to close the bed of myomatous nodes. Subjects and methods. There were two groups of patients with subserous, interstitial-subserous, and submucous-interstitial uterine myoma: a study group (n = 24) and a control group (n = 25). The number of nodes varied from one to nine in the study group. The minimum and maximum sizes of myomatous nodes were 1 and 15 cm. In the comparison group, the number of nodes varied from 1 to 4, their size was 1.0 to 21.0 cm. All patients underwent myomectomy. The data were statistically processed with Microsoft Office Excel 2013 and Statistica 7.0. Results. During surgical treatment as laparoscopic myomectomy without opening the uterine cavity, the average operative blood loss and the average duration of the surgery in the study group (suturing the myomatous node bed with a V-Loc thread) were 20 and 9.7% lower, respectively. When combined operations were performed without opening the uterine cavity in this group, these were 14.5% and 40% higher, respectively. Conclusion. The application of the V-Loc 180 thread reduces the duration of surgery and the volume of blood loss, greatly facilitates surgical techniques during surgical treatment as laparoscopic myomectomy, and increases the above indicators when performing the combined operations.

Objective. To determine the prevalence and patterns of sexual dysfunctions in women visiting a gynecology clinic to be screened for sexual health. Subjects and methods. A total of 834 women were examined for sexual function, by carrying out a clinical interview using the Female Sexual Function Index (FSFI) scale. Results. Sexual dysfunctions were found in 16.7% of the respondents. There were statistically significant differences (p < 0.00) in FSFI total and domain scores reflecting the patterns of sexual function in women with sexual dysfunctions and in sexually healthy women (23.9±4.1 versus 29.2±3.1). A significant difference was established in FSFI total scores and sexual health self-assessment in the age groups less than 29, 30-44, and 45-59years (p = 0.00). In the age groups less than 29 and 30- 44years, motivation to seek medical advice was related to sexual health self-assessment (p=0.00). Conclusion. The Russian language version of FSFI can be recommended to screen women for sexual functioning in general health care

Form No. 32 of the Federal Statistical Observation is of paramount importance in analyzing the structure of morbidity and mortality in newborns and pregnant and parturient women and in determining maternal mortality rates; its data are used to analyze the situation in the regions and in the country as a whole. Objective. To identify and structure main problems in presenting data in Form No. 32 and Insert No. 232, by taking into account changes during more than 30 years, to formulate ways of their solution based on the experience of receiving annual reports, and the analysis of the data presented. Materials and methods. The normative documents, starting with Form No. 32 in 1984, as well as the content of these forms (including Insert No. 323) provided by the subjects of the Russian Federation in 2000-2015, were analyzed. The detected defects based on the results of receiving the forms in 2014-2015 and their main contained health and demographic indicators were also analyzed. Results. The approved and currently used version of Form No. 32 gives no possibility of obtaining data on babies who were born at 22 or more weeks’ gestation, but weighed less than 500 grams, by considering still-born infants weighing less than 1000 grams at birth in relation to the causes of death. A number of terminological defects, such as differences in the periodization of gestational ages (22-27 and 22-28 weeks and 28-36 and 28-37 weeks) were identified, which leads to the erroneous presentation of the data. The incorrect term “healthy preterm infant” is used. There are problems in taking into account critical obstetric conditions and interhospital and intrahospital transfers. Conclusion. A lack of detailed instructions for filling in Form No. 32 and Insert No. 232 results in the ambiguous consideration of diseases in pregnant and parturient women, newborn infants, and obstetric operations. The ways of improving Form No. 32 were proposed to ensure the greater validity and reliability of statistical data.

Uterine fibroids are one of the most common diseases in reproductive-aged women, a risk factor for infertility, and reproductive failures. Patients with uterine fibroids are now managed by different strategies, including conservative treatment with high-efficacy gonadotropin-releasing hormone (GnRH) agonists. Objective. To evaluate the efficiency of conservative therapy with GnRH agonist (buserelin long) for uterine fibroids. To assess the results of IVF treatment for infertility and the course and outcome of pregnancy after using GnRH agonists for the therapy of uterine fibroids. To substantiate pathogenetic GnRH agonist therapy as part of pregravid preparation in patients with infertility and uterine fibroids. Subjects and methods. A retrospective comparative study of pregnancy outcomes was performed in 69 women with uterine fibroids and infertility. The inclusion criteria were age younger than 45 years, an anti-Müllerian hormone concentration of >1.0 pg/ml, the absence of severe extragenital pathology, the presence of types 2- 6 fibroids, and good-quality embryos. Conclusion. The use of GnRH agonists (buserelin long) as part of comprehensive pregravid preparation is a highly effective conservative treatment for uterine fibroids. After GnRH agonist therapy, there was a significant increase in IVF pregnancy rates as compared to population-based rates The low rate of gestational complications in pregnant women who had received GnRH agonist therapy for uterine fibroids before entry into the IVF program indicates the validity of this management tactics for infertility concurrent with uterine fibroids.

Objective. To improve treatments for different clinical forms of VVC. Subjects and methods. A total of 105 women, including 85patients with Candida infection a study group) and 20 healthy women (a control group), were examined. All the women underwent bacterioscopic and bacteriological examinations to detect the bacterial and Candida microflora. A Candiselect-4 diagnostic kit (Bio-Rad, USA) was used to determine yeast fungal species and concentration. The patients with Candida infection were divided into 2 groups: 1) 70patients with Candida monoinfection; 2) 15patients with mixed bacterial and Candida infection. Results and discussion. All the patients received sertaconazole (zalain), a derivative of benzothiophene and imidazole, having fungistatic and fungicidal effects on fungi and antibacterial activity. The drug was administered as one 300-mg vaginal suppository weekly overnight or in combination with zalain cream Conclusion. The investigations have indicated that sertaconazole (zalain) has a high (94%) activity against any type of vaginal candidiasis in both monoinfection and mixed Candida and bacterial infection. By acting not only on Candida albicans, but also on non-Candida albicans, the drug rapidly resolves the clinical manifestations in the acute and chronic course of the disease, which together with the absence of adverse reactions allows one to recommend its use in patients with different clinical forms of vulvovaginitis.

Background. The complexity of terminating non-developing pregnancy is that the cervix uteri is not ready and the myometrium is inert, which lead to the prolonged inability of the uterus to expulse an embryo or fetus. The treatment of patients with this pathology uses a large range of drugs, the efficacy of which is not always sufficient, which is due to the severity of the process, reduced immune reactivity, and the presence of severe extragenital diseases. Case reports. The paper describes three complex clinical cases of abortion in cases of intrauterine fetus/embryo death in the presence of severe comorbidity, by applying a Dilapan-S osmotic dilator. Discussion. It is noted that DILAPAN-S not only causes cervical canal dilatation, but, in some cases, results in self- induced miscarriage. Conclusion. This instrument can be separately used to resolve an incomplete abortion in the presence of severe extragenital diseases