No 5 (2017)

Objective. To determine the rate of pelvic floor dysfunction (PFD) in women during pregnancy and in postpartum and late periods. Material and methods. The data of 50 foreign and Russian sources found in international databases on this topic were analyzed. Results. PFD (urinary incontinence and pelvic organ prolapse) occurred in 40% of women already during pregnancy and lasted in the majority of them 6-8 weeks postpartum. After one year, the rate of PFD increased by 7-10% and following 10 years, it rose by 25%, amounting 50-77%. The rate of sexual dysfunction was correlated with the manifestations of PFD, increasing from 20% postpartum and up to 50-80% in the late periods. On the contrary, the rate of fecal incontinence decreased, but not in women who had experienced third-to-fourth degree perineal ruptures. Conclusion. The findings suggest that there is a need to screen women who require therapeutic measures, starting just in the postpartum period.

Objective. To carry out a systematic analysis of the data available in the current literature on the clinical significance and characteristics of the diagnosis and therapy of major vaginal microflora disorders, such as of bacterial vaginosis (BV) and aerobic vaginitis (AV). Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in electron bibliographic databases on this topic. Results. The vaginal microflora balance disorders including BV and AV were described to have a negative impact on female reproductive function. Similarities of and differences between these two conditions were analyzed. Evidence-based approaches to diagnosing and treating BV and AV were given. Conclusion. BV and AV can cause abnormal vaginal discharge and lead to diseases of the genitourinary system and infectious complications of pregnancy. Microscopic vaginal discharge examination is a main laboratory method for the diagnosis of these diseases. Treatment for BV and AV is to inhibit overgrowth of opportunistic bacterial pathogens associated with these conditions.

Objective. To study the literature data that analyze current methods for diagnosing the common forms of endometriosis. Material and methods. Literary sources were sought in the Pubmed and Medline databases, by using key words. 32papers on this topic were selected. Results. Problems in diagnosing the common forms of endometriosis are relevant in modern gynecology and surgery because of the involvement of the adjacent organs in the process and are associated with the planning of formation of multidisciplinary surgical teams, the determination of a surgical access and volume, and the prevention of intraoperative complications. The common forms of endometriosis should be diagnosed with the current imaging techniques for visceral lesions, which reveal organ dysfunctions. Ultrasound, colonoscopy, magnetic resonance imaging, and computed tomography are informative and complementary techniques to diagnose this pathology. Conclusion. The comparative data of these techniques are not given in sufficient volume; there are no criteria for the specificity and accuracy of each of them, especially in diagnosing the common forms of endometriosis. Therefore, further studies in this area are needed.

Objective. To reduce the incidence of perinatal losses in pregnant women with acute pancreatitis (AP) through optimization of therapeutic and preventive measures. Subjects and methods. The investigation enrolled 127 pregnant women with AP. A study group consisted of 43 pregnant women for whom a package of therapeutic and preventive measures including discrete plasmapheresis on days 1 and 3 and micronizedprogesterone (Invention Patent No. 2535108dated October 8, 2014) was additionally included. A comparison group of 84 patients received standard therapy for AP. A control group included 30 healthy pregnant women. Examinations were made in accordance with the standards; hemodynamic parameters in the uterine arteries and the serum concentrations of prolactin (PRL), estradiol (E), and dehydroepiandrosterone sulfate (DEAS), progesterone (P), cortisol (C), trophoblastic beta-1-glycoprotein (TBG) and placenta-specific alpha-1-microglobulin (PAMG-1) were additionally investigated in the pregnant women. Results. The occurrence of AP in the pregnant women was accompanied by an increase in the stress hormones PRL, C, and DEAS, maladjustment of the synthesis of placenta-specif ic proteins (a decrease in TBG and a rise in PAMG-1), impaired uteroplacental blood flow, which resulted in chronic placental insufficiency in 78.8% of cases during their conventional management and is complicated by acute placental insufficiency in 21.2% of cases. Pregnancy concurrent with AP increased the rate of spontaneous abortion (11.9%), non-developing pregnancy (29.8%), and preterm delivery (60.7%) and contributes to higher perinatal mortality rates (up to 281.3%co) and the percentage of total reproductive losses (up to 45.2%). The additional incorporation of discrete plasmapheresis and progesterone was found to contribute to the correction of hormonal, hemodynamic disorders in the mother-placenta-fetus system, by preventing the progression of placental dysfunction and its negative consequences for the development of a fetus/embryo. Conclusion. The developed method decreases the rate of threatening abortion in the presence of AP by 3 times and the number of preterm deliveries by 13 times and reduces perinatal mortality rates to zero.

Objective. Study of the proteomic composition of cervicovaginal fluid to determine the risk of cervical neoplasia malignancy in reproductive age patients with HPV infection. Subjects and methods. The clinical examination, molecular biology methods, cytology, extended colposcopy, PCR, proteomics research of cervicovaginal fluid. Results. 4 group were formed including 30 women: 7 patients (23%) - NILM (I group - control), 23 (77%) - HPV-positive, divided into 3 groups: II group of 11 (49%) with ASCUS, III group - 7 (30%) with LSIL, IV group - 5 (21%) with HSIL. High-risk HPV was detected in 90.9% of cases in the group with ASCUS and 100% - in the group with LSIL and HSIL. The most common types of HPV are 16 (34.8%) 31 (17.4%) 52 58 56 (13%) 18 35 (8.7%), other types were at least 5%. 69% of patients had a viral load of 5.2log (on average - 5.6log) with no significant differences between groups. Normal normal colposcopic picture was in 7 (23%) patients, abnormal - 23 (87%). Significant separation of the control samples with NILM and groups with ASCUS, LSIL, HSIL was revealed by semi-quantitative analysis of proteomic composition of CVF. The concentration of heat shock proteins S100-A9, S100-P, S100-A11, HSPA8, acetyl- CoA-binding protein, Annexin A1 and A2 in the group with neoplasia was an order of magnitude higher compared to the control group. Multivariate analysis of patients’ proteome and transcriptome data was performed by PLS method. A significant clusterisation of the group with a low risk of development/progression of cervical dysplasia and high-risk group was achieved. CVF proteins which made a major contribution to this separation were associated with oncogenic processes, among which a special place belongs to malignant transformation of lung epithelium, esophagus, rectum, cervix and other types of HPV-associated cancers. Conclusion. CVF proteins which made an important contribution to the differentiation in the groups with normal cervical epithelium and groups with cervical neoplasia of varying severity were identified.

Objective. To investigate the transcriptional profile (transcripts) of cumulus cells when using a gonadotropin-releasing hormone (GnRH) agonist or human chorionic gonadotropin (hCG) as an ovulation trigger. Subjects and methods. The investigation analyzed 179 cumulus cell samples from 35 patients who had undergone an IVF/ICSI program. The patients were divided into 2 groups according to the injected ovulation trigger: 1) hCG at a dose of 10,000IU (n = 17); 2) a GnRH agonist 0.2 mg (n = 18). The mRNA expression of 13 genes in the cumulus cells was investigated by a real-time RT-PCR assay. Results. Differences were found in the expression of CALM2 (0.08 vs 0.05; P < 0.0001), TRPM7 (0.82 vs 0.70; P = 0.007), AL CAM (0.26 vs 0.37; P = 0.0008), and PFKP (3.46 vs 4.70; P = 0.0005). All changes were less than 2 times. The mRNA expression of the TP53I3 gene was higher in the cumulus cells of oocytes that later formed blastocyst (0.3 vs 0.23; P = 0.0304).

Oxidative stress develops due to an imbalance between the prooxidant and antioxidant systems of the body. The role of oxidative stress in the pathogenesis of various diseases has been demonstrated, while the impact of oxidative stress on the processes of folliculogenesis and oogenesis has been inadequately studied today. Objective: To evaluate the informative value of oxidative stress markers in the blood and follicular fluid of patients in predicting the outcomes of assisted reproductive technology (ART) programs. Subjects and methods. The prospective cohort study included 108 married couples with infertility of different genesis; according to the onset of a clinical pregnancy as a result of the investigated ART cycle, all the patients were divided into 2 groups: 1) 38 patients with the clinical onset of pregnancy; 2) 70 women with no pregnancy after an ART cycle. Malondialdehyde (MDA), the ratio of reduced glutathione to oxidized glutathione (GSH/GSSG), and the enzymatic activity of catalase were used as parameters characterizing the level of oxidative stress and the activity of the body’s antioxidant systems. Results. Blood MDA levels were significantly higher and amounted to 4.9±0.7in Group 2 than those in Group 1 (4.5±0.7) (p = 0.0473). In addition to MDA levels, the occurrence of pregnancy was affected by patient age, anti-Müllerian hormone (AMH) concentrations, and the number of obtained mature oocytes. In Group 1, the MDA levels did not correlate with other markers of oxidative stress and with the clinical and laboratory characteristics of the patients. In Group 2, the level of MAD in the blood had a statistically significant strong positive correlation with that in the follicular fluid (r = 0.703; p < 0.0001) and a statistically significant negative correlation with the enzymatic activity of catalase in the follicular fluid (r = -0.319; p = 0.0455). Conclusion. This investigation determined the importance of oxidative stress markers in predicting the outcomes of ART programs. The manifestations of systemic oxidative stress may result in IVF failure, which is most likely due to the decreased quality of oocytes and embryos. This hypothesis is evidenced by the fact that the patients with IVF failures had significantly higher blood levels of oxidative stress markers, which had an impact on the level of prooxidants in the follicular fluid.

Objective. To evaluate the diagnostic value of WIF-1 gene promoter region methylation in the development of cervical intraepithelial neoplasia. Subjects and methods. The investigation included 62patients aged 18 to 55 years who had come to the Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, in the period February to August 2016 for examination and undergone liquid-based cytology, quantitative and qualitative tests for human papillomavirus (HPV), histological examination of cervical biopsy specimens, and extended colposcopy. Bisulfite sequencing was used to study the level of WIF-1 promoter methylation in 62 samples of cells taken from the cervical canal with a cervix brush. Results. The normal mean level of WIF-1 promoter region methylation was 2.3±5.4%. The women diagnosed with high- or low-grade squamous intraepithelial lesions were observed to have a more statistically significant than normal value (p < 0.0001), abnormal WIF-1 gene promoter region hypermethylation at mean frequencies of 29.2±17.2and 54.8±18.7%, respectively. Conclusion. The findings suggest that the level of WIF-1 gene promoter region methylation significantly correlates with the stage of HPV-associated cervical disease. Thus, evaluation of the WIF-1 gene methylation status may be regarded as a potential diagnostic marker for cervical carcinogenesis and a predictive clinical marker during combination treatment for cervical cancer.

Objective. To provide an update-based assessment of the relationship between genetic disorders of the receptor system and somatic and autonomic dysfunctions developing in the framework of premenstrual syndrome and premenstrual dysphoric disorder. The results of new trials of the efficacy of tofisopam (grandaxin) were also analyzed. Material and methods. Publications available in the international science citation databases were sought and analyzed. Results. Tofisopam (grandaxin) is an anxiolytic drug but without muscle relaxant effects; and it can therefore be used in patients who continue to perform their professional duties. Tofisopam has the greatest autonomic stabilizing effect. Tofisopam has been shown to be particularly effective against autonomic disorders accompanying anxiety. Conclusion. Tofisopam remains one of the best drugs in the safety and efficacy ratio today.

Background. Meckel’s diverticulum (MD) is a remnant of the vitelline duct of the foetus and develops in the sixth week of embryogenesis. It is present in 2-3% of population and remains the most common anomaly of the digestive tract. There are only a few conf irmed cases detected prenatally. Description. We present a case study of a pregnant woman where from the 17 weeks’ pregnancy an anechoic area in the fetal abdomen was observed. During a routine ultrasound examination, a round cyst measuring 11.9 x 8.1 mm, with hyperechogenic thick walls was found just below the liver. In check- up scans conducted every three weeks, no progression was discovered. Conclusion. Our case is the only one in the literature documented so well by prenatal scans preformed every 3 weeks and followed up for three years from detection. Meckel’s diverticulum should be an element of differential diagnostics of intra-abdominal anechoic areas in a foetus.