No 7 (2017)

Objective. To carry out a systematic analysis of the data available in the current literature on the impact of influenza vaccination on the course of pregnancy and on fetal and neonatal development. To comparatively analyze the effects of subunit non-adjuvanted and subunit immunoadjuvant influenza vaccines on increases in the titer of antibodies against influenza virus strains in mother-neonate pairs with regard to the trimester of pregnancy. Material and methods. The review includes the current and topical materials of foreign and Russian investigators from the MEDLINE database in the past 10years. Results. Inactivated subunit influenza vaccines administered in the second and third trimesters of pregnancy have been found to have no impact on the course of pregnancy, the development of a fetus and a baby within first 6 months of life and to result in the synthesis of antibodies that can protect not only the vaccinated women, but also their infants during the first 3 to 5 months of life. Conclusion. Influenza vaccination with inactivated subunit vaccines in the second and third trimesters of pregnancy is a safe and effective method to protect both pregnant women and their babies against influenza.

Objective. To carry out a systematic analysis of the data available in the current literature on the role of the vitamin K-dependent protein periostin in the outcomes of an assisted reproductive technology (ART) program. Material and methods. The review includes the data of foreign and Russian articles found in Pubmed on this topic. Results. Investigations conducted in recent years provide evidence that periostin exerts an effect on some important steps in the implantation process. Due to a wide range of its functions, periostin is expressed in various organs and tissues. The follicular fluid and serum level of periostin can be correlated with oocyte quality indicators, embryo development, and pregnancy and live birth rates. The paper gives the data of an investigation of the vitamin K-dependent protein periostin as a non-invasive marker to predict oocyte and embryo qualities and pregnancy onset rates. Conclusion. The investigations performed confirm that the use of periostin is promising and relevant in predicting the effectiveness of an ART program.

The paper presents the results of a pilot study on the determination of proinflammatory factors of mitochondrial damage-associated molecular patterns (mtDAMP) in pregnant women with physiological pregnancy and recurrent early miscarriages. Objective. To determine the levels of proinflammatory factors of mtDAMP in the peripheral blood of patients with threatened and recurrent miscarriage versus the similar indicators in women with physiological pregnancy. Subjects and methods. The investigation enrolled 24 pregnant women whose peripheral plasma samples were selected retrospectively after successful achievement of 22 weeks’ gestation in 12patients (a control group) and in 12 patients with recurrent early miscarriage (a study group). To determine the level of mtDAMP proteins in the patients of the examined groups, their venous blood was fractionated, microvesicles were isolated from the obtained plasma, and mitochondrial protein levels were analyzed by Western-blotting. The findings were statistically processed using the SPSS program according to the ANOVA method. Results. Comparative analysis of the relative content of mitochondrial proteins in the plasma microvesicles showed that in the women with threatened and recurrent miscarriage, whose pregnancy spontaneously aborted, the levels of all marker proteins were significantly lower than those in the women of the control group (p < 0.01). Conclusion. The low levels of proinflammatory factors of peripheral plasma mtDAMP are shown to be an unfavorable factor for early pregnancy.

Objective. To investigate the role of a progesterone-induced blocking factor in the genesis of preterm labor. Subjects and methods. A comprehensive examination was made in 63 puerperas (34 with preterm labor and 29 with term labor). Results. There was evidence for the effects of micronizedprogesterone on placental PIBF1 gene mRNA expression. A direct correlation (correlation coefficient r = 0.66 (95% CI 0.22 to 1.12)) was found between plasma progesterone levels and placental PIBF1 gene mRNA expression. Patients with low PIBF1 gene mRNA expression were ascertained to have histological signs of placental insufficiency. Conclusion. In the presence of progesterone deficiency, the reduced placental PIBF1 gene mRNA expression could lead to the breakdown of maternal adaptive reactions aimed at maintaining pregnancy and will be one of the factors that initiate preterm labor.

Objective. Compare efficacy and safety of oral dydrogesterone (DYD) and micronized vaginal progesterone (MVP) for luteal support in IVF, with focus on Russian subjects. Subject and methods. Double-blind, randomized, multicenter non-inferiority study (Lotus I). Women undergoing IVF were randomized to DYD 10 mg or MVP 200 mg TID. Primary objective was the presence of fetal heartbeats at pregnancy week 10 (12 weeks’ gestation). Results. In the full analysis sample (FAS), 497(DYD [106 Russian]) and 477 (MVP [103 Russian]) subjects were randomized. DYD was non-inferior to MVP (FAS): difference in pregnancy rate at 12 weeks’ gestation of 4.7% in favor of DYD (95% CI: -1.2-10.6%). In Russian subjects, this difference was 14.2% in favor of DYD (95% CI: 1.1-27.2%). DYD and MVP had similar safety profiles. No health issues reported for Russian infants (6-month follow-up). Conclusion. In Russian subjects and overall, DYD was as efficacious as MVP. DYD may replace MVP for luteal support in IVF.

There is a growing body of evidence supporting the significant role of systemic inflammation and oxidative stress in the genesis of polycystic ovary syndrome (PCOS) in adult patients. The indicators of mitochondrial functioning early in the development of PCOS in adolescence remain little studied. Objective. To study the characteristics of mitochondrial function and systemic inflammation in adolescent girls with different metabolic PCOS phenotypes compared with healthy girls. Subjects and methods. The investigation enrolled 95 girls aged 15 to 17 years inclusive with PCOS according to the Rotterdam criteria. A control group consisted of 30 healthy age-matched regularly cycling girls. All the participants underwent a complete clinical and instrumental examination and estimation of the levels of C-reactive protein, malondialdehyde (MDA), the mitochondrial membrane potential of peripheral blood mononuclear cells (MNC) and MNC fractions with highly polarized mitochondria. The level of glutathione, the ratio of its oxidized (GSSH) to reduced (GSH) forms (GSSR/GSH), and the enzymatic activity of catalase, glutathione reductase and glutathione peroxidase were determined. Results. As compared with the healthy girls, the normal weight patients with PCOS in the absence of metabolic abnormalities (PCOS-MANW) had a lower concentration of MDA, decreased activity of the antioxidant enzyme glutathione reductase, a higher level of the reduced form of the antioxidant glutathione and its ratio to the oxidized form, and a higher percentage of MNCs with highly polarized mitochondria (p <0.05 for all indicators). The patients with PCOS-MANW showed lower C-reactive protein (CRP) and MDA levels than those with PCOS-MA_OW) (p < 0.05). The girls with PCOS-MA_OW) had higher levels of CRP and enhanced glutathione reductase and MDA activities than those with PCOS-MANW (p < 0.05). Comparison of the girls PCOS+MAOW) and those with PCOS+MANWrevealed significant increases in the levels of CRP and MDA and the activity of glutathione reductase (p < 0.05). The girls with PCOS-MAOWhad a higher MDA level than those with PCOS+MANW(p < 0.05). As compared with the healthy girls, the PCOS+MANWgroup had a lower level of MDA, an elevated concentration of reduced glutathione, and lower activity of glutathione reductase (p < 0.05). The found characteristics are confirmed by a correlation analysis and by the results of two-factor analysis of variance. Conclusion. An adaptive mechanism for reducing the manifestations of oxidative stress and systemic inflammation with the high coupling of mitochondrial respiration and the level of antioxidant protection is realized in the normal weight adolescents with PCOS. The manifestations of oxidative stress, which are mediated by mitochondrial uncoupling due to impaired cholesterol and glucose metabolism, are pronounced, which is enhanced by the addition of carbohydrate metabolic disturbances in the overweight adolescents with PCOS. Mitochondrial dysfunction is associated with the activation of systemic inflammatory response in the overweight adolescents with PCOS in the presence of insulin resistance.

Objective. To determine the stages of formation of the cerebral cortex and the terms of initial echographic visualization of its furrows in very preterm infants to reach a post-conceptual age of 40 weeks, by applying 3D neurosonography. Material and methods. Archival 3D files of weekly brain scans from 39 very preterm infants were analyzed in the framework of a prospective study. Results. In-depth analysis of serial sections by 3D neurosonography revealed a certain sequence of appearance of furrows in the image during the postnatal development of the cerebral cortex. The examination revealed no clear differences in the timing of initial echographic imaging of fissures in babies born from singleton and multiple pregnancies. Conclusion. 3D neurosonography is a priority method for monitoring the postnatal development of the cerebral cortex in very preterm infants. The results of this investigation can be used to assess the postnatal structural development of the cerebral cortex in very preterm infants, by using ultrasound imaging techniques.

Objective. To carry out a systematic analysis of the data available in the literature on possible methods for preparing the cervix uteri for childbirth and to identify possible complications due to the application of cervical preparation methods. Material and methods. The review included the data of Russian and foreign articles given in Pubmed on this topic. Results. This review sets forth current methods for preparing the cervix uteri for childbirth, as well as the possible risks associated with their use. Conclusion. The data of the conducted investigation confirm the need to search for more effective methods or a combination of already existing ones of cervical preparation for childbirth.

Objective. To analyze the data available in the current literature on the effect of myo-inositol on the effectiveness of assisted reproductive technology (ART) programs and its role in the physiology of the female reproductive system. Material and methods. The article includes the data of foreign and Russian articles published in the past 5 years and found in Pubmed on this topic. Results. Possible mechanisms of myo-inositol involvement in oocyte maturation processes are described. The use of myo-inositol in the treatment of infertility in patients at high risk for obtaining immature germ cells (oocytes) can improve the quality of oocytes obtained during superovulation and increase the frequency of fertilization at the embryonic stage. Conclusion. In detecting a high risk of obtaining immature sex cells, the use of myo-inositol in IVF preparation programs can increase the chance of obtaining mature oocytes by providing a full meiotic, as well as reduce the hormonal load and increase the effectiveness of the procedure in general.

Background. Catastrophic antiphospholipid syndrome (CAPS) is the most severe form of antiphospholipid syndrome (APS) that manifests itself as multiple microthromboses in the microcirculatory bed of vital organs and as evolving multiple organ dysfunction in the presence of high titers of antiphospholipid antibodies (APA). CAPS is a life-threatening condition and requires emergency treatment. Unfortunately, the optimal treatment of CAPS has not been developed. A case report. Below is given a case of CAPS in a pregnant woman with complicated pregnancy and an elevated APA level. The patient has been under the authors’ scrutiny for subsequent 2years. The authors observed her next pregnancy that was uneventful during anticoagulant therapy under constant control of the hemostatic system. Her pregnancy lasted 39 weeks and resulted in a natural delivery and the birth of a full-term living fetus. Conclusion. The emergence of obstetric complications in female patients with APS is always suspicious of CAPS. Identification of APA should be mandatory in all pregnant women with preeclampsia, recurrent miscarriage, and early signs of pyoseptic diseases. This will assist in timely establishing the diagnosis of CAPS and in immediately initiating the currently developed optimal therapy.