No 8 (2017)

Objective. To analyze the relationship between the provision of vitamins and trace elements during pregnancy and the so-called minor malformations Material and methods. The review presents the results of a systematic analysis of foreign and Russian studies of the associations between trace element deficiencies and the pathogenesis, incidence, and severity of fetal congenital malformations (CMFs). Results. Trace element deficiencies during pregnancy are associated with obvious CMFs (syndactyly and other limb defects, impaired dentition, hernias, etc.) and CMF that manifested itself in early childhood (congenital heart defects, defects of the ureter, gallbladder, etc.). An analysis has shown that folates fall far short of being not the only trace element that is needed to prevent malformations, including the so-called minor ones (defects of the limbs, teeth, etc.). For example, zinc that regulates the activity of more than 1200 zinc-dependent proteins, as well as vitamin A and vitamin PP have no less an important role to play in the prevention of defects of dentition, fingers, auricles, lungs, diaphragm, and gallbladder. Deficiencies of zinc, vitamins A, E, D, and C and any of the B vitamins (including folates, pyridoxine and cyanocobalamin) stimulate the development of both minor and major malformations. Conclusion. The data from basic researches and evidence-based medicine indicate that it is necessary to mandatorily use vitamin-mineral complexes, including all the above trace elements, for the effective primary prevention of any fetal malformations.

Objective. To carry out a systematic analysis of the data available in the current literature on the pathogenetic interaction of malignant neoplasms as a risk factor for thrombotic events and on the impact of hemostatic system activation on the potentiation of tumor growth and metastasis. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in e-Library and PubMed, and Cochrane Library on this topic. Results. Current views are given on the pathogenetic features of functioning of the hemostatic system during tumor growth. The first category of such factors is represented by specific tumor-dependent one; the second category includes general pathological risk factors; the third does therapy-dependent risk factors. Conclusion. Malignant neoplasms are a risk factor for thrombotic events while hemostatic system activation promotes tumor growth and metastasis.

Objective. To consider the issues of fertility restoration in patients who have undergone reconstructive plastic surgery of the uterus. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in PubMed on this topic. Results. Based on numerous publications, the authors analyzed the anatomical and functional state of the endometrium and myometrium (including scar tissue), as well as the functional activity of the ovaries in patients who had undergone reconstructive plastic surgery of the uterus for obstetric and gynecological indications. Conclusion. In modern obstetrics, the concept of uterine preservation in placenta increta and subsequent metroplasty has been actively realized in recent years. In gynecology, the organ-sparing approach in patients with uterine myoma allows myomectomy to be actively used; and this trend is now becoming traditional and sustainable.

Much attention is now paid to investigations of of the processes of oxidative stress in pregnant women. An imbalance between the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) and the function of the antioxidant system can lead to cell and tissue structural damage, by inducing various pathologic processes. During pregnancy, in both its normal and abnormal course, the total level of oxidative stress increases. In abnormal pregnancy, the formed ROS and RNS, which trigger a cascade of free radical reactions leading to the formation of lipid peroxidation products, such as malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE) and nitrosyl derivatives (NDs), which serve as objective indicators of oxidative damage to proteins. Objective. To determine the level of the products of ROS, RNS, and antioxidant enzymes in the peripheral blood of pregnant women in different trimesters in the presence of preterm labor (PL), preeclampsia (PE), fetal growth restriction (FGR), and physiological pregnancy (PP). Subjects and methods. The course of pregnancy and the outcomes of labor were analyzed in 131 women from 4 groups. The level of oxidative stress was estimated from the blood concentrations of lipid peroxidation products, such as MDA and 4-HNE, protein peroxidation products, such as NDs, the content of the antioxidant enzymes glutathione peroxidase and superoxide dismutase, and the activity of catalase. Results. In physiological pregnancy, the levels of MDA and peroxynitrite adducts significantly increased. The PL group showed no significant differences in MDA levels between the trimesters. In this group, the level of NDs increased during the second trimester. The PE group displayed increased oxidative stress with pregnancy progression. In this group, the level of NDs rose in the second trimester. In the FGR group, the level of MDA increased with pregnancy progression in the presence of lower concentrations of NDs in the second trimester and their elevation in the third trimester. Comparison of the PL and PE groups with the PP group revealed significant increases in NDs and 4-HNE and decreases in glutathione peroxidase in the PL group and catalase activity in the PE activity. On the contrary, the catalase activity was higher in the FGR group than that in the PP group. Conclusion. The investigations confirmed increased oxidative stress levels during physiological pregnancy. The women with PE and those with PR were observed to have elevated blood levels of oxidative stress products in the presence of attenuation of the antioxidant systems. On the contrary, the women with FGR had enhanced activity of the antioxidant enzyme catalase, with a decline in NDs in the second trimester and its dramatic rise in the third trimester. The findings suggest that it is necessary to continue investigations of oxidative stress and activity of the antioxidant enzymes in both women with physiological pregnancy and those with abnormal pregnancy to create a shared understanding of normal and abnormal reactions.

Objective. To make an external evaluation of the effectiveness of three published algorithms in the first-trimester prediction of preeclampsia (PE) in a prospective cohort study of a Russian population. Material and methods. Clinical and anamnestic factors, echographicparameters (uterine artery pulsatility index), and biochemical markers (PAPP-A, PlGF, and sFlt-1) during singleton pregnancies were prospectively analyzed during combined screening at 11-13 weeks’ gestation. After receiving information on pregnancy outcomes, the risks for early-onset (<34 weeks) or late-onset (≥34 weeks) PE were calculated using the algorithms proposed by Poon (2009), Parra-Cordero (2013), and Crovetto (2015). The effectiveness of predictive algorithms was compared with that presented in the original publications and evaluated for factors explaining the prediction differences. Results. Three algorithms for the prediction of both early- and late-onset PE were examined in 4000pregnant women. Labor was induced in 29 (0.7%) women before 34 weeks’ pregnancy due to early-onset PE and in 73 (1.8%) women after 34 weeks’ gestation due to late-onset PE. Gestational hypertension was diagnosed in 119 (2.9%) cases. The area under the ROC curve for early-onset PE tests was 0.79 (0.76-0.81), 0.69 (0.66-0.72), and 0.75 (0.72-0.78) and that for late-onset PE tests was 0.74 (0.71-0.77), 0.65 (0.62-0.68), and 0.66 (0.630.69). The sensitivity of tests for early-onset PE ranged from 31.6% to 57.8%; that of tests for late-onset PE was 25.5 to 37.2% with an overall false-positive rate of 10%. Conclusion. External validation of algorithms in the first-trimester prediction of PE in a Russian population has demonstrated the high negative predictive value of the sensitivity that is lower than stated in the original studies and, in general, the moderate effectiveness in the prediction of early-onset PE. There is a need for further investigations to determine the most optimal algorithms for predicting PE.

Objective. To identify the genes, the expression of which in the eutopic proliferative endometrium differs in patients with endometrioid ovarian cysts (EOC) compared to that in the eutopic proliferative endometrium of women without endometriosis. Subjects and methods. Two patient groups (10 women with EOC (a study group) and 10 women without endometriosis (a control group)) were examined. All the patients underwent a full clinical-anamnestic examination: history data collection, general physical and gynecological examinations, pelvic ultrasonography, clinical and laboratory examination. Eutopic endometrial tissue pipelle biopsy specimens were obtained directly intraoperatively before hysteroscopy, with subsequent endometrectomy and histological examination. Total RNA was isolated from the specimens; an expression prof ile was subsequently obtained by microarray hybridization using the GeneChip Human Exon 1.0 ST Arrays (Affymetrix, USA) according to the manufacturer’s protocol. Results. The eutopic proliferative endometrium of the women with EOC (a study group) showed increased expression of 27 genes and decreased expression of 17 genes (the microarray measures the expression level of a total of 14318 transcripts) as compared with that from the women without endometriosis (a control group). All these genes are encountered in the works on eutopic endometrial expression; thus, our results are largely consistent with the published data, which makes these genes promising biomarkers for endometriosis. Conclusion. The obtained data on the increased expression of the FOS, EGR-1, FOSB, DUSP1, ZFP36, JUNB, and JUN genes in the eutopic proliferative endometrium of women with EOC agree with the results of previously published works, which makes these genes promising biomarkers to create real-time PCR-based diagnostic systems for the determination of mRNA levels in endometrial tissues.

Objective. To evaluate the efficiency of incorporating the micronized progesterone pragisan into a package of measures to prevent and treat miscarriage during early pregnancy. Subjects and methods. The investigation enrolled 30 women who had received first trimester threatened miscarriage treatment and 32 patients with clinical signs of threatened miscarriage who had refused treatment for various reasons. Threatened miscarriage was diagnosed based on complaints and ultrasound diagnosis (shortening of the cervix and dilation of the internal os). Results. The incorporation of the micronized progesterone pragisan into a package of measures aimed at preserving and prolonging pregnancy showed its high efficacy in patients with threatened miscarriage. Pregnancy could be preserved and prolonged to full term by 29 out of the 30 women with threatened miscarriage in the pragisan group and by only 19 (59.4%) in the group of those who had refused treatment. The timely restoration of vaginal biocenosis was also shown to contribute to the normalization of the course of pregnancy. Conclusion. The pronounced clinical efficacy, convenient dosing, and no adverse reactions of pragisan suggest that the drug may be incotporated into a package of measures to treat threatened miscarriage.

Background. Primary hyperparathyroidism is very rarely detected during pregnancy because of the paucity of clinical symptoms and the lack of its history. Medical management of hyperparathyroidism during pregnancy can lead to severe disorders in both the mother and the fetus. A case report. The paper gives the results of examination and treatment in a 31-year-old pregnant woman with a complicated obstetric history. Severe hypercalcemia (more than 3.5 mmol/l) resistant to medical therapy, a high parathyroid hormone level, and a tumor of the left parathyroid gland threw no doubt about the diagnosis. The patient underwent parathyroid adenomectomy with intraoperative monitoring of the time course of changes in intact parathyroid hormone, resulting in the recovery of the patient, carrying of a pregnancy, and birth of a healthy baby. Conclusion. The timely diagnosis and surgical correction of primary hyperparathyroidism in pregnancy is accompanied by elimination of the negative implications of the disease on the course of pregnancy and childbirth.