No 9 (2017)

Objective. To carry out a systematic analysis of the data given in the current literature on obstetric complications in women with polycystic ovary syndrome (PCOS). Materials and methods. The review includes the data of foreign and Russian studies, which have been published in the electronic databases Medline, PubMed, and Cochrane Library over the past 10 years. Results. The given review considers data on pregnancy complications in PCOS, such as miscarriage, multiple pregnancy, gestational hypertension and preeclampsia, gestational diabetes, birth of premature babies and macrosomic ones, as well as some pathophysiological processes that may underlie these complications. Conclusion. Hyperandrogenia, insulin resistance, obesity, and dyslipidemia, which are characteristic of PCOS, are likely to be crucial factors for the processes of trophoblast invasion and placentation and can affect the health of mother and child. Pregravid counseling in women with PCOS and close monitoring during pregnancy are recommended to prevent adverse pregnancy outcomes.

Objective. To analyze the data of current research literature on the role of antibodies against gonadotropins and female sex hormones in reproductive disorders in women. Material and methods. The review includes data of foreign and national articles on the research topic found in Pubmed and eLIBRARY and published in the last 20 years. Results. According to scientific publications the production of antibodies against gonadotropins is induced by the use of hormonal drugs or contraceptive vaccines, and can also occur spontaneously in women with infertility and recurrent pregnancy loss. The effect of antibodies is associated with their ability to neutralize the biological activity of the hormone. Enzyme-linked immunosorbent assay is most commonly used for the detection of antibodies in blood, and intradermal testing is employed for diagnosis of hypersensitivity to female sex hormones. Antibodies against gonadotropins and female sex hormones are considered as possible risk factors for infertility, IVF failure and pregnancy loss. Conclusion. Early detection of antibodies or hypersensitivity to the hormones and carrying out appropriate treatment and preventive measures can increase the treatment efficacy of infertility and improve outcomes of pregnancy in women with recurrent abortion.

Objective. Evaluate the „Lesser Abnormalities” occurrence frequency of cervical lesions and analyze their methods of diagnostic. Material and methods. The review of the published studies on the issue of cervical lesions „Lesser Abnormalities”, their methods of diagnostic and the disease progress prognosis was carried out. Results. Published studies analysis showed that the cervical lesions „Lesser Abnormalities” diagnostic and disease progress prognosis can be significantly expanded by the molecular-genetic and immunocitohimicheskie methods. Conclusion. The search of the molecular genetic-markers is necessary for the process progress risk evaluation.

Objective. To reveal regularities in the development of humoral immune responses during pregestational and gestational immunocytotherapy (ICT) in patients with recurrent miscarriage (RM), by estimating the level of antipaternal anti-leukocyte antibodies (anti-PAb). Subjects and methods. Anti-PAbs were determined by cross-reactivity using flow cytometry at different stages of gestation in 85 control pregnant women and in 92 women with RM, among whom there were 69 women who received pregravid preparation (PP) involving immunization with their partner’s lymphocytes (ICT) as monotherapy or in combination with oral dydrogesterone, and 23 who had no PP. Results. In the controls, anti-PAbs were detected in 5.9-7% of the pregnant women at less than 34 weeks’ gestation and in 25.9% at 38 weeks. The level of anti-PAbs at 5 to 6 weeks of gestation was signif icantly higher in the patients who received PP including ICT. In the patients who had no PP, the anti-PAB levels gradually increased after each immunization procedure in the first trimester to the level seen in those who received PP. Conclusion. The emergence of anti-PAbs during pregnancy in patients with RM is the result of ICT, which indicates the importance of an anti-PAb test that reflects the immunomodulatory effect of an alloimmunization procedure.

Objective. Identify common pathogenetic mechanisms of preeclampsia and placental insufficiency to justify the possibility of a common approach to prevention. Material and methods. In the course of pregnancy were examined 140 women at high risk of decompensation of placental insufficiency. Taking into account the outcome of the pregnancy two comparison groups were formed: I group comprised 68 women with PN; II - 72 women with a combination of Mo and PE. pregnant Group II results of the survey further analyzed taking into account the period of implementation of PE (early manifestation of PE to 34 weeks, late PE - after 34 weeks.). III The control group consisted of 30 healthy women with physiological gestation. In the blood of women by enzyme immunoassay, immunofluorescence, biochemical tests determined the content of endothelial dysfunction, hemostatic markers of apoptosis and inflammatory response, decidualization stromal cells, placental angiogenesis and power, modulation of the immune response, the general reactive capacity of magnesium concentration and endogenous carbon dioxide. Results. The study showed a high incidence of severe combination of Mo and PE with one-pointedness of changes both in the PN development and realization of PE at that favors the formation of pathogenic communication disorders embryo (feto) placental complex and development of PE. When the characteristic changes in the placenta early as embrioplatsentarnoy dysfunction later realized early PE, late PE for changes is formed in the later stages of the functioning of the FPC. Laboratory predictors recorded for 4-6 weeks before clinical manifestation of PE and PN, which justifies a predictive and preventive approach to the differentiated management of pregnant women at high risk. Conclusion. Allocation of common pathogenetic mechanisms of formation of the PN and PE allows you to stratify pregnant women in the choice of a single prevention method.

Objective. To estimate the possibility of differential diagnosis of the severity of cervical squamous intraepithélial lesions on the basis of quantitative assessment of microRNA expression: has-mir-22-3p, has-mir-25*-3p, and has-mir-92a-5p in cervical epithelial scrapings. Subjects and methods. The investigation enrolled 95 women aged 18 to 49 years (mean age, 32.7±0.5 years) who were divided into 4 groups: 1) 32 patients without cervical disease; 2) 31 patients with low-grade squamous intraepithelial lesion; 3) 26 patients with high-grade squamous intraepithelial lesion; 4) 6 patients with cervical cancer. For a clinical diagnosis, cytological and histological examinations, extended colposcopy, and HPV testing were used and the level of microRNA expression was measured by quantitative real-time PCR. Results. In cervical squamous intraepithelial lesions, the synthesis of mir-22 was considerably decreased and the expression of mir-92a was, on the contrary, increased. The expression of mir-25 was elevated Insignificantly. A logistic regression analysis could reveal the mir-22 and mir-92a expression thresholds that allowed the differentiation of cervical cancer with a diagnostic accuracy of more than 80% in both patients without visible abnormalities and those with squamous intraepithelial lesions. Conclusion. Along with traditional methods, the investigation permits the expression level of miRNAs, mir-22, and mir-92a to be considered as an informative molecular marker to predict the extent of involvement of the cervical epithelium in pre-cancer and cancer of the cervix uteri.

Background. Haemorrhage is a leading cause of maternal death worldwide, accounting for over 30% of maternal deaths in Africa and Asia. Postpartum bleeding was also 1.6 times higher in women with preeclampsia than in normotensive women. Objective. We aimed to prevent postpartum haemorrhage in patients with severe preeclampsia by using either carbetocin or misoprostol. The primary outcome was postpartum haemorrhage (blood loss of ≥ 500 ml) while our Secondary outcomes included use of other uterotonics, blood transfusion, maternal complications and maternal death. Methods. This prospective, randomised study was done in Department of Obstetrics and Gynecology, Benha university hospital, Benha University. 60 pregnant women candidate for vaginal delivery with severe preeclampsia received either carbetocin or misoprostol after delivery of the baby. Results. Carbetocin was superior to misoprostol with lower duration of third stage of labour (P=0.036), lower amount of blood loss (P=0.017) and lower incidence of PPH (P=0.03). There was no significant difference in the pre-delivery and the post-delivery haemoglobin concentration between the two groups with P=0.061. The need of additional uterotonics and blood transfusion was higher with misoprostol as compared to cabetocin with P=0.037 and 0.009, respectively. As regards side effects, misoprostol was associated with shivering and pyrexia in significantly high number of patients as compared to cabetocin while nausea, vomiting and headache were more associated with cabetocin. Conclusions. Carbetocin was more effective than misoprostol when used in women with severe preeclampsia to prevent postpartum bleeding.

Objective. To evaluate the efficiency of vibromagnetic impact on the pelvic floor area in treating enuresis in adolescent girls. Material and methods. This group included 36 adolescent girls suffering from involuntary urination during sleep (enuresis). Results. Combination treatment with medications and physiotherapy for enuresis in children allowed efficiency achievement in 52.3% of cases versus the comparison group in which drug therapy with M-choline antagonists (driptan) eliminated the symptoms of urinary incontinence in 26.6% of cases. This drug’s dosage was given twice less than usual. Conclusion. Therapy of enuresis in children can be performed with driptan, but the presence of side effects, such as constipation, dry mouth, palpitations, and a higher risk of diabetes insipidus, limits its use in children and adolescents. Combination treatment with medication and physiotherapy enables reductions in the dose of the drug and in its adverse reactions on the body, which can serve as the basis for recommendations for this therapy option at the facilities at all levels, in the presence of indications for and in the absence of contraindications to physiotherapy.

Objective. To carry out a systematic analysis of the data available in the current literature on the benefits and possible risks of combined oral contraceptive (COC) use. Material and methods. The review included the data of foreign articles published in the past 10 years and found in PubMed on this topic. Results. This paper disproves the myths that exist about COCs and sets out their benefits and the rules of switching from COCs to hormone replacement therapy. It presents data on the effect of COCs on cancers at different sites. The possible risks of COCs are assessed. Conclusion. COCs are not only a reliable means of contraception, but also have a number of significant benefits, including for reducing the risk of cancers at different sites. To avoid possible side effects, all possible benefits and risks of COCs should be weighed before their prescription.

Background. Pelvic organ prolapse is a common disease in women worldwide. Sacrospinous fixation is one of the most effective surgical treatments for genital prolapse. The frequency of postoperative hemorrhagic complications after this treatment is 0.2-2.2% and they mostly manifest themselves by retroperitoneal hematoma formation. The choice of a treatment for these complications depends on the size of hematoma, the clinical presentations of compression of the adjacent organs, the severity of hemorrhagic and pain syndromes, and the appearance of signs of hematoma infection. Description. The paper describes a clinical case of conservative treatment for retroperitoneal hematoma developed in a female patient on the second day after sacrospinous cervicopexy. Discussion. The lack of clear recommendations and evidence-based studies on this problem requires further investigations, elaboration of diagnostic algorithms and therapeutic protocols for postoperative retroperitoneal hematomas.