No 12 (2017)

Urogenital mycoplasmas - Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis have long been considered commensals of human urogenital microflora. Objective. To clarify whether these bacteria could cause or be associated with various obstetric complications. Materials and methods. Data from epidemiological studies published on this topic were included. Results. Epidemiologic studies have found high prevalence of Ureaplasma spp. and M. hominis among otherwise healthy population. On the other hand, U.urealyticum, U. parvum and M. hominis have increasingly been linked to adverse pregnancy outcomes such as spontaneous pre-term labor, pre-term premature rupture of fetal membranes, miscarriage, stillbirth and low birth weight. However, no convincing causal relationship has been shown. Studies have shown that antibiotics resistance is on the rise and differs considerably by regions. Conclusion. Screening of asymptomatic patients for M. hominis, U. urealyticum and U. parvum is currently still not indicated.

Objective. To carry out a systematic analysis of scientific data on the efficiency of determining telomere length and telomerase activity in follicular cumulus cells and peripheral blood lymphocytes, as well as a correlation of this indicator with the outcomes of in vitro fertilization programs. Material and methods. The review includes the data of foreign and Russian articles published in the past 7 years and found in Pubmed on this topic. Results. Based on the analyzed literature data, the authors have concluded that the study of telomere length and telomerase activity in the follicular cumulus cells and peripheral blood lymphocytes is a relevant and promising method for predicting the outcomes of assisted reproductive technology programs. Conclusion. There is a need for further investigations assessing the correlation of telomere length and telomerase activity in the follicular cumulus cells and peripheral blood lymphocytes with the quality of oocytes and embryos, as well as with the effectiveness of infertility treatment programs involving in vitro fertilization techniques.

Objective. To evaluate infusion-transfusion therapy during cesarean section in pregnant women with placenta previa et increta. Material and methods. A study group consisted of 15 patients with placenta previa et increta. They delivered babies at 32-36 weeks’ gestation. Clinical and laboratory examinations and special studies were applied. Infusion-transfusion therapy and postoperative complications were analyzed. Results. The mean age of the pregnant women was 33.8±4.3 years. All the pregnant women underwent bottom cesarean section. Organ-sparing surgery (metroplasty) was performed in 12 (80%) women; three (20%) had hysterectomy. Intraoperative blood loss ranged from 750 ml to 6000 ml and averaged 2471.42±1528.53 ml. The volume of crystalloid sterofundin solutions was 1361.53+1052.40 ml and that of other solutions was 688.4±123.5 ml. 80% of the patients were injected with colloidal solutions, such as gelofuzin averaged 969.66±351.86 ml; geoplasma did 620.8±124.8 ml. The volume of 6% hydroxyethyl starch (HES) 130/04 solutions averaged 744.4±120.45 ml. Fresh frozen plasma in an amount of 1526.7±762.83 ml was transfused in 60% of the women. The average dose of tranexamic acid was 2.6±0.84 g. Recombinant activated factor VII (rFVIIa) 90 μg/kg was administered to three patients. Prothrombin complex concentrate (1200 units) was infused in 3 patients. The volume of reinfused autoerythrocytes averaged 793.7+424.17 ml. That of donor red blood cells during surgery amounted to 775.1±120.2 ml. Conclusion. In placenta previa et increta, the complex infusion-transfusion program for surgical delivery, by applying the current technologies, and a multidisciplinary approach allow organ-sparing tactics to be implemented in 80% of the women.

Objective. To evaluate the possibility of using anamnestic data, biophysical indicators, and biochemical markers for combined prenatal screening to predict preeclampsia in the first trimester of pregnancy. Subjects and methods. 511 patients (27 with preeclampsia) with singleton pregnancy at 10-13 weeks gestation were examined. Anamnestic data, systolic blood pressure (SBP), and uterine artery pulsatility index (PI), and trophoblastic proteins were explored. The diagnostic threshold (cut-off point) of the analyzed factors was determined by ROC analysis. Results. The normal range was 0.94-1.10 MoM for SBP, 0.87-1.27 MoM for PI, the median placental growth factor was 1.02 (0.67-1.59) MoM. The authors developed a scoring table to predict preeclampsia, using 9 factors, for each a diagnostic cut-off being calculated in scores. A patient with a sum equal to (-2) points or more (the diagnostic cut-off) belongs to a group at high risk for preeclampsia. Conclusion. The method developed to predict preeclampsia in the first trimester of pregnancy has a useful estimate (AUC = 0.82±0.052; LR+, 3.21; and LR-, 0.29) and can be used in clinical practice.

Objective. To explore the possibility of using the transcriptional prof ile in the cumulus cells to predict embryo quality in women with diminished ovarian reserve in the superovulation protocols in the follicular and luteal phases of the menstrual cycle. Materials and methods. 160 cumulus cell samples from 40 patients with diminished ovarian reserve, who underwent an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) program, were analyzed during this investigation. The retrieved oocyte-cumulus complexes were divided into 2groups according to the treatment protocol phase. Group 1 (17 women; 70 samples) included oocytes obtained by IVF/ICSI procedures in the follicular phase of the cycle; Group 2 (23 women; 90 samples) comprised oocytes retrieved via IVF/ICSI during the luteal phase of the cycle. To identify the relationship between the expression levels of mRNA genes and the indicators of embryo quality in women with reduced ovarian reserve in the IVF/ICSI programs, the obtained cumulus cells were divided into three classes based on the quality of embryos according to the morphology assessment criteria: 1) good-quality embryos (n = 42); 2) satisfactory-quality embryos (n = 43); 3) poor-quality embryos (n = 17). A real-time RT-PCR assay was used to estimate cumulus cell mRNA expression for 10 genes: HAS2, PTGS2, GREM1, VCAN, ITPKA, ALCAM(CD166), SDC4, CALM2, SPSB, and TP53I3. Results. Analysis of embryological indicators revealed no statistically significant differences. The mean number of oocytes retrieved on the day of transvaginal puncture was 3.6±1.9 and 4.2±2.0 in the follicular and luteal phase stimulation groups, respectively (p > 0.05). The number of blastocysts was 1.6±1.4 and 1.9±1.8, respectively (p > 0.05). The cumulus cells of good-quality embryos displayed an increase in the mRNA expression levels for the HAS2, VCAN, and PTGS2 genes by 1.8, 2.0, and 2.9 times, respectively; and a decrease in that for the ITPKA gene by 1.9 times (p < 0.05). The logistic regression model was proposed to predict embryo quality in women with diminished ovarian reserve, which took into account mRNA expression levels for the VCAN, HAS2, and PTGS2 genes (the sensitivity and specificity of the technique were 90.5 and 70.6%, respectively). The mRNA expression level for the VCAN gene is the most important marker of embryo quality according to the morphology assessment criteria in the IVF/ICSI program. There was a statistically significant increase in the cumulus cell mRNA expression levels for the VCAN, SDC4, and TP53I3 genes in Study Group 2 (p = 0.003, p = 0.005, and p < 0.001, respectively). Conclusion. The mRNA expression levels for the VCAN, HAS2, and PTGS2 genes may be used as predictors for the good quality of developing embryos in women with diminished ovarian reserve. Superovulation induction during the luteal phase of the menstrual cycle has no negative impact on the developmental potential of oocytes and the quality of obtained embryos.

Objective. To comparatively analyze the level of the mitochondrial proteins TFAM, OPA1, and VDAC1 as possible damage-associated molecular patterns (DAMPs) in the microvesicular fraction from the plasma of pregnant women with preeclampsia (PE), chronic/gestational hypertension and that of healthy pregnant women. Material and methods. The microvesicular fraction was obtained from the plasma of patients by differential centrifugation. The levels of TFAM, OPA1, and VDAC1 were determined by chemiluminescent western blotting. Results. The severe PE group was found to have a significant increase in the expression level of ОРА1L and pre-TFAM proteins and a correlation with the level of proteinuria as an important diagnostic marker for PE. Conclusion. The ОРА1-L and pre-TFAM proteins can lay claim to being PE-associated DAMPs. It is necessary to perform further investigations of the association between certain DAMPs and the development of PE.

The introduction of endoscopic methods to correct congenital malformations is one of the priorities in neonatal surgery. The current techniques of processing visual information and the possibilities of computer graphics maintain a surgeon’s work in natural environments and augmented reality conditions. Objective. To analyze the authors’ own experience with the follow-up and surgical treatment of newborn infants with malformations and to identify disease groups, the surgical correction of which requires intraoperative navigation. Subjects and methods. A total of 1354 newborns with malformations were followed up in 2010 to 2016; their medical records were retrospectively analyzed. Results. Surgical removal of space-occupying lesions and endoscopic interventions for pulmonary and renal malformations are accompanied by the greatest technical difficulties and risks for complications in searching for a pathological focus, mobilizing tissues, and isolating the feeding vessels. Conclusion. The intraoperative navigation complex is the most in-demand in surgery for congenital malformations of the lung, in the removal of space-occupying lesions, and in the reconstructive surgeries of kidney anomalies

Objective. To investigate the efficacy of a venous protector in the complex relief of postembolization syndrome in patients with uterine myoma after uterine artery embolization (UAE). Subjects and methods. 30 patients with uterine myoma and signs of venous/lymphatic insufficiency in the legs (Group 1) were given a venous protector (hesperidin 50 mg, diosmin 450 mg) as one tablet (500 mg) twice daily for one month on the first day following UAE. A control group (Group 2) consisted of 30 patients with post- UAE uterine myoma and without signs of venous/lymphatic insufficiency in the legs, who were not treated with a venous protector. The patients of the analyzed groups were matched for age, the location, size, and number of myomatous nodes. The time course of changes in the regression of myomatous nodes was assessed from ultrasonographic findings at 3 months after UAE. The degree of post- UAE pain syndrome was estimated using a 10-point scale. Results. All the patients described the nature of pain syndrome in the first week after UAE equally; however, the 10-point scale intensity was much more pronounced in Group 2. Regression of myomatous nodes was more pronounced in Group 1 patients (36.5% versus 20.3%). Conclusion. The findings may suggest that venous protective therapy can be used in patients undergoing UAE as a technique to optimize X-ray endovascular treatment and to reduce the severity of postembolization syndrome especially in patients with uterine myoma and venous/lymphatic insufficiency in the lower limbs.

Objective. To analyze the data available in the current literature on the epidemiology, etiology, and treatments of the clinical manifestations of papillomavirus infection. To systematize the results of investigating the clinical efficiency of using inosine pranobex (isoprinosine) in patients with different forms of papillomavirus infection. Material and methods. Foreign and Russian articles published on the investigation topic were analyzed. Results. The paper gives an update on the epidemiology, etiology, and treatments of the clinical manifestations of papillomavirus infection. It describes the results of investigating the efficiency of monotherapy and combination treatment for papillomavirus infection with inosine pranobex (isoprinosine). Conclusion. The current investigations have established the high efficiency of using inosine pranobex to treat human papillomavirus infection: in combination therapy (87.5-97%) and in monotherapy (72.4-95%). There is evidence for an improvement in the regeneration processes in the genital tract mucous membrane when isoprinosine is used after destructive therapy and an increase in the rate of human papillomavirus elimination as a result of the treatment.

Objective. To carry out a systematic analysis of the data available in modern literature on genital herpes and to evaluate the efficacy of valvir (valaciclovir) in the treatment of patients with recurrent genital herpes. Material and methods. The article includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. Genital herpes is one of the most common sexually transmitted infections, and their associated physical and psychological diseases are frequently underestimated. Conclusion. Valvir (valaciclovir) is a standard treatment for genital herpes in immunocompetent patients. The investigations have shown that the drug is effective in suppressing the virus and preventing recurrent genital herpes.

Premature rupture of membranes (PROM) is one of the major causes of high neonatal mortality and morbidity. Very preterm PROM, fetal pulmonary hypoplasia, and fetal inflammatory response syndrome are associated with the loss of amniotic fluid and the development of oligo/anhydramnios. Objective. To extend the duration of pregnancy prolongation without increasing the infection risk with continuous amnioinfusion via a subcutaneous port system. Materials and methods. A patient with PROM at 25 weeks’ gestation had continuous amnioinfusion (100 ml/h, 2400 ml/day, SDP (4±2 cm)) via a subcutaneous port, by using a hypotonic solution by the properties similar to those of amniotic fluid. Conclusion. The f irst experience with continuous amnioinfusion allowed us to increase the interval of pregnancy prolongation up to 10 days in PROM. This new method can certainly be used in pregnant women with PROM and oligo/anhydramnios at term < 28/0 weeks of gestation.