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No 11 (2017)

Articles

Regulation of water and electrolyte homeostasis in preeclampsia

Khlestova G.V., Karapetyan A.O., Baev O.R.

Abstract

Objective. To analyze the data available in the literature on the regulation of water and electrolyte homeostasis in patients with preeclampsia. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed. Results. Major changes in water and electrolyte balance and the possible mechanisms that regulate ion homeostasis are described in patients with preeclampsia. Conclusion. There is a need for further investigations of the pathophysiological mechanisms regulating water and electrolyte homeostasis in preeclampsia for the elaboration of new approaches to predicting and treating this pregnancy complication.
Obstetrics and Gynecology. 2017;(11):5-9
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Correction of isthmic-cervical insufficiency in multiple pregnancies: Debating points

Dobrokhotova Y.E., Kuznetsov P.A., Dzhokhadze L.S., Konstantinova K.I.

Abstract

Objective. To evaluate the efficiency of a cervical pessary and cerclage and to identify criteria for their application in multiple pregnancy. Material and methods. A search was conducted in the PubMed database and in Russian-language peer-reviewed journals over the last 15 years. Results. Procedures reducing the frequency of preterm birth in multiple pregnancies were analyzed. Conclusion. Multiple pregnancy does not always call for the use of a pessary or suturing. Cervical sutures are unambiguously indicated when the length of the cervix is less than 15 mm at 22 weeks’ gestation; it is also worth considering the possibility of using cerclage when the cervical length is 15-25 mm. Cervical pessary placement is justified in women with a cervical length of less than 25 mm before 30 weeks of gestation.
Obstetrics and Gynecology. 2017;(11):10-15
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Role of HOX genes associated with infertility in female reproductive system diseases

Knyazeva E.A., Kalinina E.A., Bystritsky A.A., Alieva K.U., Bairamova G.R.

Abstract

Objective. To carry out a systematic analysis of the data available in the current literature on the role of HOX genes in realizing the reproductive potential in women. 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. The search depth was 7years. Results. The paper gives data on the impaired work of individual genes of the HOX gene family in a number of reproductive system diseases: endometriosis, uterine fibroids, chronic endometritis, etc. It highlights that the НОХА10 and НОХА11 genes are important in the regulation of endometrial receptivity and describes that there may be a relationship between these genes and infertility. Conclusion. The results of the performed investigations conf irm the prospect and urgency of a study of the role of the НОХА10 and НОХА11 genes in the etiology of infertility, as well as methods for influencing the expression of the above genes.
Obstetrics and Gynecology. 2017;(11):16-22
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Features of reproductive function realization in HIV-infected women

Selimova F.N., Perminova S.G., Mityurina E.V., Kozyrina N.V.

Abstract

Objective. To analyze the peculiarities of reproductive function realization in HIV-infected women, the impact of HIV infection and antiretroviral therapy (ARVT) on the quality of gametes and the outcomes of assisted reproductive technology (ART) programs. Material and methods. The review includes more than 50 foreign and Russian publications. Results. The impact of HIV infection and ARVT on fertility, the quality of gametes, and the effectiveness of ART programs is discussed in women with HIV infection. Conclusion. The negative impact of HIV infection and ARVT on fertility creates preconditions for the in-depth study of problems and for the development of a personalized approach to realizing the reproductive function of HIV-infected women.
Obstetrics and Gynecology. 2017;(11):24-29
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Clinical significance of predictors for preeclampsia: prediction capabilities

Nikolaeva A.E., Kaika I.A., Yuabova E.Y., Kutueva F.R., Kutusheva G.F., Kapustin S.I., Kachanova T.L.

Abstract

Objective. To identify preeclampsia predictors in the general population of pregnant women. Subjects and methods. The investigation enrolled 92 patients who had been followed up in Saint Petersburg Women’s Health Clinic Twenty-Two in 2014-2015. They were examined for the carriage of genetic markers for thrombophilia and that of the genes involved in the regulation of endothelial function and for the serum level of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1). Results. Assessment of delivery outcomes revealed no symptoms of preeclampsia in 74 pregnant women observed during the first and the second trimester. 18 pregnant women showed signs of varying severities of preeclampsia. According to the findings, the elevated sFlt-1/PlGF ratio of above 34.0 in the first trimester of pregnancy and 37.5 in the second trimester was taken in our laboratory as reference values for the preliminary prediction of preeclampsia. The ratio of sFlt-1/PlGF higher than the average level was observed in pregnant women with the most severe forms of preeclampsia. Conclusion. The elevated serum sFIt-1/PlGF ratio is an early markerfor preeclampsia and suggests that the latter may develop. The value of this indicator is associated with the severity of preeclampsia.
Obstetrics and Gynecology. 2017;(11):30-36
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Results of using a combined method of cervical preparation for childbirth

Brega Y.S., Sakharova G.K., Pekarev O.G.

Abstract

Objective. To optimize approaches to preparing the cervix uteri for childbirth in patients with the maternal passages being unprepared for labor. To comparatively evaluate the efficiency of a combined method for cervical preparation for childbirth with DILAPAN-S in combination with mifepristone, that of mechanical methods for cervical preparation with DILAPAN-S and a Foley catheter, as well as medical preparation of the cervix with prostaglandin E/PGE). Subjects and methods. The prospective comparative study enrolled 158 pregnant women aged 23 to 38 years (259-284 days of pregnancy). DILAPAN-S 4 was inserted for up to 12 hours in combination with mifepristone 200 mg twice at a 24-hour interval to prepare the cervix uteri for childbirth in 28 women (Group 1); the cervix uteri was prepared for childbirth, by inserting four DILAPAN-S dilators in 30 patients (Group 2); this was carried out, by inserting the balloon of a Foley catheter into the cervix for up to 12 hours in 50 patients (Group 3); the soft maternal passages were prepared for childbirth, by administering PGE2 gel 0.5 mg twice at a 6-hour interval in 50patients (Group 4). Results. The DILAPAN-S + mifepristone group displayed a mean Bishop score of 1.5, 2.14, and 1.9 higher than in the DILAPAN-S, Foley catheter, and PGE2 gel groups, respectively. In addition, the proportion of vaginal births was significantly higher in Group 1 than in the Foley catheter and PGE2 gel groups. The duration of labor differed in Groups 1-3, 2-3, and 3-4. Additional labor preinduction and induction were needed only in Groups 2, 3, and 4. Conclusion. The combined method of cervical preparation for childbirth with DILAPAN-S in combination with mifepristone of 200 mg twice is a more effective method than mechanical techniques, such as DILAPAN-S, a Foley catheter or medical preparation of the cervix with PGE2 gel.
Obstetrics and Gynecology. 2017;(11):37-43
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Micronized progesterone therapy of recurrent pregnancy loss (results of multicenter TRISTAN-1 study)

Saveleva G.M., Aksenenko V.A., Andreeva M.D., Bazina M.I., Bashmakova N.V., Borovkova L.V., Bryuhina E.V., Bushtyireva I.O., Volkov V.G., Gurev D.L., Dankova I.V., Dobrohotova Y.E., Egorova A.T., Ivanova T.V., Konstantinova O.D., Korotkih I.N., Kravchenko E.N., Kramarskiy V.A., Kuleshov V.M., Lebedenko E.Y., Maltseva L.I., Manuhin I.B., Martirosyan S.V., Mihelson A.F., Olina A.A., Pashov A.I., Rogozhina I.E., Sahautdinova I.V., Selihova M.S., Serova O.F., Sinchihin S.P., Sichinava L.G., Tapilskaya N.I., Tshay V.B., Yarmolinskaya M.I.

Abstract

Subject and methods. The study involved 800 women with recurrent pregnancy loss (2 or more consecutive interruptions of pregnancy in history). 383 patients in group 1 started taking micronized progesterone from pregravid preparation before conception during luteal phase of menstrual cycle and during pregnancy (intravaginally 200- 400 mg per day), 417 pregnant women (group 2) started taking micronized progesterone only after clinical confirmation of pregnancy, from 8 weeks 0 days (intravaginally 200-400 mg per day). Observation of patients of both groups continued in the first half of pregnancy from 8 weeks 0 days until 22 weeks and 0 days of gestation. Current pregnancies were observed during the study: the use of additional drugs, the presence of complications, hospitalizations and their duration, as well as adverse events that occur in patients throughout the observation period. All performed medical research and procedures in the study were routine, used in everyday clinical practice. The statistical analysis of the data was performed using IBM SPSS 23. Results. The main criterion for the therapy effectiveness was prolongation of current pregnancy from 8 weeks 0 days up to 22 weeks 0 days. In group 1 (who had micronized progesterone pregravid preparation), the frequency of pregnancy loss was 2.3%, while in group 2 (who start taking micronized progesterone only after clinical confirmation of pregnancy) - 7.7% (p <0.001). The analysis of the obtained data showed effectiveness and safety of micronized progesterone administration from pregravid stage for the therapy of recurrent pregnancy loss. It can be concluded that the relative risk of interruption of pregnancy decreases with the use of micronized progesterone during pregravid preparation and during pregnancy compared with the use of micronized progesterone only after clinical confirmation of gestation (from 8 weeks 0 days), RR = 0.306 (95% CI 0.148-0.633), p < 0.001. The frequency and nature of adverse events in the groups was statistically comparable (p> 0.05). Conclusion. Results of the study demonstrate effectiveness and safety of micronized progesterone (Utrogestan) administration during pregravid preparation and during pregnancy up to 22 weeks 0 days of gestation in case of recurrent pregnancy loss. The use of micronized progesterone after clinical confirmation of pregnancy (from 8 weeks 0 days) is less effective.
Obstetrics and Gynecology. 2017;(11):44-55
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Clinical and cost-effectiveness analysis of preimplantation genetic screening in patients of late reproductive age

Dolgushina N.V., Korotchenko O.E., Beik E.P., Abdurakhmanova N.F., Ilyina E.O., Kulakova E.V.

Abstract

Objective. To evaluate the clinical cost-effectiveness of preimplantation genetic screening (PGS) in patients of late reproductive age in in vitro fertilization programs (IVF). Subjects and methods. The prospective cohort study included 85 childless couples of late reproductive age, who were divided into groups according to the use of PGS on 3 and 5 days. To search for the least cost-based and maximally effective (birth of a euploid child) procedure, IVF and IVF/PGS using comparative genomic hybridization (CGH) on day 5 were compared by a decision-making analysis. Results. Odds ratio (OR) for the onset of pregnancy due to PGS by CGH used on day 5 in the group of patients aged 40 years and older was 3.6 (95% CI, 0.9; 14.1). OR for live births due to PGS by CGH used on day 5 day in the same group was 4.7 (95% CI, 1.1; 19.1). The mean per-live-birth cost of IVF was 754,060 rubles and that of IVF/PGS was 495,797.8 rubles. The per-live-birth cost of treatment by IVF/PGS for infertility was 34% less than that of IVF treatment. Conclusion. The use of IVF/PGS in patients aged 40 years and older leads to an increase in clinical pregnancy and live birth rates. IVF with PGS using CGH in this patient group is a clinical and cost-effective treatment. The findings support the view that PGS is an important step to plan pregnancy in women of late reproductive age.
Obstetrics and Gynecology. 2017;(11):56-61
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The value of HPV L1 and NuMA1 proteins in the prediction of cervical intraepithelial neoplasia associated with high-risk human papillomavirus

Ershov V.A., Lisyanskaya A.S., Ronzhina E.A., Rakhminova E.R.

Abstract

Objective. To define the role of HPV L1 and NuMA1 expression in predicting cervical Intraepithélial neoplasias (CIN). Material and methods. Cervical biopsies from 138 women with cervical neoplasias associated with high-risk human papillomavirus (HR-HPV) were investigated by cytological, histological, immunocytochemical, and PCR assays. Results. HR-HPV-positive mild (45.7%), moderate (29.7%), and severe (23.9%) forms of dysplasia, or carcinoma in situ (0.7%) were verified. Of them, there were 7.2% of pregnant women. Regression of dysplasia was noted in 61.4% of the studies of CIN with the nuclear expression of L1 and NuMA1; the persistent severity of a squamous epithelial lesion was shown in 31.8% of the studies, and progression of dysplasia was detected in 6.8%. Dysplasia regression and persistence were found in 52.2 and 47.8% of cases with CIN and NuMA1 expression, respectively. The regression, persistence, and progression of CIN were seen in 34.6, 57.7, and 7.7% of the studies of this lesion with L1 expression, respectively. Restoration of the typical structure of the cervical squamous epithelium was revealed in 71.4% of the women with the expression of L1 and NuMA1 or one of these proteins in the atypical cells during pregnancy. A control study demonstrated CIN persistence in pregnant women with no production of L1 and NuNA1 proteins by atypical cells. Conclusion. With the atypical cells producing L1 and NuMA1 or one of these proteins, the regression, persistence, and progression of cervical squamous epithelial dysplasia were revealed in 51.6, 43.0, and 5.4% of the studies, respectively.
Obstetrics and Gynecology. 2017;(11):63-68
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Predictors of the efficacy of metformin in polycystic ovary syndrome

Naidukova A.A., Ananyev E.V., Donnikov A.E., Chernukha G.E.

Abstract

Subjects and methods. The investigation enrolled 143 women (mean age, 26.4±4.6 years; mean body mass index, 23.8±4.8 kg/m2) with PCOS. All the patients were treated with metformin 1500 mg/day for 6 months. All the study participants were divided into two groups: 1) 70 (53.1%) patients with a complete response to therapy; 2) 48 (36.3%) patients unresponsive to metformin therapy. 14 (10.6%) patients with a partial response to therapy were excluded from analysis. A comprehensive examination, including pelvic organ ultrasonography, determination of the serum levels of androgens, anti-Müllerian hormone (AMH), luteinizing hormone (LH), and follicle-stimulating hormone, and a two-hour glucose tolerance test was carried out to estimate the concentrations of glucose and insulin at baseline and after 6 months of therapy. Results. The comparative analysis revealed the higher levels of AMH, total testosterone (TT), and the A/G index in the nonresponse group. The levels of AMH of less than 13.3 ng/ml, TT of 1.81 ng/ml, and A/G index of less than 0.9 can be considered prognostically favorable. After 6 months of metformin therapy, there were decreases in the level of androgens in Group 1 (p < 0.05) and in that of AMH in both groups. Conclusion. Comprehensive examination, including the assessment of the hormonal profile and body composition, is indicated before metformin therapy for PCOS. Metformin therapy responses can be predicted, by estimating the serum levels of TT, AMH, and A/G index, which allows optimization of management tactics for patients with PCOS.
Obstetrics and Gynecology. 2017;(11):69-76
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Efficiency of ovarian stimulation protocols in different phases of menstrual cycle in patients with diminished ovarian reserve

Bogatyreva K.A., Mishieva N.G., Martazanova B.A., Lapina V.S., Abubakirov A.N.

Abstract

Objective. To investigate the efficiency of protocols for ovarian stimulation in the follicular phase of the menstrual cycle and for double stimulation in patients with diminished ovarian reserve. Subjects and methods. The investigation enrolled 148 patients aged 25 to 42 years with diminished ovarian reserve. The patients were divided into two groups according to the phase of ovarian stimulation. Group 1 included 72 patients who underwent superovulation in the follicular phase; Group 2 (subgroups a and b) consisted of 76 patients who received an in vitro fertilization (IVF) program in the follicular and luteal phases. Results. There were no significant differences between the groups in the blood level of follicle-stimulating hormone on the first day of stimulation and on the day of transvaginal ovarian puncture (TVOP) (p > 0.05). The groups showed no statistically significant differences in luteinizing hormone (LH) levels throughout function stimulation either (p > 0.05). There was a gradual serum estradiol increase that accompanied follicular growth; however, no noticeable differences in the estradiol levels were noted in the groups (p > 0.05). Progesterone levels were much higher in Group 2b on the day of starting the ovarian stimulation (p < 0.001) and on day 6 of treatment (p < 0.001), which was due to the continuing hormonal activity of the corpus luteum; however, by the day of ovulation triggering, progesterone concentrations leveled off in the examined groups; on the day of TVOP, the progesterone levels were also comparable regardless of the phase of stimulation. Analysis of embryological indicators in Group 2 revealed that Group 1 and 2 had a statistically significantly larger number of retrieved oocytes (4.4±2.1 and 8.8±4.2, respectively (p < 0.001), mature oocytes (3.8±2.0and 7.4±2.6 (p < 0.001), as well as obtained embryos (1.8+1.5 and 2.7±2.7 (p = 0.039) and top quality embryos (1.0+0.5 and 2.1+1.1 (p = 0.018). The pregnancy rate per embryo transfer was statistically significantly higher in Group 2 and amounted to 55.3 and to 48.6% in Group 1 (p = 0.041). Conclusion. The findings can lead to the conclusion that luteal phase stimulation does not affect the embryological outcome of the IVF program, therefore double stimulation in a single menstrual cycle results in a larger number of mature oocytes and top quality embryos, which is shown by the high rate of pregnancy.
Obstetrics and Gynecology. 2017;(11):78-83
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Investigation of the in vitro activity of lactic acid and its value for clinical practice in the treatment of vaginal infections

Kira E.F., Rybalchenko O.V., Orlova O.G., Korshakova N.Y.

Abstract

Objective. To investigate in vitro morphological and functional changes in the cells of microorganisms in the presence of lactic acid, to study its effect on the development of cultures of opportunistic bacteria (S. aureus, E. colli) and the fungi C. albicans and their ability to form a biofilm as compared with probiotics, and to explore the ability of probiotic lactobacilli to form biofilms (both in the presence and absence of lactic acid). Material and methods. The objects of the investigation were two test cultures of museum Lactobacillus strains; 5 Lactobacillus strains included in the probiotics ecofemin and lactoginal; 2 museum opportunistic bacteria strains, and 1 museum C. albicans strain. The investigators used different methods, including inoculation in the medium containing an agent, as described by O’Toole to explore biofilm formation; determination of the number of microorganisms in the biofilms according to the Koch method; and transmission and scanning electron microscopy. Results. Lactic acid, the active ingredient of femilex, has an antimicrobial effect, by changing the morphological features and functional status of the cells of opportunistic bacteria and fungi, inhibits the development of the cultures of E. coli by 4 times and S. aureus by 2.6 times and the microscopic fungi C. albicans by 2.4 times compared with controls, and also prevents the formation of biofilms. Lactic acid exhibits an average 2-fold greater antimicrobial activity than probiotics against opportunistic bacteria and fungi and at the same time stimulates the growth of lactobacilli and their ability to form biofilms. The combined effect of lactic acid and lactobacillus on the conditionally pathogenic microflora has been found. Conclusion. The present work is the first fundamental study of lactic acid as a main factor in maintaining the local biological homeostasis of the vagina.
Obstetrics and Gynecology. 2017;(11):84-90
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Clinical and immunological characteristics of newborn infants from mothers with cancers

Makieva M.I., Matveeva N.K., Vanko L.V., Tsoi T.A., Zhukova A.S., Shatalova E.A., Polushkina E.S., Averyanova M.V., Timofeeva L.A., Krechetova L.V., Zubkov V.V., Shmakov P.G.

Abstract

Objective. To provide the clinical characteristics of the health status and to assess the immune status of neonates born to mothers with cancer who had received chemotherapy during pregnancy. Subjects and methods. Pregnant women with cancer (n = 60) and their newborn infants (n = 64) underwent physical examination. Ultrasonography was used to examine the brain, abdominal organs, kidneys, and heart in ail the babies. Flow cytometry was employed to assess the composition of lymphocyte subpopulations in the umbilical cord blood of 27 newborn infants and in the venous blood of their mothers. Results. The babies born to women with cancer had lower weight and height and higher frequency of complications in the early neonatal period, which can be attributed to a lower gestational age due to premature delivery that necessitated a more aggressive therapy in the mother. The signs that stemmed from imbalance in the cellular component of immunity, which were manifested by decreases in the immunoregulatory index and in the count of B lymphocytes and by increases in the level of activated T lymphocytes and in that of lymphocytes ready for apoptosis, were observed in pregnant women with cancer who had received immunosuppressive therapy. The umbilical cord blood of their newborn infants displayed a reduction in the relative content of B lymphocytes in the absence of significant differences in the number of T lymphocytes in the control group. Conclusion. The satisfactory status of neonates, the course of the neonatal period, and the lack of considerable changes in the immune status of newborn infants from cancer mothers receiving chemotherapy may be indicative of the adequacy of the performed drug therapy necessary to suppress disease activity and to ensure a successful pregnancy.
Obstetrics and Gynecology. 2017;(11):92-99
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Sociomedical characteristics of HIV-infected patients in IVF programs

Isakova K.M., Nazarenko T.A., Krasnopolskaya K.V.

Abstract

Objective. To investigate the sociomedical characteristics of HIV-infected patients and the features of their reproductive history and reproductive behavior. Subjects and methods. The bulk of HIV-infected patients who sought advice for IVF treatment programs was HIV-serodiscordant couples with an infected male, there were 64 (65%) and 39 (35%) infected men and women, respectively. Results. Out of the examinees, 68.7% of the men were infected parenterally due to drug use; 28.2% of the women were infected via drug use, which shows that parenteral infection remains to be of paramount importance in more than half of the men and in one third of the women. The social characteristics of the examinees demonstrated their social adaptability when the vast majority had education, employment, steady income, and place of residence. The HIV-positive women were found to have negative reproductive behavior factors and poor reproductive and gynecological health. Thus, only 9% of the HIV-serodiscordant couples regularly used contraception; every three women had abortions; more than half of the patients had a history of pelvic inflammatory diseases, cervical diseases, ectopic pregnancies, miscarriage, and infertility. Conclusion. Conclusions are drawn concerning the necessity of broadening the scope of examining HIV- infected patients, as well as a careful analysis of their social characteristics and reproductive history.
Obstetrics and Gynecology. 2017;(11):100-106
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Medical activity of mothers and neonatal health in the context of the influence of sociomedical factors

Shuvalova M.P., Chausov A.A., Grebennik T.K., Prikhodko N.A., Kurochka M.P., Bushtyrev A.V.

Abstract

Background. To increase mothers’ medical activity and literacy in relation to the preservation, promotion, and restoration of the health in children at the early stage of their development contributes to the formation of health-promoting behavior in the family. Objective. To assess the influence of sociomedical factors and personality traits on the proclivity of mothers for taking actions to preserve, promote, and restore the health of their newborn infants. Subjects and methods. An anonymous survey was conducted in 367 puerperas. The questionnaire consisted of questions to explore the medical activity of a woman, such as medical advice for neonatal care; that for complaints about the health of her newborn infants; breastfeeding; neonatal immunization; implementation of her doctor’s recommendations; choice of a medical organization and a doctor for her child. Homogeneous groups were identified using an algorithm for the hierarchical clustering of objects. Results. According to the results of cluster analysis, all the study participants were divided into three groups (clusters). Within each group, the respondents had a similar set of medical activity parameters. Cluster 1 included 53 (14.5%) women. This group was characterized by an orientation on medical advice for newborn care and complaints, as well as an indifferent attitude to breastfeeding. Cluster 2 that comprised the largest number of puerperas (n = 262 (71.4%)) was willing to visit a doctor and, if there were complaints about their newborn infant’s health status, to breastfeed, and to choose a medical organization and a doctor for their child. Cluster 3 consisted of 52 (14.1%) women who were convinced of the importance of seeking medical advice for complaints and of the necessity of breastfeeding; the respondents showed their indifference to the choice of a medical organization and a doctor. Conclusion. The vast majority of puerperas have no formed aims to ensure the maximum medical activity in preserving, promoting, and restoring the health of their newborn infant. The high communicativeness of a woman and the priority of family values have a positive impact on the level of medical activity in mothers.
Obstetrics and Gynecology. 2017;(11):108-113
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Peripartum cardiomyopathy and clinical masks of severe preeclampsia: Issues of differential diagnosis and management tactics

Ignatko I.V., Strizhakov L.A., Timokhina E.V., Afanasyeva N.V., Ryabova S.G.

Abstract

Background. Noncoronary heart diseases remain one of the least studied cardiologic problems, including those in pregnant women. The introduction of highly informative noninvasive diagnostic techniques, including echocardiography into clinical practice, could identify special nosological entities in a group of noncoronary diseases of the myocardium (cardiomyopathies). Description. The paper presents a clinical case of peripartum cardiomyopathy (PPCM) in a 39-year-old pregnant woman and that of respiratory failure in a 29-year-old pregnant woman with severe preeclampsia that required a thorough diagnostic and differential diagnostic search for PPCM. It considers the pathogenesis of PPCM, the features and community of vasculopathy in PPCM and preeclampsia, diagnosis and differential diagnosis, the prediction of adverse outcomes, and therapy characteristics. Conclusion. The timely diagnosis, differential diagnosis, consideration of all the classical clinical manifestations of the disease, and correct and pathogenetically grounded treatment may result in rapid relief of the signs of heart failure and pulmonary edema and in complete recovery of systolic function of the heart.
Obstetrics and Gynecology. 2017;(11):114-122
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Pelvic floor dysfunction in pregnant women in the third trimester

Sukhanov A.A., Dikke G.B., Kukarskaya I.І.

Abstract

Objective. To estimate the frequency and severity of pelvic floor dysfunction (PFD) symptoms in pregnant women in the third trimester. Material and methods. The study enrolled 395pregnant women at 28-38 weeks’ gestation, who filled out a Pelvic Floor Distress Inventory (PFDI-20). Results. 280(61.7%) of the 395 pregnant women specified 2 or more symptoms characteristic of prolapse; colorectal and urinary symptoms were reported by 304 (77%) and 292 (73.9%) of the 395respondents, respectively. Although prolapse symptoms were statistically less frequently reported than were colorectal and urinary ones, but the degree of their severity was higher. One-quarter of the women experienced moderate or severe prolapse symptoms and the same number of women pointed that they should reduce evagination to empty the bowel and bladder, suggesting that they might have more than grade 1 prolapse. Every four women among those who had colorectal symptoms noted that the latter were moderate or severe. Every six women of those who indicated the presence of urinary symptoms also pointed to their severity with frequent and very frequent urine leakage associated with coughing, sneezing or laughing; every three of them said that this symptom was of the greatest significance. Conclusion. The high frequency of PFD symptoms in pregnant women suggests that these risk groups need to be actively identified through screening and to be provided with timely medical care.
Obstetrics and Gynecology. 2017;(11):123-128
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New opportunities in the treatment of vaginitis in patients with chronic salpingoophoritis

Shatunova E.P., Dakhnyuk S.E.

Abstract

Objective. To evaluate the clinical and antirecurrent efficacy of Elgyna in the combination therapy of chronic salpingoophoritis (CSO) concurrent with nonspecific colpitis and bacterial vaginosis. Material and methods. Physical examination and bacteriological and statistical studies were made in 60 patients with an exacerbation of CSO concurrent with vaginitis. All the patients with an exacerbation of CSO were divided into 2 groups according to the performed treatment: 1) those who took Engyna in addition to standard therapy; 2) those who received standard treatment (with other topical antiseptics). Results and discussion. The incorporation of Elgyna into a set of standard therapy during an exacerbation of CSO led to substantial positive clinical changes and a decrease in the rate of recurrent vaginitis. Conclusion. Elgyna is not only an effective, but safe treatment for vaginitis in women with CSO.
Obstetrics and Gynecology. 2017;(11):129-133
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Optimization of combination therapy for bacterial vaginosis in reproductive-aged women

Abashova E.I., Shalina M.A., Yarmolinskaya M.I., Misharina E.V.

Abstract

Objective. To evaluate the efficacy and tolerability of Multi-Gyn ActiGel used in the combination treatment of recurrent bacterial vaginosis (BV) in reproductive-aged women. Subjects and methods. Fifty reproductive-aged women with recurrent BV were randomized equally into 2 groups: 1) those who received a standard two-stage treatment regimen with clindamycin phosphate vaginal cream 2% for 7 days, followed by intravaginal application of Multi-Gyn ActiGel for 5days; 2) those who used long-term treatment: after the standard regimen they continued to have Multi-Gyn ActiGel twice weekly for 3 months. BV was diagnosed using the clinical data, Amsel’s criteria, and microscopic and molecular techniques. The effectiveness of treatment for BV was evaluated 1 and 3 months after start of therapy. Results. The effectiveness of therapy at 1 month after start of two-stage treatment in patients with recurrent BV in both groups was high and amounted to 88% and 84%, respectively. Following 3 months, the recurrent BV rate was significantly lower among the women receiving the long-term treatment regimen (p < 0.05) and was confirmed by clinical and laboratory data than that in patients with the standard regimen using intravaginal Multi- Gyn ActiGel. Conclusion. Multi-Gyn ActiGel is well-tolerated, convenient, and easy-to-use, has no side effects, thus shows high compliance, including that during its long-term use. The long-term use of intravaginal Multi-Gyn ActiGel in the two-stage treatment of bacterial vaginosis significantly (p < 0.01) increases the number of lactobacilli in the vaginal biotope, reduces vaginal pH values, and restores normal microflora, which allows a relapse of the disease to be prevented in 80% of patients with bacterial vaginosis.
Obstetrics and Gynecology. 2017;(11):134-140
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High-frequency ultrasound study in the diagnosis of pointed warts on the external female genitalia

Gasanova G.F., Gorbunova E.A., Saidova A.S., Dodova E.G., Belkov P.A., Bashirova B.L., Apolikhina A.I.

Abstract

Objective. To optimize the diagnosis of pointed warts (PWs) on the external female genitalia. Subjects and methods. 98 patients who attended the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in the period from October 01, 2013 to December 01, 2014, were examined. All the women underwent high-frequency ultrasound study of the skin and mucosae of the external genitalia; extended colposcopy/vulvoscopy; photo fixation in the presence of PWs; their biopsy with subsequent morphological examination. Results. Echo signs characteristic of this nosological entity were established; these included homogeneous hypoechoic or anechoic masses with a deformed outer contour as pyramids, waves, or ridges, which were clearly demarcated from the underlying tissues; and their lower ultrasonic density. The combination of these signs allows for the diagnosis of PWs. To verify the diagnosis of PWs needed their morphological examination. The diagnostic sensitivity of the technique was 94%; a false-positive result was noted in 6% of cases. The specificity of the method was 100%. No case of a false-negative result was seen. Conclusion. The technique can enhance the efficiency of non-invasive diagnosis of PWs, detect subclinical lesions invisible to the naked eye, and determine the depth of the lesion on visible foci.
Obstetrics and Gynecology. 2017;(11):141-147
pages 141-147 views

Menopausal hormone therapy and cervical cancer: A current view of the problem

Yakushevskaya O.V., Yureneva S.V., Khabas G.N., Protasova A.E.

Abstract

Objective. To carry out a systematic analysis of the results of investigations of whether menopausal hormone therapy (MHT) can be used in patients who have been diagnosed with cervical cancer (CC) and/or completed treatment. Material and methods. The article includes the data of foreign articles published in Pubmed and Medline the past 20 years. Results. This paper presents the results of retrospective studies, the purpose of which was to determine the rate of recurrent CC in women receiving MHT compared with the control group. Conclusion. On the one hand, menopausal symptoms developing after surgery (after both panhysterectomy and organ-sparing surgery) and radiation with or without systemic (cytostatic) treatments continue to remain relevant to patients who have successfully completed treatment for squamous cell cancer of the cervix. On the other hand, clinicians need to have clinical protocols regulating the basic criteria for prescribing MHT.
Obstetrics and Gynecology. 2017;(11):148-153
pages 148-153 views

Echography in intrauterine contraception

Demidov V.N.

Abstract

Objective. To present all currently used intrauterine devices (IUD) and to describe the characteristics of their ultrasound imaging. Material and methods. The article includes the data of foreign and Russian articles found in Pubmed on this topic. Results. The paper reports the efficiency of the contraceptive effects of various IUDs. It describes in detail practically all of the complications associated with their use. There is also the possibility that IUDs can be used to treat certain types of gynecological diseases. Conclusion. IUD is an optimal contraception method for healthy parous women who have a regular partner and no inflammatory diseases.
Obstetrics and Gynecology. 2017;(11):154-159
pages 154-159 views

A method for photothermal tissue reconstruction using Er:YAG laser Fotona in modern gynecology

Kulikov I.A., Spokoiny L.B., Gorbunova E.A., Apolikhina I.A.

Abstract

Objective. To analyze Russian and foreign data on the efficiency and safety of noninvasive erbium laser therapy aimed at enhancing pelvic floor muscle tone. Material and methods. Articles on the use of erbium laser in gynecology in the past 7 years were chosen and analyzed in PubMed, the international base for citation of scientific medical publications, were selected and analyzed. Results. Many studies describing the successful experience with non invasive laser procedures in gynecology were identified. The absolute majority of authors note not only the high efficiency of the technique, but also its safety, which makes it possible to regard it as a worthy alternative to both the existing surgical procedures and accepted therapies. Conclusion. This type of therapy represents a promising treatment technology with a high efficiency and an optimal safety profile.
Obstetrics and Gynecology. 2017;(11):160-167
pages 160-167 views

Complementary and alternative therapy for menopausal symptoms

Kuznetsova I.V., Burchakov D.I.

Abstract

Objective. To carry out a systematic analysis of the data available in the literature on alternative therapy for symptoms occurring in women during the menopause transition and postmenopause. Material and methods. Foreign and Russian articles published in the past 15 years were sought in the international database Pubmed for analysis. Results. The data of investigations of the efficiency of therapy for menopausal symptoms with nonhormonal medicines, herbal remedies, biologically active food additives, and non-drug therapies are systematized. In most studies, the criterion for evaluating the therapeutic effect is the frequency and severity of hot flushes. It is noted that alternative techniques can demonstrate a positive impact on other pathological menopausal symptoms. Conclusion. Alternative therapy options need to be further investigated and assessed not only from the standpoint of a reduction in vasomotor symptoms, but also with regard to the effects against other clinically significant menopausal disorders.
Obstetrics and Gynecology. 2017;(11):168-174
pages 168-174 views

Mirror syndrome in the presence of fetofetal transfusion syndrome

Kostyukov K.V., Gladkova K.A., Sakalo V.A., Tetruashvili N.K., Gus A.I., Pyregov A.V., Shmakov R.G.

Abstract

Background. Mirror syndrome is a rare complication with an adverse pregnancy outcome to both the mother and the fetus. The authors give the data available in the literature and their own clinical cases that demonstrate diagnostic methods, management tactics, and a pregnancy outcome in mirror syndrome resulting from fetofetal transfusion syndrome (FFTS). Case report. Two clinical cases of mirror syndrome in multiple pregnancy complicated by FFTS are analyzed. Conclusion. In FFTS, there is a risk for mirror syndrome that is accompanied by a high rate of maternal and perinatal complications. The timely treatment of FFTS or termination of pregnancy after failure of treatment can prevent severe obstetric complications.
Obstetrics and Gynecology. 2017;(11):176-180
pages 176-180 views

Boris I. Medvedev

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Obstetrics and Gynecology. 2017;(11):181-182
pages 181-182 views

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