No 11 (2017)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.