No 7 (2018)

The paper provides a systems analysis of data on functional changes in the resident uterine and placental stem cells in preeclampsia (PE) and fetal growth restriction syndrome (FGRS); in particular, it discusses a reduction in their proliferative and angiogenic potential and an increase in the production of proinflammatory factors. It considers different aspects of cell therapy, ranging from the type of stem cells and their sources to the supposed mechanisms of therapeutic action, which determine the positive effect, as applied to therapy for PE and FGRS. The analysis of the data available in the literature could lead to the conclusion that cellular technologies are promising in treating PE and FGRS. Nonetheless, for their successful introduction into clinical practice, it is necessary to conduct further investigations of the comparative characteristics of stem cells in normal and pathological pregnancy, as well as the decoding of their molecular behavior in both cases.

The authors analyzed current approaches to diagnosing pelvic floor damages during childbirth. Analysis of the data available in the literature showed that damage to the puborectalis muscle is the most common consequence of vaginal delivery. Current diagnostic principles, such as perineal 2D/3D ultrasound, significantly extend the possibilities of examination in female patients with pelvic floor damages, allowing for objectifying the process of examination and treatment. aking into account the efficiency of the given approaches to diagnosing birth trauma, they should be introduced into practical health care.

The paper provides a systems analysis of the data available in modern literature on possible methods for correcting menopausal disorders in peri- and postmenopausal women. It sets forth in detail the following aspects: classification; characteristics of the stages of reproductive system aging; pathogenesis; clinical manifestations of menopausal conditions; laboratory and instrumental diagnosis;principles of hormonal and non-hormonal therapy for menopausal disorders; and prevention of long-term menopausal complications. Menopausal hormone therapy is shown to be an effective method to correct menopausal symptoms, but it has certain risks and side effects. In this connection, further investigations are required to search for new non-hormonal treatments for menopausal disorders.

Objective. To investigate the clinical and laboratory characteristics of HELLP syndrome and to compare the clinical manifestations of nephropathy in women with moderate and severe preeclampsia (PE) and HELLP syndrome, by correlating them with the blood levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1). Material and methods. The course and outcome of pregnancies were studied in 141 women who were divided into 4 groups: 1) HELLP syndrome; 2) severe PE; 3) moderate PE; and 4) a control group. The investigators assessed and compared main laboratory, clinical, biochemical, and immunological parameters, including imbalance of placental angiogenic factors (sFlt-1 and PlGF) and conducted instrumental studies. Results. The patients with HELLP syndrome were found to have a significantly lower sFlt-1/PLGF ratio (median value, 254±93.51 pg/ml) than those with severe (median values, 439.08±112.29pg/ml) or moderate (306.62±164.59 pg/ml) PE. In addition to damage to the liver, the signs of involvement of other organs in the pathological process were seen in almost all the patients; at the same time renal failure was more pronounced than in those with PE (median values of serum creatinine was 110.80±20.62, 73.26±4.55, and 71.73±6.16 ymol/l in HELLP syndrome, severe PE, and moderate PE, respectively). There was a moderate direct correlation of the level of lactate dehydrogenase (LDH) with that of creatinine (r = 0.539) and total bilirubin (r = 0.606) and an inverse correlation of LDH with platelets (r = -0.384). The role of the imbalance of placental angiogenic markers in the development of clinical manifestations in HELLP syndrome was discussed. Conclusion. HELLP syndrome is unlikely to be a more severe variant of PE. HELLP syndrome is a clinically manifest variant of thrombotic microangiopathy. PE appears to be only a trigger for the development of HELLP syndrome.

Objective. To analyze the course of pregnancy, by evaluating the cervical status, and labor in patients previously treated for different types of HPV-related disease. Subjects and methods. The course of pregnancy and labor was analyzed in 128 patients who had a history of HPV-related cervical disease, by using various therapeutic techniques. Results. Isthmicocervical insufficiency established by cervical echographic parameters occurs 3.9 times more frequently (p < 0.05) after cervical surgery. The most pronounced cervical shortening in HPV-related epithelial disease is observed at 16-18 weeks’ gestation. Conclusion. When the symptoms of threatened miscarriage appear in patients, it is necessary to perform combination treatment aimed at preserving pregnancy: correction of vaginal microbiocenosis, use of МсDonald’s cerclage, insertion of Doctor Arabin’s pessary, and administration of micronized progesterone. The used therapy allows pregnancy to be prolonged to the delivery date.

Objective. To determine the efficiency of portable electrical myostimulation of perineal muscles and radio wave vulvar tissues lifting using a combined method for the prevention and conservative correction of pelvic floor dysfunction in patients in the late postpartum period. Subjects and methods. The investigation enrolled 34 reproductive-aged patients with early manifestations of pelvic floor dysfunction and with clinical types of no higher than Pelvic Organ Prolapse Quantification System (POP- Q) grade 1 genital prolapse. A study group consisted of 18 women; 6 patients of them were found to have POP- Q grade I genital prolapse. A control group included 16 women; 5 patients were observed to have POP-Q grade 1 colpoptosis. The inclusion criteria were the desire of a patient to participate in the study; the manifestations of pelvic floor dysfunction in the late postpartum period. The exclusion criteria were pregnancy; POP- Q grade 2 or higher genital prolapse; severe extragenital pathology; congenital abnormalities of the genitourinary system; pelvic surgery; acute or chronic inflammatory diseases of the pelvis and urogenital tract during an exacerbation; cancers; active-phase skin diseases; sexually transmitted diseases; and neuropsychiatric disorders. The investigation methods included a detailed history data collection to identify risk factors for perineal muscular incompetence both before and after birth; a thorough analysis of complaints; an objective examination; a visual inspection of the perineum by functional tests and perineometry; bimanual vaginal abdominal examination; laboratory examination; and transvaginal and transperineal ultrasonography. The patients were interviewed using the Pelvic Floor Distress Inventory-Short Form 20) (PFDI-20), the Female Sexual Function Index with 19 items (FSFI-19), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). To restore pelvic floor functions and to improve their quality of sexual life in the late postpartum period, after preliminary training the study group patients underwent pelvic floor muscle training with a SensaTONE portable electromyostimulator (China) and a parallel cycle of radio wave lifting with a Surgitron DFS5 radio wave generator (USA) at 4.0MHz according to the Pelleve technology. After completing the cycle of postpartum pelvic floor rehabilitation, the authors analyzed the complaints made, the results of evaluating the perineum and those of perineometry, and the data of transperineal ultrasonography. Statistical data processing, plotting, and result analysis were made on a personal computer using Microsoft Word programs and Microsoft Excel spreadsheets. Statistical calculations were done using the application package Statistica version 7.0. Nonparametric statistical techniques (the MannWhitney U test) were used when the distributions differed from normal. Results. The results of the survey, perineometry, and estimation of the contraction force of the pelvic floor muscles according to the Oxford scale showed that the study group patients unlike the controls showed a significant reduction in the symptoms of pelvic floor dysfunction (p < 0.05) during electrical myostimulation in conjunction with radio wave perineal lifting procedures. The transperineal ultrasound changes in the study and control groups at 3 months after the beginning of the rehabilitation program proved statistically insignificant. Conclusion. Exposure of vulvar and perineal tissues to radio wave radiation of a certain spectrum, by using a Surgitron DF S5 radio wave generator at 4.0 MHz according to the Pelleve technology (USA) in combination with portable electromyostimulation of the pelvic floor muscles, is quite effective to the author’s opinion, as it is a combined technique and has an impact at several levels: the vulva, perineal tissues, and cross-striated pelvic floor muscles.

Objective. To analyze modern literature on the legal regulation of surrogacy for Russian and foreign citizens. Materials and methods. The review presents the results of a systems analysis of foreign and Russian legislations and literature on the population’s rights to surrogacy. Results. The investigation revealed the present-day problems of legal regulation of surrogacy in the Russian Federation. Conclusion. The current surrogacy law has been proposed to be changed.

Objective. To investigate the clinical efficacy of Elgyna in the medical treatment of human papillomavirus (HPV)-associated cervical intraepithelial neoplasias (CIN). Subject and methods. The results of antibacterial therapy prior to destructive treatment were comparatively analyzed in 53 patients with severe dysbiosis in HPV-associated CIN. A study group included 27 patients who took the combined drug Elgyna as one vaginal tablet twice daily (6 administrations); a comparison group of 27 patients received the combined drug Tergynan as one vaginal tablet twice daily (6 administrations). A control group comprised 20 women with the visually unchanged cervix. All the women underwent standard examinations and vaginal microbiocenosis estimation by RT-PCR assay using the Femoflor test. Results. The use of the combined drug Elgyna during medical treatment before destruction was found to normalize molecular biological parameters at the local level and contributes to a significant reduction in the time of epithelialization and a decline in the number of recurrences. Conclusion. HPV-associated cervical neoplasias are accompanied by the development of pronounced dysbiotic processes in the vagina with the predominant involvement of obligate anaerobes. Taking into account the properties of the combined drug Elgyna that provides a normalizing effect on the parameters of biocenosis in accelerating healing and in preventing a recurrence of the process, it is appropriate to prescribe the drug before destructive treatments.

The changes in the 8th edition of the TNM classification of malignant tumors of the ovary, fallopian tube, and peritoneum, by examining the 2013 FIGO classification were reviewed; a rationale for these changes was provided. The paper presents the new 8th edition of the TNM classification of malignant tumors of the ovary, fallopian tube, and peritoneum, which is based on the 2013 FIGO classification. It describes in detail the key differences between the new classification and the previous one, as well as the features of using the new classification in clinical practice. In addition, there is concise information on the epidemiology of ovarian tumors, as well as modern views on their etiology. The main innovations of this classification are as follows: its inclusion of tumors of the fallopian tube and peritoneum; the importance of identifying the histological type of a tumor and the degree of its differentiation; assignment of isolated lesions of the retroperitoneal lymph nodes to stage IIIA; differentiation of tumor extension from the peritoneum into the hepatic or splenic parenchyma (stage IIIC) and that of isolated metastases in the parenchyma of these organs (stage IVB).

Background. Uterine arteriovenous malformation (AVM) is a rather rare condition that can cause life-threatening obstetric hemorrhage. AVMs are classified as congenital and acquired. Acquired uterine AVMs result from previous uterine operations (diagnostic or therapeutic curettages, cesarean section, myomectomy, etc.) or myometrial morphological changes (adenomyosis, metroendometritis, trophoblast diseases, etc.). In recent years, the world has seen a substantial increase in the frequency of cesarean section; in parallel, there have been increasingly more publications on the detection rates of uterine AVM. Case report. The paper describes a case of maternal mortality from fulminant massive obstetric hemorrhage in the second trimester of pregnancy in the presence of uterine AVM and placenta increta. Conclusion. The data obtained from the analysis of the case may be useful in predicting this pregnancy complication in risk group patients.