No 9 (2018)

The paper analyzes the results of current studies of the role of DNA methylation during human embryonic development and the effects of tobacco smoke from maternal smoking on the epigenetic status of a developing child. The molecular mechanisms mediating the association between maternal smoking and its effects on the development and health of the offspring, especially its long-term effects that manifest throughout his/her life are the object of active research in medicine and biology. Human genomics studies in recent years have shown that one of these mechanisms may be the epigenetic regulation of gene activity, namely, stable tobacco smoke-induced alterations in this system can cause concomitant smoking-related developmental and health problems. Active smoking is an important risk factor for morbidity and premature mortality, while maternal smoking during pregnancy has a double effect: firstly, it adversely affects women’s health and secondly, it leads to irreparable fetal developmental disorders and affects the health and development of the newborn and the quality of his/her subsequent life.

The paper analyzes the data available in the current literature on the role of molecular hydrogen in the combination therapy of subfertility and infertility. It gives data on the possible mechanisms of antioxidant action of molecular hydrogen, as well as those on the methods for its use, which are available in clinical practice. There are also results of individual studies demonstrating the efficacy of molecular hydrogen in the treatment of some forms of infertility. The results of ongoing investigations confirm that molecular hydrogen is one of the promising antioxidant drugs used in clinical practice. To create algorithms for the individual preparation of patients for pregnancy, it is necessary to conduct further studies of sufficient power.

The paper presents historical data on the use of estrogens in gynecology. The advantages of transdermal drug formulations are shown to be the constant rate of release and absorption of the active ingredient, which ensure the minimal variability of its concentrations in the systemic circulation, greater bioavailability, and no effect of the ingredient on the gastrointestinal tract and metabolic profile. The authors analyze the currently available data on the use of transdermal estrogens in assisted reproductive technology programs in the most common clinical scenarios: donor oocyte/embryo and cryopreserved embryo transfers in patients with ovarian anovulation or depletion and a thin endometrium.

Objective. To evaluate the expression of estrogen receptors (ER) and progesterone receptors (PR) in the nuclei of the glandular epithelium and endometrial stroma, and intrauterine synechiae in reproductive-aged women. Subjects and methods. Endometrial samples from 30 patients with intrauterine synechiae and from 10 control group patients, who had been operated on at the Department of Gynecology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, were examined during a prospective study. Endometrial tissue samples were taken using pipelle biopsy and then morphologically studied by the standard procedure. Histological findings could reveal 3 grades of intrauterine synechiae. Immunohistochemical examination was made using monoclonal antibodies against PR (clone 636, Dako, Denmark) and ER (clone 1D5, Dako, Denmark); the Dako REAL EnVision system (Dako, Denmark) served as secondary antibodies. After immunohistochemical reactions, the sections were contrasted with hematoxylin and eosin and placed into the Shandon mount TM medium (USA). The degree of nuclear staining intensity was determined by a semiquantitative assay. Results. The immunohistochemical examination showed that the ER expression in the glandular epithelium and endometrial stroma was significantly higher in the women with moderate and medium intrauterine synechiae than that in the apparently healthy women; that the PR expression in the glandular epithelium and endometrial stroma was lower in the women with all grades of the adhesive process than that in the endometrium of the apparently healthy women. Conclusion. The found increased ER expression in the epithelium and stroma of intrauterine synechiae and surrounding endometrium in the proliferative phase of the menstrual cycle in reproductive-aged women with grades I and II intrauterine synechiae, as well as the decreased ER expression in all grades of the process are a prerequisite for a differentiated approach to prescribing hormone therapy after surgical adhesiolysis.

Background. Fat metabolism disorders in reproductive-aged women are becoming a pandemic and are one of the most important causes of maternal and perinatal morbidity and mortality. In addition, clarifying the contribution of gestational weight gain to birth outcomes will also promote the optimization of obstetric tactics. Material and methods. A total of 179 pregnant women were examined and delivered, divided into 4 groups and subgroups according to initial body weight and normal/excessive gestational weight gain. The data obtained were entered into the Microsoft Excel database. The results were statistically processed using the IBM SPSS Statistics 22 software package. Results. The most vulnerable group of patients with premorbid obesity (group III) was identified in terms of intranatal and neonatal complications. The same group was noted to have the highest incidence of delivery complications and birth trauma, which requires that the obstetric tactics should be revised to more actively manage the labor process. Conclusion. The findings require the elaboration of differentiated approaches to managing childbirth depending on the degree of obesity and gestational weight gain, which will improve obstetric care quality and obstetric and perinatal indicators.

Objective. To conduct a retrospective, comparative study of the morphological state of the fallopian tubes. Subjects and methods. Histological, immunohistochemical and morphometric examinations were used to examine the histological specimens of the fallopian tubes in 714 reproductive-aged women. Among them, there were 127 women diagnosed with nonspecific cervical inflammatory processes, 122 with uterine fibroids, 177 with genital endometriosis and uterine adenomyosis, and 223 women with benign ovarian cysts. The fallopian tube specimens from 65 women without genital pathology served as a control. Results. The findings were analyzed taking into account the assessment of structural elements in different parts of the fallopian tube, the thickness of its wall layers, the characteristics of arterial and venous blood supply and microarchitecture of the fallopian tube wall in different phases of the ovarian and menstrual cycle in concomitant extratubal pathology of the genital tract. The findings were compared with the histological and morphometric data of the control group, without indicating concomitant genital pathology in the clinical protocol. Conclusion. The finding may lead to the conclusion that the observed changes in the fallopian tube wall in various types of genital tract pathology play an important role as a morphological substrate for the clinical data related to the low efficiency of assisted reproductive technologies. This study makes it possible to clarify a diagnostic algorithm and to introduce a novel method for the treatment of patients in a female infertility clinic.

Objective. To investigate the features of the expression of P16 and Ki67 in women with an abnormal colposcopic pattern and chronic cervicitis associated with bacterial and viral infections. Material and methods. The materials were genitourinary discharge and cervical biopsy samples from women diagnosed with chronic cervicitis. The investigators made microscopic examination of Gram stained smears from the urethra, vagina, and cervical canal, as well as culture and RT-PCR assay of cervicovaginal secretions, cervical cancer cytology, and p16 and Кі-67 histological and immunohistochemical studies of cervical tissues. Results. In women with chronic cervicitis, the association of high oncogenic risk human papillomavirus (HPV) with Chlamydia trachomatis and Mycoplasma genitalium was found to increase the frequency of Ki- 67 expression in two thirds of the cervical epithelium by 4 times as compared to that of high oncogenic risk HPV with Mycoplasma hominis and/or Ureaplasma urealyticum. Conclusion. When the abnormal colposcopic pattern is detected in women with chronic cervicitis, a histological study of cervical tissues should be complemented with Ki-67 expression examination for the differential diagnosis of the severity of cervical neoplasia.

Objective. To estimate the prevalence of pelvic floor dysfunction (PFD) symptoms in reproductive-aged women and their association with childbirth. Subjects and methods. A total of 1637 women aged 18 to 45years (mean age, 30.8±5.7years) underwent an anonymous survey using the Pelvic Floor Distress Inventory-20 (PFDI-20) and FSFI (Female Sexual Function Index) questionnaires. Results. The symptoms of pelvic organ prolapse (POP) were recorded in 46.6% of the respondents; there were colo-recto-anal, urinary, and sexual disorders in 43.3, 49.7, and 80.7%, respectively. A relationship was found between PFD symptoms and childbirth: POP (χ2 = 92.96, p = 0.0001), colo-recto-anal (χ2 = 132.22, p = 0.0001), and urinary (χ2 =123.68, p = 0.0001) disorders. There was no relationship of sexual disorders to the number of births in the history (χ2 = 0.1005, p = 0.751). Conclusion. The investigation established the high prevalence of PFD symptoms in reproductive-aged women and its association with childbirth, which requires the development of a package of measures for the prevention of these disorders in women in the postpartum period.

The paper analyzes the assisted reproductive technology legislation, in accordance with which malignant neoplasms at any site are contraindications to the use of the basic assisted reproductive technology program. Nonetheless, numerous gynecological oncology studies prove the efficiency of organ-sparing treatments used to preserve reproductive function in young female patients. There is evidence for the need for the legislative consolidation of a possibility to use assisted reproductive technology techniques for the treatment of infertility in people with malignant tumors, provided that there is a positive decision of the Medical Commission chaired by an oncologist/gynecologist, as well as voluntary informed consent from the patient herself.

Objective. To obtain data on the efficiency of preventive use of hygiene products (sanitary pads containing the probiotic strain Lactobacillus acidophilus in women suffering from recurrent vaginal infections caused by opportunistic microorganisms, by estimating the frequency of exacerbations of the chronic process and the changes in the titer of Lactobacilli during the two parallel-group study. Subjects and methods. The investigation was conducted in two age- and menstrual cycle-matched female groups (a study group included women who used probiotic-containing sanitary pads and a control group consisted of those who did not apply probiotic-containing sanitary pads). The duration of each woman’s participation in the study was three months. Vaginal microcenosis in the absence of a recurrence during the study was investigated at two points: before and three months after the study through culture medium inoculation and microscopy of Gram-stained vaginal smears. When relapses of the chronic process occurred during the study, additional microbiological testing for recurrent opportunistic vaginal infection was performed. Results. This pilot study showed an apparent, but statistically insignificant decline in the number of recurrent opportunistic vaginal infections and an increase in the Lactobacillus titer in the vaginal discharge of women who regularly applied probiotic-containing pads. The group of women using probiotic-containing sanitary pads had a recurrence rate that was twice as low as in the control group (22.5% versus 50%). The normal microscopic pattern was more frequently observed in the study group (92.5%) than in the control group (65%). The study group showed a higher Lactobacillus titer than the control group (37.5% versus 15%) by both the total number of diseases and individual conditions associated with a lower Lactobacillus titer. Conclusion. There is a need for further investigations of the effectiveness of prevention of opportunistic vaginal infections with hygiene products containing probiotic Lactobacillus strains on larger patient groups, by typing the Lactobacilli isolated from the vaginal secretions of women.

Vasovagal reaction (VVR) is one of the complications of office hysteroscopy (OH). The frequency of VVR has decreased from 20% to less than 1% over the last 20years. When this complication develops during OH, surgery is stopped or discontinued. There may be a fall and injury when VVR occur prior to and following surgery. The prevention of this complication is to carefully examine the patient’s history of previous VVR episodes and to use office hysteroscopes and a noncontact procedure for Bettocchi office hysteroscopy. The occurrence of VVR in OH is nonfatal, but can lead to negative health consequences. Knowledge of the clinical presentations of VVR allows for the prevention of this complication and, if the latter occurs, contributes to the provision of medical care.

The paper analyzes the data available in the current scientific literature on the problem of human papillomavirus (HPV) vaccination in women over 25 years of age. Based on the data on the incidence and prevalence of HPV, sexual behavior and HPV transmission, and the lack of reliable immunity after natural infection, it is shown that sexually active middle-aged women are still at risk for a new HPV infection, which can lead to cervical cancer. HPV vaccines are immunogenic and safe in this age group and should be proposed to adult women. A combination of screening technologies and HPV vaccination has a great potential for reducing the incidence of cervical cancer in women of all ages.

Urinary tract infections (UTIs) are among the most common infectious diseases. Uncomplicated UTI usually develops in people without obstructive uropathies and structural changes in the kidney and urinary tract in the absence of background diseases. Unreasonable and irrational antibacterial therapy is a factor leading to the chronization of the process. The emergence of resistance of microbial strains to the most commonly used antibiotics causes a range of drugs to treat acute cystitis to be changed. Adequate antibiotic therapy is the cornerstone of successful treatment for acute uncomplicated cystitis. The once-daily antibiotic regimen has many undeniable advantages. Phosphomycin trometamol is a highly effective agent for the elimination of the causative agents of UTI and has a high safety profile.

Background. Chromosomal abnormalities are a leading cause of non-developing pregnancy. Numerous cytogenetic studies have shown that trisomies and polyploidies are a predominant type of genetic disorders in abortuses. According to many studies, chromosomal losses are mainly related to the X chromosome. Autosomal monosomies in the abortuses are considered to be a unique event; their qualitative spectrum and rate have not been previously studied systematically. Case report. The investigators carried out a cytogenetic analysis of the villus cells of the chorion obtained during artificial termination of non-developing pregnancy in a 39-year-old woman. All the analyzed chorionic cells in the abortus had a monosomy 21 karyotype. That this abnormality in embryos can be detected during non-developing pregnancy is confirmed by the previously described cases. Conclusion. Monosomy 21 in at least some cases is compatible with embryonic development up to 8 weeks or more of pregnancy. However, also fully monosomy and its mosaic variants generally lead to intrauterine embryonic death in the first trimester of pregnancy. The rate of abnormalities in the abortuses does not usually exceed 0.8% of the total number of samples with chromosomal abnormalities.