No 2 (2019)

The authors have carried out a systematic review of data on aspects of the occurrence of the adhesive process in women with acute pelvic inflammatory diseases and on possible ways to prevent this complication. Many investigators identify the infectious agent as a major factor in the genesis of the adhesive process in acute inflammatory diseases. The high frequency of pelvic inflammatory diseases, adhesions, and tuboperitoneal infertility necessitates the development of new treatment and rehabilitation measures to prevent and treat pelvic adhesion for the reduction of the frequency.

To carry out a systems analysis of the data available in the current literature on methods for visual diagnosis and prediction of outcomes in congenital diaphragmatic hernia. The review includes the articles by foreign and Russian authors, which have been published in the journals cited in PubMed on this topic in the past 15 years. There are currently at least 15 outcome-predicting procedures, most of which are based on direct or indirect lung volume calculations using echography and magnetic resonance imaging. Others include the evaluation of displacement of the abdominal organs into the chest, among which the assessment of the position of the liver is most commonly done. Correct estimation of the degree of lung tissue maturity is one of the key points in predicting the outcomes of the disease. There is a need for further studies of congenital diaphragmatic hernia and for visual diagnostic methods to be developed for its comprehensive assessment in order to determine the most informative criteria for predicting outcomes and management tactics in pregnant women.

The normal development of the umbilical cord, which involves a coiled spiral appearance and the course of its vessels, underlies optimal fetal-placental blood flow. The article presents an analysis of the data available in the literature on the causes of umbilical cord coiling and the clinical signif icance of its degree. To quantify the vessel tortuosity of the umbilical cord, the investigators used a method to determine its coiling index, by dividing the number of complete coils of umbilical cord vessels by the total length of the umbilical cord in centimeters during ultrasound examination of a pregnant woman and/or macroscopic examination of the placenta immediately following birth. There is 1 coil per 5 cm or 0.2 coil per 1 cm in the normal umbilical cord. The umbilical cords with a coiling index of less than 0.07 coil/cm are regarded as hypocoiled; and those with a coiling index of more than 0.30 coil/cm are deemed as hypercoiled. The abnormal umbilical cord coiling indicators (hypocoiled or hypercoiled) are associated with different pregnancy and fetal developmental disorders: meconium-stained amniotic fluid, oligohydramnios, fetal growth restriction, fetal distress, placental abruption, premature birth, low Apgar scores, low ponderal index, and higher perinatal mortality rates.

Subjects and methods. The investigation enrolled 34 women, whose pregnancy was complicated with PE (a study group) and 30 women with uncomplicated pregnancy (a control group). The levels of amino acids in the amniotic fluid were determined in the second and third trimesters of pregnancy, by using an automated amino acid analyzer. Results. PE was found to develop in the presence of multidirectional changes in the content of amino acids involved in many metabolic processes required for normal fetoplacental function. Different trimesters of pregnancy differ in the magnitude of the deviations found in the composition of amino acids in the amniotic fluid. The most pronounced imbalance was observed in the second trimester. The possibility of damage to different metabolic pathways in the second and third trimesters is discussed. Conclusion. The findings make it possible to expand our understanding of the biochemical mechanisms of the formation and development of PE and to elaborate criteria for predicting this pathology.

Objective. To compare central hemodynamics in non-pregnant women with that in women with singleton and multiple pregnancies, late in the third trimester before delivery. Materials and methods. This study used non-invasive bioimpedance analysis to examine central hemodynamics in 20 non-pregnant somatically healthy women and 100 patients in the third trimester of pregnancy including 60 patients with singleton pregnancies and 40 women with twin pregnancies. Results. A comparative analysis of the study findings across the groups showed significant differences in the main parameters of central hemodynamics. Patients with multiple pregnancies had significantly lower stroke volume, cardiac index, oxygen delivery index and higher total peripheral vascular resistance than non-pregnant women and women with singleton pregnancies. Conclusion. When choosing anesthesia and preoperative care for the prevention of intraoperative arterial hypotension and disorders of uteroplacental perfusion, incomplete removal of aortocaval compression in patients with multiple pregnancies should be taken into account.

Objective. To study peripheral blood cytokine levels in primiparous women according to the phase of the first period of labor. Subjects and methods. Peripheral blood samples were collected from 38 primiparous women in the latent and active phases of labor. Serum cytokine levels were determined using the standard Bio-Plex Pro Human Cytokine 17-plex Assay (Bio-Rad, USA). Results. The active phase of labor was found to be characterized by increased IL-6 levels and decreased TNF-α, IFN-γ, IL-12, IL-4, and IL-13. Conclusion. Cytokine balance is important in the dynamics of delivery and in the mechanisms of its abnormal development.

Objective. To study the associations of polymorphic loci of the LIN28B gene with age of menarche in the Russian women of the Central Black Earth Region of the Russian Federation. Subjects and methods. The study sample comprised 696 women. The polymorphic loci rs4946651, rs7759938, rs314280, and rs314276 of the LIN28B gene were genotyped. Results. The polymorphism rs314276 in the LIN28B gene was established to be associated with the age of menarche in the Russian women of the Central Black Earth Region of the Russian Federation: menarche occurs 0.18years later in women with the A/A and C/A genotypes than in those with the C/C genotype. The study showed the important regulatory value of the polymorphism rs314276of the LIN28B gene (located in the region of histones labelling promoters and enhancers in different tissues and affects affinity for the regulatory motifs of DNA to 3 transcription factors: OTX, HNF17, and Pou2f2_known5) and its significant association with the level of expression of the LIN28B gene in the pituitary gland. Conclusion. The polymorphic locus rs314276 of the LIN28B gene is associated with the age of menarche in the Russian women of the Central Black Earth Region of the Russian Federation, has a significant regulatory potential and is linked with the expression of the LIN28B gene in the pituitary gland.

Objective. To determine the prevalence of HPV type 16 variants in the Russian Federation (Moscow and Moscow region) and investigate the association between mutations of human papillomavirus type 16 in the long control region (LCR), E6 and E7 genes and the probability of detecting high-grade CIN and cervical cancer. Material and methods. The study examined 63 cervical epithelial scrape samples positive for HPV type 16 that was confirmed by histological and cytological evidence. Results. Sixty-two of 63 samples belonged to lineage A, and only one sample was assigned to lineage D. Six substitutions for reference sequences were detected, of which four were in the LCR (G7193T, A7316C, T7496C, C24G), and 2 in the E6gene (T109C, T350G). C24G substitution was statistically significantly more common in samples from CIN2-3 and cervical cancer lesions (OR = 2.41, p = 0.04). Conclusions. This study for the first time reported the prevalence of HPV type 16 variants in the Russian Federation (Moscow and the Moscow Region) and showed that the population of HPV type 16 is quite monogenic and represented by the European lineage. Six substitutions were found in the examined fragment, and one of them (C24G) was statistically significantly more common in samples from CIN+ lesions. Substitutions A7316C, T109C and T350G showed a trend towards higher detection rates in samples showing CIN2-3.

Objective. To determine the impact of chronic endometritis (CE) on the formation of an incompetent uterine scar (IUS) and the results of laparoscopic metroplasty. Subjects and methods. The investigation included 50 patients with IUS in the periods longer than 1 year after cesarean section. Laparoscopic metroplasty was performed in conjunction with preparatory and rehabilitation activities. The outcomes were compared between two groups: 1) 26 patients with CE and 2) 24patients without CE. Results. The rate of CE in patients with IUS was 52%. The overall efficiency of laparoscopic metroplasty was 92%. The outcomes were the same in patients with and without CE: the onset of pregnancy was 60 and 81%, respectively (p = 0.22), birth was in 60 and 64.7% (p = 0.21), the progression of pregnancy was in 20 and 12.5% (p = 0.35). Conclusion. The high rate (52%) of CE suggests that the latter has a possible role in the pathogenesis of IUS. Laparoscopic metroplasty in combination with preparation and rehabilitation is effective in 92%.

Objective. To study the time course of changes in the serum level of 25(OH)D in the use of different doses of cholecalciferol as chewable tablets dispersed in the mouth (the dietary supplement (DS) Ultra-D Vitamin D3). Subjects and methods. A total of 125 reproductive-aged patients took cholecalciferol as chewable tablets dispersed in the mouth (DS Ultra-D Vitamin D3). Groups 1, 2, and 3 received DS Ultra-D Vitamin D3 in daily doses of 4.000, 5.000, and 6.000 IU, respectively. The use duration was 8 weeks. 25(OH)D was determined by a chemiluminescent microparticle immunoassay. Results. When the chewable tablets were used in a daily dose of 4.000 IU, the vitamin D levels above 30 ng/ml were achieved in 100% of patients; M ± s 45.75 ± 7.84ng/ml; the dynamics was 123 А%. When the chewable tablets were given in daily dose of 5.000 and 6.000 IU, the vitamin D level above 30 ng/ml was achieved in 93.5 and 96.8% of the patients, respectively; its mean concentrations for the group were 36.86 ± 6.03 and 40.64 ± 4.95ng/ml, respectively; the dynamics was 103 and 116.5 A%. Conclusion. The 8-week use of cholecalciferol at a daily dose of 4,000IU as chewable tablets dispersed in the mouth is sufficient to achieve an adequate vitamin D level.

The paper analyzes the data available in the literature on the topic: migraine attacks during pregnancy and strategic approaches to managing women with migraine during this period. It shows the relevance of diagnosis and therapy in women with migraine attacks during pregnancy. The main management principles for this category of patients are non-drug interventions, behavioral recommendations, safe and effective headache attack relief, and, if necessary, preventive therapy. This can significantly reduce disadaptation and improve quality of life in women during this period. Further investigations are needed to determine effective and safe therapeutic approaches in the presence of headache attacks in women with migraine during pregnancy.

Background. Epithelioid trophoblastic tumor was first described by morphologists in 1995; the world literature reports only about 90 cases of this tumor, which confirms its extreme rarity. This type of tumor is characterized by high malignancy and fairly rapid distant metastasis. At the same time, the current chemotherapy regimens, even those for distant metastases, show a good sufficient efficiency. Clinical case report. The paper analyzes the features of clinical course, diagnostic difficulties, and the observation in epithelioid tumor. It presents difficulties in the interpretation of clinical data and in the differential diagnosis of morphological features in this type of tumor. The authors show the expediency and high informative value of immunohistochemical examination of a tissue specimen. Conclusion. This category of patients should be examined and treated in specialized clinics that have a possibility to perform combined treatment and positive experiences in treating patients with trophoblastic tumors.