No 3 (2019)

The paper presents a systems analysis of the data of modern Russian and foreign literature on ultrasound in labor and delivery. It assesses whether ultrasonography can be used during childbirth to diagnose the correct and incorrect positions of the fetal head. The authors describe the technique of ultrasonography and the ultrasound signs of anterior and posterior occipital presentations, the transverse position of the arrow-shaped suture, and extensor and asynclitic insertions of the fetal head. Ultrasound allows a more accurate diagnosis of the type and position of a fetus in labor and delivery. Ultrasound used during labor is an additional tool to diagnose complications associated with the incorrect position of the fetal head and permits the timely and correct determination of delivery tactics.

Uterine malformations are one of the possible causes of pregnancy loss and complications of pregnancy, labor, and delivery. The paper presents data on the frequency of uterine malformations. Different classifications of genital malformations, including current classifications, are considered. Various methodological approaches to diagnosing uterine malformations, which are based on ultrasonography findings, are given.

The paper analyzes the data available in the literature on current methods for predicting and diagnosing uterine fibroids and identifies risk factors for disease recurrence. Further investigations of the pathogenetic features of recurrent uterine fibroids and development of new diagnostic criteria using non-invasive or minimally invasive methods will be able to predict possible recurrences and growth rates of fibroids.

Thyroid disease is more common in women of reproductive age. The paper reviews modern literature on the impact of autoimmune thyroiditis, hypo- and hyperfunction of the thyroid, as well as its structural changes on the female reproductive system. Autoimmune aggression against thyroid cells is frequently associated with reproductive system diseases and is the most common cause of primary hypothyroidism. Hypothyroidism is an easily identifiable risk factor for infertility and pregnancy complications, which responds well to drug therapy. Fetal exposure to the elevated levels of maternal thyroid hormones and thyroid-stimulating hormone (TSH) receptor antibodies can stimulate the fetal thyroid and also lead to the development of a number of diseases at a later period. During pregnancy, the thyroid undergoes structural and functional changes. The management tactics depends on the presence of dysfunction and on the benign/malignant nature of the disease.

Objective. To determine the effectiveness and safety of using a double balloon catheter for cervical ripening in the induction of labor. Materials and methods. The study comprised 60 women with singleton pregnancies at > 34 weeks’ gestation diagnosed with a cephalic presentation, unripe cervix (Bishop score <8), and indications for labor induction. A double balloon catheter for cervical ripening was inserted through the cervix. After 12 hours, the balloon was removed, and the patients were examined again. Depending on the Bishop score, patients underwent additional cervical ripening with either dinoprostone gel or amniotomy. If they failed to respond, induction of labor was performed by oxytocin infusion. Results. The mean gain in the Bishop score was 3. 13.3% of patients went into labor before balloon removal. The onset of labor was observed on average 3 hours after catheter removal. Sixty percent of women gave birth vaginally. The overall rate of operative delivery was 45%. Failed labor induction was observed in 18.3% of cases. All the infants were born alive. The birth weight of the newborns corresponded to the population estimates. There were no infectious complications or significant adverse effects. Conclusion. The use of the double balloon catheter is effective in cervical ripening and induction of labor at 35- 41 weeks’ gestation without causing significant adverse effects on the mother or fetus.

Objective. To compare levels of PDGFR and CD15 in eutopic, ectopic and normal endometrium. Materials and methods. Group I included 70 patients with ovarian endometriotic cysts, and Group II comprised 24 patients with unexplained infertility without endometriosis. Endoscopic removal of endometriotic cyst and hysteroscopy were performed in women in Group I; laparoscopy, chromohydrotubation and hysteroscopy with material sampling for immunohistochemistry were performed in Group II. Results. An increase in CD15 expression in the ectopic endometrium was observed both in the gland (35(32;37), 8 (8;9), p = 0.002) and in stroma (16(15;22), 1(0.8;1.3), p = 0.003); an increase in PDGFR was also detected both in the gland (38(38;41), 9(8; 10), p = 0.002), and in stroma 18(17; 19), 1.1(0.8;1.4), p = 0.001). We noted an increase in CD15 (8(8;9), 8(6.5;8), p = 0.006) and PDGFR (9(8;10), 8(7.5;9), p = 0.001) in the glands of the eutopic endometrium in comparison with the normal one. Conclusion. The results obtained during the study confirm the theory of the role of stem cells in the pathogenesis of endometriosis, which may underlie the development of pathogenetic therapy for this disease.

Objective. To investigate the relationship between reproductive function (RF) and the recurrent depressive disorder (RDD) in women. Material and methods. The study comprised 120 women with RDD and 120 mentally healthy women aged 18-65 years. Results. The findings included quantitative characteristics of RF in women with RDD and healthy women. RDD was associated with a later onset and irregularity of menstruation, earlier recovery of menstrual function after childbirth, the occurrence of PMS and premenopause, which leads to a decrease in the number of pregnancies, births, and children. Depression impaired social and family adaptation. Depressions occurring in puberty and postmenopause had the most and the least harmful effect on RF, respectively. Conclusion. Depressive disorders are associated with periods of hormonal adjustment. Depressive symptoms in PMS may help predict depression in the future or indicate incomplete remission. Women with RDD had impaired menstrual function and decreased childbearing potential.

Objective. To determine the incidence and analyze the clinical and diagnostic characteristics of the metabolic bone disease of prematurity (MBDP) presenting with non-traumatic fractures. Materials and methods. The study was conducted in 2013-2017 and comprised all premature infants with MBDP-associated bone fractures, who had no surgical diseases. Results. Fractures were diagnosed in 7 children; femoral and rib fractures were more common than humerus fractures. All children received total parenteral nutrition lasting from 9 to 43 (median 19) days; in 5 of them, enteral nutrition did not meet their nutritional needs. In the 1st month of life, all infants had severe hypophosphatemia; in 5 patients the level of alkaline phosphatase increased. Conclusion. MBDP-associated bone fractures were observed in 2.1% of children with birth weight less than 1500g (6.25% with ELBW; 0.4% with VLBW). All children had multiple risk factors for MBDP. In 3 infants, bone fractures were diagnosed belatedly, when they were in the stage of consolidation.

Objective. To enhance diagnostic accuracy for endometrial competence. Subjects and methods. A total of 96 patients with a history of reproductive failures were examined. Menstrual blood was analyzed for glutathione peroxidase-1, interleukin-6, and E-selectin, by using a monoclonal antibody-based sandwich ELISA. To determine the regulatory limit values, the material of 30 healthy women was studied. The results were assessed using the logistic regression method. A mathematical model was developed, which could determine the probability of endometrial pathology at the threshold value of the integrative indicator P ≥ 0.29. Results. Patients with diagnostically significant P levels were observed to have signs of chronic inflammation and dystrophic changes in the endometrium. The mean probability (Pmean of the disease was 0.59 for patients and 0.22 or healthy women. The diagnostic sensitivity and specif icity of the test were 93.3 and 92.86%, respectively. Conclusion. It is appropriate to calculate the prognostic probability of endometrial pathology, by measuring the concentration of biologically active substances in the menstrual discharge for the primary non-invasive diagnosis of endometrial non-tumor pathology.

Intravenous iron complexes are actively used in clinical practice and now allow short-term safe pathogenetic therapy for iron deficiency anemia. This clinical evolution has been achieved with intravenous ferric carboxymaltosate complex, the effectiveness and safety of which has been proven in numerous clinical trials. The designed intravenous iron (III) hydroxide oligoisomaltosate complex has theoretical bases for a low immunogenicity and can be administered at a higher dose in a single infusion. The clinical feasibility of administering more than 1000 mg of iron requires a comprehensive and balanced approach and the confirmation of the safety of iron (III) hydroxide oligoisomaltosate needs systems monitoring of its clinical use.

A novel surgical procedure for restoring the reproductive potential was performed at the National Medical Centre for Obstetrics, Gynecology and Perinatology in Moscow on March 06, 2019. A 36-year-old patient who experienced premature ovarian failure was operated. Due to the impact of various epigenetic factors (harmful environmental impact, dietary patterns, etc.), there has been an increase in the proportion of young women aged 40 years or younger suffering from premature ovarian failure. It results in inability to achieve pregnancy with their own oocytes, even using assisted reproductive technologies. Scientists around the world are searching for new methods for restoring reproductive function in late reproductive age women and patients with premature ovarian failure.