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No 5 (2019)

Articles

Innovative approach to prediction and therapy of preeclampsia: global experience

Timokhina E.V., Strizhakov A.N., Zafiridi N.V., Gubanova E.V.

Abstract

The article analyzes an update on the prediction of preeclampsia (PE) as a life-threatening condition for the mother and fetus. A biomarker with a high diagnostic value in predicting the severity of PE and its complications would be a significant progression, especially if it could also become the goal of targeted treatment. A search for a single biomarker to predict or diagnose PE is doomed to fail, since this complication has many causes. Angiogenic imbalance is considered to be leading. Placental ischemia results in the secretion and release of antiangiogenic factors (sFlt-, sEng, TGF-в receptor cofactor) into the maternal bloodstream, which are able to serve as markers of the development of PE in isolation or in combination. The authors analyze the PE prognostic approach adopted in the world’s leading centers. This review analyzes promising therapeutic approaches both to prevent PE and to increase its severity due to targeted effects on circulating angiogenic factors.
Obstetrics and Gynecology. 2019;(5):5-10
pages 5-10 views

Antenatal prevention of fetal respiratory distress syndrome: a glimpse into the future

Khodzhaeva Z.S., Gorina K.A.

Abstract

The literature devoted to the impact of consequences of the misuse of antenatal prevention of fetal respiratory distress syndrome (RDS) and to the assessment of potential methods for its objectification has been sought and analyzed. The misuse of glucocorticosteroids affects long-term cognitive, behavioral, psychological, and physical outcomes, which is especially important, by considering that pregnancy is prolonged in 50% of women at 7-14 days after the first cycle of prevention. Functional and laboratory tests for fetal lung maturity (FLM) can avoid using drugs unreasonably for the prevention of fetal RDS. Antenatal prevention of fetal RDS is one of the most common tools in the hands of obstetricians, therefore, the issues of pre- and perinatal programming, when the diseases developed in adulthood are caused by prenatal drug loading, must be under special control.
Obstetrics and Gynecology. 2019;(5):12-18
pages 12-18 views

Relationship between reproductive dysfunction and high cardiovascular risk

Krutova V.A., Dudnikova A.V.

Abstract

The increased incidence of cardiovascular morbidity in women of childbearing age has become a trend in recent years, and therefore an interest has arisen in the female problem of cardiovascular morbidity and mortality. The aim of the study was to analyze the data available in the modern scientific literature on the possible pathophysiological mechanisms of an association between the main types of infertility and the risk of early cardiovascular events. The data of foreign and Russia papers on the research topic, which had been found in Pubmed and eLIBRARY and published in the last 7 years, were analyzed. According to current data, infertility is associated with cardiovascular disease. Understanding the pathogenetic mechanisms expands the possibilities for improving the mechanisms for providing comprehensive care to women with reproductive dysfunction.
Obstetrics and Gynecology. 2019;(5):19-24
pages 19-24 views

The role of NOD1 and NOD2 receptors in recognizing pathogens in the female reproductive tract

Lebedeva O.P.

Abstract

NOD1 and NOD2 receptors belong to the NOD-like receptor (NLR) family. They are cellular cytosolic innate immune receptors that recognize the components of bacterial peptidoglycan and viral RNA. NOD1 and NOD2 are expressed in all organs of the female reproductive tract, with their maximum expression observed in the fallopian tubes. The endometrial expression of NOD1 mRNA does not depend on the phase of the menstrual cycle, while the expression of NOD2 is maximal in the late secretory phase. NOD1 and NOD2 are able to recognize a number of opportunistic and pathogenic bacteria, viruses, and protozoa. Some microorganisms (Listeria monocytogenes, Neisseria gonorrhoeae) have mechanisms to avoid recognition, which ensures their long-term intracellular persistence.
Obstetrics and Gynecology. 2019;(5):25-29
pages 25-29 views

Adenomyosis: a surgical approach and reproductive outcomes

Biryukova E.I., Rukhliada N.N., Krylov K.Y.

Abstract

Adenomyosis is a benign uterine tumor process, a form of endometrioid disease. Surgical treatmentfor adenomyosis is still the matter of discussion by many authors; however, the principle of surgical interventions (excision of the myometrium affected by glandular invasion) remains unchanged. The paper considers main adenomyomectomy techniques and the results of surgical interventions in the aspect of women’s reproductive function. The authors also describe their original procedure for uterine suturing after performed surgical interventions.
Obstetrics and Gynecology. 2019;(5):30-34
pages 30-34 views

Chlamydia infection: topical issues

Dubrovina S.O., Rubanik L.V., Ardintseva O.A.

Abstract

The 14th International Symposium on Chlamydial Human Infections was held in Zeist, the Netherlands, in July 1 to 6, 2018. The main issues discussed were genitourinary chlamydial infection as one of the most common sexually transmitted infections; fundamental approaches and achievements in its laboratory diagnosis; the immunopathogenetic aspects of development of diseases; and the standards and tactics of Chlamydia treatment. The paper outlines current knowledge on human chlamydial infection. It presents the latest data from studies on Chlamydia trachomatis, as well as trends of the most promising researches.
Obstetrics and Gynecology. 2019;(5):36-42
pages 36-42 views

Menopause, obesity, and comorbidity: possibilities of menopausal hormone therapy

Protasova A.E., Yureneva S.V., Bairamova N.N., Komedina V.I.

Abstract

The steady increase in cancer incidence rates necessitates studies of global risk factors for cancer and a search for novel methods of effective primary prevention. According to the International Cancer Research Agency (IARC, 2017), obesity also increases the risk for development of 13 most common malignant neoplasms (MNs), including breast, colon, pancreas, bladder, and endometrial cancers; the incidence of MNs caused by overweight and obesity among women is 5.4%. Menopausal metabolic syndrome (metabolic syndrome associated with the development of hypogonadism) occurs in 40% of postmenopausal women. Menopausal hormone therapy (MHT) for women in the early postmenopause and/or those who are younger than 60 years, and overweight control reduces overall mortality from 30 to 52% and contributes to the primary prevention of a number of MNs, including breast cancer, type 2 diabetes mellitus, and cardiovascular disease. In addition to MHT, lifestyle modification should be recommended to control body weight and to increase physical activity.
Obstetrics and Gynecology. 2019;(5):43-48
pages 43-48 views

To the question of predictors for the development of preeclampsia in gestational diabetes

Bettikher O.A., Zazerskaya I.E., Popova P.V., Vasiljeva E.Y., Bart V.A.

Abstract

Objective. To investigate the relationship between the level of C-peptide, the severity of arterial stiffness and the presence of obesity in preeclampsia and gestational diabetes. Materials and methods. The study comprised 114 pregnant women at more than 24 weeks’ gestation, including patients with gestational diabetes and preeclampsia (n = 22), preeclampsia (n = 23), gestational diabetes (n = 36), and control subjects (n = 33). The patient evaluation included fasting serum level of C-peptide, augmentation index, and body mass index. The statistical analysis involved correlation coefficients, analysis of variance, and empirical ROC curve. Results. There was an independent association between C-peptide level and preeclampsia (p = 0.04) and obesity (p <0.001), but not concurrent gestational diabetes and preeclampsia. The augmentation index threshold was determined at -45% in relation to the presence of preeclampsia among patients with a C-peptide level above 3.1 ng/ml (sensitivity 0.92; specificity 0.59; OR = 17.14; 95%CI = [1.80; 163.8]). No statistically significant correlation was found between augmentation index and body mass index (r = -0.01; p = 0.9). Conclusion. The study established the values of C-peptide and augmentation index that may be suggested for further evaluation as possible predictors for preeclampsia and cardiovascular diseases after preeclampsia, regardless of the presence of gestational diabetes.
Obstetrics and Gynecology. 2019;(5):50-56
pages 50-56 views

Risk factors for gestational diabetes mellitus

Zhutovets I.V., Levakov S.A., Leshchenko O.Y.

Abstract

Objective. To identify significant risk factors for developing gestational diabetes mellitus (GDM) in women with hypothalam ic dysfunction (HD) and metabolic disorders of puberty for predicting adverse pregnancy outcomes. Materials and methods This prospective study of 170 female adolescents with HD in puberty was conducted from 2000 to 2014. Seventy-two pregnant women with a history of HD were examined for socioeconomic and biomedical risk factors of GDM. Relative risk (RR) and 95% confidence interval (95%CI) were used to estimate the effects of specific risk factors. Results The predictors with the best accuracy for predicting the probability of developing GDM were diabetes mellitus among family members (OR = 5.6) and induced pregnancy (OR = 1.4). Conclusions. Women with a history of HD and metabolic disorders, who plan to use assisted reproductive technologies to treat infertility, should be considered a high-risk group for GDM.
Obstetrics and Gynecology. 2019;(5):57-62
pages 57-62 views

Placental angioarchitecture in monochorionic twin pregnancies with twin-twin transfusion syndrome. Perinatal outcomes

Bugerenko A.E., Sukhanova D.I., Donchenko Y.S., Panina O.B., Sichinava L.G.

Abstract

Objective. To investigate the role of arteriovenous (AV), arterioarterial (AA) and venovenous (VV) anastomoses in the development and progression of twin-twin transfusion syndrome (TTTS). Material and methods. Seventy-four patients with TTTS underwent laser photocoagulation of placental anastomoses. The number and types of anastomoses were analyzed. The patients were divided into 2 groups based on perinatal outcomes: group 1 (n = 54) with at least one surviving twin and group 2 (n = 20) with no surviving twins. The imbalance in blood flow between the twins was evaluated. Results. The number of large AA and VV anastomoses in the two groups was not significantly different, but they differed in the number of large AV anastomoses (p = 0.03). Conclusion. In patients with TTTS, the presence of more than three AV placental anastomoses predicts adverse perinatal outcomes. A A and VV anastomoses do not play a protective role and are not associated with TTTS severity.
Obstetrics and Gynecology. 2019;(5):63-69
pages 63-69 views

Umbilical cord blood acid-base balance and gas composition in relation to the use of epidural analgesia in vaginal delivery

Tysyachnyy O.V., Baev O.R., Evgrafova A.V., Prikhodko A.M., Pismensky S.V.

Abstract

Objective. To study the parameters of umbilical cord blood acid-base balance and gas composition in relation to the use of epidural analgesia (EA) in childbirth. Subjects and methods. The investigation enrolled 380 women; a study group (n = 188) received no EA; a comparison group (n = 192) had EA. The parameters of umbilical cord blood acid-base balance and gas composition were determined using a gas analyzer. Results. The pH values in the EA and non-EA groups were 7.28 (0.06) and 7.31 (0.07), respectively (p = 0.02). In these groups, Base Excess (BE) was 8.3 (2.3) and 6.7 (1.7), respectively (p = 0.004). The partial pressure of oxygen and carbon dioxide did not differ. Conclusion. EA in childbirth does not have a clinically significant negative effect on the fetus and newborn, but is combined with a decrease in pH (p = 0.02) and an increase in the level of BE deficiency (p = 0.004)
Obstetrics and Gynecology. 2019;(5):70-76
pages 70-76 views

Features of the cervical canal microbiota in prenatal amniorrhea and full-term pregnancy

Kaganova M.A., Spiridonova N.V., Kazakova A.V., Devyatova O.O., Galkina D.A., Golovina O.N.

Abstract

Objective. To investigate the composition of the microflora in full-term pregnancy and premature rupture of the membranes (PROM) in comparison with timely amniorrhea. Materials and methods. At the N.I. Pirogov City Clinical Hospital One, 143pregnant women at 37-41 weeks’ gestation, including 85 women with PROM and 58 control group patients with timely amniorrhea during childbirth, underwent microscopic examination of vaginal smears, bacteriological cultures from the cervical canal for flora and antibiotic sensitivity, as well as real-time PCR of swabs taken from the cervical canal. Results. In PROM, the scrapes from the cervical canal exhibited a marked predominance of the anaerobic microflora in 5 (22.7%) cases, a preponderance of Lactobacillus spp. and aerobes in one (4.5%) patient and absolute prevalence of Lactobacillus spp. only in 7 (31.8%) cases (p = 0.002). Lactobacillus spp. decreased significantly and Raoultella spp. was more frequently found in the PRPO group (14% versus 1.3% in the study group). Conclusion. The cervical canal in PROM is characterized by a predominance of anaerobic bacteria, which was diagnosed by real-time PCR diagnosis.
Obstetrics and Gynecology. 2019;(5):77-84
pages 77-84 views

Organ-sparing surgery for adenomyosis

Rukhliada N.N., Krylov K.Y., Biryukova E.I.

Abstract

Objective. To analyze the results of organ-sparing treatment in women with adenomyosis. Material and methods. Since 2003, a total of 203 adenomyomectomies, with the initial uterus sizes being at 9 to 22 weeks’ gestation, have been performed. A number of interventions were made according to the original procedure, when on one side, the myometrial flap is rolled and stitched to the bottom of the formed niche, and the second flap completely covers the defect, blocking it repeatedly. Thus, at least 4-5 myometrial layers rather than 1-2 ones are formed above the uterine cavity. Results. Pain syndrome was eliminated in 15% of women; at 3 months after surgery, 74% of women showed a significant decrease in the intensity of pain from 8.2±2.4 to 3.2±2.2 scores (p < 0.001); in 11% of patients, the operation did not led to a reduction in the severity of pain (p < 0.001). In the follow-up period of up to 12 months after surgery, the hemoglobin concentration was noted to normalize in 84% of cases in the absence of pregnancy. Pregnancy occurred in 39 (47.6% or 19.2% of all interventions) out of 82 women who were interested in fertility restoration. Conclusion. The elimination of bleeding and anemia in 84% and a significant reduction in pain syndrome in 74% of the operated patients lead to the conclusions that quality of life is improved in patients with adenomyosis after adenomyomectomy.
Obstetrics and Gynecology. 2019;(5):86-89
pages 86-89 views

Identification of differentially expressed non-peptide molecules with metabolomics approach in pregnancy-induced hypertension

Xuguang T., Xiucui L., Jing P., Meijiao Z., Xinlinag Z., Peirong W., Nanbert Z.

Abstract

Objective. Pregnancy-induced hypertension (PIH) is a pregnancy syndrome characterized by hypertension and proteinuria after 20 weeks of gestation. The pathophysiology of the PIH is not clear yet. The specif ic objective of this study is to investigate the differential metabolomic molecules presented in PIH. Materials and methods. A total number of 29 placentas, including 14 from PIH and 15 from normal pregnancies were subjected to metabolomic assessment. Results. A total number of 537 peaks (fractions) of non-peptide small molecules have been detected and computerized at thep<0.01 value. Among which, 84peaks were identified to be shared by all PIH types, including PIH1 that was defined as having blood pressure (BP) ranged 140-159/95-100 mmHg, PIH2 group with BP 160-179/105-125 mmHg, and PIH3 group with BP >180/100 mmHg. The level of 113 peaks decreased and 37 peaks increased when the control group was compared with that of PIH1, the level of 259 peaks was lower and that of 8 peaks was higher in PIH2 group, and the level of 311 peaks decreased and 16 peaks increased in PIH3 group. Two molecules, one (Feature 897.2/466) with increased expression from PIH1 group and another (Feature 736.1/1870) with decreased expression from PIH3 group showed excellent separation in PIH groups and control group. These two molecules could be potentially considered as bio-signature candidates for further investigations. Two molecules, Feature 894.2/467 and Feature 418.2/1345, showed a good separation in both intergroup and intragroup. Conclusion. Our findings justified a further investigation to characterize the molecules of the featured peaks and to perform prospective assessment of metabolomic technology as a screening tool for PIH. It may improve the diagnosis of PIH and preeclampsia using non-peptide biochemical markers.
Obstetrics and Gynecology. 2019;(5):90-101
pages 90-101 views

Relationship between polymorphism in NOS3, AGTR1, TLR9, DRD4 genes and severity of congenital pneumonia in newborns

Ionov O.V., Donnikov A.E., Bezlepkina M.B., Nikitina I.V., Balashova E.N., Kirtbaya A.R., Kryuchko D.S., Baibarina E.N.

Abstract

Objective. To identify variable region gene polymorphisms associated with the severity of congenital pneumonia in newborns. Material and Methods. The study comprised 101 newborns with confirmed congenital pneumonia requiring respiratory support after birth. The infants were divided into three groups. Group I (n = 63) included newborns whose respiratory therapy was limited to nasal non-invasive support including CPAP or non-invasive mechanical ventilation in the bi-level CPAP (Biphasic) mode. Newborns in group II (n = 25) required endotracheal intubation and invasive ventilation. Group III (n = 13) included newborns requiring aggressive invasive ventilation (МАР > 12 Н2,O и FiO2 > 0.5) and high-frequency oscillatory ventilation (HFOV). All patients were genotyped to identify DNA polymorphism is specific loci. Results. We identified a statistically significant association between the polymorphic locus of the NOS3 gene: -786(р = 0.028), the AGTR1 polymorphic locus: 1166A>C (p = 0.009), the TLR9 polymorphic locus: 1486T>C (р = 0.022) of the DRD4 polymorphic locus: 521C>T (р = 0.04) and severity of the disease, need for aggressive invasive ventilation, and high-frequency oscillatory ventilation (HFOV). Conclusions. Severity of congenital pneumonia in newborns requiring aggressive invasive ventilation (MAP> 12H2O and FiO> 0.5) and HFOV was associated with polymorphism in NOS3 genes (synthesis of endogenous nitric oxide), AGTR1 (angiotensin converting receptor enzyme), TLR9 (toll-like receptor 9 is a membrane protein from the group of toll-like receptors playing an essential role in the innate immunity), and DRD4 (encodes a subtype of D4 receptor dopamine). Model experiments investigating targeted proteins and interaction pathways of the altered gene products are needed to confirm the predictive value and clinical significance of the studied polymorphism.
Obstetrics and Gynecology. 2019;(5):102-111
pages 102-111 views

Factors influencing the participation of women in cervical cancer screening programs

Apolikhina I.A., Bashirova L.K., Gasanova G.F.

Abstract

The data available in the literature on the factors influencing the effectiveness of cervical cancer (CC) screening are analyzed. These are shown to include the subjective experience of women and a number of psychological factors. Different attitudes of the examinees towards a medical examination procedure and towards material sampling for human papillomavirus (HPV) are noted. It is stated that the reason for non-participation in screening may be a lack of understanding of the importance of screening and underestimation of the risk of CC; a major role is played by socioeconomic and sociocultural factors. Most authors believe that self-sampling may result in more women willing to participate in CC screening programs. This approach encourages women to experience a greater sense of confidentiality and independence, which is extremely important for a number of social groups. Most women report positive experiences with self-sampling, which contributes to increasing their compliance with CC screening programs.
Obstetrics and Gynecology. 2019;(5):112-118
pages 112-118 views

The features and efficiency of therapy for uncomplicated cystitis in pregnant women and puerperas

Serov V.N., Balushkina A.A., Tyutyunnik V.L., Kan N.E.

Abstract

Objective. To investigate the features of therapy and to evaluate its efficiency for acute uncomplicated cystitis in pregnant women andpuerperas. Matetials and methods. The investigation enrolled 46 pregnant women and 10 puerperas with acute uncomplicated cystitis. All the patients underwent clinical and laboratory examination and received therapy with fosfomycin trometamol at a single 3-g dose. Results. Fosfomycin demonstrated a significant efficacy: there was regression of clinical symptoms in 96.4% of the patients and complete pathogen elimination in 94.6%; there were no recurrent cystitis at a 3-month follow-up after therapy. Neither side effects nor adverse reactions were found; a high compliance to therapy was noted. Conclusion. The first-line empirical treatment of acute uncomplicated cystitis in pregnant women and puerperas is single-dose fosfomycin trometamol that exceeds antibacterial drugs in a long-term dosage regimen in terms of convenience of use.
Obstetrics and Gynecology. 2019;(5):120-124
pages 120-124 views

Modulation of the local expression of innate immune factors in patients with chronic endometritis and infertility

Dobrokhotova Y.E., Gankovskaya L.V., Borovkova E.I., Zaidieva Z.S., Skalnaya V.S.

Abstract

Objective. To enhance the efficiency of therapy for chronic endometritis, by modulating the local expression of innate immune factors. Subjects and methods. A study group of 43 patients with chronic endometritis and a comparison group of 15 healthy women were examined. Endometrial material was obtained by aspiration biopsy. The immunohisto-chemistry technique was used to estimate the number of pinopodia, receptors, infectious agents, CD138, CD20, CD8, CD4, CD56, and HLA-DRII. The investigators applied an reverse transcription-PCR assay to evaluate the expression of TLR4, TLR2, HBD1, and TNFa and ELISA to measure the level of HNP1-3. A 20-day cycle of cytokine therapy with Superlymph was performed. Results. Epstein Bar virus was verified in 55.8% of the samples. After therapy, the number of pinopodia showed a 1.3-fold increase and the incidence of Epstein-Barr virus displayed a 2.2-fold decrease. The detection rates for CD138and CD20decreased by 1.6and 1.4 times, respectively. There were 1.7- and 1.5-fold increases in the levels of T-helpers and HLA-DRII, respectively; a 1.3-fold decrease in the expression of the TLR2 gene; the expression of the TLR4, TNFa, HBD1, and HNP1-3 genes increased by 1.5-, 1.2-, 2.1-, and 1.57-fold, respectively. Conclusion. Cytokine therapy leads to a 1.27-fold increase in the number of pinopodia;, there was a rise in the expression of TLR4 and HBD1 receptors by 5 times, TNF-a by 2.2 times, and HNP1-3 by 1.57 times. The diagnosis of active chronic endometritis was ruled out in 62.8% of patients; this condition advanced into an inactive stage in 37.2%.
Obstetrics and Gynecology. 2019;(5):125-132
pages 125-132 views

Possibilities of echography in determining the weight of an extreme large fetus

Derkatch E.A., Guseva O.I.

Abstract

Objective. To estimate the accuracy of determining the weight of an extremely large fetus using the. Faschingbauer equation and the computer program developed by V.N. Demidov. Material and methods. The weight of 10 giant fetuses was calculated. The time that elapsed since the last study before the birth of a fetus ranged with in 0-5 days. Results. The error in calculating the fetal weight, by using the computer program by V.N. Demidov and the Faschingbauer equation was 269.2 and 345.8 g, respectively. The difference between them was 76.6 or 28.5%. The error greater than 500g made using the computer program was observed less frequently in 20% of cases than that with the equation in 25%. The permissible error not exceeding the true fetal weight more than 10% in the application of the computer program and the equation was noted in 20 and 25% of cases, respectively. Calculation of the weight of an extremely large fetus proved to be impossible in 20% cases. Conclusion. The computer program elaborated by V.N. Demidova is a reliable method for determining the weight of an extremely large fetus and can be recommended for its widespread use in clinical practice.
Obstetrics and Gynecology. 2019;(5):133-136
pages 133-136 views

The problem of multiple pregnancy in the infertility treatment with assisted reproductive techniques

Papysheva E.I., Karaganova E.Y., Breusenko L.E.

Abstract

Analysis of the results of studies presented in the international databases MedLine and EMBASE devoted to the problems of IVF-related multiple pregnancies has shown that the risk of complications in IVF pregnancies is higher than in spontaneous ones; the most promising and effective measures to reduce the risk of poor outcomes of IVF pregnancy are transfer of one good quality embryo and pregravid preparation prior to infertility treatment using assisted reproductive techniques. Conclusion. The frequency of obstetric complications in IVF pregnancy remains an urgent task of modern reproductive medicine.
Obstetrics and Gynecology. 2019;(5):137-143
pages 137-143 views

Gestational diabetes mellitus and obstetric complications

Zagarskikh E.Y., Kurashova N.A.

Abstract

Gestational diabetes mellitus is not only an important medical, but also a serious social problem in developed countries. Despite the sufficiently high level of development of modern medicine, the prevalence of gestational diabetes mellitus is gradually increasing and reflects an increase in the incidence of obesity and type 2 diabetes mellitus worldwide. The specialized literature has been reviewed to analyze the main issues of the etiopathogenesis and diagnosis of gestational diabetes mellitus. The paper analyzes the data of Russian and foreign studies of the causes and risk factors of gestational diabetes mellitus. The presented materials demonstrate that gestational diabetes mellitus is associated with several maternal and fetal comorbidities in the short term and carries a high risk of type 2 diabetes and cardiovascular diseases for both mother and child in the future in the long term. In this connection, a search for universal markers is needed to identify women at high risk of gestational diabetes mellitus.
Obstetrics and Gynecology. 2019;(5):144-148
pages 144-148 views

Late pregnancy termination by a medical technique in combination with cervical osmotic dilators

Tyutyunnik V.L., Dikke G.B., Kan N.E., Uzdenova Z.K., Shcherbatykh E.Y.

Abstract

Objective. To analyze the effectiveness of late pregnancy termination by mifepristone/misoprostol in combination with Dilapan-S cervical osmotic dilators. Materials and methods. The publications available in the Cochrane and PubMed databases, as well as the guidelines of international and Russian professional communities and the clinical trials published in the public domain were analyzed. Results. The review presents scientific data suggesting that Dilapan-S osmotic dilators in the simultaneous use of mifepristone and misoprostol can achieve cervical dilation, induction of uterine contractility, and pregnancy termination in a shorter time (within one day) than mifepristone/misoprostol only. The use of Dilapan-S is shown to be more preferable than that of Laminaria in the medical pregnancy termination protocols. Conclusion. The most optimal procedures for cervical preparation have not yet been determined and further investigations are needed to work out clearer recommendations for specific clinical situations.
Obstetrics and Gynecology. 2019;(5):149-154
pages 149-154 views

Metric analysis of comorbidity ratios between miscarriage, endometriosis, menstrual disorders, and micronutrient provision in screening reproductive-aged women

Torshin I.Y., Gromova O.A., Tetruashvili N.K., Kodentsova V.M., Galustyan A.N., Kuritsyna N.A., Lavrov N.V., Grishina T.R., Limanova O.A., Kalacheva A.G., Fedotova L.E., Lapochkina N.P., Kerimkulova N.V., Mozgovaya E.V., Tapilskaya N.I., Semenov V.A., Malyavskaya S.I., Lebedev A.V., Frolova D.E., Rubashkina A.N., Rudakov K.V.

Abstract

Objective. To evaluate relationships between micronutrient provision and a history of recurrent miscarriage, endometriosis, and menstrual disorders. Subjects and methods. Metric methods for big data analysis were used to examine a clinically homogeneous sample of623 women aged 18-35years (3,922 indicators). Results. The investigators revealed complex interactions were established between miscarriage, anamnestic and biochemical indicators, and inadequate intake of vitamins, macro- and micronutrients, including those as components of vitamin-mineral complexes (VMCs). lower intake of vitamins D, A, E, B-group, and folate, potassium, magnesium, calcium, omega-3 polyunsaturated fatty acids (PUFA) and the trace elements Fe, Zn, Cu, Mn, and Se was established for patients with miscarriage. Their inadequate intake was confirmed by blood micronutrient marker testing. Conclusion. The intake of special VMCs among reproductive-aged women is an important resource for the prevention of miscarriage, endometriosis, and menstrual disorders.
Obstetrics and Gynecology. 2019;(5):156-168
pages 156-168 views

Vitamin D deficiency in adult women

Gromova O.A., Torshin I.Y., Tetruashvili N.K., Malyavskaya S.I.

Abstract

The negative effects of vitamin D deficiency are much wider than only increased bone degradation. The paper gives the results of a systematic analysis of 1190 clinical and experimental studies of the effects of inadequate vitamin D supply during the menopausal transition and postmenopause. Vitamin D def iciency has been shown to contribute to the development of metabolic syndrome, breast tumors, muscle strength loss and sarcopenia, rheumatoid arthritis and lipid disturbances. Accordingly, adequate daily supplementation with vitamin D (20004000 IU/day) during the menopausal transition and subsequent postmenopause will compensate for vitamin D deficiency and contribute to the prevention of comorbidities.
Obstetrics and Gynecology. 2019;(5):170-178
pages 170-178 views

Review of current guidelines for the management of women with vaginal discharge

Pustotina O.A., Ostromensky V.V.

Abstract

The paper reviews current Russian and foreign guidelines for the management of women complaining of vaginal discharge, which deal with the diagnosis of recurrent discharge and algorithms for its laboratory examination, treatment, and prevention in women of reproductive and postmenopausal ages. It presents an algorithm for examining women with complaints of vaginal discharge. Anti-adhesive agents that block the adhesion of pathogenic microorganisms to the vaginal epithelium are shown to be effective in preventing dysbiotic and inflammatory diseases. There is evidence that it is necessary to regularly use gel moisturizers that exert protective and regenerative effects on the vaginal mucosa, which is a necessary condition for the restoration and preservation of vaginal biocenosis.
Obstetrics and Gynecology. 2019;(5):180-184
pages 180-184 views

Menstrual bleeding: diagnosis and treatment

Andreeva E.N., Sheremetyeva E.V.

Abstract

Heavy menstrual bleeding (HMB) is a common reason for women and adolescent girls to seek medical advice. This pathology increases maternal morbidity and mortality rates in pregnant women with existing anemia associated with heavy menstrual bleeding. The underestimation of the severity of this condition continues to be a pressing problem among clinicians and patients. HMB considerably worsens quality of life; therefore the purpose of therapy for this condition is to reduce menstrual blood loss, to normalize iron metabolic parameters, and to significantly improve quality of life.
Obstetrics and Gynecology. 2019;(5):186-192
pages 186-192 views

Placenta previa and increta into the lower segment myometrium and cervical canal with uterine artery aneurysm in pregnant women with no uterine scar

Tskhai V.B., Glyzina Y.N., Yametov P.K., Levanova E.A., Lobanova T.T., Gritzaeva E.A., Chubko M.A.

Abstract

Objective. To demonstrate cases of uterine artery aneurysm and placenta increta into the internal cervical os in pregnant women who have no uterine scar. Material and methods. Two clinical cases of placenta previa and increta into the internal cervical os were analyzed in multiparous women. The diagnosis was confirmed by ultrasound, magnetic resonance imaging (MRI), and histological examination. Results. According to ultrasound and MRI, placenta previa and increta into the cervical canal was diagnosed in two cases. One female patient who was 29 years of age and had given birth twice underwent a caesarean section at 32 weeks’ gestation; the other patient who was aged 37 years and had given birth once had the section at 38 weeks. Intraoperatively, in both cases, the placenta was located on the anterior wall of the uterus; there was uterine artery aneurysm (10*14 and 10*12 cm in size) and deep placental penetration into the cervical canal, which required hysterectomy; the total blood loss was 900 and 1700 ml, respectively. Conclusion. Timely diagnosis of placenta previa and increta is one of the most important components of the prevention of severe obstetric complications. Multiparous women with placenta previa are likely to develop uterine artery aneurysm and placenta increta not only into the area of the lower cervical segment, but also in the cervical canal.
Obstetrics and Gynecology. 2019;(5):194-199
pages 194-199 views

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