No 10 (2019)

The paper gives data on the pathogenesis of disorders in the hemostatic system in the presence of septic conditions, which is associated with coagulation activation at the site of primary infection and the subsequent development of coagulopathy. The clinical presentation of sepsis consists of the primary septic focus and concomitant syndromes: disseminated intravascular coagulation (DIC), acute respiratory distress syndrome, and shock with damage to the corresponding organs and tissues. Activation of hemostasis occurs in septic conditions when the endothelium is damaged by toxins of a pathogenic microorganism, activated immunocompetent blood cells, and proinflammatory cytokines, which results in the synthesis and release of tissue factor. Moreover, a decrease in the level of ADAMTS-13 and a subsequent increase in that of von Willebrand factor is also part of the pathogenesis of sepsis, which in turn can lead to thrombotic microangiopathy. The severity of DIC and thrombotic microangiopathy in sepsis is a governing factor of the severity of the condition and largely determines an unfavorable, including fatal, outcome.

The authors have carried out a systematic analysis of the data available in the literature on current methods for diagnosing and treating nonimmune hydrops fetalis. They have analyzed the main etiological factors leading to the development of nonimmune hydrops fetalis and its pathogenesis. The features of the manifestation of nonimmune hydrops fetalis and outcomes have been found according to the underlying etiology. The paper describes the basic principles of diagnosis and intrauterine treatment of nonimmune hydrops fetalis; however, there is still no comprehensive approach to this problem that necessitates further investigations.

The paper analyzes the results of recent studies of the influence of a chemical factor in the working environment on the female reproductive health. The review includes the authors’ own investigations and the results of a search in the e.LYBRARY, PubMed, and Embase databases. The health risks to working women are still high in the conditions of modern production. The most significant adverse factors are reproductive toxicants that affect the health not only of the woman herself, but also her subsequent generations. The possible consequences of exposure are disorders of the ovarian-menstrual cycle, infertility, complications of pregnancy and childbirth, cancer, endometriosis, and others. The timely detection of maladaption to chemical exposure is particularly important for occupational health risk management, which determines the relevance of biomarker studies.

Recent new progressive and technological options necessitate making a change in everyday patient management tactics. This review analyzes studies on the effectiveness of interdisciplinary programs, such as one day surgery, fast track surgery, and enhanced recovery after surgery (ERAS). The experience in introducing the programs into gynecological practice is generalized; their cost-effectiveness is evaluated.

Every year there is an increasing number of women with malignant neoplasms of the reproductive system. The problems that emerge during the diagnosis and treatment of cancer of female genital organs cause limitations in the implementation of sexual function, which negatively affects the physical and mental status of patients, lowering their quality of life. To date, insufficient attention has been paid to the sexual health of gynecologic cancer patients, although intimacy disorders, such as female sexual dysfunctions, are detected in most of them. This literature review analyzes foreign and Russian publications on the sexual health of patients with the most common types of gynecologic cancer. It presents the research results published in Pubmed, eLIBRARY, and Google Scholar over the past 10 years.

Aim. To compare early neonatal and postpartum complications in puerperal women after vacuum-assisted vaginal delivery using various vacuum extractor systems. Materials and methods. We conducted a prospective analysis of birth data and child’s medical records of patients who were admitted to maternity wards of the N.I. Pirogov Samara City Clinical Hospital No. and underwent vacuum-assisted vaginal delivery using a Kiwi vacuum system. The historical control group comprised 34patients who underwent vacuum-assisted vaginal delivery using a reusable Silc cup vacuum extractor with a silicone cup. The groups were comparable. The indication for vacuum-assisted vaginal delivery in all cases was fetal distress. Results. The study group had shorter delivery time, lower episiotomy rate, a lower rate of transfers of the newborns to the next stage of nursing, lower perineal injury rate, and shorter hospital stay. Conclusion. Vacuum-assisted delivery using Kiwi disposable vacuum extractors does not increase the risk of early neonatal and postpartum complications compared with reusable silicone cups.

Objective. To estimate mitochondrial DNA (mtDNA) copy number in cumulus cells (CC) in patients of late reproductive age in in-vitro fertilization programs and to analyze the relationship of the indicators under study with the parameters of oogenesis, embryogenesis, embryo ploidy, and treatment outcomes. Subjects and methods. A prospective study was conducted to determine mtDNA copy number in 454 CC from 67 patients aged 35-45years. The relative level of mtDNA was determined by real time polymerase chain reaction. Results. A cohort of patients with a mean age of 37.8years showed a statistically significant relationship between the mean level of mtDNA in CC and age (p = 0.008), as well as the level of anti-Mtillerian hormone (p = 0.003). There was no correlation between mtDNA copy number in CC and oocyte maturity, fertilization rate, morpho- logical quality, and blastocyst ploidy. There was a tendency to an increase in mtDNA levels in CC in the embryo implantation group versus the non-embryo implantation group (p = 0.08). Conclusion. The determination of mtDNA copy number in CC can become a reliable biomarker of reproductive system aging, takin into consideration that the age given in the passport does not always reflect the true fertility potential of women. Also, the estimation of the level of mtDNA in CC may become a possible predictor of embryo implantation potential. However, further randomized trials are needed.

Objective. To estimate the diagnostic informative value of instrumental examinations in patients with retrocervical endometriosis (RCE). Subjects and methods. According to the extent of RCE and a concurrence of pelvic organ diseases, 120 patients were divided into 4 subgroups: IA) 30patients with RCE; IB) 30patients with RCE and with colon involvement; IC) 30 patients with RCE and endometrioid ovarian cyst; ID) 30 patients with RCE concurrent with uterine myoma. The extent of RCE was determined according to the data of gynecological examination, transvaginal ultrasound (TVUS), MRI, magnetic resonance imaging (MRT), colonoscopy, laparoscopy, and histological examination of surgical material. Results. TVUS was more informative in endometrioid ovarian cysts (95%) and intestinal lesions (87.3%) than in the isolated form of RCE (68.75%). MRI had the highest diagnostic value in identifying endometrioid infiltrates spreading to the intestinal wall (98.6%), or ovarian lesions (97.4%). The sensitivity of TVUS and MRI in uterine fibroids concurrent with RCE was 36.6% and 89.6%, respectively. Both TVUS and MRI in unobvious pelvic adhesions were uninformative (29.13% and 59.23%, respectively). Conclusion. Only laparoscopy enables full visualization of a pathological focus and access to organs. One should not deemphasize the role of preoperative examination including TVUS, MRI, and colonoscopy. Each of the techniques has its own diagnostic value and does not replace, but provides additional information.

Objective. To assess the clinical and socio-hygienic characteristics of patients with endometriosis-associated infertility and to comparatively evaluate the effectiveness and compliance of a combined approach to its treatment using gestagen (dienogest) and a gonadotropin-releasing hormone (GnRH) agonist. Subjects and methods. The investigation enrolled 150 patients with histologically confirmed endometriosis-associated infertility, by excluding other causes of infertility. Study design: a randomized, open-label, monocentric trial. Group 1 consisted of 75 women who, after surgical treatment for endometriosis (ablation and/or excision), took the GnRH agonist buserelin or diphereline at a dose of 3.75 mg once every 28 days for 3 months intramuscularly (subcutaneously). Group 2 included 75 women who were postoperatively prescribed gestagen (dienogest) at a dose of 2 mg daily for 6 months continuously. Results. The combined treatment of endometriosis-associated infertility via surgery, followed by the administration of both the GnRH agonist and dienogest, was highly effective in reducing the clinical manifestations of endometriosis, such as pelvic pains, dysmenorrhea, dyspareunia, and bleeding. The spontaneous pregnancy rate in both groups was similar (53.3% and 54.7%, respectively; p = 0.870). The patients receiving dienogest versus those taking the GnRH agonist were recorded to have a significantly lower frequency of adverse effects (16% and 92%, respectively), a tendency toward lower rates of undeveloped pregnancy (9.3% and 17.3%). and a higher rate of live births (90.7% and 82.7%; p = 0.489). Conclusion. The use of gestagen in the combined therapy of patients with endometriosis-associated infertility and pelvic pain has advantages over that of the GnRH agonist due to their similar eff icacy and the lower frequency of adverse effects.

Objective. To find a threshold level for soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor placental growth factor (PlGF) and serum sFlt-1/PlGF ratios as predictors of poor perinatal outcomes in patients with severe preeclampsia. Subjects and methods. The investigation enrolled 28 pregnant women with severe preeclampsia. According to perinatal outcomes, all the patients were divided into 3 groups: 1) 5 patients with perinatal losses; 2) 7patients without the latter, but with intermediate perinatal outcomes (Apgar scores of less than or equal to 7 at five minutes; a neonatal umbilical cord pH less than 7.2 at birth; a lactate level greater than or equal to 4.8); 3) 16 patients without losses with favorable perinatal outcomes (Apgar scores of more than 8 at five minutes; an umbilical cord pH more than or equal to 7.2 at birth; and a lactate level less than 4.8). Results. The level of sFlt-1/PlGF was statistically significantly higher in the patients with perinatal losses than in those in Groups 2 and 3 [1162 (940-1276) vs 277(233-335) and 137(120-396)]. In Group 1, the PlGFscore was lower than in the intermediate and favorable perinatal outcome groups [15 (13-17) vs 75 (44-112) and 68 (32-78), respectively]. There were no group differences in the serum concentration of sFlt-1. Conclusion. Determination of the sFlt-1/PlGF ratio and the serum concentration of PlGF can be used as a predictor of poor perinatal outcomes. The threshold level for the sFLt-1/PlGF ratio for predicting perinatal losses was 1197, with a sensitivity of 60% and a specificity of 96%. Estimation of the sFlt-1/PlGF ratio is an additional tool not only for diagnosing preeclampsia and for determining the severity of PE, but also for defining the time of delivery in order to prevent poor perinatal complications.

Background. Lobular breast cancer (BC) occurs in 10-15% of BC cases and more frequently than ductal one, it metastasizes to the gastrointestinal organs. Case report. The authors present their own experience in treating patients with metastases to various segments of the gastrointestinal tract. Conclusion. The localization of metastases in the organs of the gastrointestinal tract calls for a differential diagnosis of a primary gastrointestinal tract tumor from metastatic lobular cancer; the diagnosis of lobular cancer requires additional examination of the organs of the gastrointestinal tract for the early detection of metastatic lesions and the prevention of complications.

Background. The priority area of modern oncology is to develop and introduce organ-sparing treatments for patients of reproductive age. Case report. The paper describes a case of successful implementation of reproductive function in a patient with invasive cervical cancer after laparoscopic radical trachelectomy using high-tech diagnostic and treatment techniques. The sentinel lymph nodes were detected applying the innovative radiopharmaceutical Alotech by means of a Rad Pointer laparoscopic gamma scanner. A uterine obturator was intraoperatively formed using a titanium nickelide shape memory implant. The result of the study was a full-term pregnancy and successful delivery via cesarean section. Conclusion. The recommendations for a follow-up and delivery were formulated in this category of patients.