No 6 (2020)

Pregnancy in patients after kidney transplantation continues to be an urgent problem due to the high risk of complications. The review includes scientific publications over the past 10 years (mainly systematic reviews and meta-analyses by foreign and Russian authors), which have been found in the Pubmed database and on other available search platforms: Cochrane, Web of Science, MEDLINE, and Google Scholar. It summarizes the existing data on the course of pregnancy, the nature of immunosuppressive therapy in accordance with kidney transplant function and gestational complications, the possibility of their early prediction for prevention and timely therapy. Conclusion. Further studies on the identification of the predictors of early-stage kidney damage are needed to reduce the incidence of pregnancy complications and to improve prospects for long-term graft survival.

Aim. To assess the effectiveness of complex compression hemostasis in treating different grades of the placenta accreta spectrum disorders. Materials and methods. A prospective analysis included 127 patients identified as having placenta accreta (n=62), placenta increta (n=58), and placenta percreta (n=7). All patients underwent a cesarean section and metroplasty with complex compression hemostasis. Results. The blood loss volume was associated with the grades of the placenta accreta spectrum disorders making up 2943 (2039) ml, 1437(694.5) ml and 1187(632.6) ml, in patients with placenta percreta, placenta increta and placenta accreta, respectively. Conclusion. Patients with different grades of the placenta accreta spectrum disorders had statistical differences in intraoperative blood loss volume and transfusion volume. Complex compression hemostasis was an effective hemostatic surgical technique for treating different grades of the placenta accreta spectrum disorders.

Objective. To identify risk factors for threatened preterm labor in modern conditions on the basis of longitudinal clinical and epidemiological study. Materials and methods. This was a continuous longitudinal clinical and epidemiological study of 1417 pregnant women of the Ivanovo region in the early stages of pregnancy. The survey included 261 women with a risk of preterm birth during the current pregnancy and 1156 women with normal course of pregnancy or other obstetric abnormalities. Results. The study revealed 25 risk factors for threatened preterm labor. The most significant factors are pregnancy following IVF, previous history of threatened preterm labor, uterine leiomyoma, previous history of threatened abortion and preterm labor, infertility. The present study identified the differences in risk factors for threatened preterm labor and spontaneous preterm labor. Conclusion. The findings on risk factors for threatened preterm labor can be included in information systems monitoring pregnant women with the aim of detecting groups at risk and timely decision making about the obstetric department where a pregnant woman should be admitted for the delivery.

Objective. To analyze the indicators of fetoplacental hemodynamics in intrauterine growth restriction (IUGR) pregnancies and to assess the effect of fetoplacental circulation on the neonatal outcome. Materials and methods. The analysis of data was based on 138 birth records of women with IUGR who delivered infants with a weight less than 2000g. Results. The evaluation of the perinatal outcomes and their correlation with the disturbances of fetoplacental circulation revealed that the risk of neonatal death is three times higher if there are severe disturbances in fetoplacental hemodynamics. Conclusion. The results of the study have demonstrated the significance of regular ultrasound Doppler evaluation of fetoplacental circulation in IUGR pregnancies in order to control intrauterine fetal condition and improve perinatal outcomes.

Objective. To assess the role of complex neurophysiological studies in detecting pudendal neuropathy in patients with painful syndrome associated with pelvic organ prolapse. Materials and methods. The study included 44 patients with pelvic organ prolapse and pelvic pain syndrome. All patients underwent a complex examination including physical examination, colonoscopy, defecography, sphincterometry and complex neurophysiological examination using stimulation electroneuromyography for the investigation of latency of motor nerve conduction (M-response latency), deep pudendal reflex (DPR) and bulbocavernous reflex (BCR). Results. According to the findings of the neurophysiological study, neuropathy in patients with pain syndrome associated with the pelvic organ prolapse occurred unilaterally or bilaterally in all cases. Neuropathy was diagnosed in 65.9% of patients on the basis of the increased M-response latency (in combination with changed parameters of BCR/DPR), and in 34.1% of cases this condition was identified only due to changed parameters of DPR and/or BCR. Conclusion. The neurophysiological studies have shown that neuropathy in patients with pain syndrome associated with the pelvic organ prolapse occurred unilaterally or bilaterally in all cases. Neuropathy was diagnosed in 65.9% of patients on the basis of the increased M-response latency (in combination with changed parameters of BCR/ DPR), and in 34.1% of cases this condition was identified only due to changed parameters of deep pudendal reflex and/or bulbocavernous reflex.

Objective. To investigate the efficacy of prolonged-release ferrous sulphate (Tardyferon) in the prevention and treatment of iron deficiency states during pregnancy. Subjects and methods. A total of 159 singleton pregnant women with mild and moderate iron deficiency anemia (IDA) were followed up. All the patients were treated with a prolonged-release drug containing ferrous sulphate 247.325 mg, calculated in terms of iron 80 mg (Tardyferon). Results. The main blood count indicators were lower in pregnant women treated with Tardyferon. After a treatment cycle, complaints of shortness of breath and weakness disappeared in all the patients. Moreover, a clinical effect was achieved after 2 weeks of therapy whereas hematological parameters became normal 4 weeks later. In addition, all the patients continued treatment with prophylactic doses during a month after delivery, as recommended in the instructions for Tardyferon use. Conclusion. Prolonged-release ferrous sulphate (Tardyferon) is highly effective in preventing and treating IDA in pregnant women, leading to statistically significant normalization of ferrokinetic parameters and blood counts, improving the general condition of patients, and reducing obstetric and neonatal complications.

Objective. To evaluate the efficiency and safety of therapy for bacterial vaginosis (BV) with Lactogynal vaginal capsules and clindamycin vaginal cream 2%. Subjects and methods. Group 1 received clindamycin and Lactogynal for 7days, then only Lactogynal for 7days; Group 2 used clindamycin and Lactogynal for 7 days; Group 3 had clindamycin for 7 days, then Lactogynal for 7 days. After therapy, the patients were followed up for 15-24 days. Results. At 2 weeks after therapy, the clinical cure rates were 88.9% in Group 1, 86.4% in Group 2, and 87.0% in Group 3. The laboratory cure rates according to the Amsel criteria were 95.6, 93.2, and 93.5% in Groups 1, 2, and 3, respectively; those according to the Nugent criteria were 95.6, 90.9, and 93.5% in Groups 1, 2, 3. The PCR cure rates were 77.8, 61.4, and 69.6% in Groups 1, 2, and 3, respectively. The global assessment of clinical and laboratory efficiencies revealed that the total therapeutic cure rates were 66.7% in Group 1, 59.1% in Group 2, and 63.0% in Group 3. The therapy was proven to be no less effective in the study group (Group 1) than in the control group (Group 3). Conclusion. The trial showed that the regimen involving Lactogynal used concurrently with the antibiotic and that of sequential use of the former were comparably effective. The concurrent use of Lactogynal with antibacterial therapy to restore the normal vaginal microflora in the therapy of bacterial vaginosis can increase adherence to treatment, and, therefore, achieve its general effect.

A differential approach to treating apical prolapse is acquiring high relevance. The article reviews the literature, including randomized trials dedicated to apical prolapse treatment via a vaginal route. Much attention is paid to up-to-date methods for correcting apical prolapse by using native tissues and by applying mesh technologies. Intra- and postoperative complications are described The complex process of choosing a surgical intervention directly depends on the nature and severity of prolapse. Conclusion. It is necessary to take into account the general condition of a woman, her desire to save the uterus, as well as the preferences and capabilities of a surgeon. Knowledge of topographic anatomy, compliance with the implant placement technique, and an individual approach ensure the success of surgical treatment.

Background. There are rather small numbers of publications on the management of pregnant women and delivery in women with a uterine scar after repeat cesarean section and metroplasty. However, it is precisely these cases that are associated with a high risk of adverse outcomes, primarily massive bleeding and hysterectomies. The use of organ-sparing surgical obstetrical methods makes it possible to implement reproductive plans to the extent required and to prevent massive blood loss. Case report. The paper describes a clinical case of repeat surgical delivery in a woman who has a uterine scar after 4 cesarean sections and 2 metroplasties and demonstrates the efficiency of a combined surgical treatment procedure for placenta accreta. Conclusion. Combined surgical obstetrical techniques, such as bilateral ligation of the descending branch of the uterine artery, an external uterine assembly supraplacental suture, guided balloon tamponade by Zhukovsky’s uterine and vaginal balloon catheters, allow one to perform organ-sparing surgery for placenta previa and placenta accreta-induced bleeding and to reduce the volume of blood loss.

Background. Wolffian duct cell tumor is a little studied and rarely found neoplasm. No more than 100 cases of this tumor have been described in the world literature. The tumor develops due to disorders in the process of embryogenesis. In the female fetus, the Wolffian ducts are known to undergo involution, whereas the low level of anti-Mullerian hormone allows the Mullerian duct to develop. However, when differentiation of female genital organs is impaired, the fetus develops neoplasms from the rudiments of the Wolffian duct. According to the WHO Classification of Tumors of Female Reproductive Organs, the neoplasm is presently called Wolffian duct cell tumor and is generally detected in the broad ligament of the uterus, fallopian tubes, mesosalpinx, and ovary. There have been single case reports of retroperitoneal Wolffian duct cell tumor in the lateral channel of the abdominal cavity. There are no clinical practice guidelines for the treatment of Wolffian duct cell tumor; therefore, a description of clinical cases of this rare tumor is of interest. Case report. This paper describes a clinical case of a tumor of Wolffian origin concurrent with stage IB1 cervical cancer in a 45-year-old woman. It shows the features of clinical and instrumental examinations. A morphological study plays a key role in the diagnosis of an ovarian tumor. An immunohistochemical study is a specified diagnostic method, which reveals no expression with antibodies to Inhibin, Vimentin, Calretinin, Chromogranin, CD-99, CD-10, WT-1, and estrogen receptors. The tumor cells focally expressed SK-7, EMA, andp-53, which suggested that the tumors of Wolffian origin are immunologically non-specific. The data available in the literature show that no expression with anti-CD-56 antibodies may indicate the benign course of the tumor. Conclusion. The clinical case under discussion shows that in the morphological pattern of the tumor, there are no necrotic areas or signs of invasive growth into the capsule; a low mitotic activity was found. In this connection, the tumor was regarded as apparently benign. It is recommended that the patient be followed up.