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No 6 (2017)

Articles

THE ROLE OF MITOCHONDRIAL MARKERS IN THE PATHOGENESIS OF PREECLAMPSIA AND THE EVALUATION OF THE EFFICIENCY OF RESPIRATORY THERAPY IN THE TREATMENT OF PREECLAMPSIA

Skovorodina T.V., Vishnyakova P.A., Vysokikh M.Y., Shmakov R.G.

Abstract

Objective. To carry out a systematic analysis of the data available in the current literature on the markers of preeclampsia and oxidative stress, as well as the impact of therapeutic methods on the development of preeclampsia. Material and methods. The review included the data available in foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. The paper describes the current markers of preeclampsia, such as endoglin, placental growth factor, soluble fms-like tyrosine kinase 1, and others, as well as immunological activators that have a marked proinflammatory effect (mitochondrial damage-associated molecular patterns (DAMPs)). It shows new treatments for gestational hypertension and pre-eclampsia by respiratory therapy (continuous positive airway pressure (CPAP)). Conclusion. It is necessary to perform further investigations of the impact of mitochondrial DAMPs on the development of preeclampsia and to evaluate the efficiency of CPAP support in the treatment of preeclampsia.
Obstetrics and Gynecology. 2017;(6):5-9
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EMERGENCY AND ELECTIVE SURGICAL MANAGEMENT OF TUMORS OF THE UTERINE APPENDAGES

Nikogosyan S.O., Kuznetsov V.V., Zagashtokov A.Z.

Abstract

Objective. To discuss the clinical aspects of differential diagnosis and treatment policy in patients with ovarian tumors, as well as indications for emergency and elective surgery. Material and methods. The review included the data of foreign and Russian articles published in the past 20 years and found in international databases on this topic. Results. The most significant risk factors for ovarian cancer are a family history, age, hormone replacement therapy, endometriosis, and obesity. Differential diagnosis is based on the data of transvaginal ultrasound in terms of the International Ovarian Tumor Analysis (IONA) diagnostic criteria and on the determination of the level of the markers CA 125, HE4, lactate dehydrogenase, human chorionic gonadotropin, and α-fetoprotein. The optimal method of surgical intervention is laparoscopic surgery, with intraoperative and elective histological examination. Conclusion. When diagnosing malignant ovarian tumor, the latter should be treated only in specialized clinics.
Obstetrics and Gynecology. 2017;(6):10-17
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ON THE PATHOGENESIS OF REPRODUCTIVE DISORDERS IN WOMEN WITH OBESITY

Vedzizheva E.R., Kuznetsova I.V., Uspenskaya Y.B., Gitel E.P., Vasilyeva I.V.

Abstract

Objective. To carry out a systematic analysis of the data available in the current literature on the role of adipokines in reproductive dysfunction in obese women. Material and methods. For analysis, foreign and Russian works published in the past 15 years were sought for in the international citation system Pubmed. Results. The modern theories of the mechan ism of reproductive disorders in obese women were described; the key factors of impact of adipose tissue on fertility were described. The importance of regulation of the body’s metabolic processes in restoring fertility and preparing women for pregnancy was highlighted. Conclusion. Most current studies often show conflicting and ambiguous results, which leads to the need for further research.
Obstetrics and Gynecology. 2017;(6):18-25
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ACTIVE VITAMIN D METABOLITES IN THE THERAPY OF MENOPAUSAL OSTEOPOROSIS

Kuznetsova I.V.

Abstract

Objective. To carry out a systematic analysis of the data available in the literature on the problem of therapy with active vitamin D metabolites for menopausal osteoporosis. Material and methods. For analysis, foreign and Russian works published in the past 15 years were sought for in the international citation system Pubmed. Results. The modern theories of the mechanism of development of menopausal osteoporosis are described. The specific features of metabolism of vitamin D and its effects on bone tissue are depicted. International and Russian guidelines for the treatment of osteoporosis are given. The data of investigations demonstrating the possibility of using active vitamin D metabolites in the therapy of menopausal osteoporosis are analyzed. Conclusion. The use of active vitamin D metabolites alone or in combination with bisphosphonates is an effective method with a good safety profile for treating women with menopausal osteoporosis.
Obstetrics and Gynecology. 2017;(6):26-34
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IMPAIRED AUTONOMIC REGULATION IN PREGNANT WOMEN WITH IRON DEFICIENCY ANEMIA AND WAYS OF ITS CORRECTION

Sheveleva G.A., Fedorova T.A., Dubrovina N.V., Sokur T.N., Bakuridze E.M.

Abstract

Objective. To investigate the corrective properties of medical ozone, ozone, and an iron-containing supplement and only an iron-containing supplement in the combination treatment of iron deficiency anemia (IDA) in pregnant women in relation to the functional state of the autonomic nervous system. Material and methods. Cardiointervalographic analysis was used to study the specific features of autonomic regulation in 60 pregnant women (divided into 3 groups) with mild and moderate IDA in the second (before treatment) and third (after treatment) trimesters of pregnancy. Results. The use of ozone, or ozone in combination with an iron-containing supplement, contributes to a substantial improvement in the autonomic balance of regulating systems in the majority of patients and suggests that it is expedient to incorporate ozone in the combination therapy for IDA. The iron supplement used alone was ineffective and depended on the type of autonomic homeostasis in women.
Obstetrics and Gynecology. 2017;(6):35-40
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MATERNAL AND PERINATAL OUTCOMES IN EARLY AND LATE PREECLAMPSIA

Khlestova G.V., Karapetyan A.O., Shakaya M.N., Romanov A.Y., Baev O.R.

Abstract

Great attention is paid to the study of early and late preeclampsia (PE). It is known that PE can lead to poor perinatal outcomes; however, the impact of the time of PE manifestation on maternal and perinatal outcomes has been understudied, making it difficult to predict pregnancy outcomes in this group of patients. Objective. To conduct a comprehensive study of the course of pregnancy, maternal and perinatal outcomes, and the neonatal period in patients with early and late PE. Subjects and methods. The prospective cohort study enrolled 70 patients, including 40 patients with early PE (Group 1) and 30 patients with late PE (Group 2). Results. Patients with early PE suffered from chronic hypertension 2.63 times more often and had a history of PE 5.25 times more frequently. In these patients, the average times of admission and delivery were shorter. The patients with early PE were noted to have placental insufficiency and fetal growth retardation 10.5 and 3.8 times more commonly. There were no differences in the severity of hypertension and in the indicators of kidney function between the groups. The patients with early PE showed an increase in the level of liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) and a decrease in the count of platelets, although their mean levels remained within the reference values. The cesarean delivery rate was not significantly different between the groups. However, the effect of the therapy was absent and the severity of placental insufficiency was increased in early PE. The babies in the early PE group had lower birth weights (1895±1018 vs 2890±587g; p < 0.001), one- and five-minute Apgar scores (7±1.2 vs 7.7±0.7;p < 0.001) and (8±1.0 vs 87±0.5;p < 0.001), respectively. In addition, the infants in this group frequently needed treatment in the neonatal intensive care unit. Conclusion. The traditional approach is inadequate in predicting complications and perinatal outcomes in the two phenotypic variants of PE, as these classical clinical manifestations of this complication as hypertension and proteinuria are not decisive in characterizing the severity of the condition. The most important clinical feature of early PE is its earlier onset and long duration and the high frequency of metabolic disorders and placental insufficiency, which must be considered when determining the severity of the pathological process. In this connection, the perinatal outcomes in early PE were significantly poorer than those in late PE. It is necessary to continue investigations of the specific features of early PE and an expansion of a range of laboratory and instrumental methods for the early detection of characteristic homeostatic disorders.
Obstetrics and Gynecology. 2017;(6):41-47
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FEATURES OF SOME VASOACTIVE HORMONES AND VASCULAR FACTORS IN WOMEN WITH METABOLIC SYNDROME AND THEIR INFLUENCE ON THE DEVELOPMENT OF OBSTETRIC COMPLICATIONS

Palieva N.V., Botasheva T.L., Linde V.A., Avrutskaya V.V., Zheleznyakova E.V.

Abstract

Objective. To investigate the characteristics of effector hormones of peripheral endocrine glands (adrenaline, noradrenaline, cortisol, angiotensin II, and endothelin-1) in women with metabolic syndrome and their influence on the development of obstetric pathology. Subjects and methods. The prospective case-control study used an enzyme immunoassay technique to determine the serum levels of adrenaline, noradrenaline, cortisol, angiotensin II, and endothelin-1 in 150 patients with metabolic syndrome and in 143 women with normal metabolism over time during pregnancy (1-3 trimesters). For data analysis, the investigators used descriptive statistics procedures that were employed to estimate the median values and interquartile ranges (25%, 75%). The significance level was set to be equal to 0.05. Results and discussion. Just in the first trimester, the patients with preeclampsia in the presence of metabolic syndrome showed a more pronounced increase in the level of endothelin-1 (p = 0.0327), adrenaline (p = 0.0211), and cortisol (p = 0.0018) than the women with fetal growth retardation, which indicates an increased likelihood for vasoconstrictor effects and the development of endothelial dysfunction in case of preeclampsia. Conclusion. The findings may assert that just in early pregnancy, the women with metabolic syndrome have a considerable increase in the levels of vasoactive hormones, which is exaggerated by endothelial dysfunction, in the presence of which the vasospastic processes are predominant mainly in women with preeclampsia.
Obstetrics and Gynecology. 2017;(6):48-54
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TIME COURSE OF CHANGES IN THE SUBPOPULATION COMPOSITION OF PERIPHERAL BLOOD LYMPHOCYTES IN THE PREGRAVID PREPARATION OF WOMEN WITH RECURRENT MISCARRIAGE

Krechetova L.V., Vtorushina V.V., Golubeva E.L., Saribegova V.A., Khachatryan N.A., Agadzanova A.A., Tetruashvili N.K.

Abstract

Pregravid preparation that may encompass both immunocytotherapy (ICT) and medical treatments (with gestagens) occupies a special place in the therapy of idiopathic recurrent abortion. Objective. To investigate the time course of changes in the subpopulation composition of peripheral blood lymphocytes after various options of immunomodulatory therapy during pregravid preparation of women with recurrent miscarriage of alloimmune genesis. Subjects and methods. A study group consisted of 51 women with an established diagnosis of recurrent miscarriage of unclear (alloimmune) genesis. A control group comprised 15 fertile women. Pregravid preparation of the women was done by three schemes: ICT with allogeneic cells from partners, ICT together with dydrogesterone, or medical treatment with dydrogesterone. The content of the main subpopulations of immunocompetent T cells (СD3+, CD4+, CD8+), B cells (CD19+), B1 cells (CD19+CD5+), NK cells (СD56+, СD16+), as well as Treg (CD4+CD25highCD127low/-). Results. After ICT, there was a significant increase in the subpopulation of lymphocytes with the CD5+CD19+ phenotype compared to the control and no changes in the level of the other subpopulations; in the ICT + dydrogesterone group, the concentration of subpopulations with the CD56,16+, CD56+, and CD3+CD56,16+ phenotypes significantly exceeded that in the control group; and the content of Treg remained unchanged. After two dydrogesterone treatment cycles, the levels of Treg, CD200+, CD19+, CD5+19+, CD3+8+, CD3+CD56,16+ cells remained unchanged; but there was a considerable increase in the concentrations of CD3-CD8+, CD3-CD16+, CD16+, CD56+, CD3-CD56,16+, and CD56,16+ subpopulations and a substantial decrease in CD3+, CD3+CD4+ ones. Conclusion. Each of therapeutic options has a certain immunomodulatory effect, the clinical significance of which remains to be estimated in further investigations conducted during pregnancy.
Obstetrics and Gynecology. 2017;(6):55-63
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AN ASSOCIATION BETWEEN THE FREQUENCIES OF SINGLE NUCLEOTIDE POLYMORPHISMS IN THE ZNF366 AND VEZT GENES AND THE RISK OF EXTERNAL GENITAL ENDOMETRIOSIS: DATA ON A RUSSIAN POPULATION

Pshenichnyuk E.Y., Kuznetsova M.V., Bourmenskaya O.V., Kochetkova T.O., Nepsha O.S., Trofimov D.Y., Adamyan L.V.

Abstract

Objective. To determine the frequency of rs10859871 and rs4703908 among women with different forms of external genital endometriosis (EGE) (ovarian endometrioid cysts (OEC), deep infiltrating endometriosis, and pelvic peritoneal endometriosis) in a Russian population. Subjects and methods. The collection included peripheral blood samples from 143 patients with EGE and 75 patients without this disease. The samples were taken directly intraoperatively. DNA in all the samples was amplified with primers to the genome regions rs10859871 and rs4703908. Sequence fragments were identified by the Sanger sequencing method. The allelic states of each single-nucleotide polymorphism were visually genotyped from chromatograms using the BioEditprogram. Results. There was a positive association between the heterozygous genotype of the C/G locus at rs4703908 and the risk of OEC (OR=1.78; 95% CI: 0.88-3.62; p > 0.05) and deep infiltrating endometriosis (OR=2.02; 95% CI: 0.85-4.73; p > 0.05). There was a positive association between the C/G locus at rs4703908 and the risk of pelvic peritoneal endometriosis (OR=1.24; 95% CI: 0.49-3.16; p > 0.05); however, OR did not exceed 1.5. There was a positive association between the homozygous genotype of the CC locus at rs10859871 and the risk of OEC (OR=5.61; 95% CI: 1.8-17.49; p < 0.01), and deep infiltrating endometriosis (OR=5.92; 95% CI: 1.68-20.83; p < 0.01) and pelvic peritoneal endometriosis (OR=4.44; 95% CI: 1.15-17.07; p < 0.05) compared with the apparently healthy women in the main comparison group. There was a negative association between the homozygous genotype of the AA locus at rs10859871 and the risk of OEC (OR=0.77; 95% CI: 0.40-1.45; p > 0.05), deep infiltrating endometriosis (OR=0.44; 95% CI: 0.19-1.00; p<0.05), pelvic peritoneal endometriosis (OR=0.58; 95% CI: 0.25-1.38;p < 0.05). Conclusion. The heterozygous genotype of the C/G locus at rs4703908, which is located near the ZNF366gene, is associated with an increased risk for OEC and deep infiltrating endometriosis in the Russian population. The homozygous genotype of the CC locus at rs10859871, which is located near the VEZT gene, provides a significantly higher risk for all forms of EGE in the Russian population (an autosomal recessive inheritance pattern). The homozygous genotype of the AA locus at rs10859871 performs a protective role and reduces the risk of OEC, deep infiltrating endometriosis, and pelvic peritoneal endometriosis. The results of this investigation make rs10859871 be a likely candidate marker, by which testing may reveal an increased risk for EGE in the women of the Russian population.
Obstetrics and Gynecology. 2017;(6):64-73
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COMPARATIVE ANALYSIS OF THE LIPID COMPOSITION OF PERITONEAL FLUID AND BLOOD PLASMA IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS AND UTERINE MYOMA

Borisova A.V., Chagovets V.V., Kozachenko A.V., Starodubtseva N.L., Kononikhin A.S., Salimova D.F., Kogan E.A., Adamyan L.V., Frankevich V.E., SUKHIKH G.T.

Abstract

Objective. To enhance the efficiency of diagnosing external genital endometriosis by direct mass spectrometry. Subjects and methods. A case-control study covered 100 patients with external genital endometriosis (a study group) and 50 patients with uterine myoma (a control group) who had been operated on at the Gynecology Department, V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation. The diagnosis of external genital endometriosis was based on diagnostic and therapeutic laparoscopy and finally confirmed histologically. To determine the lipid composition of blood and peritoneal fluid, their samples were obtained from all the study participants. The lipidome was qualitatively and quantitatively assessed using electrospray mass spectrometry. An analysis revealed more than 140 molecular characteristics, most of which were five lipid classes: phosphatidylcholines, phosphatidylethanolamines, sphingomyelins, diglycerides, and triglycerides. The obtained experimental data were analyzed using the multivariate partial lest squares-discriminant analysis (PLS-DA). The created statistical models well group data based on a case-control sign and could identify lipids, which make the greatest contribution to the clustering of the data. Results. Unlike the comparison group, the patients with endometriosis showed a substantial decrease in the blood and peritoneal fluid level of four lipids: phosphatidylcholine PC 36:4, lysophosphatidylcholine LPC 16:0, sphingomyelin SM 34:1, and phosphoethanolamine PE O-34:1. The level of phosphoethanolamine PE 0-20:0 was increased not only in the endometrial tissues, but also in the biological fluids of patients with endometriosis, suggesting the possible diagnostic value of this lipid. The sensitivity and specificity of the method was 93% and 95%, respectively for blood plasma; those were 90 and 95% for peritoneal fluid. Conclusion. This investigation confirms the involvement of phospholipids and sphingolipids in the pathophysiology of endometriosis and opens up new possibilities for the noninvasive diagnosis of external genital endometriosis.
Obstetrics and Gynecology. 2017;(6):74-82
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A CHANGE IN THE CELLULAR COMPOSITION OF THE FALLOPIAN TUBE EPITHELIUM AS A PREDICTOR FOR HIGH-GRADE SEROUS OVARIAN CARCINOMA

Asaturova A.V., Adamyan L.V., Ezhova L.S., Munavarovna F.N., Nikolaevich K.G., Viktorovna S.M.

Abstract

Objective. To study whether the development of high-grade serous ovarian carcinoma (HGSOC) can be predicted using an estimate of changes in the cellular composition of the fallopian tube epithelium (secretory cell expansion (SCE) and secretory cell outgrowth (SCOUT)) depending on patients’ age. Subjects and methods. Examinations were made in 287 patients with benign extraovarian pathological changes (n = 70), serous ovarian cystadenomas/cystadenofibromas (n = 75), serous borderline ovarian tumors (n = 73), and HGSOC (n = 69). Morphological, immunohistochemical (the markers p53 and Ki-67), and statistical (the Kruskal-Wallis test, the Mann-Whitney test, the pairwise linear regression method with an estimate of the tightness of Pearson’s correlation, and discriminant analysis) studies were used to investigate 287fallopian tubes (3-4 fimbrial fragments). Results. The increase in SCE and SCOUT with age was observedfor all studied pathological changes (p < 0.001), although the number of SCE in all the groups was higher than that of SCOUT; and the correlation between age and the number of SCE was stronger than that of SCOUT (Pearson’s correlation coefficients, 0.86 and 0.35, respectively). Comparing the groups of patients with different diseases revealed that the number of SCE and SCOUT in the HGSOC group was significantly higher than that in the other groups (p < 0.001). The predictive formula HGSOC = 0.22*SCE + 0.055*SCOUT - 0.068*AGE + 0.72) was derived. A woman with HGSOC and more than 1.663 belonged to a group at high risk for ovarian serous carcinomas; a woman with less than 1.663 formed a low-risk group. To avoid false-negative results, the age limit for applying the formula was proposed to be 47 years of age. Conclusion. The findings have led to the conclusion that age is an important independent risk factor for HGSOC. In addition, SCE as an isolated marker has a greater efficiency than SCOUT; however, a joint estimation of SCE, SCOUT, and patients’ age has the highest efficiency, as demonstrated in the present study using the proposed prognostic formula. The overall percentage of the original observations correctly classified by the proposed formula (diagnostic eff iciency) was 98.2%. The sensitivity of the used function was 92.8%; the specif icity was 100.0%.
Obstetrics and Gynecology. 2017;(6):83-90
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THE ASSOCIATION OF SPERM DNA FRAGMENTATION WITH EMBRYOLOGICAL CHARACTERISTICS AND EFFECTIVENESS OF ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS

Dudarova A.K., Smolnikova V.Y., Makarova N.P., Zobova A.V., Gorshinova V.K., Kalinina E.A., Naimi Z.M.

Abstract

Objective. To determine the relationship between sperm DNA integrity in the ejaculate, embryological parameters (oocyte fertilization rate; blastulation rate), clinical outcomes of assisted reproductive technology programs, and methods for sperm selection by hyaluronic acid binding. Subjects and methods. 67 married couples with a high rate of DNA fragmentation in the ejaculate of sexual partners, who had been treated using the in vitro fertilization/intracytoplasmic sperm injection ((IVF/ICSI) and IVF/physiological intracytoplasmic sperm injection (PICSI) programs, were examined during the prospective case-control study. The couples were divided into 2 groups according to the type of fertilization (ICSI, PICSI): 1) 37 couples who had ICSI; 2) 30 couples who had PICSI. The investigators estimated the rate of sperm DNA fragmentation in the partner’s ejaculate and embryological parameters (oocyte fertilization rate; blastulation rate), and clinical outcomes of the IVF/ICSI programs with various methods for sperm selection. The embryological parameters (oocyte fertilization rate; blastulation rate), clinical outcomes in the IVF/ICSI programs with various methods for sperm selection were also assessed. Results. Our investigation showed that both groups had no statistically significant differences in the rates of oocyte fertilization and blastulation and in the number of early reproductive losses, which may be associated with a small sample size in the groups. However, there was an obvious trend toward an increase in clinical pregnancy rates in the group where sperm was selected by hyaluronate binding before an ICSI procedure. In addition, there were significant differences in live birth rates in favor of using the methods for the physiological selection of male gametes. According to our data, there are also significant differences in implantation rates between the ICSI and PICSI groups, demonstrating the direct relationship of the quality of embryos to the genetic adequacy of the gametes. Conclusion. The choice of a fertilization technique for oocytes from a patient should be individualized. Determination of the rate of DNA fragmented sperm from a partner can serve as an additional test used in clinical practice to optimize the choice of methods for fertilization of oocytes from a female patient according to the type of sperm selection and to improve the efficiency of IVF programs as a whole.
Obstetrics and Gynecology. 2017;(6):91-98
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COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF AN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAM DEPENDING ON AN OVULATION TRIGGER

Eapen S.M., Pavlovich S.V., Mishieva N.G., Abubakirov A.N., Martazanova B.A.

Abstract

Objective. To evaluate the effect of the type of an ovulation trigger on the clinical and embryological indicators of the effectiveness of IVF/ICSI programs in patients with a normal ovarian response to superovulation stimulation. Subjects and methods. The investigation enrolled 250 patients who were divided into 2 groups according to the injected ovulation trigger: 1) 125patients who received human chorionic gonadotropin (hCG); 2) 125patients who took a gonadotropin-releasing hormone agonist (GnRH-A). The luteal phase was supported by micronized progesterone at a dose of 600 mg/day in Groups 1 and 2. In Group 2, for luteal phase support, the investigators additionally injected once hCG at a dose of 1,500 IU on the day of transvaginal ovarian drilling (TOD) and estradiol valerate (Progynova, 4 mg/day) on the following day after TOD. Results. There were statistically significant differences in the incidence of mild ovarian hyperstimulation syndrome (OHSS) in Groups 1 and 2 (p < 0.02). Mild OHSS developed in 9 (6.5%) and 22 (16.9%) patients in the GnRH-A replacement and hCG groups, respectively. Comparison of the frequency of moderate OHSS revealed no statistically signif icant differences in the examined groups: 5.4% (n = 7) in Group 1 and 4.3% (n = 6) in Group 2. In Group 1, two patients developed severe OHSS and required hospital treatment. No case of severe OHSS was recorded in the GnRH-A group. Trigger ovulation replacement did not significantly affect the number of obtained follicles and oocytes in patients of both groups. At the same time, the number of mature MII cells was significantly higher in Group 2 patients. There were no statistically significant differences in clinical pregnancy, spontaneous abortion, and birth rates between the groups. Conclusions. The use of GnRH-A as an ovulation trigger in the GnRH antagonist protocols enables the pregnancy rate to be achieved when modifying the luteal phase at the same frequency as in the use of hCG. Moreover, the rate of moderate or severe OHSS reduced to a minimum
Obstetrics and Gynecology. 2017;(6):99-103
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QUALITY OF LIFE IN PERIMENOPAUSAL WOMEN WITH CLIMACTERIC SYNDROME TREATED WITH THE PINEAL HORMONE MELATONIN

Usoltseva E.N.

Abstract

Objective. To assess the quality of life in perimenopausal women with climacteric syndrome treated with melatonin. Subjects and methods. Seventy women aged 53.6±5.5 years, who had taken melatonin 3 mg before bedtime for three months, were examined. The investigators evaluated the efficiency of the treatment, by using the Kupperman index, and assessed the quality of life by the SF-36 and WHQ questionnaires before treatment and 1 and 3 months after follow-up. Results. Neuroautonomic, metabolic, endocrine, and psychoemotional symptoms were relieved three months after treatment. The SF-36 data showed that physical functional and role physical functioning were statistically significantly increased, and WHQ indicated a reduction in somatic symptoms, sleep problems, depression, and anxieties/fears. Conclusion. The pineal hormone melatonin is effective in the treatment of mild climacteric syndrome and improves some quality-of-life indices in female women.
Obstetrics and Gynecology. 2017;(6):104-110
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THE RELEVANCE OF EARLY ULTRASOUND DIAGNOSIS IN NEWBORN INFANTS WITH PERINATAL AND SURGICAL RISK FACTORS FOR THROMBOTIC EVENTS

Morozova N.Y., Burov A.A., Podurovskaya Y.L., Filippova E.A., Ushakova L.V., Pykov M.I., Vinogradova M.A., Degtyarev D.N.

Abstract

Objective. To assess the role of ultrasonography in the diagnosis of thromboses in newborn infants having risk factors for thrombotic events. Material and methods. A total of 1112 medical records of newborn infants admitted to the Unit of Neonatal Surgery, Department of Neonatology and Pediatrics, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, for surgery for congenital malformations in 2010 to 2015 were retrospectively analyzed. Thrombotic events were diagnosed using an expert-class SIEMENS AC US ON S2000 ultrasound device in B and color Doppler flow mapping modes, linear transducers at frequencies of 7-14 and 16-20 MHz. Results. Of 971 neonates operated on for congenital malformation, 14 patients were diagnosed with thrombotic events on postoperative days 2-3. Thromboses were mixed in all the cases. All cases of thrombotic events, except 3 cases occurring and diagnosed intraoperatively, were diagnosed ultrasonographically. Conclusion. Ultrasonography can quickly and objectively diagnose neonatal thromboses in the early postoperative period. The relatively high frequency of thrombotic events in neonates operated on for malformations and necessitates the introduction of ultrasound screening in these patients in the postoperative period. The introduction of ultrasound screening can assist in detecting thrombosis in the early stages, in preventing the generalization of thrombotic events, and in enhancing the efficiency of the treatment.
Obstetrics and Gynecology. 2017;(6):111-117
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IMPACT OF MAGNESIUM DEFICIENCY ON THE COURSE OF CLIMACTERIC SYNDROME

Makatsariya A.D., Dikke G.B.

Abstract

Objective. To estimate the prevalence of magnesium deficiency (MD) and the characteristics of clinical symptoms in women with climacteric syndrome (CS) and to determine the efficacy of Magne B6 forte in improving the quality of life in patients. Subjects and methods. A total of 3808 women with climacteric syndrome were examined. In the first phase of the study, the symptoms of CS and the prevalence of MD were assessed using the standardized Mood Disorder Questionnaire (MDQ) and/or serum magnesium levels were measured. The quality of life in the women with CS was estimated according to the WHOQOL-BREF questionnaire. In the second step, the patients with MD were treated with a magnesium citrate-containing drug for 4 weeks; the therapeutic efficiency was evaluated. Results. The high prevalence of MD was noted in the patients with CS (60%). The clinical efficacy of Magne B6 forte was confirmed by an increase in serum magnesium levels (from 0.67±0.09 to 0.80±0.25mmol/l;p < 0.001), normalization of MDQ scores (from 43.4±11.9 to 24.0±14.9; p < 0.001), a reduction in the severity of more than half of the CS symptoms by 2-2.5 times, and an improvement in quality of life. Conclusion. The use of Magne B6 forte in patients with CS contributes to improvements in the course of the disease and in the quality of life.
Obstetrics and Gynecology. 2017;(6):118-126
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POSSIBILITIES OF THERAPY FOR HPV-ASSOCIATED CHRONIC CERVICITIS IN WOMEN

Maltseva L.I., Farrakhova L.N.

Abstract

Objective. To study the possibilities of the diagnosis and treatment of chronic cervicitis in women with human papillomavirus (HPV) infection in relation to the biomarkers of proliferation and carcinogenesis in the cervical epithelium. Subjects and methods. 245 female patients with HPV-associated chronic cervicitis and 20 healthy women were examined for the ratio of the urinary estrogen metabolites 2-OHE1 to 16α-ОНЕ1 (Estramet test system) and the expression of p16ink4α in the cervical epithelium by immunocytochemical assay. For the treatment of HPV-associated cervicitis, 30patients used a combination of promisan and interferon-α or Panavir; 30 more patients received only Panavir or interferon-α. Results. The oncoprotein р16іпк4α expression and the low 2-ОНЕ1/16α-ОНЕ1 ratio were found to be directly related to the long-term persistence of HPV and the progressive course of cervical pathology. Conclusion. Six-month combination treatment with promisan and interferon-α led to normalization of the exchange of the estrogen metabolites, the elimination of HPV, and regression of an inflammatory response from CIN I-II to the cytological normal value in 86.7-93.3% of the women.
Obstetrics and Gynecology. 2017;(6):127-134
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PROBIOTICS FOR PROPHYLAXIS OF VULVOVAGINAL CANDIDIASIS RELAPSES (RESULTS OF THE INTERNATIONAL MULTICENTER OPEN-LABEL REVOLACT STUDY)

Bashmakova N.V., Volkova N.Y., Gnatko E.P., Dankova I.V., Dobrokhotova Y.E., Karakhalis L.Y., Maltseva L.I., Nadeliaeva Y.G., Potapov V.A., Serova O.F., Suturina L.V., Tarasova M.A., Tatarchuk T.F.

Abstract

Objective. To evaluate efficacy and safety of L. casei rhamnosus Doderleini strain (lactogynal, vaginal capsules), for prevention of recurrences of vulvovaginal candidiasis in the multicenter international multicenter open-label REVOLACT study. Subject and methods. After antimycotic therapy using sertaconazole (zalain, suppository 300 mg once and 2% cream 2 times a day for 8 days), female patients from main group (74 women) received intravaginal lactobacillus lactogynal within 21 days; the comparison group (80 women) of patients did not receive any probiotics. The period of dynamic observation of patients was 5 months, during which the registration of recurrences of vulvovaginal candidiasis (reporter and laboratory confirmed) was conducted. Results. Results demonstrate the effectiveness of combined therapy using sertaconazole (zalain, suppository 300 mg once and 2% cream 2 times a day for 8 days) followed by the application lactogynal within 21 days to prevent recurrence of vulvovaginal candidiasis compared to monotherapy with sertaconazole (zalain, suppository 300 mg once and 2% cream 2 times a day for 8 days). Time before relapse of vulvovaginal candidiasis after therapy with sertaconazole in the lactogynal group was 148.45±2.04 days and 137.40±4.41 days in the comparison group. The incidence of vulvovaginal candidiasis in the lactogynal group was significantly lower: 12 patients (16.2%) vs. 24 patients (30%) in the comparison group (p <0.05). Conclusion. Study demonstrates the efficacy and safety of L. casei rhamnosus Doderleini culture (lactogynal, vaginal capsules) in the complex treatment of vulvovaginal candidiasis for the prevention of relapse.
Obstetrics and Gynecology. 2017;(6):135-142
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THERAPY FOR VULVOVAGINAL ATROPHY IN POSTMENOPAUSAL WOMEN: CLINICAL AND PATHOGENETIC ASPECTS

Yureneva S.V., Glazunova A.V., Yeprikyan Y.G., Donnikov A.E., Yezhova L.S.

Abstract

Symptoms of vulvovaginal atrophy (VVA) disturb as high as 57% of postmenopausal women. A number of investigations have shown that VVA not only negatively impacts quality of life, but also adversely affects the sexual health of women. Local hormone therapy (HT) with estrogen is the gold standard for treating the symptoms of VVA. Currently, there is a trend towards the use of low-dose local estrogens in European countries. Objective. To investigate the time course of vaginal atrophic changes in postmenopausal patients with VVA receiving low-dose local HT regimens, by using subjective and objective criteria. Subjects and methods. 44 patients with VVA were selected for the investigation. The follow-up lasted 3 months. Block randomization was used to divide the study participants into 2 groups of 22 people in each. Group 1 used a drug composed of estriol at a dose of 0.5 mg; Group 2 had the agent containing the freeze-dried culture of Lactobacillus casei L. rhamnosus Doderleini 341 mg, estriol 0.2 mg, and progesterone 2.0 mg. Treatment regimens with the equal estriol cycle dose amounting 9.8 mg were developed for both patients groups. The studies encompassed a questionnaire-based survey of patients, cytological examination of the vaginal wall, followed by estimation of the vaginal epithelial maturation index (VEMI), vaginal pH, vaginal health index (VHI), and PCR diagnosis of vaginal biocenosis. Results. A full treatment cycle was completed by 91 % of the women in Group 1 and by 95.5% in Group 2. After the therapy, the patients of both groups reported alleviation or relief of vaginal symptoms. The low-dose local estriol therapy regimen contributed to the restoration of the vaginal epithelium, as confirmed by statistically significant increases in VEMI and VHI, by a reduction in pH values, as well as by an elevation in the amount of lactobacilli and by normalization of vaginal biocenosis. When the low-dose local HT regimen was used, the symptoms of vaginal atrophy gradually reduced. Conclusion. Analysis of complaints according to the scale designed by D. Barlow showed a statistically significant decrease in the intensity of symptoms only in Group 2, the participants of which took a combined drug containing estriol, lactobacilli, and progesterone. There was also more efficient recovery of lactobacilli and normalization of the vaginal microflora during therapy with the combined drug.
Obstetrics and Gynecology. 2017;(6):143-150
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POLYMICROBIAL ASSOCIATIONS IN THE ETIOLOGY OF INFLAMMATORY DISEASES OF THE FEMALE GENITAL ORGANS

Dikke G.B.

Abstract

Objective. To assess the role of polymicrobial associations in the genesis of inflammatory diseases of the female genital organs and to determine the most rational approaches to diagnosis and treatment. Material and methods. The materials of the World Health Organization, the Cochrane Society, the guidelines of leading professional societies, and clinical trials published on official websites and in open access were analyzed. Results. There was information on the frequency of female genital tract inflammatory diseases caused by microbial combinations, as well as the established facts on resistance to antimicrobial agents, recommendations for their diagnosis and treatment, by indicating the strength of the evidence and convincingness of recommendations. Conclusion. The recent changes in the epidemiology of inflammatory diseases, the prevalence of polymicrobial associations in their etiology, and the increasing microbial resistance require new approaches to the treatment and prevention of sexually transmitted infections and diseases accompanied by abnormal vaginal discharge.
Obstetrics and Gynecology. 2017;(6):151-158
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A NEW APPROACH TO TREATING BACTERIAL VAGINOSIS

Khryanin A.A., Reshetnikov O.V.

Abstract

Objective. To carry out a systematic analysis of the data available in the current literature on the efficacy of lactic- acid bacteria, Lactobacillus strains in particular, in treating bacterial vaginosis. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found on this topic. Results. The paper analyzes the results of the found studies of the efficacy and safety of lactic acid bacteria-containing agents in the treatment of bacterial vaginosis. Their evidence level is estimated. Conclusion. It is concluded that Provag containing Lactobacillus strains has a clinical effect and safety, which enable its use to be recommended for the treatment of recurrent bacterial vaginosis and aerobic vaginitis. At the same time the drug is also effective in treating other diseases associated with these conditions, papillomavirus infection in particular.
Obstetrics and Gynecology. 2017;(6):159-164
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ANTIVIRAL THERAPY IN PATIENTS WITH ANOGENITAL HERPESVIRUS INFECTION

Rakhmatulina M.R.

Abstract

Objective. To systematize the results of investigating the clinical efficiency and safety of etiotropic antiviral therapy in patients with the different course of genital herpes. Material and methods. Foreign and Russian articles published on the investigation topic were analyzed. The search depth was 20 years. Results. The paper gives data on the efficiency of episodic and suppressive therapy in patients with anogenital herpes infection. Conclusion. The use of the antiviral drug valacyclovir in the therapy of genital herpes contributes to the reduction of the clinical severity and rates of recurrences, lowers the risk of potential transmission of herpes simplex virus, including asymptomatic virus shedding, and substantially improves quality of life in the patients.
Obstetrics and Gynecology. 2017;(6):165-169
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IMPLEMENTATION OF AN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAM IN A LIVER TRANSPLANT PATIENT

Belyaeva N.A., Kalinina E.A., Smolnikova V.Y., Makarova N.P.

Abstract

Background. Current advances in organ transplantation and active development in pharmaceutical industry allow women with organ transplants to spontaneously carry a pregnancy and give birth to babies today. Taking into account the fact that these patients may have a reduced reproductive potential due to the underlying disease, some cases need assisted reproductive technology (ART) to achieve pregnancy. However, there are features in the preparation and management of patients with organ transplants within the IVF program and their subsequent monitoring during pregnancy. Clinical case report. The paper describes a clinical case of a 28-year-old patient with a liver transplant who has received an ART program and given birth to a healthy baby. Conclusion. Accumulated clinical experience with ART programs in women with organ transplants will be able to optimize approaches to treating infertility in these patients by minimizing maternal and fetal risks.
Obstetrics and Gynecology. 2017;(6):170-175
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MYCOPLASMA HOMINIS AS AN ETIOLOGICAL AGENT OF TUBO-OVARIAN ABSCESS AND PYOSALPINX: MYTH OR REALITY?

Guschin A.E., Rumyantseva T.A., Khayrullina G.A., Makhova T.I., Dukhin A.O.

Abstract

Background. Despite the fact that M. hominis is commonly assigned to opportunistic microorganisms, there are many reports of clinical cases with the involvement of M. hominis as the only microorganism in the development of severe inflammatory processes in the lung, intervertebral discs, kidney, liver, heart, and brain. The role of M. hominis in the development of pelvic inflammatory diseases (PID) remains unexplored. Clinical case reports. The paper gives data on two patients admitted to hospital to be treated for tubo-ovarian abscess and pyosalpinx. The patients underwent a comprehensive examination, as well as laparoscopy, during which intraoperative samples were obtained and investigated by PCR to detect DNA of a broad spectrum of microorganisms. The material obtained from the two patients with PID displayed M. hominis DNA at a concentration of 108 GE/ml (that corresponded to total concentration of DNA of the bacteria that were present in the biomaterial). Other microorganisms were not found in one case; their concentration was 100 and more times lower than that of M. hominis in the other case. Conclusion. The most probable etiological role of M. hominis was established in two clinical cases of PID. The possible role of M. hominis in the development of PID should be taken into account when elaborating the tactics of examination and treatment for patients with this condition.
Obstetrics and Gynecology. 2017;(6):176-182
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TREATMENT FOR ANOGENITAL WARTS: A CLINICAL CASE

Olina A.A., Meteleva T.A.

Abstract

Background. Human papillomavirus (HPV) infection has a special place among sexually transmitted infections due to its high prevalence, a wide range of clinical manifestations of genital lesions from pointed condylomas to intraepithelial neoplasia and to the absence of etiotropic therapy. A case report. The paper describes a clinical case of recurrent anogenital warts treated with inosine pranobex as monotherapy. Conclusion. The given clinical case allows us to consider inosine pranobex as the drug of choice in treating anogenital warts, especially in cases of recurrent HPV infection and ineffective interferon therapy.
Obstetrics and Gynecology. 2017;(6):183-186
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