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No 10 (2014)
- Year: 2014
- Articles: 18
- URL: https://journals.eco-vector.com/0300-9092/issue/view/6365
Articles
Noninvasive prenatal diagnosis of aneuploidies by extracellular DNA sequencing: The current view on the problem
Abstract
The article sets forth the current views on noninvasive prenatal diagnosis (NPD) by sequencing to determine aneuploidies in both high- and low-risk pregnant women. It describes the results of the investigations conducted in the past 3 years, which determine the sensitivity, specificity and accuracy of tests versus conventional screening methods in pregnant women. The advantages and limitations of NPD methods and the opinions of leading obstetrics societies on whether it is expedient to use them as diagnostic and screening tools are defined.
Obstetrics and Gynecology. 2014;(10):4-7
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Role of folates in the prevention of hyperhomocysteinemia and its sequels in pregnant women
Abstract
The paper presents the results of an analysis of Russian and foreign studies of the relationship between fetal malformations and folic acid provision. It gives the epidemiological data showing that multivitamin support including folic acid is effective in preventing placental detachment. It is concluded that it is necessary to include recommendations for the dietary intake of a multivitamin/mineral/folate supplement in the algorithm of standard counseling to prevent obstetric and perinatal complications and to form the basis for the development of healthy generations.
Obstetrics and Gynecology. 2014;(10):8-15
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Promises for using the possibilities of determining the level of follicular oxidative stress as a success criterion of assisted reproductive technology programs
Abstract
The article gives an update on the importance of the oxidative stress factor determining the success of assisted reproductive technology programs, as well as the quality of oocytes and embryos. Oxidative stress is defined as an imbalance between the pro-oxidant and anti-oxidant systems - the cause of the induction of oxidative stress is drastically increased reactive oxygen species (ROS) production and/or impaired antioxidant defense mechanisms. The review presents and discusses the data of studies into the dualistic nature of ROSs that are not only a maturation factor, but also perform a role of one of the major damaging factors during oocyte maturation. The induction of oxidative stress in the follicular antrum and fluid is shown to affect oocyte maturation and embryo fertilization and implantation during ovarian stimulation in the in vitro fertilization (IVF) programs. The review covers a controversial issue of whether measurements of the oxidation products of biological macromolecules in the blood and follicular fluid of patients may be used to predict IVF program success. It also discusses the impact of different ovarian stimulation protocols in the IVF/ICSI programs on the level of oxidative stress.
Obstetrics and Gynecology. 2014;(10):16-21
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Prediction of fetal growth retardation in pregnant women with undifferentiated connective tissue dysplasia
Abstract
Objective. To create a mathematical model for the prediction of fetal growth retardation in patients with undifferentiated connective tissue dysplasia (USTD). Subject and methods. A prospective cohort study was conducted in 201 pregnant women. According to the Fenton percentile growth chart, all the patients were divided into two groups. A study group consisted of 63 women whose babies were rated to be in the 3 rd to 10 lh percentiles. A comparison group included 138 patients whose babies were assigned to the 10 th or more percentile range. The magnitude of dysplasia was determined by the modified growth chart. Results. The investigators determined the clinical and molecular genetic predictors of fetal growth retardation, such as the magnitude of USTD, threatened miscarriage in the second trimester, an exacerbation of chronic urinary tract diseases, and threatened preterm labor during ultrasound study, as well as VEGFA gene polymorphisms: -634 G>C and VEGFA: 936 C>T. Conclusion. A mathematical model including the clinical anamnestic and molecular genetic parameters was developed to predict fetal growth retardation in patients with USTD.
Obstetrics and Gynecology. 2014;(10):22-26
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Specific features of peripheral blood lymphocyte phenotype in women with recurrent miscarriage
Abstract
Objective. To study peripheral blood lymphocyte subpopulations in women with recurrent miscarriage of alloimmune genesis, by estimating the counts of natural killer cells with a different phenotype, CD200 molecule, and natural regulatory T cells. Subject and methods. The phenotype of peripheral blood lymphocytes was determined on 18-20 days of the menstrual cycle in 70 patients with recurrent miscarriage after ruling out its known causes and in 15 fertile healthy women in a control group. Results. The married couples with recurrent miscarriage of alloimmune genesis constitute 21.9% of all married couples with recurrent pregnancy losses. The women with recurrent miscarriage had significantly higher levels of cells with the phenotype CD3 -CD8+, CD56+, CD3+CD56,16 +, CD3 -CD56,16 +, SCD56,16 +, CD5+CD19+, CD200 v, significantly lower counts of cells with the phenotype CD4 +CD25 highCD127 low/-, and a significantly higher ratio of cells with the phenotype CD20(+ and CD4+CD25 hig hCD127 low/-. Conclusion. The patients with recurrent miscarriage of alloimmune genesis versus the fertile women commonly show significant changes in the lymphocyte subpopulations of natural killer cells with a different phenotype and in the count of natural regulatory T cells and lymphocytes with the phenotype CD200+. The potential role of these changes in the diagnosis and monitoring of the efficiency of performed therapy is to be further investigated.
Obstetrics and Gynecology. 2014;(10):27-32
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Meta-analysis of the efficacy and safety of magnesium preparations used in obstetric practice
Abstract
Objective. To give the results of meta-analysis for evaluation of efficiency of drugs based on citrate, lactate, magnesium pidolate on pregnancy outcomes, mothers and newborns health. Subject and methods. 11 randomized clinical trials using citrate, lactate, magnesium pidolate in combination with pyridoxine (registered under the trade name Magne B/Magne B 6 Forte in the Russian Federation) per os during pregnancy (n = 2130) were analyzed. Results. Meta-analysis showed that nutritional support of pregnancy with magnesium preparations was associated with a lower risk of miscarriage (6 trials, OR 0.49; 95% CI, 0.34...0.71, Р = 0.00015), placental insufficiency (6 trials, OR 0.33; 95% CI 0.22...0.50; Р = 1.1*10- 7), threatened miscarriage (3 trials; OR 0.39; 95% CI 0.25...0.62; Р = 4.1х10- 5), preeclampsia (9 trials; OR 0.35; 95% CI, 0.26...0.48; Р = 1.6*10- 8), preterm delivery (5 trials; OR 0.34; 95% CI0.21...0.55; Р=7.1*10 -6), cesarean delivery, (6 trials; OR 0.26; 95% CI0.17...0.41; Р=1.9x10- 6), maternal hospitalization (2 trials; OR 0.47; 95% CI 0.26...0.87; Р = 0.014), fetal growth retardation (6 trials; OR 0.44; 95% CI0.28...0.69; Р=0.0003). Conclusion. Nutritional support of pregnancy with magnesium preparations based on organic salts, such as citrate, lactate, and pidolate, in combination with pyridoxine favorably affects the course and outcomes of pregnancy with a high safety level and no adverse reactions.
Obstetrics and Gynecology. 2014;(10):33-40
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Growth factors as prognostic criteria for conception in IVF cycles
Abstract
Objective. To establish the optimal time to estimate growth factors during an IVF cycle and to determine their association with conception rate in the cycles. Subject and methods. The present paper gives the results of a comparative analysis of the levels of the examined factors in the cervical mucus (CM) obtained on the day of transvaginal puncture (TVP) of follicles and on that of embryo transfer (ET) into the uterine cavity in 97 infertile women depending on whether pregnancy occurred as a result of IVF. Results. There was a significant increase in the level of granulocyte-macrophage colony-stimulating factor (GM- CSF) and vascular endothelial growth factor (VEGF) (p < 0.01) in the CM obtained on the day of TVP and on that of ET in 50 women with occurred pregnancy versus a group of women (n=47) in whom pregnancy did not. The CM levels of GM-CSF and VEGF on the day of ET were significantly associated (p < 0.05) with conception during IVF cycles and can predict it with a 69% chance. Conclusion. The CM levels of GM- CSF and VEGF on the day of ET are the most informative indicators for assessing endometrial receptivity in the IVF cycle.
Obstetrics and Gynecology. 2014;(10):41-47
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Submucosal myomatous nodules treated by uterine artery embolization
Abstract
Objective. To study the possibility of using uterine artery embolization (UAE) to treat uterine myoma with submucosal nodules. Subject and methods. A total of 1610 reproductive- and premenopausal-aged patients diagnosed as having uterine myoma who had been treated by UAE were examined. The examinees’ age ranged from 21 to 56 years (mean age 40.8±0.7 years). The examination involved the consultations of a gynecologist and an interventional radiologist, small pelvic ultrasound study determining the Doppler readings of blood flow in the uterine arteries, their branches, and perifibroid plexus vessels, biochemical and clinical blood tests, smears to define purity grade and flora, and a test to detect urogenital infection. To evaluate the endometrium, the investigators performed aspiration and, if indicated, hysteroscopy and separate curettage of the uterine cavity. Results. UAE was carried out in 1003 (62.3%) patients with solitary submucosal or multiple myoma; one of its nodules displayed submucosal growth. Myoma belonged to type 0 in 17 (1.7%) of the patients, type 1 in 361 (36%), and type 2 in 625 (62.3%). 334 (33.3%) women were observed to have either myolysis or expulsion of uterine nodules and their generation or vaginal removal in the period 2 weeks to 1 year after UAE. Spontaneous generation of nodules occurred in 71 (7.1%) patients. Long-standing nodules in the cervical canal were noted in 15 (1.5%) patients. A nodule was surgically removed by the traditional procedure. Bleeding occurred in 5 patients at 2 months postembolization, which required emergency admission and transvaginal myomectomy. None of these cases needed any radical surgical intervention. Postmyomectomy small pelvic ultrasonography demonstrated complete recovery of the topography of the uterine cavity without any additional surgical interventions. Conclusion. UAE alone and as a treatment stage may be used to treat uterine myoma with the submucosal arrangement of a nodule in any size of a myomatous nodule, at any patient age. It may be carried out in patients with submucosal uterine myoma as an alternative to hysterectomy and when transcervical myomectomy is impossible. UAE is the method of choice in the treatment of this pathology in high risk surgical/anesthetic patients.
Obstetrics and Gynecology. 2014;(10):48-51
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The quality of life in women according to climacteric syndrome
Abstract
Objective. To give a clinical portrait of and to assess their quality of life in patients with menopausal syndrome versus those with urogenital atrophic infections and osteoporosis. Subject and methods. One hundred and six women with menopausal syndrome, including 48 patients with urogenital atrophic disorders, 113 with osteoporosis, and 64 with physiological normal climacterium, were examined. The SF-36 health survey questionnaire was used to assess quality of life in the patients. Results. Comparison of the clinical portrait of the women revealed that menopause occurred in them earlier than in Russia’s female population as a whole. All the patients had a poor obstetric/gynecological history. The proportion of somatic diseases was a maximum in patients with osteoporosis and in those with physiological normal climacterium. Conclusion. The highest quality-of-life indices were detected in the women with physiological normal climacterium and in those with menopausal syndrome; the moderate and lowest indices were seen in osteoporosis and urogenital atrophic disorders, respectively.
Obstetrics and Gynecology. 2014;(10):52-58
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The phenotypic and functional characteristics of phagocytes in the blood of premature infants in the early neonatal period
Abstract
Objective. To evaluate the specific features of the subpopulation composition and functional activity of white blood cells in premature infants at birth and in the early neonatal period depending on gestational age and the presence of congenital infectious pathology. Subject and methods. This prospective study was performed using the umbilical cord blood samples obtained from 43 premature infants, 24 of whom were found to have symptoms of congenital infectious disease; a control group consisted of 8 healthy full-term infants. The white blood cells were phenotyped by flow cytofluorometry applying monoclonal antibodies to the markers CD95, CD45, CD14, CD11b, CD16, cD64, CD38, and HLA-DR. The rate of reactive oxygen species (ROS) generation by whole blood cells was estimated by luminol-dependent chemiluminescence. Results. There was a correlation of the levels of activated phagocytes and their ability to produce ROS depending on gestational age. The presence of infectious disease does not reflect on the expression of the differentiated phagocytes detectable with the markers; yet it affects the functional activity of ROS-producing umbilical cord blood cells. The early neonatal period is characterized by the higher rate of expression of activated markers on granulocytes and by enhanced cell functional activity. The innate immunity of premature infants with intrauterine infection was shown to develop more rapidly than that of non-infected babies; moreover, there was monocyte pool exhaustion with the activated mechanisms of immune defense in the neonates exposed to pathogens in utero.
Obstetrics and Gynecology. 2014;(10):59-65
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Clinical and laboratory manifestations of congenital infectious and inflammatory diseases in extremely low and very low birth weight infants
Abstract
Objective. To study the clinical and laboratory manifestations of congenital infections in extremely low and very low birth weight (ELBW and VLBW) infants. Subject and methods. A prospective study included 129 ELBW and VLBW neonatal infants, 51 of whom were found to have congenital infection, 52 babies formed a group at high risk for congenital infection; the latter was excluded in 26 newborn infants. Clinical blood tests were carried out on day 1 of life and repeated on 3 of life; biochemical blood and hemostasiogram tests were done on day 3 of life; acid-base balance (ABB) and capillary blood lactate levels were estimated every 6-8 hours; C-reactive protein (CRP) and procalcitonin (PCT) were measured on day 3 of life; neurosonography, abdominal ultrasonography, echocardiography, and chest X-ray study were performed on day 1 of life. According to the babies’ status, neurosonography, echocardiography, and chest X-ray study were repeated on day 3 of life. Results. The characteristic manifestation of congenital infectious and inflammatory diseases in ELBW and VLBW infants in the first 72 hours of life is multiple organ dysfunction with the development of mainly respiratory and hemodynamic disorders and renal failure, which was accompanied by significant metabolic disturbances (hyperglycemia and persistent ABB disorders). Inflammatory changes in clinical blood tests have no sufficient sensitivity and specificity in verifying the diagnosis of congenital infection in ELBW and VLBW infants in the first 72 hours of life. The exception is the neutrophil index measured in the first 24 hours of life, which has moderate specificity, but low sensitivity. Conclusion. The isolated increase of one of the biochemical markers for systemic inflammation (CRP or PCT) in the absence of other clinical and laboratory signs may not be used as a significant sign of the diagnosis of congenital infection in ELBW and VLBW babies at least in the first 72 hours of life.
Obstetrics and Gynecology. 2014;(10):66-71
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Newborn low birth weight: Combined impact of glutathione-S-transferase gene polymorphisms and prenatal exposure to cadmium and lead
Abstract
Background. Cadmium (Cd) and lead (Pb) are toxic metals and may have effects on babies’ birth weight. Glutathione-S-transferases (GST) are involved in the detoxification of many heavy metals by glutathione conjugation. Objective. To reveal a relationship between prenatal Pb and Cd exposure, GST Ml (GSTM1) and GST T1 (GSTT1) gene deletions, and newborn birth weight. Subject and methods. The population-based cross-sectional study included 166 puerperas randomly selected from a population of Chita pregnant women. The inclusion criteria were age of 20 to 40 years and at least 5-year residence in the region. Women with fetal malformations, multiple pregnancy, diabetes mellitus, or preeclampsia/eclampsia were not included in the study. The urinary concentrations of Pb and Cd in the mother-infant pairs were tested using atomic absorption spectrometry. Commercial PCR test systems (Research-and-Production Association “DNA-Technology”, Russia) were used to determine the genotypes of GST(GSTM1 and GSTT1). Results. Birth weight was found to be inversely correlated with urinary Cd and Pb levels in the puerperas and neonatal infants in both the absence of and the presence of GSTM1 and GSTT1 gene deletion (p < 0.0001) and in the presence of concomitant variants of the latter. The groups with lower and higher Cd and Pb levels showed no significant difference in neonatal body weight in relation to GSTM1 gene deletion whereas GSTT1 gene deletion was associated with a considerable decrease in the weight of infants who were more exposed to Cd and Pb. Conclusion. Prenatal exposure to Pb and Cd may have impact on a newborn baby’s weight in relation to the presence of GSTT1 gene deletion.
Obstetrics and Gynecology. 2014;(10):72-80
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On medical rehabilitation of women after surgical termination of pregnancy in the first trimester
Abstract
The paper considers the core components of medical rehabilitation after surgical termination of pregnancy in the first trimester: the rational preventive use of antibiotic therapy - the choice of drugs, their regimens and time; differentiated physiotherapy in relation to the term of pregnancy and the method of its termination; the choice of adequate postabortion contraception on an individual basis. The proposed algorithm of therapeutic and preventive measures in accordance with the principles of insurance medicine may be recommended the obstetricians and gynecologists of women’s health clinics and gynecological hospitals.
Obstetrics and Gynecology. 2014;(10):81-86
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Current ideas on the laboratory diagnosis and treatment of small pelvic inflammatory diseases
Abstract
To paper gives the recent European Guidelines for the management of patients with small pelvic inflammatory diseases, which became available at the website of the International Union against Sexually Transmitted Infections in late 2012. Thus, these are today’s most recent guidelines on this topic, the basis for which are the principles of evidence-based medicine.
Obstetrics and Gynecology. 2014;(10):87-90
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Efficiency of using epigen intim in combination with a radiowave surgery technique to treat preinvasive cervical neoplasias in reproductive-aged women
Abstract
Objective. To study the efficiency of using epigen intim in combination with a radiowave surgery technique to treat preinvasive cervical neoplasias in reproductive-aged women. Subject and methods. After comprehensively examined, 52 patients with H-SIL and c-r in situ of the cervix uteri underwent its electric conization using a radiowave surgery apparatus. To prevent inflammatory complications and to stimulate regeneration, the cervix uteri was treated with epigen intim within 10 days before and after destruction. Results. High-risk human papillomavirus (HPV) was detected in 48 women; 4 were infected with low-risk HPV. After medical therapy in the preoperative period, a reduction in the signs of inflammation was revealed by optical coherence tomography under colposcopic control (OCT colposcopy). Postdestruction healing of the cervix uteri also occurred without inflammatory complications and accompanied by minor bloody or sanious discharge. Posttreatment monitoring showed that 96% of the women were completely healthy. Conclusion. Cervical radiowave destruction in combination with epigen intim can avoid postoperative inflammatory complications and optimize reparative processes after surgical treatment.
Obstetrics and Gynecology. 2014;(10):91-94
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Combination therapy with depantol and lavomax for diseases of the cervix uteri
Abstract
It is important to develop more effective methods for diagnosis and combination therapy, which are aimed at accelerating the processes of cervical epithelial regeneration and at preventing cancer of the cervix uteri (CCU) in the presence of human papillomavirus (HPV) infection. Objective: to study the therapeutic efficacy of the immunomodulator lavomax and depantol vaginal suppositories, which stimulate tissue epithelialization after damage, in order to improve management tactics for women with HPV-associated genital lesions and for those with the symptoms of cervicitis in the presence of cervical ectopy. Subjects and methods. The comparative randomized investigation enrolled 80 patients aged 18 to 50 years; their follow-up lasted 6 months. Clinical, laboratory, and instrumental findings and evaluated the efficiency and safety of treatment with above mentioned agents versus the conventional clinical tactics were analyzed. Results. Incorporation of lavomax and depantol into the combination therapy of papillomavirus-associated diseases of the cervix uteri in combination of destruction of the abnormal epithelium significantly exceeds therapeutic effectiveness versus monoablation. Depantol therapy for chronic cervicitis in the presence of ectopy and immature metaplasia significantly improves its clinical picture as evidenced by colposcopy, cytology, subjective complaints versus passive follow-up tactics. Conclusion. The traditional treatment regimens for patients with HPV-associated cervical diseases should include lavomax (7 days before cervical destruction: as a 125-mg tablet once daily in the first two days, after a one-day interval at the same dosage: a course dosage of 125-mg tablets once daily for 20 days, also after two weeks: one depantol suppository twice daily for 10 days. Women with chronic slowly progressive cervicitis in the presence of ectopy and an extensive transformation area with no signs of dysplasia should use depantol by the scheme: one suppository twice daily for 20 days.
Obstetrics and Gynecology. 2014;(10):95-103
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Current therapeutic and prophylactic tactics for women with genital descent and prolapse. Physicians’ knowledge and practical skills
Abstract
Currently, the problem of pelvic organ prolapse has assumed more urgent importance due to its higher incidence rates (longer life span), difficulty completely emptying the bladder/bowel, high postsurgery recurrence rates (2040% of recurrences after surgery without tissue transplantation, 10% of recurrences following surgery with tissue transplantation), and increased requirements for quality of life. Objective. To estimate the level of knowledge and practical skills among physicians in rendering health care to women with pelvic organ prolapse in an outpatient setting. Subject and methods. 460 questionnaires filled out anonymously by obstetricians/gynecologists served as the material of this investigation. Results. Most physicians prefer the surgical approach, which has been generated by the International Continence Society/International Urogynecological Association and described in clinical guidelines, to the current medical approach in treating pelvic organ prolapse, by considering that the medical methods (pessaries) are insuff iciently effective and without having necessary training and logistical support.
Obstetrics and Gynecology. 2014;(10):104-110
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Principles of iron deficiency anemia treatment in women with gynecological diseaseGuideline for practitioners
Abstract
The paper describes the role of iron and its metabolism in the body and the causes of iron deficiency states. It presents the clinical picture of iron deficiency anemia, its diagnostic criteria and treatment principles in patients with gynecological disease. The results of treatment with iron polymaltose complex (37 patients) versus ferrous sulfate (30 patients) are given. There is evidence for the high efficacy and safety of maltofer.
Obstetrics and Gynecology. 2014;(10):111-115
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