![Open Access](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_open.png)
![Restricted Access](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_unlock.png)
![Restricted Access](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
No 11 (2015)
- Year: 2015
- Articles: 22
- URL: https://journals.eco-vector.com/0300-9092/issue/view/6378
Articles
ROLE OF VITAMIN D IN THE OUTCOMES OF ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS
Abstract
Objective. To make a systems analysis of the data available in the current literature on the effect of vitamin D on the efficiency of assisted reproductive technology (ART) programs and its role in the physiology of the female reproductive system. Subject and methods. The review includes the data of Russian and foreign articles found in the Pubmed database on this topic and published in the past lOyears. Results. The possible mechanisms of vitamin D involvement in embryo implantation processes and the impact of the concentration of this vitamin on the ovarian reserve marker anti-MUllerian hormone are described. The genetically caused vitamin D metabolic features are presented. Conclusion. There is a need for further investigations of the effect of vitamin D on an ovarian response to gonadotropin stimulation and on the outcomes of in vitro fertilization, the occurrence of clinical pregnancy and the birth of a healthy baby in the assisted reproductive technology programs.
Obstetrics and Gynecology. 2015;(11):5-10
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
CURRENT APPROACHES TO DIAGNOSING THE CUTANEOUS MANIFESTATIONS OF HUMAN PAPILLOMAVIRUS
Abstract
Objective. To highlight current views on the diagnosis of the cutaneous manifestations of human papillomavirus infection, one of the most common sexually transmitted virus infections. Subject and methods. More than 40 Russian and foreign sources, including 12 from the Pubmed database, on the diagnosis of human papillomavirus-associated skin diseases were reviewed. Results. Analysis of the performed investigations has indicated that the timely diagnosis andfurther therapy of the subclinical cutaneous manifestations of human papillomavirus may substantially reduce recurrence rates. Conclusion. A search for novel diagnostic methods and improvement of existing ones for human papillomavirus- associated skin diseases are promising and relevant.
Obstetrics and Gynecology. 2015;(11):11-15
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
CURRENT IDEAS ON MANAGEMENT TACTICS FOR PATIENTS WITH INFILTRATING ENDOMETRIOSIS
Abstract
Objective. To study current ideas on endometriosis. Subject and methods. Articles were sought using the key words: endometriosis, treatment, diagnosis, and pathogenesis in the PUBMED and Russian Science Citation Index databases. Sixty-five papers were selected after the search. Results. The only internationally recognized classification system of the American Society of Reproductive Medicine is widely used in the world. The following stage processes: attachment of endometrial cells to the mesothelial cells; penetration of endometrial cells into the mesothelium; angiogenesis in the endometrioid implants; proliferation of ectopic cells; and process involvement of inflammatory cells maintaining the development of implants are considered as the key components of the pathogenesis of endometriosis. Long-term diagnostic delay and lower quality of life have been found in women with endometriosis. The main techniques for diagnosing endometriosis were ultrasonography, magnetic resonance imaging, colonoscopy, and cystoscopy. Laboratory methods are of additional value. A combined approach involving surgical and medical treatments is a generally recognized tactic. The endometriosis recurrence rate after surgical treatment is 21-40%. Conclusion. In spite of numerous investigations and the considerable social value of the problem, there is no uniform system concept of a multidisciplinary approach to the organization and surgical treatment of patients with disseminated forms of endometriosis.
Obstetrics and Gynecology. 2015;(11):16-22
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
PHYSICAL AND PSYCHOMOTOR DEVELOPMENT IN INFANTS WITH INTRAUTERINE GROWTH RETARDATION
Abstract
Objective. To study the data available in the literature on the physical and psychomotor development of children with intrauterine growth retardation (IUGR). Subject and methods. Key words, such as premature infants, intrauterine growth retardation, physical development, psychomotor development, nutrition, and nutritional status, were used to seek information in the international and Russian databases. A total of 50 sources meeting the criteria were selected. Results. The presented data reflect the current techniques for diagnosing physical and psychomotor development, which are one of the basic methods in evaluating the nutritional status and auxiliary methods in correcting nutrition in infants with IUGR. Conclusion. It is necessary to improve nutrition support and to elaborate nursing and rehabilitation measures for infants with IUGR.
Obstetrics and Gynecology. 2015;(11):23-27
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
HORMONAL CONTRACEPTION IN YOUNG WOMEN: PREFERENCES, EXPECTATIONS, ADHERENCE
Abstract
Objective. To define contraceptive methods preferred by young women, their expectations of chosen hormonal means to prevent an unwanted pregnancy, and a way to enhance their adherence. Subjects and methods. The results of a sociological survey of 1007young women, conducted in 2012, were analyzed. A structured interview, a method to retrieve information from a questionnaire containing open- questions, was applied; 402 Moscow students were anonymously interviewed. Results. The survey demonstrated the current characteristics of marriage, reproductive, and contraceptive behavior in 20-24-year-old women: a decline in the number of registered marriages (29.3%), stabilization of birth rates at a level of 90%o, a 26% reduction in abortion rates in the past 15 years; condom preferences (59%), coitus interruptus (26%), and combined oral contraceptives (COCs) (33%) with a low adherence to the latter. The main expectations of the women in choosing a hormonal contraceptive were its high efficacy, minimum side effects, convenience and easiness to use, and good menstrual cycle control. The above parameters were used to compare a number of COCs. The latter in a 24/4 regimen containing 20 fig of ethinylestradiol and 3 fig of drospirenone were noted to have advantages in reducing the incidence of adverse reactions and in having additional non-contraceptive benefits that were of importance for the young women to choose a contraceptive. Conclusion. Reliable contraceptives containing minimal hormones, which guarantee minimum side effects and high menstrual cycle control, may become an effective alternative for young women, by enhancing their adherence.
Obstetrics and Gynecology. 2015;(11):28-35
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
DIFFERENTIAL DIAGNOSIS OF HYPERTENSIVE DISORDERS IN PREGNANCY
Abstract
Pregnant women with chronic arterial hypertension (CAH) have a more favorable prognosis than those with preeclampsia. In addition, the principles of treatment for preeclampsia and CAH are different. Objective. To develop a procedure for the differential diagnosis of hypertensive disorders in pregnancy. Subjects and methods. Examinations were made in 60 pregnant patients in the third trimester (20 with physiological pregnancy, 20 with CAH, and 20 with severe preeclampsia). Central hemodynamic parameters, oxygen status, and lactate levels were analyzed. Results. The most marked abnormal hemodynamic parameters were noted in pregnancy complicated by preeclampsia. The patients with hypertensive disorders were found to have arterialized venous blood, suggesting microcirculatory disorders. Discriminant analysis could obtain a decision rule to determine a diagnostic index. Conclusion. The timely and correct revelation of the causes of hypertensive disorders in pregnancy are of great importance for the use of adequate therapy and for the expediency of pregnancy prolongation.
Obstetrics and Gynecology. 2015;(11):36-40
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
INVASION OF PLACENTA PREVIA IN PATIENTS WITH A UTERINE SCAR AFTER CESAREAN SECTION: CLINICAL AND MORPHOLOGICAL SECTIONS
Abstract
Objective. To compare clinical data and pathomorphological characteristics in patients with a uterine scar concurrent with placental presentation. Subjects and methods. The retrospective investigation enrolled 104 patients with a uterine scar, placental presentation, and a pathomorphologically verified diagnosis of placenta accreta. Results. Out of the 104 women, 51 (49%), 36 (34.7%), 15 (14.4%), and 2 (1.9%) had a scar after 1, 2, 3, and 4 cesarean sections, respectively. After fetal extraction for hemostasis, 45 (43.3%) patients underwent uterine artery embolization; temporary balloon occlusion of the common iliac arteries was carried out in 22 (21.2%), ligation of internal iliac arteries was done in 2 (1.9%). Sutures applied to the placental bed on the side of the uterine cavity were used in 35 (33.6%) patients with an insignificant extent of abnormal placental presentation. The thinning or absent of decidual tissue is a main pathomorphological sign of placental invasion. The wall of the uterus on its side has a scalloped surface, the shape of which is similar to that of placenta accreta. An incompetent uterine scar due to its dehiscence is represented by the fibrous tissue covered by the peritoneum adjoined by chorionic villi. A pronounced commissural process between the wall of uterus and the posterior wall of the bladder and the gestational rearrangement of the vessels of the latter imitate placenta percreta. Conclusion. Invasion of placenta previa into cicatrical tissue after cesarean section is different from that into uterine muscle. It is impossible to reveal the penetration of chorionic villi to the thickness of a uterine scar and the wall of the bladder.
Obstetrics and Gynecology. 2015;(11):41-45
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
EFFICIENCY OF USING COMBINED ORAL CONTRACEPTIVES, ESTRADIOL VALERATE, AND GONADOTROPIN-RELEASING HORMONE ANTAGONIST FOR THE PROGRAMMING OF IN VITRO FERTILIZATION CYCLES
Abstract
Objective. To study the efficiency of programming an induced cycle using combined oral contraceptives (COCs), estrogens, and gonadotropin-releasing hormone (GnRH) antagonists. Subjects and methods. The investigation was conducted in the period October 2012 to November 2014. It enrolled 135 women who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) programs at the Academician VI. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. All the patients were divided into 3 groups according to their preliminary preparation. Forty- five patients received COCs (ethinyl estradiol 0.03 mg/desogestrel 0.15 mg) for 14 days on day 2 of their menstrual cycle as preliminary preparation. Further ovarian stimulation was initiated using the standard protocol on day 5 after COC discontinuation. Forty-five women received estrogens (estradiol valerate 4 mg/day) on day 25 of their previous cycle, which was discontinued a day before ovarian stimulation. Forty-five patients were given GnRH antagonists in the early follicular phase (on day 2 of the cycle), followed by switching to standard stimulation with gonadotropins according to the GnRH antagonist fixed protocol on day 5 of the cycle. Results. The number of preliminary preparation days is much more in Group 1 than that in Groups 2 and 3 (14.0+0, 5.3+0.9, and 1.8+1.1, respectively). The indicators of stimulation cycles were comparable in the three groups. The implantation rates were 19.2, 38.5, and 39.0%, respectively, which was statistically significant. The conception rates were 35.5, 44.4, and 55.6%, respectively (p>0.05). The rate of biochemical (15.0, 0, and 4.0%) and clinical (28.8, 33.4, and 40.0%)pregnancies and early reproductive losses (2.2, 4.4, and 8.8%, respectively) were comparable between the groups. Conclusion. All the three examined regimens of preliminary preparation for stimulation in the IVFprograms using GnRH antagonist protocols were effective in obtaining clinical results. The programs with preliminary preparation with estrogens and GnRH antagonists showed virtually identical values in the number of stimulation days, the summary dose of administered gonadotropins, and conception and embryo implantation rates. Meanwhile, preparation with GnRH antagonists turned out to be significantly more effective in having conception and embryo implantation rates than that with COCs.
Obstetrics and Gynecology. 2015;(11):46-52
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
THE SPECIFIC FEATURES OF THE EXPRESSION OF MOLECULAR BIOLOGICAL MARKERS IN GLANDULAR AND FIBROUS ENDOMETRIAL POLYPS IN ELDERLY AND SENILE WOMEN
Abstract
Objective. To study the expression ofproliferation markers in the cells offibrous and glandular endometrial polyps (FGEP) to specify the pathogenetic aspects of endometrial hyperplastic processes in elderly and senile women. Subjects and methods. Examinations were made in 288elderly and senile women suspected of having endometrial pathology, as evidenced by ultrasound screening, who had undergone hysteroscopy, endometrial biopsy, followed by morphological verification. Immunohistochemical examination was performed in 9 postmenopausal patients with FGEP; a comparison group consisted of 10 reproductive-aged patients. Results. As compared with reproductive-aged women, the menopausal women showed a statistically significantly lower expression of estrogen and progesterone receptors in the nuclei of epithelial and stromal cells of FGEP. The expression of the apoptosis inhibitor Bcl-2 in the epithelial and stromal cells was more marked and that of the apoptosis inductor Bax antigen was, on the contrary, significantly suppressed. The expression of ACP450 was also pronounced manly in the epithelium of the glands. Conclusion. As compared to the reproductive-aged women, the menopausal women had basic molecular biological differences in FGEP, which suggests that the polyps are less related to the effect of estrogens and progesterone and that there is an increased risk for neoplastic transformation.
Obstetrics and Gynecology. 2015;(11):53-57
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
PAPILLARY TUBAL HYPERPLASIA: CONCURRENCE WITH SEROUS BORDERLINE OVARIAN TUMORS AND MOLECULAR BIOLOGICAL CHARACTERISTICS
Abstract
Objective. To study changes in the endosalpinx of the fallopian tubes in serous borderline ovarian tumors (SBOT) and high-grade serous ovarian carcinomas (HGSOC) and to determine the molecular biological features of papillary tubal hyperplasia (PTH). Subject and methods. The investigation included the records of 81 patients, 34with SBOT, 33with HGSOC, and 14 with extraovarian pathology. Histological and immunohistochemical (IHC) examinations were performed using the markersp52 and Ki-67. Statistical analysis was carried out applying the Mann-Whitney test. Results. PTH was identified in 73, 21, and 5% of the fallopian tubes in SBOT, HGSOC, and extraovarian pathology, respectively. Serous tubal intraepithelial carcinoma (STIC) was detected only in HGSOC (in 30.2% of the fallopian tubes). In PTH, a weak staining of the nuclei in the fallopian tubal epithelial cells for p53 was seen in 70% at the sites of PTH; Ki-67 expression was low and high in 90 and 10% of the cases, respectively. In all cases of STIC, a high expression of Ki-67 was noted at the sites of high p53 expression. In extraovarian pathology, a weak staining of the nuclei in the fallopian tubal epithelial cells for p53 was observed in 40%; Ki-67% was low in 100%. Conclusion. The development of PTH was shown to be statistically significantly associated with SBOT, IHC examination revealed wild-type p53 accumulation that was typical of PTH, as well as a low proliferative index unlike STC that is characterized by mutantp53 accumulation and high Ki-67 expression. Thus, there may be two different pathways for the pathogenesis of low-grade serous ovarian carcinomas - the development of STIC gives rise to HGSOG; that of PTH leads to SBOT and further low-grade serous ovarian carcinoma.
Obstetrics and Gynecology. 2015;(11):58-64
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
ESTIMATION OF THE DIAGNOSTIC VALUE OF MARKERS FOR THE EARLY DETECTION AND PREDICTION OF THE PROGRESSION OF CERVICAL DYSPLASTIC PROCESSES ON THE BASIS OF AN INVESTIGATION OF THE EXPRESSION OF SOME PROTEINS OF THE OUTER MITOCHONDRIAL MEMBRANE
Abstract
Objective. To enhance the efficiency of diagnosis and management tactics in patients with cervical intraepithelial neoplasia (CIN), by studying the markers of prediction, such as voltage-dependent anion channel 1 (VDAC1) in the outer external mitochondrial membrane and the protein hexokinase 2 (HK2). Subjects and methods. The investigation enrolled 32 women. According to the results of cytological examination, all the patients were divided into 4 groups: a control group, patients with atypical squamous cells of undetermined significance (ASCUS), low-grade squamous lesion (TSIT), or high-grade squamous lesion (HSIL). In all the patients, VDAC1 and HK2 protein expression levels were determined in the cervical epithelial scrapes using a western-blot analysis and chemiluminescent detection protocol. Results. Analysis of the findings revealed a relationship between VDAC1 protein expression levels, the enzyme HK2, and the degree of CIN. Conclusion. The examined proteins may be potential markers for predicting the progression of CIN and breast cancer at their early stages, which calls for further investigation.
Obstetrics and Gynecology. 2015;(11):65-69
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
USE OF HERBAL DOPAMINE MIMETICS IN ADOLESCENTS AND YOUNG WOMEN WITH MENSTRUAL IRREGULARITIES
Abstract
Functional impairments of the menstrual cycle constitute a significant proportion in the pattern of gynecological diseases in adolescents and young women. Non-hormonal correction is one of the leading therapies of these impairments. Objective. To evaluate the efficiency of using a Vitex agnus-castus-containing drug in adolescents and young women with menstrual irregularities. Subjects and methods. The open-label randomized comparative trial enrolled 80 adolescents and young women with functional impairments of the menstrual cycle who were randomized into two groups receiving cyclodynon (a study group) or a multivitamin complex (a control group) for 6 months. Results. The use of cyclodynon was found to shorten intermenstrual intervals and to improve acyclic bleeding control in patients with oligomenorrhea, to significantly reduce the degree of mastalgia, to improve autonomic function, and to normalize prolactin secretion. Conclusion. The administration of cyclodynon may be regarded as a therapy option in patients with functional menstrual cycle impairments presumptively associated with disorders of prolactin secretion.
Obstetrics and Gynecology. 2015;(11):70-77
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
PATHOGENETIC RATIONALE FOR THE THERAPY OF CHRONIC ENDOMETRITIS
Abstract
Objective. To comparatively evaluate the efficiency of different treatment regimens for chronic endometritis (CE) in view of pathogen eradication, normalization of the endometrial morphological structure, and restoration of the reproductive potential. Subjects and method. The investigation enrolled 101 patients with CE and 31 apparently healthy women. According to the treatment received, the patients with CE were randomized into two groups: 1) empiric antibiotic (AB) therapy using antibiotic combinations in conjunction with antiaggregants and antihypoxants regardless of the presence of the pathogen (n = 54); 2) personified complex treatment including AB and/or nonsteroidal antiinflammatory drugs (NSAIDs) in combination with antiaggregants and antihypoxants was prescribed on the basis of a detailed assessment of the microbial landscape (n = 47). Before and after treatment, the patients included in the study underwent ultrasonography of the small pelvic organs, hysteroscopy, and diagnostic curettage or pipelle endometrial biopsy with further morphological examination, as well as real-time polymerase chain reaction study of the microflora in endometrial biopsy specimens. Statistical processing used Student’s t-testand Mann- Whilney U-test, X 2 test to compare discrete quantities, and McNemar’s test. P-values < 0.05 were considered statistically significant for all types of analysis. Results. Following empiric AB treatment (Group 1), abnormal uterine bleeding was noted in 30.3% of the cases; the infectious agents in the endometrium were detected in 21.2%; the endometrial morphological pattern became normalized in 60.6%; the conception rate was 30.3%; after selective therapy with regards to the presence or absence of a microbial agent (Group 2), these indicators were 6.1% (p = 0.009), 3% (p = 0.024), 90.9% (p = 0.003), and 63.6% (p = 0.007), respectively. Conclusion. It is necessary to study the endometrial microbial landscape compulsorily to choose adequate therapy for CE in each specific clinical case. If the infectious agents are present in the uterine cavity in CE, combination therapy should be used in conjunction with AB agents in view of the detected pathogen; the morphological efficiency is 68.4%; reproductive function is realized in 42.1%. If the infectious agents are absent in the endometrium to treat CE, it is expedient to incorporate NSAIDs into combination treatment; the morphological efficiency is 94.7%; the conception rate is 63.2%.
Obstetrics and Gynecology. 2015;(11):78-85
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
TREATMENT FOR MENOPAUSAL DISORDERS
Abstract
Objective. To evaluate the efficiency and safety of menoril plus used long as a prophylactic medication for recovery of menstrual function and treatment of mild early menopausal disorders. Subjects and methods. The investigation Included 60 women aged 36- 45 years (their mean age was 40.5±0.2 years). All the patients were given menoril plus at a dose of 1 capsule twice a day during a meal for 12 months (the daily dose of genistein was 30 mg). Its efficacy was evaluated after 3, 6, 9, and 12 months of a follow-up. The clinical efficacy was evaluated by the following criteria: improved quality of life (by a 5-point system) and no effect; analysis of the patients’ complaints before treatment and over time. Results. The majority of patients (n = 33) reported clinical improvement and the absence of the major autonomic vascular manifestation of the climacteric symptom - sweating just by the first month of treatment; the patients with this complaint were 100% at 3 months of therapy. Menstrual function recovered more slowly; at 3 months, the patients complaining of a shorter menstrual cycle were 49% and those who complained of oligomenorrhea were 44% of the total number of the patients; by the end of the first year of treatment, such patients were 6 and 12%, respectively. Small pelvic ultrasonography carried out in phase 1 of the menstrual cycle to evaluate the endometrium and ovarian function could indicate that long continuously used menoril plus had no effect on endometrial and proliferative processes. Analysis of the health status and better quality of life in accordance with the 5-point scale showed that 49 (81%) patients noted improvement by 5 scores, accounting for 82%; 7 (12%) patients assessed treatment effects by 4 scores; 2 (3%) patients reported that their treatment was ineffective. Conclusion. One-year use of menoril plus in late reproductive-aged women with primary menstrual irregularities and the first manifestations of their mild early symptoms substantially improves their general condition due to the disappearance and reduction of autonomic vascular and psychoemotional disorders and to gradual normalization of menstrual function.
Obstetrics and Gynecology. 2015;(11):86-89
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
COMPREHENSIVE APPROACH TO TREATING CERVICAL PRECANCEROUS DISEASES (HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS) IN THE PRESENCE OF HPV
Abstract
Objective. To investigate the efficacy of Isoprinosine in the combination therapy of cervical precancerous diseases in the presence of human papillomavirus (HPV) types 16 and 18 in combination with conization of the cervix uteri. Subjects and methods. Eighteen patients with morphologically verified high-grade squamous intraepithelial lesions and HPV 16/18 were examined. A control group consisted of 10 gynecologically and somatically healthy women whose mean age was 25.8+5.7years. Results. Post-treatment analysis of changes in T cell components indicated that Isoprinosine had a marked immunomodulatory effect. CD3, CD4, CD8, CD20, and IgG were responsible for a significant increase in the indicators versus the baseline values. The patients tolerated the used treatment without complications. Conclusion. The investigation conducted proves once again the need for combination treatment for cervical precancerous diseases. Timely adequate treatment will prevent malignant processes of the cervix uteri.
Obstetrics and Gynecology. 2015;(11):90-94
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
CURRENT APPROACHES TO TREATING UTERINE MYOMA
Abstract
Objective. To draw the portrait of a patient with myoma in order to choose therapy that preserves the ovarian reserve. Subjects and methods. There were 19 myoma patients receiving esmya as preoperative preparation or therapy under the control of general clinical, hormonal, and ultrasound examinations. Results. Esmya lessens risksfor postoperative complications and makes it possible to refuse surgery; therapy cycles reduce myoma sizes, by preserving the ovarian reserve. Conclusion. Ulipristal acetate lowers blood loss and a risk for postoperative complications and preserves the ovarian reserve, promoting the use of selective progesterone receptor modulators as the therapy of choice in patients with unsolved reproductive function.
Obstetrics and Gynecology. 2015;(11):95-101
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
CONSERVATIVE APPROACHES TO CORRECTING POSTMENOPAUSAL UROGENITAL DISORDERS
Abstract
Objective. To estimate changes in the degree of postmenopausal urogenital disorders (UGD) during trioginal therapy. Subjects and methods. Sixty-nine postmenopausal patients (mean age 58.46+3.59 years) with UGD were examined and enrolled in the trial. The patients were treated with vaginal trioginal by the scheme: 2 capsules simultaneously once daily for 14 days, then 1 capsule daily for 7 days, thereafter the patients took 1 capsule twice weekly for 2 months. Changes in the degree of UGD were estimated using questionnaires and the data of instrumental and laboratory studies, including calculation of karyopyknotic index (KPI), at baseline and at every subsequent visits. The magnitude of psychoemotional, autonomic vascular, and urogenital symptoms and metabolic disturbances was estimated using the Kupperman index (KI). A quality of life questionnaire was separately applied in conjunction with the evaluation of dysuria (Scale S and Scale L). Results. The symptoms of urinary incontinence were observed to be reducedjust two weeks after therapy initiation. During the therapy, there was a 2.8-fold improvement in quality of life (L) and pronounced positive changes in KI. The mean KPI increased by more than twice. There were positive changes in pH level. During the therapy, all the patients had no signs of endometrial thickening, as evidenced by ultrasound study. All the investigation participants completed a trioginal treatment cycle in accordance with the study design without changing the therapy regimen. Conclusion. The good tolerability, no adverse events of, and satisfaction with the performed treatment permit trioginal to be recommended for use as a highly effective and safe drug to correct postmenopausal UGD.
Obstetrics and Gynecology. 2015;(11):102-109
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
FETAL MECONIUM PERITONITIS: ULTRASOUND DIAGNOSIS AND OUTCOMES
Abstract
Objective. To study the significance of different echographic intrauterine signs of meconium peritonitis in determining the severity of the disease and final prognosis for a neonatal infant. Subjects and methods. Thirty-four cases of meconium peritonitis diagnosed at 22-38 weeks’ gestation were analyzed. Results. The accuracy of ultrasound diagnosis was 100%>. The main echographic signs of this abnormality were hyperechogenic adhesive mass; thickening of the intestinal wall and its increased echogenicity; calcifications in the abdominal and thoracic cavities and scrotum; dilated intestinal loops; the presence of pseudocysts; ascites, adhesions, and serous fluid collection. After birth, 62.5% of the babies needed surgical treatment. Postoperative neonatal survival was 95%. Conclusion. Meconium cyst, ascites with adhesions, dilated intestinal loops with the hyperechogenic and thickened wall are the most important echographic signs necessitating postnatal surgery.
Obstetrics and Gynecology. 2015;(11):110-116
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
PREVENTION OF RHESUS IMMUNIZATION DURING A POTENTIALLY SENSITIZING EVENT
Abstract
The paper presents experience in following up and managing rhesus-negative pregnant women having a gestational complication as threatened miscarriage with vaginal bleeding (a potentially sensitizing event (PSE)). It notes the importance of preventive measures as a component of management tactics and the necessity of preventing the development of immunization in unsensitized patients. Objective. To assess the risk for rhesus immunization in rhesus-negative pregnant women with threatened miscarriage when preventing and not preventing PSE. Subjects and methods. The investigation included 56 rhesus-negative pregnant women aged 27-35years without antibody titers with the above-mentioned gestational complication. A study group consisted of 29pregnant women with threatened miscarriage accompanied by vaginal bleeding, who underwent prenatal ad hoc prevention of rhesus immunization with human immunoglobulin anti-rhesus Rho(D). A comparison group comprised 27 pregnant women with threatened miscarriage accompanied by vaginal bleeding, who had not prenatal ad hoc prevention of rhesus immunization because of their refusal. Results. The immunized pregnant women who had not received a prophylactic immunoglobulin dose for gestational complications were 7.4% (n=2); and those who had not used this dose for gestational complications and refused prenatal prophylaxis at 28-30 weeks’ gestation were 11.1%. Conclusion. Ad hoc prevention of Rh immunization in this cohort of patients in conjunction with decreed antenatal and postnatal prophylaxis prevents the development of maternal immunization to Rh-1) antigen.
Obstetrics and Gynecology. 2015;(11):117-120
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
CAPACITIES OF TOPICAL ANTIFUNGAL AGENTS TO TREAT GENITAL CANDIDIASIS
Abstract
Objective. To study current ideas on the specific features of vulvovaginal candidiasis (VVC) and ways of its correction according to the data of Russian and foreign investigations. Material and methods. Information was sought in the international and Russian databases, by using key words, such as genital candidiasis, antimycotic therapy, and sertaconazole. Twenty sources reflecting the state of the problem are selected. Results. The paper presents literature data on the clinical course of VVC and current procedures for its diagnosis. It also gives the results of multicenter European and Russian investigations suggesting the clinical efficacy of sertaconazole. Conclusion. To treat patients with VVC, it is necessary to use broad-spectrum antimycotics against its uncomplicated course. Comparative analysis of different antimycotics has shown the benefit of sertaconazole - its clinical efficacy during short-term treatment.
Obstetrics and Gynecology. 2015;(11):121-125
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
CLINICAL OBSERVATION: PROLONGATION OF PREGNANCY WITH A FAVORABLE OUTCOME IN A PATIENT WITH CRITICAL AORTIC PROSTHETIC THROMBOSIS
Abstract
Background. Prosthetic heart valve thrombosis during pregnancy is a rare, but very serious complication and poses a threat to maternal and fetal life and the time and method of its treatment remain controversial. Description. The paper presents a case of successful pregnancy prolongation with a favorable outcome in a patient with critical aortic prosthetic thrombosis and further operations: delivery, aortic valve reprosthetic replacement, and dual chamber pacemaker implantation. Conclusion. In case of pregnancy prolongation, only a comprehensive approach to managing these patients may offer the prospect for a favorable outcome for a pregnant women and a fetus.
Obstetrics and Gynecology. 2015;(11):126-130
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)
Lidiya S. Logutova
Obstetrics and Gynecology. 2015;(11):131-132
![pages](/img/style/pages.png)
![views](/img/style/views.png)
![](/img/style/loadingSmall.gif)