Nº 6 (2018)

The paper presents current generalized data on the immunological aspects of preeclampsia development and progression and emphasizes the role of immunological maladaptation of the mother to pregnancy with the participation of key factors of the immune system in response to the formation of a semi-allogenic fetus and placenta. The results of recent studies allow us to take a fresh look at therapeutic approaches to managing patients with preeclampsia, by taking into account targeted exposure methods against the most important component of its pathogenesis, in particular to prevent excessive activation of the complement system.

Female diseases associated with natural aging occur on average 10 years after the onset of menopause. The risk of cardiovascular diseases increases at the menopause. According to the latest scientific data, estrogens play an important role in maintaining the functional and morphological parameters of the vascular wall. The findings suggest that menopausal hormone therapy (MHT) provides a certain level of cardioprotection when MHT is performed in early postmenopause. A new concept of eu-estrogenemia (Eu-E) is proposed: that is the optimal concentration of estrogens, which provides/maintains the normal functioning of estrogen receptors (ERs) (the so-called functional density) in non-productive target organs. Chronic hypoestrogenemia leads to a primary ER functional defect with a further decline in the number of functioning ERs. (There is a reduced functional density). The concept of Eu-E makes it critical to estimate the timing of hormonal therapy initiation, at which there can be a protective effect on the vascular wall and the central nervous system.

Objective. To comparatively analyze the content of mitochondrial components in the placenta and whole blood of women with physiological and fetal growth restriction-complicated pregnancy. Subjects and methods. Examinations were made in 32 women (10 patients with physiological pregnancy and 12 patients with diagnosed fetal growth restriction) starting at 24 weeks’ gestation. The levels of OPA1, DRP1, VDAC1, TFAM, and hOGG1 proteins were estimated using chemiluminescence western blotting. The blood levels of mitochondrial DNA copy number were determined by real-time PCR. Results. There was an increased hOGG1 protein content without changes in the levels of mitochondrial fusion and fragmentation factors in the placental tissue of the examined groups. There was a significant reduction in mitochondrial DNA abundance at 25, 29, and 37 weeks’ gestation in the blood of patients with fetal growth restriction compared to the similar weeks of physiological pregnancy. Conclusion. There are pronounced manifestations of oxidative stress in fetal growth restriction-complicated pregnancy. The reduction in the maternal blood mitochondrial DNA abundance in fetal growth restriction may be suggestive of obvious mitochondrial dysfunction in the placenta and be used as a prognostic marker for this pathology

Aim. To investigate clinical and diagnostic features of patients with external genital (retrocervical) endometriosis (RCE). Material and methods. The study comprised 44patients with RCE, who were examined and underwent surgery at the V.I. Kulakov NMRC for OGP from October 2016 to December 2017. Patients were divided into four subgroups. Baseline diagnostic work-up included gynecological and somatic history and diagnostic imaging (transvaginal ultrasound (TVUS), pelvic magnetic resonance imaging (MRI), and colonoscopy). All patients underwent laparoscopic surgery. The type of surgery was chosen based on location, the depth of invasion in the affected organs, the degree of spread in the rectovaginal space, and co-occurrence of colon endometriosis. Results. The main clinical manifestations of RCE included pelvic pain, dysmenorrhea, dyspareunia, infertility, and dyschezia. The absence or presence of the endometriotic infiltration of retrocervical adipose tissue, found during the bimanual and rectovaginal examination, does not rule out infiltrating rectosigmoid endometriosis. Pelvic MRIcomplements ultrasound clarifying the location and extent of the endomeriotic lesion, and involvement of the pelvic organs in the pathological process. Bloating, mucus in stool, dyschezia during menstruation, ultrasound, and MRI findings suggestive of colorectal endometriosis, warrant a colonoscopy. The intraoperative findings complement and refine the data obtained during the pre-operative diagnostic work-up. Conclusion. Patients with RCE need comprehensive diagnostic evaluation with laparoscopy as the final stage, excision of endometriotic lesions, and histological conf irmation of the diagnosis.

Objective. The paper highlights the issues associated with the possibility of using echohysterosalpingography with ultrasound contrast agents to diagnose fallopian tube patency. Subjects and methods. A total of 3,365 female patients with primary and/or secondary infertility were examined at the Departments of Ultrasound and Functional Radiation Diagnosis, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in the period from June 2015 to June 2017. Fallopian tube patency was diagnosed by X-ray and ultrasound hysterosalpingographies with different types of contrast and their diagnostic efficiency was analyzed. Results. The results and diagnostic characteristics of X-ray and ultrasound hysterosalpingographies in the diagnosis of fallopian tube patency were analyzed. The obtained results of a sensitivity of 90.3% and a specificity of 83.3% allow us to characterize ultrasound hysterosalpingography using contrast agents as an effective diagnostic technology. Conclusion. The investigation indicated that contrast-enhanced echohysterosalpingography under transvaginal echography guidance, which was used to evaluate fallopian tube patency in women with tuboperitoneal factor infertility, could achieve full visualization of the fallopian tubes and uterine cavity in 98.8% of cases, which made it possible to effectively diagnose the anatomical status of the fallopian tubes and to determine further management tactics for infertile patients.

Objective. To determine a drug that is predominant in terms of pharmacoeconomic analysis for the treatment of infertility in patients with an insufficient ovarian response. Material and methods. An information search for publications on the appropriate topic of this study was conducted in the PubMed, Medlink, and Cochrane Library databases. A total of 134 articles and abstracts were found. Two publications on an open prospective randomized controlled trial by Ferraretti et al. (2004) and an open randomized trial by Carone et al. (2012) were selected for further analysis. These articles are unique in the contents and design of the study. Results. It was established that there was presently a limited number of studies available on the treatment of infertility in women with a suboptimal ovarian response, which had been conducted on a large sample of patients. An economic evaluation of the effectiveness of infertility treatment was made in patients with an insufficient ovarian response on the basis of effectiveness analysis, cost analysis, cost-effectiveness analysis, budget impact analysis, and sensitivity analysis. The compared alternatives were follitropin-alpha + lutropin-alpha/ recombinant follicle-stimulating hormone (rFSH) + recombinant luteinizing hormone (rLH), follitropin-alpha/ rFSH, and menotropin/human menopausal gonadotropin (hMG). Conclusion. The results of pharmacoeconomic analysis have shown that follitropin-alpha + lutropin-alpha dominates in terms of cost-effectiveness analysis and leads to cost savings in the treatment of infertility in patients with a suboptimal ovarian response.

Objective. To analyze main obstetric and gynecologic care drawbacks fallen in the judicial sphere. Material and methods. Methods for a comparative analysis and systematization of information were used during the study to examine the materials of 61 lawsuits on the disputes related to obstetric and gynecologic care in the Ural Federal District. Results. Disputes on the quality of obstetric and gynecologic care regularly become a trial subject. The structure of these disputes was analyzed. The position of health care facilities and an obstetrician/gynecologist was found to be highly vulnerable. The causes of unfavorable outcomes of obstetric and gynecologic care and made drawbacks are given. Conclusion. The unfavorable outcomes of obstetric care for some complications (preeclampsia, placental abruption, fetal distress, meconium aspiration, etc) require a particularly thorough expert analysis to establish a causal relationship between the medical staffs actions and the consequences.

Objective. To identify comorbidities and clinical, epidemiological, and hormonal features in women with reproductive disorders and genital tuberculosis. Subjects and methods. Examinations were made in 648 women with reproductive disorders from a genital tuberculosis risk group, who were referred from the Ulan-Ude general polyclinic network to the G.D. Dugarova Republican Clinical Tuberculosis Dispensary to rule out genital tuberculosis. The latter was diagnosed in 92 (14.2%) women. Random sampling was used to form a comparison group of 115 people out of 556 women with undetected genital tuberculosis. Results. In 2012-2015, the prevalence of female genital tuberculosis in the Republic of Buryatia was 14.2% (1.2 per 100,000 population) (95% CI, 0.11-0.17). There were no statistically significant differences in the frequency of infertility, miscarriage, pelvic inflammatory diseases, menstrual irregularities, and gynecological comorbidities in patients with reproductive disorders and documented and undocumented genital tuberculosis. The shortest duration of infertility was common in women without genital tuberculosis. A significantly lower serum level of ovarian hormones was established in women with infertility and genital tuberculosis than in the comparison group. The concurrence of sexually transmitted infections (STIs) (trichomoniasis, gonorrhea, chlamydiasis, cytomegalovirus infection, and herpes simplex virus type 1 and type 2) was statistically significantly more frequent in women with reproductive disorders associated with genital tuberculosis. The clinical characteristics of women with infertility and genital tuberculosis were associated with systemic intoxication. Conclusion. It was established that ovarian hormone levels were decreased and reproductive disorders concurrent with STIs were significantly more often encountered in women with genital tuberculosis.

Background. The rate of umbilical vein aneurysm ranges from 0.4% to 1.1% per 1,000 placentas, accounting for about 4% of all umbilical vein malformations. The data obtained by both Russian and foreign authors on the characteristics of pregnancy and delivery in this abnormality are extremely limited. Case report. The paper describes a clinical case of placental umbilical vein branch aneurysm as a solid structural mass along the placental edge, which is suspected in a 29-year-old patient at 32 weeks’ gestation. Color Doppler mapping detected mosaic blood flow within the mass; hereupon the diagnosis was differentiated between vascular anomaly of the umbilical cord and placental hemangioma. Cesarean delivery was carried out at 35 weeks’ gestation due to progressive polyhydramnios and fetal health problems. Contrast-enhanced computed tomography indicated a placental umbilical vein branch aneurysm volume of 176 cm3 in the bearing placenta; the volume of the placenta was 503 cm3. The morphological examination of the placenta showed that at the umbilical cord attachment site, there was an 8х7х3-cm space-occupying lesion spreading under the amnion as a vein varix having a length of 13 cm and a diameter of 1.2-2 cm. Signs of fine-cystic degeneration of the muscle layer were microscopically found in the aneurysm wall. Conclusion. The diagnosis of an umbilical vein aneurysm is valid when detecting local umbilical vein varix, the diameter of which is more than 9 mm or if the diameter in the region of dilation is more than 50% higher than that in the unaffected areas. On the basis of the literature data and the given case, the authors suggest that the most important points in the detection of umbilical vein aneurysm are to determine management tactics for a pregnant woman and to choose the optimal delivery method, depending mainly on the development of aneurysm complications, concomitant fetal lesions, and gestational age.

Background. An increasing incidence of malignant tumors and rejuvenation of this pathology lead to the fact that the physician increasingly faces cervical cancer in pregnant women in clinical practice. Case report. The paper describes a clinical case of a 36-year-old female patient who was diagnosed with invasive cervical cancer at 29 weeks’ gestation and placenta previa and increta at 34 weeks. Surgical intervention was performed with the participation of an oncologist. A special treatment regimen including radiation and polychemotherapy was planned. Conclusion. Cervical cancer and placenta previa and increta-complicated pregnancy is a menacing disease requiring the joint efforts of an obstetrician/gynecologist and an oncologist in high-tech medical centers.