Nº 1 (2016)

Objective. To carry out a systematic review of the data available in the present-day literature and the principles and methods of diagnosing complications due monochorionic multiple pregnancy. Materials and methods. The review included the data of the foreign articles published in the past 5 years, which had been found in Pubmed and ScienceDirect on this topic. Results. The diagnostic criteria for twin-to-twin transfusion syndrome and anemia-polycythemia syndrome were described. The early diagnostic markers of developing the complications and the fundamentals for examining monochorionic multiple pregnancy were given. Conclusion. The use of the clinical guidelines and examination protocols in monochorionic twins, which are given in the review, will be able to timely diagnose the complications and to perform adequate treatment.

Objective. To make a systematic analysis of the data available in the present-day literature on procedures for evaluation of the psychoneurological status of premature infants born with intrauterine growth retardation at birth and over time during the neonatal period. Material and methods. The review included the data of the foreign and Russian articles published in the past 10 years, which had been found in Pubmed on this topic. Results. The data available in the literature on procedures for monitoring the psychoneurological status of premature infants born with intrauterine growth retardation, including rating scales and instrumental examinations, were presented. Conclusion. There is a need for further investigations to optimize an algorithm for diagnostic examination of neonatal infants born with intrauterine growth retardation to reveal neonatal impairments and to timely initiate rehabilitation measures and, if necessary, drug therapy aimed at reducing the incidence of postnatal nervous system lesions.

Objective. To establish the specific functions of the cardiovascular system in pregnant women with diabetes mellitus (DM) during gestation. Subjects and methods. The results of examinations were analyzed in 204 women with type 1 DM, including 45 (22%i), 110 (54%), and 49 (24%) patients in the first, second, and third trimesters of pregnancy, respectively. A control group comprised 30 women with uncomplicated pregnancy, including 10 (33.3%), 10 (33.3%), and 1 (33.3%) patients in the first, second, and third trimesters, respectively. The patients underwent instrumental examination: echocardiography and Doppler echocardiography; the standard echocardiographic characteristics were assessed in relation to the presence of diabetic nephropathy. The examined pregnant women had neither respiratory nor heart failure. The findings were statistically analyzed. Results. The paper gives new evidence for the functional status of the cardiovascular system in pregnant women with type 1 DM. The examined patients with DM were ascertained to have a significant increase in glycated hemoglobin and to have no protective hypervolemia or hyperdynamic circulation inherent to the development of pregnancy. Conclusion. The course of pregnancy in patients with DM was characterized by hyperglycemia. Glycated hemoglobin levels during gestation were elevated and ranged from 9.54 to 8.18%. The course of pregnancy in the women with DM was unattended by significant echo-CG morphometric changes provided that DM was corrected. The patients with this condition were found to have no protective hypervolemia or hyperdynamic circulation typical of the development of pregnancy. The function of the cardiovascular system in pregnant women with diabetic nephropathy during gestation is characterized by the decreased cardiac output; the required minute volume is maintained by increased heart rate.

Numerous studies indicate that surgical techniques used to suture uterine wound affect the process of cicatrization. At present, there is no consensus as to optimal uterine wound suturing techniques. The study of the intraoperative features and ultrasound and elastographic characteristics of the uterus in the early and late postoperative period in relation to the type of an applied suture allows expansion of an idea on the impact of surgical delivery on the uterus, the course of cicatrization, and prediction for further pregnancy. Objective. To investigate thefeatures of the uterine status and the possibilities of using echography and elastography in the early and late postoperative period to assess myometrial changes in relation to the type of an applied suture. Subjects and methods. The investigation enrolled 129 women after cesarean section. The uterus was closed with a one-row continuous suture in 57patients, with a one- row locking suture (after Reverdin) in 30 patients, and with a double-row suture in 42. The uterus was stitched by suturing all its layers (perimetrium, myometrium, and endometrium) in 102 patients; the uterine wall was restored without pricking the endometrium in 27. Thirty-four patients underwent a control examination 3 months after cesarean section. During cesarean section, the uterine wall was restored using one-row stiches in 15 of them, one-row locking stitches in 9, and double-row stiches in 10. The endometrium was pricked in 22 patients and was not in 7. В-mode ultrasonography was carried out at Stage 1. Tissue elasticity was estimated in real-time, by using compression elastography and calculating the elastographic index (El) at Stage 2. Examinations were performed in all the 129 cases on day 4 after delivery and in 34 also three months following cesarean section. Results. The surgical duration was noted to be shorter when applying one-row blanket sutures or one-row locking sutures than double-row ones (p = 0.005) and (p = 0.0172). On day 4postsurgery, hemoglobin values were higher when a one-row blanket suture had been used than a locking one had (p = 0.03). On that day, the cervical length was shortest after applying a double-row suture. Ultrasound assessment 3 months after cesarean section provided no statistical significant data in relation to the uterine wall suturing method. However, the highest El was seen in the women undergoing the double-row uterine suturing technique. Conclusion. The benefits of the one-row procedure for suturing the uterine wall are a shorter surgical duration and higher hemoglobin and hematocrit values in the early postoperative period. In this period, the cervical length was shorter in the women who had undergone the double-row uterine suturing technique than in those who had a one-row technique. Despite the fact that there were differences in myometrial thickness at the site of a uterine scar in the postoperative period; the stiffness values for the tissues in this area were highest when the double-row uterine suturing techniques had been used. There were differences in the status of a uterine scar after applying the one-row or double-row uterine suturing techniques. It is necessary to continue investigations to determine how the found differences are associated with the morphofunctional status of the scar during the next pregnancy.

Objective. To create a multigenic model for predicting the probability of obtaining immature oocytes in assisted reproductive technology programs through preliminary genotyping in patients. Subjects and methods. A total of 160 patients aged 18 to 36 years who were referred for in vitro fertilization (IFV) programs to be treated for infertility were examined during a prospective study. Single nucleotide polymorphisms (SNP) associated with the processes of folliculogenesis and oogenesis were chosen as potential molecular genetic predictors to obtain immature oocytes. Results. A mathematical model that could predict the probability of obtaining immature oocytes in the IVF programs in terms of the patients’ genotype was created. The predictive accuracy for obtaining immature oocytes using the AMHR2 gene polymorphism (-482 A>G), ESR2 G>A [Rsal], LHCGR 935 A>G (Asn312Ser), and LHCGR 872 A>G (Asn291Ser) was 68.6%. The sensitivity was 73.6%; the specificity was 62.5%. Conclusion. Genetic studies make it possible to enhance the accuracy of predicting the outcomes of superovulation induction and to optimize the implementation of IVF programs.

Objective. To study the possible association between the allelic and genotypic variants of TNF-a rsl800629gene polymorphism in the development of cervical intraepithelial neoplasia (CIN). Subjects and methods. A total of 91 ethnic Uzbek ethnic women aged 24 to 50 years (a study group) were examined. The controls were DNA samples from 95 apparently healthy ethnic Uzbek women, from the DNA bank of the Department of Molecular Medicine and Cell Technologies, Research Institute of Hematology and Blood Transfusion. Results. A statistically significant difference was found between the patients with CIN and the healthy donors in the frequency of the allelic variants of the examined TNF-a rsl800629gene polymorphism. The marked increase in the frequency of a heterozygous genotype in the patients with CIN versus the controls is evidence in favor of the associativity of the G/A genotype of rsl800629gene polymorphism of TNF-a, the key proinflammatory cytokine of the immune system, at high risk for CIN. The distribution of the genotypes of rsl800629 polymorphism was as follows: In Subgroup 1, the G/A genotype was 2.8-fold more common than that in the control one. The risk for developing the pathology in the presence of this mutant genotype increased more than four-fold. In Subgroup 2, the frequency of the G/A genotype was also 1.8 times higher than that in the controls; however, due to a small number of the groups examined, this difference proved to be statistically insignificant (%2=2.3; P=0.1; OR=2.0; 95% Cl, 8066, 4.895). Conclusion. There was a significant association between the unfavorable G/A genotypic variant of TNF-a rsl800629 gene polymorphism with the development of CIN, particularly this was clear-cut in the subgroup of patients with endometrial hyperplasia. The identification of the functionally unfavorable genetic marker in women with different cervical lesions makes it possible to predict a risk for CIN and to define the further tactics of therapeutic and preventive measures.

Objective. To evaluate the impact of a forced feeding procedure on the rate and degree of hyperglycemia in extremely low and very low birth weight (ELBW and VIBW) infants. Subjects and methods. A total of 120 neonates, including 47EIBWinfants and 73 VLBWinfants, who had been treated in an intensive care unit in January 2012 to January 2014, were examined. Blood glucose levels were determined in all the babies. The two-fold increased blood glucose level (>8.0 mmol/l) at a 4-hour interval was considered to be hyperglycemia. The infants were divided into the following groups according to gestational age: 1) 25-27weeks (n=22); 2) 28-29 weeks (n=43), 3) 30-31 weeks (n=40), and 4) 32-33 weeks (n=15). Each group was divided into subgroups in relation to a parenteral feeding procedure: A) forcedfeeding; B) traditional feeding. Results. The investigation established that the difference in the rate of hyperglycemia was statistically insignificant in relation to the feeding procedure. This trend was noted in all the groups. Comparative analysis of the two parenteral feeding procedures also re vealed no increase in the mean blood glucose levels in the forced feeding subgroups in the first week of life. Comparison of the rate of intragastric bleeding (IGB) in the examined groups showed a statistically significant increase in the rate of grade 1-2 IGB in Subgroup В of Group 1 versus Subgroup A. Examination of the two parenteral feeding procedures revealed no statistical difference in the incidence of retinopathy of prematurity. Analysis of the possible complications of parenteral nutrition in Group 1 patients demonstrated a rise in the incidence of neonatal cholestasis in Subgroup В versus Subgroup A. There was no significant difference in the incidence of neonatal cholestasis or IGB in the groups of infants at more than 27 weeks’ gestation (p > 0.05). Conclusion. The forcedfeeding procedure in ELBW and VLBW infants does not result in a significant increase in the rate and degree of hyperglycemia. The lack of an increase in the frequency of complications of hyperglycemia, such as IGB, retinopathy, neonatal cholestasis, additionally suggests that the forced feeding procedure is safe.

Objective. To evaluate the efficiency of using Multi- Gyn Actigel in the therapy and prevention of recurrent bacterial vaginosis (BV). Subjects and methods. In Group 1, 112 patients received combined therapy with a topical antianaerobic agent for 7-10 days and then Multi-Gyn Actigel twice daily for 5 days; in Group 2, 104 patients had monotherapy with Mult- Gyn Actigel twice daily for 10 days. Results. Multi- Gyn Actigel is an effective agent to treat BV and to prevent its recurrences. The agent shows a high efficacy for the treatment and prevention of recurrent BV and a good compliance because it is easy to use and can rapidly achieve a therapeutic effect. Conclusion. Genetic studies make it possible to enhance the accuracy of predicting the outcomes of superovulation induction and to optimize the implementation ofIVFprograms.

Objective. To make a systematic analysis of the data available in the present-day literature on the possibilities of menopausal hormone therapy (MHT) in maintaining the quality of life during menopause, including during premature menopause, and to assess its associated cancer risks. In addition, an attempt was undertaken to answer the question of whether MHT may be used in women at risk for hereditary malignant tumors (in BRCA1 and BRCA2 gene mutation carriers) after prophylactic surgery. Material and methods. The review included the data of the foreign and Russian articles published in the past 10 years, which had been found in Pubmed on this topic. Results. Indications for MHT and its possible regimens in women during menopause, including in those with some cancers, as well as in BRCA1 and BRCA2 gene nutation carriers after prophylactic surgery are described. Conclusion. There is a need for further investigations to elucidate possible cancer risks in the use of MHT, especially in young BRCA1 and ВRCA2 gene nutation carriers. It has been already proven that short-term MHT in these women will aid in alleviating some, but not all postcastration symptoms. The investigations of long-term quality of life and health after removal of the uterine appendages have yet to be completed. It is conceivable that a new era for cancer treatment will come soon.