Vol 2, No 3 (2015)

Original papers
Angiogenic growth factors in the pathogenesis of pre-eclampsia
Murashko A.V., Faizullin A.L., Murashko L.E.
Abstract
The pathogenetic mechanisms of pre-eclampsia are reviewed, modern risk factors are described, and probable consequences for the mother during the postpartum period and for the fetus in postnatal life are discussed.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):4-7
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MRgFUS: New potentialities and better results of therapy
Batarshina O.I., Sidorova I.S., Baranov I.I., Stepanov A.V., Ageev M.B., Kurashvili Y.B.
Abstract
The results of examinations and treatment of 349 patients with uterine myoma are analyzed. The patients were divided into 3 groups by the type of uterine myoma and clinical effi ciency of FUS therapy. Noninvasive dehydration of typical uterine myomas with edemas was used for extending the potentialities of MRgFUS and improvement of its results. Noninvasive lymph drainage was carried out in 42 patients with typical uterine myomas with stromal edemas. Dehydration led to shrinkage of the myoma nodule (by 20-40%) and attenuation of MR signal (by 50±15 U) in 85.7% (36) cases. Checkups 1, 3, 6, and 12 months after MRgFUS showed lesser intensity of uterine hemorrhages (according to PBAC tables), stable pain alleviation, and improvement of the quality of life (according to questionnaires).
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):8-12
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Efficiency of organ-sparing treatment for uterine myoma
Kurashvili Y.B., Sidorova I.S., Ageev M.B., Batarshina O.I.
Abstract
A total of 31 patients of reproductive age with uterine myomas were examined and treated after standard MRT diagnosis. The patients were divided into 3 groups by the variants of organ-sparing treatment, suggested on the base of the MR-histological parallels. Twenty (64.5%) patients received MRgFUS therapy (group 1). Embolization of the uterine arteries was carried out in 8 (25.8%) patients (group 2). Myomectomy was carried out in 3 (9.7%) patients (group 3). The treatment effi ciency was evaluated 1, 3, 6, and 12 months by MRT, detailed ultrasonic examination, and quality of life score (PBAC tables (Higham, Janssen); Short-Form MacGill Pain Questionnaire; UFS-QoL Questionnaire).
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):12-16
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Potentialities of magnetic resonance tomography in differential diagnosis of uterine myoma of various types
Kurashvili Y.B., Sidorova I.S., Ageev M.B., Batarshina O.I.
Abstract
A total of 37 patients of reproductive age with uterine myomas were examined and treated; MRT diagnosis was carried out in the standard and specifying modes. Biochemical characteristics of various types of myoma nodes and blood supply were studied by 1H-MPS proton spectroscopy and dynamic contrast amplification. Parallels between MRT data and histological findings were detected by analysis of tomograms of 37 women (58 nodes) and the morphology of 58 histological preparations. The results of this analysis demonstrated that complex MRT precisely differentiated the major histological types of uterine myomas - detected the nodes with predominant connective tissue (common myomas), with predominant cellular component (proliferating myomas), and uterine myomas with secondary destructive changes.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):16-19
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Diagnosis and treatment of benign hyperplastic diseases of the uterus in women with endocrine metabolic disorders
Masyakina A.V., Kudrina E.A.
Abstract
The aim of this study was to optimize the diagnosis and therapy for benign hyperplastic diseases of the uterus in women with endocrine metabolic disorders. The study was carried out in 154 women with endometrial hyperplasia, uterine myoma, adenomyosis, and combinations thereof. The patients were divided into 2 groups. The main group included patients with endocrine metabolic disorders, the reference group consisted of patients without disorders of this kind. Comprehensive clinical, laboratory, and instrumental studies were carried out in all patients. Endocrine metabolic disorders were evaluated, and pathomorphological fi ndings were analyzed. Detection of the clinical, biochemical, and morphological parallels in the studied cohort of patients with metabolic shifts prompted us to distinguish (for the fi rst time) three pathogenetic variants of the endocrine metabolic disorders. The role of leptin resistance in the pathogenesis of uterine myoma, adenomyosis, and endometrial hyperplasia was evaluated more precisely. The fi ndings indicated that hyperleptinemia was a potent endocrine factor of clinical manifestation of uterine myoma, adenomyosis, and endometrial hyperplasia. Measurements of serum leptin can serve as an important laboratory test for predicting the progress of latent benign hyperplastic diseases of the uterus and formation of combined forms of the organ involvement. Based on the results, a pathogenetically-based algorithm for examinations and treatment of patients with benign hyperplastic uterine diseases was created. Metabolic rehabilitation of patients, aimed at leptin resistance and insulin resistance control, body weight and lipid tissue control, was suggested. Early correction of the endocrine and metabolic disorders in accordance with the pathogenetic variants defi ned should be the key component of combined therapy and secondary prevention of benign hyperplastic uterine diseases.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):20-24
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Role of growth factors in the development of placental failure and pre-eclampsia
Murashko A.V., Magomedova S.M.
Abstract
The role of insulin-like growth factor-1 (IGF-1) and placental lactogen (PG) in the development of placental failure and preeclampsia was studied in order to develop measures for early prevention of prenatal morbidity and mortality. A total of 102 pregnant women were examined, distributed into 4 groups. Group 1 (n=30) were patients with placental failure, median age 33±3 years. Group 2 (n=30) included patients with moderate pre-eclampsia, median age 33±5 years. Group 3 (n=10) were patients with placental failure and pre-eclampsia, median age 33±2 years. Group 4 (reference group; n=32) were pregnant patients without above conditions, median age 34±5 years. Serum IGF-1 and PL were measured in all women at weeks 20-30, in addition to standard examinations. The level of IGF-1 increased in normal pregnancy with its prolongation. Its levels were lower in groups 1 and 2. In group 3 IGF-1 levels were lower than in control and higher than in groups 1 and 2; this fact could indicate reduction of the compensatory potential. The concentration of PL was normal in normal gestation, higher than normally in pre-eclampsia, and lower in placental failure. Hence, changed levels of IGF-1 and PL could indicate early disorders in the fetoplacental function, which suggested early drug correction of metabolic disorders in order to reduce perinatal mortality.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):25-28
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Relationship between previous induced abortions and the course of labor and neonatal status
Fedorova O.I., Maltseva A.E., Kuznetsova T.A.
Abstract
The relationship between previous induced abortions and fetal biometrical and functional parameters and course of labor were studied. The status (Apgar score) of newborns whose mothers had a history of abortions was worse 5 min after birth than the status of newborns whose mothers were primigravida/primipara. The newborns of mothers with a history of abortions had lesser head circumference, body length, and a low Vervek’s index, indicating a trend to brachimorhism.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):28-32
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Urgent states in obstetrics. Experience gained by a mobile resuscitation center
Evdokimov E.A., Bratishchev I.V., Shabunin A.V.
Abstract
A pressing problem is discussed - critical care in obstetrics. The authors present the experience gained over many years by the mobile center of resuscitation, working at S.P. Botkin Hospital. The epidemiology of critical states in obstetrical practice is discussed on the base of extensive clinical material, and modern approaches to therapy of these conditions are presented. A mobile long distance medical complex is now used to optimize decision making in intricate clinical situations, and interdisciplinary consultations are carried out. The modern concept of improving anesthesiological safety is presented. This organizational approach (mobile anesthesiological resuscitation care) proved to be very effective and economically efficient in the maternity care system of Moscow.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):33-39
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Pregnancy and heart disease: A viewpoint
Krasnopolsky V.I., Mravyan S.R., Petrukhin V.A., Kovalenko T.S.
Abstract
A modern approach to the management of pregnancy and labor in women with heart disease is presented. The 3-level system of follow-up of this patient population is based on stratification of cardiological risks, determining the algorithm ofphysician’s steps and optimizing the strategy of outpatient and inpatient treatment. Risk stratification is supplemented by quantitative EchoCG values, reflecting the hemodynamic overloading of the myocardium and facilitating the work of the doctor. Special attention is paid to pregnant women with a history ofpalliative cardiosurgery, with intact myocardial contractile function, with a good prognosis for pregnancy prolongation and often spontaneous labor.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):40-44
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Intensive care for ovarian hyperstimulation syndrome. National clinical recommendations
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V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):45-54
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Surgical prevention and management of obstetrical hemorrhage
Zharkin N.A.
Abstract
Protocol the surgical conservative management of obstetrical hemorrhage associated with Caesarean Section was applied in more than 120 C/S. Good effect has got in 92%. Hysterectomy has made in 8%.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):54-55
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Retrospective analysis of the course of pregnancy and labor in patients with disseminated sclerosis
Muravin A.I., Boiko A.N., Murashko A.V., Popova E.V.
Abstract
Multiple sclerosis (MS) is a multifactorial, autoimmune, demyelinating disease of nervous system, affecting predominantly women of reproductive age. In our study we analyzed course ofpregnancy and puerperium, based on medical documentation of 64 women with MS. Frequency of complications during pregnancy in women with MS meets population approximately. At the same time relaps of MS during pregnancy and puerperium was noticed in 14% and 47%, accordingly. Moreover, high frequency of Postpartum depression was identified (50%), that could indicate relaps of MS.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2015;2(3):55-56
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