Vol 5, No 4 (2018)

Original papers
DISCORDANT ANOMALIES IN MONOZYGOTIC TWINS
Panchenko V.A., Sosnova E.A.
Abstract
Monozygotic twins, as a rule, have the same genotype and phenotype. Cases, where disturbances develop in only one of two twins are very rare. Such cases are called discordant anomalies. The purpose of the work is to systematize the data on the causes of discordant anomalies, their phenotypic manifestations and methods of managing pregnancy in the case of discordant anomalies, search for articles on this topic in the PubMed database and analyze the found literature. Data analysis showed following factors to be able to serve as causes of discordant anomalies: mutations occurred both before and after the separation of the blastomeres; inactivation of one of the X chromosomes in women; variations in the number of copies of genes; different embryo attachment to the placenta; epigenetic factors. Most often there are discordant anomalies of the central nervous system, the cardiovascular system, and defects of the abdominal wall. There are less common chromosomal abnormalities - Down syndrome, Patau syndrome, Klinefelter syndrome. Isolated cases are cystic hygroma and autism spectrum disorders. The average gestational age at which discordant anomalies are detected is 17 weeks in monochorial twins, and 21 weeks in bichorial twins. Malformations of one of the fetuses increase the risk of the miscarriage or premature birth. When detecting twins, discordant for a large anomaly, selective reduction of embryos is appropriate. For bichorial twins, an intracardiac injection of potassium chloride is used. In monochorial twins, umbilical cord coagulation is used, because often monochorial fetuses have vascular anastomoses, and the cardiotoxic agent can enter into a healthy fetus. Discordant anomalies are rare, poorly understood pathology. Anomalies can affect any organ system, often there are multiple malformations. Large anomalies can be an indication for the selective reduction of the fetus.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):172-176
views
DIAGNOSIS AND PHARMACOTHERAPY OF PELVIC INFLAMMATORY DISEASES IN WOMEN
Skvortsov V.V., Lunkov M.V., Skvortsova E.M.
Abstract
The article is devoted to modern issues of etiology, in particular, the theory of biofilms as the most promising direction of research. Biofilms are most often represented by the association of microorganisms in which they, through coexistence in close contacts, acquire new properties, expressed in an atypical clinical picture. This determines problems of rapid diagnosis and pathogenesis, in which both the local and systemic secondary immunodeficiency state is put in the forefront, autoimmune inflammation and reactions of free radical oxidation. The most typical symptoms and signs of inflammatory diseases of the pelvic organs include, in particular, chronic salpingo-oophoritis - a common nosological item from this group, which has important social and demographic significance, since the most affected group, according to statistics, are women of reproductive age. The emphasis was placed on approaches to diagnosis using not only data from the collected history and physical examination but also methods based on modern instrumental and minimally invasive methods. Special attention was paid to measures aimed at correcting risk factors and preventing this disease, etiotropic therapy with the presentation of a specific scheme of the most rational antibiotic therapy, pathogenetic and symptomatic treatment to alleviate the condition before the eradication of the pathogenic microorganism or their association in the composition of biofilms and cure patients, and correction such unpleasant complications as vaginal dysbiosis, which can develop against a background of powerful antibiotic therapy and is not a measure of inadequate treatment and change of the selected regimen.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):177-181
views
CANCER AND PREGNANCY
Silkina M.O., Bakhtiyarov K.R.
Abstract
Cancer during pregnancy is not a common problem, but when it is detected, a serious clinical situation arises. The coexistence of a malignant neoplasm and pregnancy is a condition in which there is an ambiguous dilemma about the simultaneous development of a new life and a life-threatening disease. Ultimately, the doctor managing this patient faces two problems - the struggle for life as well the mother as the unborn child. Based on the literature studied from the MedLine database, an analytical review of cancer information during pregnancy in 2014-2018 was conducted. The pregnancy is established to be most often combined with the following oncological diseases: cervical and breast cancer (62% each), stomach and rectal cancer (11% each), ovarian cancer (5.5%). In addition, the literature describes isolated cases of lung cancer and brain tumors during pregnancy. During information processing, the late both first pregnancy, and first births it was revealed to increase the risk of cancer. Treatment of such patients should be carried out in specialized centers, and for all cases it is necessary to collect a consultation team consisting of oncologists, surgeons, obstetricians-gynecologists, radiologists, neonatologists and pediatricians. Over the past 20 years in world practice, the most preferred approach is a comprehensive start of treatment of patients without interrupting pregnancy, therefore the survival rate of both mother and fetus tends to increase.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):182-186
views
LYSTERIOSIS AND PREGNANCY: ACTUAL ISSUES OF DIAGNOSTICS, TREATMENT, AND PREVENTION
Belova A.V., Nikonov A.P., Kaptilnyy V.A., Naumenko N.S.
Abstract
The review considers current data on the diagnosis, treatment, and prevention of listeriosis during pregnancy. There are highlighted issues of epidemiology and transmission. The main methods of preventing listeriosis in pregnant women from the standpoint of evidence-based medicine are given.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):187-192
views
IMPLANTATION CONTRACEPTION: A MODERN VIEW ON THE PROBLEM
Kuzina O.V.
Abstract
Implantable contraception, despite some side effects and contraindications, has shown itself not only as a prolonged method with high efficacy and safety, but also as a method with a high degree of compliance. This suggests that this method of protection is easy to use for any patient, which means that its potential for contraceptive reliability will be realized to the highest degree.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):193-196
views
PREDICTORS OF THE DEVELOPMENT OF SYNDROME OF THE HYPER-INHIBITION OF GONADOTROPIC FUNCTION OF THE HYPOPHYSIS FOLLOWING LONG-TERM INTAKE OF COMBINED ORAL CONTRACEPTIVES
Aksenova A.V., Sosnova E.A.
Abstract
The review presents information on the syndrome of hyper-inhibition of gonadotropic function of the pituitary gland (HIGHFG) developing in patients against the background of a long (from a year or more) intake of combined oral contraceptives. This syndrome is presented in the form of secondary amenorrhea after drug withdrawal. Depending on the severity, moderate and full forms of the syndrome are separated. The pathogenesis of the development of HIGHFG, diagnostic criteria, clinical and laboratory predictors of the development, and preventive measures are considered.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):197-201
views
DISABILITY OF PREGNANCY IN PATIENTS WITH “NON-CRITERIA” FACTORS PREDISPOSING TO THE DEVELOPMENT OF THROMBOPHILIA: A MODERN VIEW ON THE PROBLEM
Baymuradova S.M., Slukhanchuk E.V.
Abstract
Many practitioners in our country diagnose thrombophilia when detecting thrombogenic mutations, as well as antiphospholipid antibodies. At the same time, there is a rejection of thrombophilia in the genesis of obstetric complications, and its overdiagnosis in healthy women. The incidence of polymorphisms and mutations included in the classification of thrombophilia (the so-called “criterion” forms) among patients with obstetric complications is low. The frequency of hypercoagulable states in patients with obstetric complications is much higher, and their use of pathogenetic therapy leads to a positive outcome. In such patients, combinations of “non-criteria” forms of thrombophilia, a combination of polymorphisms in the genes of one coagulation unit, a combination of hereditary and acquired thrombophilia are detected. The study, which included 350 patients, including early pre-embryonic losses (failures of assisted reproductive technologies, biochemical pregnancy) - 59, spontaneous abortions - 223, antenatal death of the fetus - 68, demonstrated the importance of thrombophilia in the genesis of obstetric complications. The clinical implementation of thrombophilic defects has been shown to be possible both with point “criterion” mutations of thrombophilia and their combination, and with a combination of defects of the hemostasis system, including “non-criteria”, polymorphisms and mutations of genes in one link of the hemostasis system, with combinations of mutations and/or polymorphisms with acquired thrombophilia and/or risk factors.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):202-207
views
TRADITIONAL FASTING CESAREAN SECTION: WHAT IS GOOD AND WHAT IS BAD?
Medzhidova D.R., Shifman E.M., Kulikov A.V., Nurmagomedova M.N.
Abstract
Delivery by cesarean section can be considered as a risk factor for developing hypoglycemia in the early neonatal period, as it is preceded by a period of pre-operative fasting. One of the important components of the “fast track” concept, which is actively introduced into surgery, is “rapid metabolic optimization” aimed at reducing the period of pre-operative fasting and activating intracellular glucose transport by using combined carbohydrate-protein-glutamine drinks for the purpose of prevention of insulin resistance. The aim of the study was to determine the influence of the methods of the management in the perioperative period during abdominal delivery on the level of glucose in the blood of the puerpera and in the blood of full-term newborns Material and methods. The study was approved at the meeting of the ethical committee of the Dagestan State Medical University of the Ministry of Health of Russia on April 17, 2018. In total, in the study there were included 87 patients, whose delivery was performed in term in the Perinatal Center of the Dagestan Republican Hospital by abdominal mode and their newborns; of them, 39 patients with a common perioperative period management regimen made up a comparison group, and 48 - with abdominal delivery in the fast track strategy (with carbohydrate load) - the main group. In all puerperas the glucose level was determined in blood obtained from the vein, in the blood from the umbilical cord and in the blood taken from the newborns from the finger in the first 6 to 15 minutes of life, using the ROKI-6T biochemical analyzer. Results. The concentration of glucose in the blood of full-term newborns it was found to be significantly reduced during the management of the preoperative period without oral administration of carbohydrate mixtures. The best results were obtained in newborns whose mothers took a carbohydrate drink 2 hours prior to surgery during the perioperative period under the concept of fast track.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):208-212
views
GENETIC MARKERS OF METABOLIC DISORDERS AFTER RADICAL HYSTERECTOMY AND OOPHORECTOMY
Ginzburg E.B., Sosnova E.A., Tumbinskaya L.V.
Abstract
In 38 operated patients with benign uterine diseases, represented by such isolated forms as endometrial hyperplasia, uterine myomas and adenomyosis, as well as their combination, a clinical assessment of the quantitative indices of fat metabolism disorders, such as the average value of the body mass index (BMI) before treatment, 3, 6 and 12 months after surgery, as well as changes in blood pressure (BP). Clinical and laboratory analysis and analysis of genetic markers made it possible to identify alleles of high risk of arterial hypertension, as well as disorders of fat metabolism and the formation of metabolic syndrome (MS), to conclude that the identified candidate alleles allow predicting changes in BMI, BP and to form risk groups, to take preventive measures to prevent the formation of complications such as diabetes, myocardial infarction and stroke in overweight patients who have undergone surgery. The aim of the work is to identify prognostically significant genetic markers for the development of arterial hypertension, disorders of fat metabolism, and MS after subtotal hysterectomy. Material and methods. There were examined 38 patients after subtotal hysterectomy with bilateral adnexectomy or without it. Within 12 months after surgery, changes in BMI and systolic BP were observed in dynamics. The polymorphism of the following genes was studied in all patients in the studied groups: s.388T> C and p.526 C> T in the ApoE gene, pp. 306-109-2306-108insA288 in the ACE gene, p.176T> C in the IGBT3 gene. DNA samples obtained by the method of phenol-chloroform extraction from 10 ml of whole venous blood served as the material for the study of polymorphisms. Analysis of single nucleotide polymorphisms of genes (SNP) was performed by the method of minisequencing followed by mass spectrometric fractionation of oligonucleotide probes using time-of-flight (MALDI-TOF) mass spectrometry. Results. Specific alleles of the ACE and ApoE genes, characteristic of a high risk of developing hypertension, as well as prognostically significant candidate alleles of MS development, and the likelihood of impaired fat metabolism were established.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):213-221
views
COLONIC PSEUDO-OBSTRUCTION: OGILVIE’S SYNDROME
Gasimova U., Elhamamsy S.
Abstract
Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is a rare disorder associated with spontaneous colonic dilatation with signs and symptoms of mechanical bowel obstruction and dilatation on imaging. We report a 37 year-old female, with three-month history of Caesarian Section at 38th week of pregnancy due to fetal malpresentation. Abdominal CT-scan revealed chronic diffuse colonic distention, 17 cm in diameter. No cause of obstruction could be determined. A diagnosis of Ogilvie’s syndrome was made. The increased size of the colon with leukocytosis warranted urgent colonoscopic decompression. The patient recovered well. If not managed appropriately, Ogilvie’s syndrome can progress to bowel ischemia and perforation with significant morbidity and mortality. The first line of treatment of early disease is conservative management with neostigmine or colonoscopic decompression. Our purpose is to review the diagnosis and management of this potentially lethal rare condition.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2018;5(4):222-224
views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies