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Vol 63, No 3 (2014)

Articles
Premature rupture of membranes (modern view to etiology and pathogenesis, prediction perspectives)
Afanasiyeva M.K., Bolotskikh V.M., Polyakova V.O.
Abstract
This article presents a review of contemporary views to biochemical, immunologic, genetic aspects to the etiology and pathogenesis of premature rupture of membranes (PROM). The article marks further ways in studying predictions of premature rupture of membranes at the advanced pregnancy periods.
Journal of obstetrics and women's diseases. 2014;63(3):4-11
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Clinical significance of prenatal diagnosis of macrosomia by ultrasound
Bayeva I.Y.
Abstract
Оbjective: Establish the diagnostic value of ultrasound examination in prenatal diagnosis of macrosomia among the women without diabetes and to determine its effect on birth outcomes. Мethods: This is a retrospective cohort study done at the Orenburg municipal perinatal center and maternity hospital № 2 since 2006 to 2012. In this study 3760 pregnant women were analyzed who delivered term, singleton, live born infants. The estimated fetal sonographic weight by the formula Hadlock’s was obtained within the last week prior to delivery. The study population was divided into 4 groups (true positive, true negative, false positive, false negative) according to the estimated fetal weight (EFW) and regarding the birth weight (BW). Receiver-operating characteristics (ROC) curves were generated to compare the prediction of macrosomia when using different observation methods. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. The mean value of two groups were compared using two sample t test and χ² test for comparison of proportions. Results: In order to assess the accuracy of the ultrasound in prenatal diagnosis of macrosomia the study population was divided into 4 groups according to the estimated fetal weight (EFW) and regarding the birth weight (BW): true positive (n-147), false negative (n-229 ), false positive (n-353), true negative (n-3031). Results of the study showed no statistically significant differences between the birth weight and estimated fetal weifht by ultrasound alone only in the macrosomia group with true-positive results (p = 0.9). In applying the ROC (Receiver Operating Characteristic curve) performance analysis sensitivity and spesificity in the prediction of the macrosomia by ultrasound revealed the average predictive power of the method. Area under the curve (Area under ROC curve, AUC) made 0.7295 (95 % CI: 0.695-0.781), which corresponds to a predetermined average accuracy. The accuracy of macrosomia prediction by ultrasound methods was 90 %, sensitivity - 35 %, specificity - 93,5 %. Сesarian sections were performed for 40 % of the pregnant women, where fetal macrosomia was truly ruled in (true positive) and 16% of the women who delivered normal weight infants (true negative). Overestimation of fetal weight (false positive) has led to the 30 % rate of cesarean sections. Underestimation of fetal weight (false negative) has decreased to the 24% rate of cesarean sections but in this case perinatal complications have increased. Conclusion: Results showed an average accuracy in predicting macrosomia by the formula Hadlock’s. The results of the study have proved that the inappropriate prediction macrosomia of fetal weight has influence on the mode of delivery. Overestimation of fetal weight has led the proportion of cesarian sections. Underestimation of fetal macrosomia has increased perinatal complications.
Journal of obstetrics and women's diseases. 2014;63(3):12-20
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Morphological substantiation of applying the Er: YAG-laser for the treatment of stress urinary incontinence in women
Bezmenko A.A., Shmidt A.A., Koval A.A., Sibirev S.A., Karpishchenko Z.M., Gayvoronskikh D.I.
Abstract
The article presents the results of morphological evaluation of the vaginal tissues in women before and after treatment of stress incontinence with Er: YAG-laser (technologies IntimaLase and IncontiLase). Marked histological changes (increase of quantity and activity of fibroblasts, the increase of density of connective tissue, the emergence of neoangiogenesis plots) confirm the clinical efficacy of the method (the positive effect was obtained in 70,7 % of patients with I type of UI and 47 % with the II type of UI light and medium gravity).
Journal of obstetrics and women's diseases. 2014;63(3):21-25
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Pregnancy and influenza: pathological manifestations of the infection caused by virus A/H1N1
Gladkov S.A.
Abstract
Background. Pregnant women are a high-risk group for severe complications and mortality from influenza. There is limited information on the detection of specific pathological signs of viral injury of the organs outside the respiratory system, as well as of the placenta and fetus by transplacental passage. Purpose. In this paper clinicopathologic peculiarities of lung lesion and associated morphological changes outside the respiratory system have been studied. Materials and methods. The author has analyzed 4 fatal outcomes of influenza A/H1N1 which occurred at hospitals of the Arkhangelsk region in women who become ill on the third trimester of pregnancy in 2009 and 2011. The analyses of patient cards, autopsy data and postmortem histological examination have been performed. The results were compared with clinical and morphological data of influenza A/H1N1 fatal outcomes in 8 non-pregnant adults (control group). Microscopic changes in the placenta and lungs of antenatal deceased fetus have been investigated in one case. Results. The clinical presentation and morphological findings in respiratory system in pregnant women were not different from those of the other patients died from total viral pneumonia. However, morphological signs of generalized influenza infection with brain and heart involvement were observed in three of the four pregnant women, while in the control group outside respiratory specific changes, characteristic for infection caused by the flu virus, were not detected. In one case with identified morphological signs of generalized infection in the mother’s body a similar changes in the placenta and lungs of antenatal deceased fetus were confirmed.
Journal of obstetrics and women's diseases. 2014;63(3):26-35
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Features of pregnancy and delivery in minors female in a metropolis (by the example of St. Petersburg)
Mikhaylin Y.S., Ivanova L.A., Savitskiy A.G., Zhibura L.P., Minina A.G.
Abstract
The article presents a retrospective analysis of peculiarities of pregnancy and childbirth in 483 pregnant women minors, representing 15 % of all juveniles who have given birth in St. Petersburg from 2004 to 2013. Among somatic diseases prevailed kidney disease exacerbation during pregnancy, cardiovascular diseases, diseases of the gastrointestinal tract, eyes and skin. Among the complications of pregnancy among minors prevailed preeclampsia, threating of premature labor, anemia and chronic placental insufficiency. Among the complications of childbirth - preterm rupture of membranes, weakness of uterine activity and fetal hypoxia. Cesarean section was mainly carried out by emergency indications during childbirth. The above analysis basically confirms the literature data about the poor physical health and a lot of complications in pregnancy and childbirth in minors in metropolis because pregnancy is not a normal physiological phenomenon for minors.
Journal of obstetrics and women's diseases. 2014;63(3):36-43
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Optimization of diagnostics and treatment of mixed and stress urinary incontinence in women
Rusina Y.I.
Abstract
Save or occurrence «de novo» of the bladder and urethra dysfunction in surgical correction of urinary incontinence (UI) among women is impotant problem of Urogynecology. Purpose: To evaluate the role of complex diagnostics in determination of the pathogenetically based tactics with mixed and stress incontinence among women. Materials and Methods: The study included 633 patients 22-88 years old with complaints of mixed (n = 356) and stress (n = 277) UI before treatment (medical, physiotherapy, sling surgery): 119 - clinically, 514 - complexly (clinical examination and complex urodynamic testing). Surgical correction of pelvic organ prolapse is performed to 270 patients. Complex examination was repeated to all of them in 1-3 and 12-36 months after treatment. Results: detrusor overactivity - DO (32.9 %) and urethral instability (23.1 %) before surgery is more common among patients with complaints of mixed incontinence, but among patients with stress complaints this pathology is also found in 5 %, and 8.3 % of cases, respectively. 55.9 % patients with complaints of mixed incontinence and 47.2 % - with stressful complaints were not operated in connection with full or significant reduction of complaints on the background of pathogenic conservative therapy. The efficacy of sling operations for stress and mixed incontinence is high but not statistically different and generally amounts to 97.1 % in 3-36 months after surgery. The frequency of postoperative dysfunction among clinically examined patients with complaints of mixed incontinence was in general 46 %, the frequency among complexely examined patients - 9.7 %. (OR 7,7, 95 % CI 2,9-20,3). Conclusion: Complex examination with the use of urodynamic testing, the therapy of bladder and urethra neuro-muscular dysfunction, the selection of patients for surgical treatment leads to a significant reduction of dysfunction number in early and late postoperative period and improve patients’ satisfaction with the treatment.
Journal of obstetrics and women's diseases. 2014;63(3):44-52
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Ovarian function in women with type 1 diabetes mellitus
Tolpygina M.G., Potin V.V., Tarasova M.A.
Abstract
To study the hormonal and ovulatory ovarian function in women with type 1 diabetes mellitus 180 patients of reproductive age with type 1 diabetes were examined. Basal-bolus insulin therapy received 146 patients (81.1 %), insulin pomp therapy received 34 women (18.9 %). Examination included: determination of blood glucose level and glycated hemoglobin, content of FSH, LH, prolactin, estradiol, total and free testosterone, and progesterone in peripheral blood by enzyme-linked immunosorbent assay, determination of autoantibodies against ovarian tissue by indirect immunofluorescence, pelvic ultrasonography. Ovarian insufficiency was present in 62.2 % of women surveyed. An association of ovarian insufficiency with the glycemia level, glycosylated hemoglobin and the dose of insulin was found. There was no dependence of ovarian function and insulin regimens or the severity of microvascular complications of diabetes. Patients with type 1 diabetes had an increase of ovarian volume and the number of antral follicles compared with those in healthy women. These patients exhibit elevated levels of LH, estradiol and free testosterone in peripheral blood. Ovarian volume increased correlated with the presence and severity microvascular complications of diabetes and the dose of insulin. Autoantibodies against ovarian tissue were found only in 3.6 % women of type 1 diabetes mellitus.
Journal of obstetrics and women's diseases. 2014;63(3):53-57
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Frequency and weight of complications of pregnancy and childbirth at women with tuberculosis of various localization in Krasnoyarskiy kraY
Vetushenko S.A., Zakharova T.G.
Abstract
The purpose of researches - to reveal clinical manifestations of obstetric complications at pregnant women with tuberculosis of various localization on the basis of results of medical monitoring, and also to establish the complications of fetoplatsentarny insufficiency taking place in the studied period, at pregnant women with tuberculosis according to localizations of tubercular process. During medical monitoring stories of families of 210 women with tuberculosis of various localization and a condition of their newborns during 2006-2013 on the basis of interdistrict maternity hospital N 4 of Krasnoyarsk, profiled on this pathology are analysed. As a result of the analysis of structure of obstetric complications at women with tuberculosis in the territory of Krasnoyarsk Kray it is established: from 210 pregnant women at 76 there were no complications; at 133 pregnant women with FPN clinical manifestations are noted it are 43 cases of a hypoxia of a fruit, 31 cases of SZRP, 14 cases of SZRP with a hypoxia, thus clinical manifestations were accompanied by lack of water and abundance of water at the level of 22 and 4 cases respectively; in the same group the increase in number of complications of pregnancy by a preeklampsiya, anomalies of patrimonial activity, premature birth at the level of 51, 16 and 28 cases respectively is looked through. From only 133 pregnant women with placentary insufficiency 11 cases of childbirth without clinical manifestations of FPN are noted. The revealed number of clinical manifestations of placentary insufficiency and other complications of pregnancy says that at pregnant women with a disease of tuberculosis these indicators many times is more, than at pregnant women without disease of tuberculosis. The established structure of obstetric complications at pregnant women with tuberculosis of various localization highlighted prevalence of FPN proceeding with heavy clinical manifestations, such as SZRP, the fruit hypoxia, and also revealed most often meeting complications of pregnancy, such as a preeklampsiya, abnormal patrimonial activity, premature birth. It is the indication for development of effective measures of prevention and treatment of these complications, their forecasting from early terms of pregnancy for improvement of perinatal outcomes.
Journal of obstetrics and women's diseases. 2014;63(3):58-65
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A clinical case of pregnancy with suspected trophoblastic disease in 3 trimester
Mikhaylin Y.S., Ivanova L.A., Lisyanskaya A.S., Savitskiy A.G., Minina A.G., Gederim M.N.
Abstract
Cases of trophoblastic disease in the presence of the living fetus during 2-3 trimesters of pregnancy is a rare phenomenon. The description of the clinical case of suspected trophoblastic disease at term of 26 weeks is provided in article. The decision of pregnancy prolongation under control β- HCG was made. Therapy of gestosis, improvement of maternal-placental blood flow, anticoagulant therapy was carried out. Cesarean section was made at 30 weeks of pregnancy (preterm premature rupture of fetal membranes). In the postpartum period, a decrease of b-HCG to zero was within 1,5 months. In the postoperative period we did not receive convincing pathomorphological data for the presence of trophoblastic disease, so the question of whether there was in this case partial hydatidiform mole in combination with alive fetus, or received changes in the placenta and anomalously high values of b-HCG were the result of primary placental insufficiency with the intrauterine infection, remains open.
Journal of obstetrics and women's diseases. 2014;63(3):66-70
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Saturation of pregnant women organism vitamin D and the course of perinatal period
Gurkina Y.Y., Petrova N.V., Novikova T.V., Yuryev V.V., Dorofeykov V.V., Zazerskaya I.Y.
Abstract
The review presents the criteria of vitamin A deficiency D adopted by in different countries and approaches to the appointment of vitamin D during pregnancy. Analyzed data from the most important studies in recent years devoted to this problem.
Journal of obstetrics and women's diseases. 2014;63(3):71-81
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Modern diagnostics of human papillomavirus infection: a review of worldwide research
Orekhova Y.K., Khachaturyan A.R.
Abstract
The Human papillomavirus infection is a major risk factor for neoplastic processes of the cervix. In addition to a clinical examination of the cervix using a speculum and a light source, the cervix can be inspected using a variety of noninvasive and invasive diagnostic methods. In spite of this, clinical practice requires development and clinical of new disposable and highly informative methods for the detection of virus-induced cell proliferative activity to clarify the degree of neoplasia and manage the disease.
Journal of obstetrics and women's diseases. 2014;63(3):82-89
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