Vol 65, No 3 (2016)

Articles
The features of the expression of sex steroids hormone receptors, pro-inflammatory markers and cyclin-dependent kinase inhibitor protein p16ink4a in endometrium at external genital endometriosis
Aylamazyan E.K., Tolibova G.K., Tral T.G., Kogan I.U., Kvetnoy I.M.
Abstract
Background. A local inflammatory reaction in the endometrium caused by viral infection and associated with external genital endometriosis (EGE) can affect the implantation properties of endometrium and be one of the causes of infertility. The aim of the study was to investigate the expression of estrogen and progesterone receptors, pro-inflammatory markers and inhibitor of cyclin-dependent kinases p16ink4a in the endometrium of women with infertility associated with EGE. Materials and methods. The object of the study was the material taken from 133 patients aged 19-35 years. Inclusion criteria were the presence of external genital endometriosis confirmed by laparoscopy and the absence of hormone treatment for 6 months prior to this study. Endometrial biopsies were obtained on 19-24 day of the menstrual cycle. Histological and immunohistochemical studies of endometrial biopsies were performed using standard methods. The expression of estrogen (ER) and progesterone receptors (PgR), inflammatory markers (CD8+, CD20+, CD4+, CD138+) and inhibitor of cyclin-dependent kinase p16ink4a were examined by immunohistochemistry. The evaluation of the expression of studied markers was performed in the epithelium of the glands and endometrial stromal component separately, using semiquantitative method H-Score, as well as qualitative and quantitative methods in image analysis system “Morphology 5.0” (VideoTest, Russia). Statistical analysis was performed using statistical software (STATGRAPHICS v.6.0). Results. A significant decrease in the expression of ER and PgR in endometrial stromal component was noted on the background of the high incidence of chronic endometritis in patients with EGE. All patients of the main group had a positive expression of p16ink4a. Conclusions. The obtained results indicate a high incidence of disorders of eutopic endometrial secretory transformation in patients with infertility associated with external genital endometriosis. The high incidence of the virus associated with chronic endometritis and sensitivity violation of endometrial tissue to sex steroid hormones, such as progesterone, may be a major determinant of infertility of patients in this group.
Journal of obstetrics and women's diseases. 2016;65(3):4-11
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The possibility of modifications methods of determine volume of amniotic fluid
Mudrov V.A.
Abstract
Selection of the optimal tactics of pregnancy and childbirth significantly depends on the expected volume of amniotic fluid. The amount of amniotic fluid reflects a condition of a fetus and changes at pathological conditions of both a fetus, and an uteroplacental complex. The aim of the study was a modification of methods for determining the expected volume of amniotic fluid. On the basis of maternity hospitals Trans-Baikal Region in the years 2013-2015 was held retrospective and prospective analysis of 300 labor histories, which were divided into 3 equal groups: 1 group - pregnant women with a body mass index (BMI) for Quetelet less than 24, Group 2 - with a BMI from 24 to 30, group 3 - with a BMI more than 30. In order to determine the expected volume of amniotic fluid were used the subjective method, the Chamberlain’s and Phelan’s methods. The error in determining volume of amniotic fluid by the existing methods exceeds 10 %, that defined need of creation of a quantitative method. On the basis of mathematical and 3d-modeling of the volume of amniotic fluid and fetal weight determined pattern change, which is expressed by the formula: VAF = IAF × М × π / GA2, where IAF - index of amniotic fluid (mm), M - fetal weight (g), GA - gestational age (weeks). Through a comprehensive analysis of anthropometric research of the pregnant women defined formula’s volume of amniotic fluid: V = 0,017 × HUF × (AC - 25 × BMI / GA)2 - М, where GA - gestational age (weeks), AC - abdominal circumference of the pregnant women (cm), BMI - body mass index for Quetelet in the first trimester of pregnancy (kg/m2), HUF - height of an uterine fundus (cm), M - the estimated fetal weight (g). In calculating volume of amniotic fluid according to the proposed ultrasonic formula error does not exceed 5,3 %, anthropometric formula error does not exceed 10,2 %. Thus, the method has a smaller error compared to the standard, and can be used to reliably determine volume of amniotic fluid in II and III trimester of pregnancy.
Journal of obstetrics and women's diseases. 2016;65(3):12-17
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The role of leptin in the pathogenesis of ovarian insufficiency in obesity women
Riazantceva E.М.
Abstract
Actuality. Ovarian insufficiency can be diagnosed in more than 30% of reproductive age women with obesity. The role of leptin in the pathogenesis of ovarian insufficiency in obesity is not well understood and needs to be detalised. The aim of the study: to ivestigate the role of leptin in the pathogenesis of ovarian insufficiency in obesity. Materials and methods. 50 reproductive age females with BMI > 26.5 kg/m2 were studied. 10 healthy reproductive age females were used as control. Blood levels of leptin, gonadotropins, prolactin, sex steroid hormones were measured by immunoenzymatic assay and pelvic echoscopy were performed in all studied patients and co ntrols. Results. 72% of obese women had signs of ovarian insufficiency, such as ovarian enlargement and increased antral follicular count. The level of leptin did not correlate with the presence or absence of ovarian insufficiency in our patient group. The positive correlation between leptin level and BMI, luteinizing hormone (LG) and oestradiol and negative correlation between leptin level and follicular stimulating hormone (FSH) were revealed. Conclusion. The results of our study do not support the hyperleptinemia as the main cause of ovarian dysfunction in alimentary obesity. The most potential reason of ovarian dysfunction in these women could be ovarian or non-ovarian origin hyperoestrogenia leading to premature LG piques, and, thus, disturbing folliculogenesis in ovaria.
Journal of obstetrics and women's diseases. 2016;65(3):18-24
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Risk factors of the previa placenta formation
Fadeeva N.I., Belnitskaya O.A., Myadelets I.A., Serdyuk G.V., Nikolaeva M.G.
Abstract
Placenta previa is associated with a high risk of adverse outcomes for the fetus and mother. The aim of our study was to identify risk factors form a complete placenta previa. A comparative analysis of clinical and paraclinical characteristics of 70 patients with placenta previa in time delivery, 150 women with favorable migration in the second trimester placenta previa at baseline and 100 women with physiological placentation. It was found that a history of hormone-dependent gynecological disorders (p < 0.001), infertility (p < 0.001), contraceptive intrauterine device (p < 0.05), as well as hypertensive syndrome (p < 0.001), presence of hemostasis and folate metabolism defective alleles genes associations (p < 0.01) hepatitis B and C (p < 0.001), and autoimmune processes (p < 0.001) are risk factors of conservation of total placenta previa to delivery.
Journal of obstetrics and women's diseases. 2016;65(3):25-31
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Microbiological, behavioral and anamnestic predictor factors of bacterial vaginosis in women with vaginal discharge
Shipitsyna E.V., Khusnutdinova T.A., Ryzhkova O.S., Krysanova A.A., Budilovskaya O.V., Rybina E.V., Vorobyova N.E., Savicheva A.M.
Abstract
Introduction. Bacterial vaginosis (BV) is the primary cause of pathological vaginal discharge in women of reproductive age. Gardnerella vaginalis and Atopobium vaginae are considered key components of the vaginal microflora in BV. Etiology, pathogenesis and modes of transmission of BV are actively studied, however these questions still remain unanswered. Objective: investigate predictor factors of BV in women with vaginal discharge. Material and methods. In total, 318 women were included. As clinical material, vaginal samples were used. BV was diagnosed using the Nugent method. For quantitative determination of G. vaginalis and A. vaginae DNA, real-time PCR was used. Behavioral and anamnestic data were obtained from questionnaire filled out by the patients. Results. BV was diagnosed in 27 % of women. G. vaginalis and A. vaginae DNA was detected, respectively, in 93 % and 83 % of patients with BV, 73 % and 59 % - with intermediate microflora, 52 % and 38 % - with normal microflora. Difference between the three types of microflora in the frequency and concentrations of these microorganisms were statistically significant. Detection of G. vaginalis and A. vaginae were significant predictor factors of BV (OR 12.2; 95 % CI 5.1-29.4 and OR 7.9; 95 % CI 4.2-14.9, respectively), with chances to diagnose BV being manifold increased when clinically significant concentrations of these bacteria were detected (≥3×106 and ≥8×105 DNA copies/ml for G. vaginalis and A. vaginae, respectively). Detection of clue cells in Gram stained preparations was shown to be the strongest BV predictor (OR 765.6; 95 % CI 99.6-5883.2). Conclusions. BV is diagnosed in more than one fourth of women with vaginal discharge. Detection of G. vaginalis and A. vaginae, especially in clinically significant concentrations, and clue cells in Gram stained preparations are significant predictor factors of BV.
Journal of obstetrics and women's diseases. 2016;65(3):32-42
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Functional morphology of the placental villous tree at term singleton pregnancies, achieved by methods of assisted reproductive technology
Sosnina A.K., Tral T.G., Krylova J.S.
Abstract
Introduction. Of special interest in the use of assisted reproductive technology techniques (ART) is the placenta as the main authority responsible for the formation and growth of the fetus. Purpose and objectives. The aim of our research is to study the morpho-functional state of placenta after pregnancy achieved by means of ART. Research objectives: histological and immunohistochemical study using the CD34, NOS-3 and HIF in these placentas. Methods. Total 98 placentas from full-term singleton pregnancies with gestational age were examined. Two study groups were formed: a basic group - the placenta from pregnancy induced methods of ART (n = 60) was divided into I subgroup, which included 30 placentas from women with primary infertility and II subgroup - 30 placentas from women with secondary infertility comparison group consisted of the placenta from the naturally ensuing pregnancy (12 placentas from primigravidae and 26 placentas from multiparous patients). Results. Histological examination of the morphological structure of the placenta was found that the incidence of chronic placental insufficiency was 1.4 times higher than in the subgroup with secondary infertility. Immunohistochemical study of placentas in the basic group, there was a significant decrease in the expression of cell adhesion marker (CD34) in the vascular epithelium chorionic villi, decreased expression of vascular tone marker (NOS-3) and increase the expression of hypoxia-inducible factor (HIF-1α) in the basic group compared to placenta s from children born naturally. Changes in the expression of the studied markers are most pronounced in the placentas from children born with secondary infertility, which is likely due to the high incidence of inflammatory diseases of the pelvic organs in this subgroup. Conclusions. Endometrial pathology in primary and secondary infertility, can cause the formation of functional disorders and morphological structure of placental complex and occurrence in the future placental insufficiency.
Journal of obstetrics and women's diseases. 2016;65(3):43-51
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The role of prolactin аnd dopamine in the pathogenesis of endometriosis
Suslova E.V., Yarmolinskaya M.I., Potin V.V.
Abstract
Background: to consider the modern ideas of a role of prolactin and dopamine in a pathogenesis of the endometriosis and possibility to apply of agonists of dopamine in disease,s therapy. Materials: literary data of foreign and native authors from 1972 for 2015. Methods: systematic analysis and synthesis of publications. Conclusion: Carrying out further researches of a role of prolactin and dopamine in a pathogenesis of endometriosis and multicenter supervision is necessary for confirmation of safety and effectiveness of therapy by dopamine agonists.
Journal of obstetrics and women's diseases. 2016;65(3):52-63
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Experience of using fluorescence diagnosis and photodynamic therapy genital endometriosis
Khachaturyan A.R., Yarmolinskaya M.I.
Abstract
The article describes the experience of the application of fluorescence diagnosis and photodynamic therapy in the treatment of deep infiltrating endometriosis.
Journal of obstetrics and women's diseases. 2016;65(3):64-74
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Umbilical cord entanglement in мonochorionic monoamniotic twins
Shelaeva E.V., Prokhorova V.S., Arzhanova O.N., Oganyan K.A., Bolotskikh V.M.
Abstract
The case of umbilical cord entanglement in мonochorionic monoamniotic twins pregnancy is presented in this article. The role of systematically ultrasound and color Doppler examinations in the diagnosis of the umbilical cord entanglement and modern approaches in management of мonochorionic monoamniotic twins pregnancies is discussed.
Journal of obstetrics and women's diseases. 2016;65(3):75-78
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Modern possibilities of drug treatment of uterine fibroids
Aganezova N.V.
Abstract
Uterine fibroids is one of the most common gynecological diseases. Modern drug therapy of uterine fibroids can reduce or reverse the symptoms of a tumor, in some cases, to avoid surgery.
Journal of obstetrics and women's diseases. 2016;65(3):79-83
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