Vol 65, No 5 (2016)

Clinical picture and diagnosis of genital endometriosis
Yarmolinskaya M.I., Rusina E.I., Khachaturyan A.R., Florova M.S.
Endometriosis is a widespread gynecological disease which affects every tenth woman of reproductive age. The main symptoms of disease are chronic pelvic pain, sterility and miscarriage, that leads to a reliable decline in quality of life and working capacity, mental disorders. Timely and complete diagnostics of endometriosis allows choosing the best option of treatment and minimizes the costs of treatment. This article describes in detail the existing methods of diagnosis of endometriosis. Modern literature and the results of own studies are summarized in the text.
Journal of obstetrics and women's diseases. 2016;65(5):4-21
Monitoring of surgical plethysmographic index as a tool for monitoring the adequancy of antinociceptive protection during general anesthesia
Gorban V.I., Shchegolev A.V., Alecsanin S.S., Kovjazina N.A.

Objective — to execute verification research of the importance of monitoring of a surgical plethysmographic index (SPI) when carrying out the general combined anesthesia with use of the automated control of concentration of anesthetic.

Materials and Methods. In a prospective study there were 112 patients included operated for the pathology of the spine and the spinal cord of varying severity, extent and localization. The estimation of the ratio of numerical values of SPI, the level of stress hormone (ACTH, cortisol), the standard hemodynamic measures of the low-flow anesthesia with Et-control using the extended (due to entropy and SPI) monitoring.

Results. Monitoring the adequacy of antinociceptive protection based on the performance of surgical plethysmographic index (SPI) allows detection of nociceptive responses to an earlier stage.

Conclusion. The study revealed that the use of SPI monitoring the operations of high-risk permits anesthesia, with optimum concentration of opioids required, and minimal hemodynamic response of the patient.

Journal of obstetrics and women's diseases. 2016;65(5):22-28
Experience of application anti adgesivebarrier in the treatment of patients with Asherman’s syndrome
Makarenko T.A., Nikiforova D.E., Ul’yanova I.O.

Relevance. Asherman’s syndrome is one of the most difficult problems in gynecologic practice, because in addition to complex clinical picture, which includes secondary amenorrhea and infertility is a significant difficulty in diagnosis and treatment. The purpose was to improve the results of treatment of Аsherman’s syndrome after conducting hysteroresectoscope adhesiolysis using anti adhesive barrier “Antiadgezin”.

Materials and methods. The study included 36 patients with peritoneal process in the uterus of varying severity. Group I consisted of 20 women who are in the postoperative period in the uterine cavity was entered “Antiadgezin”, group II — 16 women with similar pathology without introducing anti adgesive barriers.

Results. All women 3 months after adhesiolysis was performed a control hysteroscopy. The presence of adhesions was diagnosed in 2 (10%) patients in the first group, while adhesions were isolated delicate and easily destroyed by the sheath of a hysteroscope. In group II adhesions had recurrences in 5 (31,3%) patients (p = 0,038), and one patient was visualized “tunnel” — uterus, which is extremely unfavorable course of disease.

Conclusion. Treatment of Asherman’s syndrome, as extreme degree of intrauterine adhesions, requires a comprehensive approach, which is based on prevention of recurrence of the formation of adhesions after surgical interventions. Research on application anti adgesivebarriers will continue, as intrauterine their use on the example of antiadgezin showed good results.

Journal of obstetrics and women's diseases. 2016;65(5):29-32
Biochemical parameters of amniotic fluid in fetal distress during delivery
Melnik E.V., Maloletkina O.L., Shilkina Y.V.

Aim. Amniotic fluid is the unique biological medium that reflects the activity of the fetoplacental complex. The aim of our study was to examine a wide range of biochemical parameters of amniotic fluid to detect factors for fetal distress during labor.

Materials and methods. The article presents the data of anterior and posterior amniotic fluid biochemical examination of women with full-term pregnancy. The main group consisted of patients who have experienced fetal distress during labor according to the CTG parameters and acid base balance parameters of cord blood during labor. The control group consisted of mothers without fetal distress.

Results. We found that in fetal distress during labor the anterior amniotic fluid have lower levels of total protein, triglycerides, gamma-glutamyl transferase, alpha-amylase, iron. Creatinine was higher in the posterior amniotic fluid. Conclusion. Biochemical examination of amniotic fluid may provide additional valuable information of fetal and fetoplacental complex condition.

Journal of obstetrics and women's diseases. 2016;65(5):33-40
Morfological and functional features of placentas in minor women
Mikhaylin E.S., Tolibova G.K., Tral T.G.

Relevance. An in-depth study of the state of feto-placental complex, the characteristics of its reactions in response to hypoxia on the background of juvenile immaturity of minors can help to identify the main directions of the prevention of certain complications of pregnancy and childbirth among minors in the first place — placental insufficiency, preeclampsia, fetal hypoxia. Purpose of the study was to explore features of the histological structure of placentas and expression of HIF-1α and VEGF-A markers in placentas in minors.

Materials and methods. 74 placentas from minors were investigated by histological methods. The comparison group consisted of 25 placentas from healthy women the average reproductive age (20-30 years). The immunohistochemical study was performed in 35 placentas from minors who were divided into groups according to age and the presence or absence of chronic placental insufficiency. To study vascular status of villous tree of placentas were used the monoclonal antibodies of the vascular endothelial growth factor VEGF-A (Clone UG1; 1 : 50, Dako), to assess hypoxia in placenta were used the monoclonal antibodies of hypoxia — inducible factor HIF-1α (H1 alpha 67; 1 : 100, GRTP (Abcam).

Results. It was revealed that the placenta in minors is characterized by hypertrophy (559,5 ± 10,5 g vs. 478,7 ± 12,9 g), it is pathologically immature (33,8% vs. 7,0%), there is significantly greater frequency of chronic placental insufficiency in minors (33,8% versus 4,0%) with significantly lower severity of compensatory-adaptive reactions (86,5% vs. 100%). It is shown increased expression of hypoxia — inducible factor (HIF-1) and vascular endothelial growth factor-A (VEGF-A) in placentas of minor women with chronic placental insufficiency, compared with placentas of minor women without chronic placental insufficiency.

Conclusion. Chronic placental insufficiency at the time of birth, detectable more frequently in minor patients can make a difference in violation of adaptive mechanisms and quality of life of children in the postnatal period. Increased expression of HIF-1α and VEGF-A in the placentas of minor women with chronic placental insufficiency reflects activation of angiogenesis in response to intrauterine fetal hypoxia in chronic placental insufficiency.

Journal of obstetrics and women's diseases. 2016;65(5):41-48
Features of vascular stiffness in pregnancy complicated by preeclampsia and postpartum
Riabokon N.R., Zazerskaya I.E., Bolshakova O.O.

Actuality. Pre-eclampsia during pregnancy is a major cause of maternal mortality, intra- and neonatal pathology [1]. Sharply there is a question about the search method of determining the predictors of pre-eclampsia and the degree of influence on a woman’s body for the purpose of timely diagnosis and treatment. Interest in the method of determining the parameters of arterial stiffness is growing every year because of the availability and relative ease of use to determine the degree of maladjustment of the vascular system and assessing the risks of cardiovascular disease.

Objective. Evaluation of indicators characterizing stiffness of the arterial wall in pre-eclampsia during pregnancy and after childbirth.

Materials and Methods. In a prospective cohort comparative study included 62 pregnant women aged 19 to 35: 35 women with physiological pregnancy without physical abnormalities and 27 women with preeclampsia moderate, without preeclampsia history. Surveys were carried out in time for 22-24, 32-34 weeks of gestation and at 8 hours after delivery. To evaluate the rigidity of the vascular wall used complex BPLab.

Results. In pregnant women with pre-eclampsia there is an increase of arterial stiffness parameters at 22 weeks of pregnancy in comparison with the original data at 12 weeks of gestation, IA uvelichilsyana 29.3%, 12.5% PWV. Most significantly in the intervention group to the third trimester have changed the following parameters: IA averaged – - 28% (± 5,5) + 37% from baseline, PWV – 8 m/s (± 0,9) + 12,5%, in the control group: IA – - 39,6% (± 8,1) + 12,2% in comparison with the data of 12 weeks’ gestation, PWV – 7.43 m/s (± 0,82) + 12,5%, demonstrating various adaptive features of the vascular wall in groups. In the early postpartum period significantly positive dynamics of arterial stiffness parameters in the group with physiological pregnancy, pre-eclampsia in the group with the values remain the same or change slightly.

 Conclusions. Thus, from the data of the pulse wave analysis is the best method for measuring vascular stiffness non-invasively in pregnant women. This method demonstrates the physiological adaptation of vessels to the gestational process, and shows the changes associated with preeclampsia as the background of pregnancy and after childbirth. Thus, this method makes it possible to evaluate the adaptive reserve of the vascular wall for the purpose of forecasting the development of cardiovascular complications.

Journal of obstetrics and women's diseases. 2016;65(5):49-55
Role hyperleptinemia, insulin resistance and hyperestrogenemia in the development of ovarian failure in women with obesity
Ryazantseva E.M., Misharina E.V., Potin V.V., Tarasova M.A.

Actuality of the study. Ovarian insufficiency is present in more that 30% of reproductive age women. The role of leptine and insuin resistance in the pathogenesis of ovarian insufficiency is not yet established and has to be clarified. The aim of the study to investigate the role of hyperleptinemia, insulin resistance and hyperestrogenemia in the pathogenesis of ovarian insufficiency in obesity.

Materials and methods. Fifty reproductive age women with BMI > 25,6 kg/m2 were studied. Ten healthy reproductive age women were included as controls. The plasma level of leprin, honadotropins, prolactin, insulin and sex steroid hormones assayed by immunoenzyme analysis, morning fasting blood glucose and the glucose level after glucose tolerance test, pelvic echography, “whole body” program of dual x-ray absorptiometry were studied in both patients and controls.

Results. Thirty-six out of 50 women had signs of ovarian insufficiency. The presence and severity of ovarian insufficiency did not correlate with the level of leptin in blood or with insulin resistance. The positive correlation between oestradiol level and both presence and severity of ovarian insufficiency could be demonstrated.

Conclusion. The results of our study do not support the hyperleptinemia and insulin resistance as the main cause of ovarian insufficiency in alimentary obesity. The most potential reason of anovulation in these women could be hyperoestrogenia due to increased conversion of androgens into oestrogenes in fat tissues and ovaria.

Journal of obstetrics and women's diseases. 2016;65(5):56-63
Obesity and ovarian insufficiency
Misharina E.V., Abashova E.I., Potin V.V.

The article presents resent date of the pathogenesis and treatment of ovarian insufficiency in obese women and overweight and features and complications of pregnancy and delivery in obese women.

Journal of obstetrics and women's diseases. 2016;65(5):64-74
Possibilities of diagnosis fetal macrosomia at present stage
Mochalova M.N., Ponomareva Y.N., Mudrov A.A., Mudrov V.A.

Presently, reduction of perinatal morbidity and mortality is a priority task of medical obstetrics in the world. An important role in the structure of perinatal pathology is taken to labor of macrosomic fetus. High rates of asphyxia (9,2-34,2 %), birth trauma (10,9-24%) during childbirth of large fetus are great medical and social problem.

The aim of the study was to define possibilities of diagnosis fetal macrosomia at present stage of science’s development.

Materials: literary data of foreign and domestic authors in the period from 1992 to 2016.

Methods: a systematic review and synthesis of the literature data.

Conclusion. It is necessary to determine an optimal algorithm for the diagnosis of fetal’s macrosomia, which will optimize the tactics of pregnancy and childbirth.

Journal of obstetrics and women's diseases. 2016;65(5):75-81
Modern methods of diagnosis and prognosis fetal-pelvic disproportion
Mochalova M.N., Ponomareva Y.N., Mudrov A.A., Mudrov V.A.

Reduction of perinatal morbidity and mortality is a priority task of medical obstetrics in the world. A significant role in the structure of perinatal mortality and morbidity has a clinically narrow pelvis. The incidence of clinically narrow pelvis in the world according to some authors is 1,4-8,5%, fetal-pelvic disproportion during labor of large fetus is 5,8-60 %. High rates of birth trauma (24-60%) as a result of fetal-pelvic disproportion determine the relevance of the study. The aim of the study was to define possibilities of diagnosis and prognosis fetal-pelvic disproportion at present stage.

Materials. Literary data of foreign and domestic authors in the period from 1959 to 2016.

Methods. Systematic review and synthesis of the literature data.

Conclusion. It is necessary to determine an optimal algorithm for the diagnosis and prognosis fetal-pelvic disproportion, which will optimize the tactics of pregnancy and childbirth.

Journal of obstetrics and women's diseases. 2016;65(5):82-91
Management of pregnancy and delivery in hla compatibility of spouses for 4 alleles (clinical observation)
Mikhaylin E.S.

The article presents a clinical observation of the course of pregnancy and delivery in patient with immunological form of habitual miscarriage, having HLA compatibility with the spouse for the four alleles. Pregnancy proceeded with the risk of miscarriage, signs of cervical incompetence. We used high doses of glucocorticoids, Intralipid, low molecular weight heparins continuously in therapeutic doses. The birth took place by caesarean section at term 39/40 weeks, without features.

Journal of obstetrics and women's diseases. 2016;65(5):92-95
The experience of organ-preserving surgical treatment of patients with severe forms of adenomyosis
Makarenko T.A., Tskhay V.B.

Relevance. Severe forms of adenomyosis still remain a serious gynecological problem regarding reproductive outcomes. There are about 93% of unsuccessful results after conservative treatment of this pathology what makes doctors search new solutions of this disease.

Objectives: improving the efficiency of organ-preserving surgical treatment of patients with severe forms of adenomyosis using the method of adenomyomectomy by Japanese professor H. Osada.

Materials and methods. 18 patients with adenomyosis were operated by the method of H. Osada from 2012 to 2016 by the staff of the Krasnoyarsk state medical University.

Results. Period of following up the operated patients currently ranges from 2 to 42 months. Normalization of menstrual function is observed in all women (100%). The resumption of the pathological symptoms of the disease are not registered. Spontaneous pregnancy occurred in two women, ended by cesarean delivery and birth of live full-term babies. Currently 7 patients are receiving postoperative hormonal treatment and 6 patients are planning their pregnancy with the help of reproductive technologies.

Conclusion. Organ-saving surgery of severe adenomyosis by the method of H. Osada is a good alternative to hysterectomy in such group of patients; it stops the development of pathological symptoms of the disease, and in some cases facilitates woman’s reproductive function.

Journal of obstetrics and women's diseases. 2016;65(5):96-99
Clinical efficacy of agonist toll-like receptor 9 on the process of reparations after loop conization (LEEP) of the cervix
Minaev N.N., Ivanova M.N., Bugrimov D.J., Klimovich A.A.

The aim of this study to explore the use of the agonist Toll-like receptors 9 (TLR 9) in the postoperative period after the LEEP, performed for cervical intraepithelial neoplasia, influences the process tissue repair cervix.

Materials and methods. In a randomized, longitudinal, prospective, comparative study included 70 patients with squamous intraepithelial lesions (HSIL и LSIL). Patients first test group (n = 36) was obtained postoperatively as a TLR agonist Derinat 9 immunomodulator. Two patients, the control group (n = 34), postoperative not administered any medication drugs. In the process of diagnosis all patients were performed conventional cytology and colposcopy, PCR-test for human papillomavirus (HPV). These parameters were examined postoperatively at 1 month and 6 months.

Results. Systemic administration agonist TLR 9, drug Derinat in clean postoperative wound of the cervix pathogenetically justified because it, together with the alteration leads to a synergistic effect to the reparative function of the macrophages through activation of Toll-like receptors 9 and the subsequent synthesis of cytokines directly accelerates the process of repair and immune supervision of malignant transformation cervical intraepithelial neoplasia tissues.

Conclusion. Patients after LEEP is recommended the appointment of the drug Derinat, agonist of toll-like receptor 9, immunomodulator with the reparative effect, intramuscular injection of 15 mg/mL, 75 mg after 24 hours number 10.

Journal of obstetrics and women's diseases. 2016;65(5):101-112

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