Vol 65, No 6 (2016)

Articles
Role of Kisspeptine in Regulation of Reproductive Function
Yarmolinskaya M.I., Ganbarli N.F., Ailamazian E.K.
Abstract

Research objective: to identify a role of kisspeptine in the regulation of reproduction function.

Materials: literature data by foreign authors for the period from 1985 till 2016.

Methods: systematic analysis and compilation of information in the literature.

Results. The article provides a review of literature data on research of kisspeptine gene and its receptor; it includes description of their role in regulation of reproduction function and mutation in the genes responsible for realization of kisspeptine and neurokinin signaling pathways. Features of kisspeptine secretion in patients with hypogonadotropic hypogonadism, premature sexual development, hyperprolactinemic deficiency of ovaries, polycystic ovarian syndrome, genital endometriosis and opportunity of kisspeptine use in clinical practice as an ovulation trigger are described.

Conclusion. It is necessary to carry out further studies for clarification of kisspeptine role in patients with various diseases and the opportunity of its use as a therapeutic target.

Journal of obstetrics and women's diseases. 2016;65(6):4-18
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Signal molecules as biomarkers of prediction of the premature rupture of membranes (clinicodiagnostic aspects)
Afanasyeva M.H., Bolotskih V.M., Polyakova V.O.
Abstract

One of the most commonly encountered pregnancy complications is the premature rupture of membranes. This pathology results in the increase of frequency of operative delivery, birth traumatism and neonatal complications. The purpose of the research described was verification of key signal molecules, providing integrity of fetal membranes, with subsequent development of possible biomarkers of non-invasive prediction of the premature rupture of membranes. This work presents the comparison studies of expression of VEGF, MMP-9, connexin 37, connexin 40, endorphins, enkephalins, actin, miosin in a buccal epithelium and fetal membranes for 70 patients of the basic group (with premature rupture of membranes) and for 70 patients of the control group (with timely rupture of membranes). Research of fetal membranes and buccal epithelium was carried out by means of primary monoclonal mouse antibodies to the investigated markers. The universal basis set was used as the secondary antibodies, containing of biotinylated anti-mouse immunoproteins. The study of the preparations was carried out in the confocal microscope OLYMPUS FLUOVIEW FV 1000 at the image enlargement of ×400 and ×1000 with use of the system MRC-1024, with the software suite for computer processing OLYMPUS FLUOVIEW 5.0. Statistical processing of the material was carried out with the application of the standard statistical software suite Statistica 10.0. Obtained in a group with the premature rupture of membranes and in a control group were the reliable differences of expression of MMP-9, VEGF, connexin 37 and connexin 40 were. The multifactorial analysis of the indices of expression of signal molecules allowed to discover the high information significance for premature rupture of membranes prediction, matrix metalloproteinase ММP-9, connexin 37 and connexin 40, as well as VEGF. Matrix metalloproteinase ММP-9, connexin 37 and connexin 40, VEGF can be considered as non-invasive markers of premature rupture of membranes prediction.

Journal of obstetrics and women's diseases. 2016;65(6):19-27
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Drug-induced cytolytic syndrome in pregnancy: clinical and biochemical diagnostic criteria
Borisova I.V.
Abstract

The aim of the study was evaluation of clinical and laboratory manifestations of drug-induced cytolytic syndrome in pregnancy. In the research group included 62 pregnant women with drug-induced liver injury (DILI) in the first trimester of pregnancy. These pregnant women received hormone therapy at the planning stage and/or during pregnancy for the prevention and treatment of miscarriage and had clinical and biochemical manifestations of cytolytic syndrome. Pregnancy after IVF and ovulation induction was in 60.8% of cases. Hormone therapy for pregnant patients received long-term, 85% of pregnant women used estrogen and progestin drugs. DILI during pregnancy characterized by low-symptom or asymptomatic clinical manifestations. DILI manifested cytolytic biochemical syndrome, in which there is isolated increase of transaminase levels, in some cases accompanied by increased level of gamma glutamyl transpeptidase, liver glutamate dehydrogenase and decreased total protein levels, in the first place due to the albumin fraction.

Journal of obstetrics and women's diseases. 2016;65(6):28-35
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Outcomes of pregnancy and delivery large fetus
Mochalova M.N., Ponomareva Y.N., Mudrov A.A., Mudrov V.A.
Abstract

In spite of large number of studies on the issue of delivery pregnant with large fetus, avowed tactics of pregnancy and delivery does not exist. High rates of mother’s birth trauma and adverse perinatal outcomes during delivery large fetus are great medical and social problem.

The aim of the study was to investigate the course of pregnancy and delivery, and perinatal outcomes during delivery large fetus.

Materials: literary data of foreign and domestic authors in the period from 1991 to 2016.

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

Conclusion: It is necessary to determine an optimum tactics of pregnancy and delivery large fetus that will reduce significantly perinatal morbidity and mortality.

Journal of obstetrics and women's diseases. 2016;65(6):36-44
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Clinical and cytological characteristic of a condition of the oral cavity at pregnant women with various types of a diabetes mellitus
Orekhova L.Y., Aleksandrova A.A., Aleksandrova L.A., Musaeva R.S., Tolibova G.K., Posokhova E.V.
Abstract

Introduction. More and more researches dedicated to the communication of diseases of the oral cavity of pregnant women with diabetes. It is proved that the intensity of caries and inflammatory periodontal diseases (gingivitis and periodontitis) increase significantly during pregnancy, while the presence of comorbidities, such as diabetes, increase these indexes.

Aim. The aim of the work was to study the dental status of pregnant women with diabetes.

Materials and methods. The study compared women with gestational diabetes mellitus, type 1 diabetes, and type 2 diabetes, to a control group of pregnant women without diabetes. In addition to clinical research methods, liquid-based cytology of the contents of the gingival sulcus was performed.

Results. The results of clinical and laboratory studies have shown that inflammatory diseases of periodontium and teeth within pregnant women with diabetes are more common than within the pregnant women without this disease. It should be noted that the frequency of occurrence and severity of these diseases in the pregnant women with type I diabetes is higher than in the other groups.

Conclusion. Pregnant women with diabetes are at risk for dental disease and require more attention from dentists, endocrinologists and obstetricians. The use of liquid-based cytology method helps in the diagnosis of inflammatory periodontal diseases.

Journal of obstetrics and women's diseases. 2016;65(6):45-51
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Comparative evaluation of morphological criteria of endometrial dysfunction in patients with infertility associated with pelvic inflammatory disease, external genital endometriosis and uterine myoma
Tolibova G.K.
Abstract

Background. The comparative evaluation of morphological criteria of endometrial dysfunction in patients with primary infertility associated with pelvic inflammatory disease, external genital endometriosis and uterine myoma revealed common morphological manifestations in the form of an imbalance of the endometrium receptor profile on the background of the high frequency of chronic endometritis.

The aim of the study was the comparative evaluation of ER and Pg receptors expression, inflammatory markers and an inhibitor of cyclin-dependent kinases p16ink4a in the endometrium of women with infertility associated with pelvic inflammatory disease, endometriosis and uterine myoma.

Materials and methods. The study was included 298 patients: 95 patients with infertility associated with pelvic inflammatory disease, 73 women with infertility associated with external genital endometriosis degree I-II, 70 patients with infertility associated with uterine myoma and 60 patients with infertility associated with male factor. All patients were examined and treated in FSBSI “The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott”. Endometrial biopsies were performed on 19-24 day of the cycle. Histological and immunohistochemical study of endometrial biopsies were performed by standard methods. The expression of ER and PgR receptors, inflammatory markers (CD8+, CD20+, CD4+, SD138+) and cyclin-dependent kinase inhibitor p16INK4a was studied by the immunohistochemical method. The evaluation of the markers expression was performed by semiquantitative method H-Score, as well as qualitative and quantitative methods of computer image analysis system “Morphology 5.0” (VideoTest, Russia). Statistical processing of the results was performed using statistical packages (STATGRAPHICS v.6.0).

Results. There is a violation of the endometrium secretory transformation in patients with infertility associated with pelvic inflammatory disease, uterine myoma and external genital endometriosis on the background of the high frequency of chronic endometritis. Receptor imbalance is characterized by impaired ER and PgR receptor ratio in the glands and in endometrial stromal component as a result of chronic inflammation.

Journal of obstetrics and women's diseases. 2016;65(6):52-60
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The СYP24A gene expression the placental tissue during pregnancy
Shelepova E.S., Freylikhman O.A., Riabokon N.R., Zhebrun D.A., Kostareva A.A., Zazerskaya I.E.
Abstract

Aim. To study the nature of CYP24A1 gene expression in the placental tissue in women with different saturation of the body with vitamin D during normal pregnancy and preeclampsia.

Materials and methods. Cohort retrospective and prospective study. There were examined 110 pregnant women in Saint Petersburg and Leningrad region, who took multivitamin complex containing 400 IU of vitamin D from 12 weeks of pregnancy. Time of inclusion is from September to June. All pregnant women were taken blood samples with the following determination of the level of 25-hydroxycalciferol, fragments of placental tissue with the following study of mRNA expression of CYP24A1 gene.

Results. There were analyzed two groups of pregnant women. During the analysis of the saturation level of the body with vitamin D there were revealed the following things: the frequency of vitamin D deficiency in the main group was 69.6% in the group of comparison vitamin D deficiency was not found. The frequency of vitamin D insufficiency in the main group was 21.5% in the group of comparison – 18.5%. The frequency of the normal level of vitamin D in the main group was 8.9% in the group of comparison – 81.5%. Differences between the main group and the group of comparison are reliable (p < 0,0001). There revealed a statistically significant increase of the relative expression of mRNA of CYP24A1 gene in the placental tissue in women with preeclampsia (31,8 ± 20,6), in comparison with women with physiological pregnancy (11,2 ± 17,9) (p = 0.03)

Conclusion. In women with preeclampsia low level of vitamin D in blood serum (less than 30 ng/ml) is 5 times more common, that is why insufficiency and deficiency of vitamin D in pregnant women can be attributed to risk factors for the development of preeclampsia. Expression of mRNA of CYP24A1 gene in placental tissue in patients with preeclampsia is three times higher in comparison with patients with a normal pregnancy. Thus, the increased expression of CYP24A1 gene in the placental tissue can be considered as one of the risk factors for the development of preeclampsia.

Journal of obstetrics and women's diseases. 2016;65(6):61-67
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The differential diagnosis of benign and malignant ovarian neoplasms (history)
Egunova M.A., Kutsenko I.G.
Abstract
The history of the differential diagnosis of ovarian neoplasms at the preoperative stage is presented in the review article. This is still a problem due to the high incidence of tumors and tumor-like formations of ovaries, the continuing upward trend in the index of ovarian cancer, along with a slight decrease in mortality and 5-year survival. Considerable success of surgical treatment and chemotherapy in the early stages of ovarian cancer suggests the earliest possible detection and accuracy of differential diagnosis of ovarian neoplasms. It highlights the role of the different research methods, including radiation imaging techniques, tumor markers and their potential advantages and disadvantages.
Journal of obstetrics and women's diseases. 2016;65(6):68-78
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Uterine fibroids and effiency of in vitro fertilization programs
Dzhemlikhanova L.K., Niauri D.A., Abdulkadyrova Z.K.
Abstract

The aim of this review is to estimate etiologic role of uterine fibroids in female infertility; it based on the results of current studies of infertility in various cases of fibroids (submucous, intramural and subserous). In article was analyzed the efficiency of the treatment of infertility in women with uterine myoma in IVF programs.

Conclusion: a detailed study of endometrial receptivity in women with uterine fibroids is necessary to for personalized strategy in patients with uterine fibroids (myoma) and infertility.

Journal of obstetrics and women's diseases. 2016;65(6):79-87
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Lactoginal for correction of abnormal vaginal microbiocenosis in pregnant woman with cervical cerclage: clinical case and literature review
Tapilskaya N.I., Savicheva A.M., Shipitsyna E.V.
Abstract

The present paper describes for the first time a case of using the preparation of vaginal lactobacilli Lactoginal (strain Lactobacillus rhamnosus Lcr35) for correction of vaginal microflora disturbance, associated with cervical cerclage in pregnant woman with a history of pregnancy miscarriage. Administration of the probiotic lactobacilli preparation up to the delivery resulted in steady normalization of the vaginal miсrobiocenosis, which might have, to a certain extent, contributed to its normal course and delivery. The obtained results are discussed in the context of literature data.

Journal of obstetrics and women's diseases. 2016;65(6):89-95
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Analysis of the frequency of specific complications endovideosurgical intervention in gynecology
Vartanova I.V., Shirokov D.M., Korostelev Y.M.
Abstract
The analysis of specific complications endovideosurgical gynecological interventions cases detected ekstraabdominal gas after laparoscopic operations with imposing carboxyperitoneum and resorption of the irrigation solution during hysteroscopy. We present possible mechanisms for the development of subcutaneous emphysema, pneumothorax, pneumomediastinum and overhydration along with discussion of methods of diagnosis and treatment.
Journal of obstetrics and women's diseases. 2016;65(6):96-99
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Morphological substantiation of pathogenetic therapyof external genital endometriosis
Markar’yan I.V., Yermolova N.V., Drukker N.A., Mazhugin V.Y., Rymasheuski A.N., Trushina S.A.
Abstract
With the help of morphological study examined endometrioid heterotopias and eutopic endometrium in external genital endometriosis. Histological examination of surgical specimens of endometrial cancer were detected in endometrioid heterotopia, in eutopic endometrium occurred glandular-cystic hyperplasia of the proliferative and secretory type. Have been identified in the heterotopias expressed angiomatosis in patients with III-IV stages of endometriosis. It is proved that inflammatory changes in endometrioid heterotopias more pronounced with stage I-II stages of endometriosis, whereas hyalinosis sclerosis and how the outcomes of the process prevalent in patients with stage III-IV. The difference parameters in ectopic and eutopic endometrium shows marked morphological heterogeneity of both nuclear and cytoplasmic structures. Morphological changes in the heterotopias are intended to justify Dienogest (2 mg) for the treatment of external genital endometriosis.
Journal of obstetrics and women's diseases. 2016;65(6):100-103
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Features of proand antioxidant systems in patients with uterine leiomyoma and its combination with adenomyosis and endometrial hyperplasia and the development of recurrence after organ-saving operations
Popov E.N., Arutyunyan A.V., Sudakov D.S., Dymarskaya Y.R.
Abstract
We assessed the incidence of uterine leiomyoma recurrence after myomectomy in cases of its isolated development and combination with other hyperplastic processes of endo- and myometrium. We showed the role of pro- and antioxidant systems’ disturbances in the recurrence of combination of leiomyoma, adenomyosis and endometrial hyperplasia. We propose indole-3-carbinol and epigallocatechin administration as preventing post-operative treatment.
Journal of obstetrics and women's diseases. 2016;65(6):104-108
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The model final results how the method of complex evaluation of improving quality of care in obstetrics
Yaroslavsky K.V., Atlasov V.O., Bolotskykh V.M.
Abstract
The article considers the issues of managing quality of medical care in obstetrics, the aim of which is to consider different management models, their advantages and disadvantages. Described the system of total quality management based on the needs of the patient. The presented method models outputs and its use in obstetric institution for integrated assessment activities and ensure continuous improvement and improve the quality of care. The calculation of the performance of the obstetric hospital and dynamic analysis of their effectiveness.
Journal of obstetrics and women's diseases. 2016;65(6):109-115
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