Vol 66, No 1 (2017)

Efficacy and safety of labor induction methods using prostaglandin E1
Blagodarniy G.V., Mozgovaya E.V.
Worldwide incidence of induced births continues to rise. In developed countries, labor induction frequency approaching 30% of total delivery. The procedure of induction of labor can not be considered completely secure, which leads to the need to find an effective and safe method of labor induction. The aim of the study was to determine the effectiveness of various schemes of labor induction with prostaglandin E1 and their effect on perinatal outcomes. We studied vaginal and oral misoprostol, as well as induction of labor scheme “chinin-oxytocin”. Evaluated the main parameters of the act of birth and the condition of the fetus and newborn. The high efficiency of misoprostol for induction of labor used, as in the oral and vaginal administration. It was revealed that vaginal administration of misoprostol every third pregnant woman meets irregular, discoordinated contructions, whereas the oral administration of misoprostol this anomaly uterine activity is less common. Most of the children in all groups were born with Apgar scores of 7 points or higher. The data indicate that the efficacy and safety of misoprostol used for labor induction.
Journal of obstetrics and women's diseases. 2017;66(1):9-20
Vacuum extraction of the fetus: the version and controversy
Medvedevа I.N., Svyatchenko K.S., Barbashova Y.Y.

Actuality. Although in the developed countries of the surgical vaginal delivery by a vacuum extraction of the fetus the widespread introduction, this method is not sufficiently popular in our country, due to the unfounded opinion of the highest injury to the mother and fetus. However, due to the improvement of models and the obvious advantages of simplicity and ease of use, the application of this operation becomes reality.

Aim. The assessment of the surgical vaginal delivery by a vacuum extraction of the fetus on the shape of parturient women and newborns.

Materials and methods. Made a retrospective analysis of the outcome of the 192 vaginal operative deliveries by using a single use vacuum system KIWI according to the labor histories and stories of newborns for 2014-2015 in regional perinatal center, Kursk. We studied the anamnestic data and the results of monitoring the pregnancy, childbirth, postpartum and newborn state. The calculations were made using the package of standard programs.

Results. In the majority of cases the postpartum period was uneventful, the cases of severe obstetric injury was not revealed. 80.21% of the children were recovered in a satisfactiry condition, although acute fetal hypoxia was observed in 90.1% of cases, suggesting the efficacy of using the vacuum extraction. Clinically significant lesions, such as subgaleal hematoma, skull fracture are not registered.

Conclusions. Analyzing the consequences of this method, we can confidently say that the operation of vacuum extraction with timely and correct use of a technical execution has no negative impact on the organisms of mother and child and is justified by positive outcomes in emergency situations.

Journal of obstetrics and women's diseases. 2017;66(1):21-26
Morphological characteristics of uterine fibroids among women of reproductive age
Safarova S.M.

The article deals with modern views on etiopathogenesis of uterine fibroids. Increased knowledge of the markers of proliferation and their study will help to predict the course of the disease and thus to develop the optimum tactics of the further treatment of the early stages. Much attention is paid to the study of markers that characterize apoptosis. By immunohistochemistry in tissue fibroids 15 patients studied protein expression Ki-67 and Bcl-2. Analyzed values of the correlation expression of the proteins according to the clinical and morphological features of the tumor. It showed a reduction in the proliferation marker Ki-67, and increased expression of apoptotic Bcl-2 inhibitor.

Background. Presented by changes in the nature of proliferation and apoptotic activity in myoma nodes among women of reproductive age who underwent conservative myomectomy.

The aim of the research was to study the performance of protein antibody Ki-67 proliferation and apoptosis inhibitor of Bcl-2 in women with uterine myoma.

Material and methods. Surveyed 15 women with uterine fibroids who underwent conservative myomectomy. Inclusion criteria were: the reproductive age, uterine fibroids the size of which does not exceed the 12-week pregnancy. Exclusion criteria were the size of fibroids greater than 12 weeks of pregnancy, acute inflammatory diseases of the pelvic organs, severe somatic diseases, cancer of the reproductive organs. It was carried out histological and immunohistochemical study of remote myoma node. We examined by immunohistochemistry proliferation protein monoclonal antibody Ki-67 (Clone MIB-1, 1 : 150, Dako), inhibitor of apoptosis Bcl-2 (NCL-bcl-2-486). (Novocastra). Evaluation of the expression of markers studied conducted qualitative and quantitative methods in computer image analysis system “Morphology 5.0” (Video Test, Russia). Statistical processing of the results was performed using statistical analysis packages (STATGRAPHICS v. 6.0).

Results. Age of women surveyed averaged 33,4 ± 4,1 years. Histological study of benign tumors of the uterus body showed the presence of degenerative changes, necrosis and inflammatory infiltration in every fourth case of the material.

Conclusions. Immunogistohimichesoe study of uterine leiomyomas body revealed a significant increase in the expression of apoptosis inhibitor of Bcl-2 and reducing the proliferation marker Ki-receptor expression in all 67 tested samples, which is consistent with a histological study of the absence of mitotic activity in leiomyomas.

Journal of obstetrics and women's diseases. 2017;66(1):27-31
Effect on ovarian reserve using various techniques to reduce blood loss for myomectomy
Tsivyan B.L., Troik E.B., Mekoshvili C.V., Konstantinova E.V.
The aim of this study was to establish clinical effectiveness and impact on ovarian reserve different techniques reducing blood loss, after laparoscopic myomectomy (LM). Research included 72 patients who were estimated the level of Anti-Mullerian, FSH and antral follicle counts by ultrasound 12 months after surgery. The study showed that the patients were carried out UAE revealed decreasing the ovarian reserve.
Journal of obstetrics and women's diseases. 2017;66(1):32-37
Evaluation of the content and the pathogenetic role of cytokines in the peritoneal fluid in patients with deep infiltrative endometriosis
Tsitskarava D.Z., Yarmolinskaya M.I., Selutin A.V., Selkov S.A.

Background. Deep infiltrative endometriosis (DIE) is characterized by the invasion of endometriosis lesions in tissues and organs to a depth of over 5 mm. In recent years, the proportion of infiltrative forms of endometriosis has been steadily increasing. The main clinical manifestations is chronic pelvic pain syndrome and infertility. A key element in the pathogenesis of deep infiltrative endometriosis is an ineffective inflammatory response.

Objective. Evaluate the content and the role of pro- and anti-inflammatory cytokines, growth factors and chemokines in the pathogenesis of deep infiltrative endometriosis for pathogenetically grounded immunomodulatory therapy.

Materials and methods. The present study included 120 women with deep infiltrative endometriosis. In the peritoneal fluid, using IFA determined the level of IL-33, and with the help of running cytofluometry format NEA has estimated the levels of IL-2, IL-6, IL-10, IP-10, MCP-1 and growth factors – FGF, TGF-β.

Results. In the study of peritoneal fluid of patients with DIE was a significant decrease in the level of IL-2 and IL-10 6.7 times compared to the control group. The level of IL-6 was increased in 1.5 times, as well as the level of IL-33, and was awarded the data link cytokines with the severity of pain. DIE is characterized by increased levels of MCP-1 in 2 times and decrease in IP-10 1.3 times, as well as increased levels of FGF 1.5 times and reduced levels of TGF-β in 1.9 times in comparison with the control group.

Conclusion. For effective treatment of DIE and to increase the duration of recurrence-free period actual and pathogenetically justified is the inclusion of a combined treatment of immunomodulatory therapy with recombinant IL-2 aimed at the elimination of immunological disorders in the pelvic cavity.

Journal of obstetrics and women's diseases. 2017;66(1):38-45
Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE
Shkarupa D.D., Bezmenko A.A., Kubin N.D., Shapovalova E.A., Pisarev A.V.

Introduction. Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6-45% in patients with prior hysterectomy for uterine prolapse. Reported recurrence rate of VVP following different techniques of surgical correction is up to 10%.

Objective: to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling (Urosling 1; Lintex, Saint Petersburg, Russia) in surgical treatment of VVP.

Methods. This prospective study involved 61 women suffering from post-hysterectomy prolapse. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment.

Results. Mean operation time was 35 minutes. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted. 12-months anatomical cure rate (≤ stage I, POP-Q) was 100%, 94.4% and 100% for apical, anterior and posterior vaginal compartments, respectively. At 1 month of follow-up stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4.9%, respectively. Statistically significant (p < 0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.

Conclusion. Bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling appears to be effective and safe method for treatment patients with vaginal vault prolapse.

Journal of obstetrics and women's diseases. 2017;66(1):46-55
The use of a synthetic analogue of prostaglandin Е1 misoprostol for induction of labor
Blagodarniy G.V.
Induction of labor is often used in modern obstetrics. Labor induction methods are quite diverse. Proposed by a large number of labor induction methods, such as medication and non-medication. The growth rate of induced births dictates the need to find an effective and safe method of labor induction. One of the most studied inductors reduce the myometrium are prostaglandins. The review of literature presents data on the mechanism of action of prostaglandin E1 on the myometrium cell, given the characteristics of various methods of labor induction with a synthetic analogue of prostaglandin E1 Misoprostol.
Journal of obstetrics and women's diseases. 2017;66(1):56-65
Effects progestogel for postpartum engorgement of the breast
Alekseev N.P., Тalalaeva N.E.

Background. Severe breast engorgement can cause substantial discomfort for mothers and interfere with an infant’s ability to feed at the breast.

Aim of the study was to clarify the possibility of the influence of percutaneous the progesterone-containing gel (progestogel) to eliminate strong postpartum engorgement of the breast in lactating women.

Materials and methods. 23 patients were examined. The progestogel for transdermal therapy in an amount of 2.5-3 g was applied to the breast. Before application and after 20 min application progestogel measured the density of the mammary glands with the help of tonometer.

Results. According to our observations, application of 2.5-3g of the progestogel on the breast skin is not leading to reduction of breast swelling, engorgement and tenderness.

Conclusions. Transdermal application progestogel does not reduce the degree of engorgement of the mammary glands in the postpartum period.

Journal of obstetrics and women's diseases. 2017;66(1):66-71
Diferential dagnosis in twin-to-twin transfusion syndrome: methodology and clinical cases
Nekrasova E.S.
In monochorionic twins there exist some specific complications as twin-to-twin transfusion syndrome and selective growth restriction that could have some common features. Also in case of non-immune hydrops of one of the fetuses it could mimic the clinical features of severe twin-to-twin transfusion. In this article we describe three cases of monochorionic twins with different conditions and discuss the best way to differentiate between these diagnoses.
Journal of obstetrics and women's diseases. 2017;66(1):72-76
Modern capabilities of reproductive function realization for patients affected by deep infiltrative endometriosis
Yarmolinskaya M.I., Durneva E.I.
It is agreed that endometriosis is a disease that has a negative impact on fertility. Factors causing decrease in fertility in patients with endometriosis are very diverse: peritoneal factors, including changes in peritoneal fluid, adhesions, changes in anatomy of pelvis and impaired properties of peritoneum which may also lead to the tubal factor of infertility; ovarian factors which are linked with endocrine and ovulatory changes and lead to disturbance in oocyte quality and quality of embryos; factors leading to implantation disturbances. There are different types of strategies for overcoming infertility, caused by endometriosis: medication therapy, surgical treatment and/or methods of IVF. Cases that are presented in this article are not a routine practice and most likely are an exclusion, but they serve as examples of conceiving of women with hypergonadotropic ovarian insufficiency and reduced ovarian reserve with the use of their own oocytes after longtime and combined treatment of severe forms of infiltrative and extragenital endometriosis with unordinary approach to drug therapy.
Journal of obstetrics and women's diseases. 2017;66(1):77-81
I.I. Yakovlev, 120 years since the birth
Aylamazyan E.K.
The article is devoted to the 120th anniversary of the birth of I.I. Yakovleva - outstanding Russian obstetrician-gynecologist, a teacher, a scientist; are the main stages of his scientific-practical and pedagogical activity and characteristics of the main scientific works.
Journal of obstetrics and women's diseases. 2017;66(1):82-85

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