Vol 66, No 2 (2017)

Endometriosis as a pathology of regulatory mechanisms
Selkov S.A., Yarmolinskaya M.I.

The article represents the author’s original definition of genital endometriosis, emphasizing the main pathogenetic feature of the disease — violation of regulatory mechanisms, underlying in its development and characterizing diversity of its pathogenetic and clinical forms. The hierarchy of regulatory mechanisms is given, general ideas concerning approaches to the study of this illness and approaches to drug therapy are described. Special attention is paid to immunomodulatory therapy in patients with endometriosis, critical analysis of its advantages and disadvantages is given, and prospects of this direction are demonstrated.

Journal of obstetrics and women's diseases. 2017;66(2):9-13
Essential phospholipids use in the treatment of drug-induced liver injury in pregnant women
Palgova L.K., Borisova I.V., Zhestkova N.V., Tarasova M.A.

The aim of the study was evaluation the efficiency of essential phospholipids for the treatment of drug-induced liver disease in pregnant women. In the research group included 67 pregnant women with clinical and biochemical manifestations of drug-induced cytolytic syndrome, 58 pregnant women (the main group) were treated with hepatoprotectors, 9 women (the control group) the treatment of essential phospholipids wasn’t carried out. Patients of both groups were eliminated hormonal drugs and other drugs or their dosage is reduced as much as possible. Drug liver disease in pregnancy is manifested by increased transaminase, in some cases accompanied by increased level of gamma glutamyl transpeptidase, liver glutamate dehydrogenase. Against the background of the treatment in both groups decrease in transaminases have been reported. But the rate of decline of aminotransferases was differed, so in the main group decrease of ALT and AST was occurred faster than in the control group.

Journal of obstetrics and women's diseases. 2017;66(2):14-23
Species diversity of vaginal lactobacilli in norm and in dysbiotic states
Budilovskaya O.V., Shipitsyna E.V., Gerasimova E.N., Safronova M.M., Savicheva A.M.

Introduction. In healthy women of reproductive age, the vaginal microflora is represented mainly by lactobacilli. They provide a barrier function, preventing the propagation of opportunistic pathogens and the colonization of the vagina by pathogenic microorganisms. It is shown that the lactobacillary microflora of the vagina is very diverse, but not all species of lactobacilli can provide reliable protection of the female organism.

Objective: to characterize the species and quantitative composition of vaginal lactobacilli of women of reproductive age in norm and in dysbiosis.

Material and methods. The study involved 123 patients from polyclinic departments of the D.O. Ott Reasearch Institute of Obstetrics, Gynecology and Reproductology. For analysis of clinical material (vaginal discharge) for lactobacilli and other microorganisms, quantitative real-time PCR was used.

Results. The most common types of lactobacilli are Lactobacillus jensenii, L. Iners, L. crispatus, L. vaginalis and L. gasseri. Species diversity of lactobacilli (detection of ≥2 species) is observed much more often in women with physiological microbiocenosis than in women with vaginal dysbiosis. Our study confirms that L. crispatus is the dominant species of the vaginal biotope of healthy women, while in dysbiosis the species L. gasseri and L. Iners are most often identified.

Journal of obstetrics and women's diseases. 2017;66(2):24-32
New technologies and trends of prenatal diagnostics
Kascheeva T.K., Kuznetzova T.V., Baranov V.S.

Advantages and drawbacks of noninvasive prenatal testing (NIPT) of chromosomal anomalies are briefly reviewed. Material supply, employment issues, financial and management problems in European countries and in Russia are discussed. Many problems are rising under implementation of this new method into the clinical practice.

Journal of obstetrics and women's diseases. 2017;66(2):33-39
Demographic indicators of fertility and medico-social influenses on them
Irina S.L., Ivanova O.J., Khardikov A.V., Ivanova T.S., Abrosimova N.V.

Aim. For the past hundred years, changes in the dynamics of fertility has been terrific in Russia, the transition has been from traditional to new, modern type of reproductive behavior. The purpose of the study. To study the demographic indicators of fertility and social factors affecting these figures in the Kursk and Belgorod regions for 25 years (1990-2015).

Materials and methods. Based on annual statistical data of RosStat, we researched the dynamics of fertility in the Kursk and Belgorod regions between 1990 and 2015. According to the survey of 1291 women aged 20-34 years living in Kursk, we gave the major factors influencing on the fertility and childlessness.

Results. In the Kursk and Belgorod regions from 1990 to 2000 there is a decrease in the birth rate 34.7% and 38%, respectively, with a minimum value in 2000 (р > 0,05). But in the period from 2000 to 2015 there is an increase of this index in Kursk region 50.6%, in Belgorod – by 43.8%, in Russia – 52.9% (р > 0.05), but the birth rate has not reached the 1990 data and remains below the national average. The increase in the birth rate due to increase in births of the second and subsequent children, mostly in rural areas. At the same time, the total fertility rate, which is calculated for the total population, in rural areas recorded significantly lower than in the city. This is due to a lower proportion of residents of reproductive age in the total population of the village compared with the city. Between 1990 and 2015 significantly increases the share of births over the age of 25 and decreases in the age range 18-24 years.

Conclusion. It is proved that the birth rate is governed by the number of marriages, with the ratio of male and female population of reproductive age, maternal mortality.

Journal of obstetrics and women's diseases. 2017;66(2):40-48
Antibacterial treatment of pregnant women colonized by streptococcus group B
Ohanyan K.A., Arzhanova O.N., Paykacheva J.M., Zatsiorsky S.L.

Relevance. Streptococcus group B (GBS), Streptococcus agalactiae, are the causative agents of severe infections of the fetus and newborn child.

The aim of the study was to investigate the efficacy and safety of antibacterial therapy with the use of amoxicillin with clavulanic acid and josamycin pregnant women with GBS, as well as the impact of antibiotic therapy on perinatal outcomes.

Materials and methods. For isolation and identification of Streptococcus and Ureaplasma used bacteriological method of research. The article presents the results of a survey of 99 pregnant women, the urogenital tract, which are colonized by streptococcus group B (GBS) and Ureaplasma, during their pregnancy, delivery and perinatal outcomes.

Results. All women were divided into three groups: I group — 29 (29.3%) women, with the presence of GBS in the urogenital tract and treated during pregnancy amoxicillin with clavulanic acid, group II — 24 (24,2%) women with the presence of GBS and Ureaplasma treated during pregnancy josamycin, group III — 46 (46.5%) of women with available GBS, which antibacterial therapy during pregnancy was not conducted. Our results confirmed the data of foreign authors about the high frequency of complications of pregnancy and delivery in women colonized by Streptococcus group B who did not receive antibiotic therapy. Thus it often happened GBS colonization of the skin and mucous membranes of infants, develop in utero infection in children born to these mothers.

Conclusion. Upon detection of GBS in the urogenital tract of pregnant women is necessary to carry out antibacterial therapy for the prevention of complications of pregnancy, delivery and intrauterine infection of the fetus. Moreover, in the simultaneous detection of Streptococcus group B and Ureaplasma effective to schedule josamycin (wilprafen), which acts on both of the microorganism.

Journal of obstetrics and women's diseases. 2017;66(2):49-54
Ovarian cancer: current approaches to classification, diagnostics, staging and differential management of patients
Solopova A.G., Bitsadze V.O., Solopova A.E., Makatsariya A.D., Rozanov I.A.

Purpose of this study: systematic analysis of the data available in the modern scientific medical literature on contemporary aspects of the diagnosis, staging and differential treatment tactics of patients with epithelial ovarian tumors.

Research method used in this article is the systematic analysis of the medical literature, both domestic and western.

Results. This article attempts to summarize the experience of modern medicine and the world’s leading centers for the fight against ovarian cancer of epithelial origin and offer solutions relevant to everyday clinical practice. Problems of the modern classification of forms of the disease are described in detail; description of instrumental diagnostic methods also is given in thus article; problem of lack of effective proved themselves in clinical practice of screening methods also was disccused; and, thus, current understanding of the disease staging and differential tactics for treatment of patients are given.

Conclusion. One of the most important directions of development of gynecological oncology is a decision the existing problems related to the diagnosis and treatment of ovarian cancer: namely, the development of effective screening programs, improving diagnosis and therapy methods, the development of measures of postoperative management of patients with ovarian cancer, including medical rehabilitation measures.

Journal of obstetrics and women's diseases. 2017;66(2):55-66
Prospects of metformin in the treatment of endometriosis
Florova M.S., Yarmolinskaya M.I., Potin V.V.

According to recent year studies, the classical biguanide metformin has antiproliferative, proapoptotic and anti-inflammatory effects in addition to the main hypoglycemic effect. There are clinical and experimental studies these effects in the therapy of oncological and benign hyperplastic diseases. There is no data about the clinical efficacy of metformin in the therapy of endometriosis in the domestic literature, and there were a few studies in foreign sources. There was a decrease in the severity of the pain syndrome and an increase of pregnancy rate in two clinical studies with small samples. However, future studies are needed to investigate the mechanisms of the target drug effect and to develop effective regimens for the treatment of endometriosis.

Journal of obstetrics and women's diseases. 2017;66(2):67-76
Classifications of endometriosis
Aylamazyan E.K., Yarmolinskaya M.I., Molotkov A.S., Tsitskarava D.Z.

In the article a review of the main classifications of endometriosis is presented. Main drawbacks of existing classifications have been revealed. A need for a new classification of the disease, which has to be empirical, evidence-based, containing terms that have unambiguous definitions, applicable for various clinical situations, taking into account new clinical forms and able to predict a course of the disease (including the development of pain syndrome and infertility), it’s outcomes and a risk of recurrence is stressed. The new classification of endometriosis has to be based on resolutions of a consensuses and applicable for new guidelines for diagnosis and treatment. For the new classification it is essential to be approachable and easy-to-use in routine clinical practice. It has to allow a physician to determine a stage the disease promptly and meaningfully. A new Protocol taking into account a combination of different forms of endometriosis (superficial, deep infiltrative, adenomyosis, endometriomas, extragenital), color of endometriotic lesions, special aspects of clinical course, results of hormonal examination, reproductive plans and prior hormonal therapy is proposed.

Journal of obstetrics and women's diseases. 2017;66(2):77-92
Actual diagnostic and clinical problems in post-term pregnancy in modern obstetrics
Burkitova A.M., Prokhorova V.S., Bolotskikh V.M.

This review is devoted to etiology and diagnostics post-term and prolonged pregnancy. We analyzed the results of studies aimed at the study of diagnostic, pregnancy and complications in childbirth in pregnant women at high risk for post-term pregnancy. When evaluating methods of prenatal training in prolonged and post-term pregnancy most studies showed greatest efficacy in the preparation of the cervix, and the lowest frequency of complications in childbirth when using antigestagens in comparison with other methods of preparing the cervix for childbirth. Despite the long history of the study of this problem, many questions concerning post-term pregnancy, are not fully studied and actual to this day.

Journal of obstetrics and women's diseases. 2017;66(2):93-103
Significance of glutathione peroxidases in endometrium function: facts, hypotheses, and research perspectives
Razygraev A.V., Matrosova M.O., Titovich I.A.

Enzymes of glutathione peroxidase (GPX) family, together with peroxiredoxins, form thiol peroxidase superfamily, the property of which is the thiol-dependent catalysis of the hydroperoxide reduction. This property determines them as antioxidant protectors. Among human GPXs the eight forms are known, five of which are selenium-dependent (GPX1,2,3,4, and 6). The most number of facts supporting the substantial role of GPX in functioning of endometrium are linked with the GPX3, which is the secretory GPX. The number of candidate progesterone response elements in the promoter of GPX3 gene prevails over the number of candidate estrogen response elements; GPX3 is upregulated gene during postovulatory phase of reproductive cycle and during pregnancy; in the endometrial stroma, the transcription of Gpx3 is stimulated through the transcription factor HIF1α. Using laboratory animals, the spatial and temporal coincidence of Gpx3 activation and blastocyst implantation was observed. It was confirmed that GPX3 decreases hydrogen peroxide concentration in endometrium in pregnant animals and during in vitro decidualization. The vulnerability of reproductive function to physiological stress at the insufficient expression of GPX3 is hypothesized. The GPX3 enzymatic activity in endometrium is poorly investigated. The has been hypothesized that selenium-containing medications are effective in the endometrium receptivity improvement and in the supporting the normal embryo development (especially during the influence of physiological stressors) by the maintenance of the posttranscriptional, selenium-dependent stage of GPX3 biosynthesis in endometrium. Probably, the GPX3 expression can be increased by the steriods with gestagenic activity (through the increase of Gpx3 transcription, analogously to effect of progesterone). In contrast with the «classic» GPX (GPX1) and probably with most of other members of GPX family, GPX3 has a wide thiol specificity. It is proposed to assess the activity of GPX3 using the reduced homocysteine and cysteine as thiol substrates instead of the reduced glutathione.

Journal of obstetrics and women's diseases. 2017;66(2):104-111

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