Vol 66, No 3 (2017)

Articles
New approaches to the estimation of endometrial dysfunction
Aylamazyan E.K., Tolibova G.K., Tral T.G., Kogan I.U., Yarmolinskaya M.I., Tsipurdeeva A.A., Rodichkina V.R., Kvetnoy I.M.

Abstract

Introduction. The application of modern methods for assessing the morphofunctional state of the endometrium to verify and study the expression of sex steroid hormones, proinflammatory markers and markers of angiogenesis using confocal laser scanning microscopy will allow an objective study of the role of studied markers in the pathogenesis of the endometrial dysfunction.

The aim of the study was to evaluate the expression of ER and PR receptors in endometrium in patients with endometrial dysfunction.

Material and methods. Endometrial biopsy specimens obtained with the aid of a pile-biopsy or a scraping from the uterine cavity are used to conduct the method of immunofluorescent confocal laser scanning microscopy. It is possible to use both cryostat material and paraffin blocks to provide the immunohistochemical analysis. Monoclonal antibodies to ER (1 : 60, Dako, Denmark) and PR (1 : 50, Dako, Denmark) are used as primary antibodies, antibodies conjugated with fluorochrome Alexa Fluor 647 (1 : 1000, Abcam, England) are used as secondary antibodies). Hoechst 33258 (Sigma, USA) is used for staining of cell nuclei.

Results. A method of confocal laser scanning microscopy makes it possible to conduct qualitative and quantitative evaluation of the studied markers in different structures of the endometrium.

Journal of obstetrics and women's diseases. 2017;66(3):8-15
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The role of metastin in pathogenesis of genital endometriosis
Aylamazyan E.K., Yarmolinskaya M.I., Ganbarli N.F., Tkachenko N.N., Tolibova G.K., Tral T.G., Rulev V.V., Tsipurdeeva A.A.

Abstract

Materials and methods. 28 patients with GE of I-II degrees of prevalence (R-AFS) were included in the study. Control group consisted of 11 healthy women. All the patients underwent laparoscopy and hysteroscopy with histological examination of ovarian tissue, peritoneum and endometrium; patients with GE also were performed histological examination of endometrioid of heterotopies. Definition of levels of kisspeptin, FSH, LH, prolactin, AMH, estradiol, estrone, androgens (free testosterone, dehydroepiandrosterone – DHEA) in peripheral blood in healthy women and in patients with GE were conducted by ELISA on the 2nd and 8th days of menstrual cycle. Immunohistochemical method was used to evaluate expression of metastine (kisspeptin) and its receptor in ovarian tissue, peritoneum, in endometrioid heterotopies and in endometrium.

Results. Hormonal survey has revealed that the level of kisspeptin in peripheral blood was reliably higher compared to its level in the control group. Immunohistochemical study found that in patients with GE area of expression of KISS and KISS1R receptor in endometrium was reliably lower when compared with these values in the control group. In the foci of endometrioid heterotopies, which were located on the pelvic peritoneum, it was observed a reliable increase in protein КІЅЅ1 expression and receptor KISS1R compared to fragments of intact peritoneum. The area of expression of receptor KISS1R in endometrioid heterotopies was reliably higher than the area of its expression in endometrium of patients with GE and in endometrium of women of the control group. Direct correlation between the area of protein expression (KISS) in endometrium with level kisspeptin on the 8th day of menstrual cycle in peripheral blood (rs = 0,90) has been revealed. It has been determined that the level of kisspeptin on the 2nd day of menstrual cycle in peripheral blood correlates with the area of expression of receptor KISS1R in peritoneum (rs = 0,57). A direct correlation between the area of expression of receptor KISS1R in peritoneum with the level of kisspeptin on the 8th day of menstrual cycle in serum has been found (rs = 0,90).

Conclusion. The obtained data show a definite role of kisspeptin in pathogenesis of genital endometriosis. It can be assumed that the increase in the level of metastine (kisspeptin) in peripheral blood and increased expression of KISS1 in endometrioid heterotopies and especially its receptor KISS1R are compensatory-adaptive response aimed at deterrence of further spread of endometriosis. The obtained results justify the need to continue research in this direction for a deeper understanding of pathogenesis of the disease and possible use of kisspeptin as biomarker for non-invasive diagnostics as well as potential targeted therapy of GE.

Journal of obstetrics and women's diseases. 2017;66(3):16-24
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Causes of patients’ obstetric complications after ART
Arzhanova O.N., Paikacheva Y.M., Ruleva A.V., Kapustin R.V., Nichiporuk N.G.

Abstract

Chronic placental insufficiency remains a major cause of perinatal morbidity and mortality. In this regard, prediction of this pregnancy complications becomes particularly relevant. Currently, the frequency of pregnancy as result of assisted reproductive technology (ART) increases among the population. Pregnancies after ART administration compare to naturally occurred are accompanied by a higher risk of miscarriage as well as the formation of placental insufficiency. Older women with endocrine and physical disorder participate in the ART programs most frequently.

The aim of our study was to investigate the course of pregnancy, after ART administration, selection groups threatened by the development of placental insufficiency. 261 medical records of women with singleton pregnancies after ART have been studied. It was the main group. 167 women had a chronic placental insufficiency. There were allocated two groups of pregnant women: group I – 86 patients with placental insufficiency and preeclampsia, group II – 81 women with placental insufficiency indeed. The comparison group consisted of 30 women without infertility with a normal singleton pregnancy. The development of placental insufficiency in the main group (after ART) depends on a large causes of somatic pathology due to age of pregnant women as well. Therefore, patients after ART have to allocate in the high risk group of developing preeclampsia and placental insufficiency.

Journal of obstetrics and women's diseases. 2017;66(3):25-33
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The intrapartum fetal occiput posterior position predictors
Arnt O.S., Bolotskikh V.M.

Abstract

Fetal malpresentation, including persistent occipitoposterior position, is a major cause of cesarean section. Maternal outcomes are often worse are more common than with fetal occiput anterior positions. To identify maternal risk factors associated with persistent occiput posterior position at delivery. Calculations were made to predict the implementation of the fetal rotation.

Journal of obstetrics and women's diseases. 2017;66(3):34-41
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The contribution of polymorphism in VDR gene FОKI in the development of osteopenia in pregnancy
Bibkova O.S., Sudakov D.S., Bogdanova E.O., Shaporova N.L., Zazerskaya I.E., Galkina O.V., Dymarskaya Y.R.

Abstract

The study involved 89 postpartum women and 97 nonpregnant women aged 20 to 35 years. The results of a genetic test compared with the BMD. In parturients in the lumbar spine the highest IPC and the value of the Z-scores were in patients with genotype FF, and the lowest with the genotype ff. Patients with the heterozygous genotype were charac terized by intermediate values of the BMD and Z-scores in the lumbar spine. A similar results was observed in the proximal femur and the distal forearm. The results of the correlation analysis showed a moderate negative correlation between the ff genotype and the level of BMD in lumbar spine (r = –0,44; p < 0.05) and proximal femur (r = –0.37; p < 0.05).

Journal of obstetrics and women's diseases. 2017;66(3):42-48
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Expression of cd35 and cd57 in placenta of women with asthma
Dymarskaya Y.R., Zubzhitskaya L.B., Lavrova O.V., Shapovalova E.A., Sudakov D.S.

Abstract

Background. Prevalence of asthma (BA) among pregnant women reaches 12%. Obstetric complications (preeclampsia, placental insufficiency, IUGR, etc.) mainly occur in the absence of control of asthma. Aspects of the placenta status in women with chronic allergic respiratory disease are not well understood.

Purpuses and tasks — studying the expression of markers of immature dendritic cells (CD35) and natural killer (CD57) cells in the placenta of patients with asthma, depending on the of severity, control and the type of therapy.

Materials and methods. The study involved 200 pregnant women, including 170 with asthma (44 patients with mild intermittent, 52 with mild persistent, 61 with moderate and 13 with severe asthma), and 30 patients without pulmonary and allergic diseases. We analized complications and pregnancy outcomes, conducted the immunohistochemical study of placental samples of 134 patients for the expression of CD35 (marker of immature dendritic cells) and CD57 (marker of NK cells) on cryostat sections, immunomorphological study of the placenta with determination of the fixation of pathogenic immune complexes (PIC), IL-6, IL- 4, IL-10 in the placenta.

Results. CD35 expression in the placenta of women with asthma is increased, while in patients undergoing preeclampsia CD35 expression is lower, especially in cases of uncontrolled asthma in the 3rd trimester. In all cases with persistent and incompletely controlled asthma, the expression of the natural killer marker (CD57) in the placenta correlates with the presence of PIC, IL-6, IL-4, IL-10 and inflammatory changes in the placenta. Conclusions. The results of the study suggest that a decrease in CD35 expression in cases with the combination of uncontrolled persistent asthma and preeclampsia seems to deplete the mechanisms of the immune response. Increased NK cell marker expression (CD57) in the placenta of women with uncontrolled and persistent asthma indicates on the cytotoxic role of this subpopulation of cells, leading to morphological and immune changes in the placenta that adversely affect the fetus and newborn.

Journal of obstetrics and women's diseases. 2017;66(3):49-59
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The state of the local immune status, the content of neopterin and cortisol in different variants of preterm labor
Katkova N.Y., Bodrikova O.I., Sergeeva A.V., Andosova L.D., Shahova K.A., Bezrukova I.M., Pokusaeva K.B., Ryzhova N.K.

Abstract

Premature labour (PL) is one of the most actual and unsolved problem of obstetrics. There are many data in the li terature about the role of the disturbed ratio of pro- and antiinflammatory cytokines, neopterin in the implementation of PL. Many authors support the theory of the predominant fetus factor in the initiation of PL.

The goal of our research is studying of the characteristics of the local immune status, neopterin and cortisol levels in various variants of preterm labour.

Materials and methods. 77 patients were divided into 2 groups. The main group (52 pregnant women with PL) was also divided into 2 subgroups: the first (1A) subgroup consisted of 28 pregnant women with premature rupture of membranes (PROM) without regular labour contractions. Another subgroup (1B) was presented by 24 women with labour activity and unruptured amniotic sac (true PL). In the control group we included 25 women with term labour. The level of the expression of mRNA genes of a congenital immunity in a cervical canal by the test-system ImmunoQuantex (IL1B, IL10, IL18, TNF2, TLR4, GATA3, CD68, B2M), as well as serum levels of neopterin and cortisol. The results were analyzed by standard statistical methods.

Results. There were no significant difference in the expression levels of most of the genes of innate immunity between the study groups (p > 0.05). The investigation of expression of TLR4, GATA3 genes in different types of PL revealed a significant decrease (p < 0.05) in patients with PROM (1A subgroup). In addition in the 1A subgroup the inflammation index was higher (Me = 99,5%, p < 0.01). There were no fundamental difference in the state of the local immune status between groups of true preterm and term labour. Analysis of neopterin content among the subjects showed a significant increase in the main group (PL) compared with the control group (p = 0.0064). The comparison of the neopterin level between different variants of PL had a higher index (p < 0.025). The concentration of cortisol in the study groups had no principle difference from the main (PL) group and control group (p > 0.05). The maximum cortisol level was found in the subgroup 1B (true PL), which is significantly higher than in the subgroup 1A (with PROM) and in the control group (p < 0.01).

Conclusion. The difference in the state of local immune status in different variants of premature labour demonstrates different mechanisms of initiation of preterm labour. It is likely that the ratio of TLR4/GATA3 and index of inflammation determins the onset of preterm labour. The level of neopterin can be used as a marker of the onset of PL. The increase of cortisol determines the role of the fetus factor in the onset of labour.

Journal of obstetrics and women's diseases. 2017;66(3):60-70
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Advisability of using early generation Cephalosporines for prevention and treatment of postpartum infection
Korobkov N.A.

Abstract

Introduction: the following research investigates an availability of a long-lime treatment of postpartum infection by using of Cephalozolin (the Cephalosporine of generation I).

Matherials and Methods. Lochia samples were obtained from the uterine cavities of 21 puerperal women who did not receive drug after delivery and were cultured for the identification and the determination of the susceptibilities of the clinical isolates to Cephalozolin. The concentrations of Cephalozolin in the supernatants were measured by highperformance liquid chromatography.

Results. We determined the sensivity of the most clinically important bacteria to Cephazoline and its penetration rate to the uterine cavity. We found out the following bacteria which are sensible to Cephazoline – S. agalactiae, E. coli, K. pneumoniae, E. aerogenes. A low rate of Cephazoline ≤ 0,78 mg/ml was inhibited the growth of mentioned above bacteria. Cephazoline is also active as for S. aureus – MIC90 and was equal 3.13 mg/ml. In 3 hours after the injection of 1.0 gr of Cephazoline there was a maximum concentration in a venous blood – 1.63 mg/ml. The concentration of Cephazoline in lochia was rising gradually and it maximum in the uterus cavity in 5 hours was 1.26 mg/ml, and then its slowly went down.

Conclusions. The mention above results let us suggest that Cephazoline is penetrates actively to lochia and its still has a good antibacterial effect. Cephazoline is still a treatment of choice as for prevention and a treatment of postpartum surgical site infections by a sensitive microorganism.

Journal of obstetrics and women's diseases. 2017;66(3):71-74
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Pregnancy outcomes features in patients with different severity of asthma
Lavrova O.V., Shapovalova E.A., Dymarskaya Y.R.

Abstract

Purpose of the study. The study of the peculiarities and outcomes of pregnancy and neonatal status in patients with bronchial asthma (BA).

Materials and methods. Studied the course of pregnancy and delivery 1800 women suffering from BA. Patients were conducted and surveyed throughout the period of gestation simultaneously with pulmonologist and obstetrician; thus it was formed a complex of treatment and preventive measures, made recommendations for the primary prevention of allergic diseases of unborn child.

Results. The increase in pregnancy complications in patients with asthma is directly related to the lack of control of the disease, especially in the first trimester of gestation. The lack of ade quate treatment of asthma increases the risk of different pregnancy complications, which has a direct effect on the health status of newborns.

Conclusion. Even severe asthma, is not a contraindication to pregnancy. The main condition for the safety pregnancy and delivery is the timely appointment of a set of preventive and therapeutic measures for control of the disease that not only improve the quality of life of women during gestation, but also improve health status of newborns.

Journal of obstetrics and women's diseases. 2017;66(3):75-81
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The experience of vaginal birth after cesarean delivery in the Maternity home No 13 of Saint Petersburg
Leonova M.D., Frederiks E.V., Dymarskaya Y.R.

Abstract

Introduction. In developed countries the attempts of vaginal delivery after cesarian section are not an unjustified risk, but considered the most favorable outcome. In Russia, unfortunately, obstetricians do not risk offering a vaginal birth to pregnant women after cesarian section, and outpatient doctors often adjust the abdominal delivery from early stages of pregnancy.

The aim of the study: to identify specifics of labor and outcome of delivery for vaginal birth after previous cesarean and determine possible ways to reduce the frequency of abdominal delivery in these patients.

Materials and methods. We conducted a retrospective analysis of 337 histories of delivery of patients after previous cesarean in 2016 in “Maternity hospital No 13”. The main group consisted of 189 patients to whom vaginal birth was planned, of which 82 patients completed the birth in accordance with the previous plan (subgroup 1) and 107 women completed cesarean section (group 2). The control group consisted of 148 women who had cesarean delivery without trial vaginal delivery.

Results. Among the indications for the first cesarean section in the subgroup 1 were: breech malpresentation – 19.7%, fetal hypoxia – 22.4% and abnormalities of the uterine contractile activity – 13.2%. The most common indications for a second operation in the 2nd subgroup were: premature rupture of amniotic fluid and absence of spontaneous labor (28%), lack of cervical muturity (21.5%), abnormalities of the uterine contractile activity (18.7%), fetal hypoxia (14%), abnormal preliminary period (13.1%), placental abruption (1.9%), absence of the effect of induction (amniotomy) (1.9%), cepalopelvic disproportion (0.9%). Thus, the percentage of success of vaginal delivery was 43.3%. At the same time, the fact of the presence of uterine contractions during the previous delivery did not affect the mode of delivery in this pregnancy. The volume of blood loss in cases of vaginal delivery was significantly less than in the subgroups of patients delivered by cesarean section.

Conclusions. The analysis may lead to reviewing indications and terma for the birth after cesarean. Reserve groups have been defined for high chances of vaginal delivery: prolongation of pregnancy up to 41 weeks, induction and augmentation of labor, conservative management of labor with presumed macrosomia, that may help reduce the frequency of repeated abdominal delivery, development of intra- and postoperative complications.

Journal of obstetrics and women's diseases. 2017;66(3):82-88
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Treatment of diffuse toxic goiter during pregnancy
Lovkova J.S., Potin V.V., Tkachenko N.N., Shelayeva E.V.

Abstract

We have studied an influence of diffuse toxic goiter on the flow and outcome pregnancy. 67 pregnant women with diffuse toxic goiter were examined. The group of comparison consisted of 38 pregnant women without thyroid pathology. The levels of free thyroxin, TSH, autoantibodies to TSH-receptors and autoantibodies to thyreoperoxidasis in the blood of pregnant women and umbilical cord blood and ultrasound of the thyroid gland of newborns were analyze. Pregnancy and childbirth of the women with unresolved thyrotoxicosis were more complicated by the threat of termination of pregnancy, preeclampsia, chronic placental insufficiency, preterm rupture of membranes, fetal hypotrophy and hypoxia. A high incidence of subclinical hypothyroidism (more 50%) in newborns is associated with the transplacental pass thyreostatic drugs. Subclinical hyperthyroidism in 17% of newborns should be associated with the transplacental transition from the mother to the fetus of autoantibodies to TSH-receptors.

Journal of obstetrics and women's diseases. 2017;66(3):89-96
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Asymptomatic placental abruption in the third trimester of pregnancy
Nagorneva S.V., Prokhorova V.S., Shelaeva E.V., Tral T.G., Sosnina A.K., Tolibova G.H.

Abstract

The article presents 3 clinical cases of asymptomatic placental abruption, diagnosed occasionally during routine ultrasound. There were analyzed risk factors of placental abruption: thrombophlia, diabetes, perinatal losses. All cases demonstrated complete coincidence of ultrasonic and morphological data in placental abruption. The patients had been delivered successfully due to correct diagnostics and severe maternal and fetal complications were not realized.

Journal of obstetrics and women's diseases. 2017;66(3):97-104
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Standard approach to ultrasound investigation of monochorionic twin pregnancy in centers of primary and secondary level of care
Nekrasova E.S.

Abstract

Introduction. Management of multiple pregnancy complicated by twin-to-twin transfusion syndrome (TTTS) is one of the most difficult parts of contemporary obstetrics. This syndrome develops only in presence of anastomoses in common placenta of monochorionic twins. Without intrauterine correction of severe TTTS in 80-100% of cases one or both twins die in utero.

The aim of this study is to define the signs that can help in differentiation of monochorionic twins to low or high risk group that needs to be managed in centers of secondary level of care. We investigated 115 monochorionic twin pregnancies at gestational age weeks.

Materials and methods. There was 214 ultrasound and Doppler studies in total.

Results. We measured biometric parameters of both fetuses and PI in umbilical artery, ductus venosus and middle cerebral artery. We demonstrated that monochorionic twins with weight difference less than 15% and normal amniotic fluid can be managed in centers of primary level of care, whereas fetuses with weight difference more than 15% and olygohydramnion/polyhydramnion sequence need to be transfered to the special centers of secondary level of care. Appearance of reversed blood flow in umbilican artery of the donor twin or ductus venosus of the recipient twin is indicative for in utero laser coagulation of placental anastomoses.

Journal of obstetrics and women's diseases. 2017;66(3):105-109
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Peculiarities of placental microRNA expression in pregnancies complicated by gestational diabetes mellitus and preeclampsia
Pakin V.S., Vashukova E.S., Kapustin R.V., Arzhanova O.N., Glotov A.S., Baranov V.S.

Abstract

The aim of study was to determine feasible changes of placental miRNAs expression profiles revealed by next generation sequencing (NGS) in pregnancies with GDM complicated or not with PE. Out of 27 miRNAs, studied expression was significantly different (FDR < 0.05) only for his-miR-45a. Comparative analysis of revealed reliable differences in expression of hsa-miR-4532 (p < 0.0001, FDR = 0.0008), hsa-miR-34c-5p (p < 0.0001, FDR = 0.0083), and hsa-miR-193b-5p (p < 0.0001, FDR = 0.0139) in pregnancy complicated by PE, without of GDM. The present results suggest that GDM and PE are associated with specific alterations in the placental miRNA expression profiles. Further studies are needed to verify the role of these microRNA in molecular mechanisms underlying GDM and PE pathogenesis.

Journal of obstetrics and women's diseases. 2017;66(3):110-115
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Hypercortisolism and pregnancy
Repina M.A.

Abstract

In this study we retrospectively analyzed data from 221 autopsy protocols of maternal mortality 1996-2015 years. Pathology of adrenal cortex detected in 11 dead. Microadenoma with or without adenomatous hyperplasia of adrenal cortex detected in 8 dead, simple hyperplasia detected in 3 dead. In one case detected bilateral diffuse nodular hyperplasia adrenal cortex in combination with focal adenomatous hyperplasia basophil adenocytes pituitary. In this article presented the background pathology analysis, course and outcomes of the last pregnancy. The conclusion was that the microadenomas of adrenal cortex rarely remain asymptomatic incidentalomas, but more often occur the subclinical or clinical hypercortisolism. The pregnancy on their background carries a high risk of developing of serious complications.

Journal of obstetrics and women's diseases. 2017;66(3):116-123
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Рlacental chorioangiomas: diagnosis and management
Shelaeva E.V., Prokhorova V.S., Nagorneva S.V.

Abstract

Four cases of pregnancies with nontrophoblastic placental tumor – chorioangioma are presented in this article. Clinical symptoms depend on tumors size, vascularisation and histological types (angiomatoid, cellular and degenerative). Small tumors with poor vascularisation are essentially asymptomatic. Large ones can act as peripheral arteriovenosus shunts resulting in fetal functional disorders (polycythemia, hypervolemia, ventriculomegaly) associated with acute polyhydramnion, premature labor, maternal and neonatal complications. The role of ultrasound and color Doppler examinations, invasive procedures (amniocentesis) in the diagnosis of chorioangioma and management of such pregnancies are discussed.

Journal of obstetrics and women's diseases. 2017;66(3):124-134
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Endometrial receptivity in women with disoders in reproductive system
Aganezov S.S., Aganezova N.V., Morotskaya A.V., Ponomarenko K.Y.

Abstract

Problems in the realization of childbearing are relevant in the medical, socio-economic and personal-psychological aspects. The endometrial factor occupies a significant place in the polyethiologic syndrome of reproductive losses. The full receptivity of the endometrium at the time of interaction with the blastocyst causes a successful completion of implantation and further progression of pregnancy. The review presents an analysis of current data on the morphological and proteomic (ultrastructural) levels of the receptivity of the endometrium and their role in the genesis of reproductive dysfunctions.

Journal of obstetrics and women's diseases. 2017;66(3):135-142
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Role of natural killer cells in reproductive failure
Agnaeva A.O., Bespalova O.N., Sokolov D.I., Selkov S.A., Kogan I.Y.

Abstract

Reproductive losses are quite frequent in the modern world. They include: infertility, infertility of unknown etiology, multiple losses when IVF, recurrent implantation failure, miscarriage, recurrent miscarriage, both in the natural cycle and after ART management. It is important to note that the classification of some of these categories are not established yet. The etiology of reproductive losses is extremely diverse. Successful development of pregnancy at early terms is determined by genetic and immunological factors. Among the reproductive failures of unclear etiology, immunological causes are 50-80%. Over the past 20 years there are already known many different immunological factors that play role in the processes of fertilization. In this case, the evidence base on the role of each of them in the pathogenesis of reproductive failures is only being formed. Currently, the immunological relationship between mother and fetus is considered as a two-way communication process: the presentation of fetal antigens on the one hand, and on the other – the recognition and response to these antigens of the maternal immune system. Implantation of the embryo is accompanied by an increase in the production of proinflammatory cytokines followed by a sharp change in the cellular composition in the decidualizing endometrium, and the main population is NK cells. That is why this type of cells have a significant role in the normal development of pregnancy. The properties of NK cells in the uterus and peripheral blood are significantly different. To predict the onset and prolongation of pregnancy, peripheral blood NK (activity and quantity) is used. Evaluation of endometrial NK is often performed for the diagnosis of chronic endometritis. Currently, the definition of NK cells in peripheral blood in many clinics is proposed as a useful diagnostic test to address the issue of further appointment of immunoglobulins and evaluating the effectiveness of this therapy in patients with reproductive losses.

Journal of obstetrics and women's diseases. 2017;66(3):143-156
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Selection of the method for correction of cervical incompetence
Bespalova O.N., Sargsyan G.S.

Abstract

Cervical incompetence (CI) is one of the challenges of modern obstetrics. The practicing obstetrician-gynecologist faces a complex task of timely diagnosis, selection of correction method, timing of application and removal of cerclage. The problem of CI in pregnancy is known from the XIX century, but in the XI century, the outstanding scientist Abu Ali Ibn Sina (Avicenna) wrote about this pathology. According to the classical definition, CI is the softening, widening and shortening of the cervix prior to the 37th week of gestation in the absence of thretening termination of pregnancy. CI is characterized by inability to carry a pregnancy to full-term due to functional or structural abnormalities of the uterine cervix. To date, no objective diagnostic tests exists to identify patients at high risk of developing CI, not before and not during pregnancy. A high diagnostic accuracy during pregnancy can be reached with transvaginal ultrasound of the cervix. The ultrasound scale proposed by Salomon LJ allows to measure the length of the cervix depending on the gestational age and assists in making the right choice for the correction of short cervix. The selection of the method of correction of CI depends on the clinical situation, history, timing of gestation, the number of fetuses, cervicometry data, gynecological examination, the threat of abortion, and the doctor’s experience. There are two main methods of correction of CI: conservative and surgical. Surgical methods include transvaginal and transabdominal cerclage, while conservative includes adherence to bed rest, tocolytics, hormonal therapy, and the use of obstetric pessaries. Insertion of obstetric pessaries is a promising, safe, simple method of treatment and prevention of CI and for threatening termination of pregnancy in the II and III trimesters. The strategy of widespread use of pessaries in pregnant women from high-risk groups can reduce the frequency of preterm labor and improve perinatal outcomes.

Journal of obstetrics and women's diseases. 2017;66(3):157-168
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Aromatase inhibitors in “poor” ovarian responders undergoing in vitro fertilization
Merkulova A.I.

Abstract

Since the IVF treatment expands worldwide, it has become apparent that a proportion of women responds suboptimally to controlled ovarian stimulation with exogenous gonadotrophins. There is still no consensus on the ideal controlled ovarian stimulation protocol for patients with “poor” ovarian response. Many strategies have been studied. However, no compelling advantage for one treatment protocol over another has been identified. The addition of aromatase inhibitors in “poor” responders stimulation protocols is described in this article.

Journal of obstetrics and women's diseases. 2017;66(3):169-175
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