Vol 66, No 6 (2017)

Articles
The experience of impplamination “near-miss” obstetric bleeding and preeclampsia in deliveryhomes of the Tajikistan
Davlyatova G.K., Kamilova M.Y., Ishan-Khodzhaeva F.R.
Abstract

Background. The investigation, holding estimations methods quality aid for mothers introduction, isactuality, because have the practical importance.

Aim – to estimate the “near-miss” obstetric bleeding and preeclampsia imp lamination methods.

Materials and methods. The estimation testing results before and after study seminar and hole estimations of practice using “near-miss» obstetric bleeding and preeclampsia.

Results. The study of “near-miss” principles with using interactive methodology is effectively. The monitoring with using hole estimations of practice using “near-miss” help find severe and poorly sides.

Conclusion. Interactive study of “near-miss” principles and methodology with following monitoring help to successful imp lamination this instrument in practices delivery homes.

Journal of obstetrics and women's diseases. 2017;66(6):5-11
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Experience of intrauterine application of anti-adhesive gel based on hyaluronic acid in the prevention of Asherman's syndrome in patients with the pathology of the uterine cavity and severe forms of endometriosis
Molotkov A.S., Popov E.N., Sudakov D.S., Aivazyan T.A., Alexandrova L.A., Dymarskaya Y.R.
Abstract

Introduction. One of the leading problems of modern reproductive surgery is treatment of adhesive disease, and in turn, prevention of intrauterine adhesions after intrauterine interventions is of particular interest.

Purpose: to evaluate the effectiveness and safety of anti-adhesive gel “Antiadgesin” for intrauterine use in patients with a combination of pathology of the uterine cavity and severe forms of endometriosis.

Materials and methods. The study included 24 patients aged 23 to 39 years with a combination of pathology of the uterine cavity and severe forms of genital endometriosis. The main group consisted of 12 patients to whom the anti-adhesive gel “Antiadhesin” was applied at the end of the laparoscopic and hysteroscopic stages on the region of the ovaries, pelvic peritoneum in the areas of separation of the adhesions, and also inside the uterine cavity. The comparison group included 12 patients who received 0.9% sodium chloride solution (5 ml) on the surgical area. Patients of both groups underwent treatment with gonadotropin-releasing hormone agonists (GnRH-a) 3.75 mg for 4 months after the operation. We performed gynecological ultrasound 4 weeks after operation, 4 weeks after the last injection of GnRH-a, and after the first menstrual bleeding. Assessment of the state of the uterine cavity, diagnosis of intrauterine synechia was performed by hydrosonography.

Results. The duration of the operation, the amount of intraoperative blood loss did not differ significantly between the groups. In all patients, no complications of the postoperative period, no allergic or inflammatory reactions associated with the use of “Antiadhesin” were detected. The duration the uterine bleeding after the operation did not differ significantly between the groups. In 2 patients of the comparison group hydrosonography confirmed the adhesive pathology of the uterine cavity. In the main group there were not identified any signs of intrauterine adhesions by ultrasound. Within 12 months after the treatment, pregnancy occurred in 50% of the patients in the main group and in 33.3% of the patients in the comparison group.

Conclusion. The results of the study showed that the introduction of the anti-adhesive gel “Antiadgesin” in the uterine cavity after hysteroresectoscopy is a safe and effective method for preventing the formation of intrauterine synechia.

Journal of obstetrics and women's diseases. 2017;66(6):12-19
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Significance of ultrasound pelviometry in the diagnostics of anatomical and clinical narrow pelvis
Mudrov V.A., Chatskis E.M., Nizhegorodtseva D.A., Tttjan E.V.
Abstract

Rational management of labor with a narrow pelvis is one of the most difficult sections of practical obstetrics, because narrow pelvis is the main cause of birth trauma and childhood disability.

The aim of the study was to determine significance of ultrasound pelviometry in the diagnostics of anatomical and clinical narrow pelvis. On the basis of maternity hospitals of Trans-Baikal Region in the years 2013-2017 was held retrospective and prospective analysis of 150 labor histories, which were divided into 3 equal groups: group 1 – pregnant women with normal sizes of the large pelvis, group 2 – pregnant women with macrosomia, group 3 – pregnant women with a reduced sizes of the large pelvis. Ultrasonic pelvimetry included measurement of direct and transverse sizes of the planes of the pelvic cavity and the angle of the pubic arc through the integrated use of abdominal, transvaginal and translabial sensors of ultrasound machine Toshiba Aplio 500. In the group of pregnant women with normal sizes of the large pelvis frequency of diagnosis of anatomical narrow pelvis used by ultrasound pelvimetry is 32%. In the group of pregnant women with macrosomia is dominated the normal size of the pelvic cavity (62%) and “wide pelvis” (18%). In 20 % of cases the diagnosis of anatomical narrow pelvis in group 3 was not confirmed by the data of ultrasonic pelvimetry. The most common forms of the narrow pelvis were the transversal pelvis (46%), the simple flat pelvis (14%), the uniformly narrow pelvis (10%). On the basis of mathematical modeling defined pattern, which is expressed by the formula:

where AE – angle extension of the head, PC – angle of the pubic arc, TD1 – transverse size of the plane of the entrance, TD2 – transverse size of the plane of the output, FD1 – direct size of the plane of the entrance, FD2 – direct size of the narrowest part of the pelvic cavity, GA – gestational age, BPD – biparietal size, OFD – fronto-occipital size of the fetus’s head. When the value of the coefficient less than 1 is projected clinically narrow pelvis (r2 = 0,92). Thus, ultrasonic pelvimetry allows to determine not only the size of the pelvic cavity, but also to predict clinically narrow pelvis.

Journal of obstetrics and women's diseases. 2017;66(6):20-29
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Bacterial communities forming the vaginal micro-ecosystem in norm and in bacterial vaginosis
Nazarova V.V., Shipitsyna E.V., Shalepo K.V., Savicheva A.M.
Abstract

Background. Bacterial vaginosis (BV) is disturbance of the vaginal microbiota, characterized by displacement of lactobacilli with anaerobic bacteria and capable of adversely affecting women’s reproductive health. In the development of BV, a wide spectrum of bacteria substantially differing in their properties is involved. Grouping vaginal bacterial communities into clusters, or types of microbiocenosis, might contribute to understanding of pathogenic mechanisms and elaboration of effective tools for diagnostics and therapy of the disease.

Aim. Determination and comparative analysis of clusters of vaginal bacterial communities in norm and in BV.

Materials and methods. Women of reproductive age were enrolled in the study. For the diagnosis of BV, the Nugent score was used. Vaginal swab samples from all women were analyzed with the test Femoflor-16, intended for evaluation of the vaginal microbiocenosis using multiplex quantitative real-time PCR. Two-step cluster analysis was applied for grouping bacterial communities. Differences between the clusters were evaluated using pairwise comparisons.

Results. Of 280 women enrolled in the study, 172 had normal microflora, 27 – intermediate microflora, 81 – BV. In cluster analysis, 270 samples valid in PCR testing were included. All the vaginal bacterial communities were grouped into 4 clusters. Cluster 1 (n = 171) included cases when the vaginal microflora consisted mostly of lactobacilli. Cluster 2 (n = 11) encompassed cases of domination of aerobic microflora: Enterobacteriaceae, Streptococcus and Staphylococcus. Clusters 3 (n = 57) and 4 (n = 31) were connected with BV and included cases of prevailing of facultative anaerobes (Gardnerella vaginalis, Atopobium vaginae) and obligate anaerobes (Sneathia/Leptotrichia/Fusobacterium, Megasphaera/Veillonella/Dialister, Lachnobacterium/Clostridium), respectively. Nearly all cases of cluster 1 belonged to the category of normal microflora of the Nugent score. The majority of bacterial communities of cluster 2 matched intermediate microflora, cluster 3 – BV category with a score of 7 or 8, cluster 4 – BV category with a score of 9 or 10. The clusters differed significantly in vaginal рН, with the highest values observed for cluster 4.

Conclusions. Vaginal bacterial communities are grouped into 4 main clusters, characterized by domination of lactobacilli, aerobes, facultative anaerobes or obligate anaerobes. The clusters belong to different categories of the Nugent score and differ significantly in vaginal pH.

Journal of obstetrics and women's diseases. 2017;66(6):30-43
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Frequency and risk factors of colonization of pregnant women with group B streptococci
Khvan V.O., Shipitsyna E.V., Zatsiorskaya S.L., Grinenko G.V., Shalepo K.V., Savicheva A.M.
Abstract

Background. Group B streptococci (GBS) are opportunistic bacteria capable of causing severe infections in pregnant women and newborn infants. For effective prevention of obstetrical and perinatal GBS-associated pathology, investigation into epidemiology of GBS carriage and GBS-associated diseases, as well as elaboration of accurate and rapid methods for GBS detection are necessary.

Objectives. Validation of a molecular test for the detection of GBS and evaluation of frequency and risk factors of colonization of pregnant women with this microorganism.

Methods. For validation of PCR test for the detection of GBS DNA (AmpliSens Streptococcus agalactiae-screen-titer-FL, Central Research Institute of Epidemiology, Moscow), 1496 clinical samples from 650 women and 112 newborn infants submitted for routine GBS culture were used. For evaluation of frequency and risk factors of GBS-colonization during pregnancy, clinical samples (urine, vaginal and rectal swab samples) from 496 women at their first prenatal visit before 12 weeks of gestation were used. GBS testing was performed using culture and the validated PCR test. For evaluation of risk factors, binomial logistic regression was used.

Results. PCR method for GBS DNA detection showed high analytical sensitivity (3 ∙ 102 copies/ml) and specificity (no cross-reactions with other microorganisms). Diagnostic sensitivity and specificity of the test (81 and 97.6%, respectively) were comparable with those of culture (77.6 and 100%, respectively). GBS was detected in 16.3% of pregnant women. Testing of rectal samples in addition to vaginal samples enabled to detect 66.7% more cases of GBS carriage. Women aged 18 to 22 years had a higher risk of GBS colonization during pregnancy than older women (23 to 32 years). At the same time, women who had their sexual debut at an older age (after 18) were significantly more often colonized during pregnancy than women started their sex life at a younger age (before 18).

Conclusion. PCR method for GBS detection has high sensitivity and specificity and can be used as an alternative to culture. Simultaneous testing of vaginal and rectal samples increases the sensitivity of revealing colonized women by two thirds in comparison with testing vaginal samples only. Younger age and later sexual debut are independent risk factors for GBS colonization during pregnancy.

Journal of obstetrics and women's diseases. 2017;66(6):44-58
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Chronic polypoid and lymphofollicular endometritis: hysteroscopic and histologycal diagnostic
Ellinidi V.N., Feoktistov A.A., Lyamina A.V., Obidnyak D.M., Suvorova I.Y.
Abstract

Complex clinic-morphological study of uterine cavity scraping and a comparative hysteroscopic study of 964 women with infertility and unsuccessful IVF attemps were carried out. For the first time two prognostically meaningful clinic-morphological forms of chronic endometritis-polypoid and lymphofollicular are described. Specific features of their typical gradual morphogenesis and features of chronicity of diagnostic value are established. An algorithm for histological and hysteroscopic diagnostics is introduced.

Journal of obstetrics and women's diseases. 2017;66(6):59-65
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The content of matrix metalloproteinase-12 in pregnancy complicated by preeclampsia
Yakovleva N.Y., Vasileva E.Y., Kuznetsova L.V., Shelepova E.S., Khazova E.L., Repinskaya E.A.
Abstract

Relevance. Pre-eclampsia is the most difficult and important problem in obstetrics, it ranks third in the structure of maternal mortality. Until now, there is no single idea of the mechanisms of development of this pathological process. The study of the concentration of MMP-12 in pregnancy will determine its possible role in the development of pre-eclampsia.

Aim. Сompare the dynamics of the concentration of matrix metalloproteinase-12 (MMP-12) in pregnancy complicated and not complicated by preeclampsia.

Materials and methods. A prospective study of two groups of women: the main group is pregnant (n = 17) with preeclampsia (moderate (n = 11) and severe (n = 6)), the comparison group is women whose pregnancy was not complicated by preeclampsia (n = 83). The concentration of matrix metalloproteinase-12 was determined by the method of enzyme immunoassay in serum at 11-13, 22-24, 32-34 weeks of gestation.

Results. In the group of pregnant women without preeclampsia, there was a sharp decrease in the concentration of MMP-12 from the I trimester to II (p = 0.0001), followed by a slight increase to the III trimester. In the group of pregnant women with preeclampsia, an increase in the concentration from the I trimester to II (p = 0.0001) was established. A significant difference in the concentration of MMP-12 between groups in the first trimester of pregnancy was shown (p = 0.0001).

Conclusion. Thus, the results of the study indicate the role of MMP-12 in the initial stages of placentation.

Journal of obstetrics and women's diseases. 2017;66(6):66-72
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Kisspeptin and polycystic ovary syndrome - is there any connection?
Yarmolinskaya M.I., Ganbarli N.F., Tkachenko N.N., Nikolaeva V.I., Tolibova G.K., Tral T.G., Rulev V.V., Tsypurdeeva A.A.
Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. It is known that kisspeptin stimulates activity of GnRH neurons and secretion of FSH and LH, thus disruption of interaction between kisspeptin and its receptor leads to anovulation. The aim of the study was to investigate the role kisspeptin in the pathogenesis of polycystic ovary syndrome. Materials and methods. The study included 14 patients with classic phenotype of PCOS and 11 healthy women of the control group. All the patients underwent laparoscopy and hysteroscopy with histological examination of ovarian tissue and endometrium. Determination of kisspeptin, FSH, LH, prolactin, AMH, estradiol, estrone, androgens (free testosterone and dehydroepiandrosterone sulfate) levels in peripheral blood in healthy women and patients with PCOS was performed by ELISA on the 2d and 8th days of menstrual cycle. Progesterone levels were investigated on the 18th-22d days of menstrual cycle. Expression of kisspeptin and its receptor in ovarian tissue and endometrium was estimated using immunohistochemical method. Results. Level of kisspeptin in peripheral blood of patients with PCOS tends to increase compared to its level in the control group, but the found difference was not reliable. Direct correlation between serum level of kisspeptin and levels of LH, free testosterone and DHEA-S was revealed in patients with PCOS. Immunohistochemical study in patients with PCOS showed a significant increase in the area of expression of КІЅЅ1 and KISS1R receptor in endometrium and in ovarian biopsies compared to these values in the control group. Conclusion. The obtained data show a definite role of kisspeptin in pathogenesis of polycystic ovary syndrome, but further research is needed.

Journal of obstetrics and women's diseases. 2017;66(6):73-80
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The role of vitamin D in the pathogenesis of genital endometriosis
Denisova A.S., Yarmolinskaya M.I.
Abstract

The influence of vitamin D on the women’s health is undeniable. Here we review the modern classification of vitamin D forms and receptors, the current understanding of genomic and non-genomic regulation pathways of vitamin D synthesis. It was found that a vitamin D deficiency related to the development of many diseases, negative impact on reproductive function and pregnancy outcomes. Nowadays, vitamin D is concerned as a prohormone that has multiple effects. Special attention is given to the role of vitamin D in the pathogenesis of genital endometriosis. It is known that vitamin D has anti-inflammatory, antiproliferative and immunomodulating effects, which allow it to be considered as a forward-looking target therapy in endometriosis.

Journal of obstetrics and women's diseases. 2017;66(6):81-88
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Current views on vaginal microbiota and its impact on pregnancy outcomes
Siniakova A.A.
Abstract

Vaginal dysbiosis is one of the leading causes of adverse pregnancy outcomes. The main role in maintaining the constancy of vaginal microbiocenosis belongs to lactobacilli. The infection process can be caused by both pathogenic and opportunistic microorganism, however, in the vast majority of cases vaginal infections is associated with the normal microflora. Violation of microbiocenosis of the vagina in combination with a cervical barrier failure leads to migration of bacteria in the amniotic cavity and the launch of the pathological mechanisms leading to pregnancy loss. The paper presents current data on the influence of vaginal infection on pregnancy loss. Consider the ability of Lactobacillus iners predispose to the development of pathological vaginal microflora. Attention was paid to the basic approaches to prevention and treatment of dysbiotic disorders. Discussion on the use of bacteriophages in obstetrics and gynecology.

Journal of obstetrics and women's diseases. 2017;66(6):89-100
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The analysis of complaints of patients obstetric institutions on issues of quality of care
Petrova N.G., Bolotskykh V.M., Yaroslavskiy K.V.
Abstract

The article presents the analysis of complaints in 75 patients obstetric hospital. It is established that in the structure of reduced complaints proportion of complaints about the organization of medical care and sanitary conditions and increased the quality of medical care. Of the total number of complaints 30.7% of substantiated. The highest percentage of complaints is necessary to work the receiving Department (33,3% of the total complaints) and women’s consultations (25.4%).

Journal of obstetrics and women's diseases. 2017;66(6):101-107
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