Vol 67, No 1 (2018)

Articles
Pathogenesis of ovarian dysfunction in women with diabetes mellitus 1 type
Tolpygina M.G., Abashova E.I., Borovik N.V., Tiselko A.V.

Abstract

The main ideas about the pathogenesis of ovarian dysfunction in women with diabetes mellitus (DM) type 1 are presented. The role of increased opioid and dopaminergic tone in the pathogenesis of reducing the synthesis of the gonadotropin-releasing hormone by the hypothalamus in women with type 1 diabetes was analyzed. Presented the data of relationship between ovarian hormonal insufficiency in women with type 1 diabetes with possible damage of positive feedback mechanism of the ovaries and the pituitary gland, which intactness is necessary for the maturation of the dominant follicle and ovulation. The results of studies, suggested that the high doses of exogenously administered insulin in type 1 DM lead to stimulation of androgen synthesis in teca cells and ovarian stroma and the development of ovarian  hyperandrogenemia, as well as polycystic ovary syndrome, are reduced. In addition to exogenous hyperinsulinemia, in the pathogenesis of ovarian dysfunction, the value of the deficiency of endogenous insulin, leading to a violation of steroidogenesis in the tissues of the ovary and anovulation, is proved. The role of insulin deficiency and hyperglycemia in the development of metabolic stress lead to ovarian dysfunction in patients with type 1 diabetes was analyzed.

Journal of obstetrics and women's diseases. 2018;67(1):5-12
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The influence of the using “near-miss” on some obstetric bleeging indicators
Davlyatova G.K., Kamilova M.Y., Rakhmatulloeva D.M.

Abstract

The article reviews the use of maternal near-miss in maternity hospitals of Tajikistan and its effect on selected indicatior of maternal bleedings. The implementation of standards and the use of near miss case review in 20 maternity hospitals was shown to decrease the rate of maternal bleedings, especially hypotonic bleedings, the rate of critical hypotonic bleedings, the rate of hysterectomy, and the ratio between deaths due to maternal bleeding in these maternity hospitals and overall maternal bleeding mortality. Our results confirm, that the use of “near-miss” strategy improves the quality of maternal medical care and allows to decrease overall maternal mortality.

Journal of obstetrics and women's diseases. 2018;67(1):13-19
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The influence of clinical and laboratory characteristics on psycho-emotional status in patients with endometriosis and infertility
Ishan-Khodzhaeva F.R.

Abstract

Background. The investigations of clinical, laboratory, psycho-emotional characteristics in patients with endometriosis and infertility are very actuality, because it’s results help to improve the prepare woman for infertility overcome.

Purpose — study the influence of clinical, laboratorycharacteristics of endometriosis on psycho-emotional status in patients with infertility.

Materials and methods. The psycho-emotional status estimated with using Spilberger-Chanin and Bek tests (71 patients). The levels of gonadotropic and steroid hormones in serum determined with method of immune-ferment analysis.

Results. The reactive anxiety was show in 67,4%, personal anxiety — in 11,6%, light depression — in 39,5% woman. There were estimate factors, which influence on psycho-emotional status in patients with endometriosis and infertility: duration of infertility and not effective from previously treatment, algomenorea, dispaneuria, low level of AMH and hormonal disorders, which connect with clinical symptoms of endometriosis.

Conclusion. The estimation psycho-emotional status and psychological support will conduce to optimization of infertility overcoming women with endometriosis and infertility.

Journal of obstetrics and women's diseases. 2018;67(1):20-25
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Features of women’s vaginal delivery with uterine scar at present stage
Mudrov V.A., Mochalova M.N., Mudrov A.A.

Abstract

Introduction. Presently, the delivery of pregnant women with scar on the uterus vaginally is a strategically important task, which provides a reduction in the frequency of caesarean section and related complications. An important role in the structure of contra-indications for the vaginal delivery is devoted to determining the viability of the uterine scar.

The aim of the study was to investigate the characteristics of delivery of pregnant women with uterine scar vaginally at the present stage of scientific development.

Materials: literary data of foreign and domestic authors in the period from 1979 to 2017.

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

Conclusion. It is necessary to determine the optimal algorithm for delivery of pregnant women with a uterine scar, which allows to optimize tactics of conducting such patients.

Journal of obstetrics and women's diseases. 2018;67(1):26-37
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Dysplasia of the connective tissue is a factor, aggravating menstrual pain syndrome in adolescent girls
Orlova V.S., Trushina O.V., Kalashnikova I.V.

Abstract

Background. Menstrual pain syndrome is accompanied by a complex of neurovegetative, metabolic-endocrine and psycho-emotional disorders. Dysplasia of connective tissue is characterized by a high level of functional disorders of the central and autonomic nervous system and emotional disorders.

Aim. Detection of features of a clinical current of primary dysmenorrhea in adolescent girls with signs an undifferentiated dysplasia of connecting tissue (UDCT). Materials  and methods. 210 adolescent girls at the age of 11–17 full years suffering primary dysmenorrhea were examined. Depending on the presence or absence of clinical signs of undifferentiated connective tissue, two groups were identified. The main group consisted of 120 patients, the comparison group comprised 90 patients. The severity of the menstrual pain syndrome was assessed using the three scales of the McGill Pain Questionnaire. For psychological testing was used a scale of self-assessment of anxiety of Ch.D. Spielberger – Yu.L. Khanina.

Results. In 90.9 ± 2.6% of patients of the main group the debut of a dysmenorrhea has taken place in the period of formation of menstrual function — within the first 2 years after menarche. The average value of the rank index of pain in the main group was higher than in the comparison group (3.5 ± 0.1 and 2.8 ± 0.1, p < 0.001). In an internal picture of perception of pain at patients of the main group the emotional component prevailed. Their psychoemotional status was distinguished by a higher level of the average score of reactive (45.3 ± 0.9 and 36.3 ± 1.4; p < 0.001) and personal (49.9 ± 0.6 and 41.4 ± 1.0; p < 0.001) of anxiety.

Conclusions. The obtained results give the grounds to consider the presence of clinical manifestations of an undifferentiated dysplasia of a connecting tissue in adolescent girls as a predictor, which is making heavier a clinical current of a menstrual pain syndrome.

Journal of obstetrics and women's diseases. 2018;67(1):38-46
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Experience of cyclooxygenase inhibitor use for correction of urine overproduction in incontinent women
Osipova N.A., Niauri D.A., Gzgzyan A.M.

Abstract

Hypothesis/aims of study. Questions of urine incontinence pathogenesis and ways of treatment are actively discussed by gynecologists, urologists and neuropathologists. Urine incontinence often has multifactor origin: the causes of urine incontinence are connected, as a rule, with violation of urine continence functional mechanisms, anatomical and topographical features of the lower urinary tract or an age failure of ovaries function. At the same time changes of kidneys function play part in urine incontinence pathogenesis. In some cases urine incontinence is combined with urine overproduction or inversion of circadian rhythm of renal function due to decrease in a reabsorption sodium ions in the thick ascending limb of a Henle’s loop. The reabsorption of Na+, K+, Ca2+, Mg2+, Cl– in this department of a nephron is increased by vasopressin activation of V2-receptors. In some patients we succeeded to normalize ions transport, diuresis, circadian rhythm of urine production by desmopressin administration, however in some cases significant decrease in a diuresis did not happen. The lack of therapy effect could be connected with local production of substances resisting to effect of this hormone, in particular prostaglandin E2. The current analysis was undertaken to evaluate the clinical efficiency of Diclofenac in incontinent patients with nocturnal polyuria and polyuria.

Study design, materials and methods. A total of 44 patients with complaints of urinary incontinence, polyuria (24-urine volume of 40 mL/kg bodyweight or above) or nocturnal polyuria (nocturnal volume/24-h urine volume of 0.33 or above) (Van Kerrebroeck P., 2002) and 14 control subjects were included. Mean patient age was 42.8 ± 4.5 years, in control subjects 39.4 ± 6.3 (p > 0.05). All participants performed 72h-urinecollection to determine the voided volumes and the levels of creatinine, osmolality, sodium, magnesium and potassium for each sample. A blood sample was taken during the 72-urinecollection to determine the levels of creatinine, osmolality, sodium, magnesium and potassium. The examination of patients with polyuria and nocturnal polyuria was performed twice: in the initial state and one month after the start of treatment with optimal dose of Diclofenac.

Results. In patients with polyuria and nocturnal polyuria the glomerular filtration rate was normal, whereas diuresis and solute (sodium, magnesium, potassium) clearance in night samples in nocturnal polyuria and both in night and day samples was higher. Diclofenac use had the normalizing effect on transport of ions in a nephron.

Journal of obstetrics and women's diseases. 2018;67(1):47-57
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Gonadotrophic pituitary incidentaloma as the cause premature ovarian insufficiency
Repina M.A.

Abstract

Objective: evaluate clinical significance pituitary incidentalomas, apparently derived from gonadotropocytes.

Design: follow-up study. Patients. Three observations of pituitary microadenomas in patients whose cause for treatment was prolonged amenorrhea. Diagnosed uterine hypoplasia, decreased ovarian reserve, decreased bone mass. Patients combined expressed psycho-emotional symptoms (depression, neuroticism up to mental disorders in one case). The diagnosis of a gonadotrophic incidentaloma is suspected after exclusion of clinical and laboratory signs of prolactinoma, somatotrophic, corticotrophic and thyrotrophic adenoma.

Results. In two cases, the clinical picture of severe estrogenic failure was combined with high concentrations FSH, LH and low concentrations of anti-mullerian hormone (AMH). The increase in gonadotrophines, obviously, was both a reaction to a decreased production of estrogens, and the result of their hypersecretion by adenoma. In the observed cases there was no development of ovarian cysts, characteristic for patients with gonadotrophic adenomas, which can be explained by a reduced ovarian reserve. In the third case marked initially normal secretion of FSH and LH, not corresponding to a low concentration of sex steroids. Further there was a complete cessation of the secretion of FSH and LH with a simultaneous rapid decrease in the secretion of AMH. Given the small size of adenomas, in all cases selection of tactics for dynamic observation. All patients were prescribed hormone replacement therapy.

Conclusion. For patients with premature ovarian failure, it is advisable to carry out MRI with contrast enhancement to exclude pituitary adenoma.

Journal of obstetrics and women's diseases. 2018;67(1):58-64
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Pathogenetic determinants of endometrial dysfunction in patients with myoma
Tolibova G.K.

Abstract

Introduction. Among the patients with infertility associated with small forms of uterine fibroids (subserous and intra mural), there are a high incidence of inflammatory changes in the cervix, chronic salpingo-opharitis, hydrosalpinx, adhesive process in pelvic organs, chronic endocervicitis and endometrial dysfunction were identified more frequently.

The aim of the study was to investigate the clinical and morphological features of endometrial dysfunction in patients with infertility associated with uterine myoma. Material and methods. The study included 165 patients: 70 patients with primary infertility, 65 women with secondary infertility and 30 patients in the control group. All patients were examined and treated in The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott. Laparoscopic and hysteroscopic examination followed by endometrial biopsy was performed on the 19-24th day of the menstrual cycle. Immunohistochemical method was used to study the expression of ER, PR receptors, proinflammatory markers (CD8+, CD20+, CD4+, CD138+), endothelial marker (CD34+) and p16ink4a oncoprotein expression. Estimation of ER and PR expression was carried out by semi-quantitative method of H-Score, other markers, by computer image analysis system “Morphology 5.0” (VideoTest, Russia). Statistical processing of the results was performed using statistical packages (Stata 13).

Results. In group of patients with infertility associated with small forms of subserous and intramural uterine myomas, pathognomonic signs of endometrial dysfunction were: high frequency of chronic endometritis, pathological activation of neoangiogenesis, positive expression of inhibitor of cyclin-dependent kinase p16ink4a, reduction of ER and PR expression in the stromal endometrial component, change in receptor affinity of sex steroid hormones.

Journal of obstetrics and women's diseases. 2018;67(1):65-72
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Clinical and microbiological rationale for the prophylaxis of obstetric and perinatal pathology caused by group B streptococci
Khvan V.O., Shipitsyna E.V., Zatsiorskaya S.L., Grinenko G.V., Shalepo K.V., Savicheva A.M.

Abstract

Background. Bacteriuria caused by group B streptococci (GBS) is a major risk factor for neonatal GBS associated pathology and a risk factor for pregnancy complications such as preterm birth and preterm rupture of membranes.

Objective. Clinical and microbiological rationale for the prophylaxis of obstetrical and perinatal pathology associated with group B streptococci. Methods. A total of 496 pregnant women who made their first prenatal visit within first 12 weeks of gestation were invited to participate. As clinical samples, mid-stream urine, vaginal swabs, rectal swabs from women and inguinal swabs, urine, meconium from newborn infants were used. GBS detection was performed using culture and PCR.

Results. The frequency of GBS detection was 16.3%. GBS associated bacteriuria was detected in 9.8% of the women. The women having GBS in urine at the beginning of pregnancy were significantly more often colonized with the microorganism late in pregnancy in comparison with the women with GBS-colonization of the vagina and/or rectum. Microbiological efficiency of antibiotic therapy of GBS associated bacteriuria using amoxicillin/clavulanic acid exceeded 70%. Clinical efficiency of the therapy consisted in the reduction of preterm birth and preterm rupture of membranes by 25% and 40%, respectively.

Conclusions. Antibiotic therapy of GBS associated bacteriuria results in a decrease of pregnancy complication, which necessitate its use. GBS-colonization of the vagina and rectum in pregnant women is transitory therefore antenatal screening for GBS aimed to prevent neonatal GBS-infection should be performed late in pregnancy or before delivery.

Journal of obstetrics and women's diseases. 2018;67(1):73-84
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The role of melatonin in development of gestational diabetes mellitus
Aulamazyan E.K., Evsyukova I.I., Yarmolinskaya M.I.

Abstract

This review summarizes many of the published reports about the production of melatonin and it’s role in regulation of carbohydrate metabolism, interrelationships between melatonin, insulin, glucagon and diurnal signaling the blood-glucose-regulating of the islet. The results of experimental and clinical investigations support that low melatonin levels and absence it’s circadian rhythm play the role in the development of gestational diabetes mellitus in womens with pathology of neuroimmunoendocrinology system and suggest the possibility of prognosis and prophylactic this complication of pregnancy.

Journal of obstetrics and women's diseases. 2018;67(1):85-91
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A preimplantation genetic testing of monogenic diseases. Description of clinical case
Kogan I.Y., Iakovlev P.P., Gzgzyan A.M., Mekina I.D., Maretina M.A., Ivaschenko T.E., Misharina E.V., Krikheli I.O.

Abstract

Preimplantation genetic testing performed to analyze the chromosomal structural rearrangements, monogenic/single gene defects and aneuploidies. The aim of this study is to show the discussion of a clinical case of preimplantation genetic testing in the family of SMN1 gene mutation carriers with the subsequent birth of a healthy child.

Journal of obstetrics and women's diseases. 2018;67(1):92-95
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