Vol 67, No 5 (2018)

Articles
Effect of VDR gene polymorphism on bone mineral density in puerperants
Bibkova O.S., Sudakov D.S., Bogdanova E.O., Galkina O.V., Dymarskaya Y.R., Guziy N.S.
Abstract

This study involved 89 postpartum and 97 nonpregnant women aged 20 to 35 years. The results of the genetic test were compared to bone mineral density (BMD) values. The lowest values of BMD were detected in the puerperas with the BB genotype of the BsmI gene, the tt genotype of the TaqI gene, the aa genotype of the ApaI gene, and the ff genotype of the FokI gene. In all the examined sections of the skeleton, with the combination of the four unfavorable genes, BMD values were the lowest.

Journal of obstetrics and women's diseases. 2018;67(5):4-12
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Comparison of methods for assessing the inflammatory response of the lower parts of the female reproductive tract
Budilovskaya O.V., Shipitsyna E.V., Pereverzeva N.A., Vorobyova N.E., Spasibova E.V., Grigoryev A.N., Savicheva A.M.
Abstract

Hypothesis/aims of study. A lack of timely diagnosis and treatment of inflammatory diseases of the lower genital tract in a woman can lead to serious reproductive disorders. The detection of inflammation is an important component of the diagnosis of these diseases. This study was undertaken to compare methods for detection of local inflammation in women with complaints of vaginal discharge.

Study design, materials, and methods. A total of 87 women having vaginal discharge were enrolled in the study. For the detection of inflammation, vaginal discharge was examined using microscopy and reverse transcriptase polymerase chain reaction (the ImmunoQuantex® test, DNA-Technology Ltd., Moscow, Russia).

Results. Vaginal infections caused by opportunistic microorganisms were detected in 27 women (31%), as follows: candidal vulvovaginitis (CVV) in 10 patients (11.5%), aerobic vaginitis (AV) in 14 patients (16.1%), and bacterial vaginosis (BV) in 14 patients (16.1%), with 8 (9.2%) of them having BV combined with CVV, AV or both infections. The results of the two methods fully agreed in the analysis of samples from women with CVV and AV as vaginal infections characterized by local inflammation. Testing samples from women with BV, which is a non-inflammatory syndrome, as well as women without vaginal infections resulted in significant discrepancies between the two methods. The sensitivity and specificity of the ImmunoQuantex® test compared to the microscopic method were 85.7% and 48.9%, respectively.

Conclusion. The new reverse transcriptase polymerase chain reaction based test for the evaluation of expression profiles of selected genes of immune response enables to assess the local immune status in the vagina. Determination of the presence or absence of inflammatory reaction in the vagina can be used as a diagnostic criterion for resolving discrepancies between laboratory data and clinical manifestations, as well as for choosing effective therapy.

Journal of obstetrics and women's diseases. 2018;67(5):13-20
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Experience with intravenous immunoglobulin treatment in pregnant women with miscarriage and chronic endometritis
Pluzhnikova T.A., Mikhnina E.A., Davydova N.I., Shogiradze L.D.
Abstract

Chronic endometritis is the most common endometrial pathology in women with habitual miscarriage. Urogenital infections, persistence of pathogenic and opportunistic flora lead to chronic inflammatory process in the endometrium and secondary immunodeficiency states. In the endometrium, an increased number of NK- (CD16+ and CD56+), В- (CD20+) lymphocytes and cells expressing the late HLA-DR activation marker are determined. These lymphocytes enhance the expression of histocompatibility antigens by endometrial cells and lead to autoimmune inflammation. The imbalance between immune tolerance to the fetus and immune activation to the pathogenic organisms is associated with poor pregnancy outcomes. After a course of complex therapy of chronic endometritis, most women with miscarriage can only reduce the severity of the inflammatory process in the endometrium. The aim of this study was to assess the importance of immunomodulatory effects of human immunoglobulin during pregnancy in women with miscarriage. The study included 182 patients with a history of miscarriage and chronic endometritis. Group 1 consisted of 98 women who received an intravenous course of human immunoglobulin at 7/8 weeks of pregnancy. Group 2 comprised 84 pregnant women who did not receive immunoglobulin therapy. An analysis of the results of the course and outcomes of pregnancy showed that administering an intravenous immunoglobulin course to pregnant women with miscarriage and chronic endometritis in the history prior to the first wave of trophoblast invasion helps to reduce the frequency of threatened abortion (54% in group 1 and 95% in group 2, p < 0.001). The data obtained suggest that intravenous immunoglobulin should be recommended for women with habitual miscarriage and chronic endometritis during pregnancy up to 8 weeks.

Journal of obstetrics and women's diseases. 2018;67(5):21-31
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Vaginal microbiota in the first trimester of pregnancy in women with a history of miscarriage
Sinyakova A.A., Shipitsyna E.V., Budilovskaya O.V., Martikaynen Z.M., Grigoryev A.N., Bolotskikh V.M., Savicheva A.M.
Abstract

Hypothesis/aims of study. Dysbiotic disorders of the vagina are one of the main risk factors of miscarriage. The analysis of vaginal microbiota during pregnancy in women having a history of miscarriage may contribute to understanding the importance of specific types of vaginal flora in the development of processes resulting in spontaneous abortion or preterm birth. This study was undertaken to evaluate the vaginal flora in the 1st trimester of pregnancy in women having a history of miscarriage.

Study design, materials, and methods. To participate in the study, 160 individuals in the 1st trimester of pregnancy with and without a history of miscarriage were invited. Group 1 included 100 women with a history of miscarriage, group 2 consisted of 60 women without a history of miscarriage. The vaginal flora was analyzed with microscopic, bacteriological, and quantitative real-time PCR methods.

Results. In patients with a history of miscarriage, the frequency of dysbiotic disorders of the vaginal flora was three times higher (11.0% and 3.3%) and pH value of the vaginal fluid was significantly higher. Along with a significant reduction of the proportion of the Lactobacillus flora in the 1st trimester of pregnancy in patients having a history of miscarriage, there was a significant increase in the abundance of opportunistic microorganisms, mostly aerobic flora, such as Enterobacteriaceae, Streptococcus spp., and Staphylococcus spp. Furthermore, there was a significant predominance of Ureaplasma spp. and Candida spp. in women with a miscarriage history.

Conclusion. The vaginal microbiota in the 1st trimester of pregnancy in women having a history of miscarriage is characterized by higher pH values of the vaginal fluid, the prevalence of opportunistic microorganisms, a decrease in the abundance of the Lactobacillus flora, and a higher concentration of aerobic bacteria, Ureaplasma spp., and Candida spp. These findings indicate dysbiotic disorders of the vaginal microbiocenosis in women having a history of miscarriage, which can lead to late miscarriage and pretem birth.

Journal of obstetrics and women's diseases. 2018;67(5):32-41
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Effect of diabetes compensation on ovarian function recovery in women of reproductive age with type 1 diabetes mellitus
Tolpygina M.G., Tarasova M.A., Borovik N.V., Misharina E.V., Tiselko A.V.
Abstract

Hypothesis/aims of study. The adverse effects of type 1 diabetes mellitus on the female reproductive system have been proved by many studies. There is still conflicting literature on the impact of diabetes and other factor compensation on ovarian function in women with type 1 diabetes mellitus.

Study design, materials and methods. The current analysis was undertaken to study the effects of diabetes compensation on ovarian function in women with type 1 diabetes mellitus. In order to this, 180 individuals aged 20 to 40 years were examined. The main group consisted of 112 diabetic patients with primary ovarian insufficiency, the comparison group included 68 women with type 1 diabetes mellitus and a normal ovulatory cycle. After 18–24 months following the therapy aimed to compensate diabetes, 63 patients with ovarian insufficiency were re-examined. The examination included determination of blood glucose, glycated hemoglobin (HbA1c), FSH, LH, prolactin, estradiol, total and free testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, dihydrotestosterone, progesterone, and sex hormone-binding globulin (SHBG) levels, as well as ultrasound examination in the first and second phases of the menstrual cycle.

Results. Association of ovarian insufficiency with HbA1c level and the dose of insulin was found. Patients in the main group experienced a decrease in FSH and SHBG levels, an increase in the ovarian volume and the number of antral follicles compared to those in diabetic patients with a normal ovulatory cycle. In patients with decompensated diabetes and ovarian insufficiency, after the compensation of diabetes, the recovery of the ovulatory cycle was observed in 61.8 % of cases.

Conclusion. Ovarian function in women with type 1 diabetes mellitus depends on HbA1c level and the dose of insulin. Diabetes compensation in women with type 1 diabetes mellitus contributes to the recovery of ovulation in 61.8 % of cases.

Journal of obstetrics and women's diseases. 2018;67(5):42-49
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Effect of hormone modulation therapy on bone tissue in the treatment of endometriosis
Shalina M.A., Yarmolinskaya M.I., Misharina E.V.
Abstract

This article presents a review of the current literature on the impact of such drugs as gonadotropin-releasing hormone agonists, aromatase inhibitors, and dienogest 2 mg, which are used for the treatment of external genital endometriosis, on the mineral density state. In the paper, we discuss the pathogenetic mechanisms of the effects of various bioactive compounds on bone and the results of domestic and foreign research.

Journal of obstetrics and women's diseases. 2018;67(5):50-55
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Peculiarities of carbohydrate metabolism in pregnant women with bronchial asthma
Shapovalova E.A., Lavrova O.V., Paliychuk A.V.
Abstract

Hypothesis/aims of study. The aim of this study was to assess the effect of therapy with inhaled glucocorticoids on the course of pregnancy, childbirth, and growth-weight parameters of newborns from mothers with asthma of varying severity.

Study design, materials, and methods. 725 women aged 17 to 43 years with bronchial asthma were examined. In the group of patients with bronchial asthma, 352 patients (48.5%) received glucocorticoids or glucocorticoids + β2-long-acting agonists. Carbohydrate metabolism disorders were found in 45 (6.2%) examined pregnant women, among them 21 women (46.7%) received inhaled glucocorticoids.

Results. The frequency of detection of gestational diabetes mellitus in pregnant women with bronchial asthma, as well as growth-weight parameters of newborns do not differ from the general population.

Journal of obstetrics and women's diseases. 2018;67(5):56-61
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Molecular epidemiology of infections caused by group B Streptococcus in pregnant women and newborns, and development of preventive vaccines
Vasilyeva V.A., Shipitsyna E.V., Shalepo K.V., Savicheva A.M.
Abstract

Hypothesis/aims of study. The present analysis was undertaken to summarize current knowledge about molecular properties of group B streptococci (GBS), emphasizing potential targets of vaccines against neonatal GBS infection.

Study design, materials, and methods. This review is based on articles published mainly in the last ten years.

Results. Epidemiological data on serotypes, multilocus sequence types, clonal complexes of GBS and their relationship are presented. Genetic events in GBS populations indicate significant obstacles to vaccine development. We described key properties of major GBS virulence factors, such as capsular polysaccharide, pili, and cell adhesion molecules, as well as results of experimental immunization on their basis.

Conclusion. The population of invasive GBS strains is molecularly and genetically heterogeneous, which complicates selection of vaccine targets. Capsular switching, a low level of immunogenicity and variability of population composition are the most important factors that necessitate the accumulation and monitoring of molecular epidemiological data.

Journal of obstetrics and women's diseases. 2018;67(5):62-73
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Amniotic fluid volume assessment at the present stage of development
Mudrov V.A., Mochalova M.N., Mudrov A.A.
Abstract

Amniotic fluid not only provides conditions for normal growth and development of the fetus, but also prevents umbilical cord compression and infection of the uterine cavity due to the existing bacteriostatic effect. In addition, amniotic fluid volume varies in pathological conditions of the fetus and the uteroplacental complex, which can lead to irreversible consequences. The aim of this study was to analyze features of assessing amniotic fluid volume at the present stage of development. In this review article, we analyzed, systematized, and summarized data obtained by foreign and domestic authors from 1980 to 2017. Reliable determination of amniotic fluid volume will optimize the management of pregnant women threatened by risk of perinatal pathology.

Journal of obstetrics and women's diseases. 2018;67(5):74-84
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Pregnancy in a patient with Swyer syndrome and type 1 diabetes mellitus, resulting from the use of IVF: a case report
Misharina E.V., Borovik N.V., Yarmolinskaya M.I., Suslova S.V., Tiselko A.V., Abashova E.I., Shalina M.A.
Abstract

This article reports a case of pregnancy after in vitro fertilization using donor oocytes in a patient with Swyer syndrome and type 1 diabetes mellitus.

Journal of obstetrics and women's diseases. 2018;67(5):85-90
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