Vol 67, No 6 (2018)

Distribution of malignant neoplasms among patients with endometriosis: an epidemiological study
Bairamova N.N., Protasova A.E., Raskin G.A., Yarmolinskaya M.I., Tsypurdeyeva A.A., Gavrilova M.D.

Hypothesis/aims of study. The current analysis was undertaken to assess the incidence of malignant diseases in patients with endometriosis.

Study design, materials and methods. This is a cohort study of women with surgically verified endometriosis retrieved from the Saint Petersburg 122 Clinical Hospital Discharge Register 1996–2006 (n = 1551). Data were linked to the Saint Petersburg Cancer Agency to identify cases of malignancy.

Results. Malignant diseases were identified in 6.3% (n = 98) of cases. The median follow-up was 12.2 (7.5) years. Breast cancer (n = 29), ovarian cancer (n = 7), endometrial cancer (n = 7), thyroid cancer (n = 7), colorectal cancer (n = 6), melanoma (n = 6), non-Hodgkin’s lymphoma (n = 4), and glioblastoma (n = 3) were prevalent.

Conclusion. The incidence of cancer in patients with endometriosis is low. Women with endometriosis have an increased risk of some malignancies, particularly ovarian cancer.

Journal of obstetrics and women's diseases. 2018;67(6):5-12
Correction of immune disorders and changes in the protein/lipid spectrum of circulating erythrocyte membranes in adenomiosis
Ivanova O.Y., Telegina O.V., Konoplya A.A., Rybnikov V.N.

Hypothesis/aims of study. Disorders of immune homeostasis, morphofunctional and ultrastructural changes of erythrocytes in endometriosis lead to hypoxia, impaired micro-rheological and hemostatic statuses, dysmetabolism, organ and system dysfunction, which may contribute to the systemic consequences of this disease. The aim of this study was to evaluate the immune status and protein/lipid spectrum of erythrocyte membranes, as well as to develop methods for the pharmacological correction of impaired parameters in patients with internal endometriosis.

Study design, materials, and methods. Fifty-seven patients with verified grade I–II adenomyosis were examined, assessing some immune status parameters and determining protein and lipid fractions of circulating erythrocyte membranes before and after pharmacotherapy.

Results. The changes in the immune status parameters and protein and lipid composition of erythrocyte membranes revealed in adenomiosis disrupt the functional activity of immunocompetent cells and erythrocytes.

Conclusion. The proposed methods of pharmacotherapy are pathogenetically substantiated and contribute to the correction of both the chosen immune status parameters and structural and functional properties of red blood cells, while improving the quality of treatment of patients with adenomyosis.

Journal of obstetrics and women's diseases. 2018;67(6):13-23
Prevention of pregnancy loss in women with circulation of non-conventional antiphospholipid autoantibodies
Kornyushina E.A., Chepanov S.V., Selkov S.A., Dadayeva D.G., Shakhaliyev R.A., Chudotvorov K.N., Nemstsveridze N.N.

Hypothesis/aims of study. Patients with a history of pregnancy complications that meet the clinical criteria of antiphospholipid syndrome (APS), with circulation of autoantibodies not related to the laboratory criteria for APS, present difficulties in choosing a method for preventing recurrent complications. The aim of this study was to determine the frequency of autoantibodies in women with severe obstetric complications and habitual miscarriage and to evaluate the effectiveness of therapy used in APS for the prevention of recurrent reproductive losses in women with non-criteria autoantibodies.

Study design, materials and methods. 358 women with a history of APS clinical criteria or two pregnancy losses up to 10 weeks were examined. Anti-beta2-glycoprotein I and anti-cardiolipin (IgG/IgM) antibodies, as well as non-conventional autoantibodies for phosphatidylinositol, phosphatidylserine, phosphatidyl acid, annexin V, and prothrombin were determined in serum, with lupus anticoagulant test performed. In 39 women with clinical criteria for APS and circulating anti-annexin V or prothrombin antibodies during pregnancy, enoxaparin sodium was used (in 100% of the cases) in combination with acetylsalicylic acid (ASA) at a dose of 50-100 mg per day (in 69.2% of the cases).

Results. The frequency of all types of autoantibodies was 38.8%. Non-conventional antibodies were detected in 17.6% of the cases (isolated circulation in 11.5% of the cases); with anti-annexin V antibodies (73.0%) prevailed among them. In 39 patients with non-criteria antibodies, after the use of a prophylactic dose of enoxaparin sodium and ASA, live births were the outcome of pregnancy in 84.6% of the cases.

Conclusion. Testing for non-conventional autoantibodies may be appropriate in patients with only APS clinical criteria. Standard treatment of APS prescribed for this group of patients led to a significant increase in the frequency of live births. Further large studies are needed to evaluate the efficacy of medical prophylaxis of adverse pregnancy outcomes in women with non-criteria obstetric ABS.

Journal of obstetrics and women's diseases. 2018;67(6):24-30
Surgical treatment satisfaction in women with pelvic organ prolapse. Quantification and analysis
Korshunov M.Y., Sergeyeva I.V.

Hypothesis/aims of study. An integrated evaluation of the effectiveness of pelvic organ prolapse (POP) treatment in women requires a consistent interpretation of the criteria of treatment satisfaction. The aim of this study was to specify surgical treatment satisfaction in patients with POP.

Study design, materials, and methods. Surgical treatment was performed in 486 patients with POP stages II–IV. In 12 months, a patient survey (using a 1-5-point scale) evaluated the level of treatment satisfaction, reasons for lowered self-reported satisfaction, and respondents’ ambivalence regarding treatment results.

Results. One-year post-surgical treatment of POP stages 0–I are observed in 80.9% of patients. Full satisfaction (5 points) was self-reported by 61.1% of patients, 28.6% of patients indicated partial satisfaction (3–4 points), and 10.3% of patients indicated treatment dissatisfaction (1–2 points). Post-surgery stage of POP is weakly correlated with self-reported treatment satisfaction (r = –0.39; p < 0.0001). Most common reasons for lower self-reported satisfaction were the emergence of new issues, fear of pathology recurrence, urinary incontinence, and pain. Five patients (1.0%) indicated that their condition “became much worse” after the surgical treatment.

Conclusion. The treatment satisfaction range is variable. It is necessary to consider a variety of clinical, deontological, and psychological factors in the analysis of surgical POP treatment satisfaction spectrum.

Journal of obstetrics and women's diseases. 2018;67(6):31-37
Thrombodynamic method of evaluation of some hemostatic parametersin healthy pregnant women and in women with preeclampsia
Kuznik B.I., Zagorodnyaya E.D., Iozefson S.A., Isakova N.V.

Hypothesis/aims of study. During pregnancy, hypercoagulation develops and fibrinolysis is inhibited. These changes are particularly pronounced in pregnancy complicated by preeclampsia. The existing techniques to evaluate hemostasis are rather laborious and do not provide a complete information of the volume and density of the fibrin clot. We aimed to conduct comparative studies of the state of the hemostasis system by conventional test-tube and thrombodynamic methods in healthy non-pregnant women and in pregnant women who are suffering and are not suffering from preeclampsia.

Study design, materials, and methods. We examined 40 pregnant women aged 17–33 years (mean age 24.3 ± 3.2 years) at the gestational age of 35–39 weeks. In 18 women, pregnancy was complicated by preeclampsia. The control group consisted of 35 healthy women (mean age 25.1 ± 2.6 years). The thrombodynamic characteristics of the clot were evaluated using the T-2 Thrombodynamics Recorder device (GemaKor Ltd., Russia) using the following parameters: Tlag, clot growth delay; Vi, initial growth rate; Vs, steady growth rate; D, clot density; C30, the size of the main clot in the 30th minute.

Results. When evaluating the hemostasis system by the thrombodynamic method in healthy pregnant women and in women with preeclampsia compared with non-pregnant women, the onset time of clot formation was significantly reduced, the initial and steady rate of the clot appearance, as well as the clot density and the clot size being increased.

Conclusion. The method for evaluating thrombodynamic properties of the blood clot is objective and visual way to estimate hemostasis. It complements the coagulogram indices and gives a clear view of the hemostasis system.

Journal of obstetrics and women's diseases. 2018;67(6):38-44
Activity of nucleolar organizers in endometrial glandular and surface epithelial cells in patients with external genital endometriosis
Kurenkov E.L., Igenbaeva E.V., Uzlova T.V.

Hypothesis/aims of study. Endometriosis is a disease characterized by proliferation of tissue that is similar in morphology and function to the endometrium, outside the uterine cavity. Thanks to the theory of J. Sampson (1927), which explains endometrioid heterotopia formation by bits of endometrial tissue migrating through the fallopian tubes during menstruation and their subsequent implantation in the pelvis, research has begun on the biological properties of eutopic endometrial cells in women with endometriosis, which is still relevant today. The present study was aimed to assess the activity of nucleolus organizers in the endometrium in women with external genital endometriosis and without it at different stages of the menstrual cycle.

Study design, materials, and methods. Paraffin blocks of endometrial biopsy specimens were taken from 68 women with and without external genital endometriosis. The activity of nucleolar organizers was evaluated by the method of J. Crocker (1983).

Results. The data obtained showed a significant increase in ribosomal activity in the cells of the endometrial glandular and surface epithelium in women with external genital endometriosis at the stages of late proliferation, as well as early and middle secretions. There was also a significant decrease in the activity of the nucleolar organizers of endometrial epithelial cells at the stage of late secretion in women with external genital endometriosis.

Conclusion. The obtained differences in regulation of ribosomal synthesis in the cells of the integument and glandular epithelium of the endometrium in women with external genital endometriosis, in our opinion, can provide an increase in the total amount of epitheliocytes of the endometrium, increase their adhesive and invasive abilities, and lengthen the life cycle of cells. This contributes to the formation of endometrioid heterotopies and the development of external genital endometriosis. Changes in the activity of nucleolar organizers in the endometrium in women with external genital endometriosis may be of clinical interest for the diagnosis of this pathology.

Journal of obstetrics and women's diseases. 2018;67(6):45-49
APC-resistance as a possible predictor of recurrent thrombosis in women with Factor V Leiden
Nikolayeva M.G., Momot A.P., Zaynulina M.S., Momot K.A., Yasafova N.N.

Hypothesis/aims of study. The current analysis was undertaken to elucidate the role of Factor Va resistance to proteolytic cleavage by activated protein C in FVL(1691)GA female carriers in the development of acute and recurrent thromboses.

Study design, materials and methods. A prospective clinical cohort study of 1100 women of reproductive age was conducted, with the course and outcomes of 2,707 pregnancies analyzed. Two cohorts were specified: the main group consisted of 500 patients with FV(1691)GA genotype, and the control group consisted of 600 patients with FVL(1691)GG genotype.

Results. FVL(1691)GA genotype was significantly associated with the development of venous thromboembolic complications (VTEC) compared to FVL(1691)GG genotype (OR 9.3; p < 0.0001). Episodes of recurrent thrombosis during and outside of pregnancy were registered only in FVL(1691)GA patients (OR 5.7, p = 0.2). In all cases, at the time of the thrombotic event and during the period before the episode of acute or recurrent thrombosis, an APC resistance normalized ratio (NR) value was ≤ 0.49, with no episodes of VTEC registered with an APC resistance NR value ≥ 0.5.

Conclusion. Venous thromboses occur under the condition of expressed APC resistance with underlying FVL(1691)GA carriage. The APC resistance index can serve as an objective biochemical marker to determine the feasibility of thromboprophylaxis within the framework of personalized medicine.

Journal of obstetrics and women's diseases. 2018;67(6):50-59
Vitamin D deficiency as a factor in reducing bone mineral density after childbirth
Novikova T.V., Zazerskaya I.E., Kuznetsova L.V., Bart V.A.

Hypothesis/aims of study. Physiological pregnancy is not a reliable risk factor for reduced bone mineral density (BMD). The causes affecting BMD in reproductive age, such as smoking, heredity, low physical activity, low body mass index, unbalanced diet, ovarian dysfunction, and vitamin D deficiency are studied. The aim of this study was to assess the contribution of vitamin D deficiency and insufficiency to the development of osteopenia after childbirth.

Study design, materials and methods. This is a cohort study conducted in V.A. Almazov National Medical Research Center, Saint Petersburg, Russia in the period from October 2013 to November 2014. We examined 86 puerperas on days 3–5 after delivery. The age of women ranged from 20 to 35 years. Patients were surveyed using the questionnaire on the main risk factors for osteoporosis. The method of dual energy X-ray absorptiometry was used to evaluate BMD in the central and peripheral skeleton. Serum levels of 25-hydroxycalciferol (25(OH)D) and parathyroid hormone were determined in all pregnant women.

Results. According to the results of Х-ray osteodensitometry, normal BMD was detected in 45% (n = 38) of puerperas (comparison group), with reduced BMD revealed in 55% (n = 48) of puerperas (main group). The main group was divided into subgroups: osteopenia in the distal forearm was detected in 27 (56%) puerperas, in the proximal femur in 7 (16%) puerperas, and in the lumbar spine in 14 (28%) puerperas. 58-78% of patients showed vitamin D deficiency and insufficiency. In the group with osteopenia, vitamin D deficiency prevails, reaching 78% in women with osteopenia in the forearm, while in the group with normal BMD, vitamin D deficiency predominates in 70% of patients. The mean value of 25(OH)D in serum in the group with osteopenia and that in the group with normal BMD differ 1.5 times. The level of 25(OH)D in postpartum women with osteopenia in the forearm is two times lower, when compared to the group with normal BMD, parathyroid hormone being within reference values. In the group with osteopenia in the lumbar spine, opsooligomenorrhea is more common (p < 0.05), while in the group with osteopenia in the proximal forearm, a possible significant factor was revealed to be preeclampsia (p < 0.05).

Conclusion. Osteopenia after childbirth is found in 55% of patients. In 56% of cases, osteopenia occurs in the distal forearm. Vitamin D deficiency is a significant factor in the reduction of BMD in the distal forearm and lumbar spine. At a level of 25 (OH) D < 20 ng/ml, the risk of developing osteopenia increases by 56%.

Journal of obstetrics and women's diseases. 2018;67(6):60-68
Substantiated approaches to the diagnosis and treatment of tamoxifen-induced endometrial conditions in patients with breast cancer
Protasova A.E., Solntseva I.A., Tsypurdeyeva A.A., Semiglazova T.Y., Stenina M.B., Yureneva S.V., Yakushevskaya O.V.

Currently, tamoxifen is the gold standard in the treatment of hormone receptor-positive breast cancer, which reduces recurrent tumor risk by more than 40%. Tamoxifen, which belongs to selective estrogen receptor modulators, can cause endometrial changes in women of different age groups and increase the risk of hyperplasia and endometrial cancer by several times. In clinical practice, the occurrence of various endometrial alterations during tamoxifen treatment often leads to groundless drug withdrawal. Oncology, gynecology and radiology community knowledge related to optimal methods and criteria for diagnosing different tamoxifen-induced endometrial conditions, as well as in choosing the optimal treatment tactics, will be instrumental in the unified and correct approach to managing patients with hormone receptor-positive breast cancer and maintaining tamoxifen therapy due to its high effectiveness.

Journal of obstetrics and women's diseases. 2018;67(6):69-78
Pathophysiology of placenta and fetus in diabetes mellitus
Kapustin R.V., Onopriychuk A.R., Arzhanova O.N., Polyakova V.O., Alekseyenkova E.N.

Currently, there is a steady increase in the incidence of diabetes mellitus (DM) in the global population, which causes an increase in maternal and perinatal mortality. Children born to mothers with DM have a high risk of not only congenital abnormalities, but also cardiovascular and metabolic disorders in later life. Fetal growth is determined by both the metabolic and nutritional status of the mother, and the placental nutrient transfer capacity. Pregnancy complicated by DM is associated not only with overgrowth of the fetus, but also with the excess deposition of metabolites in the placenta. The role of disorders of carbohydrate metabolism, obesity and other factors in relation to the function of the placenta and fetal growth remains not fully understood. This review provides an overview of the literature on the placental complex status in pregnancy complicated by obesity, as well as pre-gestational and gestational types of DM. The focus is on three key substrates in these conditions: glucose, lipids, and amino acids, and their influence on placental metabolic activity and on the fetus. Improved knowledge of morphology and understanding of changes in the function of the placenta that lead to abnormal growth of the fetus will allow for the development of new therapeutic approaches to improve the outcomes of pregnancy, maternal and child health.

Journal of obstetrics and women's diseases. 2018;67(6):79-92
Pregnancy and delivery in a patient with a 40-year history of type 1 diabetes mellitus and antiphospholipid syndrome
Kapustin R.V., Borovik N.V., Musina E.V., Arzhanova O.N., Yarmolinskaya M.I., Alekseyenkova E.N., Kovalchuk-Kovalevskaya O.V., Petrov Y.A.

Type 1 diabetes mellitus is a condition associated with an increased risk of adverse perinatal outcomes such as spontaneous abortions, preterm birth, placental insufficiency, congenital malformations, and perinatal mortality. Diabetes mellitus combined with cardiovascular diseases in women during pregnancy often leads to hypertensive disorders and pre-eclampsia. The severity of the microvascular diabetic complications and frequency of hypoglycemic episodes, particularly in early pregnancy, are related to the risk of pre-eclampsia. We report the case of pregnancy and delivery of a live newborn in a 42-year-old woman with type 1 diabetes mellitus, pre-existing hypertension, heritable thrombophilia, and antiphospholipid syndrome. She had a 40-year history of type 1 diabetes mellitus with well-controlled diabetic nephropathy and retinopathy. The woman had been receiving continuous subcutaneous insulin therapy for the last five years, which allowed maintaining an appropriate glycemic control during pregnancy. Multidisciplinary supervision of course of pregnancy was carried out from the pre-gravidity stage until delivery and postpartum. In spite of the severe pre-eclampsia and preterm delivery by cesarean section at 36 weeks, she and newborn could avoid the intensive unit care and discharge from perinatal center without any complications.

Journal of obstetrics and women's diseases. 2018;67(6):93-99
Current approaches to treatment of antiphospholipid syndrome during pregnancy: a case report
Kornyushina E.A.

The article presents a clinical case of a patient with antiphospholipid syndrome (APS), with a history of deep vein thrombosis and recurrent miscarriage. The methods of additional therapy for APS during pregnancy, which are used in cases of miscarriage refractory to the standard treatment, are described: administration of intravenous immunoglobulin, plasma exchange, glucocorticosteroids. The literature data on the use of additional APS therapy in pregnancy are given.

Journal of obstetrics and women's diseases. 2018;67(6):100-105
Development of mathematical methods for calculation of the pubic arch angle
Mudrov V.A., Mochalova M.N., Mudrov A.A.

Hypothesis/aims of study. The frequency of adverse intranatal outcomes is significantly increased when the pubic arch angle (PAA) is less than 90°. The accuracy of the manual method for determining PAA depends on a large number of parameters, such as obesity of a woman, as well as stereometric sensation and the experience of a doctor. Determination of PAA using ultrasound and X-ray pelviometry is generally available and reliable; however, it requires special training. The aim of this study was to develop mathematical methods for calculation of PAA.

Study design, materials and methods. The study included a retrospective and prospective analysis of 120 birth histories based on the Regional Clinical Hospital Perinatal Center (the Chita city, the years 2017/2018), which were divided into three equal groups. Group 1 consisted of patients with body weight deficit, group 2 included patients with normal body mass index, and group 3 comprised patients with alimentary constitutional obesity. On the eve of the birth, external pelviometry, the manual method for determining PAA, and ultrasound pelviometry by translabial access were performed.

Results. PAA determined by the manual method was 99.6 ± 11.3° in group 1, 100.1 ± 14.2° in group 2, and 98.2 ± 10.7° in group 3. When ultrasound pelviometry was performed, the value of PAA was 97.4 ± 10.7° in group 1, 104.8 ± 13.8° in group 2, and 104.1 ± 12.3° in group 3. The error of the manual method was 2.2% in group 1, 4.5% in group 2, and 7.6% in group 3. On the basis of mathematical modeling of external pelviometry data, a pattern is defined, which is expressed by the formula: PAA = 180° – arccos (0,5 ∙ S1S2/S1P) – arccos (0,5 ∙ B1B2/(B2S1 S1P), where PAA is the pubic arch angle (°); S1S2, Distantia spinarum; S1P, the distance between the anterior superior spine of the ilium to the lower edge of the symphysis; B2S1, the distance between the anterior superior spine of the ilium to the tuberosity of the opposite ischium; B1B2, the transverse size of the output plane. The coefficient of determination (R-squared) is 0.82. Thus, mathematical modeling allows determining PAA with a high degree of reliability.

Journal of obstetrics and women's diseases. 2018;67(6):106-111
Peculiarities of high-risk pregnancy management after the IVF procedure: a clinical observation report
Shelaeva E.V., Musina E.V., Yarmolinskaya M.I., Prokhorova V.S., Misharina E.V., Nagorneva S.V.

This article presents an annotation and discussion of our own clinical observation of a high-risk multiple pregnancy after in vitro fertilization in a patient with tuboperitoneal infertility. We report a case of early prenatal diagnosis of a rare malformation of a single fetus in dichorionic twin pregnancy (pentalogy of Cantrell). The feasibility of cumulative assessment of the risks of assisted reproductive technology complications to determine the tactics of management and intensive observation during pregnancy, as well as the use of invasive intrauterine interventions for multiple pregnancy to reduce perinatal risks is discussed.

Journal of obstetrics and women's diseases. 2018;67(6):112-118
Sclerotic adenomyosis: a case report
Yarmolinskaya M.I., Ailamazyan E.K., Arutyunyan A.F., Dolinskiy A.K., Gaidukov S.N.

Four hundred and fifty case histories and results of histological studies of patients who underwent surgical treatment with a diagnosis of adenomyosis and uterine fibroids were retrospectively analyzed. Of all the operated patients, the sclerotic type of adenomyosis was detected in three cases according to the histological examination, which was 0.67%. The retrospective analysis allowed us to reveal the clinical, echographic, and histological characteristics of the sclerotic type of adenomyosis in these patients.

Journal of obstetrics and women's diseases. 2018;67(6):119-123

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