Vol 68, No 1 (2019)

Actual Health Care Problems
Molecular mechanisms of cyclic transformation of the endometrium
Tolibova G.K., Tral T.G., Ailamazyan E.K., Kogan I.Y.
Abstract

Structural transformation of the endometrium during the menstrual cycle is a genetically determined process and is provided by complex molecular-biological interactions aimed at the onset and development of pregnancy. Sex steroid hormones play a key role in endometrial morphogenesis, which mediate or directly affect angiogenesis and immunogenesis.

Journal of obstetrics and women's diseases. 2019;68(1):5-12
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Original Researches
Assessment of the severity of menopausal syndrome and psychosomatic peculiarities
Kostroma Y.V., Belyaeva E.N., Khazova E.L., Kuznetsova L.V., Zazerskaya I.E.
Abstract

Hypothesis/aims of study. Hormonal changes in a woman’s body impacts many systems and organs, therefore the spectrum of menopausal symptoms varies greatly. The current analysis was undertaken to investigate the relationship between the severity of the menopausal syndrome, depending on the personality traits and typological characteristics of women, and the frequency of emotional and affective disorders.

Study design, materials and methods. A study was conducted based on V.A. Almazov National Medical Research Center in which 50 women aged from 44 to 56 years participated, the average age of menopause being 50.4 ± 0.5 years and the average duration of estrogen deficiency 3.3 ± 0.3 years. The study used: 1) Cooperman Index as modified by E.V. Uvarova; 2) Zung Self-Rating Depression Scale; 3) Zung Self-Rating Anxiety Scale; and 4) “The Level of Social Frustration” questionnaire.

Results. Climacteric complaints are most characteristic of married women with a high educational level and a prosperous financial state. When entering menopause (in women with preserved menstrual cycle), endocrine and metabolic complaints came to the fore, weight fluctuations prevailing among all the symptoms. 72% of women reported a weight increase of three and more kilograms, Dyshormonal hyperplasia of the mammary glands and pain in muscles and joints occurred equally often (62%). At the same time, for postmenopausal women, the most characteristic complaints were of the genitourinary syndrome. The neurovegetative syndrome was expressed in all women, regardless of the duration of the estrogen-deficient state and the severity of the menopausal syndrome. When studying the severity of the psycho-emotional syndrome, it was found that patients most often complained of fatigue and decreased performance (99%). Manifestations of depression were not characteristic of women with milder symptoms of menopause, while a high level of anxiety was typical for women with a moderate degree of the climacteric syndrome. For 12% of those women, the depth of depressive disorders corresponded to mild severity. Besides, a high level of anxiety and an average level of depressive manifestations were characteristic of women with severe severity of the menopausal syndrome.

Conclusion. The data obtained show that the more severe the manifestations of the menopausal syndrome, the higher the severity of affective disorders.

Journal of obstetrics and women's diseases. 2019;68(1):13-20
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Role of biologically active molecules in uterine contractile activity
Kuzminykh T.U., Borisova V.Y., Nikolayenkov I.P., Kozonov G.R., Tolibova G.K.
Abstract

Hypothesis/aims of study. Myometrial relaxation and contraction require synchronous cellular interactions. At present, it has been established that the coordination of myometrial contractile activity is carried out by a conduction system constructed from gap junctions with intercellular channels. There are no clinical data on inhibiting (nitric oxide synthase) and activating (connexin-43) factors of uterine contractile activity in the myometrium during pregnancy and parturition in the published literature. This study was undertaken to measure the expression levels of nitric oxide synthase, adhesion molecules CD51, CD61, and connexin-43 in the myometrium during pregnancy and parturition; and to assess the role of inhibitory and activating factors in the development of uterine contractile activity.

Study design, materials and methods. An immunohistochemical study of myometrial biopsy specimens obtained from the lower uterus segment during cesarean section was performed in eight women with a full-term physiological pregnancy, in another eight individuals in the active phase of uncomplicated parturition, and in eight patients with uterine inertia. Integrins (CD51 and CD61 proteins) were used as markers of cell adhesion. Localization and the number of intercellular contacts were assessed by measuring the expression level of connexin-43, with the intensity of oxidative processes assessed by nitric oxide synthase activity.

Results. In the myometrium, in the active phase of physiological parturition, a three-fold increase in the expression of activating (CD51, CD61, and connexin-43) factors of uterine contractile activity and a five-fold decrease in that of inhibitory (nitric oxide synthase) ones occur compared to those in full-term physiological pregnancy.

Conclusion. In the pathogenesis of uterine inertia and resistance to labor induction, an important role is played by the decreased expression of adhesion molecules (CD51, CD61) and connexin-43 and the increased expression of nitric oxide synthase in the myometrium.

Journal of obstetrics and women's diseases. 2019;68(1):21-27
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Neuron-specific enolase and brain-derived neurotrophic factor levels in umbilical cord blood in full-term newborns with intrauterine growth retardation
Morozova A.Y., Milyutina Y.P., Kovalchuk-Kovalevskaya O.V., Arutjunyan A.V., Evsyukova I.I.
Abstract

Neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) levels in umbilical cord blood in full-term newborns with asymmetrical intrauterine growth retardation resulted from chronic placental insufficiency have been studied. Not only a 2.0–2.5-fold increase in the blood NSE level, but also a reduction in BDNF levels were observed, indicating brain damage combined with the lack of adequate compensatory capabilities. With an increase in the duration of intrauterine fetal development under conditions of chronic hypoxia, the degree of damage to neuronal structures increases. This article discusses the mechanisms of the revealed changes, as well as the diagnostic and prognostic significance of the use of biochemical markers.

Journal of obstetrics and women's diseases. 2019;68(1):29-36
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Unilateral apical sling: a new look at the sacrospinous fixation
Shkarupa D.D., Kubin N.D., Popov E.N., Shapovalova E.A., Zaytseva A.O.
Abstract

Hypothesis/aims of study. Nowadays a sacrospinous ligament fixation is one of the most studied and popular methods of colpo- and hysteropexy. Despite the high effectiveness against apical compartment defect, this technique has a number of specific side effects: chronic pain syndrome, dyspareunia, and а high rate of postoperative cystocele de novo. This study aimed to evaluate the efficacy and safety of unilateral sacrospinous ligament fixation with use of a modern synthetic monofilament mesh combined with the original technique of pubocervical fascia reconstruction using subfascial colporrhaphy.

Study design, materials and methods. This study involved 174 women suffering from anterior/apical prolapse. All patients were operated with the proposed method. Postoperative assessment was performed at 1, 6 and 12 months after surgery and included vaginal examination with evaluation of pelvic organ prolapse by standardized POP-Q system, uroflowmetry, bladder ultrasound with post-void residual urine volume measurement, and filling in validated questionnaires (PFDI-20, PFIQ-7, PISQ-12).

Results. Mean operation time was 26 ± 7.8 min. No cases of damage to the bladder or intraoperative clinically significant bleeding were noted. During a postoperative period, most of the patients showed a significant improvement in POP-Q points while maintaining the total vaginal length. Within 12 months of follow-up, the recurrence was observed in 1 (0.7%) patient in the apical compartment and in 10 (6.8%) patients in the anterior compartment. It should be mentioned that only in 3 cases of cystocele recurrence did the vaginal wall descend beyond the hymen. There were no cases of mesh erosion and pelvic pain syndrome through 12 months postoperatively. In the postoperative period, an improvement in urination was observed in all women. Most of the patients after the treatment showed a significant improvement in the quality of life. Only one patient complained of dyspareunia de novo. According to the questionnaires, satisfaction with the result of treatment was 96.5%.

Conclusion. A unilateral sacrospinous fixation using a synthetic mesh combined with pubocervical fascia reconstruction (subfascial colporrhaphy) provides a high efficiency, while significantly reducing the rate of complications related to the traditional sacrospinous fixation.

Journal of obstetrics and women's diseases. 2019;68(1):37-46
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Reviews
Interferons: pathogenetic rationale for the treatment of external genital endometriosis and clinical efficacy
Durneva E.I., Sokolov D.I., Yarmolinskaya M.I., Selkov S.A.
Abstract

Hypothesis/aims of study. Endometriosis is the main cause of infertility and social maladjustment in women, caused by the presence of inflammatory endometriotic implants outside the uterus. A number of chemokines, including interferons, compromise the immune response on the development of endometriosis raising the interest to the investigation of interferons in this context. Based on this, the purpose of this review was to study the role of interferons in the pathogenesis of external genital endometriosis and to assess the possibility of their application within comprehensive pathogenesis-based therapy.

Study design, materials and methods: literature data of national and international investigations for the period from 1996 to 2018; systematic analysis and evaluation of the literary data.

Conclusion. Type I interferons seem to be promising agents for understanding of the pathogenesis of endometriosis, and can be considered as targeted therapy for this disease. The mechanisms of their functions require a further study. Type II interferons may be used in the future as diagnostic markers for the assessment of the disease severity.

Journal of obstetrics and women's diseases. 2019;68(1):47-58
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Gardnerella vaginalis: genotypic and phenotypic diversity, virulence factors and role in the pathogenesis of bacterial vaginosis
Krysanova A.A.
Abstract

This review summarizes literature data on the structure, biological characteristics, and virulence factors of Gardnerella vaginalis. Genotypic and phenotypic diversity of the bacterium, as well as its role in bacterial vaginosis are highlighted.

Journal of obstetrics and women's diseases. 2019;68(1):59-68
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Proteomic analysis methods and their role in the diagnosis of obstetric and gynecological pathology
Sazonova N.G., Makarenko T.A., Olovyannikova R.Y., Kutyakov V.A., Salmina A.B.
Abstract

The article presents current literature on proteomic profiling and the role of proteomic technologies in the diagnosis of various obstetric and gynecological diseases. Proteomic analysis is a promising research method, as it allows for a comprehensive study of protein expression and its regulation in the biological systems, which opens up new opportunities for a more in-depth and detailed study of the etiology and pathogenesis, as well as timely diagnosis and treatment of obstetric and gynecological pathology.

Journal of obstetrics and women's diseases. 2019;68(1):69-82
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Granulocyte colony-stimulating factor as a checkpoint of the embryo invasive potential and endometrial receptivity
Tapilskaya N.I., Gzgzyan A.M., Kogan I.Y.
Abstract

Granulocyte colony-stimulating factor (G-CSF) promotes proliferation, survival, and differentiation of myeloid-lineage cells, as well as normal hematopoietic cells. The immunomodulating effects of G-CSF, which consist in stimulating the Th2 biased type immune response, prevent the development of graft-versus-host disease (GvHD) and, as a special case of GvHD, are responsible for the embryo implantation into the endometrium after the embryo transfer. G-CSF stimulates subpopulations of neutrophils, which display anti-inflammatory properties and are involved in tissue regeneration. The increased secretion of annexin A1 and IL-10 ensures the anti-inflammatory and immunomodulating effects of neutrophils. This review article presents data from four meta-analyzes aimed to explore the efficiency of G-CSF on infertile women undergoing in vitro fertilization. These data demonstrate an increase in the embryo implantation rate and clinical pregnancy rate, which is provided by the change in the endometrial receptivity and/or the invasive potential of the developing embryo.

Journal of obstetrics and women's diseases. 2019;68(1):83-92
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Uterine fibroid and reproduction
Shapovalova A.I.
Abstract

This article is devoted to the treatment of uterine fibroid in patients planning pregnancy. The role of uterine fibroid as a cause of infertility, indications for performing myomectomy in patients with infertility, features of pregnancy and childbirth in pregnant women with uterine fibroid are discussed. Attention is also paid to the technical issues of performing myomectomy and the use of pre-surgery drugs that reduce the size of the uterine fibroid nodes. In addition, the article highlights the features of pregnancy and labor in the presence of a scar on the uterus after myomectomy, after uterine artery embolization and focused ultrasound ablation of the nodes.

Journal of obstetrics and women's diseases. 2019;68(1):93-101
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