Vol 68, No 2 (2019)

Actual Health Care Problems
Skin microbiota in women of reproductive age in norm and androgen-dependent dermatoses
Vorobyova N.E., Shipitsyna E.V., Savicheva A.M.
Abstract

The skin is the largest organ of the human body and is colonized by divergent microorganisms, with a majority of them being harmless and even helpful for humans. The development of molecular methods for the identification of microorganisms has led to a conception that the skin microflora is greatly diverse and variable. Innate and adaptive immune responses can change the microbiota, and, on the other hand, the microbiota is involved in an immune response. The degree of colonization of the skin by different microorganisms varies greatly depending on the body sites, as well as endogenous and exogenous factors. There are significant gender differences in skin structure and physiology, which is substantially influenced by sex hormones. The investigation of the skin microbial component in androgen-dependent dermatoses, such as acne and seborrheic dermatitis, will contribute to understanding the pathogenic mechanisms of these diseases and to developing effective methods of therapy.

Journal of obstetrics and women's diseases. 2019;68(2):7-16
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Original Researches
Risk of developing gestational diabetes in women after assisted reproductive technologies
Arzhanova O.N., Rulyova A.V., Paykacheva Y.M., Ivanova A.O., Nichiporuk N.G.
Abstract

Hypothesis/aims of study. Gestational diabetes mellitus (GDM) is one of the leading causes of perinatal morbidity and mortality. The use of assisted reproductive technologies (ART) is an independent risk factor for the development of GDM. Among other risk factors are overweight, diabetes burdened heredity, previous GDM, previous birth weight more than 4 kgs, stillbirth, miscarriage in history, glucosuria, polyhydramnios in this pregnancy, age over 30 years, polycystic ovary syndrome. The most significant risk factor for GDM is excess weight before pregnancy. The aim of this study was to investigate the risks of GDM in patients after ART.

Study design, materials, and methods. 342 case histories of women with single pregnancy for the period 2014–2017 were studied on archival material. The main group consisted of 234 women with single pregnancy after ART. The comparison group comprised 108 medical records of fertile women with a history of single pregnancy that occurred spontaneously. The exclusion criteria in the comparison group were pregestational diabetes mellitus and severe extragenital pathology.

Results. The incidence of GDM was significantly higher in the group of women in whom pregnancy occurred after ART compared to the comparison group (15.4 ± 0.4% and 5.5 ± 0.4% respectively). In the main group, patients were more likely to have overweight, extragenital pathology and pregnancy complications.

Conclusion. The increase in the frequency of GDM among patients after ART is probably associated with late reproductive age, initially negative somatic background at the time of entry into the IVF protocols, as well as long-term hormone therapy during pregnancies after ART, starting from early terms.

Journal of obstetrics and women's diseases. 2019;68(2):17-22
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Comparative efficiency of intravenous and oral iron preparations in anemic pregnant women
Atajanyan А.S., Zaynulina M.S., Malakhovskaya E.A.
Abstract

Hypothesis/aims of study. The article is devoted to assessing the effectiveness of intravenous iron preparations in the treatment of anemia in pregnant women. The relevance of improving the treatment of pregnant women with iron deficiency anemia (IDA) is due to an increase in morbidity and adverse effects on the course and outcome of the gestational process, the state of the fetus and newborn. The aim of this comparative study was to assess the efficiency of intravenous and oral iron preparations in pregnant women with IDA.

Study design, materials and methods. The study included 131 pregnant women. The mean age of the patients was 31.75 (19; 49) years.

Results. The intravenous preparation of iron carboxymaltosate, after a single administration, has a more pronounced dynamics of hematological and ferrokinetical blood parameters compared to the oral preparation of iron (III) hydroxide polymaltosate after one month of treatment.

Conclusion. As a result of clinical and laboratory research, the expediency of the use of intravenous iron (III) preparations in the 2nd and 3rd trimester of pregnancy has been substantiated. Iron carboxymaltose exhibits high clinical efficiency, quickly replenishing iron stores in the body. The absence of side effects and ease of use (single administration) allow recommending iron carboxymaltose for the treatment of IDA.

Journal of obstetrics and women's diseases. 2019;68(2):23-32
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Somatic features and reproduction characteristics of patients with perinatal fetal death
Bezhenar V.F., Ivanova L.A., Frederiks E.V., Anashkina R.I.
Abstract

Aims of study. The current analysis was undertaken to determine risk factors for perinatal losses and assess the possibility of their prediction.

Study design, materials and methods. We analyzed 307 cases of perinatal death in obstetric facilities of the Leningrad region (main group). 357 women who gave birth to living children who lived 7 days of the perinatal period represented the control comparison group. A retrospective analysis was carried out based on medical hospital records: an examination of events during pregnancy, childbirth, postpartum, and early infancy, as well as afterbirth study findings and autopsy reports.

Results. We performed a retrospective analysis of the social (3 factors), somatic (28 factors), and reproductive (15 factors) statuses of patients with perinatal losses in order to try to assess the possibility of identifying risk groups and predicting perinatal and fetal mortality.

Conclusion. The predictors of perinatal mortality were determined, namely features of social status (absence of a marriage record and a permanent job, low level of education), somatic status (diabetes, cardiovascular pathology, arterial hypertension, chronic hemocontact infections), and reproductive status (late menarche, early sexual debut, previous infectious genital pathology, childbirth at a young age, etc.).

Journal of obstetrics and women's diseases. 2019;68(2):33-42
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Expression of kisspeptin and matrix metalloproteinases in human endometrial culture: a study of invasive and migratory properties
Kleimenova T.S., Drobintseva A.O., Polyakova V.O., Tsypurdeyeva A.A.
Abstract

Hypothesis/aims of study. Kisspeptin (KISS1) is encoded by KISS1 gene and its interaction with KISS1 receptor (KISS1R) suppresses metastasis and regulates release of gonadotropin-releasing hormone, which promotes secretion of estradiol and progesterone. Steroid hormone synthesis is regulated by KISS1/KISS1R and its activation can be involved in hormone dependent disorders such as endometriosis. KISS1 expression has been shown to inhibit the activity of a number of matrix metalloproteinases (MMPs). In this study, we aimed to isolate endometrial cell cultures from patients with and without endometriosis; to evaluate KISS1, KISS1R, MMP-2, and MMP-9 protein expression by immunocytochemistry; and to perform culture tests: the scratch assay and the analysis of cell migration activity.

Results. It was found that the endometrial cell cultures expressed KISS1, KISS1R, MMP-2, and MMP-9 proteins, with the cell migration ability enhanced.

Journal of obstetrics and women's diseases. 2019;68(2):43-50
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Possibilities of applying antigestagens in therapy
Lebedeva Y.A., Troik E.B., Molchanov O.L., Fedotov Y.N.
Abstract

In the modern medical practice, anti-progestogen therapy is widely used where RU-486 (mifepristone) is one of its variants. However, the potential of this therapy in the treatment of various pathologies is far from exhausted. In the general medical practice, it is possible to use mifepristone (RU486 metabolite) to control hyperglycemia in patients with Cushing’s syndrome, in the treatment of endogenous hypercorticism syndrome and metastatic cancer (melanoma, breast cancer, meningioma and other localizations). In the gynecological practice, it is used for contraception and early termination of pregnancy. Of particular interest is the use of antigestagens in the therapy of uterine leiomyoma. In recent years, the conservative treatment of uterine leiomyoma, aimed at the restoration and preservation of women’s reproductive health, has become a priority task for specialists. Therapy with antigestagens, in particular mifepristone, is seen as a possible worthy alternative to invasive methods of treating uterine fibroids, in which there are still many “white spots” that need to be studied.

Journal of obstetrics and women's diseases. 2019;68(2):51-58
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Anamnestic and microbiological predictors of miscarriage
Sinyakova A.A., Shipitsyna E.V., Budilovskaya O.V., Bolotskikh V.M., Savicheva A.M.
Abstract

Hypothesis/aims of study. Miscarriage is a significant medical and social problem. The etiology of pregnancy losses is diverse and depends on many factors. It is believed that dysbiotic disorders of the vagina are one of the main causes of this pathology. While the etiopathogenesis of miscarriage is actively studied, many questions still remain open. The aim of the study was to investigate anamnestic and microbiological predictor factors of miscarriage.

Study design, materials, and methods. In a prospective cohort study, 159 pregnant women were examined in the first trimester of pregnancy: the anamnesis, course of pregnancy, vaginal microflora, and present pregnancy outcome were studied. The vaginal microflora was analyzed using microscopic, bacteriological and quantitative real-time PCR methods. Depending on the present pregnancy outcome, the patients were divided into two groups: those delivered at term and women with early and late miscarriage. The analysis of predictors of miscarriage of the ongoing pregnancy was performed depending on the period of delivery.

Results. The rate of miscarriage in women was 13%. The independent predictors of early miscarriage were chronic endometritis (OR 10.54; 95% CI 2.54 to 43.64), the dominance of Lactobacillus iners in the vaginal microflora (OR 8.52; 95% CI 2.07 to 35.05), and the prevalence of non-Lactobacillus species in microscopy of vaginal preparations (OR 4.50; 95% CI 1.02 to 19.69). The dominance of Lactobacillus crispatus was a significant protective factor of late miscarriage (OR 0.20; 95% CI 0.04 to 0.99).

Conclusion. The undertaken analysis revealed significant associations of a number of anamnestic and microbiological predictor factors with miscarriage, which will enable to substantiate approaches for predicting pregnancy outcomes at different gestational age and to develop methods of pre-conception care and treatment in women with different risk of miscarriage.

Journal of obstetrics and women's diseases. 2019;68(2):59-70
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Providing psychological support to pregnant women in childbirth by obstetrician service staff
Chernetskaya N.I., Shumovskaya O.A.
Abstract

Aims of study. The aim of this study was to investigate the theoretical foundations of psychological support for women in childbirth during midwifery activities.

Results. An important condition for increasing the efficiency of the treatment process is not only taking into account the patient’s psychological peculiarities, but also providing psychological support to patients during medical care, in particular midwifery activity. Research on different aspects of psychological support is noted in the works of domestic and foreign psychologists who reveal the humanistic ideas of personal development interaction, requiring building a subject-subject relationship in the process of communication. A number of publications are presented in the modern literature concerning the role of psychological support in professional midwifery activities. According to the authors, this area is an important professional responsibility of obstetrician service staff. A special role is played by the psychological support of patients during childbirth. The relationship of the characteristics of the birth process with the emotional state of mothers is noted in modern literature. Psychological support for women in childbirth should be given with the knowledge of the patients’ specific psychological characteristics in this period. The state of consciousness of a woman in childbirth is one of the important psychological factors that require the attention of medical personnel. The altered state of consciousness (ASC) in childbirth, which has an adaptive role, is important for both active labor and reducing pain sensitivity in childbirth. A maladaptive ASC, on the contrary, interferes with the birth process and increase pain sensitivity. Depending on the activity, the psychological component of the generic dominant will manifest itself in an adaptive or maladaptive ASC, with psychological support for women during childbirth contributing to the activation of an  adaptive ASC.

Conclusion. Analysis of the psychological characteristics of women during childbirth showed the importance of considering the state of consciousness of the patient and the activity of the psychological component of the generic dominant when determining the strategy of psychological support.

Journal of obstetrics and women's diseases. 2019;68(2):71-78
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Aromatase CYP19A1, progesterone receptor PGR and estrogen receptor ESR1 gene expression in biopsy specimens of endometrioid heterotopia and endometrial tissue by reverse transcription PCR
Shved N.Y., Malysheva O.V., Osinovskaya N.S., Molotkov A.S., Tsypurdeyeva A.A., Yarmolinskaya M.I., Baranov V.S.
Abstract

Hypothesis/aims of study. Endometriosis is one of the most pressing problems of gynecology. Clarifying the expression of the estrogen receptor (ESR1) and the progesterone receptor (PGR) genes and polymorphisms in the aromatase (CYP19A1) gene in endometriosis will expand the understanding of the pathogenesis of the disease and the causes of resistance to its therapy. The objective of this study was to conduct a comparative analysis of mRNA expression of PGR, ESR1 and CYP19A1 genes in paired samples of the eutopic endometrium and peritoneal endometrioid lesions in order to search for predictive markers of response to hormonal therapy. In the future, this may allow personalizing the selection of hormonal preparations for the treatment of endometriosis.

Study design, materials and methods. Reverse transcription real-time PCR made it possible to evaluate CYP19A1, PGR and ESR1 gene expression levels in studied tissue samples from 22 patients with endometriosis and 9 women in the comparison group.

Results. Quantitative analysis revealed a high heterogeneity in the expression level of the studied genes, in both the endometrium and endometrioid lesions from patients with endometriosis. In the endometrium of patients in the comparison group, the heterogeneity of the expression level was observed only for the ESR1 gene.

Conclusion. Our findings suggest a high variability in CYP19A1, ESR1 and PGR gene expression levels in the endometrium and peritoneal foci in patients with endometriosis. This information indicates the need for an individual approach to prescribing targeted therapy, since it is obvious that the effect of treatment will depend primarily on the availability of a therapeutic target in a particular patient. The absence of a typical expression pattern for each of the genes in patients with endometriosis indicates the heterogeneity of the disease and the need to develop a molecular classification of this common pathology.

Journal of obstetrics and women's diseases. 2019;68(2):79-86
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Reviews
Womenʼs professional sports: reproductive health, hormonal contraception, doping issues
Dzhemlikhanova L.K., Niauri D.A., Safaryan G.K., Gzgzyan A.M.
Abstract

The article presents an overview of current data regarding reproductive health in female athletes, rationale and possibility of hormonal contraception use, as well as the role of licit hormonal agent use in reproductive health maintenance and restoration among female athletes.

Journal of obstetrics and women's diseases. 2019;68(2):87-94
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Amniotic fluid composition and its role in perinatal pathology
Mochalova M.N., Mudrov V.A., Mudrov A.A.
Abstract

Amniotic fluid composition reflects vital processes in the fetus, which determines its diagnostic value. This composition varies under pathological conditions of the fetus and uteroplacental complex. The aim of the study was to investigate the role of amniotic fluid composition in perinatal pathology. This systematic review summarizes and critically analyzes foreign and domestic research data obtained from 1977 to 2018. Determining the role of amniotic fluid composition will optimize the management of pregnancy and childbirth.

Journal of obstetrics and women's diseases. 2019;68(2):95-108
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Experimental models of type 1 diabetes
Yarmolinskaya M.I., Andreyeva N.Y., Abashova E.I., Misharina E.V.
Abstract

This article describes currently used experimental animal models of type 1 diabetes. The literature data on the pathogenesis of clinical and morphological patterns of the disease and the possibility of extrapolation have been summarized in the review. In addition, the advantages and disadvantages of each of the models have been evaluated. Based on the reported results, it can be concluded that preclinical research is essential as fundamental basis for the investigation of type 1 diabetes mellitus.

Journal of obstetrics and women's diseases. 2019;68(2):109-118
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