Vol 68, No 4 (2019)

Original Research

Features of the vegetative status and quality of life in patients with external genital endometriosis and chronic pelvic pain syndrome

Kuznetsova D.E., Prokopenko S.V., Makarenko T.A.


Hypothesis/aims of study. Chronic pelvic pain syndrome (CPPS) in patients with external genital endometriosis (EGE) has a mixed pathogenetic mechanism of formation, including nociceptive and neuropathic components. However, there is still no clear correlation between the severity of pain and the degree of EGE. Of particular importance in pain chronization is the imbalanced autonomic nervous system (ANS) forming complex psychosomatic status, which patients experience as stress. This condition reduces the quality of life and causes social disadaptation, which exacerbates the pathological picture of the disease and diminishes the effect of pathogenetic treatment of EGE. We aimed to investigate the features of the vegetative status and assess the quality of life in patients with EGE complicated by CPPS and with a painless course of the disease.

Study design, materials, and methods. The study included 135 patients of reproductive age with grade III/IV EGE (r-AFS classification): 105 of them with CPPS and 30 without this syndrome. All these individuals underwent special ANS function testing and were assessed for the quality of life according to the Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36).

Results. The features of the vegetative status in patients with EGE complicated by CPPS were identified, such as the predominance of the sympathicotonic type of vegetative reactivity, high scores of vegetative dysfunction syndrome (in groups of patients with CPPS in almost 100% of cases), as well as high levels of reactive and personal anxiety (p < 0.05). In addition, women with EGE and CPPS have significantly reduced quality of life compared to patients with EGE and without CPPS.

Conclusion. The presence of suprasegmental and segmental ANS disorders in women with EGE and CPPS partly explains the mechanisms of pain syndrome chronization. The identified features are likely to be the cause of ineffective relief of pain syndrome in the EGE pathogenetic treatment algorithms. The reduced quality of life of such patients dictates the need to develop an effective treatment regimen for EGE and CPPS. This therapy should include drugs of central action that stop the neuropathic component of the pain syndrome, which is based on the imbalance of ANS parameters.

Journal of obstetrics and women's diseases. 2019;68(4):5-12
pages 5-12 views

Possibilities for predicting preeclampsia development in pregnant women with bronchial asthma

Lavrova O.V., Kulikov V.D., Shapovalova E.A., Sablina A.V.


Hypothesis/aims of study. Currently, preeclampsia is one of the most pressing problems of obstetrics due to the complexity of pathogenesis and to the lack of early and reliable diagnostic criteria. The preeclampsia rate in patients with bronchial asthma is proved higher than in asthma free pregnant women. This study aimed to establish the prediction algorithm of preeclampsia development in in pregnant women suffering from bronchial asthma of varying severity and different level of control.

Study design, materials and methods. Asthma duration was studied in 110 pregnant women using the SPSS Discriminant Function Analysis method. Basic therapy and level of asthma control were studied together with respiratory tests, obstetrician medical history, and complications of the first and second trimesters of pregnancy. In addition, serum interleukin panel was assessed and placental Doppler measurement was carried out.

Results. Clinical and statistical analysis made it possible out of 87 significant risk factors for the development of hypertensive disorders and preeclampsia to form a highly informative set of signs for a linear discriminant model for predicting preeclampsia: 1) asthma exacerbation in the first trimester of pregnancy; 2) asthma duration severity; 3) average dose of inhaled glucocorticosteroid drugs administered to the exact patient during pregnancy; 4) serum levels of tumor necrosis factor, interferon gamma, and interleukins-4, 6, and 8.

Conclusion. The inclusion method of step-by-step discriminant analysis allowed establishing a highly informative four-component complex of clinical predictors for preeclampsia development in pregnant women with asthma. The results of the model testing showed its extremely high reliability (up to 100% within study selection as well as within control selection). Thus, the study results can be recommended for clinical use.

Journal of obstetrics and women's diseases. 2019;68(4):13-18
pages 13-18 views

Operative delivery in pregnant women with asthma

Lavrova O.V., Shapovalova E.A., Dymarskaya Y.R., Sudakov D.S., Paliychuk A.V.


Hypothesis/aims of study. Asthma is the most common chronic disease of the respiratory system in women during pregnancy. Numerous studies show an increased frequency of all complications of pregnancy and delivery by cesarean section in women with asthma. Such delivery is reported to be observed more often in patients with severe asthma and asthma exacerbations during gestation. There are conflicting data showing that the use of asthma medication increases the risk of complications of pregnancy and childbirth. This study aimed at analyzing the frequency of cesarean section in patients with asthma, depending on the severity, course, and control of the disease.

Study design, materials and methods. This retrospective study involved data of 170 patients with varying severity and control of asthma, who were under the supervision of a pulmonologist from the first trimester of pregnancy. According to the severity of asthma, patients were divided into subgroups with mild intermittent, mild persistent, and moderate and severe course of the disease. The control group was represented by 30 patients who did not suffer from any pulmonary and allergic diseases.

Results. The cesarean delivery rate in patients with asthma in the whole group was significantly higher than in patients of the control group. Exacerbation of asthma during pregnancy significantly increases the frequency of abdominal operative delivery, and the use of modern drugs to achieve control of asthma during pregnancy has a positive effect and is associated with a lower birth rate by cesarean section.

Conclusion. The active simultaneous management of pulmonary problems in pregnant women allows timely and adequate therapeutic measures aimed to achieve control of asthma during pregnancy, thereby reducing obstetric and perinatal risks, including those associated with the method of delivery.

Journal of obstetrics and women's diseases. 2019;68(4):19-26
pages 19-26 views

Gonadotroph adenomas as a cause of ovarian failure

Repina M.A.


Aims of study. The current analysis was undertaken to evaluate the clinical significance of gonadotropin-secreting pituitary adenoma in the development of ovarian insufficiency.

Study design, materials and methods. This follow-up study included six observations of patients with prolonged amenorrhea caused by gonadotropin-secreting pituitary microadenoma.

Results. In addition to amenorrhea, patients had complaints of headaches in history or at present, signs of psychotic depression, and neuroticism up to mental disorders in one case. There was found a dynamic decrease in the secretion of follicle stimulating and luteinizing hormones on the background of normal prolactin secretion, lowered antimullerian hormone levels, and signs of diminished ovarian reserve according to ultrasound. A tendency to a simultaneous decrease in thyroid stimulating hormone and free thyroxin concentrations was also noted. Performing MRI with contrast enhancement revealed pituitary microadenoma in all patients. They had no clinical signs of acromegaly or Cushing’s disease, with the secretion of adrenocorticotropic hormone, cortisol, somatotropic hormone and insulin-like growth factor-1 remaining normal, which excluded corticotroph or somatotroph adenomas.

Conclusion. The clinical manifestation of gonadotroph adenomas, dependent on the secretory efficacy of gonadotropins and/or their subunits, is diverse. It includes the development of recurrent ovarian cysts, abdominal pain, metrorrhagia, and the development of persistent amenorrhea with psychosomatic disorders. If these symptoms are present, it is advisable to include pituitary MRI with contrast enhancement in the examination algorithm. Patients with gonadotroph adenomas are prescribed hormone replacement therapy and follow-up observation with dynamic MRI control of the tumor size (at 2–3-year intervals if no adenoma growth is seen).

Journal of obstetrics and women's diseases. 2019;68(4):27-34
pages 27-34 views


Vaginal microbiocenosis in the prenatal and postnatal periods

Dadayeva D.G.


The article presents literature data on vaginal microbiota status during full-term pregnancy, placental microbiota status, and the characteristics of the vaginal microbiocenosis in the postpartum period. The main topic of the publication is the role of the prevailing Lactobacillus species and conditionally pathogenic microflora of the vagina and placenta in obstetric practice.

Journal of obstetrics and women's diseases. 2019;68(4):35-45
pages 35-45 views

Minimally invasive intrauterine interventions: a review of their use in the prevention of pregnancy complications in case of premature discharge of amniotic fluid and rupture of the amniotic membrane during fetoscopic interventions

Kosovtsova N.V., Putilova T.A., Pavlichenko M.V., Markova T.V.


This review article highlights the results of using the variety of methods to prevent premature discharge of amniotic fluid as a complication of minimally invasive intrauterine interventions: the imposition of tissue sealant and amniopatch; amnioinfusion with normal saline, Ringer’s solution or artificial amniotic fluid using a port system. A historical background is given on the application of these correction methods.

Journal of obstetrics and women's diseases. 2019;68(4):47-54
pages 47-54 views

Prevention and therapy of threatened preterm birth in multiple pregnancy

Kosyakova O.V., Bespalova O.N.


Preterm birth in multiple pregnancy is an important medical, economic and social problem. Currently, more than half of twins are born prematurely, which puts them at high risk of developing neonatal diseases causing lifelong disability and social maladjustment. In this regard, reducing the frequency of preterm multiple births is an important task of modern obstetrics. Improving perinatal outcomes of multiple pregnancies can only be achieved using the most effective measures that have a good evidence base. At the same time, numerous studies on the effectiveness of therapeutic interventions aimed at prolonging multiple pregnancies have reported contradictory results. This review included most of the randomized controlled trials of methods for the prevention and treatment of threatening preterm birth in multiple pregnancies, as available in PubMed, Google Academy, Elibrary, and the Cochrane Central Register of Controlled Trials. Thus far, studies on the use of bed rest, prophylactic tocolysis, most of the progestins, and cervical cerclage in multiple pregnancy have shown no efficacy in reducing the risk of premature birth. However, encouraging data were obtained on improving neonatal outcomes of multiple pregnancies using vaginal progesterone and an obstetric pessary, but these results require additional confirmation in larger multicenter randomized studies. Further clinical trials are needed to develop algorithms for timely diagnosis and adequate treatment of threatened preterm birth in case of multiple pregnancy, including the use of the most rational preventive and therapeutic methods that have a high evidence level.

Journal of obstetrics and women's diseases. 2019;68(4):55-70
pages 55-70 views

Principles of diagnosis of ovarian neoplasms — minimization of errors

Protasova A.E., Tsypurdeyeva A.A., Tsypurdeyeva N.D., Solntseva I.A.


Ovarian cancer mortality rates hold a leading position among women’s cancer, which is primarily associated with the pathogenetic features of ovarian cancer, the heterogeneity of the disease, the lack of effective screening and diagnostic methods for early cancer detection. The causes of most ovarian tumors remain unknown. Ovarian benign tumors and tumor-like formations are not among the risk factors of ovarian cancer. The purpose of this literature review is to highlight the latest data from world expert organizations on the possibilities of ovarian neoplasm diagnosis and treatment.

Journal of obstetrics and women's diseases. 2019;68(4):71-82
pages 71-82 views

The efficiency of IVF/ICSI protocols in female subclinical hypothyroidism and thyroid autoimmunity

Safaryan G.K., Gzgzyan A.M., Dzhemlikhanova L.K., Niauri D.A.


While overt hypothyroidism is a well-known risk factor for infertility, the association of subclinical hypothyroidism (SCH) or thyroid autoimmunity with reproductive failure has been still not cleared. This literature review focuses on the most current data linking SCH and/or thyroid autoimmunity with human reproduction, starting with the parameters of ovarian reserve and ending with generalized immunological alterations. The main ART outcome measures are as follows: number of oocytes retrieved, fertilization rate, embryo quality, implantation rate, clinical pregnancy rate per embryo transfer, miscarriage rate, and live birth rate. Summary of the information regarding the effect of levothyroxine supplementation on IVF outcome as well as workup and management of women with SCH and thyroid autoimmunity undergoing ART cycles is also presented in this review.

Journal of obstetrics and women's diseases. 2019;68(4):83-94
pages 83-94 views

Theory and Practice

Intrapartum fetal hypoxia: an atypical case report

Melnikov A.P., Voloshchuk I.N., Aksyonov A.N., Aksyonova A.A., Dzyuba G.S., Ulyatovskaya V.I.


A case of abdominal delivery of the patient with acute intrapartum fetal hypoxia associated with a circumvallate placenta and a furcate cord insertion with the rupture of a chorionic plate vessel is reported.

Journal of obstetrics and women's diseases. 2019;68(4):95-98
pages 95-98 views

Application of the laryngeal mask airway in cesarean section

Shadenkov V.I., Korostelyov Y.M., Vartanova I.V., Shirokov D.M.


Spinal anesthesia is considered the standard anesthetic technique for elective cesarean section, but it is contraindicated in some cases. General anesthesia in pregnant women is associated with a significant increase in frequency of complications, primarily related to airway management. In this article, we propose to use a laryngeal mask airway as an alternative to endotracheal intubation during elective operative delivery, subject to certain conditions. We present two clinical cases of general combined anesthesia with the installation of a second-generation laryngeal mask airway and mechanical ventilation — in a patient with the Arnold-Chiari type I malformation and in a patient with IV grade scoliosis.

Journal of obstetrics and women's diseases. 2019;68(4):99-106
pages 99-106 views

History of medicine

Professor Alexey S. Slepykh on the 95th anniversary

Bezhenar V.F., Turlak A.S.


In 2019, the 95th anniversary of the famous obstetrician-gynecologist Alexey S. Slepykh, who was the head of the Department of Obstetrics and Gynecology of the Leningrad Sanitary and Hygienic Medical Institute (now North-Western State Medical University named after I.I. Mechnikov), is celebrated. The article is devoted to the biography of Alexey Slepykh, in which a trace of his research path is displayed and his clinical and teaching activity with his main achievements in the field of obstetrics and gynecology are described.

Journal of obstetrics and women's diseases. 2019;68(4):107-112
pages 107-112 views

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