Vol 68, No 5 (2019)

Hypothesis/aims of study. To date, in the world, including in the Russian Federation, the number of women who use breast pumps (BPs) in the process of breastfeeding has significantly increased. Many mothers of premature and full-term babies are partially or completely breast pump-dependent for weeks or months and need a BP that should be effective and convenient. In this regard, it is of great practical interest to compare the characteristics and, above all, the efficiency of milk pumping using two types of BP — one with vacuum component and another with vacuum and compressive components. The aim of this study was to conduct a comparative assessment of the efficiency of milk removal using the Medela Symphony BP and the Lactopuls BP.

Study design, materials and methods. 14 lactating women of 19–38 years of age who volunteered to be included in this study were examined. Women had been lactating and breastfeeding normally for 5–8 days. The Lactopuls BP with vacuum and compressive components and the Medela Symphony breast pump with a vacuum component were used in the main program mode.

Results and conclusion. It was found that the Lactopuls BP is more effective for milk removal. In particular, the amount of milk expressed using it was on average 14% more than that using the Medela Symphony BP. The Laktopuls BP with vacuum and compression components has shown its higher efficacy compared to the vacuum Medela Symphony BP.

Hypothesis/aims of study. The high prevalence of gestational diabetes mellitus (GDM) and the social importance of preeclampsia (PE) due to massive perinatal morbidity and mortality, as well as the high rate of PE in GDM pregnancy define the need to study the characteristics of pregnancy course in these women to develop the prevention and management of pregnancy complication. This study aimed at evaluating clinical and laboratory features of PE in GDM pregnancy.

Study design, materials and methods. According to the inclusion criteria, 112 pregnant women were enrolled in this prospective cohort study after 24 weeks of gestation: with GDM and PE (n = 24), with PE (n = 22); with GDM (n = 37), without studied pregnancy complications (n = 37). We assessed serum levels of placental growth factor (PIGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1). Pregnancy course and labour were evaluated using medical history.

Results. Severe PE developed more often (p = 0.0014, Chi-square test) in the PE group (59%, n = 13) compared to the GDM + PE group (13%, n = 3). Elective preterm labour occurred more often in the PE group compared to other study groups (PE: 23%, n = 5; GDM + PE: 9%, n = 2; p < 0.0001, Chi-square test with Yates correction), which is in line with the severity of PE in this group. The rate of preterm labour did not differ between the GDM + PE group and the group without studied pregnancy complications. Moreover, the mean fasting glucose level was higher in the GDM group compared to the GDM + PE group (p = 0.01, Mann–Whitney test). The GDM + PE group was characterized by fasting hyperglycemia episodes and a basal insulin regimen, while the GDM group by postprandial glucose peaks, and a bolus insulin regimen. Women with GDM + PE were notable for the high pre-pregnancy body mass index (29.0 ± 6.58 kg/m²), and a family history of DM was more typical for women with GDM without PE (59%, n = 19). The sFlt-1/PIGF ratio did not differ between the GDM + PE, GDM and control groups and was lower compared to the PE group (p < 0.0001, Fisher’s LSD test). PIGF level was not different in the GDM + PE and GDM groups, but was lower compared to the control group.

Conclusion. Our study showed that PE in women with GDM is more benign than in patients without GDM, taking into account both clinical and laboratory signs. At the same time, obesity appears to be one of the most important risk factors for the both pregnancy complications. The data of this study, in addition to those described in the literature, suggest that initial carbohydrate disorders play a disease-limiting, protective role in a vicious cycle of PE due to angiogenesis stimulation. The use of angiogenesis factors as markers of PE in GDM patients is limited, which requires further research.

Hypothesis/aims of study. According to the literature, the prevalence of vitamin D deficiency and its deficiency in pregnant women reaches 60–80%, which is a significant factor in reducing bone mineral density (BMD), osteopenia, and the risk of fractures after childbirth. Hormone-mediated changes in calcium-phosphorus metabolism during lactation are an independent factor in the reduction of BMD. Therefore, the study of the relationship between vitamin D deficiency and insufficiency after childbirth and the possibility of correction is relevant. The aim of this study was to evaluate the effect of prophylactic doses of cholecalciferol and calcium carbonate over time on calcium-phosphorus metabolism indicators after childbirth.

Study design, materials and methods. A randomized controlled trial was conducted based on V.A. Almazov National Medical Research Center, Saint Petersburg. 64 puerperas, who lived in St. Petersburg from 2013 to 2014, were surveyed on the 3–5^th day after childbirth. The age of women ranged from 20 to 35 years. Blood serum levels of calcium, phosphorus, magnesium, 25-hydroxycalciferol (25(OH)D), and parathyroid hormone (PTH) were determined for all the puerpera. Using the blind envelope method, the postpartum women were randomized into groups: group I received cholecalciferol 400 IU and calcium carbonate 1000 mg after delivery for 6 months; group II received cholecalciferol 900 IU and calcium carbonate 1000 mg after delivery for 6 months. Blood sampling was performed over time to assess the levels of 25(OH)D, PTH, calcium, phosphorus, and magnesium.

Results. In group I after childbirth, the initial level of 25(OH)D in the blood serum was 22.46 ± 4.35 ng/ml, which corresponds to vitamin D insufficiency. An increase in 25(OH)D level by 3.56 ng/ml was observed after 3 months from the start of taking cholecalciferol 400 IU. After 6 months, the level of 25(OH)D reached normal values in 20% of women (p = 0.0001). In group II after childbirth, the initial level of 25(OH)D in the blood serum was 20.64 ± 5.37 ng/ml, which corresponds to vitamin D insufficiency. An increase in 25(OH)D level by 7.60 ng/ml was observed after 3 months from the start of taking cholecalciferol 900 IU. After 6 months, the level of 25(OH)D reached normal values in 56% of women, while the average level of 25(OH)D in these women corresponded to its normally low values. The levels of PTH, calcium, phosphorus, and magnesium remained within the reference values in both groups; however, there was an increase in PTH concentration 6 months after delivery, which may indicate that the cholecalciferol dose is insufficient to stabilize PTH.

Conclusion. Vitamin D deficiency and insufficiency occurred in 80-97 % of those examined after delivery. The use of prophylactic doses of cholecalciferol has a positive effect on calcium-phosphorus metabolism; however, they are not sufficient to stabilize PTH level. The cholecalciferol dose of 400 IU is insufficient to normalize the level of 25(OH)D within 6 months of administration. The cholecalciferol dose of 900 IU leads to normally low values of 25(OH)D in 56 % of women after 6 months of administration, but this does not stabilize PTH level either.

Hypothesis/aims of study. The problem of vaginal infections during pregnancy is of high importance in obstetric practice. To predict the risks and reduce the frequency of pregnancy and childbirth complications, it is necessary to dynamically assess the vaginal microflora and treat its disorders. The aim of the study was to investigate the vaginal microflora and evaluate the effectiveness of treating vaginal infections in pregnant women with a history of miscarriage.

Study design, materials and methods. The study included 153 pregnant women in the first trimester. The main group (group I) consisted of 99 women with a history of miscarriage, 35 of whom had signs of threatened abortion (subgroup IA) and 64 did not (subgroup IB). The control group (group II) comprised 54 women without a history of miscarriage and signs of threatened abortion. The vaginal microflora was examined using microscopic, bacteriological and quantitative real-time PCR methods. All patients with an established vaginal infection (bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis) received etiotropic therapy, depending on the microorganisms identified and their sensitivity to antimicrobial drugs. After treatment, in order to assess the effectiveness of the therapy, the vaginal microflora was examined in the second trimester and the outcomes and complications of present pregnancy were evaluated.

Results. In women of subgroup IA, vulvovaginitis and bacterial vaginosis were detected 3.5 times more often compared to the control group, and 1.6 times more often compared to subgroup IB (66% and 19%, respectively, p < 0.001; 66% and 42%, respectively, p < 0.05). Aerobic vaginitis was the most frequent vaginal infection in the first trimester of pregnancy in women of the main group (p < 0.05). After treatment, the frequency of the vaginal infections in the second trimester in women of the main group significantly decreased: by 1.9 times in subgroup IA and by 1.5 times in subgroup IB (p < 0.05). There were no significant differences in the frequency of adverse pregnancy outcomes in women with bacterial vaginosis or vulvovaginitis as compared to women with normal vaginal microflora. Nevertheless, pregnancy and childbirth complications were diagnosed 4 times more frequently in the main group (23% and 6%, respectively, p < 0.05), with the complications occurring significantly more often in the cases of vulvovaginitis or bacterial vaginosis and signs of threatened abortion in the first trimester (p < 0.05).

Conclusion. Etiotropic therapy of vaginal infections diagnosed in the first trimester of pregnancy in women with a history of miscarriage was highly effective. In 40% of women, vaginal microbiocenosis normalized, and the clinical symptoms of vaginosis/vaginitis disappeared. Differences in the frequency of adverse pregnancy outcomes in women with vulvovaginitis or bacterial vaginosis in the first trimester and in women with normal vaginal microbiocenosis were not significant. However, the treatment of vaginal infections in the group of pregnant women with a history of miscarriage did not significantly affect the frequency of pregnancy and childbirth complications.

Hypothesis/aims of study. Vulvovaginal candidiasis (VVC) is one of the most common inflammatory diseases of the vagina. Herewith, a synergistic effect of lactobacilli and antifungal drugs in VVC treatment is suggested. In this regard, it seems relevant to study the effect of antimycotics used to treat VVC on the enhanced L. casei rhamnosus 35 (LCR35) probiotic strain. This study was aimed to determine the sensitivity to antimycotic drugs of the probiotic LCR35 strain included in the Lactoginal® vaginal capsules, as well as the sensibility of the genus Candida yeast under separate and joint cultivation with lactobacilli.

Study design, materials and methods. LCR35 was cultured on a MRS agar. Identification of bacteria grown on the medium, as well as clinical isolates of C. albicans and C. parapsilosis, isolated from the vagina, was performed by MALDI-TOF mass spectrometry. The sensitivity of yeast was determined on a modified Müller-Hinton agar with 40% glucose and methylene blue. Discs with fluconazole, voriconazole, itraconazole, ketoconazole, clotrimazole, and nystatin were used. Interpretation of growth inhibition zones was carried out according to EUCAST-2018 or according to the recommendations of the disc manufacturer.

Results. The probiotic LCR35 strain is resistant to antimycotics that are effective against C. albicans and C. parapsilosis. When determining the sensibility of C. albicans and C. parapsilosis to antimycotics in separate and joint cultivation with LCR35, no differences were found in the degree of yeast-like fungi growth suppression.

Conclusion. The probiotic LCR35 strain, which is part of the Lactoginal® vaginal capsules, is resistant to antimycotic drugs and does not affect the sensitivity of the tested yeast-like fungi to antimycotics.

In the early 2000s, the determination of inhibin levels was used actively for the diagnosis of ovarian tumors, as a diagnostic marker for prenatal screening of Down syndrome, as well as a prognostic marker for ovarian reserve when conducting assisted reproductive technologies. However, to date, inhibin is rarely used as a marker for reproductive function. At the same time, numerous studies of recent years indicate the crucial role of inhibin in folliculogenesis and spermatogenesis, as well as in implantation and placentation. This allows to significantly expand the diagnostic spectrum of inhibin levels in various disorders of the reproductive system of both women and men.

A urinary tract infection (UTI) during pregnancy remains one of the most important problems of obstetrics, urology, and nephrology. Pregnancy as physiological process contributes to UTI. This is caused by urinary clinical signs changing during pregnancy, approaches to diagnosis and treatment, as well as to the risk of developing urological, obstetric and neonatal complications. This article analyzes contemporary literature over the past 10 years.