Vol 64, No 2 (2015)

Articles
Novel options in Prenatal Genetic Diagnostic
Baranov V.S., Kuznetzova T.V.

Abstract

Modern molecular approaches to prenatal diagnostic of inherited diseases are briefly reviewed. Advantages and limitations of molecular methods for analysis of chromosomal anomalies (QF-PCR, aCGH, NGS) are considered in line with conventional prenatal karyotyping. The special attention is paid to efficacy, limitations and diagnostic options of noninvasive prenatal genetic testing (NIPT). Some particular problems of its widespread implication into routine clinical practice are discussed. State of art in preimplantation genetic diagnostics (PGD) and obvious great opportunities of preconceptional genetic testing are highlighted.
Journal of obstetrics and women's diseases. 2015;64(2):4-12
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Clinical value of determination of markers of a thrombophylia at patients with the complicated pregnancy in the anamnesis
Andreeva M.D.

Abstract

The results of the survey of 214 patients with the complicated pregnancy (a preeclampsia, a premature detachment of placenta, antenatal fetal death, miscarriage) in the anamnesis are presented in the article. We determined the level of molecular markers of a thrombophilia (TAT, D-dimer) and aggregation activity of platelets and carried out antithrombotic therapy to these women. It is shown that 47,7 % of such nonpregnant women and pregnant early terms have the high level of D-dimer, TAT - 46,7 %, aggregation activity of platelets - 52,6 %. Determination of the increased levels of molecular markers of a thrombophilia is the indication to application the antithrombotic therapy and allow to control efficiency of this therapy.
Journal of obstetrics and women's diseases. 2015;64(2):13-17
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Premature rupture of membranes: problems of diagnosis and induction of labor
Bolotskikh V.M., Afanasieva M.K., Borisova V.Y.

Abstract

We conducted a clinical trial of the test AmniSure® ROM in women with premature rupture of membranes (PROM). The results of labor induction in cases of PROM were also studied. AmniSure® ROM test showed high sensitivity and specificity and recommendation of the use of this test in women with PROM was approved. Our study demonstrated the worsening of obstetric indicators in patients with PROM after labor induction in the absence of biological readiness for labor.
Journal of obstetrics and women's diseases. 2015;64(2):18-24
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Clinical and diagnostic criteria of cholestatic hepatosis severity in pregnancy
Zhestkova N.V., Radchenko V.G., Tumasova Z.N.

Abstract

The function condition of hepatobiliar system was investigaited in 120 pregnant with cholestatic hepatosis. The main criteria of cholestatic hepatosis severity were skin itching accompanied with increasing of biliar acids levels, transaminazes activities, alkaline phosphatase and cholesterol levels. Based on clinical and laboratory dates the outcomes of pregnancy and delivery were analysed. There were revealed that pregnancy loss, gestosis, placental insufficiency, IUGR and fetal hypoxia were met more often in groups with middle- and high severe cholestatic hepatosis.
Journal of obstetrics and women's diseases. 2015;64(2):25-32
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Strategy of prevention of bleeding-related maternal mortality
Zainulina M.S., Kornyushina E.A., Krivonos M.I.

Abstract

The article presents data on bleeding-related maternal mortality in St. Petersburg, North-West Federal District and in the Russian Federation. 6 times reduction of maternal mortality per 100 000 live births was observed in Russian Federation during the last three decades, however, the structure of maternal mortality due to bleeding, changes in the direction of increasing of rate of placental localization abnormalities and placenta previa. This trend may be related to the steady growth of the caesarean section rate. Particular attention is given to the formation of groups of patients at risk of developing obstetric hemorrhage, full examination, prevention of coagulopathy, the timely detection of placental localization abnormalities and placenta accreta. The article reviews the current approaches to prevention of obstetric hemorrhage using drugs, surgical techniques, and blood saving technologies.
Journal of obstetrics and women's diseases. 2015;64(2):33-41
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New technology of analysis of monitoring data cardiorespiratory system using cluster for caesarean section with opiate analgesia
Kiselev A.G., Korostelev Y.M., Arzhanova O.N., Kapustin R.V., Rybal’chenko P.A., Tushina A.V.

Abstract

The research of the regulation of respiratory and hemodynamic systems, conducted by modern methods of multivariate correlation analysis (cluster analysis) data monitoring cardiorespiratory system, showed a change of adaptation and regulation after cesarean section with opiate analgesia.
Journal of obstetrics and women's diseases. 2015;64(2):42-52
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Results of operative obstetrical activity in modern obstetrics
Krasnopol’skiy V.I., Logutova L.S., Buyanova S.N., Chechneva M.A., Akhlediani K.N.

Abstract

Cesarean section (CS) is the most widespread operation despite of high frequency of intra and post operational complications as opposed to spontaneous delivery. The aim of investigation (objective) is the analysis of outcomes of CS in every stages during and after CS. Material and methods. There is a retrospective analysis of 675 patients after CS. 60 women after pregnancy; 75 patients with insolvent scar after previous CS during planning of the next pregnancy; 540 scarred pregnant women in term and 24 pregnant women with implantation in the scar. Results. The application of the secondary sutures is indicated in the case of insufficient sutures on the uterine wall. The metroplastic operation is indicated during the next pregnancy. The insufficiency of the previous uterine scar is the indication for CS in more than 70 %. The earliest diagnosis of the localization of the placenta in the scar is desirable. The most cautious method of pregnancy interruption should be used with immediate or postponed metroplastic.
Journal of obstetrics and women's diseases. 2015;64(2):53-58
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Prophylactic antimicrobial drugs to pregnant women colonized with group B streptococcus
Oganyan K.A., Arzhanova O.N., Savicheva A.M., Zatsiorskaya S.L.

Abstract

Group B streptococcus (GBS), Streptococcus agalactiae, are the causative agents of severe infection of the fetus and newborn child. The aim of the study was to evaluate the efficacy of antibacterial drugs in women in the III trimester of pregnancy for the prevention of B streptococcal infection. Studied during childbirth and the postpartum period, 70 women colonized by group B streptococcus, treated and not treated with antibacterial perparaty in the III trimester of pregnancy. Evaluated as a new-born children of these women. In pregnant women who received antibiotics in the III trimester of pregnancy, significantly fewer were delayed rupture of membranes, preterm labor, subinvolution uterus. Less common was marked asphyxia. Group B streptococcus significantly more frequently (in 43.5 % of cases) were identified in children born to mothers who did not receive antibiotics during pregnancy. In 26.1 % of these children diagnosed with intrauterine infection. Thus, the use of antimicrobials in the III trimester of pregnancy in detecting GBS in the urine in any quantity, simultaneous detection of these microorganisms in urine and vaginal discharge of a concentration of greater than 104 CFU/ml reduces the rate of preterm birth, postpartum complications, and neonatal asphyxia and intrauterine infection B streptococcal etiology.
Journal of obstetrics and women's diseases. 2015;64(2):59-63
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Antenatal cardiotocography: problems and facilitiies
Pavlova N.G.

Abstract

The role of antenatal cardiotocography (CTG) in algorithm of fetal functional conditions disorders diagnosis is discussed in this article. Furthermore, visual and computer analysis of antenatal monitoring results have been compared. There were discussed Dawes-Redman criteria and based on them CTG systems of computer numeral analysis (Sonicaid System 8000, Sonicaid System 8002, Sonicaid FetalCare). There were shown that based principles of antenatal CTG registrations should be kept in any case, its analysis is possible only in time of active phase of the fetus rest-activity cycle. Any kind of questionable tracing should be analyzed by medical expert in special centers with appropriate experience.
Journal of obstetrics and women's diseases. 2015;64(2):64-68
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Features of a course of pregnancy at bronchial asthma and influence of immunological deposits on a placentary barrier
Shapovalova E.A., Zubzhitskaya L.B., Lavrova O.V., Arzhanova O.N., Dymarskaya Y.R.

Abstract

Studying of features of a course of pregnancy at the bronchial asthma (BA) and influence of immunological deposits on a placentary barrier was a research objective. Results of this research testify that the main complications of pregnancy at women with bronchial asthma is pregnancy interruption threat, gestosis and placentary insufficiency. Prevention, timely identification of these complications, joint maintaining patients by the obstetrician and pulmonologist allow women practically in all cases to give birth to the full-term healthy children. The greatest number of the immune deposits fixed in a placenta and damaging structures of a placentary barrier (endoteliya of vessels and a membrane of a sintsitiotrofoblast) is found in women with an average and a heavy current BA. Their adjournment is followed by morphological features of an immune inflammation, violation of an immune homeostasis in structures of a placentary barrier. Existence of pathogenic immune complexes in a placenta, and also detection with BA leads an antigen-presenting cells of cages in places of an immune inflammation at women to development of immunopathological process and placentary insufficiency that adversely affects the course of pregnancy, childbirth and can be a predictive factor of development of allergic diseases in the child.
Journal of obstetrics and women's diseases. 2015;64(2):69-75
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A simple program for prevention of premature birth, and some regrettable contradictions
Saling E., Lüthje J.

Abstract

Prematurity and late abortions are still major problems of modern obstetrics. An important cause is ascending genital infection, which can often be prevented by very early diagnosis of vaginal milieu disturbances by the patients themselves. In cases of recurrent late abortions or early preterm births, an operative total cercix occlusion is probably the most effective method currently available.
Journal of obstetrics and women's diseases. 2015;64(2):76-83
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To Doppler or not to Doppler
Goh W.A., Ivica Z.

Abstract

This review aims to provide the reader with an update on the present and potential clinical applications in Doppler ultrasound in perinatal medicine. Umbilical artery Doppler plays an important role in the management of intrauterine growth restriction (IUGR) and preeclampsia and aids in twin-to-twin transfusion syndrome management while notching in the waveform is a predictor of umbilical cord abnormalities. Middle cerebral artery Doppler reliably detects fetal anemia and may be useful in the assessment of IUGR as well. Abnormal uterine artery Doppler may play a role in predicting growth restriction, hypertensive disorders of pregnancy and preterm delivery. Abnormal ductus venosus waveforms can also be used to predict adverse fetal outcome and may allow for better timing of delivery while umbilical venous pulsations may be a sensitive marker for fetal heart failure in hydropic pregnancies. 3D power Doppler allows better small vessel visualization that is not affected by angle of insonation and has been used to diagnose placental and cord abnormalities. Significant improvements have recently occurred, improving the visualization and evaluation of placental vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/ or amplitude-based color Doppler ultrasound. Spatial representation of vascularity can be improved by utilizing 3D processing. Greater sensitivity of 3D Doppler ultrasound to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy. The rapid development of these new ultrasound techniques will continue to enlarge the scope of clinical applications in placental studies. As clinical experience with these new technologies increase and as the technology improves further, it is reasonable to expect that 3D Doppler and 4D ultrasound will be complementary addition to well established 2D Doppler ultrasound imaging.
Journal of obstetrics and women's diseases. 2015;64(2):84-91
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Clinical and diagnostic criteria of cholestatic hepatosis severity in pregnancy
Repina M.A.

Abstract

Discussed analyze the incidence and structure of maternal mortality from extra-genital diseases in Saint Petersburg the 1996-2014. Indicator of maternal mortality all the more depend from social factors and increase in the frequency of extra-genital diseases in reproduction ages woman.
Journal of obstetrics and women's diseases. 2015;64(2):92-96
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Pessaries in clinical practice
Bespalova O.N., Sargsyan G.S.

Abstract

Pessaries were used in medicine since ancient times, history of their use goes back thousands of years. Throughout its history, pessaries have not changed significantly, so modern products do not differ from the ancients. In modern obstetrics pessaries are used for treatment of cervical incompetence and prevention of premature birth. Transvaginal ultrasound is the gold standard for the evaluation of the cervix during pregnancy and allows a selection of patients with cervical length ≤25 mm for pessary installation. To date, the installation of pessary may be the main strategy for the treatment and prevention of threatened pregnancy termination in the II and III trimester of pregnancy.
Journal of obstetrics and women's diseases. 2015;64(2):97-107
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