Vol 64, No 5 (2015)

Articles
Severe obstetric complications as a manifestation of thrombotic microangiopathy
Makatsaria A.D., Akinshina S.V., Bitsadze V.O., Andreeva M.D.
Abstract
Thrombotic microangiopathy is one of the most serious thrombotic complications characterized by microvascular thrombosis in various organs and accompanied by thrombocytopenia and hemolytic anemia. The term thrombotic microangiopathy has incorporated several nosology, which are characterized by different mechanisms of microvascular thrombosis. Currently thrombotic microangiopathy include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), heparin-induced thrombocytopenia, HELLP-syndrome. Pregnancy presents one of the key triggers to the development of thrombotic microangiopathy. This fact gives us a significant opportunity to study the pathogenesis of thrombotic microangiopathy in the context of the physiological changes of hemostasis during pregnancy. At the same time the discovery of molecular mechanisms of thrombotic microangiopathy allows for a new research on the field of pathogenesis of thrombotic complications associated with pregnancy, as well as the pathogenesis of so-called placental obstetric complications, including severe preeclampsia, premature detachment of normally situated placenta, septic shock.
Journal of obstetrics and women's diseases. 2015;64(5):6-15
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Evaluation of violations of vaginal biocenosis in terms of diagnosis and treatment of preinvasive cervical neoplasia
Berlev I.V., Bakhidze E.V., Arkhangel’skaja P.A.
Abstract
The article analyzes the role of risk factors from the point of view of modern ideas on the viral etiology of precancer and cancer of the cervix. Particular attention is paid to the role of vaginal biocenosis, as a cofactor in the development of preinvasive cervical neoplasia. The results of own studies showing that violation of the biocenosis of the vagina can cause cytological changes similar to the signs of mild dysplasia. It was studied the influence of treatment of vaginal biocenosis on the regression of early neoplastic changes of the cervix.
Journal of obstetrics and women's diseases. 2015;64(5):16-21
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Hyperhomocysteinemia in miscarriage: biochemical and genetic aspects
Bespalova O.N.
Abstract
Elevated levels of homocysteine in the blood is an important marker of the occurrence of various obstetric pathology. As a result of hyperhomocysteinemia impairs processes of microcirculation in the placenta. This in turn can lead to defects of implantation resulting in miscarriage. One of the factors contributing to the increase in the level of homocysteine in the blood is a hereditary predisposition. The purpose of this study is to analyze the influence of gender, age, number of spontaneous miscarriages, the genotype of MTHFR and MTRR genes with folate cycle homocysteine in the blood, the couple with miscarriages.
Journal of obstetrics and women's diseases. 2015;64(5):22-31
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Role of adjuvant hormonal therapy in treatment of endometriosis-assosiated infertility
Gerkulov D.A.
Abstract
Background. In vitro fertilization (IVF) represents the most efficient means of overcoming endometriosis-related infertility. Objective. To investigate the outcomes of in vitro fertilization cycles after controlled ovarian hyperstimulation in patience operated for endometrioma after different adjuvant hormonal therapy. Material and methods. 144 patients with endometriosis-associated infertility undergoing IVF were divided into three groups: GnRH agonist administration; dienogest 2 mg daily administration; women without adjuvant therapy. Results. Сlinical pregnancy rates were 2,5 times higher (44,7 and 16,7 % respectively; p = 0,01) and live birth rate was 3 times higher (36,8 и 11,1 % respectively; p = 0,01) in dienogest administration group before IVF/ICSI cycle in comparison with no adjuvant therapy groups, respectively. Conclusion. Considering the clinical pregnancy and live birth rate rates dienogest administration may be effective in patients with mild-to-moderate endometriosis prior to IVF/ICSI cycle.
Journal of obstetrics and women's diseases. 2015;64(5):32-35
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Status of placental barrier of women at the influence of exogenous and endogenous factors
Zubzhitskaya L.B., Shapovalova E.A., Arzhanova O.N., Dymarskaya Y.R., Lavrova O.V., Semenova T.V., Stolpner E.G.
Abstract
The aim was to study the peculiarities of the placental status of women under the influence of exogenous and endogenous factors. We performed immunohistochemical, histological and immunomorphological study of 384 samples of placenta of women with the most common conditions (asthma, smoking, metabolic syndrome and obesity). We studied the expression of immunohistochemical markers, that indicate the presence of immune inflammation in placenta - CD31, CD35, CD57, CD83, alpha-amylase (α-Amyl) and melatonin receptor 1B (Rc-M-1B), identified C3 complement fraction, fibrinogen, IL-4, IL-6, IL-10, IgA, IgM, IgG. The largest number of immune deposits, fixed in the placenta that damage the the placental barrier (endothelium of vessels of chorionic villi and basal membrane of syncytiotrophoblast) were found in cases of moderate and severe asthma, in cases of who smoked throughout the pregnancy and was more common in cases with metabolic syndrome, while compared with obesity group. We had shown that various antigenic factors influencing on the pregnant woman revealed a similar pathogenetic impact of the pathogenic immune complex (PIC) on the membrane structures of the placenta. Destruction of the membrane structures of placental barrier at the areas of PIC leads to dystrophic and necrotic lesions of the placenta and impaired immune homeostasis, development of immunopathological process and placental insufficiency, which correlates with pregnancy and labour complications, and may be predictors of the possible development of allergic diseases in childhood.
Journal of obstetrics and women's diseases. 2015;64(5):36-47
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Enterococci and their role in perinatal pathology
Oganyan K.A., Arzhanova O.N., Zatsiorskaya S.L., Savicheva A.M.
Abstract
Enterococcus are opportunistic bacteria and are members of the normal microflora of the gastrointestinal tract of humans and animals. The prevalence of enterococcal infections in pregnant women is approximately 28 %. Enterococcus, colonizing the urogenital tract pregnant women mostly do not show pathogenic effect, however, it is known that they can lead to the development of such complications of pregnancy as threatened preterm labor, placental insufficiency, hypotrophy of the fetus. Of complications in childbirth most common in premature labor, untimely discharge of amniotic fluid, fetal hypoxia. According to the literature cause of neonatal bacteremia and sepsis in 10 % of cases are enterococcus. Thus, for the prevention of complications of pregnancy, delivery and perinatal outcomes in the allocation of Enterococcus urogenital tract to undergo antibacterial therapy, given the sensitivity to antibiotics.
Journal of obstetrics and women's diseases. 2015;64(5):48-54
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Significance of pregravid preparation of women with miscarriages in the past
Pluzhnicova T.A., Komarov E.K.
Abstract
Aims of this article consists in analysis of the rate of the most important reasons of miscarriages and in estimation of effectiveness of pregravid therapy of wemen with miscarriages in the past who were patients of Center in 2014. The most important reasons were the infection of genital tract (60 %), inherited thrombophilia (95 %) and AFS (3,2 %), endocrine diseases with secondary or initial insufficiency of corpus luteum (35 %), chronic endometritis (60 %). There were presented results of the investigation of the significance of insulin resistance in the pathogenesis of miscarriages and the efficiency of the treatment with metformin patients with prediabetes. There were analysed the course and results of pregnancy in 354 women with miscarriages in the past. In 92 % of women the pregnancy complete by delivery of alive baby. This results demonstrate the effectiveness of pregravid preparation of women with miscarriages in the past.
Journal of obstetrics and women's diseases. 2015;64(5):55-61
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Features of oxidative modification of proteins and erythrocyte functional state in pregnancy complicated by placental insufficiency
Shevelkova A.A., Aylamazyan E.K., Evsyukova I.I.
Abstract
Protein oxidation intensity and reduced thiols level were studied in comparison with erythrocyte functional state in pregnancy complicated by placental insufficiency. 31 women with placental insufficiency, 41 healthy pregnant and 37 healthy nonpregnant women were included. Induced protein oxidation intensity and reduced thiols level were shown to be decreased in pregnancy complicated by placental insufficiency. Erythrocyte functional state was also worsened. It correlated with protein oxidation intensity and reduced thiols level. So protein oxidation intensity, reduced thiols level and erythrocyte functional state were shown to be indicators of placental insufficiency and can be used to identify this pathology and to evaluate the effectiveness of treatment.
Journal of obstetrics and women's diseases. 2015;64(5):62-68
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Antiphospholipid syndrome in miscarriage
Shlyakhtenko T.N., Alyab’yeva E.A., Arzhanova O.N., Sel’kov S.A., Pluzhnicova T.A., Chepanov S.V.
Abstract
Purpose: the frequency of antiphospholipid in patients with reproductive failures was defined. The algorithm of the treatment of these patients was presented. Materials and methods: the study included 2150 patients: 1650 with a history of the repeated pregnancy losses; 450 with sterility and 50 healphy women. Results: the high levels of AFA were founded in 24 % of patients with spontaneous abortions and in 20 % of patients with sterility. Conclusion: Pregravid preparation and permanent monitoring the state of patients reduce frequency of unfavorable ends of pregnancy effectively.
Journal of obstetrics and women's diseases. 2015;64(5):69-76
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Instrumental methods of diagnosis of ectopic pregnancy
Ishutina T.M.
Abstract
The article presents a literary review of the capabilities of modern methods of instrumental diagnostics (x-ray, ultrasound, magnetic resonance research) with the assessment of their significance in the diagnosis of ectopic pregnancy with a brief historical digression.
Journal of obstetrics and women's diseases. 2015;64(5):77-86
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The role of obesity and overweight as a factor of gestational diabetes mellitus: a systematic review
Kapustin R.V., Arzhanova O.N., Bespalova O.N., Pakin V.S., Kiselev A.G.
Abstract
Objective: on the basis of a systematic review, clarify the role of overweight and obesity as a predictor of gestational diabetes mellitus (GDM). Materials and methods: an analysis of the literature data of the leading bibliographic sources - MEDLINE, Cochrane col., EMBASE. To evaluate the body mass index and standards of weight gain during pregnancy used the WHO guidelines and criteria of the Institute of Medicine (2009). The frequency and the odds ratio (OR) of developing GDM was estimated separately for each of the three groups in BMI. Results: A systematic review included 23 different design studies involving 740 510 women. It was found that the odds ratio of the risk of GDM in a group of pregnant women with excess weight is doubled - 2.22 (95 % CI 1.72 - 3.64), and almost four in obesity - 3.88 (95 % CI 2.97 - 5.32). The incidence of GDM in a group of pregnant women with normal body mass index - 3.77 % in the group with excess body weight - 6.59 %, in the group with obesity - 9.88 %. Conclusions: The obtained strong evidence of a direct connection between the linear increase in maternal BMI and the risk of developing gestational diabetes. Pregnant women with excess weight and obesity are at high risk for carbohydrate disorders during pregnancy.
Journal of obstetrics and women's diseases. 2015;64(5):87-95
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The role of active vitamin B12 (holotranscobalamin) in the development of anemia of pregnancy
Kerkeshko G.O., Dorofeykov V.V., Patrukhina N.A., Mozgovaya E.V.
Abstract
Modern data on the role of vitamin B12, and its biologically active form holotranscobalamin in particular, in the development of anemia of pregnancy are presented. Information on the vitamin B12 metabolism and its coupling with the folic acid and homocysteine metabolism is supplied. The new automated immunochemiluminescent method for the active vitamin B12 determination is described. Reference intervals for the holotranscobalamin and related indices that can be used for the differential diagnosis of anemia of pregnancy are specified.
Journal of obstetrics and women's diseases. 2015;64(5):96-105
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Particularity of genetic counseling in case of a family carriers of structural aberration of chromosome 6
Volkov A.N., Olennikova R.V., Ritenkova O.I.
Abstract
We discuss the case of a family carriers of structural chromosomal aberration del(6)(q24) in two generations. For the first time revealed in 2 year old girl, the aberration has become a reason for family medical and genetic examination, including prenatal cytogenetic diagnosis. The results of clinical and genetic testing of the proband were compared with published data.
Journal of obstetrics and women's diseases. 2015;64(5):106-109
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