Vol 65, No 5 (2016)

Endometriosis is a widespread gynecological disease which affects every tenth woman of reproductive age. The main symptoms of disease are chronic pelvic pain, sterility and miscarriage, that leads to a reliable decline in quality of life and working capacity, mental disorders. Timely and complete diagnostics of endometriosis allows choosing the best option of treatment and minimizes the costs of treatment. This article describes in detail the existing methods of diagnosis of endometriosis. Modern literature and the results of own studies are summarized in the text.

Relevance. Asherman’s syndrome is one of the most difficult problems in gynecologic practice, because in addition to complex clinical picture, which includes secondary amenorrhea and infertility is a significant difficulty in diagnosis and treatment. The purpose was to improve the results of treatment of Аsherman’s syndrome after conducting hysteroresectoscope adhesiolysis using anti adhesive barrier “Antiadgezin”.

Materials and methods. The study included 36 patients with peritoneal process in the uterus of varying severity. Group I consisted of 20 women who are in the postoperative period in the uterine cavity was entered “Antiadgezin”, group II — 16 women with similar pathology without introducing anti adgesive barriers.

Results. All women 3 months after adhesiolysis was performed a control hysteroscopy. The presence of adhesions was diagnosed in 2 (10%) patients in the first group, while adhesions were isolated delicate and easily destroyed by the sheath of a hysteroscope. In group II adhesions had recurrences in 5 (31,3%) patients (p = 0,038), and one patient was visualized “tunnel” — uterus, which is extremely unfavorable course of disease.

Conclusion. Treatment of Asherman’s syndrome, as extreme degree of intrauterine adhesions, requires a comprehensive approach, which is based on prevention of recurrence of the formation of adhesions after surgical interventions. Research on application anti adgesivebarriers will continue, as intrauterine their use on the example of antiadgezin showed good results.

Relevance. An in-depth study of the state of feto-placental complex, the characteristics of its reactions in response to hypoxia on the background of juvenile immaturity of minors can help to identify the main directions of the prevention of certain complications of pregnancy and childbirth among minors in the first place — placental insufficiency, preeclampsia, fetal hypoxia. Purpose of the study was to explore features of the histological structure of placentas and expression of HIF-1α and VEGF-A markers in placentas in minors.

Materials and methods. 74 placentas from minors were investigated by histological methods. The comparison group consisted of 25 placentas from healthy women the average reproductive age (20-30 years). The immunohistochemical study was performed in 35 placentas from minors who were divided into groups according to age and the presence or absence of chronic placental insufficiency. To study vascular status of villous tree of placentas were used the monoclonal antibodies of the vascular endothelial growth factor VEGF-A (Clone UG1; 1 : 50, Dako), to assess hypoxia in placenta were used the monoclonal antibodies of hypoxia — inducible factor HIF-1α (H1 alpha 67; 1 : 100, GRTP (Abcam).

Results. It was revealed that the placenta in minors is characterized by hypertrophy (559,5 ± 10,5 g vs. 478,7 ± 12,9 g), it is pathologically immature (33,8% vs. 7,0%), there is significantly greater frequency of chronic placental insufficiency in minors (33,8% versus 4,0%) with significantly lower severity of compensatory-adaptive reactions (86,5% vs. 100%). It is shown increased expression of hypoxia — inducible factor (HIF-1) and vascular endothelial growth factor-A (VEGF-A) in placentas of minor women with chronic placental insufficiency, compared with placentas of minor women without chronic placental insufficiency.

Conclusion. Chronic placental insufficiency at the time of birth, detectable more frequently in minor patients can make a difference in violation of adaptive mechanisms and quality of life of children in the postnatal period. Increased expression of HIF-1α and VEGF-A in the placentas of minor women with chronic placental insufficiency reflects activation of angiogenesis in response to intrauterine fetal hypoxia in chronic placental insufficiency.

Actuality of the study. Ovarian insufficiency is present in more that 30% of reproductive age women. The role of leptine and insuin resistance in the pathogenesis of ovarian insufficiency is not yet established and has to be clarified. The aim of the study to investigate the role of hyperleptinemia, insulin resistance and hyperestrogenemia in the pathogenesis of ovarian insufficiency in obesity.

Materials and methods. Fifty reproductive age women with BMI > 25,6 kg/m2 were studied. Ten healthy reproductive age women were included as controls. The plasma level of leprin, honadotropins, prolactin, insulin and sex steroid hormones assayed by immunoenzyme analysis, morning fasting blood glucose and the glucose level after glucose tolerance test, pelvic echography, “whole body” program of dual x-ray absorptiometry were studied in both patients and controls.

Results. Thirty-six out of 50 women had signs of ovarian insufficiency. The presence and severity of ovarian insufficiency did not correlate with the level of leptin in blood or with insulin resistance. The positive correlation between oestradiol level and both presence and severity of ovarian insufficiency could be demonstrated.

Conclusion. The results of our study do not support the hyperleptinemia and insulin resistance as the main cause of ovarian insufficiency in alimentary obesity. The most potential reason of anovulation in these women could be hyperoestrogenia due to increased conversion of androgens into oestrogenes in fat tissues and ovaria.

Presently, reduction of perinatal morbidity and mortality is a priority task of medical obstetrics in the world. An important role in the structure of perinatal pathology is taken to labor of macrosomic fetus. High rates of asphyxia (9,2-34,2 %), birth trauma (10,9-24%) during childbirth of large fetus are great medical and social problem.

The aim of the study was to define possibilities of diagnosis fetal macrosomia at present stage of science’s development.

Materials: literary data of foreign and domestic authors in the period from 1992 to 2016.

Methods: a systematic review and synthesis of the literature data.

Conclusion. It is necessary to determine an optimal algorithm for the diagnosis of fetal’s macrosomia, which will optimize the tactics of pregnancy and childbirth.

The article presents a clinical observation of the course of pregnancy and delivery in patient with immunological form of habitual miscarriage, having HLA compatibility with the spouse for the four alleles. Pregnancy proceeded with the risk of miscarriage, signs of cervical incompetence. We used high doses of glucocorticoids, Intralipid, low molecular weight heparins continuously in therapeutic doses. The birth took place by caesarean section at term 39/40 weeks, without features.

The aim of this study to explore the use of the agonist Toll-like receptors 9 (TLR 9) in the postoperative period after the LEEP, performed for cervical intraepithelial neoplasia, influences the process tissue repair cervix.

Materials and methods. In a randomized, longitudinal, prospective, comparative study included 70 patients with squamous intraepithelial lesions (HSIL и LSIL). Patients first test group (n = 36) was obtained postoperatively as a TLR agonist Derinat 9 immunomodulator. Two patients, the control group (n = 34), postoperative not administered any medication drugs. In the process of diagnosis all patients were performed conventional cytology and colposcopy, PCR-test for human papillomavirus (HPV). These parameters were examined postoperatively at 1 month and 6 months.

Results. Systemic administration agonist TLR 9, drug Derinat in clean postoperative wound of the cervix pathogenetically justified because it, together with the alteration leads to a synergistic effect to the reparative function of the macrophages through activation of Toll-like receptors 9 and the subsequent synthesis of cytokines directly accelerates the process of repair and immune supervision of malignant transformation cervical intraepithelial neoplasia tissues.

Conclusion. Patients after LEEP is recommended the appointment of the drug Derinat, agonist of toll-like receptor 9, immunomodulator with the reparative effect, intramuscular injection of 15 mg/mL, 75 mg after 24 hours number 10.