Obstetrics, Gynecology and Reproduction

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Vol 9, No 1 (2015)


6-12 1117
Objective: to investigate the predictive value of fetal weight discordance as a risk factor associated with adverse perinatal outcomes. Materials and Methods: 55 patients with monochorionic diamniotic twin pregnancies with fetal weight discordancy were analyzed. All patients underwent ultrasound examination in the 1st trimester of pregnancy (11-14 weeks) to confirm the chorionicity. Estimated fetal weight discordance was calculated as (larger estimated fetal weight - smaller estimated fetal weight) / larger estimated fetal weight. All monochorionic patients were divided into the groups according to the differences in birthweight in twins (≤10%, >10 ≤15%, >15 ≤20%, ≤20 ≤25%, >25%). Adverse perinatal outcomes included: preterm delivery rate (≤34 weeks), fetal distress, low Apgar score, perinatal death, pathological neurosonographic findings. Results: severe birthweight discordance (>20%) in our study was associated with the highest risk of prematurity (76.2%), IUGR (47.6%), fetal distress and low Apgar score (75.0%), pathological neurosonographic findings (46.3%). These adverse perinatal outcomes were more pronounced in the group of monochorionic patients with birthweight discordance greater than 25%. Fetal weight discordance (>20%) is associated with the high risk of adverse perinatal outcomes and twin pregnancies with this complication require careful antenatal monitoring and timing of delivery.
13-18 230
In the world literature many works which main object of studying are women with repeated miscarriage and infertile women after IVF are published. Majority of these researches demonstrated significant association between the circulation of thyroid autoantibodies, infertility and high risk of fetal loss. Adequate level of thyroid hormones is necessity for normal functioning of reproductive system. In this article the association of miscarriage and autoimmune diseases of thyroid gland is considered. This association arose not incidentally perhaps the mechanism of such interrelation is that fact that existence of antibodies reflects the general activation of immune system and increases autoimmune process against feto-placental system. Objective: to investigate spectrum of antiphospholipid antibodies in patients with various forms of autoimmune thyroid disease and a history of recurrent pregnancy loss. Materials and Methods: 154 women were involved including 112 women with autoimmune thyroid disease (Graves' disease, autoimmune thyroiditis, postpartum thyroiditis) and 42 with miscarriage history, but without thyroid disease. Results: there is no significant difference between the frequency of detection of antiphospholipid syndrome (APS) among women with ATD and without ATD and with anamnesis of miscarriage. However, APS most often detected in patients with thyrotoxicosis (45%; p <0.005). High incidence of APS among women with autoimmune thyroiditis (33.33%) also identified. Conclusion: check up of thyroid status for all pregnant women with increased thyroid function could be recommended. Early detection and correction of the hemostatic system and thyroid dysfunction during pregnancy will help to prevent complications.
19-31 276

Herpes simplex virus type 1 (HSV-1) and 2 (HSV-2) - is a widespread viruses that can form a lifelong infection and persistence. Genital herpes in women of childbearing age is a serious risk of vertical transmission from mother to fetus. Primary HSV infection and the first episode of genital HSV infections are particularly high risk of infection of the fetus and newborn. The infection rarely occurs in the uterus. Most often the virus is transmitted during childbirth. The greatest risk of transmission to the fetus and the newborn in the case of primary maternal infection occurred during the second half of pregnancy. The risk of transmission from mother to fetus and newborn, can be reduced or the appointment of antiviral drugs, or in specific cases, caesarean section. The purpose of this paper is to propose a possible strategy to prevent transmission of the virus from an infected mother to the fetus.

32-37 229
The problem of infectious diseases during pregnancy continues to be relevant. It could be connected with possible complications during pregnancy and with the probability of the risk of intrauterine infection. One of the most common infections in the world, including among women of reproductive period is human papilloma virus (HPV) infection. There is lack of detailed information on risk factors for intrauterine fetal contagion with HPV infection. Objectives. Study objective was to reveal risk factors of vertical transfer of HPV. Materials and methods. 102 pregnant women with various forms of a papilloma virus infection are examined using real time polymerase chain reaction (PCR). Exclusion criteria were invasive and preinvasive cervical cancer, HIV infection, with concomitant CMV or HSV infection. Results. The general frequency of prenatal HPV infection was 14.7%. Risk factors of vertical transmission: high virus load, squamosus intraepitelial lession, abnormality vaginal biocenosis, reduction of secretory immunoglobulin in cervical mucus, increase in duration of vaginal birth and duration of the waterless period. There is not found correlation between age and social risk factors, parity, physical state and the frequency of HPV transmission from mother to child (p>0.05), as well as statistically significant impact on the incidence of fetal infection, complications of pregnancy and delivery method (p>0.05).
38-43 230
The article presents analysis of intensive care results in 32 pregnant women diagnosed with tuberculosis for the period from 2009 to 2013. The average age of the patients was 28.4±5.6 years; gestational age - 34.3±7.5 weeks. It was determined that 90.6% of pregnant women with severe forms of tuberculosis during the treatment were carried out surgical delivery in relation to the severity of the pulmonary process, at the average gestational age +21 weeks. The finding says that pregnancy and postpartum period in patients with severe forms of tuberculosis were accompanied by obstetric complications of pregnancy in 59.3% of cases and septic complications in 29.3% of cases. It is shown that integrated management and intensive treatment of pregnant women with severe forms of tuberculosis make possible to ensure the survival of 81.2% of the patients
44-52 254
Combined form of hyperandrogenism is one of the leading pathogenic causes of menstrual and reproductive disfunctions. Anovulation state causes an increase in the level of the main androgens, and the luteal phase deficiency is a consequence of the negative impact of hyperandrogenism. Conducting individual pathogenesis-based therapy, taking into account the condition of the reproductive system, allows of ovulation and pregnancy on the background normalization of androgen metabolism and other indicators of the functioning of the reproductive system.
54-58 220
Retrospectively reviewed results of treatment of 147 women with benign diseases of the cervix, which was destructive treatment of pathologic cervical lesion. Examination of patients included: bakterioskopiâ smear, cytology smears, PCR diagnosis of sexually transmitted infections, advanced colposcopy with biopsy sighting testimony to the destructive treatment were the result of scar deformity ectropion of cervix (91-61.9%), pathology of the CMM combined with human papillomavirus infection (25-17.0%), dysplasia (9-6.1%), Leukoplakia (12-8.2%), cervical polyp (6-4.0%), endometriosis, CMM (4-2.7%). Group of comparison comprised 81 women with the same pathology but without the destructive interventions on the neck. After a destructive treatment in terms from 1 till 5 years pregnancy occurred at 56 (38.1%) women. Spontaneous miscarriages have been observed in 27 (28.4%) women. Nearly one-third of pregnancies in women major group (29 women) has ended medical abortion After conization of cervix regardless of how the pregnancy was significantly more complicated by her amnion protrudes like a threat of termination, at different gestational ages. destructive interference in the cervix a little (statistically unreliable p≥0.05) affect the course of pregnancy, however, there is a dependency on the reproductive function of the type and depth of destructive interference.
59-62 224
Оur paper presents the study of incidence rate of genetic polymorphism of hemostasis genes and folate cycle in patients with habitual miscarriage, residing in Krasnodar region. The property of reproduction age women with habitual miscarriage in juvenile age (75 patients) was the multigene nature of trombophilia in 76.81% of cases (53 patients) from 69 patients with mutations (92% of total number of studied patients) at low percent of incidence of factor V (Leiden) and factor II (prothrombin) gene mutation. It shows that the management of pregnant women, decision on COCs and HRT administration can’t be made with testing of a limited number of the most thoroughly studied genes, considered as unconditional and strict markers of inherited thrombophilia (FV, F II, MTHFR С677Т).
63-67 296
The level of molecular markers of a thrombophilia (TAT, D-dimer) and platelet aggregate formation activity allows to estimate risk of obstetric complications at patients with the complicated pregnancy in the anamnesis and a thrombophilia. We observed 63 pregnant women (pregnancy term from 6 to 13 weeks) and 86 women planning pregnancy from which at 54 there was a preeclampsia in the anamnesis at 43 - a premature detachment of placenta, at 52 - antenatal fetal death. 53.0% patients with the complicated pregnancy in the anamnesis had high D-dimer; TAT - 55.0%; aggregation activity of platelets - 59.7%. High level of molecular markers of a thrombophilia are the indication to application the antithrombotic therapy and allow to control efficiency of this therapy


68-76 3078
Preterm labour (PL) is one of the most important worldwide medical and social problems. PL is the main reason of perinatal mortality and morbidity. More than 50% of all PL are late PL (labour at 34(0) - 36(6) weeks). Perinatal mortality during late PL is minimal, but more than 25% of these children still are admitted to the intensive care unit. Modern view on the late PL problem and perinatal morbidity prophylaxis are provided in the review article.
77-83 170
The traditions and practices of medicine provide an important reference point for medical ethics because they are based on the obligation to protect and promote the health-related interests of the patient. Medical ethics should be understood to be the disciplined study of morality in medicine and to concern the obligations of physicians and healthcare organizations to patients as well as the obligations of patients. Ethics is an essential dimension of maternal critical care. Maternal critical care is ethically more complex when the fetus as a patient. The physiacn's role is to explain to the pregnant patient before critical care is initiated its nature as a trial of management, The physician should explain both the short-term and long-term goals and the possibility that they might not be achieved. It is better for patients and their families to prevent ethical conflicts. Preventive ethics helps to build and sustain a strong physician-patient relationship.


84-86 245
The article deals with historical aspects of life, medical practice and research of Lidia Vanina, Soviet obstetrician and gynecologist of the XX century.

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)