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Obstetrics, Gynecology and Reproduction

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Vol 9, No 2 (2015)
https://doi.org/10.17749/2313-7347.2015.9.2

ОRIGINAL ARTICLES

6-12 94
Abstract
Objective: The definition of the conditions under which women with inherited thrombophilia can have a positive pregnancy outcome. Materials and Methods. We conducted a retrospective and partially prospective analysis of 100 women with various forms of hereditary thrombophilia with the purpose of studying the conditions of a positive outcome of pregnancy. Results. We learned that normal uncomplicated pregnancy is possible if the age of the pregnant geminimen 26 years or properly selected antithrombotic therapy. Later than the time of menarche and the presence of a large number of mutations, mainly homozygous forms are markers of phenotypic manifestation of hereditary thrombophilia, starting with the first pregnancy. Conclusion. Timely diagnosis of genetic mutations and polymorphisms of thrombophilia (pre-pregnancy), pregravid proper training and appropriate management of pregnant women with the use of antiplatelet and (or) anticoagulant therapy let to get a good results by reducing the performance of reproductive losses and complications of pregnancy.
13-18 86
Abstract
Objective: to study the prevalence of polymorphisms of the coagulation system genes and folate cycle in women with recurrent miscarriage (having two or more reproductive losses. Materials and methods. Carried out of molecular genetic study of 57 women with recurrent miscarriage and 35 patients without reproductive loss and having a history of at least one normally progressing pregnancy, culminating in the birth of a healthy term baby. Results. we have revealed a high incidence of MTHFR C677T, MTRR A66G, FGB G455A, ITGB3 T1565С gene polymorphisms. Conclusion. To prevent repeated reproductive losses in patients with an anamnesis of miscarriage, when other reasons are excluded, it is necessary to conduct a study of gene polymorphisms of coagulation system and folate cycle.
19-23 68
Abstract
The aim of the study was to determine the frequency of occurrence of group B Streptococcus in women in labour and newborn babies. Materials and methods. prospective study included two groups: group 1 patients (n=35) with full-term pregnancy and term birth, group 2 patients (n=22) with preterm birth in the period from 34 to 37 weeks. All patients upon admission and all newborns was carried out rapid test for Streptococcus group B. Results. in the 1st group, the test was positive in 25.7% of women and 8.6% of newborns. In the 2nd group, the test was positive in 18.2% of women and 22.7% of newborns.a prospective study was conducted of contamination of the genital tract in pregnancy Streptococcus group B. We have formed 2 groups: group 1 patients (n=35) with full-term pregnancy and term birth, group 2 (n=22) patients with preterm birth in the period from 34 to 37 weeks. All patients upon admission and all newborns was conducted rapid test for Streptococcus group B. In the 1st group, the test was positive in 25.7% of women and 8.6% of newborns. In the 2nd group, the test was positive in 18.2% of women and 22.7% of newborns.
24-30 110
Abstract
An Insufficiency of the corpus luteum (LPI) is one of the main causes of endocrine forms of infertility and spontaneous loss of the fetus in early pregnancy. Insufficiency of the corpus luteum, and consequently, defective secretory transformation of the endometrium during the second phase of the menstrual cycle, is a direct consequence of violations of folliculogenesis. A comprehensive assessment of the reproductive system prior to initiating therapy allows to develop algorithm of examination of patients, to choose an individual, pathogenetically substantiated treatment strategy, to select the doses and to avoid the possibility of complications. The object of the study is a comprehensive comparative assessment of the reproductive system of patients with impaired function of the corpus luteum suffering from endocrine forms of infertility and optimization criteria for determining the NLF. Materials and Methods: the study involved 170 women, including the control group. During the study was assessed the state of physical, hormonal profile, as well as ultrasound picture of the state of the reproductive system. Results and Conclusion: LPI is a multifactorial condition. Considering the performance levels of progesterone and estradiol, three forms of insufficient of luteal phase were determined and depending on it, the patients received pathogenetically grounded therapy.

SCIENTIFIC SURVEYS

32-53 101
Abstract
Сatastrophic antiphospholipid syndrome (CAPS) is an uncommon, often fatal, variant of the antiphospholipid syndrome that results in a widespread coagulopathy and high titres os antiphospholipid antibodies and affects predominantly small vessels supplying organs with the development of multiorgan failure. International approaches on terminology, risk factors, pathogenesis, criteria of diagnostics, clinical symptoms and management of patients with CAPS are reviewed. Own clinical experience of management 17 patients with CAPS development also presented. CAPS is life-threatening condition but optimal treatment for CAPS is not developed yet. CAPS presents a multidisciplinary problem.
54-61 101
Abstract
The article is dedicated to the habitual miscarriage as to one of most actual problems of modern obstetrics and gynecology. In spite of multiple, formerly known reasons of such pathology, a lot of factors, predisposing to reproductive losses, still have not been studied. In last decades scientists have been focused on the studies of the role of genetic factors in the habitual miscarriage genesis. The genetically determined insufficiency of the antioxidant system can seriously undermine the organism homeostasis. It is interesting to study the influence of carriage of polymorphic variants of genes of the antioxidant system enzymes, as of a factor, negatively impacting the course of pregnancy
62-71 116
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.
72-79 71
Abstract
Idiopathic thrombocytopenic purpura is a relatively rare disease, especially during pregnancy. Currently, there are many ways of diagnostics, monitoring and treatment of patients. Pregnant women with idiopathic thrombocytopenic purpura are at risk of hemorrhagic complications during pregnancy and postpartum period; moreover, they may give birth to infants with severe thrombocytopenia. Specialists widely discuss obstetric and perinatal risks in this disease, the risk of ante- and intranatal intracranial hemorrhage in newborns. In this review we have assessed the risks of obstetric and perinatal outcomes with different methods of delivery as well as the effectiveness of therapeutic interventions in pregnant women with idiopathic thrombocytopenic purpura.
80-88 77
Abstract
Development of methods of combined, radiation and medication therapy of malignant tumors has improved the results of survival, background of what is becoming a very important task of medical and social rehabilitation of patients. Considering psychosomatic features of cancer patients, in the framework of the rehabilitation of such patients should be performed overall patient-oriented medical work, one of the essential parts of which are individual and group psychotherapy. An important aspect of rehabilitation of cancer patients in reproductive age is the preservation or restoration of reproductive and sexual function after treatment of the underlying disease. Separately, in a program of rehabilitation of cancer patients is the question of palliative care for incurable cancer patients.
89-98 88
Abstract
Currently due to reduction of direct causes of maternal mortality increasing interest of scientists cause arterial thrombotic complications. Pregnancy-related stroke is a rare event, however, when it occurs, may be life threatening and there may be implications for management of the patient and delivery. The mechanisms and risk factors for ischemic stroke related to pregnancy and in women of childbearing age remain unclear. Pathogenesis of so severe complication in young women is not fully understood, however, there is a concept thrombosis or cerebral embolism, which can develop on the background of well-known population-based risk factors such as hypertension, metabolic syndrome, smoking, heart rhythm disorders, valvular heart disease or in relation to typical obstetric pathologies, such as preeclampsia, massive obstetrical bleeding, septic complications, amniotic fluid embolism. In recent years, there is increasing interest in the role of thrombophilia in the pathogenesis of ischemic stroke, however, data on this issue is even more limited and contradictory than for venous thrombosis. Methods of prevention of recurrent stroke and strategies of pregnancy and delivery management in women with history of ischemic stroke are also contradictory.
99-109 112
Abstract
After the first observations A. Trousseau in 1865, it is exist a host of studies on the relationship between the pathogenesis of cancer and thrombosis. There is now no doubt that the cancer patients occur much more frequently thromboembolism, and migratory venous thrombosis is a manifestation of paraneoplastic syndrome in cancer patients. In general, any manifestation of thrombohemorrhagic complications in cancer patients called Trousseau’s syndrome. While thrombotic complications such as venous thromboembolism are most frequent in cancer patients, may also experience severe bleeding symptoms due to systemic coagulopathies, including disseminated intravascular coagulation, haemolytic thrombotic microangiopathy, and hyperfibrinolysis. The basis of the pathophysiology of Trousseau’s syndrome, except the classic triad of Virchow, is overproduction of tissue factor, the main initiator of extrinsic coagulation pathway. Thus a significant release of microparticles from tumor cells bearing tissue factor is critical not only for the formation of a blood clot, but the growth and progression of tumors. Tumor cells activate the coagulation cascade or fibrinolysis system, providing conditions for its further spread, stimulation of angiogenesis, increased vascular permeability, which in turn promotes metastasis

CLINICAL CASE

110-115 73
Abstract
Questions of inspection and preparation of married couples with infertility before the application of auxiliary genesial technologies (AGT) remain extremely relevant taking into account the difficult obstetric and gynecologic status of patients belonging to programs of extracorporal fertilization, age, condition of their somatic and psychological health, and also the variety of etiological and pathogenetic factors of infertility. Objective: to determine individual algorithm of the hormonal profile assessment of genesial system for women with infertility, chronic anovulation and implications of hyper-androgyny. Materials and methods. the examined patients passed complex examination of the hormonal profile of genesial system including blood test at the 3-5th and 21-23rd day of the cycle, US monitoring of the follicular apparatus and endometrium. Conclusion. as a result of stage-by-stage inspection of patients with infertility and the adequate individually selected medicamental therapy for correction of disturbances of a menstrual cycle at the preparation for IVF, pregnancy comes in 67% of cases.

HISTORIC CASES

116-117 74
Abstract
The article highlights historic aspects of medical and research work of the French obstetrician of the XVIII century Andre Levret


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