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Obstetrics, Gynecology and Reproduction

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Vol 10, No 2 (2016)
View or download the full issue PDF (Russian)
https://doi.org/10.17749/2313-7347.2016.10.3

NEWS

ОRIGINAL ARTICLES

5-14 161
Abstract

Objective: to make analysis of isolated deterioration of blood flow in the pool of uterine arteries in low-risk pregnancy after 18-week gestation, to detect connection of blood flow deterioration with infection processes of different location in the organism of pregnant women.

Methods. Doppler screening research was made as well as analysis of spectrograms of uteroplacental and fetal blood flow of 357 pregnant women.

Results. Low-risk pregnancy was accompanied by high frequency of hyperdynamic deterioration in the system of "mother-placenta-fetus" (14%), most frequently was detected the reduction of perfusion data of uteroplacental blood flow (67,9%) with almost absolute dominance (prevalence) of one-sided deterioration; high correlation dependence was revealed between reduction of uteroplacental blood flow and existence of extragenital chronic infection foci (71,4%); asymptomatic bacteriuria and infection-and-inflammatory disease of laryngological organs; causal treatment improved hemodynamic rates, with idiopathic forms of uteroplacental perfusion deterioration, pathogenic treatment is recommended, dipyridamol – 75 mg daily (25 mg three times a day) is a chosen medicine.

Conclusion. Isolated one-sided deterioration of uteroplacental blood flow during low-risk pregnancy may be considered as the mark of chronic infection foci in the body of a pregnant woman; well-timed diagnostics and causal treatment allow to avoid progressive deterioration of hemodynamic rate.

16-22 222
Abstract

The aim of this study is assessment of hemostatic parameters in pregnant women with retrochorial hematoma (RCH).

Materials and Methods. The study involved 153 pregnant women during the first trimester. The first group comprised 90 patients with RCH, and the second group is the control group, comprised 63 pregnant women with normal pregnancy.

Results. The research results show, that soluble fibrin monomer complex (SFMS) and D-dimer indicators of pregnant women with RCH were higer in comparison with data of the second group (p<0,001).

Conclusion. Higher values of SFMC and D-dimer tend to be high probability predictors of retrochorial hematoma and have a great meaning for preclinical diagnosis of retrochorial hematoma.

24-31 178
Abstract

Objective. The research objective is the development of effective method for the treatment of complicated ectopia of the cervix, allowing to reduce the frequency of relapses.

Materials and methods. A comprehensive examination of 86 women with complicated ectopia of the cervix has been undertaken. In the main group (n=45) our proposed method of treatment of ectopia of the cervix has been applied, which, in addition to the performance of coagulation, involves two successive stages: preparing for coagulation and treatment in the postoperative period including Galavit (patent for invention № 2568768). In the comparison group (n=41) coagulation ectopia of uterine cervix was preceded by empirical antibiotic and antiviral therapy. Diagnostic measures included bacteriological and cytological examination, HPV testing, extended colposcopy, PCR diagnostic and ELISA blood test for the detection of causative agents of urogenital infections.

Results. The analysis of the postoperative period and control the colposcopy showed that in the majority of cases in the main group the reparative process ended by the end of the 3rd week (62.2%), the full impact of all the patients was recorded at the 5th week after the treatment (100%), the relapse has not been revealed within 2 years. In the comparison group the slowing down of terms of epithelialization of the wound surface of the uterus after coagulation has been noted, the lack of treatment effect has been found in 9.8% of patients, and the relapse within 2 years and 17.1% of women has been stated.

Conclusion. The developed method allows to increase the efficiency of treatment by sequential combined effects on cause and effect of pathological changes on the cervix: the elimination of etiopathogenetic factors ectopia of the cervix, coagulation of the pathological section, stimulation of the immune system and reparative processes.

32-36 132
Abstract

Objective. To substantiate indications for a differential approach in the treatment of patients with atypical endometrial hyperplasia.

Materials and Methods.The results of surgical treatment in 132 patients with atypical endometrial hyperplasia have been studied.

Results. Post-operative diagnosis was:endometrial cancer – in 19%, atypical hyperplasia – in 35%, simple and complex hyperplasia – in 33%, only atrophic endometrial changes – in 13% of patients. The tumor was within the endometrium in 5 patients, the superficial invasion of the myometrium (1-2 mm) were in 8 patients, invasion to half of the myometrium – in 9 patients, invasion of more than half of the myometrium – in 3 patients.

Conclusion. The guestions of tactics of treatment of atypical endometrial hyperplasia is under discussion.

37-43 239
Abstract

Objective: to investigate health and social factors leading to the emergence of threatening preterm birth.

Material and methods: This study was designed to evaluate the significance of social conditions, professional and material factors, obstetric and somatic history in 191 singleton spontaneous gestations, included 117 women with threatened preterm labor (О47.0 in ICD) and 74 women with physiological pregnancy. Inclusion criteria for the main group were abdominal pain and structural changes in the cervix (maturation and shortening less than 2 cm). Medical records were also a source of information about the complications and the outcome of pregnancy. We calculated odds ratio and produced a ranking number of risk factors threatened preterm labor.

Results: average general education, signs of a threatened abortion in the second trimester, smoking during pregnancy, asymptomatic bacteriuria and the presence of immunoglobulin G (IgG) antibody to Cytomegalovirus (CMV) are the most significant risk factors for threatened preterm labor.

Conclusion. It is necessary to conduct preconception preparation of women with above mentioned poor factors, as well as measures aimed at elimination of controllable risk factors, to reduce the likelihood of threatened preterm birth.

SCIENTIFIC SURVEYS

44-54 157
Abstract
Ovarian cancer is the 3rd most common cancer among women with gynecological neoplasms in Russia, at the same time, it have the highest mortality rate among malignant tumors of the female reproductive system. Because ofvague clinical picture and the lack of effective methods for early detection and screening, more than 60% of cases are diagnosed at stage III-IV, after the spread of tumor beyond the pelvis. Standard treatment for this category of patients includes debulking surgery on the first stage, followed by adjuvant chemotherapy. The main predictor of the prognosis is the residualvolume of disease after debulking surgery. Nowadays, complete resection of all macroscopic disease is considered as optimal cytoreduction. Trying to perform surgical treatment in the optimal volume dictates the need for complex, multi-component operations, accompanied by significant postoperative morbidity and mortality. In addition, in many cases, resection of all macroscopic foci of the disease is technically impossible.The use of neoadjuvant chemotherapy is designed to reduce the incidence of postoperative complications and to achieve optimal cytoreduction in the maximum number of patients.After an analysis of literature the authors could make up aconclusion that the place of neoadjuvant chemotherapy in the treatment of advanced forms of ovarian cancer is still arguable. Based on data from clinical trials, the primary debulking surgery after the diagnosis is the best treatment for this category of patients. However, among patients with markers of unresectability according to the radiologic methods, as well as patients with poor performance status, that significantly increases the risk of surgery, use of neoadjuvant chemotherapy is a reasonable method of choice.
55-63 146
Abstract
Preeclampsia (gestosis) and eclampsia, as well as the acute intranatal hypoxy often act as trigger for the development of the perinatal hypoxic-ischemic brain injury. That is accompanied by such typical structural changes as periventricular leukomalacia (PVL) and intraventricular hemorrhages (IVH). The hypoxic-ischemic brain injury in the perinatal period can have such consequences as hydrocephaly, microcephaly, infantile cerebral paralysis (ICP), epilepsy and motormental retardation. It is not always possible to determine the disease gravity and forecast of the disease by routine methods of clinical, instrumental and laboratory examination. As it is proved, that the perinatal hypoxic-ischemic brain injury is always accompanied by the disruption of Blood-Brain-Barrier (BBB) permeability for neuron-specific proteins (NSP). NSP can be considered as markers of this pathologic process. Nowadays there are more or less details on 120 NSP, namely, non-enzyme neurospecific Са+ -binding proteins; non-enzyme NSP, responsible for adhesion and intercellular recognition processes; соntractile and cytoskeletal nervous tissue proteins; secreted regulatory and transport NSP; myeline proteins and glial NSP. To evaluate BBB status it is expedient to select from the variety of known NSP most studied proteins, being neurons’ and astrocytes’ markers. Such NSP are gliofibrillary acid protein, GFAP and neuronspecific enolase, NSE. In normal conditions the NSP are within BBB and can be almost undeterminable in the blood serum. In case of the BBB permeability disruption NSP penetrate to the peripheral blood flow and can be determined. The dynamic determination of the NSP in the blood serum can be expedient to evaluate the BBB resistance, to determine the degree of the CNS injury and the disease state forecast at children with perinatal hypoxic-ischemic brain injury.
64-69 178
Abstract
The article presents a literature review on methods of diagnosis, therapy and management of patients with isthmic-cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis can be made only during pregnancy. Shortening of cervical length <25 mm before 24 weeks indicates the presence of ICN and the significant risk of miscarriage. Initial evaluation of the cervical length is from 14 weeks. When finding a shortening of the length of the closed part of the cervical canal is less than 25 mm the treatment of choice is surgical correction. When the cervical length more than 25 mm prophylactically from 19 to 32 weeks assigned to micronized progesterone 200 mg vagina. In identifying ICN after 24 weeks, the method of choice is the appointment of micronized progesterone and the installation of an unloading obstetric pessary. The use of a differentiated algorithm of management of patients with ICN reduces the chance of unexpected premature birth and neonatal morbidity and mortality.
70-76 204
Abstract
The article investigates the essence of the phenomenon of surrogacy (surrogate motherhood) from the standpoint of Bioethics and moral foundations of Law. Shows a selection of reference regulations of foreign Legislation. The authors present a Bioethical considerations of surrogacy and the most important issues related to the legal provision for surrogacy. Represented by the sample reference provisions of acts of a number of states (United States, Canada, Australia, United Kingdom, France, Russian Federation). The article suggests measures for improvement of the legislation of the Russian Federation in the context of restrictions to be imposed on the use of the surrogate motherhood technology.

SHORT MESSAGES

77-79 150
Abstract
Infertility in marriage, which is encountered by 7-8 million of women in Russia, is an important factor reducing the reproductive potential of the country’s population. The endoscopic methods of examination, allowing to determine the cause of infertility and conduct the respective treatment, have been used lately wider and wider for diagnosis of female infertility. The most advanced methods of treatment of tubo-peritoneal infertility are surgeries on the pelvic organs and assisted reproductive technologies.

HISTORIC CASES

80-83 116
Abstract
The article discusses the history of formation and development of medicine in Odessa for hundred years since its foundation.
84-85 159
Abstract
The article highlights historic aspects of medical and research work of the French obstetrician of the XIX century Alexandre Couvelaire.
86-88 172
Abstract
The invention of forceps was of great importance for practical obstetrics, however, the invention Chamberlains was kept secret for a long time, while the others approached them step by step. In addition to practical importance, the story with forceps carries a great human lesson. A lesson for generations.


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