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Obstetrics, Gynecology and Reproduction

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Vol 10, No 3 (2016)
View or download the full issue PDF (Russian)
https://doi.org/10.17749/2313-7347.2016.10.2

NEWS

 
3-4 55

ОRIGINAL ARTICLES

5-10 335
Abstract

Traditional attitude towards the role of hyperestrogenia in endometrial hyperplasia pathogenesis can be considered cogent only in case of simple endometrial hyperplasia (SEH). In case of complex endometrial hyperplasia (CEH) and atypical endometrial hyperplasia (AEH) excessive proliferation occurs only in endometrial glands not diffusely but as pockets. The signs of atrophy are often registered outside these pockets that reflects the state of hypoestrogens. The aim. To justify a differentiated approach to treatment tactics of patients with EH. Material. Pathological changes adjacent to the lesions AEH in 274 patients have been studied. Results. The structure of the endometrium outside the foci of the CEH and the AEH represents a wide spectrum of pathological changes – SEH, proliferative and secretory endometrium, polyps, atrophic endometrium, that's not confirms the role of hyperestrogenic in the pathogenesis of the CEH and AEH. Conclusion. SEH, as a result of imbalance of estrogen and progesterone, is subject to cyclic hormone therapy with progestin for the prevention of acyclic bleeding. In the case of the absence of abnormal uterine bleeding after uterine curettage under SEH and CEH without atypia valid only observation with regular control. At AEH surgical treatment is required.

11-16 173
Abstract

Objective. To assess the effectiveness for complex antithrombotic therapy with low molecular weight heparins (LMWH) after cesarean section at women with metabolic syndrome (MS). Materials and Methods. The study included 115 patients with metabolic syndrome after cesarean section. Group 1 (64 patients) with metabolic syndrome who had a complicated pregnancy in history. Group 2 (51 patient) with metabolic syndrome and no pregnancies in anamnesis. Group 3 (50 patients) – somatically healthy mothers. Сomprehensive clinical and laboratory examination was conducted, including a study of indicators of hemostasis in the preoperative period and at 1-th, 3-4-th, 9-10-th day of postoperative period. To prevent thromboembolic complications all patients with metabolic syndrome were injected enoxaparin sodium 12 hours after abdominal delivery in a dose of 40 mg daily, with further dose adjustment. Results. According to the results of studies in patients with MS from 1 day of the postoperative period there was an increased prothrombotic potential, violation of indicators of coagulation, platelet hemostasis and the system of natural anticoagulants. Due to the therapy with the use of LMWH the development of thromboembolic episodes was prevented at all patients with MC in the postoperative period. Other complications of the postoperative period were detected in 17 (14.78%) of patients with MS and 7 (14.00%) somatically healthy mothers. The incidence of postoperative complications 1st and 2nd groups were comparable with 3rd group. Analysis of laboratory parameters in patients with metabolic syndrome with complicated postoperative period, showed that the aggregation capacity of platelets with ADP, the levels of TAT and D-dimer on 9-10th day were comparable with those indices in the 1st and 3-4th day. The results show prothrombotic tendencies and violations of the hemostatic system continued to 9-10 days in these patients and also indicate a pathogenetic relationship of these tendencies in the development of postoperative complications. Conclusion. The development of thromboembolic complications in patients with MC was prevented due to the therapy of LMWH.

18-23 179
Abstract

Objective. Studying of a role of circulation of antibodies to HG during gestational process at pregnant women about pregnancy not incubation was the purpose. Materials and Methods. Selection was made by 40 women with a sensibilization to HG and pregnancy not incubation threat (the main group), and 20 pregnant women with lack of antibodies to HG, but with a similar clinical picture (group of comparison) aged from 19 till 39 years. Except the researches regulated by Orders of the Ministry of Health of Ukraine from individual consent of the woman research at 35 patients (21 women of the main group and 14 women from group of comparison) the maintenance of pro-inflammatory cytokines (IL-6 and ТNF-α), and also the level of lymphocytes with a phenotype of CD56+16+ and CD19+5 + in blood serum by IFA method is in addition conducted. Results. Reliable correlation communication between presence of the increased level of antibodies to HG and episodes of formation of hematomas behind a horion in І-st pregnancy trimester, a hypercoagulative syndrome, the IL-6 levels and TNF-α is revealed. Thus it is proved that existence of the circulating antibodies to HG leads to thrombosis changes that major factors of risk of development of complications of a gestation and thromboembolic complications. Conclusion. It is confirmed that symptomatic therapy in the course of the pregnancy complicated by threat of an abortion isn't pathogenetic reasonable and effective. An important point is influence on an immune component at a stage of preconception. It explains need of individualization of therapeutic approaches to maintaining women with habitual not incubation of pregnancy which will consider the immunological reasons of not incubation of pregnancy.

24-28 210
Abstract

The aim of our research was to estimate the relationship of levels testosterone, estradiol and levels of homocysteine and endothelin-1 at young women with polycystic ovary syndrome (PCOS). Methods. We examined 80 women (age 26.3±0.2 years, body mass index 23.3±0.9 kg/m2). Patients complained of primary infertility, menstrual dysfunction, hirsutism, acne. The control group: 20 healthy women. For the determination of the hormonal status, basal levels luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone (T), estradiol (E2), sex-hormone binding globulin, antiMullerian hormone (AMH), homocysteine (Hcy), endothelin-1 were studied in serum. Monitoring of folliculogenesis was carried out. Statistical analysis of the data was performed using the statistical package settlement Microsoft Excel and Statistica 6.0. Results. On the basis of the increase of T, AMH, coefficient of LH/FSH, ovarian volume, number of antral follicles and the decrease of level of E2 was set diagnosis of PCOS. Hyperhomocysteinemia was found at 52.5% and the increase of endothelin-1 at 80% patients. The high levels of endothelin-1 was found significantly more frequent in the group women with hyperhomocysteinemia. There is a direct correlation between endothelin-1, testosterone-estradiol ratio and negative correlation with the level of estradiol at women with PCOS. Conclusions. The young patients with PCOS have a higher risk development of hyperhomocysteinemia, which combined with hyperandrogenemia and hypoestrogenemia leads to increased level of endothelin-1.

29-34 224
Abstract

The analysis of the state of health of pregnant women was made and several risk factors for abruptio placentae were identified. The research was based on a retrospective analysis of 65 birth stories for 2014-2015 on the basis of Regional Perinatal Center of Kursk. We studied the medical history, concomitant somatic pathology and the results of monitoring of pregnancy and childbirth. In the group of studied women 45 (69.23%) of them had a complicated obstetrical and gynecological anamnesis, every second pregnancy was against the background of the threat of interruption, all patients had from 1 to 4 complications of pregnancy; high percentage extragenital primarily to changes in the vascular system of the maternal organism. An increase of various types of pathology complicates the course of pregnancy, including increasing abruptio placentae. This requires pregravid preparation, timely diagnostics and correction of violations, as well as ensuring a close relationship and succession between doctors.

35-40 202
Abstract

Objective. To analyze the structure of the gene polymorphisms of hemostasis, platelet receptors and enzymes of the folate cycle in patients with metabolic syndrome (MS) and a complicated pregnancy in history.

Materials and Methods. The study included 115 patients with MS. Of these, group 1 (64 patients) had a complicated course of pregnancy in anamnesis and group 2 (51 patient) with no pregnancies in anamnesis. The control group consisted of 50 somatically healthy mothers. All the patients were carried out molecular analysis of gene polymorphisms of the hemostatic polymorphisms of platelet receptor genes, polymorphisms of genes of folate cycle enzymes by polymerase chain reaction.

Results. In all patients with MS was identified pathology of genes of hemostasis, platelet receptors or enzymes of the folate cycle, and in all cases attended a multigenic (more than two defect genes) form of pathology. In the study, the patients with MS was significantly higher frequency of polymorphism in the gene for inhibitor of tissue plasminogen activator, in the gene of tissue plasminogen activator, fibrinogen gene, in the gene for angiotensin-converting enzyme gene of the receptor of angiotensin II 1 type. Gene polymorphisms of platelet receptors were also found significantly more often in patients with MS. Results of the study of folate cycle enzymes genes showed the prevalence of pathological polymorphisms in this group of genes in the genotype of patients with MS. In patients with MS and a complicated pregnancy in history was revealed not only a large frequency of occurrence of a pathological gene polymorphisms, but also the predominance in the structure the homozygous forms of these polymorphisms.

Conclusion. Thus, it becomes obvious pathogenetic role of latent thrombophilic states in the development of various obstetric complications in patients with MS and the reason underlying this condition is a multigenic structure of the gene polymorphisms of hemostasis, platelet receptors and enzymes of the folate cycle in all MS patients.

41-46 132
Abstract

The purpose. To compare pathological disorders of placenta in syphilis infection in women with forms of placental insufficiency.

Materials and methods. The observation of 114 women with confirmed syphilis infection. The control group included 30 women without a history of syphilis. Pregnant women enrolled in antenatal hospitalization and delivery in a maternity hospital of the city of Krasnoyarsk.

Results. According to the research results the most frequent histological changes were manifestations corresponding to utero-placental form placental insufficiency, in group I is 44.8% and II – 52.9%, against 12.5% in the control.

Conclusion. The most likely pathological mechanism of development of placental disorders-insufficient infestation cytotrophoblasts mineralnych segments of the spiral arteries, with subsequent decrease in maternal blood, obliteration of the spiral arteries, hypoxia and loss of microvision epithelium.

47-52 168
Abstract

The urgency of the problem of abortion in Russia is determined by its medical and social significance in connection with a high prevalence, significant contribution to the performance of reproductive losses, maternal mortality and gynecological morbidity. Objective. To analyze the dynamics and structure of abortions in Russia for 2008-2015.

Materials and Methods. Official statistic data (federal form №13) is analyzed by descriptive method of statistics.

Results. For the period 20082015 the total number of abortions decreased by 28.7%. During the described period the number of abortion for social reasons has decreased – by 96.7%, on the second rate of decline registered illegal abortions- by 87.0%, on the third place – medical abortions, the number of which decreased by 53.8%, the number of unspecified abortions decreased by 40.5%, the number of abortion for medical reasons decreased by 9.7%. While, the number of spontaneous abortions in opposite increased by 34.6%.

Conclusion. Despite the decline in the number of abortions their level remains high and is accompanied by adverse changes in their structure, in which the proportion of spontaneous abortion increased. Miscarriage in 2015 year is 12.3% of pregnancies ended by childbirth, is indicating an increase its prevalence in the population – as the main marker of damage of reproductive health of women.

CLINICAL LECTURES

53-65 399
Abstract

About 90 percent of ovarian cancers are epithelial tumors. High mortality rates, the lack of effective methods for early diagnosis and treatment make of the ovarian cancer a relevant problem for modern oncology. Only a wide application of clinical guidelines developed by professional societies based on the principles of evidence-based medicine could improve prognosis for that group of patients. This article attempts to summarize the experience of the world's leading centers for the fight against ovarian cancer of epithelial origin and offer solutions relevant to everyday clinical practice.

CLINICAL CASE

66-69 152
Abstract

Complication of pregnancy acute appendicitis creates complex obstetric and surgical situation. Additional difficulties occur when acute surgical pathology occurs against a background of severe obstetric pathology for longer periods of pregnancy. The cases of acute appendicitis on the background of severe obstetric pathology in the form of a Central previa and true increment of the placenta in multiple pregnancies described in the literature. Therefore this case is actual.

70-74 166
Abstract

Thromboembolism represents the most serious, potentially fatal complications of assisted reproductive technologies. This article describes the modern aspects of the pathogenesis thromboembolic complications and importance of genetic and acquired thrombophilia for their development, and also recommendations for prevention of thrombotic complications before using assisted reproductive technology. Pregnancy, in-vitro fertilization, postpartum period, use of the oral contraceptives, genetic and acquired thrombophilia are the risks factors of thrombosis of venous sinuses. This medical case shows us that.

SCIENTIFIC SURVEYS

76-84 1487
Abstract

The prevalence of HPV in Russia and the world is quite high, although epidemiological data are limited because morbidity rate of papillomatosis, particularly genital warts, are not clear. The most effective method of preventing infection is vaccination against HPV infection. One of the most effective preventive measure to reduce the risk of death from HPV-related cancer diseases is a regular screening. None of the treatments of HPV infection will not totally effective and will not prevent disease transmission. In most cases, treatment is aimed at getting rid of symptoms but not cure infection. Immunomodulators for management of HPV-associated diseases could not have evidence base. Clinically proven treatment with inosine pranobex eliminates HPV to 98% cases and 3 times reduce frequency of relapses in combined therapy. Correct and complete counseling, aimed at informing the patient about the connection of HPV infection and cancer, as well as the possibility of preventing infection by timely vaccination and proper compliance are issue at present time. Isoprinosine saves a woman from the HPV, reducing the possibility of recurrence and malignancy, only when patient has complete course of therapy.

86-93 181
Abstract

The review is devoted to a problem of the intrauterine growth restriction (IUGR). The possible role in a pathogenesis of IUGR of genetic forms of a thrombophilia and circulation of the anti-phospholipid antibodies causing a preeclampsia and placental failure to 30-50% of cases according to different authors is discussed. The approaches to diagnostics, treatment and forecasting of IUGR including use of a fetometry, cardiotocography, dopplerometry, a research of an immunoreactivity, parameters of a hemostasis and vascular growth factors are presented.

HISTORIC CASES

94-96 163
Abstract

The article highlights historic aspects of medical and research work of the German obstetrician of the XIX-XX centuries Christian Gerhard Leopold.



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