Obstetrics, Gynecology and Reproduction

Advanced search
Vol 10, No 4 (2016)
View or download the full issue PDF (Russian)



5-11 499

The purpose – to evaluate the capability of the integrated magnetic resonance imaging (MRI) with diffusion sequences in the assessment of neoadjuvant chemotherapy treatment response of ovarian cancer.

Materials and methods. 23 patients with disseminated stages of ovarian cancer underwent pelvic and abdominal MRI to clarify the tumor spread, the issue of neoadjuvant chemotherapy (NHT) and again after 1 and 3 courses in the evaluation of its effectiveness. MR-study was performed on a superconductive 1.5 T MRI, using protocol: T2-, stir, T1-, Dynamic 3D FS, DWI with b-factors 0,1000 m/mm2 , with an estimate value of the apparent diffusion coefficient (ADC). The evaluation of differences in size of the entities was performed in accordance with RECIST 1.1 criteria, parameter measured: ADC.

Results. Сomparative assessment of ADC before and after treatment revealed significant increase after 3 courses of chemotherapy (p=0.008), improvement after 1 course in the primary tumor and differences in the ADC before and after treatment in the omental and the peritoneal implants are less pronounced and insignificant (R=0.89; 0.758; 0.695 respectively). Informativity in evaluation of residual tumor and the degree of therapeutic pathomorphosis MRI were: sensitivity 93.3%, specificity 84.6%, and accuracy 91.3%.

Conclusions. Diffusion MRI has high informativity and reproducibility in determination of response to neoadjuvant chemotherapy in advanced ovarian cancer. A significant difference in the mean ADC values was obtained for the solid component of the primary tumors, suggesting greater sensitivity to neoadjuvant chemotherapeutic treatment.

12-20 500

The aim objective: to improve the methods, protocol specification and assessment of the possibilities of the complex magnetic resonance imaging in the diagnosis of ovarian lesions.

Materials and methods. From 2011 to 2015 256 patients with 289 ovarian lesions underwent pelvic and abdominal (if necessary) MRI results compared with histological data, obtained intraoperatively, or verification is made on the basis of dynamic observation for at least 6 months.

Results. Quantitative estimation showed that the amplitude of the accumulation of the contrast agent was significantly higher in malignant tumors – 167% (115.2-212.5%), than benign – 61.2% (41.2-99.0%; P<0.001) and borderline tumors – 85.7% (58.3-138,2%; P<0.01); the period of 1/2 signal intensity rise significantly higher in benign tumors of 35.1 seconds (30.8 seconds and 42.5 seconds) than in the borderline – 27.9 sec (23.5 sec to 29.8 sec; P<0.05), and malignant – 23,1 sec (20.5 h is 30.9 sec; P=0.01). Maximum slope of the contrast enhancement curve (%/sec) amounted to 1.78 (1.0-2.6); 2.86 (2.01-3.95) and 6.1 (4.19-9.46) for benign, borderline and malignant tumors, respectively, and was significantly higher in malignant invasive tumors (P<0.01). The average values of the аpparent diffusion coefficient (ADC) of malignant tumors was significantly lower than the corresponding values in benign (1.012±0.18 mm2 /s×10-3 and 1.54±0.25 mm2 /s×10-3, respectively), the value intervals do not overlap. The threshold value of ADC for malignant ovarian tumors: less 1,139 mm2 /s×10-3. Advanced MRI technique accuracy was 92.1%, with sensitivity of 93.6% and specificity of 91.2%.

Conclusions. Optimization of the technique and protocol standardization of complex MR studies in patients with ovarian lesions provides a complete diagnostic information about the nature, allows if necessary to adequately assess the spread of malignant tumors in primary staging.

21-29 582

Objective: the assessment of a condition of health of women with antiphospholipid syndrome (APS) and hereditary thrombophilia (HT) and a condition of health their newborn children.

Materials and Methods. We examine clinically and by laboratorial and special exams (coagulogram, polymerase chain reaction diagnostics of genetics of hemostasis, ultrasonography of fetus at I, II, III trimester of pregnancy, doppler ultrasonography of blood flow in umbilical arteries, cardiotocography) 92 women with thrombophilia and their 92 newborn children (neurosonography, fundoscopy, abdominal ultrasound, nephrosonography, ultrasonography of hip joint).

Results. The somatic anamnesis was more often burdened by vegetative dystonia syndrome (82.61%) at women with APS and by prolapse of the mitral valve (30.43%) and myopia (28.26%) at women with HT. In high percentage of cases fetoplacental insufficiency (60.78% at women with APS and 67.39% at women with HT), threatened miscarriage (50,00% at women with APS and 65.22% at women with HT) and cervical erosion (23.91% at women with APS and 45,65% at women with HT) was peculiarity of obstetric and gynecology anamnesis at all women with thrombophilia. Hypoxic-ischemic encephalopathy (78.26%), conjugation jaundice (56.52%) and morphofunctional dismaturity (45.65%) was diagnosed more often at children who was born to the women with APS and hypoxic-ischemic encephalopathy (65.96%) and intrauterine growth restriction (34.04%) was diagnosed at children who was born to the women with HT.

Conclusion. Rather high percentage of diseases at women with thrombophilia and at their newborn children claim further development the therapy algorithm in the system “woman – fetus – newborn” with the case of decrease of the morbidity and improvement of social adaptation of newborn children in the future.

30-38 869

Objective. To study the pathogenetic significance of genetic and acquired thrombophilia and improve the principles of prevention of preeclampsia.

Materials and Methods. 65 patients were examined, who were divided into 2 groups: I group consisted of 35 women – pregnant women with repeated episodes of preeclampsia in the present pregnancy, in the II group consisted of 30 primigravida women with preeclampsia during the current pregnancy.

Results. Pathogenetically substantiated prophylaxis with low molecular weight heparin, vitamins and antioxidants in patients with preeclampsia and multigenic thrombophilia in early pregnancy has improved during gestation and perinatal outcomes in pregnant women. This was significantly better outcomes have occurred in patients who were treated with early pregnancy and childbearing cycle.

Conclusion. Early (antenatal) diagnosis, prevention and differentiated pathogenetic therapy can not only prevent the development of obstetric complications, and, consequently, reduce maternal mortality and morbidity, and improve perinatal outcomes in patients with various forms of thrombophilia. Pathogenic prevention of recurrent episodes of preeclampsia should be based on prevention of manifestations of pro-inflammatory status and genetic thrombophilia.

39-48 503

The purpose of work – improving the efficiency of treating endometriosis by clarifying some aspects of the pathogenesis of endometriosis.

Objectives of the study – determining the expression of aromatase in atopicescom and ectopic endometrium, to identify the relationship of polymorphisms in the aromatase gene and gems of detoksikatsii to optimize the ingenious treatment of patients with endometriosis.

Materials and methods. Definition of polymorphic gene variants of CYP19 was assessed by PCR with specific oligoprimers with subsequent restriction analysis.

Results: the Expression of aromatase in the studied forms of endometriosis is positively correlated with the stage of disease. The "zero" variant of the gene GSTМ associated with pelvic pain of varying intensity, as well as recurrent forms of the disease (χ2 =of 8.78; p<0.05), which is important in the prediction of the clinical course of the disease. By gene GSTT1 any difference in the groups, as well as links with clinical manifestations of endometriosis was obtained.

Conclusion. Detection of positive expression of aromatase in the ectopic foci, and also in the endometrium atopicescom when adenomiose (58%) and external endometriosis (80%), its relationship with stage distribution of the disease and the severity of pain allows us to consider this enzyme as a promising for the diagnosis and development of new approaches to the treatment of endometriosis with aromatase inhibitors. The study of associated gene polymorphisms of the aromatase CYP19 and detoxification GSTM can be recommended as a prognostic test for assessing the risk of development and prognosis the clinical course of endometriosis.

49-53 420

Objective: to estimate efficiency of treatment with poractant alpha of premature newborns with respiratory distress syndrome and to define possibilities of its increase on the example of obstetrical medical centers in Azerbaijan.

Materials and methods. we examined routine practice of poraktant alfa usage in premature newborns with respiratory distress syndrome during 2014-2015.

Results. The general level of lethality among newborns with respiratory distress syndrome with poractant alfa herapy was 25.3%.

Conclusions. The use of poractant alpha for treatment of prematurely newborns with respiratory distress syndrome allows to keep life till 74.7% of patients. There is correlation between efficiency of treatment with poraktant alfa and weight of newborn.

54-59 426

The relevance of the analysis of indicators of maternity obstetric service, which is a kind of tool for shaping the health of the population, not only now, but also for the future is not in doubt.

Objective. To analyze the maternity obstetric service indicators in Russia in dynamics for 2006-2015 years, according to official statistics.

Materials and Methods. Official statistic data is analyzed by descriptive method of statistics.

Results. The number of births in Russia has increased during the period of study for 30.1%, and was higher than the level of 1991, from 2012. An increase in the frequency of ectopic pregnancy was marked during the study period (from 1.62 to 2.6% of all reported pregnancies). Analysis of data on the incidence of pregnant women found that its high level saves over the last six years (about 80%). At the same time there is a decrease incidence of anemia among pregnant, extragenital diseases and preeclampsia. Violations of labor decreased for 18.4% in 10 years, their number in 2015 is 88.4 for 1000 labor, that is lower, than in 1991 (96.5‰). The frequency of bleeding during childbirth has decreased during the observation period by 11.4%, the number of bleeding in the 3 period of labor decreased, whereas in the postpartum period and because of the placenta detachment and because of coagulopathy- increased. The number of caesareans has increased two times over 10 years.

Conclusion. Analysis has shown favorable trends reproductive situation in the country – an increase in the number of births, the decline of reproductive losses, some complications of pregnancy and childbirth. At the same time a high level of controlled disease in childbirth (bleeding, sepsis) determine ways to improve maternity obstetric service.


60-65 816
Endometriosis of the round ligament of the uterus is a rare clinical pathology, that is difficult for differential diagnostics. Clinical case of the endometriosis of the round ligament of the uterus is described. Issues of etiology and pathogenesis of inguinal endometriosis are mentioned. Modern views about diagnostics and treatment of endometriosis are described. Mapping of data of gynaecological anamnesis, complaints with the results of laboratory and instrumental research methods allows put correct preoperational diagnosis and decrease time from the first visit of doctor up to operative treatment.
66-71 387
Leiomyomas predominate among benign nonepithelial tumors of the corpus uteri. Leiomyoma is commonly an asymptomatic tumor and detectable in most cases at routine gynecological examinations. However, some forms of leiomyomas have a definite metastatic potential and, despite its benign morphological signs, may metastasize to the lung. Fatal cases resulting from tumor spread along the postcava to the right atrium are described.


72-82 1118
Placental insufficiency is an acute or chronic process leading to progressive deterioration in placental function and a decrease in transplacental transfer of oxygen and nutrients to the fetus. The resulting fetal hypoxemia is hypoxia and reduction in fetal growth with abnormal neurodevelopment during childhood as outcome. Current approaches in classification, diagnostics and management of placental insufficiency in women with complicated pregnancy are presented in the review article. Treatment of placental insufficiency includes antiplatelet agents, low molecular weight heparins and vitamin and mineral supplementation. Dipyridamole is most preferred antiplatelet agents that could be prescribed in I-III trimesters. Proper preconception can help to prevent placental insufficiency in women with respective risk-factors.
84-93 573
Perinatal brain ingury including hypoxic-ischemic encephalopathy (HIE) is serious problem of healthcare. Data on HIE prevalence in Russia is quite heterogeneous. Generally, prevalence in Russia is higher than in developed countries. The article presents the existing data on the prevalence of HIE in Russia, modern approaches to definition and classification. Large-scale studies and register could be helpful for further verification of the prevalence, incidence, outcomes and other measures. It is also important to further systematization of criteria for the diagnosis of perinatal CNS lesions. The usage of common approaches in routine practice, such as the RASPM classification, Sarnat classification, Levene classification would be helpful for epidemiological studies and for unifying approaches to the management of patients in order to prevent over-diagnosis and ensure proper choise of treatment.
94-104 542
Psychological rehabilitation of gynecological cancer patients is an important problem of modern medicine. Today, without the qualified psychological help is impossible to imagine the effectiveness of the therapeutic process in oncology. The use of modern methods of diagnosis and treatment has increased the life expectancy of patients. In turn, the use of these technologies have contributed to numerous complications and serious psychosocial disturbances seen in cancer patients. There is a need to change the approach to the recovery of patients by implementing the rehabilitation process of complex psycho programs aimed at the adaptation of the patients to the new conditions of life. The process of psychological rehabilitation it should be viewed as a set of individual and group psychotherapeutic interventions, the main purpose of which is to restore the cancer patient personal and social status, taking into account existing pathologies and restrictions. status, taking into account existing pathologies and restrictions. Thus, the provision of adequate psychotherapeutic assistance on the basis of oncological institutions and rehabilitation centers will improve quality and create favorable living conditions for patients in the community.
105-113 600
The article represents peculiarities of the origination and treatment of surgical menopause at women of reproductive age, principles of monitoring and approaches to the hormonal therapy. In spite of the high efficiency of the therapy of menopausal disorders by estrogen containing substances there are diseases, for which its systemic administration is restricted. The supplement of the local therapy with physicotherapeutic influence in tissues allows to reduce the pain syndrome, to reduce the length of the treatment and to obtain the earlier restoration of the vagina mucous membrane.
114-122 544
Antiphospholipid antibodies by disrupting trophoblast invasion and endometrial angiogenesis might contribute to a defective placentation and, in turn, affect the successful beginning of pregnancy. It is well known and proven that these processes begin with the founding of the utero-placental blood flow. Given the ability of aPLs to affect implantation and placentation, authors have recently suggested the possibility that aPLs may be responsible also for recurrent implantation failure, early pregnancy loss and unexplained sterility. Possible pathogenic mechanisms: the ability of aPLs to exert a direct negative effect on uterine endothelium and preimplantation embryos, increased activity of NK-cells, increased prothrombotic mechanisms and disruption of the processes of fibrinolysis and fibrin formation.


123-124 675
The article highlights historic aspects of medical and research work of the Italian physician and anatomist of the XVI century Gabriele Fallopio.

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