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Obstetrics, Gynecology and Reproduction

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Vol 11, No 1 (2017)
View or download the full issue PDF (Russian)
https://doi.org/10.17749/2313-7347.2017.11.1

NEWS

ОRIGINAL ARTICLES

5-13 376
Abstract

The aim of the study was to classify clinical and pathogenetic variants of early toxicosis in pregnant women based on clinical manifestations and markers of gestational maladaptation.

Materials and methods. In the first trimester of gestation, 45 healthy pregnant women and 160 pregnant women with early toxicosis of varying severity were examined. The comparison group was comprised of 33 healthy non-pregnant women. In addition to the clinical symptoms, a number of laboratory markers were measured. Those included the indicators of inflammation, energy balance of the reproductive system, endometrial functional activity, vascular endothelial and hemostatic disorders, as well as blood biochemistry.

Results. The obtained data were used to quantify the factors of "physiological damage" and "mechanisms of gestational adaptation" in the case of physiological gestation, and to identify the embryo-placental dysfunction as a major mechanism of maladaptation in the early stages of pregnancy. The results allowed us to propose four clinical and pathogenetic variants of early toxicosis.

Conclusion. The suggested selective approach to clinical and laboratory manifestations of early toxicosis based on its classification and severity, makes it possible to rationalize the therapy, predict the risk of severe and late obstetrical complications, and reduce the risk of adverse perinatal outcomes.

14-18 132
Abstract

The aim was to study the renin-angiotensin-aldosterone system (RAAS), the level of leptin and kidney function in women with pre-eclampsia (PE) and alimentary obesity (AO).

Materials and methods. The levels of renin, angiotensin II, aldoste-rone, leptin, insulin, cortisol, β2-microglobulin, glomerular filtration rate were measured.

Results. We show that RAAS, along with a systemic inflammatory response, is a key factor in the development of pre-eclampsia and its progression. The increasing level of leptin has a direct damaging effect on the tubular system of the kidneys.

Conclusions. Stimulating the RAAS aggravates the inflammatory response and endothelial dysfunction in women with PE and AO. Elevated concen-trations of leptin in these women have a direct damaging impact on the kidney tubules.

19-25 152
Abstract

The aim is to evaluate the diagnostic potential of the diffusion-weighted MRI sequences (DW-MRI) as compared with multi-spiral computed tomography (MSCT) for staging of ovarian malignancies (OVM).

Materials and Methods. The study was conducted (from February to December 2016) on 73 patients with suspected ovarian malignancies who underwent preoperative examination, including abdominal / pelvic MSCT and DW-MRI, using a 1.5T scanner with b-factors of 0.1000 s/mm2 and the calculation of apparent diffusion coefficient (ADC). Using the obtained data, the peritoneal cancer index (PCI) was calculated and ROC curves for DW-MRI vs MSCT were created. The imaging-based diagnoses were then compared with surgical staging and histopathological examination.

Results. The following stages of OVM were determined: 5 (6.8%) IV; 35 (47.9%) IIIC; 23 (31.5%) IIIB; 10 (13.6%) IIIA. The overall sensitivity was 55% for MSCT and 77% for DW-MRI. For example, DW-MRI was markedly superior to MSCT in detecting a tumor implantation into the large intestine mesentery (83.8% and 37.8%, respectively), into the small intestine serosa (77.8% and 28.9%), and the para-aortic lymph nodes (71.4 and 35.7%). The specificity of the compared imaging modalities was similar (79.6% – DW-MRI and 81% – MSCT). The peritoneal cancer index (PCI) calculated from the DW-MRI results correlated with the surgical staging data better than the PCI based on MSCT (r=0.706 for DW-MRI, r=0.544 for MSCT). Based on the obtained data, the ROC curves were plotted to show the areas under the curves of 0.913 and 0.655 for DW-MRI and MSCT, respectively. A decrease in the ADC values was found in secondary tumor foci (1.120±0.25 for the ovaries, 0.820±0.23 for the omentum, 0.790±0.19Ч10-3 mm2/s for peritoneal implants).

Conclusion. For the assessment of ovar-ian cancer spread, DW-MRI is significantly more sensitive than MSCT.

26-30 86
Abstract

The aim of this study is to evaluate the risk factors in babies born with a delay in intrauterine development.

Materials and methods. For 2 years, clinical examinations of 265 pregnant women were conducted. Along with that, a comprehensive assessment of reproductive health of these women was made using originally designed questionnaires.

Results. Although the examined women had various pregnancy complications, we found no clear correlation between the ways of delivery and the condition of the neonates. In the cases of utero-placental circulation abnormalities, the incidence of intrauterine growth retardation is higher than normal; consequently, the risk of unfavorable outcomes in the neonates increases.

Conclusion. Here, treatment-and-prophylactic measures are suggested. The risks associated with the fetus/neonate development need further study.

31-35 116
Abstract

The aim of the work is to analyze the cases of maternal death from bleeding in the Tula region of Russia for 15 years.

Materials and methods. We performed a retrospective analysis of anonymized copies of primary medical records, protocols of autopsy, forensic and statistical reports, as well as expert records and reviews on maternal death cases, from January 01. 2001 to December 31. 2015.

Results. Bleeding represents the second common cause of maternal deaths in the Tula region. During this 15-year period, six women died: four – from hypotonia or atonia of the uterus, and two – from premature detachment of the normally located placenta. All six women were multiparous; four of them had a third birth. Three women did not undergo due observations in the women's health clinic. The median age was 32 years (27-38 years). In three cases, the death occurred outside the hospital.

Conclusion. The optimal way to reduce maternal deaths from bleeding may be the development of an individual algorithm for preventing bleeding in patients at risk.

36-48 153
Abstract

The use of estrogen-containing hormonal drugs facilitates excretion of magnesium ions. It is therefore important to characterize women who use hormonal contraceptives, and to test correlation between the use of hormonal contraception -(HC) and the magnesium deficiency (MgD).

Objectives. To create a profile of HC-using women who enrolled in the MAGYN study.

Materials and Methods. The study included the disease registry (MgD in women with hormone-dependent diseases) and the data on safety and effectiveness of magnesium supplementation with a combination of magnesium citrate and pyridoxine. The standard questionnaire and biochemical determination of serum magnesium were used to diagnose MgD. The severity of MgD symptoms was evaluated using a 10-point visual analogue scale; the quality of life was assessed using the WHOQOL-BREF questionnaire after four weeks of therapy.

Results. Among the total of 9168 women in the MAGYN study, hormonal contraceptives were used by 1528 women (16.7%). Of these women, combined estrogen-progestin single-phase contraceptives were used in 66.2% cases, a vaginal ring with a combination of estrogen and progestogen – 11.7%, and oral combined estrogen-gestagenic two-phase medications – 10.9%. The most common complaints among the women on hormonal contraception were "fatigue", "nervousness", "irritability", "state of chronic stress"; those symptoms were significantly more frequent in women with confirmed MgD. The prevalence of MgD in the group of women receiving
hormonal contraception was 67%.

Conclusion. The present study demonstrates high prevalence of MgD in women using hormonal contraception. Correcting MgD significantly improves the women’s health and their quality of life. Since the nutrition profile, behavior patterns, quality of life and social preferences of women may depend on urban population size, larger studies are warranted in cities with a population of >250 thousand to obtain the data relevant to the entire country.

SCIENTIFIC SURVEYS

49-55 180
Abstract

Today pre-eclampsia remains one of the most urgent problems in obstetrics. This condition is associated with a high incidence of maternal and perinatal deaths, which ranges from 12.1 to 23.2%. This pathological condition occurs in 7-23% of pregnancies and it does not tend to decrease. In this review article, we present and analyze the current concepts on the etiology and pathogenesis of pre-eclampsia. The issues concerning functional disorders of the hepatobiliary system in pregnant women are also discussed.

56-63 153
Abstract

Purpose of studies – to analyze the evolution of cytological technologies in the cervical screening on the basis on the basis of the technical data.

Маterials and methods. The survey comprises the data of foreign and national articles, published in Pubmed on the topic during last 15 years.

Results. Describes the history of creation and clinical implementation of Papanicolau test (PAP-test), prerequisites for the liquid technology of the cytological studies. The comparative characteristics of ThinPrep and SurePath liquid cytology method is given, аs well as of automated analysis systems.

Conclusion. The liquid cytology has proved its advantages and during the last decade replaced the traditional method of cytological studies in screening programs of many world countries. SurePath technology combined with the automated FocalPoint analysis system increases the disease intelligence level, the laboratory efficiency and allows to improve the cervical screening quality.

65-73 167
Abstract

Malignant tumors are still a challenging problem of contemporary medicine. The incidence of malignant diseases and patient mortality is increasing with time while there is no significant growth in long-term survival. Oncological diseases affect the quality of patient’s life more than any other medical conditions. In this regard, medical professionals are expected to pay a special attention to the psychosomatic aspects of patient management. It is important to realize that social and psychological maladaptation have a negative impact on the immune defense, which may trigger the onset or relapse of the major disease. Psychotherapy can improve the patient’s response to oncological treatment; the best way is to start using psychotherapy at the time of diagnosis. For the optimal effect, it is advisable to transfer the patients to specialized rehabilitation centers.

74-80 193
Abstract

25 evidenced based clinical practice guidelines for fertility preservation in cancer patients exist. Breast Cancer in Pregnancy is a rare problem but the incidence is growing, because pregnancy will be delayed in elder age groups. Diagnosis of Breast Cancer is often delayed. If there is a mass, you have to do at first an ultrasound and than mammography if it is necessary. A tumor should be biopsied. Each kind of surgery is possible. Sentinel lymphnode dissection is controversial discussed. It is because of the blue dye, because this substance is not allowed during pregnancy. Technetium is allowed, but will be not accepted by the mother, because of fear of radiance. Radiation and hormonal treatment should be postponed after pregnancy. Chemotherapy can be done after 16 week of gestation. Delivery should not be in the first 3 weeks after chemotherapy, because the nadir of white blood cells should not be at the time of delivery to avoid infection. The fetal outcome is quite normal except weight, because of preterm delivery and growth retardation. Termination of pregnancy will not optimize the cancer prognosis. Pregnancy after breast cancer treatment is possible, perhaps with better prognosis, but that can be due to the healthy mother effect. Because the most recurrence are in the first two years, women should wait 2 years and cryopreservation of ovarian tissue, eggs or embryos before chemotherapy should be done.

HISTORIC CASES

81-82 100
Abstract

The article describes the medical and scientific contribution of the outstanding Georgian obstetrician and gynecologist Konstantin Chachava as well as a historical sketch on the "Transcaucasian midwifery institute".



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