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Obstetrics, Gynecology and Reproduction

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Vol 11, No 2 (2017)
View or download the full issue PDF (Russian)
https://doi.org/10.17749/2313-7347.2017.11.2

NEWS

ОRIGINAL ARTICLES

5-11 131
Abstract

The aim of the study was to compare the diagnostic potential of integrated diffusion-weighted magnetic-resonance imaging (DW-MRI) with multi-spiral computed tomography (MSCT) in pre-operative evaluation of resectability of advanced ovarian cancer. Materials and methods. In the period from February to December 2016, 73 patients with suspected malignant neoplasms of the ovaries underwent preoperative examination, including abdominal/pelvic integrated DW-MRI or MSCT. The DW-MRI test was run using a 1,5 T scanner (b-factors of 0-1000 s/mm2) able to compute the apparent diffusion coefficient (ADC). For each of the two methods, we calculated the peritoneal cancer indices (PCI) and the informational values pertaining to the critical areas of the peritoneal cavity and the pelvis, and compared them with the surgical findings. We used the following criteria to conclude that a surgical intervention would not achieve the optimal cytoreduction: lesions of the omental bursa (> 1 cm); foci in the diaphragm area (> 2 cm); foci on the liver surface (> 2 cm); mesentery lesions of the small and/or large intestine (>1 cm); involvement of para-aortic lymph nodes; metastases to the parenchymal organs (liver, spleen) and the PCI > 20. Results. The sensitivity of DW-MRI vs MSCT was 78,3% vs 50%; and the specificity of DW-MRI vs MSCT was 78% vs 87%, respectively. The DW-MRI based prediction on the impossibility of effective surgical cytoreduction was correct in 92% of patients. The similar figure for MSCT was 64% of patients with inoperable tumors. Conclusion. DW-MRI is an accurate instrument for pre-operative assessment of the involvement of the peritoneum and abdominal organs in the tumor process. Based on this method, it is possible to develop a sensitive and specific algorithm for evaluating the resectability of ovarian cancer, thus avoiding unnecessary surgical intervention.

12-17 125
Abstract

Objective: еvaluation of lipid metabolism, lipid peroxidation (LPO) and antioxidant system (AOS) in pregnant women with various metabolic disorders. Materials and methods. This study was conducted in pregnant women with no known metabolic disorder, in those with the symptoms of metabolic syndrome and in women with gestational diabetes mellitus. Results. We found evidence for activation of LPO in pregnant women with impaired glucose metabolism; the LPO developed on the background of decreased activity of AOS enzymes. As proposed, the active oxygen species and the LPO products caused a reduction in the level of nitric oxide (NO) - a major vasodilating substance. The resulting vasoconstriction might lead to hypoxia with its negative impact on fetus development. Conclusion. Based on the obtained data we recommend using the parameters of LPO-AOS and the markers of endothelial NO-production as additional laboratory tests in pregnant women with gestational diabetes mellitus and metabolic syndrome.

18-22 133
Abstract

The aim of the study was to evaluate the severity of pain syndrome and depression syndrome in women with endometriosis- associated pelvic pain. Materials and methods. The study included 100 women of reproductive age with external genital endometriosis. The study group consisted of 60 patients with pelvic pain associated with external genital endometriosis; the control group consisted of 40 women with external genital endometriosis without pain. The pelvic pain was ranked using the Visual Analog Scale (VAS); the level of depression was evaluated using the Beck scale; the anxiety was rated according to the Spielberger-Khanin questionnaire. Results. Among the 60 women in the study group, 20 patients (33.3%) had severe pain, 25 women (41.6%) had moderately severe pain, and 15 women (25.1%) had mild pain. The occurrence of depressive disorders in women with endometriosis-associated pelvic pain was 64%. Conclusion. The results suggest that the psycho-emotional status of women with external genital endometriosis-associated pelvic pain is dominated by high level of depression and anxiety, which significantly downgrades their quality of life.

23-28 98
Abstract

Objective. To study the effect of the protective agent ethylmethylhydroxypyridine malate on the numbers of erythroblastic islets in rats exposed to sulfur-containing gases. Materials and methods. Natural sulfur-containing gas mixtures from the Astrakhan gas-condensate field were used to model the gas-polluted environment. Male rats of various ages simulated different stages of postnatal human ontogenesis. Results. The obtained results indicate that at all stages of ontogenesis ethylmethylhydroxypyridine malate protected erythroblastic islets from intoxication by gaseous sulfur pollutants and led to partial normalization of proliferation and maturation of eryth rob lasts. Conclusion. The protective action of ethylmethylhydroxypyridine malate may be used for neutralizing the biological damage caused by toxic air pollutants at different stages of ontogenesis.

29-39 85
Abstract

The article presents an overview and results of clinical research of rare but very important diseases - mesenchymal displasias including Marfan syndrome, Ehlers-Danlos (EDS) syndrome, Osler-Weber-Rendu disease. The basic component of these diseases is the hereditary connective tissue disorder. Patients may have different symptoms, because various organs may be involved: skeletal, ocular, cardiovascular systems etc. The diagnosis is based on the clinical criteria and molecular tests. The pathogenesis of these disorders has not been fully elucidated. Pregnancy usually increases the risk of life threatening complications. Early diagnosis and multidisciplinary management of pregnancy and delivery are essential for good outcomes. The aim of this study was to evaluate the course of pregnancy and the delivery outcome in patients with mesenchymal dysplasias. Materials and methods. Fifty six pregnant women with mesenchymal dysplasias (23 with Marfan syndrome, 22 with Ehlers-Danlos syndrome, 11 with hereditary hemorrhagic telangiectasia - HHT) were examined in a specialized cardiological maternity ward. The patients underwent physical examination, routine laboratory tests, hemostasis tests, ECG, echocardiography, MRI, X-ray examination, and pulse oximetry. Results. All patients had hemorrhagic complications of various localization; 18 women with Marfan syndrome had aggravated mitral regurgitation, 10 - aortic insufficiency, 13 - mitral valve insufficiency. One patient with Marfan syndrome died because of aortic dissection on day 45 upon delivery. Pulmonary arteriovenous malformations were found in 10 patients with HHT; the symptoms of hypoxemia developed in 6 HHT patients who were diagnosed with right-to-left blood shunting. One patient with HHT developed the symptoms of vena cava inferior compression caused by an aneurism in the truncus brachiocephalicus. Forty patients showed abnormal hemostasis results (platelet dysfunction - 38 patients; DIC syndrome - 31). Cesarean section was performed in 53 patients. Vaginal delivery (3 patients with EDS) was complicated by massive postpartum hemorrhage and deep vaginal tears. Conclusion. Patients with mesenchymal dysplasias are under increased risk of different complications during pregnancy and delivery; they need multidisciplinary management and repeated hemostasis testing. Cesarean section is the preferred method of delivery in such patients.

40-44 130
Abstract

The aim was to study whether the increase in body weight during pregnancy depends on the initial anthropometric values. Materials and methods. This prospective study included 100 pregnant women; the measurements of their height, body weight, and BMI were made at the start and then on the 1st, 2nd and 3rd trimesters of pregnancy. Results. In the overweight/ obese women, an excessive weight gain during pregnancy is more common than that in the women with initial weight deficiency or those with normal weight. The least gestational weight gain was found in pregnant women with obesity. At the same time, the obese women showed more deviations from the WHO-recommended gestational body weight gain as compared with the women with normal or low initial weights. Conclusion. The magnitude of gestational weight gain depends on the initial BMI. With the increase in BMI the incidence of excessive gestational weight gain increases.

SCIENTIFIC SURVEYS

45-48 124
Abstract

The currently accepted role of hemostatic disorders (antiphospholipid syndrome, genetic thrombophilia) in the pathogenesis of frequent obstetric complications (preeclampsia, premature placental abruption, feto-placental insufficiency, recurrent miscarriage) revolutionized the prevention and treatment of these pregnancy-associated abnormalities. An increasing number of direct and indirect anticoagulants have been introduced into clinical practice. The present review addresses the mechanisms of action of dipyridamole, an antiaggregant medication commonly used in obstetrics. In addition to its antiplatelet activity, dipyridamole is also known for other pharmacological effects, including the antioxidant and endothelioprotective activities.

50-56 367
Abstract

Endometriosis is common among women of reproductive age. Due to its nonspecific clinical picture, a correct diagnosis of endometriosis is especially important in developing an effective treatment plan. Ultrasound and magnetic resonance imaging with correct interpretation, and combined with differential diagnosis, is essential for determining the location and spread of endometriosis, which helps optimize the surgical treatment.

57-68 195
Abstract

The review addresses the current concepts on polycystic ovary syndrome (PCOS), including the key elements of PCOS etiology, pathogenesis, and epidemiology. The major clinical manifestations, diagnostic standards at early and later stages, treatment regimens, and novel research are also discussed. Despite a lot of research conducted in Russia and elsewhere, many aspects of PCOS remain to be clarified. It is hoped that by introducing recent innovations we can improve medical and instrumental diagnostics, treatment and prevention of PCOS.

HISTORIC CASES

69-74 101
Abstract

The article is timed to the 245th anniversary of V.F. Snegirev Maternity Hospital № 6 (St. Petersburg). We take an insight into a remarkable story of this Institution from its foundation to the present. Through its history, this maternity hospital was led by outstanding obstetricians who contributed to its current status of highly reputable medical facility. The novel treatments of pregnancy complications and the original operational techniques developed in this medical school have not lost their relevance until now. Today the leadership and the staff of this Maternity Hospital continue to play a significant role in the science and practice of obstetrics in Russia.



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