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Obstetrics, Gynecology and Reproduction

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Vol 11, No 4 (2017)
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NEWS

ОRIGINAL ARTICLES

5-13 145
Abstract
n the case of a space-occupying lesion (SOL) of the ovary, it is up to the gynecologist to diagnose a possible malignancy and then decide upon further treatment strategy. The aim of the study was to perform a comparative analysis of the existing methods for detecting the tumor markers: CA-125 – cancer antigen 125 and HE4 – human epididymis protein 4. We also compared the prognostic indices (Risk Malignancy Index – RMI and Risk of Ovarian Malignancy Algorithm – ROMA) currently used to make differential diagnoses of benign and malignant ovarian neoplasms at the preoperative stage. Materials and methods. We conducted a prospective study in 100 patients from 18 to 79 years old scheduled for surgery for an ovarian SOL. The serum levels of the CA-125 and HE4 tumor markers, pelvic sonography, the RMI and ROMA scores, as well as post-surgery histopathology results were evaluated. Results. The sensitivities of the CA-125, HE4, RMI and ROMA indices were 85.7%, 42.9%, 85.7% and 71.4%, respectively; the values of specificity were 83.6%, 97.8%, 96.7%, 97.8%, respectively. Conclusion. The most informative parameter for the differential diagnosis of benign and malignant ovarian neoplasms at the preoperative stage was the RMI, and the least informative – the HE4 tumor marker. The HE4 determination was highly informative, however, in the differential diagnosis of ovarian malignant neoplasms with endometrioid cysts in patients with elevated CA-125 levels. Notably, patients with widespread external genital endometriosis showed false-positive results of the CA-125, HE4, RMI and ROMA tests. In a patient with clear-cell ovarian carcinoma, the sensitivity and specificity of the CA-125, HE4, RMI, and ROMA tests were confirmed to be low.
14-22 173
Abstract
Chronic endometritis (CE) is one of the most common disorders of the female reproductive system. Identification of the infectious cause of CE remains a persistent problem, especially in light of the recent concept of the microbiome. The aim of the study was to evaluate the microbiome in the cervical canal and uterine cavity in patients with CE compared with CE-free women. Materials and methods. A total of 75 women of reproductive age were examined: of those, 33 were CE-free (group 1) and 42 – diagnosed with CE (group 2). To study the microbiological characteristics of the genital tract, we used our original technique able to minimize contamination of uterine samples by cervical microflora. Results. In both groups of women, positive growth of microflora (mostly, Lactobacillus) in either cervical or uterine cavity samples was found. In women with CE, a different type microflora dominated: thus, in every 8th patient of group 2, the cervical canal samples contained β-lactamase producing by Escherichia coli, which indicated a highly rational antibiotic therapy. Conclusion. We propose that the somatic status plays a crucial role in the overall body response to a pathogenic microorganism. In our study, the microbiomes of the endometrium and the cervix were similar, but not identical; there were differences between the women with different medical conditions.
23-29 102
Abstract

The aim: to identify pathological characteristics of placenta in women with preterm labor according to the gestational age.

Materials and methods. The study involved 55 women who gave birth prematurely: 21 women with gestational age from |22 to 32 weeks (group 1) and 34 women with gestational age from 32 to 37 weeks (group 2). All the women had spontaneous singleton pregnancies followed by preterm spontaneous births. We conducted a comparative analysis of the social, clinical and amnestic information, as well as a histopathological study of the placentas; the latter included macroscopic description, organometry and microscopic morphology. The analysis aimed to identify the placental factors associated with the premature delivery occurred before and after 32 weeks of gestation.

Results. The study revealed a number of anamnestic and clinical factors associated with preterm births. At a gestational age up to 32 weeks, the placentas showed hypoplasia with a mass deficit of more than 30% in combination with proliferative vylusitis, post-inflammatory hypovascularization, abnormal differentiation of the vascular-stromal component of the villi, and insufficient compensatory and adaptive reactions. After 32 weeks of pregnancy the placenta characteristics included chronic disorders of the maternal and fetal blood circulation, compensatory hyperplasia of the terminal villi, capillaries and their syncytia capillary membranes.

Conclusion. There is a need for individual rehabilitation programs for women with the history of preterm births that would include their clinical and anamnestic background together with the pathomorphological characteristics of their placentas. Such a program is expected to help these women to be better prepared prior to their subsequent pregnancy.

30-34 104
Abstract

Aim: to analyze the usefulness of laparoscopic methods for the recovery of reproductive health in women with polycystic ovary syndrome (PCOS).

Materials and methods. A continuous retrospective analysis of 56 outpatient cards and case histories of women with PCOS and concomitant infertility for the period from 2013 to 2015 was conducted using the documentation from the Kursk Regional Perinatal Center. The average age of the patients was 28.29 ± 4.43 years, the duration of infertility – from 1 to 15 years. Anamnestic and clinical data, concomitant pathology and long-term results of laparoscopic treatment and diagnostic procedures were studied.

Results. The patients underwent surgical treatment after conservative therapy failed to restore their fertility. As a result, 49 women (87.5%) were able to restore the regular menstrual cycle and 35 women (62.5%) got pregnant.

Conclusion. The use of laparoscopy revealed the ultimate cause of infertility and allowed for surgical treatment able to restore the reproductive women’s health. 

35-42 284
Abstract

To date, self administrations of recombinant human follicle-stimulating hormone (rhFSH) are carried out using pen injectors with minimal dose increments of 8.33 IU or 12.5 IU (IU – international units of activity). To ensure the accuracy of dose titration and to minimize the dose adjustments during the treatment, new pen injectors are needed. Those would provide for the self administration of rhFSH in a wide range of doses and with a dose increment less than the existing fractional values. Aim: to develop a pre-filled, multi-dose pen injector for rhFSH solution with a 5 IU dose increment and a dose setting from 0 to 300 IU.

Materials and methods. Dispensed volumes containing the minimal dose of 5 IU were measured gravimetrically.

Results. After testing 48 pen injectors the estimated minimal dose of 5 IU (0.0083 ml of the solution) produced the following results: the mean value of the dispensed volume was 0.0081 ml, the mean deviation was ± 0.0006 ml (or ± 0.36 IU). The results are in consistence with the ISO 11608-1:2014(E) requirements of dose accuracy for the minimal dose setting in commercial injectors.

Conclusion. We have developed a pen injector for rhFSH administration with a dose setting from 0 to 300 IU and with a minimal increment of dose adjustment of 5 IU. The individual approach to the dose selection/adjustment with a minimal increment of 5 IU may help achieving a highly accurate administration of rhFSH for the controlled ovarian hyperstimulation and for the induced-ovulation protocols with growth activation of 1-2 follicles. 

43-47 164
Abstract

The aim: to evaluate the astroglial neurospecific protein – gliofibrillary acidic protein (GFAP) in the blood serum of pregnant women with post-concussion syndrome (PCS) resulted from a mild closed brain injury. The serum level of GFAP was earlier proposed to be used as a marker of the state of the blood-brain barrier (BBB) and a predictor of obstetric and perinatal complications.

Materials and methods. To evaluate the permeability of the BBB and the integrity of astrocytes during pregnancy, we measured GFAP (using the enzyme immunoassay) in the sera of 93 women: 41 with PCS (main group), 31 somatically healthy pregnant women (comparison group), and 21 non-pregnant women of the reproductive age (control group).

Results. In healthy pregnant women, the level of GFAP did not significantly differ from that in the non-pregnant women and did not exceed a threshold value of 4.0 ng/ml. In most of the pregnant women with PCS (70.73%), the GFAP values exceeded the threshold level starting from the first trimester and tended to increase subsequently, which was indicative of immunological sensitization.

Conclusion. In the obstetric and neurological practice, pregnant women with PCS are recommend to be tested for their serum GFAP as a marker of immunological sensitization and a predictor of pregnancy and delivery complications as well as neurological deterioration. 

SCIENTIFIC SURVEYS

48-56 232
Abstract
One type of ectopic pregnancy is where the pregnancy is implanted in the scar left in the uterus following a cesarean section; these cases are thought to be one in 1800-3000 pregnancies. The increase in the incidence of cesarean scar pregnancy (CSP) is a consequence of the increasing rates of cesarean delivery. If misdiagnosed CSP can be a cause of life-threatening pregnancy complications. They include morbidly adherent placenta, placenta previa, and severe hemorrhage. If such a pregnancy is allowed to continue, a uterine scar rupture with hemorrhage will ensue and necessitate hysterectomy. It is therefore crucial to timely diagnose and manage these pregnancies. The therapeutic options can be medical, surgical, or a combination of both. However there has been no consensus on the management still yet. In this article, there is a systematic up-to-date review on CSP diagnosis, treatment and prevention measures.
57-67 236
Abstract
Medical rehabilitation of oncogynecologic patients is a socially important aspect of current clinical practice; this field of medicine attracts more and more attention of medical professionals around the world. The improved methods of early diagnostics contributed to a significant increase in the number of cancer patients. Today, there is a need for comprehensive rehabilitation programs aimed at restoring the affected body functions, preventing/reducing the disability and mental disorders, as well as timely detecting complications, relapses or tumor metastases. The introduction of medical rehabilitation into oncological practice, implemented on the basis of oncology and rehabilitation centers, will improve the quality o patients’ lives and create the appropriate conditions for social adaptation and integration into the society.

CLINICAL CASE

68-71 212
Abstract
Genetic thrombophilia is a risk factor for both thromboembolic and obstetric complications. Patients with a family history of thrombotic and obstetric complications should be examined for the presence of thrombophilia. If a hemostasis problem is confirmed, antithrombotic therapy is recommended to be initiated at early stages of pregnancy. Moreover, this therapy is better to be started at the stage of preparation for pregnancy and continued throughout the pregnancy and during the postpartum period to avoid thromboembolic and obstetrical complications.
72-75 110
Abstract
Clinicians often see a recurrent miscarriage caused by isthmic cervical incompetence. Today, obstetric pessaries and surgical sutures are widely used to correct cervical incompetence during pregnancy. The occurrence rate of this abnormality continues to rise, which emphasizes the need to diagnose and correct cervical incompetence prior to the upcoming pregnancy. In the available literature there is little information about the «hidden» defects of the cervix that can lead to miscarriage in the I-III trimesters of pregnancy. Here we present a case of two different pregnancy outcomes in a single patient with cervical incompetence before and after surgical correction of the cervix by the LASH procedure. The present case supports the importance of surgical correction of cervical incompetence in non-pregnant women.

REPORTAGES

HISTORIC CASES

82-84 104
Abstract
The article highlights the contribution and major accomplishments of Ashot Moiseevich Agaronov – one of the outstanding obstetrician and gynecologist of the Soviet period


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