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Obstetrics, Gynecology and Reproduction

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Vol 12, No 2 (2018)
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NEWS

ОRIGINAL ARTICLES

5-11 105
Abstract
The aims: to study the physiological indices, which characterize the biological age (BA) of the woman, in the process of physiological pregnancy and conduct a correlation analysis between these indices and the stage of pregnancy in different age groups. Materials and methods. Total of 122 pregnant women aged 20-34 years with different gestational age were selected for the study; all participants underwent a comprehensive functional examination. From the obtained results, the BA values were calculated using the in-depth «Kiev» scale as well as our own modification. Results. Upon an increase in the gestational age, there were changes in the BA-related indices in women of various age groups; these changes pertained to the vascular wall stiffness, respiratory functions, static balancing and the lens accommodation ability. Conclusion. The absence of changes in the BA, as calculated according to our modified test, during physiological pregnancy, suggests its applicability to women of young reproductive age. This calculation approach can be recommended for further studies in obstetrics and gynecology.
12-20 93
Abstract

The number of patients with nosocomial post-cesarean endometritis is steadily growing. Aim: to study the etiology of nosocomial post-cesarean endometritis and to propose a rationalized antimicrobial therapy. Material and methods. Sixty six puerperas with post-cesarean endometritis were examined. The spectrum of microflora and its resistance to antimicrobial agents were determined using an automatic microbiological analyzer based on mass spectrometry. Results. Enterococci, E. coli, staphylococci and streptococci were the most clinically significant pathogens found in the examined patients with post-cesarean endometritis. The microflora spectrum in the endometrium reflected the previous «antibacterial history»; this association must be taken into account when developing antibacterial therapy. Conclusion. If the new mother was previously treated with antibacterial agents, it is recommended to use a combination of the reserve antibiotics in order to block the entire spectrum of possible multidrug-resistant pathogens. In cases of the resistant Gram-positive microflora (MRSE, MRSA, E. faecium), it is advisable to prescribe vancomycin. For the resistant Gram-negative microflora (Enterobacter spp., Citrobacter spp., E. coli-ESBL+ and Klebsiella spp.-ESBL+), vancomycin should be combined with carbapenems.

21-31 99
Abstract

The aim of the study was to determine the efficacy of heparin prophylaxis in preventing pregnancy complications in patients with the manifested laboratory phenotype – resistance to activated protein C (APC-resistance with NR ≤ 0.49) Factor V Leiden mutation (GA genotype). Materials and methods. A single-center, randomized, controlled trial of 141 pregnant women – carriers of the FVL(1691)GA mutation with APC-resistance ≤ 0.49 was determined at a gestation age of 7-8 weeks. Of these, 70 patients were included in the main group (mean age 30.2 ± 4.7 years); after the confirmation of the APC-resistance at 7-8 weeks of gestation, these women received a 14 day low-molecular-weight heparin (LMWH) course at elevated prophylactic doses. The comparison group (71 pregnant women of 30.3 ± 3.9 years old) received no LMWH. Results. The heparin prophylaxis (started from 7-8 weeks of gestation) at elevated doses in carriers of the FVL(1691)GA mutation with pronounced APC-resistance reduced the absolute risk (ARR) of pre-eclampsia by 29.5% (ARR: 29.5; p = 0.0003; NTT: 3.4; 95% Cl: 2.356.12), the risk of fetal growth retardation by 23.8% (ARR: 23.8; p = 0.0016; NTT: 4.2; 95% Cl: 2.8-8.7) and the risk of induced premature birth by 12.6% (ARR: 12.6; p = 0.0242; NTT: 5.8; 95% Cl: 3.7-14.1). Conclusion. The administration of LMWH at prophylactic doses for 14 days is indicated in patients with a manifested subclinical (laboratory) phenotype (APC-resistance with NR ≤ 0.49) of the FVL(1691)GA mutation starting from the gestation period of 7-8 weeks. If necessary (with a value of NR ≤ 0.49), it is advisable to repeat the courses of heparin prophylaxis at 18-19 and 27-28 weeks of pregnancy.

32-38 80
Abstract

Aim: to study the efficacy of Metrogil vaginal gel and Metrogil plus in patients with recurrent vaginal biocenosis disorders. Materials and methods. A total of 234 patients were examined. Among them, 115 women with mixed flora without Candida spp in their vaginal microbiome, received Metrogil vaginal gel treatment (group 1), and 119 women with mixed flora and Candida spp. in their vaginal microbiome, received treatment with Metrogil plus applied as an intravaginal gel (group 2). To assess the treatment efficacy, patients’ complaints, objective examination data, pH-metry, smear microscopy, and polymerase chain reaction (PCR) results were analyzed. Results. In the vaginal microbiome of all patients before treatment, the presence of heterogeneous gram-positive and gram-negative flora was detected; among those bacteria, a markedly decreased presence of Lactobacillus spp. (to 102-103 cfu/ml) and a dramatically increased presence of Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp. was found; there was also a significant amount of Candida spp. in patients of group 2. By the end of the treatment, the patients presented no complaints, there were no objective clinical symptoms, the pH values came to normal, and the PCR results showed an improvement in the qualitative and quantitative composition of the vaginal microflora. In most patients, this positive result persisted for 3 months. Conclusion. The decision on pharmacotherapy in patients with recurrent disbalance of vaginal biocenosis should be based on the qualitative composition of the vaginal microbiome.

REVIEW ARTICLES

39-47 127
Abstract

Vasomotor symptoms are most common signs of the menopausal syndrome. Frequent episodes of flushes and hyperhidrosis affect sleep, mood, and quality of life. Menopausal hormone therapy (MHT) remains the «gold standard» of treatment. However, some women have contraindications to MHT, and others refuse to take hormones due to personal reasons. In such cases, alternative therapy may become an option. This article presents a review of the literature regarding the role of alternative therapy in the treatment of vasomotor symptoms. We searched Russian and international data bases for pharmacological products (natural and synthetic) used to relieve menopausal flushes. The review presents medication registered in the Russian Federation as well as products used abroad.

48-54 84
Abstract
The article presents current data on diagnosis and treatment of patients with gestational trophoblastic disease, risk factors and their role in pathology development are also analyzed.
55-61 128
Abstract

In the present review, a new approach to studying the pathogenesis and predicting the development of preeclampsia (PE) – namely, the determination of matrix metalloproteinases (MMPs) – is discussed. Currently, the major cause of PE is thought to be an incomplete remodeling of spiral arteries because of an insufficient number of invading cytotrophoblasts or the absence/inactivation of crucial lysing enzymes, i.e. matrix metalloproteinases. The role of MMP-1, MМP-2, MМP-3, MМP-7, MМP-9 in the placenta formation, the development of oxidative stress and endothelial dysfunction is described. We propose that in the future, the MMPs may be used for differentially predicting early and late PE.

CLINICAL CASE

62-67 69
Abstract

Antithrombin deficiency is associated with a high risk of thrombotic events and obstetric complications. Even under an antithrombotic therapy, adverse pregnancy outcomes may occur. We present a case of successful pregnancy completion in a woman with newly diagnosed antithrombin deficiency and a history of miscarriages without thrombotic events. In the postpartum period, her antithrombin level restored to normal.

69-75 82
Abstract
The article describes a rare clinical case of ectopic pregnancy in the uterine scar left after a cesarean section. The case demonstrates the complexity of diagnosing this abnormality and managing such patients. The proposed approach allowed us to diagnose pregnancy in the uterus scar in due time, avoid hysterectomy, and preserve the reproductive organ.
76-79 55
Abstract
The number of post-bariatric patients is increasing from year to year; any medical specialist can see consequences and sometimes complications of these interventions. The variety of different scenarios associated with such patients is not well studied. Mini-gastric bypass (MGB-OAGB) is a major type of primary or recurrent bariatric surgery in obese patients. Biliary reflux (BR) is one of the most significant late complications of this operation. An increase in the intra-abdominal pressure during pregnancy can lead to the development of BR with its typical clinical symptoms, which may sometimes puzzle an obstetrician-gynecologist. In these cases, there are limitations in using traditional diagnostic approaches and regular medications for conservative treatment of BR. This report presents a clinical observation on a patient who underwent MGB-OAGB as a recurrent bariatric intervention for her morbid obesity. With no signs of gastroesophageal reflux before surgery, soon after it or in the I trimester of pregnancy, a typical clinical picture of BR developed in the II and III trimesters. A complete relief of the BR symptoms after the childbirth (confirmed by gastro-esophago-scopy) suggested a direct connection between the BR and the increase in intra-abdominal pressure during pregnancy.

ANNIVERSARY



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