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Obstetrics, Gynecology and Reproduction

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Vol 10, No 1 (2016)
View or download the full issue PDF (Russian)
https://doi.org/10.17749/2313-7347.2016.10.1

NEWS

SCIENTIFIC SURVEYS

5-10 257
Abstract

Microvesicles (MVs), including microparticles and exosomes, are secreted from a variety of cells. They are present in the blood circulation under normal physiological conditions, and their levels increase in a wide range of disease states. MVs contain proteins, growth and apoptotic factors, DNA fragments, microRNAs as well as messenger RNAs (mRNAs); therefore, they may function as regulators in cell-cell communication and mediators of cell signaling during multiple biological processes. The current review focuses on the role of MVs in healthy pregnancy and gestational vascular complications and discusses the involvement of MVs in thrombosis, hemostasis and cell function that overall reflect the placental-maternal crosstalk.

11-25 313
Abstract

Several direct oral anticoagulants (DOACs), namely, apixaban, rivaroxaban, and dabigatran etexilate, are currently licensed in Europe and the United States for various thromboembolic indications. They provide alternatives to low molecular weight heparin in a peri-operative setting for venous thromboembolism (VTE) prophylaxis and therapy and to vitamin K antagonists for longer term therapy. Routine coagulation monitoring is not required with DOACs but is recommended in patients with renal impairment, acute bleeding, overdoses, or emergency surgery. If bleeding is life-threatening, the offlabel therapeutic use of PCC or activated PCC may be considered in an attempt to reverse the anticoagulant effect of DOACs. DOACs provide important advantages in the short-term prophylaxis of VTE in patients undergoing hip or knee replacement surgery and in the longer term treatment of VTE and prevention of stroke in patients with atrial fibrillation compared with traditional agents, including reductions in dangerous bleeding types.

26-37 2081
Abstract

The article describes the main anticoagulant drugs used in cancer patients, taking into consideration pathogenetic aspects of hypercoagulation status in cancer patients: oral anticoagulants, heparin drugs, selective inhibitors of Xa factor. The basic advantages of low molecular weight heparin compared with unfractioned heparin. The comparison of low-molecular weight heparin drugs, their generics and biosimilar drugs is surveyed. Reviewed recommendations for the prevention of thrombotic complications in cancer patients. Overviewed the possible complications of heparin therapy and methods of prevention.

38-48 435
Abstract

The article considers the reasons and the role of the folate deficiency in development of the complicated pregnancy and congenital malformations. The biological functions of folate in an organism are described, as well as the role of folate in an exchange of methionine and a hyperhomocysteinemia as one of the reasons of malformations and complications of pregnancy. The role of a genetic mutation of MTHFR as the hyperhomocysteinemia reasons at patients with deficiency of folate and the treatment of the state of the deficiency of folate are discussed.

50-61 198
Abstract

Heart rhythm disorders during pregnancy sifnificantly increase the risk of the cardioembolism in terms of the hypercoaguability state of pregnant women. The presence of atrial fibrillation during pregnancy in conditions of additional risk factors, inculding history of stroke and thromboembolic attacks, artifial heart valves, arterial hypertension, diabetes mellitus, ischemic disease or heart failure require anticoagulant therapy during all pregnancy. Acquired or genetic forms of thrombophilia also can increase the risk of thromboembolism in women with cardiac arrhythmias during pregnancy.

62-73 168
Abstract

This clinical lecture is dedicated to the diagnostic approaches of blood coagulation disorders in newborns. The work presents a clinical substantiation of different diagnostic methods of hemostasis disorders with description of routine standard methods of research and special techniques.

75-83 453
Abstract

Because of high mortality rate, the lack of effective methods for early diagnosis and limited success in treatment, ovarian cancer of epithelial origin is a major problem in gynecological oncology. These problems are largely due to our lack of the disease etiopathogenesis understanding. This article attempts to summarize recent data on the sources and the development of the cancer process in the ovary as well as to introduce modern approaches to the diagnosis of this type of malignancy.

84-98 161
Abstract

Cancer is a risk factor for thrombotic complications, while activation of the hemostatic system contributes to the growth and metastasis of the tumor tissue. The paper presents the modern ideas of the pathogenetic features of the interaction of the hemostatic system and immune systems in terms of tumor growth. First category of such factors we refer to as "specific tumor-dependent", the second – as "general pathological risk factors", the third – as "therapy-dependent" risk factors. Pathogenesis of interaction "hemostatic system – tumor tissue – immune system" includes factors related to the response to the tumor: inflammation, acute phase reaction, dysproteinemia, focal necrosis, hemodynamic abnormalities, as well as specific factors caused by the tumor cells and tumor-associated macrophages. Namely: procoagulant and fibrinolytic activity of cancer cells and their interaction with platelets, mononuclear macrophages and endothelium, angiogenesis, iatrogenic aspects (chemoherapy, hormone therapy). Tumor cells activate the coagulation cascade or fibrinolysis system, providing conditions for its further spread, stimulation of angiogenesis, increased vascular 
permeability, which in turn promotes metastasis.

ОRIGINAL ARTICLES

100-110 218
Abstract

Aim. To study the pregnancy course and delivery outcome in patients with mesenchymal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome (EDS), Hereditary hemorrhagic telangiectasia (HHT).

Material and Methods. 56 pregnant women with mesenchymal dysplasias (23 with Marfan syndrome, 22 with Ehlers-Danlos syndrome, 11 with hereditary hemorrhagic telangictasia (HHT) were examined in specialized cardiological maternity house by using physical examination, routine laboratory tests, hemostasiological tests, ECG, echocardiography, MRI, radiology, pulse oximetry.

Results. All patients had hemorrhagic complications various localizations; 18 women with Marfan syndrome developed increasing of mitral regurgitation, 10 – aortic insufficiency, 13 – mitral valve insufficiency. 1 patient with Marfan syndrome was died due to aortic dissection in 45 day after delivery. Pulmonary arteriovenous malformations were visualized in 10 patients with HHT; the symptoms of hypoxemia developed in 6 HHT patients and were result of right-to-left. One patient with HHT developed the symptoms of compression of vena cava inferior due to aneurism of truncus brachiocephalicus. 40 patients had abnormal hemostasiological tests (platelet dysfunction – in 38 patients; DIC syndrome – in 31). Cesarean section was performed in 53 patients. Vaginal delivery (3 patients with EDS) was complicated by massive postpartum hemorrhage and deep vaginal tears.

Conclusions. Patients with mesenchymal dysplasias have a great risk of different complications, during pregnancy and delivery and require the multidisciplinary care and repeated hemostasiological testing. Cesarean section is the preferred method of delivery in such patients.

111-118 198
Abstract

Objective. To study clinical and morphological features of lower uterine segment after cesarean section to identify the causes and risk of development non-viable scar.

Materials and Мethods. The study comprised 100 pregnant women, 80 of whom had history of caesarean section (CS). These patients, according to the results of morphological studies were divided into two subgroups. The first subgroup consisted of 39 patients with signs of morphological inferiority of the scar. The second subgroup – 41 patient, who had no evident morphological changes in the myometrium. The control group consisted of 20 female first babies born through operation of the CS. Clinical criteria of insolvency of the scar was determined on the basis of the evaluation of anamnestic data, objective and ultrasound. Morphologic study of the failure scar was associated with the presence of pathological changes of connective tissue in the scar, a high degree of disorganization and disunity bundles of smooth myocytes, significant intensity and wide distribution in myometrium
hydropic (vacuolar) degeneration.

Results. The studied morphological criteria were significantly higher in women with morphological signs of insolvency, compared with women who underwent surgery for the first time. In most cases, identified the mismatch between morphological, clinical and sonographic signs of insolvency of the scar. Accurate can be considered only the data of macro – and microscopic examination.

Conclusion. As a result of the analysis of clinical and anamnestic data were risk groups of women who had the highest probability of insolvency of the scar after the CS. To them included: a shorter interval between the CS operations (1-2 years); presence of intra – and postoperative complications after the first CS; "immature" the cervix at full-term pregnancy, as well as anomalies of birth activity among the indications to the first CS.

CLINICAL LECTURES

119-122 191
Abstract

While in the "normal population", sexual dysfunction is reported by approximately 40%, this percentage is in patients with cancer of course still much higher. With oncological consultation not only the cancer should be in the foreground, but also sexual counselling must be included. For many patients, it is difficult to recover attractiveness and self-esteem after cancer. However, usually, it is only a communication problem between the partners. It would be important to address sexual issues with both the patient as well as with the partners directly during the treatment and to try to find a common solution.

123-128 380
Abstract

Abnormal uterine bleeding is one of the most frequent manifestations of diseases of female genital organs and cause 2/3 of all hysterectomies. The results of study of the surgical specimens show that 40-69% of patients not detected no organic changes. In these cases, hysterectomy may be considered excessive interference that leads to an unjustified increase the cost of treatment and risk of complications. It is very important to determine the optimal volume of diagnostic procedures necessary to exclude and/or reduce the number of unnecessarily radical surgery in patients with AUB according to the modern nomenclature AUB.

HISTORIC CASES

129-131 174
Abstract

The article highlights historic aspects of medical and research work of the Hungarian obstetrician of the XIX century Ignaz Philipp Semmelweis.



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