Obstetrics, Gynecology and Reproduction

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Vol 12, No 4 (2018)
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Aim: to identify the risk factors of meconium aspiration and study its impact on neonatal adaptation. Materials and methods. Medical records of 44 women and their infants were studied. Results. In 85 % of cases, the diagnosis of complicated pregnancy was made, in 100 % cases – there was a complicated delivery; 100 % of newborns were put on mechanical ventilation, 95 % of them were diagnosed with cerebral depression syndrome, and 72.5 % – with aspiration pneumonia. Conclusion. A differentiated approach to the management of pregnancy and labor will reduce perinatal morbidity.

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Aim. This study was designed to determine the relationship between pregnancy-associated protein A (PAPP-A), placenta localization and fetal birth weight (FBW). Materials and methods. First trimester PAPP-A levels, second trimester placental localization and birth weights of 1145 infants were obtained through a retrospective review of the patient follow up charts in Koru Hospital. Serum PAPP-A levels were recorded as the multiple of median (MоM) values, the FBW values of infants were recorded in grams, and the placental localization was recorded under seven different pre-defined categories: 1. placenta anterior; 2. placenta posterior; 3. placenta fundal; 4. placenta fundal-anterior; 5. placenta fundal-posterior; 6. placenta lateral-right; 7. placenta lateral-left. The data were analyzed using the Statistical Package for Social Sciences (SPSS) program (SPSS Inc., Chicago, IL, USA). Results. There was no significant difference between the FBW and PAPP-A levels. The comparison of seven placental localizations shows that the anterior and posterior localizations have an impact on FBW of the infants. Conclusion. The FBW was highest in the cases where the placenta was located in the corpus uteri. We believe this finding is consistent with the fact that the corpus uteri receives the largest blood supply.

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Inflammation is considered a typical response to tissue injury. At present, we see an increasing number of patients with chronic inflammation, where the damaging factor is unclear. Specifically, the pathogenetic factors of chronic endometritis (СЕ) need to be studied both in the gynecological and somatic aspects of the disease, including the functional state of other organs and systems. Aim: to analyse the microflora of the urinary tract and the intestines in patients with СЕ and various somatic conditions. Materials and methods. The intestinal and urinary tract microflora were assayed using microscopic, microbiological and molecular biological methods. To prevent false positive results and minimize sample contamination, we used our own modification. Results. The intestinal microbiota in patients with СЕ significantly differed from that in relatively healthy controls. We found a relationship between the abnormal colon microflora and the diseases of the upper and lower gastrointestinal tract, in particular, chronic cholecystitis, gastritis, and functional disorders of the intestine. These findings may become important for compbined therapy. Conclusion. The results indicate the need to individualize the pharmacol therapeutic treatment of patients with СЕ, especially those with impaired fertility. The treatment strategy should be based on minimizing the adverse drug effects, and considering the concomitant diseases.

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Although maternal mortality cases in Russia have become rare, the problem of their prevention remains relevant. To enforce the preventive measures, an analysis of critical conditions and «near miss» cases in obstetrics is commonly used. As a result, the quality of medical care in obstetric institutions improves. Aim: to assess the character and incidence of critical situations in obstetrics practice over the Ryazan region in 2015-2017 and to analyze the failures in medical care that led to such situations. Materials and methods. We analyzed 46 «near miss» cases and 1 case of maternal death recorded in the Ryazan region in 2015-2017. Results. The leading cause of critical conditions in obstetrics found in the Ryazan region was hemorrhage following an emergency caesarean section delivery. In most cases, bleeding was caused by pregnancy complications, although extragenital conditions also contributed to the development of the «near miss» situations. The main indication for emergency delivery was the premature detachment of a normally located placenta; in the normal term delivery, it was an inconsistent uterine scar after cesarean section and the accompanying pathology, such as placenta accreta. Conclusion. Considering the «near miss» cases as a separate group of obstetrics conditions contributes to the prevention of maternal mortality and improves the healthcare standards in obstetric institutions.

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Since recently, the association of premature ovarian insufficiency (POI) with an increased risk of mortality and morbidity caused by cardiovascular diseases (CVD) has been extensively discussed in the context of early detection and prevention of CVD in these patients. Aim: to evaluate the relative cardiovascular risk (CV risk) before and after hormone replacement therapy (HRT) in women with POI. Materials and methods. The study included 170 women aged from 18 to 40; among them, 85 women with POI and 85 women with regular periods. We evaluated the usual CV risk factors: smoking habits, arterial blood pressure, total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins; in addition, we determined apolipoprotein B (Apo B), high-sensitivity C-reactive protein (hs-CRP), uric acid, and endotelin-1, as well as the functional markers: the right and left carotid intima-media thickness (CIMT) and the brachial artery flow-mediated dilatation (FMD). The CV risk was calculated using the relative risk SCORE scale before and after HRT lasted for 12 months. Results. In the POI group, there were 3.8 times more women with a moderate CV risk (per the SCORE scale), whereas in the POI-free group, women with a low CV risk dominated. In addition, the levels of CV risk markers were 4-fold higher in patients with POI (high levels of Apo B, hs-CRP and uric acid, increased CIMT bilaterally, decreased FMD in the brachial artery). Cyclic HRT during 12 months contributed to the lipid profile normalization, decrease in TC, LDL and FMD in the brachial artery as well as to the decrease of relative CV risk in general. Conclusion. The estrogen deficiency in patients with POI is an independent factor in the increased relative risk of CVD. The HRT has anti-atherogenic, antiinflammatory, and angioprotective effects, regulates the production of endothelium-dependent factors of vasoconstriction and vasodilation, leading to a reduction in the relative risk of CVD in general.


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Preterm birth is an important issue in the current obstetrics as it is associated with perinatal morbidity and mortality. Today, most studies are aimed at understanding of the pathogenesis of preterm delivery. The known data on cytokine gene polymorphism indicate that in women with preterm birth, the presence of pro-inflammatory dominant alleles is typical. This may lead to increased production of pro-inflammatory cytokines in the utero-placental complex and may also initiate preterm delivery. At present, studies are under way to identify genes that determine the duration of the gestation period. A better understanding of the preterm birth pathogenesis is expected to help prevent this unfortunate outcome and decrease perinatal morbidity and mortality.

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Leukoplakia, kraurosis and pointed condylomas (papillomas) of the vulva represent the group of background benign vulvar diseases. Vulvar and vaginal intraepithelial neoplasms are classified as premalignant conditions. The etiology and pathogenesis of these diseases are not entirely clear due to their complexity. Despite the easy visual assessment of anatomic areas involved in the pathological process, these diseases are rarely diagnosed at an early stage, which might indicate insufficient vigilance of doctors and patients in relation to the early symptoms. Therefore, this field of oncogynecology needs further development ln terms of diagnosisprevention, screening and treatment.

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Vulvar cancer is a rare malignant tumor with the incidence rate of is 3–8 % of the total incidence of female genital malignant diseases. This disease is the 4th common cause of mortality (after cervical, endometrial and ovarian cancers) and accounts for 18.2 % of the total lethal outcomes. The anatomical structure of the external female organs with their extensive lymphatic and vascular networks contribute to the aggressive course, the trend to metastasize and rapid tumor growth. Progress in the timely diagnosis of vulvar and vaginal cancer is directly linked to increased competence and oncological vigilance among general practitioners and healthcare institutions. It is up to the primary care providers to identify women at risk or at the initial stages of cancer, and refer them to specialized medical facilities for further diagnostics and treatment. The high mortality from these diseases may be linked to the late detection and to the suboptimal therapy, which necessitates further research in this area.


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Combined thrombophilia is known as a probable cause of recurrent in vitro fertilization (IVF) failures. The present clinical case demonstrates the importance of considering the possibility of inherited or acquired thrombophilia in patients under the preparation for IVF. Thromboses of rare locations (hepatic vein, splenic vein, mesenteric vein, ovarian vein, retinal vein, cerebral vein, portal vein, axillary and subclavian vein) are life-threatening conditions. Most often thrombosis of atypical location develops in patients with inherited hemostatic defects, e.g. genetic thrombophilia. Such thromboses can also result from acquired abnormalities of hemostasis, which include antiphospholipid syndrome, pregnancy-associated hypercoagulability, IVF, oral contraception, or ovarian hyper-stimulation within IVF procedures.


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How did the concept of sex relations change through ages? Physical intimacy – heterosexual and homosexual – has been described in history from the antiquity. The social components of sexual behavior – taboos, regulations, the influence of society and politics – have had a profound impact on the world cultures, starting from the prehistoric times.

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Aim: to study the clinical and hemostatic changes in women with menopausal syndrome (MS), receiving the dietary supplement Doctor sea «Extra youth» (EY), containing hydrolyzed caviar of sea urchins, calcium alginate and rosehip extract. Materials and methods. The study involved 60 women with MS aged 45–55 years. The patients were divided into 2 groups: the main group consisted of 30 women who received the EY supplement, the comparison group – 30 women who received no EY. During the study, women in the main group received two EY capsules twice a day for 1 month. The severity of the menopausal symptoms and the characteristics of hemostasis before and after taking the EY were evaluated. Results. After 1 month on the EY, the menopausal symptoms (hot flashes, sweating, heart palpitations, nervousness, fatigue) alleviated, general well-being improved, and a better hemostatic performance occurred (chronometric and structural hypercoagulation, a decrease in platelet aggregation and the D-dimer level). Conclusion. The dietary supplement EY can be recommended for use in general clinical practice as a means to improve the well-being of women in pre- and post-menopausal period and also to prevent thrombotic complications.

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