Obstetrics, Gynecology and Reproduction

Advanced search
Vol 13, No 1 (2019)
View or download the full issue PDF (Russian)
5-6 267


7-12 781

In this short communication, the editorial board publishes the information on safety of the combined hormonal contraceptive (CHC) Jeanine®, containing the fixed dose combination of dienogest and ethinyl estradiol. This information has been received from the Russian regulatory authority (Roszdravnadzor) and the manufacturer. According to a metaanalysis of four observational studies, women using the dienogest/ethinyl estradiol fixed dose combination had a higher risk of developing venous thromboembolism (VTE) as compared with women taking the CHCs containing the levonorgestrel/ ethinyl estradiol combination. The estimated risk of developing VTE in women taking the dienogest/ethinyl estradiol combination is 8-11 cases of VTE per 10,000 women per year, while in women taking the CHCs containing levonorgestrel, norethisterone or norgestimate the risk is 5-7 cases of VTE per 10,000 women per year. A patient information leaflet amendment is under consideration by the regulatory authorities. For now, however, hormonal contraceptives containing the dienogest/ethinyl estradiol combination accompanied with the previous version of the instruction are still available in pharmacies. Therefore, when prescribing the combined hormonal contraceptives with dienogest and ethinyl estradiol, the obstetrician-gynecologist should discuss these risks with the woman.


13-19 608

Introduction. Numerous studies have shown that vaginal dysbiosis can complicate the course and outcome of pregnancy. Real-time polymerase chain reaction (RT-PCR) allows for a multivariate quantitative analysis of conditionally pathogenic microflora from the urogenital tract, which represents a novel approach to the diagnosis of inflammatory diseases and dysbiotic conditions of the lower female genitals. Aim: to determine and compare the parameters of vaginal microbiocenosis between various clinical forms of miscarriage. Materials and methods. For the microbiological analysis, we used scrapings from the posterolateral vaginal fornix mucosa. The samples were analyzed using the RT-PCR assay. Three groups of women with clinically identified and sonographically confirmed miscarriages were examined. The clinical forms were: threatened miscarriage (TM), spontaneous abortion (SA), and undeveloped pregnancy (UP). Results. Significant differences in the vaginal microbiocenosis parameters were found between the UP vs SA and TM vs UP groups; these changes negatively affected the course and outcome of pregnancy. The highest occurrence (68 %) of microbiocenosis disorders was found in patients of the TM group. The most common carriers of Candida fungi were patients of the UP (60 %) and TM (56 %) groups. Mycoplasma genitalium was the most common infectious agent in the TM group (14 %), and Mycoplasma hominis - in the SA group (40 %). In most cases (54 %), the carriers of CMV infection were detected in the UP group. Four parameters were found statistically significant for the TM and SA groups: the reduced presence of Lactobacillus spp. (p = 0.001), the increased presence of Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp. (p = 0.01), Mycoplasma hominis (p = 0.001), and CMV infection (p = 0.004). For the UP group, the significant indicator was the presence of CMV (p = 0.001). Conclusion. The results indicate a negative role of the above infectious agents in the development of various clinical forms of miscarriage.

20-28 439

Aim: to study the fetal development during the early gestational period (7-9 weeks) in women with syphilitic infection who chose to terminate the pregnancy with the help of artificial abortions. Materials and methods. Women with a history of syphilitic infection and a physiological pregnancy of 7-9 weeks underwent ultrasound examination of the fetus. Following the abortion procedure, histological sections of the abortive material were analyzed. Results. During the ultrasound examination of these women at the gestation period of 7-9 weeks, the thickness of the collar space was 1.5-1.6 mm, the yolk sac was 4.4-4.6 mm, and the coccygeal-parietal size - 54-56 mm, with no significant differences from the control group. In the decidual tissue, foci of fibrinoid necrosis and leukocyte infiltration of the stroma were significantly more common in women with primary or anamnestic syphilis as compared with the control group. Conclusion. In the early stages of pregnancy on the background of syphilitic infection, there were no sonographic differences from non-infected pregnant women; though inflammatory and other abnormalities were found in a histological analysis of the abortion material.

29-34 536

Aim: to study the association between hereditary/acquired thrombophilia and premature detachment of normally located placenta. Materials and methods. The participating women were divided into 2 groups: the main group (n = 38) and the control group (n = 43). The main group included women, whose pregnancy or delivery was complicated by premature detachment of normally located placenta. The control group included women without previous obstetric or thrombotic complications, who gave birth to full-term live babies with an Apgar score of 8-10. The key coagulogram parameters, the presence of hyperhomocysteinemia, antiphospholipide syndrome, and polymorphisms of the hemostasis genes (by real-time polymerase chain reaction) were determined. Results. A statistically significant increase in the concentration of fibrinogen and D-dimer was found in patients of the main group. In addition, allele A of the G1691A polymorphic locus of the factor V gene and allele 4G of the 5G/4G 675 polymorphic locus of the PAI-1 gene are risk factors of placental detachment development. Conclusion. Hereditary and acquired thrombophilia are significant factors in the development of premature detachment of the normally located placenta.

35-42 1839

HELLP-syndrome is an extremely serious complication of pregnancy with a high risk of adverse perinatal and maternal outcomes. Aim: to study the clinical course, maternal and perinatal complications in pregnant women with HELLP-syndrome. Materials and methods. We conducted a retrospective study on clinical records of 28 births by women with HELLP-syndrome and 35 women with severe preeclampsia (PE) without HELLP-syndrome manifestations. The diagnostic criteria of the HELLP-syndrome in patients with severe РЕ were based on the symptoms of intravascular hemolysis typically manifested in arterial hypertension, proteinuria, and generalized edema. Results. The classical three symptoms of HELLP-syndrome were noted only in 64.2 % of cases, and the mono-symptomatic course - in 35.7 % of cases. The total triad of HELLP-syndrome (hemolysis, thrombocytopenia, elevation of hepatic enzymes) was recorded in 42.8 % of cases. The most common form was the typical HELLP-syndrome, then - the ELLP-syndrome (elevation of liver enzymes and thrombocytopenia) - 57.2 % of cases; an isolated elevation of hepatic enzymes in severe PE was found in 53.5 % of cases, thrombocytopenia in severe PE - in 64.2 % of cases. A high incidence of adverse perinatal outcomes was also found: premature births (64.2 %) and antenatal fetal death (21.4 %). Conclusion. In the above clinical situations, the diagnostic judgement should be pointed towards the HELLP-syndrome; accordingly, the adequate obstetric management should be initiated to prevent the development of life-threatening complications in both the mother and the fetus.

43-49 454

Aim: to analyze the relation between hepatitis C virus (HCV) load, the immune reactivity, and the immune-mediated lesions in the liver during pregnancy in women with chronic hepatitis C (CHC). Materials and methods. The study included 1690 pregnant women, 107 of whom had IgG antibodies to HCV; in addition, 68 women (63.5 %) were diagnosed with chronic hepatitis C and had a positive test for HCV RNA. The diagnosis of CHC was confirmed by determining serum total anti-HCV IgG antibodies using an enzyme immunoassay. The qualitative and quantitative determination of HCV RNA in the blood was performed by polymerase chain reaction. The virus replicative activity was qualitatively assessed by the viral load: low - the level of HCV RNA was up to 103 lU/ml, moderate - from 103 to 106 lU/ml, and high - above 106 lU/ml. To quantify the results, we used the positivity index, i.e, the ratio of the serum optical density to the critical optical density (cut-off) in each test. Results. In the early stages of pregnancy, signs of severe immune-mediated hepatocyte injury persisted. In the II and Ill trimesters, there was an unusual discrepancy between the severity of viral load and the degree of hepatocyte injury as the course of CHC remained usual. Another evidence of the liver involvement in this immune-pathological mechanism was an 87 % decrease in alanine aminotransferase activity with an increase in the viral load in patients with CHC in the Ill trimester of pregnancy. Conclusion. Suppression of anti-HCV humoral immunity, but not cellular immunity, begins from early stages of pregnancy and is accompanied by a significant increase in hepatocyte lesions without an increase in the severity of the inflammatory process.


50-62 870

Postpartum anal incontinence is a complex disorder that develops mainly in young women and negatively affects their social and professional activity. The aim of this review is to summarize the available literature and current concepts on the etiology, pathogenesis, diagnosis and treatment of postpartum anal incontinence. The prevalence of postpartum anal incontinence varies from 13 to 39 %. The risk factors include vaginal delivery, the use of instrumental methods, age, body mass index > 30, delivery-associated perineal tears, incontinence during pregnancy and smoking. The role of episiotomy in anal incontinence is not clear, some authors note a high risk of median episiotomy compared with mid-lateral one. Diagnosis of anal incontinence is mainly based on clinical examination and history data. The most informative imaging modality is endoanal ultrasound. Treatment of anal incontinence should begin with diet correction and medications for stool control. The efficacy of various treatment programs directed to strengthening the pelvic floor and anal sphincter muscles is controversial and needs further study. Surgical treatment is indicated if the conservative therapy is unsuccessful; the most common methods are sphincteroplasty and electroneuromodulation of the sacral plexus branches. Primary prevention measures for postpartum anal incontinence should focus on eliminating or reducing the risk factors. Special training programs for obstetricians can significantly reduce the number of perineal tears and their severity, as well as reduce the need in obstetric forceps. Secondary prevention steps include the correct choice of the first and subsequent deliveries in women with an increased risk.

63-69 2000

Kraurosis vulvae or vulvar lichen sclerosus (VLS) is a non-neoplastic skin disease that affects the female genital area. It is characterized by hypoplastic dystrophy, itching, pain, changes in the vulva appearance, narrowing of the vaginal opening, dysuria and dyschezia. Psychosexual disorders often occur in patients with VLS and can significantly impact their quality of life. In addition, there is a risk of malignization of the process. That is why such patients need timely treatment to prevent the development of a malignant disease, restore the quality of life, maintain the physical and mental status, and correct the sexual dysfunction.

70-78 658

Preeclampsia (PE) is not only a disease of pregnant women, but also a disease with lifelong consequences for mother and child. Making an early diagnosis and differential diagnosis of PE is crucial yet challenging, since PE can be mistaken for other internal diseases or surgical conditions. Despite the variety of clinical symptoms of thrombotic microangiopathy that may manifest in a non-typical picture of PE, progressive multiple organ failure develops in all cases. It seems promising to study the role of matrix metalloproteinases and determine the genetic predisposition to early and severe PE. The forecast and prevention attempts must begin from the fertile cycle. A better knowledge of biochemical and genetic markers along with the clinical and instrumental tests will reduce the morbidity and mortality in PE patients.

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