Obstetrics, Gynecology and Reproduction

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Vol 13, No 2 (2019)
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85-94 570

Aim: to analyze the endometrial expression of leukemia inhibitory factor (LIF) related to the estrogen/progesterone receptor endometrial status in women with the history of reproductive dysfunctions.

Materials and methods. The main group consisted of patients with the history of infertility (n = 81) or early pregnancy loss (n = 40). The control group included 16 women with normal fertility. At days 6–8 after ovulation, endometrial biopsy was performed and peripheral blood samples were taken to assess the estradiol and progesterone levels. Histological and immunohistochemical (to quantify the estrogen (ER)/progesterone (PR) receptors and LIF expression) examinations of the endometrium biopsy materials were carried out.

Results. In the middle phase of the secretion, women of the control group showed higher levels of LIF expression in the endometrial glands (94%; n = 15) and stroma (88 %; n = 14) significantly more often than patients with reproductive dysfunctions – 69 % (n = 84) and 44 % (n = 53) respectively (p < 0.05). There was no difference in the endometrial LIF expression between women with infertility and those with early pregnancy loss. In women with a sizable hormone-receptor 'response', a pronounced expression of LIF in the luminal epithelium (87 %; n = 52 out of 60) and stroma (68 %; n = 47 out of 69) was detected more often (p < 0.01) than that in patients with impaired hormone-receptor interactions (61 %, n = 27 of 44; 29 %, n = 20 of 68). High PR expression in the endometrial glands (H-score > 105) indicates the risk of impaired LIF expression in the luminal epithelium (OR =2.6) and stroma (OR = 2.5). Overexpression of ER (H-score > 155) in the endometrial stroma is associated with the risk of sub-normal LIF expression in the endometrial glands (OR = 2.5) and stroma (OR = 2.8).

Conclusion. A meaningful connection has been found between the endometrial estrogen/progesterone receptor status and the expression of LIF. Women with well-pronounced endometrial hormone-receptor interactions show high levels of endometrial LIF expression more often. The stromal ER and glandular PR expression levels are considered to be prognostic factors of reduced endometrial LIF expression in the uterine body mucosa.

95-102 504

Aim: to assess the incidence of complications after laparoscopic and hysteroscopic myomectomy.

Materials and methods. The results of 378 laparoscopic and 292 hysteroscopic surgeries for uterine fibroids (myomas) have been retrospectively analyzed. All patients were examined for their history of gynecological and concomitant non-gynecological diseases, past surgeries, and the menstrual, sexual and reproductive functions. The patients underwent clinical blood analysis, urinalysis, electrocardiography and chest X-ray test, blood group and rhesus factor determination, hemostasis assay, blood analysis for RV, HIV and tumor markers, as well as transabdominal and transvaginal ultrasound using SSD-1200 and SSD-2000 devices (Aloka Ltd, Japan). We characterized the patients by the type of surgical intervention (laparoscopic or hysteroscopic), and also by age, indications for surgery, the number of fibroids and their locations, size of the uterus, presence of extragenital and genital disorders, and also by the surgery techniques. The post-surgery complication incidence rate was calculated and expressed as percentage (%), arithmetic mean (M), and standard error of the mean (m).

Results. The overall incidence of severe postoperative complications did not differ between laparoscopic (2.7 ± 0.8 %) and hysteroscopic (2.1 ± 0.8 %) operations for uterine myomas (p > 0.05). The incidence of complications was significantly higher in women operated by laparoscopy if they underwent simultaneous operations (12.3 ± 4.0 % vs. 0.6 ± 0.4 % for non-simultaneous operations), if the number of fibroids was > 4 (3.9 ± 1.4 % vs. 1.1 ± 0.8 % in those with < 4 fibroids), in the presence of anemia (8.2 ± 2.9 % vs. 1.0 ± 0.6 % in cases with no anemia), and in patients with menstruation disorders (4.9 ± 1.8 % vs. 1.3 ± 0.7 % with normal menstruation). The operated patients significantly differed by the number of uterine fibroids: the average number of fibroids was larger in those operated laparoscopically (2.9 ± 0.05 vs. 2.3 ± 0.04; p < 0.01); the proportion of patients with 4 or more fibroids was also significantly higher in those patients (53.7 ± 2.6 % vs. 30.1 ± 2.7 %; p < 0.001). The compared groups also differed in the location of their myomas.

Conclusion. The risk of postoperative complications after laparoscopic surgery is relatively high if simultaneous operations take place, if the number of fibroids is ³ 4, and in the presence of anemia or menstruation disorder.

103-110 727

Aim: to study the possibility of reducing the incidence of preeclampsia (PE) by giving vitamin D and calcium (Ca) to pregnant women with a high PE risk starting from the second trimester of pregnancy.

Materials and methods. A total of 101 patients from the PE high risk group were examined on weeks 14–16 of pregnancy followed by treatment with vitamin D and Ca; then, the course of pregnancy and labor was analyzed. Serum 25-hydroxycholecalciferol, vitamin D binding protein, endothelin 1-38, and ionized Ca were determined using enzyme immunoassays.

Results. In the examined women at high risk of PE, severe serum deficiency of vitamin D and Ca was detected. In patients treated with vitamin D and Ca, a two-fold decrease in the incidence of PE, a three-fold decrease in the incidence of intrauterine growth retardation syndrome, and a decrease in the number of urgent surgery-assisted deliveries were found.

Conclusion. Therapy with vitamin D and Ca from the second trimester of pregnancy increases the availability of vitamin D, leads to a more favorable course of pregnancy, and prevents the development of severe forms and early onset of PE in patients at high risk.

111-118 717

Aim: to study the distribution of HLA-antigens in married couples with failed conception and/or carrying of pregnancy, and to assess the occurrence rate and the presence of common alleles of the main histocompatibility complex in couples with infertility and miscarriages.

Materials and methods. We conducted HLA-typing of 198 married couples with aggravated obstetric history. The main inclusion criteria were conception failures and unsuccessful outcomes of previous pregnancies. The HLA-class I antigen typing was carried out using a standard micro-lymphocyte-toxic test («Gisans», Russia); for the class II HLA-antigens, real-time polymerase chain reaction («DNA-Technology», Russia) was used. Based on the obstetric and gynecological history, the patients were divided into 2 subgroups: 1st – those with infertility and 2nd– with recurrent miscarriages. The comparison group included 101 married couples with no aggravated obstetric history, no infectious, no endocrine or anatomical abnormalities, and having 2 or more children. The occurrence rates of classes I and II HLA-antigens in women and men from the examined groups were compared with those in healthy individuals living in the same area.

Results. In the examined couples with recurrent miscarriages, the HLA-A11 antigen occurred significantly more often in men, and HLA-В35 antigen – less often in women. In women of the infertile couples, HLA-A19 antigen was detected more often than in couples with children. In women with infertility, the HLA-DRB1*08 and HLA-DQA1*0401 alleles were less common than in women without fertility disorders. In the examined couples with infertility and recurrent miscarriages, statistically significant predominance of 3 genes common to the HLA class II system was found. In couples with normal fertility functions, the absence of homologous alleles of the HLA class II system in their genotypes was typical.

Conclusion. HLA typing allows for predicting the risk of infertility and reproductive failure.


119-131 17804

Cystitis and other urinary tract infections (UTIs) in women of reproductive age can lead to infertility, significantly complicate the course of pregnancy, and cause numerous fetal abnormalities. Antibiotic therapy during pregnancy is an extreme measure since it is associated with a high risk of fetal malformations. The use of D-mannose is an effective and safe treatment for cystitis and other UTIs, especially during pregnancy. The present systematic analysis of 32111 studies indicates a significance of D-mannose for glycosylation of human proteins and for functioning of the immune, cardiovascular, urinary and other systems. By blocking the interaction between bacterial fimbriae and the endothelium, D-mannose prevents the adsorption of bacteria (uropathogenic strains of Escherichia coli, Pseudomonas aeruginosa, Shigella, leishmania, mycobacteria, etc.) to the tissue surface, thus helping prevent recurrent UTIs. Clinical studies have confirmed both high efficacy and safety of using D-mannose and the synergistic substances (such as cranberry anthocyanins) for the treatment of cystitis and other UTIs.

132-154 7567

Introduction. Human papillomavirus infection (HPV-infection) remains one of the most important health problems as it significantly reduces the quality of life and stigmatizes the patients. Also, the prevalence of cervical cancer – the most severe outcome of the HPV-infection is 5 % of the global burden of cancer. Although vaccination against human papillomavirus has been proved efficient, its availability in Russia continues to be limited. Therefore, it is important to review other methods of HPV-infection control. A number of studies have confirmed the efficacy of glucosaminylmuramyl dipeptide (GMDP) in the treatment of diseases associated with HPV-infection, but no systematic evaluation of these studies has been published in the available literature.

Aim: to analyze the data on the efficacy and safety of GMDP in the treatment of diseases and conditions associated with HPVinfection.

Materials and methods. We used the PRISMA approach. The search for the relevant publications was conducted in international scientific databases: the Scientific Electronic Library, the Google Scholar, the ScienceDirect, the Cochrane Community Library, the Pubmed/MEDLINE, and clinical research registries. For this systematic analysis, only full-text publications were used. We evaluated the reliability of evidence and the methodological quality of the studies.

Results. We used the following search queries: "glucosaminyl-muramyl dipeptide", "glucosamine L'muramyl dipeptide", "H-acetylglucosaminyl-H-acetylmuramyl dipeptide", "GMDP", "Licopid" (both in Russian and English transcriptions). Based on the results of the screening, 14 full-text publications were selected. At the final stage, review articles with secondary data were excluded; also excluded were original articles published in doubtful resources and those with an unclear status of peer reviewing. This systematic analysis includes 7 publications of acceptable methodological quality. Here, we summarize the consistent conclusions derived from these reports: the addition of therapy with GMDP to local (surgical) methods increases the efficacy of treatment and the duration of remission; destruction of condylomas is more effective when combined with the course of GMDP as compared to using the local destruction alone; GMDP enhances the production of cytokines that have a direct antiviral and antiproliferative effect in HPV-infection (interleukin-1, tumor necrosis factor alpha, gamma-interferon); GMDP causes normalization of cellular and humoral immunity (T-lymphocytes, T-cytotoxic lymphocytes, B-lymphocytes, CD3+, CD4+, CD8+, CD16+, and CD72+ lymphocytes, as well as the production of serum immunoglobulins IgA, IgG, and IgM). A high safety profile of GMDP is evidenced from the absence of reports on adverse events.

Discussion. The recommendation for the inclusion of GMDP into a comprehensive treatment for HPV-infection in addition to local interventions is a strong recommendation. The differences between the Russian and international approaches can be explained by the difference in the available resources and funding. We propose to test whether using GMDP for reducing the risk of recurrent HPV-infection is beneficial in terms of pharmacoeconomics. Conclusion. The high efficacy and safety of GMDP in the combined therapy of HPV-infection has been confirmed. Further carefully designed studies on GMDP are needed.

155-163 7867

This review examines the evolution of views and opinions on issues related to the management of pregnancy and childbirth in women with high myopia. Special attention is given to the threat of retinal detachment and its prevention during pregnancy and delivery; the need for improving the diagnosis of retinal abnormalities is also addressed. Our analysis indicates that since the early 1980s, pregnancy associated peripheral vitreochorioretinal dystrophy was considered a leading risk factor for rhegmatogenous retinal detachment during childbirth. Here, we present data on the eye hemodynamics and intraocular pressure in women at the time of delivery. We also discuss current strategies of pregnancy management in women with peripheral vitreochorioretinal dystrophy. In addition, absolute and relative indications for natural delivery in women with high myopia are presented together with ophthalmological requirements for natural delivery.

164-173 622

This review addresses the function of the protein-transporter glycoprotein-P (Pgp, ABCB1 protein) and the expression of its encoding gene MDR1/mdr1 throughout the gestational period in humans and animals. We discuss the relationship between the transporter function and the hormone fluctuations during pregnancy. We cite studies on the association between the MDR1/mdr1 gene polymorphisms and the hemato-placental barrier permeability for Pgp substrates, as well as fetal malformations. Under a separate section, drugs commonly used in pregnant women are characterized in terms of their roles as substrates, inducers or inhibitors of the Pgp transporter.

174-180 547

Aim: to study the interrelation between the myths and the scientific understanding of sex differentiation of the fetus.

Materials and methods. The study is based on the materials published in the XIX – early XX century in Russia; among them, reports by medical professionals, ethnographers, and mystics stored in the Russian State Library, including a number of handwritten texts in the Manuscripts Department.

Results. In this review, the method of comparative historical analysis was used to reveal the predominance of the religious and mystical views in the popular understanding of sex differentiation. Among them are ideas about the right and left sides of a woman’s body, about the moral behavior of a man, about the role of the menstrual cycle in the mystical context, about the couple behavior during the intercourse, and more. Methods for predicting the sex of the future child were also reviewed, as well as the signs related to the child sex planning.

Conclusion. In the XIX – early XX century Russia, the views and understandings of obstetricians about the fetal sex differentiation were rather irrational and had no academic credibility.

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