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Obstetrics, Gynecology and Reproduction

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Vol 13, No 3 (2019)
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NEWS

 
187-188 18

ОRIGINAL ARTICLES

189-196 70
Abstract

Aim: to evaluate the significance of hormonal, biochemical, and echographic methods in the diagnosis of endometrial cancer.

Materials and methods. Fifty patients (aged 62.4 ± 1.0) with endometrial cancer of varying severity and 20 practically healthy postmenopausal women (aged 68.0 ± 0.7) were examined. All patients underwent hormonal, biochemical, and echographic examinations.

Results. At the period of this study, 68 % of patients had stage I cancer, 30 % had stage II, and 2 % – stage III endometrial cancer. In the medical history of examined patients, the incidence of abortion was 46.8 %, the rate of childbirth – 70.0 %, the infertility rate – 14.9 % (n = 7). A statistically significant decrease in the luteinizing/follicle-stimulating hormone ratio (0.69 ± 0.09), an increase in the levels of prolactin (467.3 ± 35.1 ng/ml), dehydroepiandrosterone-sulfate (92.9 ± 14.4 pg/ml), estrone (101.60 ± 6.29 ng/ml), progesterone (1.90 ± 0.52 ng/ml), as well as a decrease in estradiol (17.4 ± 3.4 pg/ml) and total testosterone (0.50 ± 0.02 ng/ml) in comparison with the practically healthy postmenopausal women (control group) were found. According to the echographic examination, a pathological increase in the endometrium thickness (24.9 ± 2.7 mm) was detected against the background of uterus and ovaries enlargement. The biochemical parameters in patients with endometrial cancer in the postmenopausal period were within the normal range.

Conclusion. The risk of endometrial cancer is high in elderly women with an increased body mass index. Evaluating of their hormone levels is of diagnostic and prognostic importance in endometrial cancer. Transvaginal sonography is an accurate diagnostic method for assessing the tumor invasion into the myometrium of patients with endometrial cancer.

197-203 78
Abstract

Introduction. Analysis for TORCH infections is ordered to simultaneously detect several common infections: Toxoplasmosis, Other infections (syphilis, hepatitis B, chickenpox, Epstein-Barr virus, parvovirus and some others), Rubella, Cytomegalovirus and Herpes simplex virus. Contracting a TORCH infection in pregnancy triggers the synthesis of immune factors including antimicrobial peptides (AMPs).

Aim: to determine the levels of AMPs – lactoferrin, defensin, endotoxin, BPI (bactericidal/permeability-increasing protein) and hepcidin – in the blood serum of pregnant women with TORCH infections.

Materials and methods. The main group included 40 pregnant women with TORCH infections; in 33 of those, pregnancy continued until full-term delivery, and 7 women had miscarriages at the end of the first trimester. The comparison group consisted of 29 pregnant women free of TORCH infections. Blood for AMP measurement was taken in all pregnant women in the first trimester and in women with an ongoing pregnancy also in the III trimester. The control group consisted of 19 healthy non-pregnant women. Serum AMP was determined by enzyme-linked immunosorbent assay (ELISA).

Results. In pregnant women with TORCH infections, there was an increase in the serum levels of lactoferrin, defensin, hepcidin, BPI, and endotoxin; the increase was most pronounced in the first trimester of pregnancy. The decrease in AMP levels observed in the III trimester could be due to the antiviral treatment given to the patients in order to prevent the immunological rejection of the embryo and maintain the normal course of pregnancy.

Conclusion. The increased level of AMPs reflects the enhanced activity of the immune system and represents one of the pathogenetic links of spontaneous abortion.

204-210 44
Abstract

Aim: to assess the prevalence of V617F somatic mutation of the JAK2 gene in pregnant women.

Materials and methods. This non-interventional study was performed in the framework of routine clinical practice and included 1532 samples of venous blood from pregnant women who applied for medical assistance at Krasnoyarsk Regional Clinical Center for Maternal and Child Welfare. We used blood samples left after all routine laboratory tests had been done. These leftovers were pooled in the way that ensured an equal ratio of nucleated cells. Each pool contained 7 separate blood samples. The unused samples that remained after the pooling were frozen and stored at –20°C until the end of entire testing procedure. The V617F JAK2 mutation was detected by the real-time allele-specific polymerase chain reaction test.

Results. Among the examined pregnant women, 6 (0.4 %) were identified as carriers of V617F JAK2 mutation. Three women with this mutation suffered from infertility for 4, 5, and 10 years; two of them had repeated miscarriages in the first trimester of pregnancy. The 6 women – carriers of this mutations had no concomitant genetic polymorphisms typical of thrombophilia (factors FII, FV), and no abnormal coagulation characteristics. Analysis of their medical records showed that in the past, two of these women had gestational hypertension, one developed a clinical picture of preeclampsia, and another one (with the maximum presence of the mutant allele) had a history of acute lymphoblastic leukemia followed by stable remission.

Conclusion. The routine laboratory detection of the V617F JAK2 mutation can facilitate timely identification of the increased risk of pregnancy pathology, as well as timely diagnosis of hematological cancer.

211-216 38
Abstract

Introduction. Preventing recurrent bacterial vaginosis (BV) during pregnancy is an important issue in current obstetrics.

Aim: to assess the effect of recombinant human interferon alpha-2b on the incidence of recurrent BV during pregnancy and on the bacterial, cytokine, and antimicrobial components of the nonspecific vaginal immunity.

Materials and methods. The study included 80 pregnant women with recurrent BV, 40 of whom (the main group) were treated with recombinant human interferon alpha-2b in the first half of pregnancy and after 30 weeks of pregnancy in addition to standard therapy (metronidazole or clindamycin). The other 40 women (control group) did not receive this interferon drug. Patients of the both groups were examined for the rate of BV recurrence and also tested for their vaginal bacteria and levels of β-defensin-2 (HBD-2), interleukin-1β (IL-1β), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and interferon-γ (INF-γ) in the third trimester of pregnancy.

Results. Treatment with recombinant human interferon alfa-2b led to a 3-fold reduction in the occurrence of repeated episodes of BV and an increase in the content of lactobacilli (7.24 ± 0.33 and 7.03 ± 0.40 in patients with interferon therapy and without it, respectively; p = 0.013) mainly due to Lactobacillus crispatus (7.14 ± 0.69 in women who received interferon alfa-2b, compared with 6.36 ± 0.95 in patients on standard therapy; p = 0.003) and a decrease in the number of some types of anaerobes. Also, the use of interferon alpha-2b in pregnant women with recurrent BV led to an increase in the content of IL-1β by 2.5 times, IL-6 by 3.5 times, IL-10 by 1.5 times, INF-γ by 2 times, and HBD-2 by 4 times.

Conclusion. Treatment of recurrent BV during pregnancy with recombinant human interferon alfa-2b, aimed at boosting the nonspecific vaginal immunity helps reduce the incidence of recurrent BV.

SCIENTIFIC SURVEYS

217-226 100
Abstract

Stroke is a severe thrombotic condition that can occur in women of reproductive age during their pregnancy. Physiological changes that occur during gestation, childbirth and the postpartum period predispose a woman to the development of thrombotic complications. However, the true causes of cerebrovascular accidents are not fully understood. More than 50 % of strokes occur in the absence of obvious risk factors. The article reviews etiological and pathogenetic mechanisms of cerebral blood flow disorders and factors contributing to this condition in pregnant women.

227-238 59
Abstract

Due to the increase in life expectancy, today, most women live in a state of estrogen deficiency for more than a third of their life time. According to the recent document on the stages of aging of the female reproductive system (the STRAW+10 working group), there are three main stages that include the reproductive period, the menopausal transition, and postmenopause. One of the most common manifestations of postmenopause is vulvovaginal atrophy or genitourinary syndrome, which leads to a dramatic decrease in the woman’s quality of life. Up to 45 % of postmenopausal women suffer from this disorder, and 80 % of them experience a negative impact on their quality of life. The main symptoms of vulvovaginal atrophy are dryness, itching, burning, and dyspareunia. Caution must be exercised in relation to “silent” atrophy, which is not manifested by subjective complaints of vaginal mucosa atrophy, and can only be visualized by colposcopy. According to the recommendations of the International Menopause Society (IMS), updated in 2016, therapy should be started before the atrophic changes become irreversible; the treatment should continue for a long time to maintain the achieved therapeutic effect. If no symptoms other than vulvovaginal atrophy are noted, local estrogen therapy is indicated. Estriol has advantages over other medications due to its lower affinity for estrogen receptors. In earlier studies as well as those updated here (2014–2018), estriol applied topically as a vaginal cream or vaginal suppositories, has a selective effect on the urogenital tract and practically does not interfere with the proliferation of the uterine endometrium. The confirmed efficacy and safety of estriol allow for its permanent use, beginning with the starting dose and then switching to the maintenance one.

CLINICAL CASE

240-244 29
Abstract

A case of pregravid preparation is described for an in vitro fertilization (IVF) attempt in a woman after four previous IVF failures. Considering her personal and family aggravated medical history, including the family anamnesis, the patient underwent a hemostasis examination including a test for genetic mutations. A high titer of antiphospholipid antibodies of various types and multigene mutations associated with thrombophilia were found. For the treatment of acquired and inherited thrombophilia, vitamin-antioxidant and intravenous immunoglobulin therapy was initiated as well as a course of hirudotherapy. After starting of pregnancy throughout the gestation period, anticoagulant therapy by low molecular weight heparins, antiplatelet, and antioxidant therapy was carried out; in parallel, D-dimer, thrombin-antithrombin and platelet aggregation markers of thrombophilia were monitored. Pregnancy successfully ended by childbirth at 39 weeks.

LECTURE

245-254 38
Abstract

The most common cause of thrombosis isischemic heart attack, the second one is stroke, and the third one is venous thrombosis. According to European studies, venous thrombosis accounts for about 12 % of the population’s deaths. The pathogenesis of thrombosis is well presented in the form of the Virchow’s triad; that includes damage to the vascular endothelium, hypercoagulation and stasis. A pregnant woman is deficient in fibrinolytics and excessive in procoagulants. Pregnancy can be seen as a natural example of the Virchow’s triad: the woman develops a state of hypercoagulation only because she is pregnant. Hypercoagulable state in pregnant women directly correlates with age, genetic thrombophilias, and autoimmune diseases. The formation of a blood clot may be associated with genetic factors, the so-called familial thrombophilias. This type of thrombophilia is caused by abnormalities in the genes that carry information about proteins involved in blood coagulation – proteins C and S, antithrombin III, Leiden mutation, prothrombin anomaly G 202110A. Thus, thrombosis is the result of an interaction between genetic and acquired risk factors or a combination of them. This is confirmed by the RIETE data registry. It is highly advisable to identify patients at risk and determine the strategy of managing these patients with the least dangerous consequences.

BOOK REVIEW

255-260 176
Abstract

The licensed edition of Rebecca Fett's book, “It Starts with the Egg” has been published in Russian. Given its medical contents, it seems important to evaluate the information contained in the book from the perspective of a practicing obstetrician-gynecologist, focusing on the problem of miscarriage and pregravid preparation. Importantly, the book is based on evidence-based medicine: although the book is intended for a wide scope of readers, it contains a list of primary references similarly to that in peer-reviewed journals.

The author analyzed and summarized the data from over 60 scientific articles. Although based on primary academic sources, the author used a simple and understandable language to explain the complex pathogenesis of infertility and the manipulations used in the assisted reproductive technology (ART).

The book consists of 3 parts; each of them contains several chapters reviewing the causes of reproductive disorders and the ways to correct them. The first part addresses the reasons for poor quality of women’s eggs. The second part describes nutraceuticals and dietary supplements that can improve the quality of eggs. The third part of the book examines the diet, which helps improve this quality. A step-by-step action plan for improving reproductive function is also presented. The basic plan is suitable for those who are just thinking about pregnancy and those who have no reason to expect any difficulties, as well as for couples who have been struggling with infertility for several years. The mid-level plan is intended for those who already have some concerns about conceiving, but are not yet aware of personal problems with their reproductive function, as well as for women with polycystic ovary syndrome (PCOS) or irregular ovulation. The plan for those having serious problems is intended for women with recurrent miscarriage, as well as for couples with a decrease in the ovarian reserve who are trying to get pregnant using in vitro fertilization (IVF).

Despite some remarks regarding the role of vitamin D and magnesium in pregravid preparation, the book contains a large number of useful and balanced recommendations that can improve the woman’s health and increase her chances to get pregnant and give birth to a healthy baby. Therefore, the book can be recommended for a wide range of readers.

HISTORIC CASES

261-264 48
Abstract

Polycystic ovary syndrome (PCOS) is a gynecological disease manifested in polycystic ovarian morphology, oligo/ anovulation, hyperandrogenism, hirsutism, alopecia, and acne. PCOS affects 5–10 % of women of reproductive age. The first histological description of polycystic ovaries was made by Antonio Vallisneri. Then, Kronid Fedorovich Slavyanskiy, for the first time, described the clinical picture of PCOS, and Sergey Kuzmich Lesnoy proposed ovary wedge resection for surgical treatment. Irving Stein and Michael Leventhal studied the PCOS symptom complex and provided the recommendations on its diagnosis and treatment to restore normal menstrual cycle and fertility in such patients.

EVENTS



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