Obstetrics, Gynecology and Reproduction

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Vol 14, No 1 (2020)


7-14 715

Aim: to monitor the anthropometric, hormonal and metabolic parameters in women of reproductive age with infertility and grade I gluteofemoral obesity during treatment with a balanced hypocaloric diet.

Materials and methods. The study included 23 infertile women of reproductive age. All patients were prescribed a balanced, low-calorie diet (1200 kcal/day), exercise, and behavioral therapy. The anthropometric, metabolic and hormonal parameters were determined before and 12 months after the treatment. We measured the levels of leptin, total cholesterol, triglycerides, triglycerides, high-density and low-density lipoprotein cholesterol (HDL cholesterol and LDL cholesterol), fasting glycose. Following the measurements, the atherogenic and insulin resistance indices were calculated. In addition, the plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, estrone, estradiol, testosterone, progesterone, and immunoreactive insulin were measured.

Results. Twenty patients completed the study. A decrease in body weight (by average of 10.58 ± 5.70 kg) was found in 87 % of patients; in parallel, the body mass index decreased from 32.53 ± 1.40 to 28.55 ± 2.50 kg/m2 (p < 0.001). The decrease in body weight was accompanied by a statistically significant decrease in the levels of leptin (p < 0.001), estrone (p = 0.049), estradiol (p = 0.032), total cholesterol (p < 0.001), triglycerides (p = 0.004), LDL cholesterol (p = 0.001), fasting glycose (p < 0.001), insulin resistance index (p = 0.002), atherogenic index (p < 0.001) and an increase in the level of progesterone (p = 0.030). The ovulatory menstrual cycle was restored in all women (p = 0.007); within one year, wanted pregnancy occurred in 1 woman.

Conclusion. The use of a low-calorie diet for 12 months in infertile women with grade I gluteofemoral obesity leads to normalization of metabolic parameters, weight loss and, the restoration of the ovulatory menstrual cycle in 100 % of cases.

15-24 1818

Introduction. Intrauterine hematomas commonly found in routine ultrasound examinations represent one of causes resulting in early pregnancy loss. The most common is retrochorial hematoma resulting from fetal egg detachment from the uterine wall. Retrochorial hematoma often leads to pregnancy complications and affects gestational process.

Aim: to develop a personalized approach to the diagnosis, prevention and management of pregnancy with retrochorial hematomas in the early stages.

Materials and methods. A prospective examination of 70 females, aged 22 to 37 years old, with retrochorial hematoma was performed at gestational age ranging from 5 to 12 weeks. Here, we examined serum level for lupus anticoagulant, antiphospholipid antibodies (AFA), antibodies to cardiolipin, fi2-glycoprotein I, to annexin V and prothrombin, and ADAMTS-13. All women were examined for genetic mutations linked to high thrombogenic risk and low thrombogenic risk polymorphisms. Patients were also examined for urinary tract infections.

Results. It was found that 43 (61 %) females had aggravated obstetric anamnesis (non-developing pregnancy, spontaneous miscarriage in early stages, antenatal fetal death), whereas 13 (18.5 %) subjects had burdened familial thrombotic history (heart attack, stroke, and thrombosis occurred before the age of 55 years in first-line relatives). In addition, 22 (31.4 %) females were found to have genetic and acquired forms of thrombophilia; 6 (8.5 %) were detected to have circulatory ADAMTS-13 inhibitor; 5 females were confirmed to have decreased blood coagulation factor activity; and 38 (54.2 %) had vaginal dysbiosis.

Conclusion. Our work demonstrates that a personified and pathogenetically differentiated algorithm for diagnostics and management of pregnant women with chorionic detachments in early stages allows to lower frequency of early abortions and increases the therapeutic effectiveness.

25-33 989

Introduction. Serum proteins PAPP-A (pregnancy-associated plasma protein-A) and β-hCG (the в-subunit of human chorionic gonadotropin) levels are components of the 1st trimester combined screening aimed to detect fetal aneuploidies. In contrast to singleton pregnancies, where the values are well established, this is not the case in twins.

Aim: a comparative analysis of serum proteins PAPP-A and β-hCG levels, as well as parameters PAPP-A MoM and β-hCG MoM in the first trimester during pregnancy with dichorionic diamniotic twins that occurred spontaneously or as a result of in vitro fertilization (IVF).

Materials and methods. The study group included multiple pregnancies as a result of IVF procedure (n = 100) and spontaneous multiple pregnancies (n = 121) considered as controls. The levels of PAPP-A, β-hCG, PAPP-A MoM and β-hCG MoM were compared using nonparametric Mann-Whitney U test.

Results. The PAPP-A MoM level resulted higher in the group of IVF twins (p = 0,007) compared to spontaneous twins: 1.28 [0.97; 1.89] vs. 1.12 [0.87; 1.40] (median [interquartile range]). There were no statistically significant differences in в-hCG levels between the groups of IVF twins and spontaneous twins.

Conclusion. The results justify the need for further study of PAPP-A and β-hCG to establish their association with adverse outcomes in both groups of multiple pregnancies.

34-43 2468

Aim: to evaluate the ability of serum biochemical markers in pregnant woman - PAPP-A (pregnancy-associated plasma protein-A) and β-hCG (the в-subunit of human chorionic gonadotropin) studied in the first trimester (11+0-13+6) during combined prenatal screening to predict adverse perinatal outcomes of multiple pregnancy that occurred spontaneously and as a result of in vitro fertilization (IVF).

Materials and methods. The main group consisted from 65 women with pregnancy occurred as a result of IVF; comparison group included 56 women with spontaneous pregnancy. All pregnancies were multiple and their outcomes were known. Serum PAPP-A and β-hCG levels were measured in the first trimester. The results were expressed in absolute values and in MoM (multiples of median). Subgroups were compared with mono- and dichorionic pregnancies, complicated and uncomplicated pregnancies, distributed according to MoM index: within the reference values (0.5-2.0), below or above the reference values.

Results. PAPP-A MoM values in the spontaneous pregnancy group were 1.12 [0.8; 1.57], in the IVF group - 1.35 [1.11; 1.72] (p = 0.01). In subgroup of low PAPP-A MoM antenatal fetal death occurred in 50 %, in subgroup of normal PAPP-A MoM - in 14.58 %, in subgroup of high PAPP-A MoM - in 5.88 % (p = 0.011). In addition, a positive correlation was found between serum PAPP-A level and time of fetal death (rs = 0.564; p = 0.036). Low PAPP-A MoM values were associated with 50 % fetal mortality, 75 % of them were attributable to pregnancy as a result of IVF.

Conclusion. Identification of adverse outcomes in multiple pregnancies is still a difficult task, but evaluation of serum biochemical markers during the first trimester screening can help in early diagnosis of necessity and extent of timely prophylaxis.


44-55 1115

The article provides a contemporary view on rehabilitation of oncogynecological patients. We considered physiological and psychological problems (surgical menopause and pain syndromes; impaired sexual function, distress, general intoxication, chronic fatigue associated with malignant neoplasm) occurring in women after antitumor treatment as well as outlined potential solutions. Not only traditional methods for correction of complications after antitumor treatment, but also opportunities for using alternative and adjuvant (supportive) therapy are presented. A special attention is paid to importance of relapse prevention during rehabilitation period. It is necessary to develop and introduce a multidisciplinary approach to this group of patients with the obligatory participation of physicians from different specialties - oncologists, obstetrician-gynecologists, rehabilitologists, psychiatrists, psychologists, etc.

56-68 1229

Introduction. Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular activation of blood clotting without specific localization and arising from various causes. DIC is the most complex and high-priority problem in contemporary clinical medicine including obstetrics and perinatology. DIC significance is related to its peak perinatal mortality, as well as a large rate of complications during childbirth and postpartum period.

Aim: to conduct comprehensive data assessment related to DIC pathogenesis and management in pregnant women and newborns.

Materials and methods. A search for DIC-related publications within the past 10 years was conducted in international research databases: Scientific Electronic Library Online eLibrary, Google Scholar, ScienceDirect, Cochrane Library, PubMed/Medline. The data regarding DIC diagnostic criteria and markers, as well as current approach to its treatment are presented.

Results. DIC may be considered as one of the causes resulting in massive obstetric bleeding. The majority of pregnancy-related complications is manifested as preeclampsia, premature detachment of normally situated placenta and anaphylactoid syndrome of pregnancy. Any massive bleeding should be perceived as hemorrhage resulting from the DIC progression.

Conclusion. Knowledge of the DIC pathogenetic mechanisms is necessary for conducting a differential diagnosis and applying timely treatment.

69-79 856

Hormonal contraceptives are effective in preventing an unwanted pregnancy, but have side effects; among them stroke occupies an important place. The development of this serious disease may be associated with the hormonal drug components, but heavily dependent on additional risk factors for vascular and thrombotic complications such as smoking, arterial hypertension, genetically determined and acquired predisposition to thrombotic complications. This review presents an analysis of the most important risk factors for stroke such as genetic predisposition, hyperhomocysteinemia, thrombophilias in women using combined oral contraceptives.

80-88 694

This paper is aimed at outlining the essence, nature as well as range of child’s guarantees for receiving pediatric palliative care at prenatal stage including common scope of the rights for such patients. It is emphasized that a child at prenatal stage (starting from certain age) is able to feel pain sensation and suffer from it, thereby underlying its right for palliative care. It is underscored as to why a child’s right at prenatal stage for pediatric palliative care (if necessary) is subject to legal recognition and legal protection.


89-93 801

Here we describe a clinical case of successfully managed pregnancy and labor in female with multigenic thrombophilia (combination of homozygous Leiden and heterozygous prothrombin G20210A mutations) associated with high risk of thrombosis by using proper anticoagulant therapy. It was underlined that females with obstetric complications should be examined for inherited and acquired types of thrombophilia.

94-101 810

Here, we discuss blood management upon a risk of massive obstetric hemorrhage by describing a clinical case of female patient with obstetric complications of pregnancy such as severe preeclampsia and chronic placental insufficiency with fetal malnutrition examined by using thromboelastometry to assess a risk of developing massive obstetric hemorrhage. A rotational thromboelas-tography/thromboelastometry technology as well as available publications related to using it in obstetrics are outlined.


102-111 1203

The article describes the current issues of the epidemiology of human papillomavirus infection of high carcinogenic risk and genital herpes, affecting reproductive health. The attention is focused on modern principles of diagnosis and treatment, including approaches to immunotherapy and combination therapy.


112-116 635

Georgios Nicolau Papanicolaou was a “pioneer’ in the study of the cytological features of the female reproductive system. He became known worldwide due to creation of PAP-test, commonly known as Pap-smear that revolutionized the early detection of cervical cancer. Several hundred million women pass the PAP-test every year, and tens of thousands owe their lives to this outstanding scientist.

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