Vol 66, No 4 (2017)

Gestational diabetes mellitus (GDM) and its consequences for the mother and child represent a serious not only medical, but also an economic problem. The urgency of studying this problem also lies in the fact that the number of pregnant women suffering from this disease is progressively increasing. The aim of the study was to study the risk factors and features of the course of pregnancy and childbirth in women with gestational diabetes mellitus, as well as to improve methods for diagnosing and predicting the development of diabetic fetopathy (DF). The work was carried out in 3 stages: 1 — prospective study of the course of pregnancy and childbirth in 104 women with GDM and in 50 pregnant women without GDM (control group); 2 — determination in the peripheral blood of the pregnant women of both groups of the level of glycemia, C-peptide, insulin, calculation of the insulin resistance index (HOMA-IR) with an assessment of the prognostic significance of these markers in the development of diabetic fetopathy; 3 — prediction of the development of diabetic fetopathy using a mathematical model that includes risk factors, the results of laboratory and instrumental research methods for this pathology. It was found that the violation of carbohydrate metabolism during pregnancy promotes the development of a large number of obstetric complications and in 36.5% of cases leads to the birth of children with diabetic fetopathy, which is manifested to a greater degree by macrosomia (30%), which increases the risk of perinatal complications and worsens the course of the period newborn in the future. An increase in the level of C-peptide was diagnosed in 87% of pregnant women with gestational diabetes, and an increase in the insulin resistance index in 93%, in contrast to the control group, where these indicators were 4 and 6%, respectively (p < 0.05). Using discriminant analysis, it was determined that the threshold for predicting the development of DF should be considered an increase in HOMA-IR above 7 with a confidence of 73%, but the level of C- peptide does not have a predictive value. The mathematical model, including risk factors, data of laboratory and instrumental methods for studying carbohydrate metabolism in the mother and fetus, created using regression analysis, reflects the probability of development of diabetic fetopathy in pregnant women with gestational diabetes with an accuracy of 91.4%, which will help to prevent this complication in at an earlier stage through insulin therapy.

Relevance. Progesterone is the only hormone in the body, the main function of which is the development and maintenance of pregnancy, while its other properties are duplicated by other hormones. The hormone deficiency is part of the general mechanism of spontaneous abortion, and not its cause [1].

The aim of the study was to establish a connection between the content of the level of progesterone and its metabolites in the blood of pregnant women and the developmental disorders of pregnancy in order to determine the possibility of laboratory confirmation of pathology.

Materials and methods. The study included 31 patients with pathological pregnancy, hospitalized in the hospital, in the first and second trimesters of gestation and 34 women with physiological pregnancy in the first trimester of gestation. Pregnant women with infertility in history, severe somatic pathology, acute infectious diseases, oncological processes, with endocrine disorders, with malformations of the genital organs, endometriosis, pregnant women taking gestagens or other hormonal medications before entering the study are excluded from the study. Each patient hospitalized in a hospital and women with a physiological pregnancy had, in addition to a general clinical examination, performed a blood serum test for hormones (progesterone, cortisol, DHEA-C, 17-OH, estradiol) and ultrasound (VOLUSON 730, GENERAL ELECTRIC in 2007) using transvaginal 4-8 MHz and transabdominal 2–5 MHz sensor. Progesterone, cortisol, estradiol was determined by enzyme-linked fluorescence analysis using reagents from bioMerieux (France) using a VIDAS device from bioMerieux, France (2012). The analysis is based on a combination of a two-stage enzyme-linked immunoassay (sandwich method) and a fluorescent determination of the reaction products. The DHEA-C and 17-OH study was carried out using the ELISA method on equipment: the Freedom EVO75 laboratory automated laboratory for laboratory diagnostics produced in Switzerland (2008) using ANALYSIS MED reagents, Belarus. The statistical processing of the results of the study was carried out using the application statistical packages Statistica 6.0.

Results. It was found that with the termination of pregnancy in both I and II trimesters, the level of progesterone and estradiol statistically significantly decreased. The content of DHEA-S and 17-OH progesterone varied depending on the gestation period. The concentration of cortisol also decreased, but it was not statistically significant. It was also found that after the death of the embryo and spontaneous abortion, functional fragments of the fetal egg remain in the uterine cavity.

Conclusion. The priority of hormones in the development of pregnancy in the I and II trimester is different. If in the first trimester the most dependent on the gestation period are progesterone, estradiol, DHEA-C, then in the II trimester — progesterone, estradiol, 17-progesterone. And also that cortisol during pregnancy is predominantly synthesized outside the fruiting and amniotic complex, which explains the absence of its statistically significant changes in the unfavorable termination of pregnancy in both I and II trimester of gestation.

Introduction. “Thin” endometrium is known affect negatively to reproductive function. Treatment of “thin” endometrium remains a problem and subject of future major studies.

Aim. To justify the possibility of applying of recombinant interleikina-2 person late reproductive age patients with “thin” endometrium before using assisted reproductive technologies.

Matherials and Methods. We examined a total of 64 late reproductive age women. Three groups of patients were analyzed. The first investigated group included 25 women with histologically proven chronic endometritis; the comparison group included 20 patients with endometrium of the early proliferative phase; the second investigated group included 19 patients with “thin” endometrium, with indications for the conduct of in vitro fertilization. Interleukin 2, interleukin-4, tumor necrosis factor alpha, interleukin-1β, Interleukin-6, interleukin-8, interleukin-10, IFN-γ concentrations were determined by enzyme linked immunosorbent assay in serum and aspirates from the uterine cavity in first investigated group and comparison group. Vaginal ultrasonic examination was made for women of second investigated group in first and second phase of menstrual cycle before and after recombinant human interlejkinom-2 treatment. Statistical data processing was performed using application software package Statistica 6.0 (StatSoft, Ink. 1994–2001), adapted for biomedical research. P < 0.05 was considered significant.

Results. Were found that concentrations of interleukin 2, interleukin-10 significantly reduced and concentrations of tumor necrosis factor alpha, interleukin-1β, Interleukin-6 and interleukin-8 significantly increased in aspirates from the uterine cavity in women of late reproductive age with chronic endometritis. All changes occur at the local level in chronic endometritis. Endometrial thickness a statistically significant increase after use of recombinant human interlejkinom-2 in patients with infertility and chronic endometritis.

Conclusions. Application of recombinant interleukin-2 in patients with “thin” endometrium can become optimal schema therapy, which requires further study.

Background. Bacterial vaginosis is disturbance of the balance of the vaginal microflora, associated with a number of infectious diseases of the urogenital tract and adverse pregnancy outcomes. In this country, for the detection of vaginal dysbiotic conditions, the test Femoflor-16 (DNA-Technology, Moscow) is widely used, however interpretation algorithms of this test do not include the category of BV.

Aim. The study aimed to elaborate diagnostic criteria for the detection of BV using Femoflor-16 test.

Materials and methods. Women of reproductive age addressing a gynecologist with vaginal discharge were enrolled in the study. For clinical diagnosis of BV, the Amsel criteria were used, laboratory analysis for BV was performed via microscopic investigation of vaginal discharge using the Nugent score. Samples of vaginal discharge from all women were analyzed with the test Femoflor-16, intended for characterizing vaginal microbiocenosis using multiplex quantitative real-time PCR.

Results. A total of 280 women were included in the study. BV was diagnosed in 86 women (31%) using the Amsel criteria, and in 81 women (29%) using the Nugent score. All groups of anaerobic bacteria included in Femoflor-16 test were shown to be associated with BV, with the exception of bacteria of the genus Mobiluncus, which are detected together with phylogenetically related but not BV-associated bacteria of the genus Corynebacterium. A low amount of lactobacilli (< 10% of total bacterial load) coupled with an elevated amount of Gardnerella vaginalis/Prevotella bivia/Porphyromonas (> 1%) and/or Eubacterium (> 2%) and/or Sneathia/Leptotrichia/Fusobacterium (> 0.1%) and/or Megasphaera/Veillonella/Dialister (> 0.1%) and/or Lachnobacterium/Clostridium (> 0.1%) and/or Peptostreptococcus (> 0.1%) and/or Atopobium vaginae (> 0.2%) detected BV with a sensitivity of 99% and specificity of 93%.

Conclusions. Criteria for BV diagnosis using the test Femoflor-16 have been elaborated, which enable to detect BV or exclude it with a sensitivity of 99% and specificity of 93%. These criteria for BV and criteria of the test manufacturers for severe anaerobic dysbiosis determine to a large extent the same category of the vaginal microbiocenosis.

The secondary gravida pregnant patient with uterine scar after previous cesarean section was treated with parenteral methamizol sodium due to renal colic and acute thrombocytopenia suddenly occurred. There were supposed that this condition had been drugs induced heteroimmune thrombocytopenia. The indications for planned cesarean section were breech presentation of large fetus in patient with uterine scar. However, uterine contractions appeared in 38/39 weeks and it was decided to deliver the patient urgently after appropriate preparing. The treating of severe thrombocytopenia was substitutive — thromboconcentrate and plasma transfusion and pathogenetic — using of dexamethasone and human immunoglobulin. After transfusion of one dose of thromboconcentrate and two doses of plasma the level of thrombocytes had reached of 21 × 109/л and it was decided to start cesarean section which was performed successfully in conditions of total combined anesthesia with tracheal intubation and pulmonary ventilation. The recovery of thrombocytes quantity occurred in postoperative period with continuing using of steroid therapy.

Infertility and miscarriage are unresolved problems of obstetric and gynecological practice. Endometrial dysfunction is considered to be one of the most important factors in pathogenesis of reproductive losses. The usefulness of hormone-dependent cyclic transformation of the endometrium depends on the adequacy of the molecular interaction of sex hormones with specific receptors in the endometrium. The last also play an important role in the implementation of the correct “dialogue” between the blastocyst and endometrium. This review presents recent data on the role of the receptor apparatus of the endometrium in the genesis of reproductive dysfunctions.