Analysis of the cellular immunity status in patients with pathological placentation

AIM: The study aimed to investigate the cellular immunity in patients with placental disposition. MATERIALS AND METHODS: A prospective study analyzed birth histories and clinical and laboratory parameters of 10 patients with placental disposition. The cellular immunity status was determined by analyzing lymphocytes with a cluster of differentiation (CD), including CD3+, CD4+, CD8+, CD16+56, CD3-СD8+, TNK, and CD38+8+. Obtained data were analyzed statistically. RESULTS: Patients were 32.0 (29.0; 36.0) years old. As regards reproductive history, 60.0% had a history of three pregnancies, 20% had two pregnancies, 10% had their first pregnancy, and 10% had their fourth pregnancy. Moreover, placenta dispositions most often occurred at the second pregnancy in 70.0%, at the third pregnancy in 20.0%, and first pregnancy in 10%. In terms of cell immunity in comparison with normal indicators, the relative number of natural killer cells (CD16+56+), including activated CD3-СD8+, tended to increase. A relative increase in cytotoxic T-lymphocytes (СD8+) was found against the background of lower number of T-helper cells, along with general immunodeficiency (immunoregulatory index in the absolute number of women was less than 1.5). CONCLUSIONS: Further investigation of cellular immunity in women with placental pathology is relevant to detect additional pathogenetic mechanisms of the development of obstetric complications.

Efficacy of immunological antivirus therapy for papillomavirus-associated grade I cervical intraepithelial neoplasia

AIM: The study aimed to assess the effectiveness of alloferon in human papillomavirus (HPV)-associated cervical neoplasia (grade I) based on the analysis of the cytokine profile in cervical mucus as well as markers of apoptosis in cervical epithelial cells. MATERIALS AND METHODS: The study enrolled 98 women, including 55 women of reproductive age with cervical intraepithelial neoplasia (CIN) associated with HPV infection and 43 conditionally healthy women without HPV infection. Factors of cytokine response and markers of apoptosis under normal and pathology conditions were assessed and compared. RESULTS: The imbalance of pro-inflammatory and anti-inflammatory cytokines, in favor of the latter, is an important factor that supports the persistence of HPV-associated grade I CIN. Reducing caspase-3 and caspase-9, increasing interleukin-18, and subsequent activation of interferon gamma against the background of alloferon use are favorable signs of substantial elimination of the HPV. CONCLUSIONS: The results of this study show considerable elimination of HPV in patients with grade I CIN when using immunological antivirus therapy.

Dysmenorrhea and endometriosis in teenage girls (review)

Most adolescents experience discomfort during menstruation. Usually, girls are diagnosed with primary dysmenorrhea in the early reproductive period and respond well to symptomatic treatment with non-steroidal anti-inflammatory or hormonal drugs. If first-line therapy does not improve the symptoms of dysmenorrhea, transabdominal ultrasonography is indicated. Most often, these patients are diagnosed with endometriosis, which is the main cause of secondary dysmenorrhea in adolescents. Endometriosis should be assumed in patients with persistent, clinically pronounced dysmenorrhea that does not respond to treatment with hormonal drugs and non-steroidal anti-inflammatory drugs, especially if no other cause of chronic pelvic pain or secondary dysmenorrhea is detected on the basis of history, physical examination, and ultrasonography of pelvic organs. The aim of the therapy is to relieve symptoms, suppress disease progression, and protect future fertility.

Comparison of prenatal functional markers of retardation of fetal growth and delayed fetal development with expression of vascular growth factors in the placenta

AIM: The study aimed to investigate and compare Doppler metric indicators in the main arteries of the functional system of the mother, placenta, and fetus as well as the parameters of the activityrest cycle in fetuses with vascular endothelial growth factor (VEGF) expression and placenta growth factor (PlGF) in the presence of physiological pregnancy and placental insufficiency to analyze morphofunctional parallels between these indicators in the third trimester of pregnancy. MATERIALS AND METHODS: Twenty-nine women on the 3435 weeks of pregnancy (period of physiological maturity of the activityrest cycle in the fetus) were screened. The main group consisted of 19 patients. The inclusion criteria were as follows: single-fetal pregnancy, fetometric indicators below the 10th percentile, and presence of blood flow disorders in the main vessels of the motherplacentafetus functional system. The comparison group included 10 relatively healthy women. The criteria for inclusion in the comparison group were as follows: single-fetal physiological pregnancy, fetometric indicators above the 10th percentile, and absence of Doppler disorders of placental blood flow. Fetometry and Doppler studies of the placental blood flow in the main arteries of the functional system of the mother, placenta, fetus were performed using the Voluson 730 Expert ultrasound device (GE, USA). The activityrest cycle in the fetus was evaluated using Sonicaid Team Care fetal monitor (Oxford, UK). Placental tissue was taken from the central placental area for immunohistochemical analysis of VEGF and PlGF expression with primary monoclonal antibodies of the main women group and comparison group after childbirth (1:100, Abcam, UK). RESULTS: A direct correlation between the expression of VEGF in the central zone of the placenta and index resistance (IR), ripple index (RI) in the uterine arteries, as well as the cerebroplacental relationship CPR (r1=0.487; p1=0.035; r2=0.487; p2=0.035; r3=0.578; p3=0.030, respectively) in women of the main group was found. A direct correlation was established between the expression of VEGF in the central zone of the placenta and IR in the umbilical artery (r=0.49; p=0.033) in patients of the main group. The analysis of the restactivity cycle in fetuses of women of the main group showed that at 3435 weeks 73% of them do not form it: the behavior of fetuses is represented only by the activated state. An inverse relationship was found between VEGF expression and the motor-cardiac reflex amplitude (r=0.866; p=0.05) as well as the heart rate oscillation amplitude (r=0.866; p=0.05) in fetuses of women of the main group. CONCLUSIONS: The identified morphofunctional parallels will allow to develop non-invasive pathogenetic prognostic models for prenatal diagnosis of fetal development delay with different degrees of growth restriction.

Hepatitis B and C during pregnancy

The purpose of this article is to provide a comprehensive overview of current knowledge about pregnancy and hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and current methods to reduce mother-to-child transmission (MTCT). Maternal infection with HBV or HCV is associated with complicated pregnancy and childbirth outcomes, including MTCT. In countries, including the United States, which introduced postpartum HBV vaccination and immunization with hepatitis B immunoglobulin, MTCT overall decreased to about 5%. However, with maternal HBV levels greater than 200,000 IU/ml, the transmission rate of HBV to neonates is almost 30%. For these patients, there are new recommendations from the European Association for the Study of the Liver (EASL), which indicate that, in addition to vaccination of newborns and their immunization, treatment with antiviral drugs such as tenofovir disoproxil fumarate or telbivudine, used during pregnancy, starting from 32 weeks is necessary, that are safe and effective in preventing mother-to-child transmission. Unlike HBV, no therapy is yet available or recommended to further reduce the risk of mother-to-child transmission of HCV infection, which remains by 310%. MTCT of HCV can be minimized by avoiding obstetrics and birth trauma if possible. Young women with HCV should be sent for treatment after delivery, and newborns should be closely monitored to rule out infection. Newer, better tolerated HCV regimens have become more available and should reduce the number of women and babies infected.

Possibilities of antenatal pathology diagnostics in women after assisted reproductive technologies

PURPOSE: improving the efficiency of diagnosis of placental insufficiency using modern diagnostic methods. MATERIALS AND METHODS: The analysis of individual cards, analysis of the gynecological history and somatic morbidity of 426 pregnant women who did not have somatic pathologies and underwent screenings in accordance with the current regulations were performed. The main group of them consisted of 290 women, who showed signs of chronic placental insufficiency at different stages of pregnancy. The control group consisted of 136 women who had no signs of placental insufficiency throughout their pregnancy. RESULTS: It was revealed that the main reasons for the development of chronic placental insufficiency of the main group are preeclampsia (68.4%), the threat of termination of pregnancy (34.7%), burdened obstetric and gynecological history (32.5%), isoserological incompatibility (25.6%), pyelonephritis during pregnancy (14.2%) and anemia of pregnant women (13.2%). It was revealed that visualization of the fetoplacental complex and measurement of peripheral resistance in the umbilical artery during the second trimester of pregnancy are not very informative. To reduce the negative impact of fetoplacental insufficiency and its timely diagnosis, it is necessary to use radiation methods for examining the motherplacentafetus system. CONCLUSIONS: For timely diagnosis of fetoplacental insufficiency and reduction of its negative impact, it is necessary to use radiation methods of studying the mother-placenta-fetus system.

Differential diagnosis of obstetric thrombotic microangiopathy: a review

Thrombotic microangiopathy (TMA) is a clinical and morphological syndrome, which is based on damage of the endothelium. Clinically, TMA is characterized by a triad of symptoms: thrombocytopenia, microangiopathic hemolytic anemia, and target organ damage. In obstetric practice, TMA most often occurs with preeclampsia or HELLP syndrome, atypical HUS, TTP. The review presents the basic differential criteria for the diagnosis of TMA during pregnancy and after childbirth, as well as the management of patients.

Clinical case of differential diagnosis of retrocervical endometriosis

Endometriosis is a chronic hormone-dependent progressive disease characterized by the presence of ectopic endometrioid tissue. Most often, endometriosis affects the ovaries, fallopian tubes and the abdominal cavity, but endometrioid foci are also found in the intestines, heart, lungs, skin and other atypical localizations. This article presents a clinical case of retrocervical endometriosis diagnosed based on the results of pathological and histological examination. It is important to note the complexity of the differential diagnosis of this form of endometriosis due to secondary changes in the area of the colon and the absence of characteristic clinical manifestations.

Polycystic ovarian syndrome: long-term surgical outcomes (literature review)

Polycystic ovarian syndrome (PCOS) is a fairly common disease that occupies one of the leading positions among the reasons of endocrine infertility. Women with this diagnosis have an increased risk of developing diabetes mellitus, cardiovascular disease, metabolic syndrome (dyslipidemia, decreased sensitivity to peripheral tissue insulin, hyperinsulinemia). Currently, a step-by-step and individual approach to treatment has been applied, including both conservative treatments and surgical ones.

Vaginal extirpation of the uterus using implants made of titanium silk to prevent recurrence of the disease

INTRODUCTION: The frequency of post-hysterectomy prolapse of the vaginal dome reaches 43% in patients after surgical treatment for complete uterine prolapse. Goal ― improving the effectiveness of surgical treatment with titanium mesh implants in pre- and postmenopausal patients with complete uterine prolapse. MATERIALS AND METHODS: The study involved 21 patients with complete uterine prolapse who underwent the proposed new method of transvaginal surgical prevention of post-hysterectomy prolapse of the vaginal dome. The result of surgical treatment was evaluated by analyzing the data of vaginal examination and ultrasound. RESULTS: Patients were observed for 2 years ― after 1, 6, 12 and 24 months. Analysis of vaginal examination and ultrasound data showed no displacement of the vaginal dome, pelvic organs and deformation of titanium implants. There were no mesh-associated complications during follow-up. CONCLUSIONS: The use of the developed surgical method for the correction of post-hysterectomy prolapse of the vaginal dome with the use of implants made of titanium silk is a reliable tool that provides anatomical efficiency in pre- and postmenopausal patients.