Vol 52, No 2 (2003)
- Year: 2003
- Articles: 24
- URL: https://journals.rcsi.science/jowd/issue/view/4512
- DOI: https://doi.org/10.17816/JOWD.522
Full Issue
Environment and woman reproduction health
General and particular problems of ecological reproduction
Abstract
The position of the unity of the human body and the environment was obvious already in the "pre-scientific" antique period, when a holistic, harmonious perception of the world prevailed. In the future, in full accordance with the evolution of human knowledge and the predominance of the elementary approach to the study of biological phenomena (primarily, the dominance of morphological and functional analysis of cells, organs and tissues of the body) and individual environmental factors (physical, chemical, mechanical, biological, social), the principle of unity organism and environment for a long time left the field of vision of researchers.
Environmental health and perinatal medicine
Involvement of detoxification system enzymes in pathogenesis of some common multifactorial diseases. Predictive genetic testing
Abstract
The review summarizes the original data concerning involvement of some genes participating in Phase I and Phase 2 of detoxification systems in the origin, progression and treatment efficiency of such common multifactorial diseases as endometriosis, bronchial asthma, alcoholic cirrhosis, habitual miscarriages, gestosis, lung cancer, chronic bronchitis etc. Of special theoretical and practical value of these studies is an identification of highly nonrandom association of particular functionally inferior alleles of the genes belonging to glutathione-S- transferase super-gene family (GSTM1 (0), GSTT1 (0), GSTPi (s) as well as N-acetyl transferase - NAT-2 (s) with these diseases. Thus molecular testing of these alleles might be recommended as feasible predictive test for personal predisposition evaluation, for estimation of remote prognosis and for the treatment strategy in at least some of these diseases. Somewhat about 5-7% of all population in the North-West of Russia possess the most unfavorable combinations of GST genes genotypes (GSTM10/0; GSTTI0/0, GSTPi s/s). Early identification of these individuals by means of genetic screening supplemented with subsequent adequate social and medical care should be considered as feasible social program for efficient prevention of these diseases at the national level. Relying on these data as well as on the polymorphism studies and common mutation identification of other genes the idea of Genetic Form for the pregnant women is suggested and briefly discussed. Implementation of new sophisticated and highly productive molecular techniques amenable for the widespread population gene polymorphism screening becomes highly advisable.
Research of genetic predisposition to gestosis: polymorphism of genes, participating in vasoregulation of functions endothelium
Abstract
The polymorphism of the genes involved in the regulation of endothelial function - PLAT, PAI-1, ACE, eNOS and TNF-α - was studied in 122 pregnant women with pure and concomitant preeclampsia of varying severity and in 73 healthy puerperas. It was revealed that mutant genotypes of the studied genes are associated with more pronounced clinical and laboratory indicators of the severity of preeclampsia and the greatest increase in the level of markers of endothelial dysfunction. It is noted that the frequency of mutant genes and alleles varies depending on the severity of preeclampsia and the presence of background diseases characterized by the presence of endothelial dysfunction. The data obtained confirm the opinion that gestosis is a multifactorial disease with several, possibly independent, developmental pathways. The study of the polymorphism of genes regulating endothelial function contributes to the early identification of a risk group for the development of preeclampsia.
The analysis of complex influence of the adverse ecological/ professional factors on reproduction health of the women
Abstract
As a result of the study and generalization of the results of a comprehensive examination of 3339 women, the main mechanisms of occurrence, clinical manifestations and dynamics of reproductive health disorders in women under the combined influence of unfavorable environmental and occupational factors (radiation accident, toxic chemical production) were established and the main directions for their diagnosis, treatment and prevention were substantiated.
Light regimen, anovulation, and risk of malignant neoplasms of the female reproductive system:the mechanisms of link and prevention
Abstract
This article contains own and literature data on stimulating influence of constant light illumination on the risk of the development of anovulation, hyperplastics processes and cancers of the female reproductive system organs (mammary gland, endometrium, and ovaries) in the laboratory animals and women. Contrary, the light deprivation obstacles to the cancer development. The ata on the key role of the inhibition of production of pineal hormone melatonin in the pathology that developed under the effect of light-at-night as well as on the possible prevention of this pathology with melatonin and pineal peptides are reported.
Features of changes of menstruation function in the various periods of ontogenesis at the working women of an instrument-making industry
Abstract
The object of the study was to study the nature of changes in menstrual function in women at different periods of ontogenesis, taking into account the degree and duration of contact with lead in industrial conditions. At the same time, a statistically significant increase in the frequency of menstrual dysfunctions was revealed.
With the duration of contact with lead, the toxic effect of lead increases both on the central and peripheral link of the hypothalamic-pituitary-ovarian system, which is the reason for the formation of premature menopause in radio installers.
Medical and social aspects of pregnancy termination
Abstract
The article examines the attitude of women to the problem and the abortion procedure and the organization of the work of the gynecological service to provide assistance in connection with an unplanned pregnancy. The questionnaires of women who decided to terminate a pregnancy were analyzed, as well as the qualitative indicators of the activities of institutions.
It was shown that the main reason for the termination of pregnancy was dissatisfaction with the financial situation (28.1%). 96.3% of women knew that abortion is fraught with serious complications. 48.6% of women prefer to terminate pregnancy by mini-abortion, 33.7% by medication. Less than half of the patients are satisfied with the quality of care for termination of pregnancy. Risk groups are adolescents and women of older reproductive age. 67.6% of the respondents need advice on methods of contraception. Satisfied with the quality of consulting 38.8%.
Along with educating the population about the dangers of abortion and teaching family planning methods, it is necessary to create comfortable conditions for abortion, ensure maximum safety of the procedure, conduct rehabilitation after an abortion in order to eliminate negative consequences, advise on the prevention of unplanned pregnancy in the future, and select adequate contraception.
Efficiency of realization of complex preventive maintenance and corrections of the perinatal pathology at psycho emotional stress during pregnancy
Abstract
The scheme of the complex prophylactics and correction of the perinatal pathology at psychoemotional stress during the pregnancy is presented. Differential psychotherapy, sedative therapy, antioxydant therapy, metabolic therapy, permanent tocolitic therapy, physiotherapy (electrical therapy by interferential currents, electrophoresis of heparine by sinusoidal modulated electrical current) and delivery in perinatal center in the presense of the partner are described and explained from the pathogenetic's point of view. The present technology will allow to improve the perinatal outcome and to perform the prophylactics of the following perinatal pathology: severe placental insufficiency, the fetal hypotrophy and premature delivery.
Environmental pollution, immunology researches, humoral immunity, immunological indices of risk, pregnant women, new-born, children of the first year of age
Abstract
Pregnant women in last trimester of pregnancy living in 2 districts of Moscow were clinically examined. The immunology researches show that 69 % of all pregnant have the changes in humoral immunity: decrease of IgG, increase of IgM,CIC,and IgE.
It was also found that somatic health of women pregnancy complications and corresponding immunological changes found in last trimester of pregnancy negatively influenced on health of new-born and formation of health during first year of age. So diagnosis of intrauterine fetus hypoxia. Low Apgar score (6 points and lower), brain circulation disorders of hypoxia genesis diagnosis of hypertensional syndrome was significantly more frequent between new-born of ecologically polluted district.
The study conducted permitted to substantiate the immunological indices of risk for reproductive health of women and health of their offspring. These are: a) decrease of IgG concentration in blood, b) increase of CIC along with rise of overall IgE, c) presence of antihapten antibodies to environmental pollutants. These indices are recommended for inclusion in social and hygienic monitoring, ordinances of Health Ministry in the sphere of maternity and childhood protection.
Impaired hypothalamic regulation of reproductive function when exposed to neurotoxic compounds and melatonin
Abstract
Diurnal rhythms of the contents of biogenic amines in the hypothalamus are considered to play an important role in regulation of many functions such as motor activity, feeding behaviour, sleep-awake cycle formation as well as hormonal and immune statuses. Mechanisms of regulation of reproduction that participate in a circadian signal transmission from the suprachiasmatic nuclei (SCN) of the hypothalamus to hypothalamic structures responsible for gonadoliberin (GnRH) synthesis and secretion (the preoptic area - PA, and the medial eminence - ME) are at present being intensively studied. It has been shown that the aging caused disturbances of estrous cycles in female rats are accompanied by a disappearance of diurnal rhythms of activity of monoaminergic and opioid hypothalamic systems playing a key role in regulation of GnRH synthesis and secretion.
The experiments carried out have revealed diurnal rhythms of the contents of the studied biogenic amines in the PA, ME and SCN of the hypothalamus. The rhythms are due to the amines increasing in the morning hours when compared to their evening and night levels. The neurotoxic compounds used disturbed the rhythms of the amines. Chronic inhalation of toluene caused a disappearance of the dynamics of all the studied neurotransmitters that was typical of the control group. Meanwhile, a single administration of 1,2-dimethylhydrazine resulted in either a complete disappearance of the diurnal rhythms of the biogenic amines contents found in control, or their phase shifts. Severe disturbances of the GnRH content and of the ROS diurnal dynamics were also observed in the studied hypothalamic areas.
The literature allowed supposition that melatonin possessing entraining and antioxidant properties can be used as a protector of disturbances of central mechanisms of regulation of reproduction. However, our experiments have shown that exogenous melatonin does not only eliminate the neurotoxic compounds caused disturbances of diurnal rhythms of the studied indices, but it itself causes deep changes in their dynamics. The effect of melatonin has been found to result in a significant decrease of the catecholamines contents in all the studied hypothalamic structures, particularly of the norepinephrine content, that is accompanied by a profound decrease of the GnRH content and by a disturbance of the diurnal dynamics of reactive oxygen species (ROS) in the PA and ME. The effect of 1,2-dimethylhydrazine on the studied indices was less pronounced when compared to that of melatonin, whereas an injection of the xenobiotic on the background of the pineal gland hormone administration resulted in a predominant effect of the latter.
Both the data obtained and the literature review allow to offer a hypothesis for a possible mechanism of involvement of diurnal rhythms of biogenic amines in central regulation of reproduction. It is known that synthesis and secretion of endogenous opioid peptides in the mediobasal hypothalamus undergo diurnal oscillations with minimum in the morning and maximum in the evening and/or at night. The revealed diurnal rhythms of the biogenic amines contents had opposite oscillations. This fact allows a supposition that these rhythms are due to the opioid system activity changing. Both decreased endogenous opioids contents and simultaneously increased morning biogenic amines levels in proestrus can create a neurotransmitter background that is necessary for GnRH surge formation.
An evaluation of diurnal rhythms of the biogenic amines contents, GnRH and ROS in the studied hypothalamic structures can be used for an assessment of disturbances of central mechanisms of regulation of reproduction that are caused by other neurotoxic compounds or developed in some diseases and in aging when the functional activity of the pineal gland is altered. The data obtained testify to possible negative side effects of melatonin on hypothalamic regulation of reproduction in therapeutic use of the hormone. The effects of melatonin realized via its receptors are known to highly depend on amplitude of its nocturnal surge and on duration of its increased blood level during a day. Therefore administration of melatonin on the background of its normal synthesis can lead to a number of negative effects due to its increased blood level when compared to its physiological level. Elucidation of the exogenous melatonin caused disturbance of the studied diurnal rhythms of central regulation of reproduction is of great practical use in development of prophylactics helping to eliminate or decrease an effect of damaging factors in unfavourable environmental conditions.
Neurology of a fetus - opportunity and prospect of research
Abstract
The article presents literary review about fetal CNS development and its disorders, own investigation results of pathogenesis, diagnostic methods of fetal neurological disorders in different obstetrical and extragenital pathology in pregnant women.
Original Research
Risk factors of genital-urinary infection in women
Abstract
The article represents the data of screening carried out on 905 women attended the outpatient departments of gynecologic clinics of Saint Petersburg and Leningrad region.
Infectious diseases of genital-urinary system were diagnosed in 65.5% of the women, 53.5% having asymptomatic course, which must be important in epidemiological respect. Risk factors and characteristic symptoms of the diseases were taken into account while analyzing the questionnaires. The valuable risk factors were young age, early debut of sexual intercourse and occasional sexual contacts, the history of STI as well as the pregnancy.
Femoston 1/5 as a preparation continuous combined hormonotherapy in pre- and postmenopausal patients
Abstract
The paper presents the results of a study of a low-dose drug for continuous HRT - Femoston 1/5. The drug quite effectively eliminates (reduces) psychoemotional and vegetative-vascular symptoms of peri- and postmenopause, eases the course of hypertension, does not affect body weight gain, actually does not cause breakthrough bleeding, growth of myomatous nodes, does not affect the size of the uterus and the thickness of the endometrium (within a year reception). Taking the drug is accompanied by positive dynamics of the level of glycemia, high and low density lipoproteins, the degree of aggregation and intravascular activation of platelets, which improves the state of peripheral blood flow.
The presented data allow us to recommend Femoston 1/5 as a means of HRT for postmenopausal and perimenopausal patients with concomitant uterine myoma and endometriosis.
Experience of use indivina for treatment of climacteric syndrome in postmenopausal patients
Abstract
The paper clarified the effectiveness of a monophasic estrogen-progestogen preparation of an individual with an individual selection of dosages for the treatment of climacteric syndrome in postmenopausal women. All observed had a good effect of therapy and good tolerability of the drug.
Lectures
Estimation of a functional condition of a fetus at pregnancy and in delivery
Abstract
The lecture provides information on approaches to the assessment of fetal cardiotocography during pregnancy and childbirth. Assessment of the functional state of the fetus during pregnancy and childbirth remains one of the most difficult tasks of perinatology and obstetrics. The question of the state of the intrauterine fetus has been of interest to obstetricians for a long time. For the first time, the possibility of auscultation of fetal heart sounds was reported in 1818.
Changes of lipids exchange in the postmenopausal women
Abstract
The results of large studies have shown that women with the onset of menopause significantly increase the risk of developing cardiovascular disease.
This is associated with the loss of the cardioprotective effect of estrogens and the formation of the so-called menopausal metabolic syndrome, which includes changes in the metabolism of lipids and lipoproteins, insulin and carbohydrates, as well as hemostasis and fibrinolysis. Simultaneous shutdown of ovarian function in women of reproductive age after total oophorectomy causes the early development of delayed climacteric disorders, including cardiovascular diseases. Timely administration of hormone replacement therapy can prevent the development of adverse metabolic changes and reduce cardiovascular risk.
Reviews
Obstetrical hemorrhages (tactics, principles of infusion/transfusion therapy)
Abstract
The haemorrhage continues to be the most serious problem in obstetrical practice. The modern arsenal of means for prevention and therapy of obstetrical bleeding, organization and subsequence of emergency care in maternity departments allowed to decrease the common amount of haemmorage in intrapartum and postpartum periods. However, the full prevention of poor pregnancy and delivery outcomes is still not achieved. Two main factors determine the mortality level in obstetrical bleeding: late non-adequate haemostasis and incorrect infusional-transfusional therapy. The article is devoted to clinical management of haemorrage in preterm placenta abruption, uterine rupture, anomalies of placenta attachment and placement, uterine hypotony, and principles of infusional-transfusional therapy.
Pregnancy-associated papp-a / prombp protein complex. Physicochemical properties, molecular structure and physiological role
Abstract
Presented review is a accumulation of published data concerning discovery and investigations of pregnancyassociated protein complex PAPP-A/proMBR. Pregnancy-associated protein complex PAPP-A/proMBR belongs to pregnancy- associated protein sensu stricto but not to pregnancy specific. It is produced mainly into maternal blood circulation in the course of gestation. Certain experimental investigations suggested circulated complex PAPP-A/pro MBR to have a double origin: trophblastic and endometrial one. Nowadays molecular structure of monomers and subunits and amino-acid sequence is almost fully investigated. In spite of plentful information concerting structure and chemical properties the mechanisms of interaction with maternal immune system is not clear. Digest of available data suggested РАРР-А/ proMBR to play a rile in immunomodulation during pregnancy.
Pathological preliminary period
Abstract
Pathological preliminary period (PPP) is represented real obstetric problem, patogenesis with which up to the end stay not clear. In study of features of its occurrence and current the opportunity of a prediction serious pathology in labour (anomaly of patrimonial activity, hypoxia of a fetus etc.). Distinguish hypotonic variant PPP, at which activate fasic a component of uterus contraction, and the hypertonic variant, at which characteristic increase tonus of myometrium. At any variant similar pathology requires treatment, for what is made regularize contructionf activity of the uterus by tocolitical preparations, are arranged for the accelerated maturing cervix (prostoglandins of group E), is normalized a psyxo-somatic condition of the pregnant women (medicine dream, fysiotherapy). It is necessary to carry out a dynamic estimation uteroplacentaly hemodinamics and condition of a fetus. In case of long current PPP (more than 5 day) and unsuccessful of medical measures is recommended labor by operation section of cesarea. The further study of problems of occurrence and current PPP with attraction of modern diagnostic techniques is required, that will allow prediction of complication in labour.
History page
Work of leningrad obstetricians and gynecologists within great domestic war and blockade of city
Abstract
In the 300-year history of our city, 900 days of the Leningrad blockade were and will remain for centuries in the memory of the people. “The war could not but affect all aspects of life, even in the most remote areas from the front in our country. But its influence on the life of Leningrad is especially great because the population of our city experienced in these months not only the hardships of wartime, but also all the consequences of a severe blockade "
Scientific activity
Information about dissertations in obstetrics and gynecology, defended in the dissertation council D 215.002.05 (Military Medical Academy) in 2001-2002
Abstract
The Dissertation Council is allowed to accept dissertations in the specialty 14.00.01 for defense. - obstetrics and gynecology and 14.00.40 - urology.
For the period 2001-2002. The Council reviewed 4 doctoral and 15 master's theses. Of these, in obstetrics and gynecology: 3 - doctoral and 8 - master's theses.
Information
Greetings to the participants of the International Congress "Environment and Perinatal Medicine"
Abstract
From June 29 to July 2, 2003 in the Northern capital of Russia within the framework of the International Ecological Forum "Environment and Human Health" the International Congress "Environment and Perinatal Medicine" will take place.
The contribution of St. Petersburg scientists to the development of domestic obstetrics, gynecology and perinatology is generally recognized. St. Petersburg is associated with the beginning of training midwives in Russia (1757), the first scientific obstetric-gynecological society in Russia was created here (1866), and the Journal of Obstetrics and Women's Diseases began to be published (1887).