Vol 2, No 1 (2015)

The development of accessory reproductive technologies led to an increase in the incidence of plural pregnancies, including cases with monochorial twins. A specific feature of monochorial gestation is the formation of shunts between the circulation systems of the two fetuses. The resultant interfetal hemotransfusion can lead to the development of the feto-fetal hemotransfusion syndrome (FFHTS). Analysis of published data on the epidemiology, early diagnosis, and treatment of FFHTS indicates that the syndrome develops in 5-15% of monochorial twins at <32 weeks of gestation. The mortality in untreated cases reaches 80-90%. Te main diagnostic methods are ultrasonography, dopplerography, and magnetic imaging. The therapies used most often are amnion reduction and selective laser photocoagulation of vascular anastomoses. The survival of at least one of the fetuses after therapy is 85-92%, of both fetuses 44-70%. In cases with postoperative complications the survival reduces to 29-88% for one and 0-58% for both fetuses. Hence, poor survival parameters necessitate the development of new diagnostic and therapeutic methods for timely detection of the syndrome and elimination of its causes.

Beta-lactamase activities were measured in the amniotic fluid and serum of pregnant women. The relationship between the parameters was analyzed and the clinical significance of biological resistance to beta-lactam antibiotics in this patient population was evaluated. A total of 40 women were distributed into groups by the following parameters: pregnancy (pregnant/nonpregnant), gestation term, and inflammatory process (present/not). Serum beta-lactamase activity was measured by the Biolactam test system. All patients exhibited beta-lactamase activities in the amniotic fluid and serum. High level of the blood beta-lactamase activity is a factor preventing effective therapy by beta-lactam antibiotics. Hence, evaluation of biological resistance to beta-lactam antibiotics before therapy prevents their unjustified prescription and improves the treatment efficiency.

The study was carried out in 151 women aged 35-47 years with uterine myomas of different location in the myomatous nodes (the exception were subserous myomatous nodules on a thin base), clinically manifesting by profuse menses and pain, with normal hormonal profiles. Patients with unrealized reproductive function were excluded from the study. The ovarian function and ovarian reserve after embolization of the uterine arteries (EUA) were evaluated by the levels of antimuller hormone (AMH), inhibin B, FSH, LH, estradiol, and progesterone. Positive results were attained in 82.4% cases. Menorrhea became less painful in 69.2% cases and less intense in 74.9%, the cycle normalized in 42.9%. Pain reduced or completely regressed in 63.4% cases, urination improved in 41.7%, defecation in 38.6%. Hormone measurements were carried out in 66 women 6 and 12 months after EUA. The levels of AMH and inhibin B were low after 6 months in 37 (24.7%) and 55 (36.4%) patients, respectively, which indicated reduction of the ovarian reserve. The women’s ages varied from 41 to 47. The levels of AMH normalized 12 months after EUA in two women, aged 42 and 44 years. The levels of inhibin B remained critical under conditions of a regular cycle. The levels of FSH and LH were high 6 months after EUA in 14 (9.3%) and 9 (6%) patients, respectively. The age of these patients was 44-47 years. These patients had high levels of estradiol (12-16% higher than normally) and progesterone (8-11% higher than normally). The patients complained of hot flushes, irritability, and liable to change of moods. The cycle was irregular in only 4 women. The hormonal profile normalized after 12 months in 6 patients, menopause ensued in 5 women. These results indicated the efficiency and safety of EUA as a method for the treatment of uterine myoma. Importantly that EUA was an organ-sparing method, preventing the disease relapses. However, EUA modulated the ovarian reserve and hence, reduced the fertility. Spontaneous pregnancy was hardly probable after this treatment, more likely as a result of accessory reproductive technologies. This fact should be decisive in choice of the treatment strategy for patients with uterine myoma, planning pregnancy in future.

A clinical case is presented and the hemostasis system in women is analyzed from the conclusive medicine viewpoint. The authors suggest a formulation of the specific strategy of anticlotting therapy in postmenopausal patients with atrialfibrillation.