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Reproductive health and hormonal status of women with polycystic ovary syndrome
to Fung E. B. [1], 2010, the maj ority of adult patients with thalassemia had healthy body composition with rare obesity, young, non-transfused patients appear at risk for being underweight. Findings of Fung E. B. [2], 2012 study suggest that vibration therapy may be an effective non-pharmacologic intervention in Thal. According to Valizadeh N. [3], 2014 patients with all type thalassemia and hemoglobin H disease in age of higher than 8 year old should: Perform annual BMD and Treat low BMD with different medications (administration ofbisphosphonate, calcium and vitamin D supplements). Medical consultation
with a rheumatologist and/or an endocrinologist should be performed in these patients. Adequate calcium containing foods, avoiding heavy activities, stop smoking, iron chelation therapy in adequate dosage, early diagnosis and treatment of endocrine insufficiency and regular blood transfusions can help to achieve an optimal bone density in these patients. Changing lifestyle with mild daily exercise,
Further research is needed to identify: Risk factors, means of prevention and also to establish specific PA engagment guidelines and recomandations for this social category.
References:
1. Fung Ellen B., Xu Yan, Kwiatkowski Janet, Vogiatzi Maria G., Neufeld Ellis, Olivieri Nancy, Vichinsky Elliott P., Giardina Patricia J. , and Thalassemia Clinical Research Network.//J Pediatr. - 2010, October. - 157 (4): 641-647. - e2. doi:10.1016/j. jpeds.2010.04.064.
2. Fung Ellen B. , Gariepy Catherine A. , Sawyer Aenor J. , Higa Annie, and Vichinsky Elliott P. The effect of whole body vibration therapy on bone density in patients with thalassemia: A pilot study.//American Journal of Hematology. - Published online 28 June 2012 in Wiley Online Library//[Electronic resource]. - Available from: htpp://wileyonlinelibrary.com. -DOI: 10.1002/ajh.23305
3. Valizadeh N. M., Farrokhi F., Alinej ad V., Said Mardani S. M., Valizadeh N., Hej azi S., Noroozi M. Bone density in transfusion dependent thalassemia patients in Urmia, Iran.//Iranian Journal of Pediatric Hematology Oncology. - Vol 4. - No 2. - 2014.
4. Vincent L., Feasson L., Oyono-Enguelle S., Banimbek V., Monchanin G., Dohbobga M., Wouassi D., Martin C., Gozal D., Geyssant A., Thiriet P., Denis C., Messonnier L. Skeletal muscle structural and energetic characteristics in subjects with sickle cell trait, -thalassemia, or dual hemoglobinopathy.//J Appl Physiol. - 2010. - 109: 728-734.
5. Hamidieh A. A., Hamidi Z., Nedaeifard L., Heshmat R., Alimoghaddam K., Larijani B., Ghavamzadeh A., Mohajeri-Teh-rani M. R. Changes of Bone Density in Pediatric Patients with ^-thalassemia Major after Allogenic Hematopoietic Stem Cell Transplantation.//Arch Iran Med. - 2013. - 16 (2): 88-92.
6. Karimi M., Fotouhi Ghiam A., Hashemi A., Alinejad S., Soweid M., Kashef S. Bone mineral density in betathalassemia major and intermedia.//Indian Pediatr. - 2007. - 44 (1): 29-32.
7. Schundeln M. M., Goretzki S. C., Hauffa P. K., Wieland R., Bauer J., et al. Impairment of Bone Health in Pediatric Patients with Hemolytic Anemia. - 2014. - PLoS ONE 9 (10): e108400. doi:10.1371/journal. pone. 0108400.
8. Trikas A., Tentolouris K., Katsimaklis G., Antoniou J., Stefanadis C., Toutouzas P. Exercise capacity in patients with Bthal-assemia major: relation to left ventricular and atrial size and function.//Am Heart J. - 1998. - 136: 988-990.
9. World Bank 2006, report of a joint WHO-March of Dimes meeting. - 2006.
Gulammakhmudova Dilobar Valijanovna, Republican specialized scientific-practice medical center of obstetrics and gynecology, Tashkent, Uzbekistan, scientific explorer E-mail: dilobar.gulommahmudova@mail.ru
Reproductive health and hormonal status of women with polycystic ovary syndrome
Abstract: In this work there have studied reproductive health, also features of reproductive and hormonal disturbances at polycystosys ovarian syndrome (POS) among of women at the active reproductive age, which belongs to the uzbek population.
Keywords: ovarian polycystosys, reproductive health, hyperandrogenia.
Actuality. Nowadays problem of population’s reproductive health protection takes one of the first places in the laws and politics of modern progressive society and is one of the priority directions in the Republic of Uzbekistan. One of the most frequent causes of reproductive function
violations of women of fertile age is polycystic ovary syndrome (POS) [1; 5; 6; 7]. Therefore, this pathology is under close attention of doctors in various countries and in our Republic as well. Along with that clinical practice dictates the need to assist the patients suffering from POS and help them
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Section 8. Medical science
in solving problems, the main of which, undoubtedly, is the infertility [2; 3; 4]. Moreover, menstrual disorders increased hair growth, acne, and overweight are symptoms that can be present in various combinations in all patients with POS and require treatment. Unfortunately, the quality of life and health status of women with POS has not been adequately studied.
Aim. Aim of this work is studying of regional features, structure and clinical course of POS and its effect on the reproductive health of women of childbearing age.
Materials and methods. The objects of the study were 104 women of reproductive age with POS of ovarian and extraovarian origin. A comprehensive study of the anthropometric data included measurement of growth, weight, calculation of body mass index, measurement of the waist size, hip size, and body type determination. During the investigation we use specially developed protocols for patients with POS and scales recommended for use in clinical practice (modified Ferriman-Gallwey’s scale). Ultrasound examination of small pelvis has been carried out on the “Interscan-250” device. The MRI of the brain and adrenal glands has been carried out for cause. Also determining of the level of gonadotropic
hormones (FSH, LH, PRL) estradiol, testosterone, DHEA, 17-pregnenoldione, cortisol, TSH, T3, T4 on the 3rd and 6th days of the menstrual cycle in the serum with the help of EIA using the Multiscan PLUS device have been carried out. The blood sampling has been conducted in the morning on an empty stomach from the cubital vein. The functional probes with dexamethasone (low dexametasona test): 4 mg/day for 4 days has been carried out for cause.
Study results. Analysis of the POS clinical features of women of active fertile age has been carried out in two clinical groups: patients with ovarian hyperandrogenism (HAGS POS) and patients with extraovarian forms of hyperandrogenism (HAGS SPOS). The reproductive health anamnestic data analysis revealed that women with various forms of POS have almost identical age of menarche. Meanwhile gynecological morbidity in patients with HAGS regardless of the form of the disease is almost three times higher in comparison with the control group.
Patients with HAGS several times more likely suffer from primary and secondary infertility of hormonal etiology recurrent miscarriages, and dysfunctional uterine bleeding.
Table 1. - Features of gynecological history of women of fertile age with POS in a comparative aspect
Parameters HAGS, SPOS n = 44 HAGS, POS n = 60 Control group n = 40
Menarche age (years) 13.4 ± 0.1 13.6 ± 0.39 13.0 ± 0.37
Gynecological history burdeness ( %)
Is not burdened 18.18 ± 1.1* 21.43 ± 1.6* 60 ± 4.1
Secondary sterility 18.2 ± 1.1* 14.5 ± 1.2* 5 ± 0.4
Primary sterility 11.4 ± 1.0* 35.71 ± 2.6* 2.5 ± 0.2
Not developing pregnancy 9.1 ± 1.2* 14.29 ± 1.2* 2.5 ± 0.2
Spontaneous abortion 18.6 ± 1.6* 7.14 ± 3.5 12.5 ± 0.8
Note: * — reliability of data in comparison with the control group (* — P < 0.05)
Anthropometric differences have been observed among women with ovarian hyperandrogenism: there are significantly important differences in weight, BMI, circumferences of waist and hips. Women with POS in 42 % of cases were overweight or obese with predominant adipopexia in the abdominal area.
Generalized anthropometric parameters of women with extraovarian HAGS forms were similar to those of women from the control group. Noteworthy is the fact that more than half of overweight women associate their overweight with COC (that have been taken for treatment) or with pregnancy.
As demonstrated data in table 2 parameters of weight and growth have differences both with the control group and with compared with clinical group, in patients with POS. Femoral obesity type has been observed in 14.29 % of cases, and abdominal type — in 14.29 % of cases. Striae were more likely have been expressed in patients with extraovarian hyperandrogenism forms, that can be explained by increased adrenal glands activity. Every fifth patient with POS had dark spots. This symptom is a clinical manifestation of insulin resistance, in patients with extraovarian hyperandrogenism forms this symptom has not been observed. Acne vulgaris with equal frequency have
been observed of women from both clinical groups average in 3.5 times more often compared with the control group.
Performed hormonal studies revealed the hyperandrogenic states structure in young women. It has been revealed that ofwomen of active fertile age ovarian hyperandrogenism predominate (65.9 % of cases). Adrenal and/or mixed hyperandrogenism have been revealed in 5.6 % of cases.
Hyperandrogenemia caused by total testosterone level increasing has been revealed in 72.5 % of surveyed women. Herewith analysis of generalized parameters revealed statistically significant increase of these parameters in patients from both clinical groups (table 3).
The DHEA serum concentration in patients with extraovarian hyperandrogenism forms was significantly higher relative to the control group whereas in patients with POS this parameter does not differ from the control group. Women had the estradiol concentration almost identical to the control group, and hyperandrogen ovarian failure was typical for SPOS.
Averaged prolactin level of women with SPOS was two times higher than in control group which is probably can be associated with higher hyperprolactinemia prevalence in active fertile age.
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Reproductive health and hormonal status of women with polycystic ovary syndrome
Table 2. - Parameters of body type and menstrual cycle type among women of reproductive ages in a comparative aspect
Parameters Control group n = 40 HAGS, POS n = 60 HAGS, SPOS n = 44
Bodytype N 90 ± 4.9 57.14 ± 4.7 90.91 ± 4.9
Obesity 0 21.43 ± 5.4 0
Overweight 10 ± 4.9 21.43 ± 5.4 9.09 ± 4.9
Obesity type No 90 ± 1.9 57.14 ± 3.2 81.82
«Apple» 0 14.29 ± 1.3 0
«Pear» 0 14.29 ± 1.3 0
Mixed 0 0 9.09 ± 4.9
Menses Type Regular 90 42.86 ± 4.9* 54.55 ± 6.2*
Irregular 10 ± 4.9 57.14 ± 5.2* 45.45 ± 6.1*
Striae Present 10 ± 4.9 14.29 ± 4.3 45.45 ± 6.1*
Absent 90 85.71 ± 5.3 54.55 ± 6.2
Black spots Absent 90 ± 4.9 78.57 ± 5.2 81.82 ± 5.7
Present 10 ± 4.9 21.43 ± 2.4 0
Acne vulgaris Absent 90 ± 4.9 64.29 54.55 ± 6.2
Present 10 ± 4.9 35.71 ± 5.6** 36.36 ± 3.7**
Note: * — reliability of data in comparison with the control group and л — reliability of data between HAGS groups (* — Р < 0.05; ** — Р < 0.01; л — Р < 0.05)
Table 3. - The hormonal status in surveyed women of fertile age with POS in a comparative aspect (n = 144)
Parameters HAGS, SPOS n = 44 HAGS, POS n = 60 Control group n = 40
LH 9.93 ± 0.76** 11.77 ± 2.52** 4.69 ± 0.84
FSH 7.4 ± 5.46 8.71 ± 1.32 7.51 ± 0.68
Е2 26.66 ± 5.46* 71.44 ± 10.69л 75.81 ± 4.50
PRL 35.83 ± 2.66* 17.24 ± 3.53л 12.98 ± 2.16
Т 1.27 ± 0.27* 1.26 ± 0.17* 0.50 ± 0.02
DHEA-S 2.92 ± 0.59** 1.88 ± 0.29 1.29 ± 0.18
К 533.9 ± 123.95* 203.65 ± 76.64л 172.2 ± 20.54
TSH 1.73 ± 0.19** 2.15 ± 0.53*л 3.11 ± 0.36
insulin 8.35 ± 0.02** 5.72 ± 0.85**,лл 13.51 ± 0.52
Note: * — reliability of data in comparison with the control group and л — reliability of data between HAGS groups (* — Р < 0.05; ** — Р < 0.01; л — Р < 0.05; лл — Р < 0.01)
The low concentrations of insulin in patients with POS compared both with the control group and with the clinical group is noteworthy.
Conclusion. Thus, POS is the most common cause of reproductive health disorders of women of active fertile age, which caused increasing of frequency of primary and secondary infertility of hormonal etiology, miscarriage, dysfunctional
uterine bleeding, which are based on the menstrual cycle disorders, and such hormonal disorders as hyperandrogenism. Therefore, hormonal disorders in young women mainly can be characterized by hyperandrogenism, ovarian hyperandrogenism predominates hyperandrogenic states structure (in 65.9 % of cases). It has been identified that hyperandrogenism frequency caused by total testosterone level increasing reach 72.5 %.
References:
1. Dedova I. I., Melnichenko G. A. Polycystic ovary syndrome: Guidelines for practitioners/Edited. - М.: «Medical information agency» Ltd, 2007. - Р. 386.
2. Dedov I. I., Melnichenko G. A., Fadeev VV Endocrinology: Textbook. - Moscow: Medicine, 2000. - Р. 632.
3. Manuchin I. B., Gevorkian M. A. Polycystic ovary syndrome. - М., 2004.
4. Shilin D. E. Polycystic ovary syndrome. International diagnostic consensus (2003) and ideology of modern therapy.//Con-silium-medicum. - Volume 06. - No. 9. - 2004.
5. The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group.//Hum Reproduct, 2004. - 19: 41 -7, -FertilSteril 2004. - 81: 19-25.
6. The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group* March 2-3, 2007, Thessaloniki, Greece.
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7. Polycystic ovary syndrome and pregnancy./Sir-Petermann T., Ladr n de Guevara A., Villarroel A. C., Preisler J., Echibur B., Recabarren S. - 2012.
8. Polycystic ovary syndrome: physiopathology review./Fux Otta C., Fiol de Cuneo M., Szafryk de Mereshian P./Rev Fac Cien Med Univ Nac Cordoba. - 2013. - 70 (l):27-30.
Dauletova Mexriban Jarilkasinovna, Republican specialized scientific-practice medical center of obstetrics and gynecology, Tashkent, Uzbekistan, scientific explorer E-mail: mexriban85@mail.ru
Analysis of maternal intracardiac hemodynamics and fetoplacental blood flow in women with myocarditis
Abstract: In purpose of to estimate of the central hemodynamics and feto-placentary complex condition at pregnant with myocarditis 128 pregnant with myocarditis aged about 17-40 years were studied. Received results are shown, that at 68.5 % women with myocarditis the strike fraction (SF) was increased (> 70 %). At women with high SF (SF >70 %) in 64 % cases there are revealed failure of blood groove in uterine arteries, in 18 % cases — failure in placental blood groove and in 12 % cases failure of maternal-placentary blood groove.
Keywords: myocarditis, pregnant, hemodynamics, systolic myocardial dysfunction.
Introduction
Diseases of the cardiovascular system in pregnant women predominate among extragenital pathology [1; 2; 4]. They account for more than 60 % of all internal organs diseases. They are one of the leading causes of maternal and perinatal mortality, cause serious complications and lead to women invalidization [1; 2; 6; 7]. Percentage of cardiac diseases in the maternal mortality structure is from 5 to 32 %, and in the perinatal mortality structure is 4.3 to 25 % [3; 6; 7]. Statistical data of results of the maternal mortality in the United States analysis showed that gestational cardiomyopathy takes a leading position in the cardiovascular pathology structure [3; 5], and more than half of the cases occur in myocarditis.
American literature indicates that cardiomyopathy leads to the risk of maternal mortality development in 15-60 % of cases [1; 3; 6]. The analysis of maternal mortality for the last 5 years in the Republic of Uzbekistan confirmed the data of the leading scientists of the world that requires paying close attention in pregnant women.
Experts from around the world share a common opinion that the true percentage of myocarditis is not determined due to a number of reasons:
- Misconception in myocarditis diagnostics;
- Absence of pathognomonic complaints and typical objective data;
- Features of the latent period, and also that fact that histological and instrumental methods of examination, which can verify inflammatory lesion of the myocardium, are unavailable for broad audience of practicing physicians [6; 7]. Moreover, difficulties in the myocarditis diagnostics in pregnant women are associated with physiological changes in the cardiovascular system, which occur during gestation.
Aforesaid indicates the relevance of myocarditis in pregnant women.
Assessment of central maternal hemodynamics in case of myocarditis and state of placentofetal blood flow in this disease could disclose new aspects of the pathogenesis of obstetric and perinatal complications in women with this pathology.
Aim
Assessment of central maternal hemodynamics and state of placentofetal blood flow in pregnant women with postinfluenzal myocarditis.
Materials and methods
We studied 128 pregnant women with myocarditis which have turned to the consultative polyclinics of the Republican specialized scientific-practical medical center of obstetrics and gynecology (RSSPMCOG Tashkent, Uzbekistan). The age of pregnant women ranged from 17 to 40 years.
The inclusion criterion was the presence of the postinfluenzal myocarditis in pregnant women. Exclusion criteria were presence of rheumatic myocarditis, organic diseases of the heart and blood vessels and symptomatic hypertensions.
The study was carried out in 2 stages: 1st stage consisted of the hemodynamic changes features on the background of myocarditis in different age periods analysis; 2nd stage of our research consisted in a comparative study of the influence of the degree of contractile function of the left ventricle violation on the placentofetal blood flow. In this connection we choose the ejection fraction evaluated with the help of echocardiography as the main parameter, which would characterize the contractile function of the myocardium. Therefore, at this stage, the patients were divided taking into account values of ejection fraction. The values of ejection fraction from 55 to 70 % have been considered as normal parameters.
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