The aim: To determine the association between the Glu298Asp (G894T) polymorphisms of the eNOS gene with metabolic disorders in excessive gestational weight gain (GWG) pregnancy. Materials and methods: 97 pregnant women in 9-12, and 37-39 weeks of gestation were examined. The recommended GWG was diagnosed in 33 (34.0 %), insufficient in 19 (19.6 %), and excessive in 45 (46.4 %) patients. Genetic variants of eNOS were analyzed by real-time polymerase chain reaction, lipid profile, and carbohydrate status were performed. The results were statistically analyzed using Statistica 6.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. Results: GWG in the group of patients with gene eNOS TT polymorphism was significantly higher (1.5-fold) compared to pregnant with GG – genotype (р<0.05). Pregnant, inherited the TT allele of the eNOS gene, associated with higher levels of hypertriglyceridemia, hypercholesterolemia, of lipoprotein low density, glycemia, hyperinsulinemia, and higher HOMA–IR compared to carriers of GG and GT alleles (р<0.05) in the third trimester, which is especially manifested in excessive GWG. Conclusions: Decreased activity of the eNOS gene in the presence of pathological alleles is the initiator of impaired lipid and carbohydrate metabolisms and, as a consequence, excessive GWG. A high risk of excessive GWG was found in pregnant women with TT polymorphism Glu298Asp (G894T) (OR=4.52; 95%CI: 1.18-17.32; р<0.05) (frequency distribution of 73.7 %). Endothelial dysfunction is a pathogenetic link of excessive body weigh in pregnancy.

Objectives: to investigate the hormonal and genetic determinants of the poor response to controlled ovarian stimulation (COS) in women of late reproductive age.Materials and methods. 130 patients from assisted reproductive technology programs were examined. The main group of 80 older reproductive aged patients (35 years and older) was divided into 2 subgroups according to the POSEIDON criteria. Subgroup 1 included 34 women with a predicted poor response to COS, subgroup 2 – 46 patients with a predicted normal response to COS. The comparison group consisted of 50 patients under the age of 35 with a predicted normal response to COS.The pituitary hormones (luteinizing, follicle-stimulating hormones, prolactin), steroid hormones (testosterone, estradiol, progesterone), cortisol, anti-Mullerian hormone (AMH) and inhibin B values was determined in blood serum by the ELISA. Blood was taken on the third day of the menstrual cycle. A molecular genetic study of FSHR gene polymorphism (Ala307Thr, Ser680Asn) was performed.Results. AMH decrease, estradiol increase and inhibin B decrease in potentially poor responders to COS may be an additional indication of reduced ovarian reserve. The level of follicle-stimulating hormone increases with age, but does not have high specificity as a marker of ovarian reserve. Elevated levels of cortisol emphasize its role in reproduction and correspond to increased stress value. The effectiveness of IVF if there were 4 or more mature oocytes obtained is associated with higher levels of AMH and inhibin B, and lower estradiol and cortisol values. The multifaceted dependence of the COC effectiveness in women of older reproductive age on the parameters of the hormonal profile, confirmed by correlation analysis, reflects the complexity of the reproductive function implementation with the use of auxiliary reproductive technologies in such patients. The combination of AA/SS genotypes for the Thr307Ala and Asn680Ser polymorphisms of the FSHR gene can be an additional marker of COC inefficiency.Conclusions. Determination of the hormones levels (inhibin B, estradiol and cortisol), the study of Thr307Ala and Asn680Ser polymorphisms of the FSHR gene can provide additional information for predicting the response to COS in women of older reproductive age.

Objective of the study: improvement of diagnostic methods for pregnant women with tumor-like formations and ovarian tumors.Materials and methods. 60 pregnant women were examined and divided into 3 groups: group I – 28 pregnant women with ovarian tumors who underwent surgical treatment during pregnancy; group II – 21 women with ovarian tumors who underwent surgical treatment at various times after spontaneous delivery; group III (control) – 11 women with a normal course of pregnancy without ovarian tumors.Doppler ultrasound was performed on a mandatory basis at the screening time, and as well as needed. MRI was performed in 8 diagnostically difficult cases. In the II trimester of pregnancy at 12–24 weeks in 49 women with ovarian tumors tumor markers were determined: CA-125, HE-4, β2-microglobulin, transthyretin, transferrin and apolipoprotein A-I, and combined ROMA and RMI indices.Results. The analysis showed the characteristic echographic signs of most ovarian tumors in pregnant women. The overall accuracy of ultrasound in determining the ovarian tumor structure at the outpatient level was extremely low and amounted to 21.8%, in a specialized medical institution it was 79.2%. In the diagnosis of mature teratomas were found MRI sensitivity and specificity of 100%, less diagnostic value (sensitivity 91.7%, specificity 96.9%) was typical for endometrioid ovarian cysts. MRI efficiency in detecting malignant potential (borderline and malignant tumors) was quite high (sensitivity 80.0%, specificity 97.4%).The presence of any ovarian tumor, except for mature teratomas, was accompanied by a significant increase in CA-125 level. The strongest correlation was found for RMI index and CA-125 and HE-4 tumor markers.Conclusions. Doppler ultrasound and MRI are complementary highly informative methods for diagnosing ovarian tumors in pregnant women. Tumor markers used for the differential diagnosis of benign and malignant tumors outside pregnancy (CA-125, HE-4, apolipoprotein A-I, transferrin, transthyretin, β2-microglobulin) do not have a high enough diagnostic value in ovarian tumors in pregnant women, therefore their tests should be supportive.

Nowadays, women’s reproductive health is a topical issue of obstetrics and gynecology, therefore, great importance is attributed to timely diagnosis and prevention of diseases that influence fertility. The topicality of the issue of uterine hyperplasia, in particular, uterine fibroids, is accounted for by the social significance of the disease. Its incidence rate is constantly growing and makes up from 30 to 50% in women older than 35 years and, according to the data of autopsy, - up to 80%. No doubt, the peculiarities of development and progression of hyperplasia are determined by the reserve potential of various systems and organs, including the hepatobiliary system.The aim of research is to analyze the results of instrumental examinations of the functional capacity of hepatocytes in women affected by uterine fibroids and functional disorders of the hepatobiliary system. Research materials and methods. To accomplish the set objective, we used the following contemporary instrumental examination methods: ultrasonography and rheovasohepatography as well as a clinical and paraclinical analysis of caserecords of 150 women aged between 35 and 45 and affected by uterine fibroids, who were treated at the gynecological department of the Regional Perinatal Centre.Research results. As the research result show, uterine fibroids and the related hormonal disorders often go together with functional and morphological lesion of hepatocytes. Patients affected by uterine fibroids have preconditions for the development of functional disorders of hepatocytes as they present significant disorders of hepatic hemodynamics, decreased blood supply of the liver, as a result of pre- and postcapillary resistance.Conclusions. There is a close connection between uterine fibroids with concomitant hepatobiliary disorders and the severity of hormonal disorders, and the significant lesion of hepatocytes may be irreversible. Thisrequires pathogenetic correction by introducing drugs with hepatoprotective and antioxidant effects.

Intrahepatic cholestasis of pregnancy (idiopathic jaundice of pregnancy, recurrent familial jaundice of pregnancy) is a benign familial disease manifesting itself in the gestational period in itching and (or) jaundice. As a rule, the disease is observed in the 3rd trimester of pregnancy, that is in the 28th-30th week, and may disappear by itself a few days after labor and recur during future pregnancies.The aim of this research is to study the role and factors of vascular homeostasis regulation in women with infertility treated with assisted reproductive technologies (ART) and with concomitant intrahepatic cholestasis. Intrahepatic cholestasis is characterized by the damage of endothelial cells of hepatic sinusoids, changes in the intrahepatic hemodynamics, increased production of cytokines and free radicals. The processes of angiogenesis in the liver are also closely connected with the functional capacity of endothelium. The L-arginine level in blood was measured using the photometric method based. The homocysteine level was measured by the enzymatic cycling method. To measure the level of placental growth factor (PGF) in blood plasma samples, we used the immunochemical method.The research has found especially severe complications in the course of pregnancy after ART in those women with intrahepatic cholestasis whose placentas developed under the conditions of endothelial dysfunction from the very beginning of pregnancy.So, these factors may be early prognostic markers of severe obstetrical and perinatal disorders in women with induced pregnancy and hepatobiliary disorders.