Gynecology

 

About

Gynecology is the peer-review journal dedicated to providing the very latest information in clinical and research fields related to a wide range of topics in obstetrics, gynecology and women’s health. 

The journal publishes editorial conference updates, original research, reviews, clinical case reports, commentaries, clinical and laboratory observations by Russian and international authors, pertinent to readers in CIS countries and around the world.

The Journal emphasizes vigorous peer-reviewing and accepts papers in Russian and English with most rapid turnaround time possible from submission to publication. Abstracts for all papers are available in both languages.

It has served the interests of gynecologists, endocrinologists and all other professionals in gynecology and women's health by providing on bimonthly basis clinical information and practical recommendations to various aspects in the field of women's health. 

Special area focus/ journal sections:

  • Inflammatory diseases of the pelvic organs
  • Endometriosis
  • Contraception
  • Pregnancy failure
  • Hysteromyoma
  • Current methods of diagnosis and treatment

The journal welcomes papers both from researcher and clinical gynecologist, endocrinologist and pharmacologist from all around the globe to deliver up-to-date and authoritative coverage of leading research and clinical practice relevant to specialists in CIS and other countries. 

 

Publications

Bimonthly issues publish since 1999 in print and online in Open Access under the Creative Commons NC-SA 4.0 International Licensee.

 

Editor-in-Chief

Vera N.Prilepskaya
MD, PhD, Professor
ORCID: https://orcid.org/0000-0003-3993-7629

 

Indexation

  • SCOPUS
  • Russian Science Citation Index (RSCI) on Web of Science
  • Core Collection on e-library.ru
  • Directory of Open Access Journals (DOAJ)
  • Ulrich’s Periodicals Directory
  • Dimensions
  • WorldCat
  • EBSCO
  • VINITI Database RAS
  • ROAD

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Current Issue

Vol 24, No 6 (2022)

REVIEW

Endometriosis-associated pain and new therapeutic options: A review
Yarmolinskaya M.I., Beganova A.K., Revenko A.S.
Abstract

Pelvic pain is one of the most common and significant clinical symptoms of endometriosis. The complex pathogenesis and paradoxical nature of endometriosis-associated pain, its chronicity and centralization, a marked decrease in the quality of life of patients, the lack of an "ideal" and effective remedy with no limitation for all patients, as well as the progressive and recurrent nature of the disease are factors that determine the need for novel, additional therapeutic options. The pain mechanisms in endometriosis and the potential pathogenetic effects of trans-resveratrol and indole-3-carbinol on various aspects of endometriosis-associated pain are addressed based on the literature sources presented in electronic databases PubMed, CyberLeninka, and Google Scholar. The described pharmacological properties of the compounds suggest that the combined use of trans-resveratrol and indole-3-carbinol is a pathogenetically justified and promising treatment for complex endometriosis-associated pain.

Gynecology. 2022;24(6):444-450
pages 444-450 views
Predictors of late spontaneous miscarriage: new aspects of an old problem: A review
Rachenkova T.V., Dudareva Y.A.
Abstract

The main objective of this paper was to review the current studies that consider changes in concentrations of various biologically active substances at the local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. Many biological markers, such as proinflammatory cytokines (interleukins [IL-2β, IL-6, IL-10, IL-1β] and tumor necrosis factor α), are considered prognostic markers. Changes in their concentrations in various biological media (serum, cervical mucus, amniotic fluid) may indicate a cellular immunological imbalance in the "mother–placenta–fetus" system, which is often the main pathogenesis link of late spontaneous miscarriage. Changes in concentrations of fetoplacental complex hormones such as progesterone, estradiol, and human chorionic gonadotropin have also been described. The concentrations of hypoxia-induced factor HIF1a in amniotic fluid and exosomal HIF1a in patients with cervical incompetence as one of the most common causes of late spontaneous miscarriage are presented as markers. Thus, the review shows the role of changes in concentrations of various biologically active substances at local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. The following methodology was used during work on the article: selection of publications using modern information databases, analysis of the obtained information, systematization of materials, and presentation of conclusions. An electronic search was conducted using publications identified in the following databases: eLIBRARY.RU, Google Scholar, and PubMed.

Gynecology. 2022;24(6):451-457
pages 451-457 views
Estetrol: a new estrogen component in combined oral contraceptives: A review
Hamadyanova A.U., Tuhtaboev A.H., Shafieva V.A., Kolodyazhnaya E.A., Mansurova J.R., Muratova A.A., Andreeva A.A., Muzafarova J.A.
Abstract

Estetrol (E4) is a steroid hormone found in the urine of pregnant women in 1965. E4 is produced only during pregnancy and enters the maternal bloodstream through the placenta. Its concentration in maternal human plasma increases during pregnancy, reaching a maximum by the end of pregnancy (≥1 ng/mL). The pharmacological properties of E4 make it a promising agent for hormonal therapy and contraception. To date, phase II and III studies have shown promising results with the combination of 15 mg of E4 and 3 mg of drospirenone: this combined oral contraceptive has shown a good effect with a neutral metabolic effect. However, evidence is scarce about the effect of the new combination on the breast and bone tissue. Further studies are needed to consolidate the available data and to investigate possible side effects of prolonged use of E4-containing combined oral contraceptives compared to known ethinylestradiol and estradiol-containing combinations.

Gynecology. 2022;24(6):459-464
pages 459-464 views
Efficacy of laser remodeling in the genitourinary syndrome of menopause: A review
Orazov M.R., Silantyeva E.S., Radzinsky V.E., Mikhaleva L.M., Khripach E.A., Dolgov E.D.
Abstract

The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 2012–2022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice.

Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause.

Gynecology. 2022;24(6):465-470
pages 465-470 views
Sleep disturbances in pregnancy: features of diagnosis and therapy: A review
Burchakov D.I.
Abstract

Physiological changes during pregnancy often disrupt women's sleep. If these changes are combined with other factors (obesity, iron or magnesium deficiency, anxiety, etc.), the pregnant woman may develop sleep disorders: obstructive sleep apnoea syndrome, restless legs syndrome, leg cramps, and insomnia. These disorders increase the risk of pregnancy complications, reduce the quality of a woman's life, and form the basis for somatic and mental disorders in the postpartum period. Therefore, the obstetrician has to be familiar with the phenomenology, diagnosis, and treatment of sleep disorders in pregnant women to treat them promptly or to refer a woman to a neurologist or psychiatrist. This review briefly describes the common sleep disorders occurring in pregnant women, especially the various types of insomnia. The main groups of sedative agents are characterized, of which only doxylamine is acceptable for use in routine practice because of its proven efficacy and safety during pregnancy.

Gynecology. 2022;24(6):471-477
pages 471-477 views

ORIGINAL ARTICLE

Endometrial receptivity in women of reproductive age with "thin" and "absolutely thin" endometrium
Aganezova N.V., Aganezov S.S., Gogichashvili K.E.
Abstract

Aim. To evaluate the expression of steroid receptors (estrogen [ER] and progesterone [PR]) in the endometrium during the implantation window in females with a history of fertility disorders in "thin" and "absolutely thin" endometrium versus healthy females.

Materials and methods. A prospective comparative study was conducted. The study group (n=42) included patients with "thin" endometrium (7 mm > M-echo ≥5 mm at cycle days 11–13 according to ultrasound); the comparison group (n=10) included females with "absolutely thin" (<5 mm according to ultrasound in the pre-ovulatory days) endometrium (females in both groups had a history of infertility and miscarriage of unclear reasons in the anamnesis); the control group included 16 healthy fertile females. A Pipelle biopsy of the uterine mucosa was performed on day 6–8 after ovulation, and a peripheral blood sample was obtained to measure the concentration of sex steroids (estradiol [E2] and progesterone [P]). Endometrial samples were examined by histological and immunohistochemical methods (ER, PR expression).

Results. All study participants had an ovulatory cycle of P≥16.1 nmol/L (day 6–8 after ovulation) and normal estrogen levels (E2, pmol/L). E2/P was similar in all cohorts (p>0.05 for all measures). ER and PR expression in the endometrium similar to those in healthy females was detected in 20% of patients in the study and comparison groups (M-echo = 4.8–3.1 mm): 21% (9/42) and 20% (2/10), respectively. ER and PR expression in the endometrial glands and ER expression in the endometrial stroma were significantly different (p<0.05) from healthy females in 79% (41/52) of patients with "thin" endometrium and 80% (8/10) of patients with "absolutely thin" endometrium. No differences in the ER or PR expression in the endometrium in females with hypoplastic endometrium were found (p>0.05).

Conclusion. The M-echo value does not accurately determine endometrial hormonal-receptor abnormalities: 20% of the study participants with hypoplastic endometrium had ER and PR expression comparable to those in healthy females. No differences were found in the expression of endometrial estrogen and progesterone receptors in females with "thin" and "absolutely thin" endometrium.

Gynecology. 2022;24(6):478-486
pages 478-486 views
Effect of combined oral contraceptives with estrogen identical to natural estrogen on the metabolic profile and body composition in females during the menopausal transition
Komedina V.I., Yureneva S.V., Kuznetsov S.Y.
Abstract

Aim. To study the effect of combined oral contraceptives (COC) with estrogen identical to natural estrogen on the metabolic profile and body composition in females during the menopausal transition.

Materials and methods. Females in the menopausal transition who needed contraception were divided into two groups. Group 1 (19 patients) received COCs containing estradiol valerate/dienogest (E2V/DNG) with a dynamic dosing regimen; Group 2 (19 patients) received monophasic COCs containing 17β-estradiol/nomegestrol acetate (E2/NOMAC) for 6 months. Blood pressure (BP), parameters of carbohydrate and lipid metabolism, leptin, adiponectin, C-reactive protein, uric acid, and body composition by dual-energy X-ray absorptiometry were assessed initially and after the 6 months of therapy.

Results. No significant changes in weight and body composition after 6 months of COC use were found in both groups. COCs with E2V/DNG had no significant effect on BP and all assessed metabolic parameters. Females taking COCs with E2/NOMAC showed increased fasting glucose of 4.85 (0.43) and 5.30 (0.37) mmol/L (p=0.002), insulin of 4.97 (2.35) and 8.82 (4.67) µU/mL (p=0.012), NOMA index of 1.06 (0.54) and 1.88 (0.75); p=0.010 compared to baseline. However, the parameters remained within the reference values.

Conclusion. COCs containing estrogens identical to natural estrogens do not affect body composition and have no significant adverse effect on BP and metabolic parameters in females during the menopausal transition, indicating that the use of these agents is acceptable from the perspective of their metabolic effects in this group of patients.

Gynecology. 2022;24(6):487-493
pages 487-493 views
Diagnosis of premalignant and malignant cervix diseases in HPV-positive females: Digene test performance evaluation
Lyalina G.Z., Yashchuk A.G., Zainullina R.M., Muhamadeeva O.R., Gareev E.M.
Abstract

Background. Cervical cancer is one of the most preventable malignancies in females. However, there is an increasing trend of disease incidence mainly due to the low specificity of routine screening tests.

Aim. To assess the diagnostic value of standard tests for the diagnosis of cervix disorders based on the Digene test.

Materials and methods. The obtained data were processed using the Statistica software package. Due to the unique features of specimens obtained, non-parametric methods were used for small samples with extreme data variability and possible artifacts. These methods do not require an assumption of "normality" of distribution. Kruskal–Wallis rank analysis of variance and Mann–Whitney test for comparison of individual samples were used to estimate the relationship between the studied parameter and controlled factors. Median (Me) and quartiles (Q1 and Q3) were used in describing the results.

Results. The study found a low performance of colposcopy and cytology and a higher performance of status assessment for human papillomavirus.

Conclusion. Our findings indicate that viral load measurement is only sometimes informative. This test can be used as a stage 2 screening; additional data are needed for further patient management. Digene test helps to determine the risk group for a follow-up study.

Gynecology. 2022;24(6):494-498
pages 494-498 views
Reproducibility of cytological diagnoses in evaluating liquid cervical smears and immunocytochemical co-expression of p16/Ki-67 using manual and automatic methods
Tregubova A.V., Tevrukova N.S., Ezhova L.S., Shamarakova M.V., Badlaeva A.S., Dobrovolskaya D.A., Bayramova G.R., Nazarova N.M., Shilyaev A.Y., Asaturova A.V.
Abstract

Aim. To assess the reproducibility of cytological diagnoses in evaluating liquid cervical smears and immunocytochemical co-expression of p16/Ki-67 using manual and automatic methods.

Materials and methods. Cytological smears prepared using the liquid cytology method on the Becton Dickinson device (SurePath technology) were studied. An immunocytochemical study was carried out using a Ventana BenchMark Ultra automatic immunostainer with a commercial CINtec kit (determination of p16/Ki-67 co-expression). In total, 100 cytological slides (50 pairs of Pap-smears and immunocytochemical slides) were studied. The diagnostic kit was reviewed by five cytologists independently, and the cytologic slides were evaluated using four categories according to the Bethesda system (2014) and according to the categories of normal/abnormal. The co-expression of p16/Ki-67 was assessed per the manufacturer's recommendations (Roche) using the manual method (light microscope) and the automatic Vision Cyto Pap ICC system. Statistical processing of the results was performed using the SPSS software package version 26.0.0.0 with the calculation of the reproducibility indices of Cohen's kappa and Fleiss' kappa.

Results. When assessing the reproducibility of four categories of cytological diagnoses according to the Bethesda system (2014), Cohen's kappa was 0.048–0.265. The overall Fleiss' kappa between all cytologists was 0.103. When only two categories (normal/abnormal) were used, the reproducibility ranged from 0.058 to 0.377. When assessing the co-expression of p16 and Ki-67, Cohen's kappa reproducibility was from 0.196 to 0.574, while the overall Fleiss' kappa was 0.407. When comparing the evaluation results of each of the cytologists with the neural network, Cohen's kappa reproducibility ranged from 0.103 to 0.436.

Conclusion. The reproducibility of cytological diagnoses according to the Bethesda system (2014) and two categories (normal/abnormal) based on the Pap smear study was low. Such results are primarily due to a large number of abnormal smears in the study. The immunocytochemical method has diagnosis reproducibility three times higher, indicating the need to measure the co-expression of p16 and Ki-67 to increase the sensitivity and specificity of the cytological method. Similar reproducibility when comparing the manual and automatic evaluation of the "double label" suggests that the neural network algorithm can currently help in decision support rather than replace the cytologist at the diagnostic stage.

Gynecology. 2022;24(6):499-505
pages 499-505 views
Initial results of use and prospects of hospital-substituting technologies in gynecology
Podzolkova N.M., Bedin V.V., Vardanyan V.A., Kuznetsov R.E., Vengerov V.Y., Yakomaskin V.N., Glazkova O.L., Ismailova S.S., Kalinskaya A.N., Sozaeva L.G.
Abstract

Background. The first day-care hospital (DCH) in the Russian Federation with 30 beds was established in the departments of general surgery, urology, and gynecology of the Botkin Hospital in 2016 in Moscow.

Aim. To analyze the six-year experience of the gynecological DCH based on the Botkin Hospital.

Materials and methods. The six-year experience (2016–2021) of the gynecological DCH based on the Botkin Hospital was analyzed.

Results. The number of patients treated in the DCH increased progressively from 2016 to 2019. Due to the gain in the experience of DCH, patients with a broader spectrum of diseases can receive care in DCH settings, the number of hospitalized patients with a higher anesthetic risk has increased, and the proportion of patients over 65 years of age has also increased.

Conclusion. Analysis of the activities of the DCH based on the Botkin Hospital showed that the pilot project can be considered successful due to good clinical and economic indicators. This activity format can be widely implemented, and it is optimal to establish such hospitals in multidisciplinary clinics.

Gynecology. 2022;24(6):506-511
pages 506-511 views
Latent iron deficiency therapy in pregnant women
Kutsenko I.I., Kravtsova E.I., Kholina L.A., Tomina O.V.
Abstract

According to various studies, the overall population incidence of latent iron deficiency (LID) ranges from 70% and more. However, routine tests cannot detect LID during preconception examination and in the first trimester of pregnancy; therefore, women receive no proper treatment, and iron deficiency manifest in the second and third trimesters of pregnancy. LID causes hypoxia, leading to pregnancy, labor, and postpartum complications.

Aim. To evaluate the effectiveness of iron with folic acid supplements compared to vitamin-mineral complexes in pregnant women with LID to improve maternal and perinatal outcomes.

Materials and methods. A prospective cohort non-interventional study (observational program) in real clinical practice was conducted. In total 461 pregnant women aged 19 to 35 with LID were included in the study. During the study, women were divided into two groups according to the method of LID correction: administration of iron sulfate 247.25 mg, which corresponds to an iron content of 80 mg + folic acid 350 μg (Gyno-Tardyferon®), or vitamin-mineral complexes with an iron content of 14–18 mg. Routine complete blood count, serum iron, serum ferritin, and transferrin were monitored over time.

Results. Gyno-Tardyferon® showed high therapeutic and prophylactic efficacy; the rate of favorable outcomes was 100% and 35% for multivitamin iron-containing complexes. No LID progression to manifest iron deficiency during pregnancy can also be considered a favorable outcome.

Conclusion. The results showed that timely treatment of LID with an iron-containing medication (Gyno-Tardyferon®) prevents manifested iron deficiency and hemic and circulatory hypoxia, which ultimately reduces the rate of pregnancy, labor, and postpartum complications.

Gynecology. 2022;24(6):512-517
pages 512-517 views
Obesity and pregnancy: possible ways to overcome complications and improve reproductive outcomes
Lapina I.A., Dobrokhotova Y.Е., Taranov V.V., Sorokin Y.A., Chirvon T.G., Malakhova A.A.
Abstract

Introduction. Obesity, due to its high prevalence and relevance, can be considered an epidemic of modern society. Obesity-related microcirculatory vascular disease and chronic inflammation with endothelial dysfunction are associated with adverse effects on reproductive potential. Sulodexide reduces the risk of hemostatic complications in patients planning pregnancy due to its polypotent effect, which is especially important in metabolic disorders and comorbidities. Therefore, it is promising to assess the effectiveness of integrated management of obese patients as part of pregnancy planning.

Aim. To modify the complex treatment of obesity in patients planning pregnancy to reduce the risk of reproductive losses and gestational complications.

Materials and methods. The prospective analysis included 92 patients with grade 1 obesity. According to the clinical protocols and guidelines of the Reproductive Health Professional Medical Association, 46 patients in the control group (group 1) were prescribed treatment to reduce the body mass index, including lifestyle correction, folic acid, and vitamin D. Patients in the comparison group (Group 2, n=46) also received endotheliotropic agent sulodexide. The treatment efficacy was analyzed based on the frequency of pregnancy, the change of laboratory markers of endothelial dysfunction, the incidence of gestational complications, and reproductive losses.

Results. The study showed that in comparison group patients, the frequency of pregnancy (58.7% of cases in Group 1, 71.7% in Group 1), favorable course of the first trimester (39.1% in Group 1, 63.0% in Group 2), and delivery at term (30.4% in Group 1, 56.5% in Group 2) were higher compared to the control group. There was also a more significant decrease in the body mass index and endothelial dysfunction factors (homocysteine level in group 1 before treatment was 17±2.4 μmol/L, and 14±1.8 μmol/L after treatment; 19±1.7 μmol/L before treatment and 9±1.4 μmol/L after treatment in Group 2, respectively) in patients receiving complex treatment with sulodexide. Analysis of the pregnancy course showed a lower risk of gestational diabetes (33.3% in Group 1 and 13.8% in Group 2).

Conclusion. Treatment of obesity in patients planning pregnancy requires a complex effect aimed at correcting lifestyle, reducing body weight, restoring the endothelial layer, and reducing the severity of chronic inflammation, thus improving reproductive outcomes and minimizing the risk of gestational complications.

Gynecology. 2022;24(6):518-524
pages 518-524 views
Antitumor immune cycle proteins and HPV status in patients with HSIL and cervical cancer
Kayukova E.V., Belokrinitskaya T.E., Romanyuk S.V.
Abstract

Background. Cervical cancer (CC) is a common malignant tumor among women worldwide. The anti-tumor immune cycle (AIC) is a necessary molecular mechanism that prevents the occurrence and progression of a tumor. It is known that during the development of CC, several mechanisms disrupt the AIC and contribute to tumor progression. Recent data show the role of human papillomavirus (HPV) in the AIC regulation as a mechanism for the emergence of tumor resistance to the anti-tumor immune response.

Aim. To study the levels of AIC proteins (sCD25, 4-1BB, B7.2, TGF-b1, CTLA-4, PD-L1, PD-1, Tim-3, LAG-3, Galectin-9, sCD27, PD-L2) in patients with high-grade squamous intraepithelial lesion (HSIL) and CC, depending on the HPV status.

Materials and methods. A prospective study enrolled women of reproductive age with HSIL (n=53) and stage I–III СС (n=93). The control group included female volunteers without cervical abnormalities (n=30). The study material was the cervical epithelium. Study methods: flow cytometry, diagnostics using the polymerase chain reaction for HPV status and viral load. Statistical processing was performed using the IBM SPSS Statistics version 25.0 software package using non-parametric statistics methods.

Results. The obtained data indicate an expression increase of AIC inhibitors: PD-1 and PD-L2 in patients with HPV infection and sCD27 in patients with mono-HPV infection. There were no significant differences in the levels of AIC proteins, depending on the HPV viral load in patients with HSIL and CC.

Conclusion. The effect of HPV infection and its type on regulating the expression of specific AIC proteins has been established, which is one of the mechanisms of tumor progression.

Gynecology. 2022;24(6):525-528
pages 525-528 views
Neural network interpretation techniques for analysis of histological images of breast abnormalities
Fomina A.V., Borbat A.M., Karpulevich E.A., Naumov A.Y.
Abstract

Background. Neural networks are actively used in digital pathology to analyze histological images and support medical decision-making. A common approach is to solve the classification problem, where only class labels are the only model responses. However, one should understand which areas of the image have the most significant impact on the model's response. Machine learning interpretation techniques help solve this problem.

Aim. To study the consistency of different methods of neural network interpretation when classifying histological images of the breast and to obtain an expert assessment of the results of the evaluated methods.

Materials and methods. We performed a preliminary analysis and pre-processing of the existing data set used to train pre-selected neural network models. The existing methods of visualizing the areas of attention of trained models on easy-to-understand data were applied, followed by verification of their correct use. The same neural network models were trained on histological data, and the selected interpretation methods were used to systematize histological images, followed by the evaluation of the results consistency and an expert assessment of the results.

Results. In this paper, several methods of interpreting machine learning are studied using two different neural network architectures and a set of histological images of breast abnormalities. Results of ResNet18 and ViT-B-16 models training on a set of histological images on the test sample: accuracy metric 0.89 and 0.89, ROC_AUC metric 0.99 and 0.96, respectively. The results were also evaluated by an expert using the Label Studio tool. For each pair of images, the expert was asked to select the most appropriate answer ("Yes" or "No") to the question: "The highlighted areas generally correspond to the Malignant class." The "Yes" response rate for the ResNet_Malignant category was 0.56; for ViT_Malignant, it was 1.0.

Conclusion. Interpretability experiments were conducted with two different architectures: the ResNet18 convolutional network and the ViT-B-16 attention-enhanced network. The results of the trained models were visualized using the GradCAM and Attention Rollout methods, respectively. First, experiments were conducted on a simple-to-interpret dataset to ensure they were used correctly. The methods are then applied to the set of histological images. In easy-to-understand images (cat images), the convolutional network is more consistent with human perception; on the contrary, in histological images of breast cancer, ViT-B-16 provided results much more similar to the expert's perception.

Gynecology. 2022;24(6):529-537
pages 529-537 views

IN AID OF THE CLINICIAN

HPV-associated cervicitis
Andreeva M.V., Zakharova K.I.
Abstract

Cervical inflammatory disease associated with papillomavirus infection is one of the most common inflammatory diseases of the pelvic organs and plays a role in developing cervical dysplasia and cancer. Over the past 15 years, Russia has seen an increase in the proportion of neglected cervical cancer cases. Currently, the management and treatment strategy for cervicitis associated with human papillomavirus (HPV) and cervical intraepithelial dysplasia ranges from monitoring with HPV testing and cytological control to excision and cervical conization. The immune status determines the course of the papillomavirus infection, which may be transient, latent, or persistent. In most cases (70–80%), HPV is eliminated spontaneously. The detection of HPV DNA with clinical and morphological changes indicates a latent course of the disease. The complex use of clinical data and morphological and molecular biological studies results is most promising in identifying early prognostic markers of cervical malignancy. It is the basis for further search for cervical precancer progression pathogenetic markers.

Gynecology. 2022;24(6):539-542
pages 539-542 views

CLINICAL CASE

Principles of fast-track surgery in the treatment of giant uterine fibroids: а clinical case
Lapina I.A., Tyan A.G., Dobrokhotovа Y.Е., Gomzikova V.M., Sorokin Y.А., Taranov V.V., Malakhova A.А., Chirvon T.G., Gudebsckaia V.А., Firstova S.V., Zateeva A.А.
Abstract

The article addresses the treatment of uterine fibroids, which is still relevant. According to numerous studies, about 70% of females under 50 have uterine fibroids, the most common condition among perimenopausal women. The prevalence of giant forms is not high and accounts for less than 5% of all cases, especially at early diagnosis. The surgical strategy in such cases is individual and depends on many factors: size, location of nodes, and women's reproduction plans. In these clinical cases, the management of patients with giant uterine fibroids is presented according to the multimodal principles of fast-track surgery in a modern gynecological hospital. We described the main approaches in diagnosis, preoperative preparation, surgery features, and subsequent recovery to reduce the complication rate, the duration of inpatient treatment, and postoperative rehabilitation in the treatment of giant uterine fibroids.

Gynecology. 2022;24(6):543-548
pages 543-548 views


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