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 23, No 1 (2021)

REVIEW
Pregnancy and childbirth in patients with endometriosis
Artymuk N.V., Vaulina E.N., Zotova O.A.
Abstract

Aim. To review the current publication highlighting the features of pregnancy and childbirth outcomes in patients with endometriosis.

Materials and methods. The analysis of 45 foreign and domestic publications on this topic has been carried out.

Results. Patients with endometriosis have fertility problems, and when pregnancy occurs, it was characterized by a higher risk of preeclampsia, placenta previa, gestational diabetes, miscarriage and preterm labor, as well as delivery by caesarean section. Newborns in women with endometriosis have an increased risk of prematurity and small for gestational age. Probably, in addition to the presence of endometriosis, the risk of obstetric and neonatal complications is influenced by the localization and severity of the disease, as well as the use of assisted reproductive technologies.

Conclusion. The results obtained indicate that patients with endometriosis have a high risk of perinatal complications and require additional antenatal monitoring and care.

Gynecology. 2021;23(1):6-11
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Endometriosis: impact on fertility and pregnancy outcomes
Gabidullina R.I., Koshelnikova E.A., Shigabutdinova T.N., Melnikov E.A., Kalimullina G.N., Kuptsova A.I.
Abstract

Aim. To investigate the modern condition of the problem of infertility and obstetric complications in endometriosis and the main management aspects of women with endometriosis in pregnancy planning.

Materials and methods. The article presents a systematic literature review on the results of search for studies in electronic databases MEDLINE, PubMed, EMBASE, Cochrane Library and eLibrary.

Results. Endometriosis is one of the most common causes of infertility. A cascade of adverse reactions caused by endometriosis prevents a successful pregnancy. Currently, there is an evidence that patients with endometriosis have a high risk of several obstetric complications, such as spontaneous miscarriage, premature birth, preeclampsia, low birth weight and gestational diabetes. Progestogens belong to the first line of therapy of endometriosis, and dydrogesterone is a drug that meets all the necessary requirements. The use of dydrogesterone in the treatment of endometriosis helps to reduce the negative symptoms of endometriosis, improve the quality of life and increase fertility. Dydrogesterone is the only progestogen that has two effective regimens for endometriosis, which allows prescribing therapy for women who are planning pregnancy and for those who have already realized their reproductive plans. Dydrogesterone is the only progestogen that has been suggested to increase the chances of pregnancy in women with endometriosis. Dydrogesterone has been shown to be effective in supporting the luteal phase in ART programs, treating threatening and recurrent miscarriages.

Conclusion. Endometriosis is associated with infertility and a high risk of obstetric complications. Dydrogesterone has a number of advantages compared to other progestogens.

Gynecology. 2021;23(1):12-17
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Endometrial hyperplasia: without atypia and with atypia
Sabantsev M.A., Shramko S.V., Levchenko V.G., Volkov O.A., Tretyakova T.V.
Abstract

The article analyzes and presents data for the last 70 years from the PubMed database on endometrial hyperplasia (EH), which is one of the leaders in the structure of gynecological diseases and the main predictor of endometrial cancer (EC). The chronicle of the EH classification is highlighted with a focus on changing the designation and relevance of adenomatous EH. It is shown how the current classification of EH, due to the fact that a large number of synonyms is limited by two options, allows to maximize the reproducibility of the diagnosis, improve the interaction of the obstetrician-gynecologist with the pathologist and reduce the treatment inefficiency. The results of modern studies on the prevalence and risk factors of EH and EC differ from previously accepted ones and destroy “the Bohman triad”. The risks of EH development with tamoxifen and menopausal hormone therapy are determined. The data of current research methods aimed at the diagnosis of EH and EC are indicated. The differences in etiopathogenesis, prevalence, diagnosis, risk factors for development and progression to the malignant process presented in the review represent two types of EH (without atypia and with atypia) as completely different endometrial diseases included in the same classification.

 

Gynecology. 2021;23(1):18-24
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Real clinical practice and contraception for young women with children
Aganezova N.V., Aganezov S.S.
Abstract

The review presents the psychosocial characteristics of young women in today’s millennial generation and survey data regarding their hormonal contraceptive requirements. The results of randomized clinical trials and real-life studies of the use of the combined oral contraceptive (COC) Qlaira® containing estradiol valerate and dienogest (E2V/DNG) in a dynamic dosing regimen were analyzed, in which the reliability of the contraceptive effect of the drug was identified and confirmed, the restoration of fertility was population level after drug withdrawal, its minimal effect on metabolism and a reduced risk of cardiovascular complications (venous and arterial thrombosis) when using Qlaira® COC in comparison with other COCs. The absence of a negative effect of COC E2V/DNG on body weight, sexual function and vaginal microbiocenosis in most women has been proven. The data on satisfactory characteristics of menstrual bleeding (lighter and shorter) in users of Qlaira® COC and a decrease in symptoms associated with a hormone-free interval, which often occur when taking other COCs in the 21/7 regimen, are presented. The favorable efficacy and safety profile of COC E2V/DNG in real conditions, the advantages of estrogen bioidentical to the endogenous, in the composition of the drug, the dosage regimen 26/2, the positive effect on the lifestyle, determine the significant satisfaction of young women, including young women with children, and the ability to use the drug for a long time until menopause.

Gynecology. 2021;23(1):25-32
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New trends in current menopausal hormone therapy
Balan V.E., Tikhomirova E.V., Zhuravel A.S., Titchenko J.P., Lovygina T.V.
Abstract

The article presents the results of recent studies on the effectiveness, safety and duration of menopausal hormone therapy (MHT). The main cardio-metabolic risk factors for cardiovascular diseases are formed in women precisely during the transition to menopause and are clearly associated with the appearance of vegetative menopausal symptoms and the development of endothelial dysfunction, which is a predictor of future serious health problems, especially cardiovascular diseases. The results of a number of epidemiological studies have shown that in women with severe climacteric manifestations, especially with hot flashes, the overall risk of developing cardiovascular diseases is increased. The need for early initiation of MHT is an indisputable truth and is not disputed by anyone, but the formed tendency to discontinue treatment in 5–6 years raises many questions among patients and their doctors. However, recent guidelines from the International Menopause Society state that there is no reason to arbitrarily limit the duration of MHT. This paper presents current evidence on the indications and benefits of low and ultra-low doses of MHT. In view of the high efficacy and safety of low doses of MHT, they seem to be the most acceptable starting doses of oral MHT for most women. In addition, women with early menopause should also receive higher doses of estrogens, as they are more physiological for them. The choice in favor of starting MHT in a postmenopausal woman with a low or ultra-low dose in each case should be selected individually.

Gynecology. 2021;23(1):33-36
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Modern understanding of bacterial vaginosis
Khryanin A.A., Knorring G.Y.
Abstract

Bacterial vaginosis is an infectious non-inflammatory syndrome characterized by the replacement of the usual microflora by the polymicrobial associations of anaerobes and Gardnerella vaginalis. The review is devoted to current issues of this disease, including pathogenesis, clinical manifestations and approaches to laboratory diagnostics. Discussion issues of this disease related to the possibility of sexual transmission are discussed. Particular attention is paid to the factors causing the development of bacterial vaginosis. The classical concepts of diagnostic criteria for diagnosis are presented. Bacterial vaginosis is not characterized by the presence of a specific microorganism, but is the result of the formation of a bacterial biofilm on the epithelium of the vagina or foreskin. The main component of this biofilm is G. vaginalis. Bacterial vaginosis is caused by polymicrobial gardnerella biofilm, which can only be transferred as a whole (for example, with the help of key cells) only during sexual intercourse. Along with this, the authors discuss modern aspects related to the problem of microbial biofilm formation. In this regard, the authors propose to use a new term – «biofilm vaginosis», which more accurately reflects the essence of this problem. The modern possibilities of treating bacterial vaginosis are presented. The use of combined local therapy of nonspecific inflammatory processes of the vulvovaginal zone is becoming especially relevant at the present stage. The use of a local combination drug (Gainomax) with the widest possible spectrum of action allows doctors to achieve rapid relief of symptoms and high efficiency of therapy.

Gynecology. 2021;23(1):37-42
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Clinical course, maternal and neonatal outcomes of COVID-19 infection in pregnancy: an epidemiological study in Siberia and the Far East
Belokrinitskaya T.E., Artymuk N.V., Filippov O.S., Frolova N.I.
Abstract

Aim. To assess the incidence, clinical course, outcomes of a novel coronavirus infection (NKI) COVID-19 for mother and child in the population of pregnant women in the Far Eastern (FEFD) and Siberian Federal Districts (SFD).

Materials and methods. The study design: a population-based epidemiological prospective study. We analyzed operative information on NKI COVID-19 incidence and features of clinical course in pregnant women, women in labor and parturient women as well as maternal and perinatal outcomes for March 11 to December 25, 2020 which were provided by the FEFD and SFD chief obstetricians-gynecologists. Mathematical analysis included methods of descriptive statistics, analysis of contingency table, where the value of ÷2, the achieved level of significance (p) was estimated.

Results. In the FEFD and SFD, over the COVID-19 2020 epidemic, the SARS-CoV-2 virus was revealed in 8485 pregnant women, women in labor and postpartum women (5.9% of pregnant women subjected to regular medical check-up; 1.71% of the sick entire population). The incidence rate in pregnant women was 3.0 times higher than in the entire population: 5933,2 vs 1960,8 per 100 thousand (p<0.001). Among SARS-CoV-2 infected patients, 27.4% (2324) were asymptomatic, 52.7% (4471) have mild, 16.6% (1388) – moderate, 2.5% (210) – severe 0,5% (39) – extremely severe clinical course. In the intensive care and anesthesiology departments, 3.57% of pregnant women and 2.24% of the entire population (p<0.001) have been treated. Rate of using invasive artificial lung ventilation in pregnant women was lower than in the population: 0.48% vs 1.05% (p<0.001). 27.97% (2373) of women with confirmed NKI COVID-19 completed pregnancy. 81,7% of mothers delivered on time, 18.3% – prematurely. Cesarean delivery was performed in 42,0% of women, operative vaginal delivery (vacuum extraction, obstetric forceps) was registered in 0.2% of cases. 12 (0.14%) mothers died. The maternal mortality rate was 505.69 per 100 thousand live births (0.51% of patients with COVID-19 who gave birth). Mortality rates and the proportion of deaths in the entire population were statistically significantly higher: 1948.93 per 100 thousand sick population and 1.95% (p<0.001), respectively. 37 (1.56%) cases of perinatal losses were registered, of which 31 (1.30%) – stillbirths, 6 (0.26%) – early neonatal mortality. The SARS-CoV-2 virus was revealed in 148 (6.2%) newborns with the observance of anti-epidemic measures and separation of the mother and child immediately after delivery.

Conclusion. The rate of revealing SARS-CoV-2 virus in pregnant women, women in labor and parturient women in Siberia and the Far East was 3.0 times higher than in the entire population, while clinical course of infectious process was less severe (less need for invasive mechanical ventilation, lower mortality rate). In mothers with COVID-19, preterm birth rate was 3.0 times higher, caesarean delivery rate –1.4 times higher compared with the average population indicators. Reveling SARS-CoV-2 virus RNA in 6.2% of newborns suggests the possibility of vertical transmission of the infection.

Gynecology. 2021;23(1):43-47
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ORIGINAL ARTICLE
Facilities of a comprehensive examination in the diagnosis of benign breast diseases and breast cancer
Aminodova I.P., Perminova E.V.
Abstract

Aim. To assess the effectiveness of a comprehensive examination of women of different ages in the diagnosis of benign breast diseases and breast cancer (BC).

Materials and methods. Retrospective analysis of medical records (600 cases), questionnaires of 300 women, prospective analysis of the results of a comprehensive examination of 300 patients.

Results. The link between low screening coverage and insufficient activity and awareness of the population has been established. The significance of various risk factors, including reproductive history, lifestyle, use of hormone therapy and heredity, for benign breast diseases and BC, has been clarified. It was shown that breast diseases are often combined with endometrial hyperplastic processes, uterine myoma, menstrual dysfunctions, severe lesions of the cervical epithelium and neuroendocrine diseases. The diagnostic efficiency of different examination methods and their combined use for the timely identification of BC and differential diagnosis of benign and malignant breast diseases has been clarified. A high frequency of faults in the preparation of primary medical documentation was revealed, that impedes adequate assessment of risk factors and the formation of group for dispensary follow-up.

Conclusion. It is necessary to correct measures for the secondary prevention of BC, including the formation, registration and dynamic follow-up of a cohort of women with a high risk for BC. One of the options for solving the issue of inadequate diagnosis for breast tumors can be a complex multiparametric approach to assessing the reproductive system, including the assessment of risk factors, the combined use of ultrasound and X-ray examination methods, which makes it possible to increase the accuracy of primary and differential diagnostics, and the development of a personalized follow-up algorithm for women with high risk for benign breast diseases and BC.

Gynecology. 2021;23(1):48-54
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An integrated approach to the management of patients with endometrial hyperplasia and metabolic syndrome
Lapina I.A., Dobrokhotova Y.E., Ozolinya L.A., Chirvon T.G., Taranov V.V.
Abstract

Despite the achieved success in the treatment of endometrial hyperplasia processes, some issues related to the treatment of these diseases have not been completely resolved, especially in the presence of metabolic syndrome.

Aim. To optimize the management of patients with endometrial hyperplasia and metabolic syndrome.

Materials and methods. The study included 50 women with a verified diagnosis of recurrent endometrial hyperplasia. As a control value, a BMI of 25.0 kg/m2 was taken, two subgroups were identified – with normal body weight and with overweight and obesity of the 1st degree. Treatment with GnRH was carried out in the following regimen: intramuscular injection of the drug at a dose of 3.75 mg once every 4 weeks with an assessment of the results after 3 and 6 months. In the course of the study, we assessed metabolic parameters, parameters of the hemostasis and fibrinolysis system before and during therapy. The baseline studied parameters were compared with the control group of healthy women without endometrial hyperplastic processes and overweight as well as patients of the control group with metabolic syndrome.

Results. Hormonal treatment of recurrent endometrial hyperplasia without atypia using GnRH a positive effect on the dynamics of clinical manifestations, which is confirmed by the data of ultrasound and histological research methods and does not cause a sharp procoagulant shift, regardless of the patient’s body weight.

Conclusion. Our results allow GnRH to be the drugs of choice in the treatment of endometrial hyperplasia in overweight patients, since they have a fairly safe and effective effect. It is necessary to remember about an integrated approach to patient management and to carry out the prevention of endothelial dysfunction in this group of patients due to the high risk of complications to potentiate a beneficial effect on hemostasiological and metabolic parameters.

Gynecology. 2021;23(1):55-61
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Comprehensive treatment of cervical intraepithelial neoplasia
Mkrtchian L.S., Grivtsova L.I., Kiseleva V.I., Aleshina A.M., Krikunova L.I.
Abstract

Aim. To study the effectiveness of the use of Neovir (sodium oxodihydroacridinyl acetates) as immunomodulatory and antiviral drug in the comprehensive treatment of various grade cervical intraepithelial neoplasia (CIN). Study design: prospective comparative study.

Materials and methods. The study included 60 patients (mean age 34.7±8.2 years) with morphologically verified various grade CIN, who were received comprehensive treatment, including the use of Neovir (sodium oxodihydroacridinyl acetate) as the drug with immunomodulatory and antiviral activity, 250 mg/2 ml intramuscularly every 48 hours, 10 injections before (group 1) or after (group 2) multi-stage radiosurgical diagnostic and treatment procedure or only a similar surgical intervention (group 3). All patients underwent complete clinical, morphological and laboratory examination with monitoring for the presence of high-risk human papillomavirus (HPV) in the cervical scraping and the dynamics of peripheral blood lymphocyte subpopulations.

Results. Dynamic follow-up showed that in a month after surgery, patients who were treated with radiosurgical resection as monotherapy (group 3) had the lowest rate of complete epithelialization of the cervical stump – 30.0% vs 55.0 and 65,0% in the group 1 and group 2 respectively. In this group, the proportion of patients with persistent viral infection was 1.5–2 times higher than in the groups where an antiviral drug was used in combination with radiosurgical intervention – 35.7% vs 17.6 and 22.2% in the group 1 and group2, respectively. In 6 months, elimination of high-risk HPV in groups with comprehensive treatment reached 94.5 in the group 1 and 94.1% in the group 2 (p>0.05) vs 78.6% in the group 3. The lowest number of TNK- and NK-cells was found in the group of patients who received radiosurgical treatment as monotherapy, which correlated with the highest incidence of high-risk HPV persistence after treatment in this group.

Conclusions. In patients with various grade CIN, the use of an immunomodulatory drug with antiviral activity in combination with radiosurgical intervention promotes early epithelialization of the cervix and elimination of high-risk HPV, which is confirmed by significant changes in the lymphocyte subpopulations which provide antiviral immunity.

Gynecology. 2021;23(1):62-67
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Role of adjuvant hormonal therapy in restoring reproductive function in women after endosurgical treatment of ovarian follicular cysts
Shukurov F.I., Aiupova F.M.
Abstract

In the structure of the causes of female infertility, follicular ovarian cysts make up 7–10% of cases. Despite the studies on the reproductive health of women undergoing endosurgical treatment of follicular ovarian cysts, the problem of restoring reproductive function has not yet been resolved.

Aim. To assess the effectiveness of a preparation containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.

Materials and methods. The study group included 100 women, of whom 70 patients (the main group) received adjuvant therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate after endosurgery, and a comparison group of 30 patients who did not receive adjuvant therapy. The diagnosis of follicular ovarian cysts was established on the basis of hormonal, ultrasound, endoscopic and immunohistochemical studies. The levels of gonadotropic hormones (LH, FSH), steroid hormones estradiol and progesterone were determined twice – at the beginning of the follicular (3–5 day) and secretory phase (20–22 day) of the menstrual cycle. An ovarian ultrasound was performed at the beginning of the follicular phase and on days 20–22 of the menstrual cycle. Immunohistochemical studies of estrogen and progesterone receptors in the ovaries were carried out using a Bond-max immunostimulator from “Leica” (Germany) using monoclonal antibodies: clone 1D5 and clone 1A6 “Dako” (USA).

Results. Menstrual irregularities were detected in 36 (51.4%) patients, of which: irregular menstruation in 18.0%, algomenorrhea in 15.1%, polymenorrhea in 11.0%, and menorrhea in 7.3% of patients, infertility was observed in 34 (48.6%) patients. Endosurgical treatment of follicular ovarian cysts was performed for all examined patients. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate was received by 70 patients. Menstrual function was restored in 70 (100%) patients. Pregnancy occurred in 60 (86.0%) of them.

Conclusion. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate allowed to restore menstrual function (100% of cases), pregnancy at 4.3 times (86.0% of cases), which confirms its high efficiency in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.

Gynecology. 2021;23(1):68-72
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Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations
Seregin A.A., Nadezhdenskaia A.B., Makarova A.S., Sheshko P.L., Tregubova A.V., Kirilova E.V., Kopnenkova D.K., Pronin S.M., Khabas G.N., Asaturova A.V., Ovodenko D.L.
Abstract

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it.

Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group – 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers.

Results. The duration of laparoscopic operations performed using plastic containers «main group» was 85.69±25.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time «control group» – 88.75±30.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.69±67.50 ml in the main group, 125.00±99.54 ml in the control. The duration of hospitalization in the main group was 4.66±1.76 days, in the control group 5.79±3.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%).

Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

Gynecology. 2021;23(1):73-77
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Comparison of the results of clinical and morphological methods of research in HPV-associated diseases of the cervix (retrospective study)
Attoeva D.I., Asaturova A.V., Prilepskaya V.N., Starodubtseva N.L., Sheshko P.L., Uruymagova A.T.
Abstract

Aim. To conduct a retrospective analysis and evaluate the morphological methods for HPV-related intraepithelial lesions detection in women of reproductive age.

Materials and methods. The data of cytological diagnosis, as well as the results of histological reports were analyzed for the period from 2018 to 2019. A comparative analysis was performed in 415 patients with HPV-related intraepithelial lesions, who applied to the scientific and polyclinic department of the Kulakov National Research Medical Center at the age of 19 to 45 years. Morphological examination was carried out by specialists of the 1st pathology department of the Center.

Results. According to the results of a comparative analysis of cytological and histological conclusions, 3 groups were formed: 1 – the group of coincidence (agree) of cytological and histological conclusions; 2 – group of minor discrepancies (minor under/ over) between cytological and histological finding; 3 – group of major discrepancies (major under/ over) between cytological and histological findings. Cytological and histological compliance was achieved in 194 (46.74%) patients. The total number of minor nonconformities was 192 (46%) cases. The total number of significant discrepancies between cytological and histological findings was 29 (6.9%) patients: 20 (4.8%) cases were found in the group «NILM, hr. cervicitis – HSIL» and 9 (2.1%) cases in the group «HSIL – hr. cervicitis according to the results of histological examination».

Conclusion. Cervical screening reduces the risk of breast cancer due to cytological examination of the cervix, but histological examination is crucial in making a correct diagnosis, since its result determines the choice of treatment method. The comparative analysis showed that in all groups there were cases of hypo- and hyperdiagnostics during cytological examination although the major discrepancies which can change treatment algorithm, were found only in 6.8% cases.

Gynecology. 2021;23(1):78-82
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CLINICAL LECTURE
What a patient needs to know about the virus human papillomas and cervical cancer?
Sinchikhin S.P., Stepanyan L.V.
Abstract

According to experts of the World Health Organization, cervical cancer is the only cancer that can be completely prevented through the introduction of mass screening and educational information in the population. One of the activities of the obstetrician-gynecologist is the conduct of health education. However, for a variety of reasons, a practical doctor may have difficulty preparing for informational and educational meetings with patients.

Aim. To prepare a clinical lecture for the obstetrician-gynecologist, which can be used in educational work with the population on the prevention of human papillomavirus infection and cervical cancer.

Materials and methods. The information material includes data from foreign and domestic scientific articles available at PubMed on this topic and published over the past 10 years.

Results. A systematic analysis of the data contained in the modern literature on human papillomavirus, human papillomavirus infection and cervical cancer has been carried out. Information is presented on the prevalence of diseases, diagnostic methods, and features of the course of human papillomavirus infection, the role of human papillomavirus in the development of cervical cancer. Attention is drawn to the importance of preventive examinations. Part of the information is presented in the form of answers to patients’ questions, which makes the information presented especially memorable.

Conclusion. It is hoped that the prepared lecture will be useful for the educational work of the obstetrician-gynecologist and will increase the educational information of the population on the prevention of cervical cancer.

Gynecology. 2021;23(1):83-87
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CLINICAL CASE
Pregnancy and childbirth with genital prolapse
Chechulina O.V., Iupatov E.I., Davliatshina L.R.
Abstract

Pelvic organ prolapse is a pathology that extremely worsens the quality of life of a woman at any age. Usually, this pathology is encountered in patients of the older age group, where the correction of the pathology is reduced to improving the quality of life. Other challenges are pelvic organ prolapse in women of reproductive age, and especially in combination with pregnancy. The task of obstetricians and gynecologists in this situation is not only to preserve and prolong pregnancy, to choose an adequate method of delivery that is optimal for the mother and newborn, but also to correct the anatomical location of the genitals, which requires certain surgical skills. The given clinical observation demonstrates the course of pregnancy and childbirth in a patient with pelvic organ prolapse of stage II according to the POP-Q classification, contains brief judgments on the management of pregnancy at the outpatient stage.

Gynecology. 2021;23(1):88-91
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The efficacy of alternative treatment tactics for uterine infertility
Orazov M.R., Krasnopol’skaia K.V., Silant’eva E.S., Mikhaleva L.M., Orekhov R.E., Lagutina E.V., Semenov P.A.
Abstract

Chronic endometritis is associated with adverse reproductive outcomes such as implantation failure and miscarriage. A high percentage of ineffective use of assisted reproductive technologies in chronic endometritis determines the need to study morphogenesis, timely diagnosis and pathogenetic therapy of this disease. The article presents a modern view of etiopathogenesis, diagnosis, treatment tactics, as well as a clinical case of managing a patient with uterine infertility associated with repeated implantation failures, according to domestic and foreign literature.

 

Gynecology. 2021;23(1):92-96
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Laparoscopic treatment of vesicouterine fistula (a literature review and case report)
Kholtobin D.P., Nabiev A.O., Nekludov S.A., Kulchavenya E.V.
Abstract

Urogenital fistulas are common complication of obstetric and gynecological surgery; the most common are vesicovaginal fistulas. Vesicouterine fistulas are rare, which explains the difficulties in diagnosis and treatment. The literature review and own clinical case presented in article. A 43-years-old female patient was consulted with complaint of urinary leakage from vagina, which appeared 1 month after the cesarean section and vesicouterine fistula has been diagnosed. Successful laparoscopic treatment of vesicouterine fistula was performed at the Avicenna Medical Center after 3 months. The urethral catheter was removed 7 days after surgery. At control examination after 1, 3 and 6 months, ultrasound examination of the pelvic organs confirmed the consistency of the scar on the uterus. Urination remained free and painless, the patient did not notice urine leakage. This clinical observation shows the possibility of treating a vesicouterine fistula with a laparoscopic approach with a good result and the possibility of early rehabilitation.

Gynecology. 2021;23(1):97-101
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IN AID OF THE CLINICIAN
The contribution of chronic endometritis to reproductive system disorders in patients with repeated implantation failures
Radzinsky V.E., Orazov M.R., Toktar L.R., Mikhaleva L.M., Silant’eva E.S., Orekhov R.E., Semenov P.A., Lagutina E.V.
Abstract

Chronic endometritis (CE) is a disease of continuous and invisible inflammation characterized by infiltration of plasma cells in the stromal region of the endometrium. Numerous studies have proven that CE leads to repeated implantation failures. While it is believed that the etiology of CE is mainly associated with microorganisms, the key links in pathogenesis are yet not fully understood, although there is a modern evidence that CE causes local immune disorders and impaired endometrial decidualization. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistant pathogens, or in the case of viral chronic endometritis, regimens with additional treatment that affect other etiopathogenetic pathways of CE development and maintenance are necessary. One of the methods that affects etiopathogenesis of CE is a cytokine therapy. In this review, the authors tried to consider CE with special emphasis on the etiology, epidemiology, clinical features, pathophysiology, and treatment of CE and reproductive disorders in women in association with repeated implantation failures. The review ends with a description of the clinical case.

Gynecology. 2021;23(1):102-106
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