Gynecology

Background. Vaginal infection complicates the course of pregnancy and adversely affects perinatal outcomes for the mother and fetus. With the global increase in microorganism resistance to antimicrobial drugs, the treatment of vaginitis in pregnant women is not always effective, leading to recurrent pathology. Therefore, seeking new therapeutic solutions is a pressing task.

Aim. To evaluate the effectiveness of a new form of benzyl-dimethyl [3-(myristoylamino) propyl] ammonium chloride monohydrate (Miramistin® suppositories) in the treatment of vaginitis in pregnant women.

Materials and methods. A prospective study included 60 pregnant women with a confirmed diagnosis of nonspecific vaginitis. All patients received therapy with Miramistin® suppositories vaginally once a day for 7 days. Clinical dynamics and microbiological characteristics of the vaginal biotope were assessed.

Results. Disappearance or significant reduction of clinical symptoms was noted in 96.7% of pregnant women within two days from the start of treatment. The duration of the relapse-free period was more than 4 weeks. No adverse drug reactions were observed. There was high satisfaction with the treatment results among both physicians and patients.

Conclusion. Treating vaginitis in pregnant women using the new form of benzyl-dimethyl [3-(myristoylamino) propyl] ammonium chloride monohydrate (Miramistin® suppositories) is an effective method for controlling vaginal infection.

Background. Intrauterine infection (IUI) remains an urgent obstetric problem.

Aim. Identification of modern, reliable markers of intrauterine infection.

Materials and methods. We conducted a retrospective analysis of 510 ultrasound (US) examinations and clinical, microbiological, and morphological data of 54 pregnant women (main group) with symptoms of placental insufficiency (PI) and IUI confirmed after childbirth. The control group included 48 patients with a normal course of pregnancy and childbirth.

Results. Valuable and accessible markers of IUI and PI were identified in the main group using sonography: structural changes in the placenta [n=25 (46.3%)] and umbilical cord [n=15 (27.8%)], abnormal changes in the internal organs of the fetus (nonimmune hydrops [n=9 (16.7%)], calcifications [n=8 (14.8%)], etc.), oligohydramnios [n=26 (48.1%)], fetal growth retardation [n=11 (20.4%)], impaired fetoplacental blood flow [n=41 (75.9%)]. These changes occurred in patients with a history of pelvic inflammatory diseases [n=30 (55.6%)], mother's somatic diseases (history of urinary tract infections [n=19 (35.2%)], pregnancy complications: threatened miscarriage [n=19 (35.2%)], threatened premature birth [n=26 (48.1%)], infectious diseases in newborns. The study of afterbirth in the main group showed signs of purulent chorioamnionitis in 30 (55.6%) cases.

Conclusion. Maternal infectious diseases through the transplacental and ascending pathways increase the risk of miscarriage, preterm delivery, and fetal and neonatal disease and lead to adverse perinatal outcomes. Ultrasound predictor marker of the initial complications of PI and IUI is early oligohydramnios detected using the method of maximal vertical pocket by 3D/4D echography [in the main group, n=24 (44.4%)], which precedes the development of early fetal growth retardation [n=4 (7.4%)] and decompensation of fetoplacental blood flow [n=7 (13%)]. The timely use of ultrasound markers of IUIs helps to choose the effective approach for prenatal care and delivery.

Aim. To evaluate the effectiveness of treatment of bacterial vaginosis (BV) with the nifuratel+nystatin complex and its effect on the lactobacillus profile (LBP) in the vagina.

Materials and methods. A multicenter, prospective, observational study included 41 patients diagnosed with BV (main group) who were treated with vaginal capsules containing 500 mg of nifuratel and 200,000 IU of nystatin (Macmiror® Complex). Efficacy was assessed at 2 weeks and 4–6 weeks after treatment based on clinical data (absence of pathological discharge). The control group for the comparative assessment of LBP included 25 healthy women. Lactobacillus index (LI, the proportion of lactobacilli in the total bacterial mass) and the abundance of Lactobacillus crispatus, L. gasseri, L. jensenii, and L. iners were assessed using a polymerase chain reaction before treatment with BV, at 2 weeks and 4–6 weeks after the end of therapy, as well as in the control group. Additionally, the vaginal pH level was measured.

Results. Clinical recovery was achieved in all main group patients and persisted throughout the observation. In all patients in this group, lactobacilli comprised 0.01–100% of the total bacterial mass. The frequency of lactobacilli species in the control group was relatively uniform, with a relatively uniform abundance of lactobacilli and a slight dominance of L. crispatus, with frequent isolation of two species in samples and high LI (>70%) in 80% of females. Before treatment in the main group, the majority of vaginal samples contained one species of lactobacilli; 40% had LI<70%, and in 62.5%, L. iners was isolated. LBP did not change significantly within 2 weeks after treatment, and after 4–6 weeks, it became comparable to that in the control group. A decrease in pH was associated with LBP recovery. However, there was no strong correlation between LI and individual species of lactobacilli in samples with or without BV.

Conclusion. Nifuratel+nystatin complex is highly effective in BV treatment. The treatment had no adverse effect on LBP, which did not differ significantly immediately after treatment compared to the baseline. However, 4–6 weeks after the treatment, LBP recovered spontaneously, reaching comparable indicators with a group of clinically healthy females regarding species composition and LI.

Background. In recent decades, the frequency of intrauterine pathology (IUP) has increased: endometrial hyperplasia and polyps, submucous uterine fibroids (SMUF), and other conditions that affect 38–72% of women of reproductive age. An imbalance in cell proliferation, differentiation, and death plays an important role in the pathogenesis of IUP.

Aim. To study and assess proteins regulating cell apoptosis and proliferation in patients of reproductive age with various IUPs.

Materials and methods. We analyzed the comprehensive examination data of 87 women of reproductive age (mean age 43.8±3.27 years) undergoing inpatient treatment at the N.V. Sklifosovsky Research Institute of Emergency Medicine from 2023 to 2024 with various IUPs. All patients underwent a general clinical and comprehensive instrumental examination (pelvic ultrasound, hysteroscopy, and/or hysteroresectoscopy with separate diagnostic curettage of the endocervix and endometrium and morphological examination of biopsy specimens). Plasma concentrations of proteins activating the external pathway of apoptotic cell death were measured: soluble Fas, soluble Fas ligand, and tumor necrosis factor-related apoptosis-inducing ligand. The growth factor levels were also measured: the main fibroblast growth factor, hepatocyte growth factor, and stem cell factor. A multiplex analysis was performed on the Luminex 200 platform (xMAP technology) using the MILLIPLEX MAP Human Circulating Cancer Biomarker Magnetic Bead Panel reagent kit. Based on the results of the morphological examination, patients were divided into four groups: Group 1 included 20 (22.9%) patients diagnosed with endometrial hyperplasia (EH) without atypia based on histological examination; Group 2 included 44 (50.6%) patients with endometrial polyps (EP); Group 3 included 16 (18.4%) patients with EP and concomitant EH without atypia; Group 4 included 7 (8.0%) patients with type 0–II SMUF according to the European Society of Hysteroscopy Classification of Submucous Fibroids with a node size of up to 3.5 cm. The comparison group for assessing the apoptosis of blood lymphocytes included 20 healthy females (HW) of reproductive age.

Results. In patients with EH without atypia and EP, dysregulation of cellular homeostasis was observed due to a change in the balance of factors of cell apoptosis and proliferation. A decrease in the concentration of apoptosis trigger factors and an increase in soluble Fas, which functions as a "trap," is associated with abnormal induction of programmed death of endometrial cells. Also, the decrease in factors activating cell apoptosis may be due to decreased growth factors involved in physiological regeneration. In patients with SMUF, no changes in the regulation of apoptotic cell death were detected, while a decrease in stem cell growth factor was noted.

Conclusion. The comprehensive use of instrumental methods improves the accuracy of diagnosis of various nosological forms of IUP. The analysis of the results supports further studies in patients with various types of IUP after surgical treatment and restoration of the menstrual cycle during the outpatient follow-up.

Vaginal contraceptive rings are one of the prolonged methods of preventing unwanted pregnancies that do not require daily use. The vaginal contraceptive rings have high contraceptive efficacy and several advantages over traditional oral pills, increasing adherence to the method due to the absence of the need for daily control by the woman. Also, it has some non-contraceptive properties and features that can be used in specific clinical situations that require tailoring a contraception method. The article presents a literature review on the vaginal contraceptive method, a comparative description of combined oral contraceptives with vaginal contraceptive rings, the main advantages and disadvantages of vaginal contraceptive rings, as well as the basic rules of professional counseling.

Infectious and inflammatory diseases are significant healthcare problems exacerbated by the increase in antibiotic resistance in pathogens. The ineffectiveness of traditional antibacterial therapy leads to prolonged infections, complications, and decreased patient quality of life. The article discusses the urgency of the problem of antibacterial drug use and reviews, from a clinical and legal point of view, the prospects for the use of enzyme-based agents as additional therapy. The mechanisms of action of enzymes, their potential effectiveness against resistant pathogens, the prevention of complications, and the possibility of combined use with antibiotics, considering legal and medical aspects, are discussed. The results of the studies demonstrate the prospects of using enzyme therapy to reduce the severity of the inflammatory process, improve the microbiocenosis state, increase the effectiveness of antibacterial therapy, and prevent complications of infectious and inflammatory diseases in gynecological practice. There is a legal justification for applying certain measures to prevent complications.

Abdominal pregnancy (AP) is rare and is associated with high rates of maternal and perinatal mortality compared to other ectopic pregnancies (EP). Despite using advanced imaging techniques in prenatal diagnosis, diagnosing and treating AP remain challenging. Progressive advanced AP may remain undiagnosed for a long time due to the absence of specific clinical symptoms, errors in the interpretation of echographic patterns by radiologists, and a lack of alertness due to the rarity of this type of EP. This article describes two authors' observations of AP that resulted in critical obstetric conditions due to massive blood loss. The first case of AP in a pluripara patient concluded at week 34 with live birth and hysterectomy for placenta ingrowth (PAS2). In the second case, the AP was terminated early. In both patients, the trophoblast was implanted on the uterus; there were no known risk factors for EP, and the diagnosis of AP was established intraoperatively. According to modern Russian and foreign literature, in most cases, EP is diagnosed intraoperatively due to the lack of a standard algorithm for diagnosis and treatment. Standardization of treatment guidelines for AP trimesters II and III, perioperative treatment options, and postoperative management, based on a summary of all cases reported worldwide, could reduce the risk of maternal and fetal complications and mortality.