Gynecology

The review is devoted to modern notions of vaginal microbiocenosis and the use of hormonal contraception as well as modern methods of researching and assessing vaginal microbiocenosis.

On the basis of molecular biological studies of 80 patients with cervical intraepithelial neoplasia II-III an algorithm was developed, using a personalized approach to the correction of vaginal microbiocenosis based on molecular biological studies of vaginal microbiocenosis and restore the pH, followed by degradation via radiowave surgery. The selected tactics allowed to reduce the frequency of recurrence of violations of the vagina dysbiotic for 9 times, complications after inflammatory destruction for 4 times.

The deterioration of women's reproductive health in recent years all over the world is due to the steady growth of the virus of genital infections and above all - herpes and human papillomavirus, leading to severe genital lesions, complications of pregnancy and perinatal pathology. The treatment of viral infection is a challenge, due to the damage to the immune system in patients. Review of the literature demonstrates the feasibility of using antiviral drugs, interferons and immune modulators to reduce or prevent the likelihood of emergence of resistant mutants of herpes viruses and human papillomavirus and increase the effectiveness of therapy.

In Sklifosovsky RIEM for 10 years 27 women were operated on with spontaneous pneumothorax. Thoracic endometriosis was in 4 females, pneumothorax evolved during menstruation, but without the macroscopic features and morphological verification of thoracic endometriosis - in one woman. Overall endometriosis related complications amount to 5 patients (18,5%). This article describes two clinical observation of patients with catamenial spontaneous pneumothorax caused by thoracic endometriosis. This article shows the complexity of the diagnosis and treatment of this pathologic condition. Use of simultaneus approach of gynecologist, thoraxic surgeons, and radiologist - a way to successful treatment of such complications.

Hormone therapy is widely used in obstetric practice for the treatment of miscarriage, but, despite the known facts about the decisive influence of hormones on the sexual differentiation of the brain, long-term effects of intrauterine exposure to steroid drugs (drugs) on the formation of sexual behavior insufficiently studied. Therefore, the purpose of the study was to assess the performance of psychosexual development of children whose mothers received hormonal drugs during pregnancy. The cross-sectional study included 148 children whose mothers took estrogens and/or progestogens, and/or glucocorticoids, or did not take steroids (control group). The evaluation of indicators of mental development of children using the methods of «Age and gender identification», «Figure-posture-clothing», «Picture yourself», «Drawing the human behind the front» has been held.Results. Most of the children's sexual development was in line with the norm, gender and age identification formed by age and without features, elements of sexual dysontogenesis observed in isolated cases. Deviations were more common in girls whose mothers took estrogens and progestogens, and boys whose mothers received corticosteroids, but the proportion of these children were not significantly different from the proportion of children in the group of women who did not receive hormone therapy.Conclusion. The data obtained refute assumptions about the relationship of hormonal drugs during pregnancy with the development of disorders of puberty and sexual behavior anomalies in the offspring.

The data on the efficacy of micronized progesterone (Prajisun) for the prevention of miscarriage in women with a obstetric and gynecological history. Materials and methods. The study involved 56 women aged 19-38 years at 4-14 weeks of pregnancy, of which the main group of 30 were: infertility in anamnesis - 17 thrombophilic states against the background of the centers of urogenital infection - 7, uterine malformations - 6 pregnant. A control group comprised 26 healthy women without a history of complications during current pregnancy. All patients have gone through the physical examination, including the definition of the parameters of hemostasis D-dimer, AIII, protein C and S. In the study, blood levels of progesterone, interleukin-1b, interferon-y before and after treatment with micronized progesterone. Changes in the hemostatic system is also evaluated in the dynamics of observation and treatment.The results of the study. Among women, in the main group lower levels of progesterone in the blood were found, with the most pronounced case being retrochorial hematoma. The threat of abortion directly correlated with the level of progesterone and content of proinflammatory cytokines in the blood, the values of which are several times higher than health indicators: , interleukin-1b - 5, interferon-y - 3,7 times. Against the background of treatment with 400 mg Prajisun vaginally within two weeks there was a significant decline in pro-inflammatory cytokines, increased progesterone levels, normal levels of fibrinogen, D-dimer and spontaneous rate of platelet aggregation. Pregnancy progressed successfully in all women.Conclusion. The use of micronized progesterone Prajisun in early pregnancy in women with obstetric and gynecological history pathogenetically substantiated and effective in reducing high risk of miscarriage.

The article presents the issues of application of endovascular mini-invasive method - uterine artery embolization (UAE) in the treatment of patients with uterine leiomyoma (UL). Reflected controversial aspects of the use of UAE depending on the location and size of fibroids. Presented testimony and contraindications for UAE in patients with UL, technical difficulties and complications that arise in its implementation.

The objective of this study was to estimate the circadian rhythm of urine formation and its association with the quality of life in incontinent women. 277 patients with complaints of urinary incontinence were analysed according to a specific protocol: urodynamic testing, transperineal ureterovesical segment ultrasonography, a 3-day frequency-volume (FV) chart. Subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. The overall prevalence of nocturia was 39,7%. The nocturics were classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 30%, a low functional bladder capacity in 23,6%, a combination of both in 24,5%, polyuria in 21,8% of the cases. In 54,5% of nocturics nocturia is due to change of physiological urine formation rhythm-nocturnal polyuria. So nocturnal polyuria is a frequent symptom among urinaryincontinent patients, with a negative impact on several aspects of the quality of life.

The article presents the indications, contraindications, specific techniques for using various physical factors in various, individually controlled and differentiated ways, in patients after abortion up to 12 weeks by different methods. Physical factors are used at all in order to prevent possible complications, as well as for the treatment of already established complications in women with a history of somatic and gynecological diseases in combination with drug therapy. Displaying differential use of medical factors, depending on the age of patients, parity, type of abortion, individual response to physiotherapy.

The efficacy and safety of laktagel in the treatment of bacterial vaginosis was studied. Two components proved more effective in treatments based on the use of metronidazole and ornidazole with lactic acid, compared with the monotherapy group of 5-nitroimidazole. The combined use of local ornidazole and lactic acid is a safe method to achieve high efficiency and reduce the frequency of relapses in the separated BV period. BV complex therapy and examination algorithm in patients of various age is presented.

Очередной XXI Всероссийский научный конгресс с международным участием «Амбулаторно-поликлиническая помощь: от менархе до менопаузы» состоялся в Москве в период с 3 по 6 марта 2015 г. Конгресс был организован Министерством здравоохранения Российской Федерации, ФГБУ «Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова» Минздрава России, Российским обществом акушеров-гинекологов, Российской ассоциацией по кольпоскопии и патологии шейки матки, Российским обществом по контрацепции. Он собрал 898 участников из 67 субъектов РФ и 150 городов, а также специалистов из 8 стран мира (Россия, Австрия, Беларусь, Казахстан, Молдавия, Украина, Франция, Швейцария).В рамках Конгресса было проведено более 35 научно-практических мероприятий: пленарные, секционные заседания, семинары, круглые столы, школы и мастер-классы и т.п., на которых было сделано свыше 200 докладов. Ведущими зарубежными экспертами в области акушерства, гинекологии и перинатологии были прочитаны лекции для практикующих врачей.