Vol 20, No 1 (2018)

Articles
Yubiley Galiny Mikhaylovny Savel'evoy
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Abstract
Gynecology. 2018;20(1):4
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Genitourinary menopausal syndrome: the potential of estriol
Prilepskaya V.N.
Abstract
Genitourinary menopausal syndrome is estrogen-dependent age-related changes due to estrogen deficiency and affecting the urethra, bladder, vagina. As for the leading methods of treatment, the diseases include estrogen hormone therapy, among which estriol deserves attention in view of its specific features of the action on target organs and the absence of a proliferative effect on the endometrium and mammary glands.
Gynecology. 2018;20(1):5-8
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Dysmenorrhea, endometriosis, adenomyosis: clinical and pathogenetic relationships
Unanian A.L., Sidorova I.S., Nikonets A.D., Kostina Y.V., Kuzenkova N.N., Elisavetskaia A.M., Baburin D.V.
Abstract
This publication is devoted to the most common problem in women of reproductive age - dysmenorrhea. Unfortunately, the underestimation of the importance of dysmenorrhea often occurs on the part of both patients and doctors. Meanwhile, dysmenorrhea causes not only a decrease in the quality of life, but also a number of serious disorders, including the risk of developing endometriosis, adenomyosis and even tumorous diseases. With such articles as prevention and prevention of diseases.
Gynecology. 2018;20(1):9-15
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Pathophysiological features of development of functional hypothalamic amenorrhea in patients with anorexia nervosa
Chernukha G.E., Gusev D.V., Tabeeva G.I., Prilutskaia V.Y.
Abstract
The energy deficit is the result of insufficient energy intake compared to its high costs. The development of energy deficiency is often associated with the desire to lose weight, a strict diet, as well as the woman's concern about her weight along with a change in eating behavior. The result of eating disorders in combination with a decrease in body weight is anorexia nervosa, accompanied by an energy deficit. Physiological changes occurring against a background of chronic energy deficiency contribute to the inclusion of compensatory mechanisms of energy conservation to provide vital physiological functions. The most frequent metabolic changes include hypoleptinemia in the presence of a decrease in the percentage of fat tissue, a decrease in triiodothyronine, and an increase in the concentrations of ghrelin, peptide YY and neuropeptide Y. The effect of energy and metabolic changes leads to suppression of the hypothalamic-pituitary-ovarian axis, gonadotropin releasing hormone secretion, with the subsequent suppression of the release of luteinizing and follicle stimulating hormones. The suppression of the hypothalamic-pituitary-ovarian axis leads to chronic estrogen deficiency, which is accompanied by the development of functional hypothalamic amenorrhea.
Gynecology. 2018;20(1):16-22
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Vitamin D and estrogen-dependent tumors
Gromova O.A., Torshin I.Y., Frolova D.E., Lapochkina N.P., Gromov A.N.
Abstract
Vitamin D is characterized by undeniable antitumor properties that are important for both prevention and treatment of tumor diseases. The results of a systematic analysis of the molecular mechanisms of antitumor effects of vitamin D (inhibition of the Wnt/b-catenin cascade, the transcription factor WSTF) and the results of clinical studies of patients with estrogen-dependent tumors are presented, indicating the promise of combined use of estrogen and vitamin D.
Gynecology. 2018;20(1):23-30
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Primary dysmenorrhea: strategy and tactics of treatment
Dobrokhotova Y.E., Borovkova E.I., Zalesskaia S.A.
Abstract
The article summarizes the results of numerous randomized studies and structured the approach to the tactics of managing patients with primary dysmenorrhea. The starting therapy is the administration of non-steroidal anti-inflammatory drugs and/or estrogen-progestational drugs. In the absence of the effect of therapy for 3 months, it is advisable to switch to a drug of another group or a combination of drugs. Failure to achieve the desired therapeutic result within 6 months is the basis for clarifying the diagnosis. The article is illustrated by the clinical case of a patient with primary dysmenorrhea.
Gynecology. 2018;20(1):31-34
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Oxidative stress in the syndrome of polycystic ovaries: prognostic value, correction possibilities
Zakharov I.S., Bukreeva E.L.
Abstract
Polycystic ovary syndrome (PCOS) is a widespread multifactorial endocrine pathology, which includes both reproductive system disorders and non-reproductive disorders. Among the links in the pathogenesis of metabolic disorders in PCOS, the so-called mitochondrial dysfunction plays an important role, which has a close connection with the formation of oxidative stress. In this regard, the markers of the oxidative stress should be used in the complex diagnosis of PCOS and associated complications. The use of antioxidants in complex correction and prevention of disorders accompanying this syndrome deserves special attention.
Gynecology. 2018;20(1):35-38
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Molecular mechanisms for pharmacological effects of drugs based on Cimicifuga racemosa extracts
Gromova O.A., Torshin I.Y., Tetruashvili N.K., Fedotova L.E., Lapochkina N.P.
Abstract
An estrogen-like activity is considered to be the main mechanism of action for Cimicifuga extract. At the same time, results of modern studies of molecular composition together with modern fundamental data indicate such critical mechanisms of action as activation of serotoninergic and GABA-ergic ways of neurotransmission, as well as anti-inflammatory and antidiabetic effects. The use of drugs based on C. racemosa extracts is perspective for accompanying replacement hormonal therapy with estrogens due to antineoplastic and osteoprotective effects of standardized C. racemosa extracts.
Gynecology. 2018;20(1):39-46
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Contraception and folates: new opportunities for prevention and treatment
Prilepskaia V.N., Nazarenko E.G.
Abstract
The article presents the latest information on new contraceptive drugs containing folic acid in the form of levomefolate calcium, which have not only contraceptive properties, but also have new capabilities for preparing for a future pregnancy and preventing neural tube defects in the fetus, as well as treating cosmetic defects such as mild and moderate acne vulgaris, depressive disorders, fluid retention in the body.
Gynecology. 2018;20(1):47-49
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An infected late miscarriage associated with a genetically determined enhanced immune response in patients with recurrent viral and bacterial infections
Tsechoeva L.S., Glushakov R.I., Tapilskaya N.I.
Abstract
Microbiological and genetic examinations of patients previously treated for an infected late miscarriage were performed. Materials and methods. Women (n=36) with viral excretion of cytomegalovirus, bacterial vaginosis, two or more relapses of herpes virus infection localized in the genital area within 6 months, and absence of any other reproductively significant infections were selected. All patients underwent vaginal microbiocenosis studies in dynamics, as well as polymorphisms associated with the enhanced immune response, NOS3 (4a/4b), PAI-1 (4G/5G), IL1B (C3954T, C511T), TNFA (G238A, G308A), PPARG (Pro12Ala), PGC1A (Gly482Ser), GSTM1 (del), GSTT1 (del), MMP1 (1G/2G). Results. In the course of the correlation analysis within the group between qualitative signs (recurrent bacterial vaginosis) and the presence of genetic polymorphisms, it was established that the presence of polymorphisms in matrix metalloproteinase - collagenase-1 (r=0.59) and tumor necrosis factor a (r=0.51) genes is associated with a recurrent course bacterial vaginosis. There is no reliable correlation between the polymorphism of the studied genes and the virus release of the cytomegalovirus. The conclusion. As a preparation for pregnancy, patients with an infected miscarriage in anamnesis or with recurrent viral and bacterial infections require the appointment of therapy aimed at regulating the immune response. One of the drugs of choice is inosine pranobex (Isoprinosine®), which stimulates cellular immune response that contributes to a change in the cytokine profile and increases the functional activity of the effector cells.
Gynecology. 2018;20(1):51-56
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Risk factors for adverse pregnancy outcomes in women with intrahepatic cholestasis of pregnant women
Uspenskaya Y.B., Sheptulin A.A., Kuznetsova I.V., Gitel E.P., Goncharenko N.V., Gerasimov A.N.
Abstract
Intrahepatic cholestasis of pregnant women (ICPW) is associated with an increased risk of complications of pregnancy. Objective prognostic markers of adverse pregnancy outcomes except for a high level of bile acids (BA) in the mother's blood serum, exceeding 40 μmol/l, do not currently exist. However, the determination of the BA levels is not available in all laboratories, which indicates the need to search for other informative prognostic markers of complications of pregnancy in patients with ICPW. Objective: to determine the risk factors for adverse pregnancy outcomes in ICPW. Materials and methods. A prospective study included 97 pregnant women diagnosed with ICPW. The diagnosis was established with an increase in the serum level of the BA in excess of 10 μmol/l. Patients underwent clinical and laboratory examinations with assessment of biochemical markers of liver damage, antioxidant status (determination of superoxide dismutase, glutathione peroxidase, selenium, zinc level). Biochemical indices and severity of pruritus were assessed at the time of diagnosis of ICPW, after 1 and 2 weeks of treatment with ursodeoxycholic acid (UDCA) at a dose of 500 mg to 2 g per day. In the study of perinatal outcomes, the term of delivery, the method of delivery, the presence of signs of intrauterine fetal hypoxia, the state of the fetus at the time of birth were taken into account. Results of the study. In the observed group of patients, the incidence of preterm birth was 31.9%, intrauterine fetal hypoxia 29.9%, pre-eclampsia 23.7%, the need for a cesarean section due to the development of pregnancy complications arose in 40 (41.2%) cases. The risk factors for complications of pregnancy in patients with ICPW were: early onset and longer duration of ICPW, reactivation of cholestasis after its regression against the background of UDCA treatment and less effective treatment of skin itching in patients with manifest forms of ICPW. The laboratory markers of adverse pregnancy outcomes were a high level of maternal total serum BA and a low efficiency of its reduction against the background of treatment, a slow rate of decrease in hepatic transaminase activity against the background of treatment, a low level of antioxidant protection enzymes. The use of sex hormones during pregnancy promoted more frequent development of preeclampsia and increased the frequency of indications for cesarean delivery. The conclusion. Patients with early manifestation of ICPW and reactivation of cholestasis after its regression on the background of treatment, low effectiveness of treatment of pruritus, and also taking drugs of sex hormones require special attention and active management in connection with an increased risk of complications of pregnancy. It is advisable to carry out dynamic monitoring of the level of BA, hepatic transaminases and antioxidant enzymes in dynamics against the backdrop of treatment with ICPW to assess the effectiveness of treatment and timely prediction of possible complications of pregnancy.
Gynecology. 2018;20(1):57-61
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The features of adhesions’ prevention and treatment in patients with chronic inflammatory pelvic diseases
Sulima A.N., Davydova A.A., Rybalka A.N., Beglitse D.A., Baskakov P.N.
Abstract
Pelvic inflammatory diseases (PID) are on the second place in the structure of gynecological incidence. It has been proven, that PID develops in case of disturbed immune balance and often complicated by pelvic adhesions. Aim - to study in a comparative aspect the features of expression and distribution of proinflammatory cytokines (IL-1, IL-2, IL-6 and TNF-a) in the tissue of intact pelvic peritoneum and adhesions in women of reproductive age with PID, and evaluate the effectiveness of the proposed method of prevention of pelvic adhesions at women of reproductive age. Materials and methods. One hundred patients of reproductive age suffering from tubal and peritoneal form of infertility, who had a history of chronic PID and pelvic adhesions and thirty healthy women in the control group, were included at this study. Results. The presence of macrophages and proinflammatory cytokines IL-1, IL-2, IL-6 and TNF-a in adhesions of the abdominal cavity in patients with PID is the evidence of their internal inflammatory activity. According to the received data, the number of patients without pelvic adhesions was 4.3 times higher in the main group compared to the control group. Сonclusion. The proposed scheme of pelvic adhesions’ prevention, taking into account the pathogenic role of inflammatory disorders in the adhesiogenesis, allows to reduce the adhesion after the surgical treatment in 4.3 times and the density of the reformed adhesions in 8 times.
Gynecology. 2018;20(1):62-6
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The possibilities of clindamycin and butoconazole containing vaginal cream in reducing the risk of recurrence of urogenital candidiasis in comorbid patients with bacterial vaginosis
Sergiyenko G.S., Tazina T.V., Zhuchkov M.V.
Abstract
Purpose - a study of the efficacy of clindamycin cream with butoconazole (Clindacin B prolong) in the treatment of urogenital candidiasis in combination with bacterial vaginosis (BV) in women of reproductive age outside of pregnancy, the study of the potential of Clindacin B prolong in reducing the risk of recurrence of urogenital candidiasis in comorbid patients with BV. Material and methods. The study included 53 patients aged 18 to 45 years (mean age 31.5±9.4 years) with urogenital candidiasis in combination with BV. All women underwent antibacterial therapy with Clindacin B prolong at 1 dose (5.0 g) in the vagina at night for 3 days. Results. After 3-day therapy with Clindacin B prolong, a 100% cure effect has been achieved, both clinically and laboratory-wise. Then the patients were observed for 6 months. The relapse rate was 10.2%. The conclusion. The clinical efficacy of clindamycin cream with butoconazole (Clindacin B prolong preparation) in the treatment of urogenital candidiasis in combination with BV in women of reproductive age outside of pregnancy was 89.8% with observation for 6 months.
Gynecology. 2018;20(1):68-70
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Diagnostic significance of markers of inflammation in the cervical canal in pregnant women with bacterial vaginosis
Karapetian T.E., Lomova N.A., Kesova M.I.
Abstract
The aim of the study was to determine the proinflammatory and anti-inflammatory cytokines in the cervical canal as indicators of the state of local immunity in pregnant women with bacterial vaginosis (BV). Material and methods. The study included 45 pregnant women, who applied early in gestation. The main group consisted of 32 pregnant women, who had verified the diagnosis of BV, the comparison group - 13 pregnant women with normal vaginal microbiocenosis. In the mucus from the cervical canal, the content of pro-inflammatory cytokines (tumor necrosis factor a, interferon-g, interleukins - IL-1a, IL-2, IL-6, IL-8) and anti-inflammatory cytokines (IL-4, IL-10) was determined. Results. Local immunity before treatment of pregnant women with BV was characterized by a significant increase in the level of pro- and anti-inflammatory cytokines in relation to their production in pregnant women with normal vaginal microcenosis. After treatment with BV, cytokine levels were approaching those of healthy pregnant women, but the levels of tumor necrosis factor a and IL-8 changed little, which is probably due to the low production of these cytokines, since the leukocyte reaction in the epithelial vaginal locus is not expressed in vaginosis. The conclusion. Qualitative and quantitative changes in cytokine levels reflect the degree of activation of immunocompetent cells in any pathological process. The results obtained in this study reflect a certain autonomy of immune responses in the lower sections of the female genital tract.
Gynecology. 2018;20(1):71-74
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Infections of the genital tract in women with verified laparoscopy of the pathology of the fallopian tubes and normal laparoscopic results
Dubrovina S.O., Ardintseva O.A.
Abstract
Introduction. Pipe and peritoneal factors are important causes of infertility and inflammatory diseases of the pelvic organs (PID). It is well known that Neisseria gonorrhoeae and Chlamydia trachomatis are etiologic agents of pelvic inflammation leading to infertility. There is a very limited number of publications about which representatives of sexually transmitted infections (STIs) or other microorganisms can be found in the fallopian tubes during reconstructive plastic surgery. Knowledge in this area is necessary for the proper selection of antibiotic therapy during and after operations. The purpose of our study is to determine the microbial landscape of the contents of the fallopian tubes in infertile patients with a tubal peritoneal infertility factor diagnosed during laparoscopy and normal uterine tubes. Materials and methods. 22 women with infertility were included in the study. 12 of them (the main group) had tubal peritoneal pathology, 10 women had no pathology of the fallopian tubes (control group). The average age of patients in the first group was 25 years (20-29), in the control group - 31 years (20-36). For all women, laparoscopy was part of the infertility survey. In the 1 st group, the changes in the fallopian tubes according to the type of fibrosis, hydrosalpinx or adhesions in the region of the periampulal or fimbrial part were identified. During laparoscopy, the fallopian tubes were washed with 2-4 ml of saline immediately after laparoscopic and laparoscopic instruments. Through the lateral trocar, the material was taken from the fallopian tubes using a bacteriological loop to perform bacteriological inoculation. Identification of the DNA of the pathogens was carried out by the polymerase chain reaction method according to the instructions. Identification and sensitivity determination of the isolated cultures was performed using an automatic bacteriological analyzer Vitek 2 Compact 30. Results. In all women without an identification of STIs and PID in the history and absence of abnormalities of the fallopian tubes in laparoscopy (control group), we did not find any microorganisms in the fallopian tubes. We did not detect C. trachomatis, N. gonorrhoeae or Trichomonas vaginalis in the fallopian tubes. However, we found twice Ureaplasma urealyticum in the fallopian tubes (16.7%), while in the control group this microorganism was also detected once. An important feature of salpingitis is extensive tissue remodeling, leading to chronic effects, such as scarring and obstruction, during which STIs and other microorganisms are eliminated by the immune system. In this study, we identified twice in the fallopian tubes of U. urealyticum. Perhaps U. urealyticum persists after antibiotic therapy and selective elimination of the main pathogens, since certain antibiotics affect the cell wall that is absent in this microorganism.
Gynecology. 2018;20(1):75-77
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Structural changes in uterine tissues after uterine artery embolization in patients with leiomyoma complicated by uterine bleeding
Titova G.P., Damirov M.M., Kokov L.S., Oleynikova O.N., Belozerov G.E.
Abstract
Uterine leiomyoma (UL) is often complicated by the development of uterine bleeding. In urgent gynecology for the implementation of endovascular hemostasis, uterine artery embolization (UAE) is used. Performing UAE allows to stop and/or significantly reduce the intensity of bleeding and prepare a patient for surgical intervention. At the same time, the morphological changes that occur in uterine tissues in operated UL patients after performing the UAE are not studied. The aim was to study the peculiarities of pathomorphological changes in uterine tumors and tissues in operated UL patients complicated by uterine bleeding after performing UAE. Material and methods. The results of morphological changes appearing in tumors and tissues of the uterus in 39 operated UL patients, who were used for stopping uterine bleeding, were analyzed. Results. After applying different types of embolizing agents in macroscopic study of the uterus, signs of ischemia of its tissues were revealed, and the most pronounced disorders were detected in the UL nodes. Morphologically it was established that UAE microemboli resulted in vessel occlusion with increasing thrombosis in their distal sections. UAE was not accompanied by occlusal occlusion of the arteries and resulted in small-scale necrosis of the tumor with complete regeneration of the endometrium. Conclusions. The results of the morphological study showed that after the UAE was performed, the myomatous nodes underwent dystrophic, necrobiotic and necrotic changes. Depending on the nature of occlusion of the uterine arteries, various variants of necrosis (scale and completeness of the process) developed in the tumor tissue, which was aseptic in nature.
Gynecology. 2018;20(1):78-82
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The method of hermetic sealing of iatrogenic damage of fetal membranes during fetal surgical interventions
Shneyderman M.G., Fatkhudinov T.K., Tetruashvili N.K., Kostyukov K.V., Sakalo V.A., Arutyunyan I.V., Gladkova K.A., Shmakov R.G.
Abstract
The article presents a new method for treating iatrogenic damage to membranes in fetuscopic interventions. Since surgical treatment during pregnancy is associated with the use of trocar and amniotic fetal puncture, the most frequent complication of this procedure is premature discharge of amniotic fluid and abortion (28-67%). The new method of treatment is based on the use of the technique of safe and effective hermetic sealing of fetal membranes in fetoscopy, which will reduce the frequency of iatrogenic complications. The Ministry of Health of the Russian Federation has developed a method and created the main components for hermetic sealing of membranes: a tissue sealant from the blood components of the mother - a plasma enriched with platelets, which can be injected into the area of the defect of the fetal bladder in the form of a gel and an amniotic catheter providing effective sealing of the trocar hole from the inner and outer surfaces of the membranes. We described the results of a laboratory experiment on animals, discussed the effectiveness of a new method of treatment and the possibility of its practical application.
Gynecology. 2018;20(1):84-87
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The surgeon's look at the unresolved issues of prolapse of pelvic organs
Chursin V.V., Zhorova V.E., Buralkina N.A., Chursin D.V., Chuprynin V.D.
Abstract
The article highlights modern ideas about the etiology and pathogenesis of pelvic prolapse, risk factors, clinical manifestations, surgical methods of correction.
Gynecology. 2018;20(1):88-91
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Urinary incontinence. Methods of treatment
Ilyina I.Y., Dobrokhotova Y.E., Narimanova M.R., Chikisheva A.A., Malikova V.O., Goncharov I.Y.
Abstract
Urinary incontinence is a serious social and medical problem in Russia and throughout the world. However, even a small percentage of women who purposefully go to the doctor about having incontinence symptoms, only 2% of patients receiving the qualified urological aid. Medical therapy is used as the primary method for all patients with an overactive bladder. As the drugs of choice, the use of M-cholinolytics affecting muscarinic receptors of the bladder is recommended. The article presents data indicating the possibility of using trospium chloride in patients of different age categories. Objective - to determine the effectiveness of the use of M-cholinolytic drug (trospium chloride) in women of different age categories. Material and methods. The study included 68 patients with symptoms of a hyperactive bladder, which, depending on their age, were divided into 2 groups. All patients received trospium chloride (Spasmex®) for 6 months. Results. After 3 and 6 months of the use of trospium chloride in patients of both groups, the complaints decreased significantly. Attention is drawn to the fact that the decrease in the number of complaints during the treatment significantly decreased more in the first three months. In women of the reproductive period, the results are more significant than in postmenopausal patients, which can be explained by the presence of hypoestrogenic condition in patients of the 2nd group, which can make the pathology worse and require the appointment of etiopathogenetic treatment. Conclusion. Trospium chloride can be recommended to patients reproductive and postmenopausal periods for relief of symptoms of overactive bladder with the contraindications. In postmenopausal women, in addition to taking trospium chloride, the need to prescribe menopausal hormone therapy (systemic, local) should be considered to compensate for the deficiency of estrogen. In the presence of prolapse of the genitals and stress component of urinary incontinence, it is necessary to resolve the issue of the need for timely surgical treatment aimed at coping with stress urinary incontinence and correction of prolapse of the genitals.
Gynecology. 2018;20(1):92-95
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Method of photothermal tissue reconstruction in modern medical practice using ER:YAG laser
Kulikov I.A., Spokoynyy L.B., Gorbunova E.A., Apolikhina I.A.
Abstract
This article is devoted to the review of domestic and foreign data on the efficacy and safety of non-invasive erbium laser therapy aimed at increasing the tone of the pelvic floor muscles. The search for literature data allowed to reveal a lot of studies describing the successful experience of non-invasive laser procedures in gynecology, as well as not only the high effectiveness of the method, but also its safety. This type of therapy represents a promising treatment technology with a high level of efficacy and an optimal safety profile.
Gynecology. 2018;20(1):96-101
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Breast cancer associated with pregnancy: a clinical case
Dobrokhotova Y.E., Arakelov S.E., Danelyan S.Z., Borovkova E.I., Zykov A.E., Zalesskaya S.A., Nagaytseva E.A.
Abstract
Associated with pregnancy is breast cancer, which was first detected during pregnancy, during the first year after childbirth or at any time against lactation. Diagnosis of the disease in the first trimester is an indication for abortion. The detection of the disease after 20 weeks and the desire of the woman to maintain pregnancy is the basis for conducting a total mastectomy followed by polychemotherapy with doxorubicin with cyclophosphamide or with fluorouracil. Radiation therapy during pregnancy is not applied. The timing and method of delivery are determined individually and depend on the stage of the process and the period of pregnancy, when it was identified. A clinical case of a patient with edematous-infiltrative form of breast cancer of the IV stage, diagnosed for the first time in 22 weeks of pregnancy, is presented.
Gynecology. 2018;20(1):102-108
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Effectiveness of programs of auxiliary reproductive technologies in patients of late reproductive age
Beik E.P., Syrkasheva A.G., Dolgushina N.V.
Abstract
The aim of the study was to study the effectiveness of assisted reproductive technologies (ART) programs in patients of different age groups, taking into account clinical and laboratory data. Materials and methods. A prospective cohort study included 188 patients with infertility of various genesis who were stratified according to age: group 1 (n=87) - patients of late reproductive age - LRA (>35 years), group 2 (n=101) - patients of early reproductive age (≤35 years). Results. In patients with ART compared with patients with LRA, the chances of pregnancy were reduced by 2.2 times (odds ratio - OR 2.2, 95% confidence interval - CI 1.1-4.3), the chances of live birth were 2 times (OR 2.0; 95% CI 1.0-3.9). The only factor affecting the onset of pregnancy in addition to age was the number of embryos received. The threshold age at which and above which the chances of pregnancy and live birth decreased as much as possible were the age of 37 years: the OR of pregnancy 2.6 (95% CI 1.4-5.1, AUC 61.3%), OR live birth 2.6 (95% CI 1.3-5.1, AUC 60.8%). Conclusions. In patients of LRA there is a twofold decrease in the effectiveness of ART programs due to a significant decrease in the number of oocytes obtained, mature oocytes, and, accordingly, embryos.
Gynecology. 2018;20(1):109-112
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Thickness of endometrium: predictor of the effectiveness of IVF/ICSI programs (literature review)
Bagdasaryan L.A., Korneyeva I.E.
Abstract
The aim of the study is to systematically analyze the data available in the modern literature on the relationship between endometrial thickness and the frequency of pregnancy in the program of assisted reproductive technologies (ART). Materials and methods. The review includes data from foreign and domestic articles found in PubMed on this topic. Results. The article presents data on the relationship between the thickness of the endometrium and the frequency of pregnancy in ART programs. The greatest number of studies is devoted to the evaluation of the relationship between the thickness of the endometrium and the frequency of pregnancy on the day of the ovulation trigger. Data are presented on the existence of a correlation between the thickness of the endometrium measured on the day of the ovulation trigger and the frequency of clinical pregnancy, as well as data on the need to evaluate the structure of the endometrium and the state of subendometric blood flow. The importance of multilayered (three-layered) endometrium as a prognostic marker of success in in vitro fertilization/intracytoplasmic sperm injection programs in the ovum is emphasized. The conclusion. The thickness of the endometrium can not be used as an argument for canceling the cycle or abolishing embryo transfer to the uterine cavity. Further studies in this direction are needed with a study of the morphological and molecular genetic characteristics of the endometrium, which in the future will allow us to evaluate the relationship between the thickness of the endometrium and the probability of pregnancy.
Gynecology. 2018;20(1):113-116
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Modern possibilities of optimization of local hormonotherapy of urogenital disorders in women on the basis of combined use of vaginal forms of estriol and progesterone
Tyuzikov I.A., Zhilenko M.I., Polikarpova S.R.
Abstract
In the review article, the problem of optimization of local hormone therapy of urogenital disorders in women from the perspective of evidence based medicine on the basis of the modern multifactorial concept of genito-urinary menopausal syndrome (GUMS), which implies an important pathogenetic role of not only the age-related estrogen deficiency, but also the deficiency of other sex hormones in the pathogenesis of disorders urogenital tract in women in peri- and postmenopausal women. The important role of bioidentical progesterone as a metabolically active hormone possessing not only classical (reproductive) physiological effects in the body of a woman but also a whole spectrum of nonclassical (nonproductive) effects that demonstrate the pathogenetic justification of the expediency of topical administration of preparations containing a bioidentical analog of natural progesterone within the framework of a complex and personalized treatment of various clinical manifestations of GUMS, especially in women with sop favoring endogenous progesterone deficiency, which can occur chronologically after the 35 years preceding the age of estrogen deficiency. The comparative characteristics of the available dosage forms of progesterone delivery are demonstrated, and the pathogenetic expediency and effectiveness of the additional prescription of topical progesterone to local estrogen therapy in the most common clinical variants of the GUMS is demonstrated using the latest research.
Gynecology. 2018;20(1):117-125
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