Vol 20, No 2 (2018)

Articles
Postpartum contraception: efficacy and safety
Nazarova N.M., Prilepskaya V.N., Nekrasova M.E.
Abstract
Timely and reasonable selection of methods of contraception after childbirth from the standpoint of safety for the mother and the child, in addition to preventing unwanted pregnancy, preserves the reproductive health of the woman. When choosing a method of contraception in the postpartum period, it is necessary to take into account the impact of the method on lactation, the condition of the mother and child. Prenatal counseling allows to increase the commitment of women selected method of postpartum contraception.
Gynecology. 2018;20(2):5-8
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Efficacy and safety of drospirenone-containing microdosage combined oral contraceptive use with starting contraception
Khachaturian A.R., Misharina E.V., Yarmolinskaya M.I.
Abstract
Androgen-dependent dermopathy, as well as premenstrual syndrome of varying severity in young women, can cause emotional depression, difficulties in social adaptation and even depressive disorders. The aim of the study was to study the safety and efficacy of using a combined oral contraceptive (COC) Dimia® containing 20 μg ethinyl estradiol and 3 mg drospirenone in young women, as well as its therapeutic effects in androgen-dependent dermopathy. Materials and methods. The study included 57 young women aged 23.1±2.2 years with signs of androgen-dependent dermopathy. The evaluation of the change in the character of menstrual bleeding, the anthropometric parameters (body weight, waist circumference and hips), the therapeutic effect of the drug on the symptoms of androgen-dependent dermopathy, as well as the dynamics of arterial pressure, hemoglobin level, serum iron have been studied. The psycho-emotional state was assessed using the SAN questionnaire (well-being-activity-mood). Results. During 6 months of observation, there was no significant change in the body mass index, waist circumference, and hips, and the drug did not affect the blood pressure numbers. Against the background of taking the drug, there was an increase in the parameters of iron metabolism (hemoglobin content, serum iron). After 3 months of taking the contraceptive with drospirenone, the number of patients with a complaint about the abundance of menstruation decreased more than twofold (from 22.8 to 10.5%), and after 6 months of taking the drug no patient noted the profuse nature of menstruation. Before the start of taking COC with drospirenone, 57.9% of women reported painful menstrual bleeding. Against the background of taking the contraceptive within 3 months, this complaint was stopped in all patients. Sufficient efficacy of treatment of androgen dependent dermopathy in young women with the help of a microdosed drospirenone-containing combined oral contraceptive is estimated from the dermatological acne index. The analysis of the SAN questionnaire made it possible to reveal the improvement in the psychoemotional state of patients on the background of taking the drug. The conclusion. The results obtained proved the effectiveness and safety of the microclinized COC Dimia®. The drug has no significant effect on body weight, blood pressure, provides reliable control of the cycle and a decrease in menstrual bleeding, which results in stabilization of iron metabolism in the body. Dimia® is effective in the treatment of androgen-dependent dermopathy and can be recommended to young women for starting contraception.
Gynecology. 2018;20(2):9-13
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Etiological structure and diagnosis of abnormal uterine bleeding
Chernukha G.E., Ivanov I.A., Efendieva Z.N., Dumanovskaya M.R., Asaturova A.V.
Abstract
Abnormal uterine bleeding (AUB) is one of the most common indications for hysteroscopy. Most of the AUB cases occur due to endometrial or myometrium pathology. Among it, endometrial polyps (EP) and chronic endometritis (CE) prevalent in reproductive age, while endometrial hyperplasia (EH) and EP dominate in perimenopause. It was determined that EP and CE are characterized with menorrhagia and metrorrhagia approximately equally, whereas EH reveals AUB with oligomenorrhoea. Verification of exact endometrial pathology by ultrasound examination is hindered, that results in deviations of ultrasound and histological diagnosis. The usage of ultrasound data and AUB’s characteristics may improve the diagnostic accuracy on preadmission period.
Gynecology. 2018;20(2):14-17
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Opportunities for prevention and correction of genitourinary menopausal syndrome
Zakharov I.S.
Abstract
In the manifestation and development of urogenital atrophic processes associated with the onset of menopause, the leading role is played by the growing deficiency of estrogens. An important circumstance is the fact that genitourinar menopausal disorders are often accompanied by other climacteric disorders. In this regard, a key place in the prevention and correction of hypoestrogenic conditions is systemic menopausal hormone therapy. Among the representatives of systemic menopausal hormone therapy, clinical efficacy and low risk of possible complications were demonstrated by preparations containing 17b-estradiol in combination with drospirenone. In the literature there is a significant number of publications reflecting the positive effect of these drugs on the condition of women with vasomotor, psychoemotional climacteric disorders, with a decrease in bone mass. Also, these drugs are used in the therapy and prevention of atrophic processes of the urogenital tract. This allows us to apply this combination of hormones in the complex correction of systemic and local genitourinary menopausal disorders.
Gynecology. 2018;20(2):18-22
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Choosing the optimal contraceptive: focus on "natural" estrogen
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Abstract
В марте 2018 г. в Москве состоялся III Общероссийский семинар «Репродуктивный потенциал России: версии и контраверсии. Весенние чтения», организованный под эгидой Минздрава России, Российского общества акушеров-гинекологов, Комитета по качеству медицинской помощи, Междисциплинарной ассоциации специалистов репродуктивной медицины и др. В научную программу мероприятия входили такие популярные и актуальные темы, как прегравидарная подготовка, преждевременные роды и невынашивание, бесплодный брак и вспомогательные репродуктивные технологии в женской консультации, пролиферативные заболевания в гинекологии, непрерывное медицинское образование и, конечно, были затронуты вопросы контрацепции.
Gynecology. 2018;20(2):23-27
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Efficacy of intrauterine administration of autologous peripheral blood mononuclear cells prior to embryo transfer in patients with recurrent implantation failures in assisted reproductive technology programmes
Amyan T.S., Perminova S.G., Krechetova L.V., Vtorushina V.V.
Abstract
Study objective. To evaluate the efficacy of intrauterine administration of autologous peripheral blood mononuclear cells (PBMC) prior to embryo transfer in patients with recurrent implantation failures in IVF program. Materials and methods. The study enrolled 129 patients with recurrent implantation failures in an IVF programme. Group 1 - 42 patients who had intrauterine administration of autologous PBMC activated with hCG (Pregnyl 500 IU). Group 2 - 42 patients who had intrauterine administration of autologous PBMC without hCG activation. Group 3 (placebo) - 45 patients who had intrauterine administration of saline. Study results. In the hCG-activated PBMC group, the rates of positive blood hCG tests, implantation, and clinical pregnancy were significantly higher than the respective rates in the non-activated PBMC group and in the placebo group, both in a stimulated cycle and in an FET cycle (р≤0.05). Conclusion. Intrauterine administration of autologous PBMC prior to embryo transfer in an IVF/ICSI programme increases the efficacy of IVF program in patients with a history of recurrent implantation failures.
Gynecology. 2018;20(2):28-33
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Effect of smoking on the development of placental lesions
Shchegolev A.I., Tumanova U.N., Mishnev O.D.
Abstract
The literature data on the effect of smoking on the development of placental lesions and complications of pregnancy are analyzed. The adverse effect of smoking on the morphofunctional state of the placenta is based on toxic substances that are released during smoking. Disturbances in the development of the placenta are noted both with active smoking and with passive smoking, both with smoking before pregnancy and during it. Smoking and tobacco smoke contribute to the more frequent development of miscarriage, chorioamnionitis, impaired of vascularization of chorion villi, previa and placental abruption, premature rupture of the membranes. Therefore, it is necessary to state the fact of smoking a pregnant woman in a clinical diagnosis. At the same time, smoking refers to preventable risk factors for complications of pregnancy and fetus.
Gynecology. 2018;20(2):34-40
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Diagnosis and management patients with cervical insufficiency
Dobrokhotova Y.E., Borovkova E.I., Zalesskaya S.A., Nagaitseva E.A., Raba D.P.
Abstract
The article is devoted to diagnostic methods, therapy possibilities and algorithms of management of patients with cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis is only valid during pregnancy. Shortening the length of the cervix <25 mm indicates the presence of cervical insufficiency and the risk of premature birth. The optimal timing for the initial evaluation of cervical length are from 16 to 20 weeks. At length of a neck of a uterus more than 25 mm, but less than 30 mm with the preventive purpose from 19 to 34 weeks assigned micronized progesterone 200 mg in the vagina. Identification of cervical insufficiency after 24 weeks the method of choice is the appointment of micronized progesterone and the installation of unloading obstetric pessarium. Shortening of cervical length before 24 weeks of gestation is an indication for cerclage, with subsequent treatment of the micronized progesterone. The use of a differentiated algorithm for management of patients with cervical insufficiency reduces the likelihood of unexpected premature birth and neonatal morbidity and mortality.
Gynecology. 2018;20(2):41-45
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Modern tocolysis and adverse effects of tocolytics
Baev O.R., Vasilchenko O.N., Karapetyan A.O.
Abstract
Relevance. Toсolytic therapy is the only method that is used in the treatment of pregnant women with preterm labor. However, the effectiveness and safety of this therapy is still a matter of debate. One of the least studied issues of this problem is the safety of therapy, which is primarily manifested by the frequency of side effects. The aim is to carry out a comparative study of the safety of the most common tocolytic agents - atosiban, nifedipine and hexoprenaline sulfate. Material and methods. The study included 173 pregnant women with threatening premature births in a period of 28 to 34 weeks. In 54 cases, tocolysis with nifedipinum, 57 with atosiban, 62 with hexoprenaline was performed. To assess the effectiveness of tocolysis, clinical and instrumental methods of control (ultrasound with cervicometry) were used. The primary outcome points were the frequency of prolongation of pregnancy at 48 h and the incidence of side effects, including those requiring the termination of tocolysis. Results. Prolongation of pregnancy at 48 h was achieved in groups of nifedipine, atosiban and hexoprenaline sulfate, respectively in 46 (85.19%), 55 (96.49%) and 53 (77.40%) pregnant. Atosiban showed significantly higher efficacy. In 8 cases of tocolysis with nifedipine and 3 - hexoprenaline, the tocolysis protocol was not performed due to intolerance of treatment. In these observations, the highest frequency of preterm labor occurred. After excluding these observations from the analysis of differences in the frequency of prolongation of pregnancy was not. The overall frequency of adverse events in the groups was 38.9, 12.3 and 82.3%, and was significantly lower in the atosiban group than nifedipine and hexoprenaline sulfate. Conclusions. The effectiveness of tocolysis is affected by the tolerability of the drugs. Atosiban showed the best of the three drug safety profile. With comparable efficacy, atosiban has proven to be a drug that, to a greater extent than nifedipine and hexoprenaline sulfate, meets the current requirements for tocolytic drugs.
Gynecology. 2018;20(2):46-50
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Purpose of the study. Evaluate the prognostic value of an independent and medical fence of the vaginal discharge for the HPV test
Belokrinitskaya T.E., Turanova O.V., Frolova N.I.
Abstract
The aim of the study is to assess the prognostic value of self-and medical sampling of vaginal discharge for HPV test. Materials and methods. The study included 200 women aged 18-45 years (mean age 32.7±6.9 years) who underwent traditional cytological testing and testing for HPV-stimulated stimulation. The vaginal secretion for the identification of HPV DNA by polymerase chain reaction (PCR) was performed by a woman alone using a Qvintip device and a doctor from the cervical canal. The predictive value of these techniques was evaluated according to generally accepted formulas. Results. 42% of those surveyed had HPV-stimulated stimulation. The most common types were HPV-16 (17.7%), HPV-56 (16.3%), HPV-39 (13.6%). 51.2% of HPV-positive women had a combination of several types of HPV-stimulated stimulation. The effectiveness of the examination with the Qvintip device was higher than when the doctor took the material: 38% vs 27.5% (OR=1.6, 95% CI 0.48-2.45, χ2=5.0, pχ2=0.025). The Qvintip device detected a 5-fold increase in HPV-SRV: 34.5% vs 9.5% (OR=5.0, 95% CI 1.61-6.71, χ2=15.3, pχ2=0.0001). An abnormal cytological picture was found only in HPV-positive women in 17.9% (χ2=19.9, pχ2=0.0005), of which LSIL were detected in 15.5% of cases, HSIL-2.4%. A comparative assessment of prognostic value revealed a higher sensitivity of the self-sampling method (100%) compared with the medical fence of the material (66.7%). High specificity of both methods of preparation of samples for HPV-test was revealed: 65% for independent and 72% for medical. The conclusion. The Qvintip device for self-sampling vaginal discharge for the HPV test has a high predictive value and can be recommended as an alternative method for screening cervical cancer.
Gynecology. 2018;20(2):51-54
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Modern approach to treatment of a recurrent bacterial vaginosis at women of the reproductive period
Pestrikova T.Y., Yurasova E.A., Kotelnikova A.V., Strelnikova N.V., Voronova Y.V., Chirkov A.V.
Abstract
Bacterial vaginosis is closely associated with increase in frequency of inflammatory diseases of woman's pelvis organs, infertility, spontaneous abortions, preterm labor, contaminating fetus, postnatal inflammatory complications and cervical neoplasia. Goal of the study was to improve treatment of relapsed bacterial vaginosis in women of reproductive age and asses the efficacy of the pathogenetic combination therapy. Materials and methods. In our research we observed 40 female patients, at the age of 18-35 years who were revealed relapsed bacterial vaginosis according to clinical and laboratory examination. We studied their anamnesis, clinical manifistation, microscopic examination of cervical discharge to detect bacterial vaginosis. Also we carried out polymerase chain reaction to identify conditionally pathogenic microbes (Femoflor-16) and pH-metry of vagina contents with colpotest. Results. Our research revealed increased quantity or lack of a normal microflora (Lactobacillus spp.) in all patients. Streptococcus spp. 45.00%; Staphylococcus spp. 40.00%; Atopobium vaginae 80.00%; Gardnerella vaginalis + Prevotella bivia Porphyromonas (titer>106) 70.00% were identified. Combination therapy allows to restore a vaginal ecosystem and prevents bacterial vaginosis relapse over period of 12 months in our patients. Conclusion. Polymerase chain reaction in real time (Femoflor-16) with vaginal pH-metry are the basic laboratory examination methods to confirm bacterial vaginosis. Use of a combination therapy allows to restore a vaginal ecosystem and prevents bacterial vaginosis relapse over period of 12 months in our patients.
Gynecology. 2018;20(2):55-58
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Topical issues in combined oral contraceptives usage
Dubrovina S.O.
Abstract
The article presents topical issues of combined oral contraceptive (COC) use: among women with obesity, the effectiveness of COC in the management of premenstrual syndrome, the risk of thrombosis among women using of COCs and the economic justification for screening thrombophilia before the appointment of combined oral contraceptives, and the "quick start" of COCs after emergency contraception.
Gynecology. 2018;20(2):60-63
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Aplasia of the vagina and uterus (Mayer-Rokitansky-Kustner-Hauser syndrome): etiology, pathogenetic aspects and theory of the formation of defect (literature review)
Kruglyak D.A., Buralkina N.A., Ipatova M.V., Batyrova Z.K., Uvarova E.V.
Abstract
The article provides data on the etiology and pathogenesis of genital malformation - vaginal and uterine aplasia (Mayer-Rokitansky-Kustner-Hauser syndrome) at the present stage.
Gynecology. 2018;20(2):64-66
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Modern aspects of tactics in the genital herpes viral infection (literature review)
Pestrikova T.Y., Yurasova E.A., Yurasov I.V., Kotelnikova A.V.
Abstract
Genital herpes affects all population groups. 98% of the adult population worldwide have antibodies to the herpes simplex virus (HSV-1 or 2). This viral infection is a significant medical and social problem. HSV can lead to a complicated course of pregnancy, causing miscarriages, premature birth, intrauterine fetal death, systemic viral disease in newborns. There is evidence that HSV has a connection with malignant tumors of the prostate and cervix, contributing to their development. This literature review contains modern aspects of epidemiology, etiology, pathogenesis, clinic, diagnosis, treatment of genital herpes, including its recurring forms with valacyclovir (Valvir). Indications for hospitalization of patients with genital herpes were noted and the prognosis of this pathology was determined. The tactics of managing pregnant women with this pathology is presented.
Gynecology. 2018;20(2):67-73
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Bemiparin sodium in prevention of tromboembolic complications in gynecological practices
Gustovarova T.A., Kirakosyan L.S., Feramusova E.E.
Abstract
The patients with complicated surgical diseases are relating to the group of high risk of nascence of vein thrombosis and tromboembolism. Aim of the study: to measure of the anticoagulant abilities of bemiparin sodium among women were operated by laparoscopic access in gynecological practices. Materials and methods. 15 women who had been operated for multiple uterine fibroid were examined and enrolled in the basic group. The patients were administered bemiparin sodium 3500 IE (0.2 ml) injected subcutaneously in 6 hours after operative treatment, then once a day during 7 days for prevention of tromboembolic complications in the postoperative period. The control group included 10 healthy women. The following parameters were defined for the control of efficiency of using of bemiparin sodium, his influence on different components of the haemostatic system: D-dimer, thrombocytes quantity and level of fibrinogen. Results. The significant elevation of level of D-dimer and fibrinogen was discovered among patients of the basic group during the preoperative period (p<0.05). The values of indicators of D-dimer and fibrinogen significantly decreased after therapy by bemiparin sodium. It was matched for the values in the control group. Conclusion. The using of bemiparin sodium in the postoperative period proved the high antitrombotic activity and the low risk of developing of bleeding.
Gynecology. 2018;20(2):74-76
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Reproductive disorders and obstetric complications in gynecological diseases
Unanian A.L., Sidorova I.S., Nikonets A.D., Aminova L.N., Alimov V.A., Shchukina A.V., Chushkov Y.V., Baburin D.V.
Abstract
This publication examines the existing risks of obstetric complications and other reproductive disorders in women with gynecological diseases. The paper also discusses the issues of the pre-school training of women with gynecological diseases, with special emphasis on the use of dipyridamole, due to its pleiotropic action.
Gynecology. 2018;20(2):77-81
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Review of the book of academician V.I.Krasnopolsky “Obligate forms of precancerous and invasive cervical cancer”
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Abstract
Gynecology. 2018;20(2):82-82
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