Vol 20, No 2 (2018)

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.

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.

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.

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.

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.

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.

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.

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.