Vol 20, No 6 (2018)


Current conservative treatment of uterine fibroids. Ulipristal acetate and liver damage: contrived tragedy?

Tikhomirov A.L.


Uterine fibroids are the most common pelvic tumor formation in women and the most common indication for hysterectomy. The effectiveness of long-term intermittent use of ulipristal acetate (UA) in patients with uterine myoma has been proven earlier. In May 2018, the ability of UA to cause a drug-induced liver injury (drug-induced liver injury, DILI) was disproved, and the European Commission approved a positive decision. According to the conclusion Expertise of the Pharmacovigilance Risk Assessment Committee (Pharmacovigilance Risk Assessment Committee - PRAC) the benefit/risk ratio remains favorable. Published recommendations are aimed at reducing the risk of liver damage. UA remains the 1st line of treatment for most myomas.
Gynecology. 2018;20(6):4-7
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Menopausal hormone therapy and women's health: experts' opinion



Gynecology. 2018;20(6):9-15
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Obstetric risks of chemotherapy during pregnancy

Dobrokhotova Y.E., Borovkova E.I.


During the first 4 weeks of gestation, the embryo is not yet differentiated and exposure to chemotherapy occurs the all-or-nothing principle. Most vulnerable to chemotherapy is the period from 5 to 10 weeks of pregnancy, the use of 1 cytostatic increases the risk of malformations in the hearth up to 10%, and a few - up to 25%. Prescription of therapy after 12 weeks is not associated with the risk of malformations. Development, but leads to delayed growth of the fetus and pancytopenia in newborns in 30%. Probability of a metostatic lesion the placenta and fetus is extremely low and is described primarily for hematogenous tumors. The course of treatment must be completed in 3 weeks. Before giving birth.
Gynecology. 2018;20(6):16-19
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Peculiarities of the genital organs in girls with aplasia of the vagina and uterus (Mayer-Rokitansky-Kyustner-Hauser syndrome)

Kruglyak D.A., Mamedova F.S., Batyrova Z.K., Chuprynin V.D., Asaturova A.V., Zaitsev N.V., Uvarova E.V., Luzhina I.A., Lunkov S.S., Filippova E.A., Buralkina N.A.


Objective - to evaluate the structural features of the external and internal genital organs in girls with aplasia of the vagina and uterus. Materials and methods. The study included 64 adolescent girls aged 15-18. The examination included a general and gynecological with an assessment of the structural features of the perineum, external genital organs and urethra, including using a specially designed measurement scheme for anatomical landmarks. An ultrasound study was performed with the aiming assessment of uterine horns and, when identifying signs of functioning, laparoscopic removal of them with histological study. In order to optimally assess the type of tissue lining the vaginal fossa zone, an analysis was carried out of the material obtained by scraping from the studied zone using liquid cytology. Results. Every third patient (34.3%) was diagnosed with urinary system pathology. In most patients, the external opening of the urethra was typical. Almost everyone had hymen (95%). Gynecological examination showed that in the vast majority of patients in the area of intended vaginal entry, was a blindly ending vaginal fossa (95.3%). The length of the fossa was on the average 1.7±0.1 cm. According to the smear scrapings from the vaginal fossa, flat cells of the superficial, intermediate, and parabasal and basal types were present. Representatives of the lactobacillus and coccal microflora were revealed. A topographic-anatomical analysis of the orientations of the perineum in girls with aplasia of the vagina showed that the depth of the vaginal fossa weakly depended from the age of the patients and did not depend on any of the suggested guide points. According to the results of instrumental methods of investigation of the pelvic organs, 68.75% of the girls had a muscular cord at the uterus place. Moreover, 22% of girls had signs of the functioning of rudimentary horns. Ovaries, as a rule, were located high, at the entrance to the small pelvis. Laparoscopy was performed in all patients with cyclic pain syndrome and closed functioning uterine rudiments, removal of the uterine horns with fallopian tubes were prefered. Histological examination of the obtained preparations was characterized by the detection of endometrial stroma and active endometrial glands. Summary. The authors emphasize that a multilateral examination of this cohort of patients is extremely important for the diagnosis and optimized treatment.
Gynecology. 2018;20(6):20-24
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The lignans 7-hydroxymatairesinol application in adjuvant therapy of gynecological diseases

Poluektova M.V., Mkrtchyan L.S., Tchirkova T.V., Vorobyova O.A., Krikunova L.I.


The antioxidant effects of lignan - 7-hydroxymatiresinol as complementary therapy for gynecological diseases Relevance. The work is devoted to the study of the antioxidant effect of lignan - 7-hydroxymatairezinol in various gynecological diseases. Materials and methods. The study included 30 women taking lignan - 7-hydroxymatairezinol (in a dose of 30 mg/day for 60 days), which was conducted mini-invasive or surgical treatment. They studied the general antioxidant status and its enzymatic link before and after drug treatment. Results and conclusions. Comparative analysis of the results showed that the drug along with antioxidant has anti-inflammatory action with good portability, which allowed him to recommend for use as a complementary therapy for gynecological diseases various nature: malignant neoplastic diseases, inflammatory diseases, etc), especially after surgery.
Gynecology. 2018;20(6):25-30
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Stress urinary incontinence: injection method of treatment (literature review)

Ermakova E.I.


The purpose of the review - presentation of clinical scientific data based on current evidence of information on the management of patients with stress urinary incontinence, the effectiveness and safety of periurethral injections of various bulking substances. Material and methods. А review of Russian and foreign sources on the prevalence, etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, in particular the injection method. Results. The review presents data of the etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, depending on the severity of the pathology. Analyzed the data of periurethral injection of various bulking materials, their effectiveness and safety.
Gynecology. 2018;20(6):31-34
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Inflammatory disease of the womans reproductive system: modern trends in diagnosis and therapy (literature review)

Pestrikova T.Y., Yurasov I.V., Yurasova E.A.


Medical, social and economic relevance of inflammatory diseases of the woman's reproductive organs requires a very careful attitude to the diagnosis and treatment of this pathology. The number of patients with genital infections and inflammatory diseases of the pelvic organs can takes the first place in structure of gynecological morbidity, and is 60.4-65.0%, and this fact is not unique to Russia, but all over the world. Incidence rate of inflammatory diseases of the pelvic organs in the first decade of the twenty-first century is increased at 1.4 times in patients who are from 18 to 24 years old and at 1.8 times in patients aged 25-29 years. At the same time, the cost of diagnosis and treatment has increased, reaching 50-60% of the total cost of providing gynecological care for population. The inflammatory diseases of pelvic organs are a collective concept. It includes of various nosological forms. There are numerous contradictions in the views on diagnostic approaches and treatment tactics, the nature of screening and control over the long-term results of treatment, the etiological and pathogenetic significance of various microorganisms found in the genital tract in patients with inflammatory diseases of the pelvic organs. Currently, there are many opinions among specialists about diagnostic approaches and treatment tactics, the type of screening and monitoring the long-term results of treatment, the etiological and pathogenetic role of various microorganisms which can be found in the genital tract in patients with inflammatory diseases. This review presents the results of a modern approach to the diagnosis, management and rehabilitation of patients with inflammatory diseases of the pelvic organs.
Gynecology. 2018;20(6):35-41
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Menopausal hormone therapy and uterine cancer: the acceptability of the tandem

Yakushevskaya O.V., Yureneva S.V., Protasova A.E., Khabas G.N., Dumanovskaya M.R.


The aim of the work is to conduct a systematic analysis of the available research results on the possibility of using menopausal hormone therapy (MHT) in patients who successfully completed the treatment of endometrial cancer (EC). Materials and methods. The review includes data from foreign articles published in PubMed and Medline, and domestic works published on elibrary.ru over the past 40 years. Results. The results obtained allow us to consider MHT as an independent method of medical rehabilitation for women who have undergone EC. A clear patient profile should be established, allowing the use of this method, with strict adherence to health monitoring. Conclusion Patients who have successfully completed the treatment of EC require the creation of special rehabilitation conditions in the interests of maintaining health and quality of life and should be under the close attention of the doctor. Argumented approaches to the appointment of MHT in such patients will avoid complications associated with estrogen deficiency after surgery, radiation with or without systemic (cytostatic) treatment methods.
Gynecology. 2018;20(6):42-47
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Appreciation of the importance of pregravid preparation and reproductive attitudes of women of childbearing age in the city of Omsk

Kravchenko E.N., Morgunov R.A.


The aim of the study. Assess the importance of pregravid preparation and outcomes of pregnancy and childbirth, depending on the reproductive attitudes of women in the city of Omsk. Materials and methods. The study included 92 women who were divided into groups: group A (n=43) - women whose pregnancy was planned; group B (n=49) - women whose pregnancy occurred accidentally. Each group was divided into subgroups depending on age: from 18 to 30 and from 31 to 49 years. For each patient included in the study, a specially designed map was filled out. These patients were interviewed at the City Clinical Perinatal Center. Results. Comparative analysis revealed the relationship between the reproductive settings of women of childbearing age and the peculiarity of the course of pregnancy and childbirth in these patients. Summary. The majority of women of fertile age are married: in subgroup AA - 25 (96.2%), AB - 13 (76.5%), BA - 25 (92.6%), BB - 20 (91.0%). The predominant number of women of fertile age have one or more abortions: in subgroup AA - 12 (46.2%), AB - 6 (35.3%), in subgroups of comparison BA - 8 (29.6%), BB - 6 (27.3%). More than half of the women of fertile age surveyed have a history of untreated cervical pathology (from 40.8% to 64.7%). The course of pregnancy in women planning pregnancy in most cases proceeded without complications: in subgroup AA - 13 (50.0%), AB - 11 (64.7%). The most common cause of complicated pregnancy in women whose pregnancy occurred accidentally is the threat of spontaneous miscarriage: in subgroup BA - 15 (55.6%), BB - 16 (72.7%). The uncomplicated course of labor more often [subgroup AA - 19 (73.0%), AB - 12 (70.6%)] was observed in women whose pregnancy was planned and they were motivated to give birth to a healthy child.
Gynecology. 2018;20(6):48-52
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Diagnosis and clinical criteria for chronic endometritis

Serebrennikova K.G., Arutyunyan N.A., Alekhin A.I.


Currently, the urgency of the problem of chronic endometritis is of medical and social importance, since it leads to impaired reproductive function. Among the risk factors there is a predominance of intrauterine devices and inflammatory complications after childbirth and abortion. Prolonged persistence of infectious agents in the endometrium in chronic endometritis leads to marked changes in the structure and function of the tissue, causes proliferative disorders, as well as disorders in cyclic transformation. Morphofunctional damage to the endometrium is not only the cause of infertility, unsuccessful attempts of in vitro fertilization (IVF) and embryo transfer (PE), miscarriage, and a decrease in the quality of life of women due to chronic pain, dyspareunia, uterine bleeding and discharge from the genital tract. Timely and accurate diagnosis is key to the success of the restoration of reproductive function. Treatment of chronic endometritis is a complex, phased process. One of the new methods is photodynamic therapy, which leads to the development of a photochemical reaction that destroys bacterial and tumor cells, and also has an antiviral effect.
Gynecology. 2018;20(6):53-59
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Use of riboflavinum and magnesium citrate in obstetrics and gynecology

Gromova O.A., Torshin I.Y., Tetruashvili N.K.


Low provision of cells with vitamin B2 and magnesium leads to a decrease in the activity of the sirtuin-1 deacetylase and an increase in the activity of the pro-inflammatory factor NF-kB, a decrease in the levels of glutathione, an increase in the levels of homocysteine, thrombus formation, the activity of mitochondria, the development of migraine, convulsions and miscarriage. The role of riboflavin in the regulation of the folate cycle in the genotype MTHFR 677TT for the prevention of folatresistant fetal malformations, the advantages of an aqueous solution of riboflavin and magnesium citrate is considered. The data on titanium dioxide, which increases the level of pro-inflammatory cytokines IL-1b, IL-4, IL-5, IL-6, G-CSF, CCL-2, CCL-3, CCL-4, are presented.
Gynecology. 2018;20(6):60-66
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Dynamics of symptoms of genitourinary menopausal syndrome and the frequency of recurrence of lower urinary tract infection in women in periand postmenopausal patients with combined therapy with Trioginal®

Pushkar D.Y., Gvozdev M.Y.


Material and methods. The study included patients (n=164) in peri- and postmenopause, having a laboratory-confirmed picture of the genitourinary menopausal syndrome - atrophic vulvovaginitis and suffering from recurrent lower urinary tract infections (UTI) - cystitis and urethritis. All patients underwent standard antibacterial therapy (ABT) UTI in accordance with the results of bacteriological urine culture according to Russian clinical guidelines on urology. Against the background of ABT, 164 patients received additional therapy with Trioginal® (the study group - SG) containing estriol, micronized progesterone and Lactobacillus casei rhamnosus Doderleini 35 (LCR 35) lactobacillus strain. Trioginal® was administered intravaginally in two stages: for 20 days, 2 capsules per day, then for 10 days, 1 capsule per day. In the comparison group - CG (n=67) with ABT, Ovipol Klio® (estriol monopreparation) was additionally intravaginally used in two stages: for 14 days, 1 suppository per day, then for 2 weeks, 1 suppository 2 times a week. The control group consisted of 30 patients receiving only standard ABT UTI, local hormone therapy for vulvovaginal atrophy (VVA) was not performed. The observation period was 12 months after the end of the course of therapy. At all stages of treatment, a subjective and objective assessment of the severity of urination disorders and urogenital atrophy (UDI-6 questionnaire), their impact on the quality of life of patients (questionnaire IIQ-7), indicators of bacteriuria, bacterial urine culture and vaginal biocenosis, frequency of undesirable phenomena were carried out. According to the initial characteristics of the group of patients were comparable. Results. At all stages of the study, in the group of patients who received therapy with the use of the Trioginal® drug, there was a significant improvement in the clinical picture of urination disorders compared to the CG and the control (main) group - MG (in SG - 18% at the end of therapy versus 100% before the start of therapy; CG - 26 % versus 100% respectively; Ledger - 58% versus 100% respectively; p<0.05); quality of life indicators - IIQ-7 score (SG - 67±6.8 at the end of therapy versus 96±8.1 before the start of therapy; TOS - 68±5,6 against 93±7.2, respectively; MG - 66±4, 3 against 41±4.4, respectively; p<0.05); symptoms of BBA (IG - 39% at the end of therapy versus 100% before starting therapy; HS - 62% versus 71%, respectively; HA - 96% versus 100%, respectively; p<0.05); indices of vaginal biocenosis (in SG, normocenosis was observed in 69% after termination of therapy versus 56% before its beginning; HS - 51% versus 57%, respectively; HA - 56% versus 61%, respectively; p<0.05). The most significant criterion was a significant reduction in the growth of pathogenic flora (in SG - 4% at the end of therapy versus 100% before the start of therapy; HS - 12% versus 100%, respectively; MG - 26% versus 100%, respectively; p<0.05). At the time of inclusion in the study, in all three groups, 100% of the patients with urinary tract infections - UTI (cystitis, urethritis) had a recurring nature - at least 3 episodes of relapses in the last year. During the period of treatment and observation (12 months), no episodes of recurrence of UTI were observed in MG in 100% of patients; in the CG, 47% of patients had a recurrence of UTI during the observation period; in GK, recurrence of UTI was noted in 62% of patients. Conclusions. Thus, the use of the drug Trioginal® in the complex therapy of recurrent cystitis and urethritis in women with peritoneal and postmenopausal VVA improves the outcomes of treatment with UTI and improves the symptoms of VVA, reduces the frequency of relapses and can be recommended for use in complex therapy of recurrent lower UTI (cystitis and urethritis ) in women with symptoms of genitourinary menopausal syndrome in peri- and postmenopausal periods.
Gynecology. 2018;20(6):67-72
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Clinical and laboratory criteria for occult form of premature ovarian failure

Marchenko L.A., Mashaeva R.I.


Purpose of the study. To develop clinical and laboratory criteria characteristic of the occult (hidden) form of premature ovarian failure. Material and methods. A prospective study included 22 women under 40 years old with an occult form of premature ovarian failure (POF). A comprehensive clinical and laboratory examination included: a hormonal profile on the 2-3rd day of the menstrual cycle (Anti-Muller hormone, Follicle-stimulating hormone, Luteinizing hormone, Estradiol), levels of biochemical and genetic markers (number of CGG repeats in the FMR1 gene). Results. 22 patients with an average age of 30±6.1 years were included in the study. As a result, we adopted diagnostic criteria for premature aging of the ovaries, based on the capabilities of modern clinical and laboratory markers of ovarian reserve, reflecting the primordial pool of follicles and predictors involved in predicting the onset of spontaneous pregnancy and premature aging of the ovaries. Conclusion. To date, there is no global consensus on the best test for an accurate assessment of the quantity and quality of eggs, and there is no consensus on the staging of premature ovarian aging, and the etiology of the disease. It is necessary to conduct full-scale multicenter, prospective, randomized, controlled studies, the results of which facilitated counseling patients and helping the clinician create an individualized treatment plan.
Gynecology. 2018;20(6):73-76
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Clinical and anamnestic characteristics of patients with adenomyosis, accompanied by pelvic pain syndrome

Orazov M.R., Radzinsky V.E., Khamoshina M.B., Dukhin A.O., Toktar L.R., Chitanava Y.S.


Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim - to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.
Gynecology. 2018;20(6):77-80
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