Vol 21, No 1 (2019)

Aim. To analyze an incidence rate of polymorphisms and combinations of genes AGT-704T> C, AGT-521C> T, AGTR1-1166A> C, AGTR2-1675G> A, еNO3-786T> C, еNOS3-894G> C, ADD1-1378G> T, CYP11B2 -304C> T, GNB3-825C> T and to assess their association with a risk of severe pre-eclampsia. Materials and methods. The study included women of early fertile age (20-35 years old) with spontaneous singleton pregnancy, no bad habits (smoking, alcohol or drug use), no extragenital diseases and no family (mother or sister) or an individual history of pre-eclampsia and with body mass index in the first trimester of pregnancy less than 35 kg/m2. The study group consisted of 100 patients with severe preeclampsia and the control group included 100 women with uncomplicated pregnancy. Genotyping was carried out by method of polymerase chain reaction. Data analysis included compliance with the Hardy - Weinberg law, Cramer's V criterion, χ2 test, odds ratio (OR) and its 95% confidence interval (CI). To assess a distribution of stated polymorphisms of genes and their alleles a general (χ2 test, df=2) and multiplicative (χ2 test, df=1) inheritance models were used. Results and discussion. Patients with severe pre-eclampsia had statistically significantly higher incidence rate of mutant homozygous genotypes AGTR1-1166CC (χ2=5,54; p=0,05) and еNO3-786CC (χ2=23,05; p=1,0E-5). A significant association between a carrier of the mutant homozygous genotype eNO3-786СC (χ2=19,780; p=0,000) and severe pre-eclampsia (OR 45,07, 95% CI 2,68-759,30) was found out. Combinations of mutant alleles of potentially predictive polymorphisms of vasoactive genes in women with preeclampsia were recorded 7,7 times more often (23% vs 3%; χ2=17,683, p=0,000; average Cramer's V link) which led to a significant association link with a risk of a disease complication (OR 9,658, 95% CI 2,795-33,367). Conclusion. A synergistic interaction between polymorphic loci in severe preeclampsia was established. The mutant homozygous genotype eNO3-786СC as well as a combination of at least two mutant alleles of genes - candidates for arterial hypertension or their combination with the mutant gene ADD1-1378TT or GNB3-825TT can claim a role of molecular and genetic predictors of severe preeclampsia.

Relevance. The issue of pelvic floor muscle dysfunction (PFMD) is common in female population. It causes severe moral suffering and reduces both social activity and a quality of patient’s life. In this regard PFMD management with modern methods for training of pelvic floor muscles using devices is the "first line" method. Aim. To study treatment effectiveness and a quality of life in women with PFMD followed radical treatment for breast cancer (BC). Outcomes and methods. A prospective clinical study on clinical efficacy of a biofeedback method in combination with electrical stimulation of pelvic floor muscles using a device “Urostim” in patients with mild PFMD followed combined treatment fpr BC was carried out at Department of Aesthetic Gynecology of V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology. The study included 15 postmenopausal women. Results. It was established that 10 sessions of pelvic floor muscles training in a mode of biofeedback result in beneficial effects on for all clinical indicators. Conclusion. PFMD treatment by training of pelvic floor muscles using devices is one of the most promising ways to reduce surgical interventions number in urogynecology and to provide a rehabilitation of women who had surgery for BC.

Aim. To analyze an efficacy of monotherapy and combined therapy (an immunomodulator + radio wave ablation) in patients with low-grade squamous intraepithelial lesion (L-SIL) caused by HPV infection. Materials and methods. The study included 210 women with human papillomavirus infection which was identified using real-time polymerase chain reaction (PCR). All women underwent a comprehensive examination which included history taking, general and gynecological examinations, extended colposcopy and a bacterioscopy of Gram-stained vaginal smears. A quantitative determination of vaginal microflora composition by PCR was carried out. Conclusion on either inflammatory response is present or absent was made on the basis of an inflammation index magnitude: with a value of more than 60% indicating a presence of local inflammation signs. Based on cervical cytology data a group consisting of 79 women who had L-SIL was formed. Patients were divided into 2 subgroups: the main one (n=45) who received combined treatment with radio wave ablation + an immunomodulator and a control one (n=34) who received only local monodestruction of L-SIL foci followed etiotropic treatment. Results and discussion. An efficacy of combined treatment which included radio wave ablation + an immunomodulator was higher compared to monodestruction only - 86.7% vs 64,7% respectively. It is important that by 6th month of follow-up a relapse of human papillomavirus infection occurred in 4.5 and 23.5% of patients of main and control groups respectively. Local inflammation was assessed as positive with an inflammation index of more than 60%. So after 6 months of follow-up this indicator decreased by 83.3 and 54.2% in the 1st and 2nd groups respectively. Clinical manifestations of an inflammatory process in the cervix was observed only with CIN recurrence. In addition, combined therapy provides a higher rate of human papillomavirus elimination at 6 months and faster cervix epithelization followed treatment by ablation.

Relevance. Despite lots of studies, issues on a choice of the most effective treatment method for patients with recurrent external genital endometriosis (EGE) as well as a role and features of assisted reproductive technology programs and ways to improve their performance are still unresolved. Aim. To provide a current understanding on etiopathogenesis and management strategy for patients with recurrent EGE and infertility according to Russian and foreign literature date. Materials and methods. In order to write this review, domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2-15 years. The review includes articles from peer-reviewed literature. Results. The article provides risk factors for EGE development, disease pathogenesis and clinical manifestation as well as drug and surgical methods for a treatment of endometriosis. Conclusion. Endometriosis remains still to be a mysterious disease for modern science. An individual approach given an age, ovarian reserve and a history of surgical treatment (numbers of surgical interventions for EGE) will allow you to elaborate a personal approach for each woman with subfertility.

Relevance. The review article is devoted to modern conceptions of etiology and pathogenesis of benign breast disease (BBD), a common female pathology, as well as the pathogenetic treatment of BBD. Aim. Substantiation of the new possibilities of the pathogenetic treatment of BBD. Materials and methods. It was conducted the analysis of domestic and world literature in the following areas: etiology, pathogenesis, treatment of BBD, prevention of breast cancer (BC). Results. Dozens of etiological factors of various natures cause BBD: genetic, reproductive, hormonal, gynecological diseases, extragenital pathology, environment and lifestyle, medical interventions. The etiological factors of BBD mostly coincide with the risk factors of BC. The lack of progesterone, the predominance of estradiol and chronic hyperestrogenemia, leading to hyperproliferation of the ductal and lobular epithelium of the mammary glands, underlie the pathogenesis of BBD. The pathogenesis of proliferative forms of BBD and BC have common features. In patients with proliferative and precancerous forms of BBD, the risk of BC increases significantly. Chronic iodine deficiency is one of the common pathogenetic pathways for the development of BBD. The drug mamoclam containing organically bound iodine from laminaria thallus is an effective and safe remedy for the pathogenetic treatment of BBD. Conclusion. Pathogenetic treatment of BBD not only improves the quality of life of patients, but also reduces the risk of BC.

Relevance. Woman’s late reproductive age is a period of complex hormonal adjustment, a preparation for menopause onset. Despite a decline in a reproductive potential and accumulation of gynecological and extragenital diseases in this population a gynecologist has to deal with their contraception as well as a treatment of menstrual disorders and a prevention of hyperplastic processes in the genitals. A search for safe and reliable drugs to solve these problems is extremely important in women of late reproductive period. Aim. Based on date of modern clinical and scientific research a relevance of combined oral contraceptives (COCs) for a safe and reliable contraception as well as for some gynecological diseases treatment and female genital organs hyperplastic and neoplastic diseases prevention was determined. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 10 years was conducted. The review includes articles from peer-reviewed literature, data of domestic and foreign clinical guidelines on contraceptive issues and Cochrane Library reviews. Results. Use administration of microdose COCs in the late reproductive period, when taking into account criteria for their acceptability, provides reliable contraception. Based on Cochrane database systematic reviews (2011-2018) reliable data on COCs non-contraceptive therapeutic and prophylactic properties at menstrual cycle disorders, endometriosis, hyperandrogenemia, premenstrual syndrome and polycystic ovary syndrome are presented. Conclusion. A choice of COC containing ethinyl estradiol 20 µg and gestodene (progestogen III generation) 75 µg, given contraindications and current observation, is a rational, effective and safe. This provides effective family planning and maintenance of reproductive health of women of late and perimenopausal age due to its wide therapeutic and prophylactic properties given woman's body features.

Aim. To provide up-to-date data on cancer risks in women who use oral hormones to protect themselves from unwanted pregnancies, since high onco-alertness is one of the most common reasons for their withdrawal. Materials and methods. To write this review a search for domestic and foreign articles in Russian and international search systems (PubMed, eLibrary, etc.) which were published in the period from 2003 to 2019 was carried out. The review included articles from peer-reviewed literature and guidelines for physicians and periodicals identified by keywords: cancer, cancer risk, hormonal contraception, hormones, non-contraceptive effects of combined oral contraceptives (COCs). Results. Hormonal contraceptives have a large number of beneficial non-contraceptive effects, particularly in relation to diseases associated with a menstrual cycle (premenstrual syndrome and premenstrual dysphoric disorder, menstrual disorders), infertility and a number of other diseases. Oral contraceptive use reduces an incidence of ovarian cancer and colorectal cancer but increases risks for cervix cancer and breast cancer. Based on the analysis of literature data, it was shown that women who have ever used hormonal contraception have a lower risk of death from all causes comparing to those who have never used them. Conclusion. To make a decision on a use of COCs patients should be examined and competently informed about benefits and risks of hormonal contraception.

Aim. To carry out a systematic analysis of available researches data on a possibility of using menopausal hormone therapy (MHT) in patients who successfully completed a treatment for malignant neoplasms of different localization. Materials and methods. The review includes data of foreign articles published in PubMed and Medline and domestic articles published in Elibrary.ru over the past 20 years. Results. The data obtained allow us to extend indications range for MHT in patients with history of malignant neoplasms in different organs. This study is one of the few attempts of clinicians to justify the use of MHT as one of the tools for the still imperfect rehabilitation of cancer patients. Conclusion. Patients who successfully completed a treatment for malignant tumors of any localization require special conditions of rehabilitation in order to keep their health and quality of life. A reasonable MHT use in these patients will allow to avoid complications caused by estrogen deficiency followed surgery, radiation with or without systemic (cytostatic) treatment methods.