Vol 21, No 2 (2019)


Efficacy and acceptability of the vaginal combination hormone system containing ethinylestradiol and etonogestrel. Literature rewiev

Mezhevitinova E.A., Prilepskaya V.N.


The review focuses on evaluating the effectiveness and acceptability of a vaginal ring and combined oral contraceptives (COC) in a comparative aspect. It is shown that the vaginal ring has high efficiency, comparable to COC, has better cycle control, fewer side effects, is convenient to use, there is no need for daily monitoring of the pill.
Gynecology. 2019;21(2):6-11
pages 6-11 views

Ladder of life of a modern woman: how to maintain health. Opportunities and prospects of phytotherapy (to help a practitioner)

Prilepskaya V.N., Nazarenko E.G.


The article provides a modern view on features of different stages of a woman’s life. It presents information on pathogenetic basis and effectiveness of modern phytotherapy with a use of certified agents for a treatment of main pathological conditions associated with different stages of a woman’s life when the hypothalamic-pituitary-ovarian system’s function is formed, actively functions and then undergoes a gradual involution. The features of the use of herbal remedies in pathological conditions of the reproductive system (premenstrual syndrome, hyperprolactinemia, menopausal syndrome, mastalgia, etc.) are described. The article is illustrated with figures and tables for better understanding by clinicians. It emphasis on the features of herbal therapy, its high acceptability, safety and efficacy in the age aspect.
Gynecology. 2019;21(2):12-17
pages 12-17 views

Gene-gene interactions and prevalence of gene polymorphism associated with disorders of hemostasis and folate metabolism in patients with recurrent miscarriage

Frolova N.I., Belokrinitskaya T.E., Strambovskaya N.N., Belozertseva E.P.


Aim. To assess the association between polymorphisms of FVL-1691G>A, FII-20210G>A, MTHFR-677C>T, MTHFR-1298А>C, РАІ-1-6755G>4G and their combinations in patients with recurrent early pregnancy losses (RPL). Materials and methods. This study included two groups of women (age range 20-35 years): 50 currently non-pregnant women with a history of 2-5 unexplained recurrent early spontaneous abortion and unknown causes of miscarriages (RPL group), and 50 currently non-pregnant women with a history of having given birth to at least one live baby and without a history of spontaneous abortion, preterm labor, stillbirth, preeclampsia and other pregnancy complications (control group). Gene polymorphisms were detected by the technique of polymerase chain reaction-real time. We have analyzed the frequencies, Hardy-Weinberg equilibrium, V-Kramer test, χ2 test, odds ratio (OR) and its 95% confidence interval (95% CI). General (χ2 test, df=2) and multiplicative (χ2 test, df=1) models of inheritance have been used to assess the presence of gene polymorphisms. Results. Significant association between heterozygotes genotype PAI-1-5G4G (72% vs 32%, p=0.000; OR 5.46; 95% CI 2.32-12.87) and RPL was found. Heterozygous genotype FII-20210GA was detected only in RPL group (4% vs 0%). Combinations of genetic polymorphisms of FVL-1691G>A, FII-20210G>A, MTHFR-677C>T, MTHFR-1298А>C, РАІ-1-6755G>4G increase the risk of RPL by 2.4 times (56% vs 20%; χ2=29.20, р=0.000; OR 3.69, 95% CI 1.52-8.97; strong V-Kramer association). The combination of two heterozygotes variants of minor alleles was found to be a risk factor for RPL (34% vs 10%; χ2=8.73, р=0.004; OR 4.64, 95% CI 1.55-3.84). Combined PAI-1-5G4G + FVL-1691GA genotypes was detected only in RPL group of women (2% vs 0%). No significant association between the combination of three heterozygotes variants of minor alleles and RPL. Conclusion. Our data suggest significant gene-gene interaction of the heterozygotes variants of minor alleles of FVL-1691G>A, FII-20210G>A, MTHFR-677C>T, MTHFR-1298А>C, РАІ-1-6755G>4G polymorphisms in patients with recurrent miscarriage. Combined genotypes FVL-1691GA/PAI-1-5G4G can be considered as a genetic molecular predictor of recurrent early pregnancy losses.
Gynecology. 2019;21(2):18-22
pages 18-22 views

Vaccination as an effective method of prevention for cervical diseases associated with human papillomavirus (literature review)

Prilepskaya V.N., Gusakov K.I., Nazarova N.M.


The role of human papillomavirus (HPV) in the development of cervical cancer and other diseases of the anogenital area has been proven and well known. Despite this, the incidence of cervical cancer is growing every year. Specific methods of HPV treatment are not developed, and the only effective method of cervical cancer prevention is to prevent infection itself. A number of randomized clinical trials have demonstrated extremely high (up to 100%) effectiveness of HPV vaccines. Currently, the HPV vaccine is approved by WHO and included in the National Immunization Program of 86 countries, 17 counties use gender-neutral program. In the clinical practice of Australia, USA and countries of the European Union, in particular Italy, Germany and France, high efficiency of vaccination for 10 or more years is reported.
Gynecology. 2019;21(2):23-27
pages 23-27 views

Hydatidiform mole: a clinical case of pregnancy

Dobrokhotova I.E., Arakelov S.E., Danielyan S.Z., Borovkova E.I., Zalesskaia S.A., Medzhidova M.K., Nagaytseva E.A.


Hydatidiform mole (HM) is a disease of trophoblast tissue with saved proliferative potential and it develops after aberrant fertilization. Complete HM is characterized by a rapid increase in a size of the uterus, a significant increase in human b-chorionic gonadotropin (hCG), bleeding, symptoms of hyperthyroidism, severe vomiting of pregnant, and early preeclampsia. Thecalutein cysts are formed in the ovaries as a result of exposure to high titers of hCG and prolactin. Multiple pregnancy may be complicated by the development of complete and partial HM in one of the fetuses in one case for 20 000-100 000 pregnancies. The article presents a clinical case of pregnancy care of a 32-year-old woman with dichorial biamniotic twins and a complete HM of one fetus. Pregnancy occurred spontaneously, proceeded with threatening miscarriage up to 12 weeks, threatened preterm labor, pre-eclampsia from 24 weeks. The patient underwent induction of labor at 28 weeks due to severe pre-eclampsia, a live premature girl with a weight of 1030 g weight, height of 33 cm tall and Apgar score of 6/7 points was born. On the 40th day after birth, b-hCG level was negative.
Gynecology. 2019;21(2):28-33
pages 28-33 views

The role of genetic polymorphisms of the VEGF, COX2, MUC genes in the development of endometriosis-associated infertility

Kulikova N.V., Kovalenko I.I., Baibuz D.V., Lebedeva Y.A.


Endometriosis-associated infertility is an important medical and social problem, because affects up to 10% of women in the reproductive case, while even after treatment the pregnancy occurs in only one third of the patients. The etiology of endometriosis is still not precisely defined, despite ongoing research on this topic. In this review of the literature, we have tried to highlight the main work concerning the participation of immunological and genetic factors in the pathogenesis, and the role of vascular endothelial growth factor, mucins and cyclooxygenase-2 in more detail. Further studies of these pathogenetic manifestations of infertility in patients with endometriosis will make it possible to correct them in a timely manner, thereby increasing the chances of pregnancy.
Gynecology. 2019;21(2):34-37
pages 34-37 views

Premenstrual syndrome: a review of the literature

Andreeva E.N., Absatarova Y.S.


Premenstrual syndrome is defined as a combination of physical and mental symptoms that have a significant impact on a woman’s quality of life and develop into the second phase of the menstrual cycle. Many patients have not been diagnosed, and therefore pathogenetic treatment is not carried out, although these complaints may disrupt the daily lives of patients and relationships with others. The article presents a review of the literature and studies that assessed the effectiveness of various treatment options (antidepressants, hormone therapy, lifestyle modification and herbal therapy).
Gynecology. 2019;21(2):38-43
pages 38-43 views

Arterial rigidity as a marker of development of cardiovascular diseases in women having hypertensive disorders during pregnancy in anamnesis

Maychuk E.Y., Voevodina I.V., Yureneva S.V., Perederko A.V., Ivanova O.S.


Currently, women-specific risk factors for cardiovascular diseases (CVD) are of particular importance, one of which is hypertensive disorders during pregnancy (HDP). The effect of hypertensive disorders on the formation of arterial stiffness as a predictor of CVD development remains insufficiently studied. Aim. To study the relationship of indicators of arterial stiffness, risk factors and metabolic changes with the presence of HDP in the history of women of different age groups. Materials and methods. The study included women aged 30 to 65 years, with one or more risk factors of CVD, which were divided into two groups: 1st - with preserved menstrual function and 2nd group - in the postmenopausal period with the presence or absence of HDP. All patients underwent daily blood pressure monitoring with determining the dynamics of central arterial pressure, determining the velocity of the pulse wave from the carotid to the femoral arteries, non-invasive determination of vascular stiffness indicators using the volume sphygmography method. Results. 90 women were examined. The first group consisted of 45 women (mean age 41±5.9 years); the second group - 45 women (mean age 55.3±5.8 years). In both groups, women with HDP are more likely to have burdened CVD heredity (p=0.02). In the 1st group with HDP, the average body weight and body mass index were significantly higher (p=0.02); menstrual disorders occurred more than twice as often (p=0.01) than in women without HDP. In the 2nd group with HDP abortions were more frequent (p=0.05) in history. In the 1st group with HDP, a significantly higher augmentation index AI (p=0.01); the average value of the average daily rate of the pulse wave in the aorta was also exceeded (11.7 m/s), which is 0.8 m/s higher than in women without HDP (p=0.02). Conclusion. A change in the AI and the average daily pulse wave velocity in the aorta, along with the presence of CVD risk factors and hormonal and metabolic disorders, are early markers of subclinical damage to target organs in women of reproductive age with a history of HDP.
Gynecology. 2019;21(2):44-48
pages 44-48 views

Features of clinical manifestations and therapy of human papillomavirus-associated diseases of anogenital localization

Kail-Goryachkina M.V., Belousova T.A.


Relevance. The article deals with one of the most common manifestations of human papillomavirus infection - condylomata acuminata/anogenital warts. Aim. To provide current information on human papillomavirus (HPV), its transmission pathways, epidemiology and pathogenesis of HPV-associated diseases of anogenital localization; to describe in detail clinical forms of anogenital warts; to discuss modern methods of anogenital warts treatment, including destructive (physical, chemical), surgical, immunological and combined ones; to show evidence of effectiveness for the use of inosine pranobex, an immunomodulator with antiviral activity, at genital warts of different localization; to present foreign and domestic studies data. 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 2-15 years was conducted. The review includes articles from peer-reviewed literature. Conclusion. The use of inosine pranobex in combination with destructive methods for a treatment of HPV-associated diseases contributes to more active resolution of the pathological process, reduces a rate of relapses and prevents carcinogenesis due to effective elimination of HPV from lesions. The drug has a good tolerability, minimal side effects, could be used in individual dose and in combinations with other treatment methods that allows to use inosine pranobex for HPV treatment in a wide range of patients.
Gynecology. 2019;21(2):49-54
pages 49-54 views

Optimization of treatment tactics in patients with abnormal uterine bleeding on the background of benign hyperplastic processes in the uterus

Khodjaeva A.S.


Aim. Optimization of management tactics for patients with abnormal uterine bleeding on the background of benign endometrial and myometrial hyperplastic processes (BEMH) using systemic enzyme therapy. Materials and methods. 90 female patients with BEMH were included. They were divided into three groups: group 1 - women with endometrial hyperplasia, group 2 - women with uterine myoma of small size (6-8 weeks) in combination with endometrial hyperplasia and group 3 - women with endometrial hyperplasia in combination with endometriosis. Systemic enzyme therapy drug was used. Results and conclusions. BEMH are accompanied by inhibition of cellular immunity (pronounced suppression of T-lymphocytes) and excessive activation of humoral immunity. Therefore, an immunomodulatory effect of systemic enzyme therapy at hyperplastic processes is the basis for its prescription for comprehensive treatment of patients with combined endometrial and myometrial hyperplastic processes.
Gynecology. 2019;21(2):55-57
pages 55-57 views

Pregravid prognostic criteria of deciduitis

Kohno N.I., Samoylova T.E., Dokudaeva S.A.


Background. Lack of adequate management of female patients with non-developing pregnancy often contributes to persistence of infectious agents in the uterine cavity. The developed clinical protocol for pregravid preparation includes a detailed examination of a woman who is planning a pregnancy, while a comprehensive examination of a married couple can improve perinatal outcomes. This protocol states: "differentiated approach based on determining high-risk groups allows to avoid pregravid excessive preparation". For this reason it is advisable to determine the risk group for miscarriage due to infections given patient medical history and clinical laboratory pregravid prognostic criteria. Aim. To determine patient medical history and pregravid clinical and laboratory prognostic criteria for a disorder of decidualization of inflammatory genesis during the first trimester of pregnancy. Outcomes and methods. A retrospective analysis of medical history data of 30 pregnant women with non-developing pregnancies in terms of 8-10 weeks (group 1) and with histologically confirmed deciduitis was carried out. Comparison group included 50 pregnant women with a favorable course of pregnancy (group 2). Results. Patient history risk factors for non-developing pregnancy with decidual membrane infectious-inflammatory disorders are a history of acute or chronic endometritis (RR=15.83 and OR=41.45); a history of miscarriages (RR=13.33 and OR=17.82); recurrent colpitis of various etiologies (specific, non-specific) in the pregravid period (RR=6.67 and OR=8.73); a history of postpartum endometritis (RR=6.11 and OR=9.07); an increment of the placenta in a previous pregnancy (RR=5.83 and OR=7.30); a history of frozen pregnancies (RR=4.67 and OR=4.37). Pregravid risk factors for a non-developing pregnancy are a lack of both increased echogenicity and coiled arteries visualization in a middle secretory phase of menstrual cycle in a pregravidary period (RR=15,00 and OR=36.00) and endometrium thickness <10 mm at 24th day of menstrual cycle in a pregravidary period (RR=7.22 and OR=11.98). There is no association of deciduitis with late miscarriages, antenatal fetal death and early neonatal death in previous pregnancies. Conclusions. Screening patient history risk factors for infectious complications of pregnancy, including a non-developing pregnancy with deciduitis has to be implicated into a practice of obstetrician-gynecologist when giving pregravidary training. Disorder of decidualization of the endometrium is a prognostically unfavorable background for the chorion, the amnion and the embryo itself pathology formation.
Gynecology. 2019;21(2):58-65
pages 58-65 views

Effects of combined oral contraceptives on the sexuality and quality of life of women

Gabidullina R.I., Galimyanova E.I., Bagirli R.R., Sharapova A.M.


Aim. Examine the impact of combined oral contraceptive on sexuality and the quality of women’s life. Materials and methods. The article presents a review of Electronic literature databases MEDLINE, PubMed, EMBASE, Cochrane Library and Elibrary. Results. Since its first introduction in the 1960s, hormonal contraception has been widely used as a highly effective birth control method. However, the hormonal components of oral contraceptives affect the neuroendocrine system of women, exerting various effects on mood, libido, on sexuality and quality of life in general. Based on literature data the effect of contraception on sexuality, the physiological and emotional state of women are various. It is known that the hormonal supplementation of sexual desire is associated with ovarian hormones. At the same time, a high concentration of estrogen and testosterone receptors has been determined in the hypothalamus, which controls sexual function and mood. The mechanisms to implement the effects of androgen and progesterone on sexual desire are ambiguous. It was found a positive relationship between a sexual interest, sexual response, sexual fantasy, frequency of sexual intercourse and a testosterone level. At the same time, it is known that estradiol can increase the ability of women to orgasmic response and sexual satisfaction by acting on specific brain structures. Conclusion. The effect of contraception on women’s sexual life is an important factor when choosing a method of contraception and an integral part in the obstetrician-gynecologist’s practice, which requires further research in this direction.
Gynecology. 2019;21(2):66-70
pages 66-70 views

The effectiveness of anti-adhesive barrier based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg in various methods of surgical treatment of ectopic tubal pregnancy

Fitisheva L.E., Mozes V.G., Zaharov I.S., Mozes K.B.


Aim. To evaluate the effectiveness of the anti-adhesive barrier in the form of a gel based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg with various techniques of surgical treatment of ectopic tubal pregnancy. Materials and methods. A randomized study was conducted on 98 women who underwent laparoscopic resection of the ampulla of the fallopian tube, together with a embryo, followed by neostomatoplasty or salpingostomy with or without an anti-adhesive barrier. The primary outcome of the study was the incidence of uterine pregnancy and its outcomes at 18 months of follow-up; secondary outcomes were the frequency of adhesions in the pelvis, the frequency of patency of the operated fallopian tube according to second look laparoscopy with chromohydrotubation by 3 months of follow-up. Results. At 3 months of follow-up, the use of an anti-adhesion barrier reduced the incidence of postoperative adhesions in the area of the operated fallopian tube and the degree of adhesions in the pelvis; increased the frequency of patency of the operated fallopian tube when performing laparoscopic resection of a portion of the ampulla of the fallopian tube, followed by neostomatoplasty. By the 18th month of observation, no statistically significant difference in the incidence of spontaneous pregnancy and its outcomes in the studied women was detected. Conclusion. Use of 5 mg carboxymethylcellulose and 2.5 mg sodium hyaluronate anti-adhesive barrier with various organ-preserving methods of surgical treatment of ectopic tubal pregnancy reduces the frequency and extent of postoperative adhesions in the area of the operated fallopian tube, in the small pelvis, but does not increase fertility in the postoperative period.
Gynecology. 2019;21(2):71-75
pages 71-75 views

Gestagens in assisted reproductive technology programs

Syrkasheva A.G., Petrosyan Y.A., Dolgushina N.V.


Background. Luteal phase (LP) drug support is an important step in assisted reproductive technology (ART) programs efficacy. Aim. To present up-to-date data on an efficacy of LP hormonal support during ART cycles as well as to conduct a comparative analysis of various gestagen drug effectiveness. Materials and methods. To write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, eLibrary, etc.) for the last 8 years. The review includs articles from peer-reviewed literature. Results. LP drug support becomes an essential step in infertility treatment in various ART programs. Although human chorionic gonadotropin drug injections in the posttransfer period leads to an activation of endogenous steroid hormones synthesis, exogenous hormones use is currently preferred because of not having a risk of ovarian hyperstimulation syndrome. Conclusions. The variety of progesterone drugs is accompanied by a lack of algorithms for their use in various clinical situations. Further studies are required to evaluate progesterone drugs efficacy for various subgroups of patients.
Gynecology. 2019;21(2):76-79
pages 76-79 views

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