Vol 22, No 3 (2020)


Cesarean scar defects: diagnosis and treatment in non-pregnant women

Martynov S.A.


The aim of the review was to summarize information on clinical manifestations, diagnostic features, as well as methods for correction of scar defects after cesarean section (CS) outside pregnancy. “Lack of the scar after CS”, “niche”, “isthmocele” are a myometrium defect in the area of scar after CS, which is most often detected by ultrasound, sonohysterography or magnetic resonance imaging and is manifested by postmenstrual bleeding from the genital tract. In some cases, it can cause menorrhagia, dyspareunia, pelvic pain, infertility, uterine rupture during subsequent pregnancy and childbirth. Conservative therapy or surgical treatment with laparoscopy, laparotomy or vaginal approach is carried out depending on the symptoms, size of the defect, the thickness of the residual myometrium, as well as the woman’s reproductive plans.

Gynecology. 2020;22(3):6-10
pages 6-10 views

Probiotics in obstetric practice: efficacy and safety

Dobrokhotova J.E., Borovkova E.I.


The intestinal microbiota modulates immune programming and can prevent the realization of an allergic phenotype. For the formation of a normal microbiocenosis of the intestine, skin and oral cavity, a sufficient quantitative and qualitative bacterial colonization of the newborn is necessary during the transition from a «sterile» intrauterine environment to microbial colonization, resulting in the appearance of more than 1014 microorganisms. Low levels of bifidobacteria and early colonization of potentially pathogenic bacteria are associated with the development of severe allergic reactions. Prescribing probiotics containing Lactobacillus rhamnosus GG (LGG) at a concentration of 108–1010 CFU from 36 weeks of gestation and during the first 3–4 months of lactation is associated with a 21% reduction in the risk of allergic reactions in the child.

Gynecology. 2020;22(3):11-14
pages 11-14 views

Chronic endometritis in women with endometriosis-associated infertility

Orazov M.R., Radzinsky V.E., Volkova S.V., Khamoshina M.B., Mikhaleva L.M., Abitova M.Z., Shustova V.B.


The article highlights modern ideas about the role of the endometrium in the genesis of reproductive failures. A crucial place of chronic endometritis in the structure of the endometrial infertility factor in endometriosis is noted. Given the frequent association of chronic endometritis and endometriosis, common features of these diseases have been identified. The characteristic of endometrial microbiota in infertility, chronic endometritis and endometriosis is given. An extremely important area of scientific research is precisely the interaction between the microbiota of the endometrium and its immunity, and not just the confirmation of the presence of microorganisms in the endometrium. The modern aspects of the etiology and pathogenesis of chronic endometritis and endometriosis are described. The main pathogenetic determinants of chronic endometritis are the failure of adaptation mechanisms to the constant effects of microbes and, as a consequence, the decrease and inferiority of the immune response and the development of autoimmune reactions. The modern paradigm for the development and progression of endometriosis involves the presence of bacterial contamination of the endometrium and the abdominal cavity, which in turn becomes a trigger for genetically-epigenetic modifications of cells, launching different cascades that underlie reproductive function disorders. The pathogenetically significant relationship between chronic endometritis and endometriosis is highlighted. It was revealed that chronic endometritis can be both a cause and a consequence of endometriosis. Disorders of the endometrial receptivity in chronic endometritis associated with endometriosis, their importance in the implementation of endometrial infertility are described. The important role of the microbiome in the formation of reproductive disorders is noted.

Gynecology. 2020;22(3):15-20
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Systematic analysis of the biological roles and pharmacological properties of D-chiro-inositol

Gromova O.A., Torshin I.Y., Uvarova E.V., Tapilskaya N.I., Kalacheva A.G.


D-chiroinositol (DCI) is one of the 9 inositol isomers that forms inositol phosphoglycans, which are mediators of the action of insulin. The metabolism of DCI and myo-inositol (MI) is impaired against the background of insulin resistance, including the patients with polycystic ovary syndrome (PCOS).

Aim. Highlight the most characteristic pharmacological properties of DCI.

Materials and methods. Systematic computer analysis of 45 600 publications on the biological roles of inositol by methods of the topological theory of pattern recognition and systems biology analysis of human proteome.

Results. A complex of interactions between metabolic disorders of DCI, PCOS, ovulation disorders, obesity associated with numerous hormonal disorders is described. Supplements with DCI and MI increase the sensitivity of cells to insulin and normalize the metabolism of androgens. An important difference between DCI and MI is the presence of DCI in the composition of inositol phosphoglycans that mediate the action of insulin on cells, as well as its participation in the realization of the therapeutic effects of metformin. The use of the MI+DCI combination allows achieving positive dynamics in reducing excess body weight, normalizing blood lipids, glucose and insulin levels, restoring the ovulatory menstrual cycle, improving oocyte quality, and helps prevent gestational diabetes in pregnant women and macrosomia of the fetus. DCI is more effective than MI in reducing the risk of folate-resistant neural tube defects.

Conclusion. The therapeutic potential of DCI in combination with MI for treating PCOS and hyperandrogenism is evident. Depending on the therapeutic expediency, various ratios of MI:DCI can be used for the treatment of PCOS and disorders of carbohydrate and lipid metabolism.A

Gynecology. 2020;22(3):21-28
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Menopausal hormone therapy: oncological risks

Musina E.V., Kogan I.Y.


The review article presents an analysis of the literature over the past 10 years on the relationship of menopausal hormone therapy and the risks of developing malignant diseases in women, including risk factors, such as mutations in the BRCA1/2 genes. The main limiting factor in the appointment of menopausal hormone therapy today remains the question: is there a connection between MHT and the development of oncological pathology, due to the high mortality rates from malignant neoplasms, which occupy the 2nd place after cardiovascular diseases. The main localization of the tumor process, which stops the appointment of MHT, is breast cancer. In the structure of the incidence of malignant neoplasms among the female population in Russia, breast cancer occupies a leading place, and this is the main interest in the effect of MHT. The results of large-scale studies are rather ambiguous and do not answer all the questions. Do not forget about other localizations of the tumor process, which MHT can also influence, and about which, there is also no unequivocal answer to the question about the relationship of MHT and the risks of tumor development. As for any therapy, for MHT there are contraindications, which are also covered in the article. The main modes of taking menopausal hormone therapy and their relationship with the risks of tumor development are also presented. The influence of the main components of menopausal hormone therapy on the processes of neoplastic transformation.

Gynecology. 2020;22(3):29-33
pages 29-33 views


Reccurence of endometrioid ovarian cysts and possible ways to its reduce

Gusev D.V., Prilutskaya V.Y., Chernukha G.E.


Aim. Comparative evaluation of the effectiveness of various types of hormone therapy for the prevention of relapses of endometrioid cysts (EC), based on clinical observation and data analysis.

Materials and methods. Retrospective analysis of 122 patients (the average age 31.7±6.12 years) with laparoscopically confirmed endometriosis. Patients were divided into groups, according to the treatment options – aGnRH (n=11), COCs (n=13), dienogest (Visanne®) (n=56). A comparison group included 42 patients who did not receive hormone therapy. There were evaluated the number of reccurence in the group without therapy and in groups with different options for hormonal therapy.

Results. Among patients treated with hormone therapy, the recurrence rate of EC was 3.75%, among those who have not received therapy – 38.1%. Of these, 31.1% of patients had recurrence rate of EC during the first year, 37.8% during 3 years, and 31.1% after 3 years. After suppressive therapy was discontinued, the relapse rate in the aGnRH group was 63.6%, COC – 50%, dienogest – 24%.

Conclusions. In addition to evaluating the ovarian reserve before and after surgical treatment, management tactics for patients with EC should include the long-term administration of dienogest as an anti-relapse therapy.

Gynecology. 2020;22(3):34-38
pages 34-38 views

The tactics of managing children and adolescents when twisting the uterine appendages from the position of international standards

Batyrova Z.K., Kumykova Z.K., Uvarova E.V., Chuprynin V.D., Buralkina N.A., Kiseleva I.A., Mamedova F.S., Chundokova M.A.


Background. Adnexal torsion (AT) takes fifth place among all emergency gynecological conditions. Suspicion of AT requires immediate diagnosis and urgent surgical treatment. The most common causes of AT are various volumetric formations, such as functional or dermoid ovarian cysts, contributing to an increase in its volume and/or anomalies in the development of the ligamentous apparatus. Timely diagnosis and detorsion contributes to the full restoration of impaired venous outflow and lymphatic drainage of the ovarian tissue, preventing the development of severe ischemia and necrosis. Over the past few decades, a surgical organ-preserving approach in managing patients with AT has been the “gold standard” of care.

Materials and methods. The article describes the results of a retrospective study of cases of AT in children and adolescents treated at the Department of Pediatric and adolescent gynecology Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology with an assessment of the clinical and anamnestic features of this cohort of patients and the choice of therapeutic tactics.

Conclusion. A multidisciplinary approach is critical to optimizing the delivery of care in cases of AT, including minimally invasive detorsion and preserving the functionality of the ovary as a treatment standard that should be used in the management of children and adolescents.

Gynecology. 2020;22(3):39-41
pages 39-41 views

The experience of using a bacteriophages-based complex antibacterial and analgesic drug in gel formulation in women who underwent various instrumental and diagnostic and treatment interventions

Vasilyev A.O., Sazonova N.A., Melnikov V.D., Gabdullin A.F., Zaitsev A.V., Shiryaev A.A., Kim Y.A., Prilepskaya E.A., Pushkar D.Y.


During the spread of bacterial infections with extensive drug resistance, the potential of existing antibacterial drugs is significantly reduced. The medical community is seeking opportunities for the rational use of antibacterial drugs, the development of new drugs, as well as the use of alternative treatments for these infections.

Aim. The objective of this study was to evaluate the effectiveness of the use of a complex antibacterial and analgesic drug based on bacteriophages in gel form during various instrumental studies and diagnostic procedures in order to minimize the risk of the urinary system infections complications.

Materials and methods. The study included 235 women aged 18 to 75 years who underwent treatment at the Moscow State Clinical Hospital named after Spasokukotsky and in the clinic of urology of Moscow State University of Medicine and Dentistry from September 2019 to January 2020. During the manipulation, all patients of the main group (n=120) used a developed preparation based on bacteriophages, and in the control group (n=115), a topical gel based on chlorhexidine dihydrochloride and lidocaine hydrochloride was used. All patients before the manipulation, as well as 10 days after the manipulation, underwent bacteriological analysis of urine. Efficiency assessment was carried out on the basis of laboratory data obtained, as well as according to the visual analogue scale of the pain syndrome severity.

Results. None of the patients in the main group showed intolerance, side effects and allergic reactions of the developed drug based on bacteriophages. Bacteriological analysis of urine received before manipulation in both groups showed the absence of clinically significant titers of pathogenic bacteria, while 1 week after manipulation the number of titers of pathogenic bacteria (≥104) was significantly higher in the control group (p>0.04). In patients of the main group, the incidence of dysuria was lower compared with the control group (p<0.05).

Conclusion. The study showed good tolerance of the developed drug and its clinical effectiveness in reducing the number of symptomatic bacteriuria; severity of pain after undergoing manipulation was relatively lower in the main group of patients. Conducting multicenter studies with the inclusion of a larger number of patients in the future will reduce the economic costs associated with treating patients by reducing the number of cases of nosocomial infections and reducing postoperative time spent by patients in the hospital.

Gynecology. 2020;22(3):42-48
pages 42-48 views

Algorithm for management of patients of the period of menopausal transition with recurrence of anomalous uterine bleeding associated with beneficial proliferative changes of endometry

Sinchikhin S.D., Kostenko E.V., Stepanyan L.V.


Aim. To compile an algorithm for managing patients during the menopausal transition with a relapse of abnormal uterine bleeding associated with benign proliferative changes in the endometrium and evaluate its outcomes.

Materials and methods. The observation of 150 patients aged 45–55 years who had recurrence of abnormal uterine bleeding due to benign proliferative changes of the endometrium. All patients underwent hysteroresectoscopic ablation of the endometrium according to the monopolar coagulation-vaporization technique using Olympus equipment (Japan). The patients were divided into two groups. One group was formed by 98 women who, before hysteroscopic ablation of the endometrium, received hormonal preparations for 1–4 months, with the help of which suppressive changes in the uterine mucosa up to 3–4 mm were achieved. The other group consisted of 52 patients of the menopausal transition who did not receive preoperative drug therapy, and the thinning of the endometrium before hysterectomy was performed instrumentally. After hysteroresectoscopy, the period of clinical and instrumental observation was 2 years.

Results. Based on the results of the study, an algorithm has been compiled for the treatment of women during the menopausal transition with abnormal uterine bleeding, including at the first stage a clinical, laboratory and instrumental examination with the selection of a group of patients to be treated by endometrial ablation, and at the second stage, measures for the preoperative thinning of the uterine mucosa, at the third stage – performing hysteroresectoscopic ablation of the endometrium; and at the fourth stage – dynamic monitoring during ie 2 years. The preoperatively achieved medical atrophy of the endometrium, followed by hysteroresectoscopy, contributes to an improvement of 20.3% in the results of treatment of patients in comparison with mechanical thinning of the endometrium before hysteroresectoscopy. In general, the developed algorithm increases the effectiveness of anti-relapse treatment to 92.8%.

Conclusion. In practical health care, the proposed algorithm should be used, including successive steps. Following the algorithm, a differentiated approach to the choice of therapeutic tactics is carried out, taking into account not only morphological changes in the endometrium, but also the associated gynecological and somatic pathology of the patient, as well as justifying the conduct of preoperative preparation for hysteroresectoscopic ablation of the endometrium and determining the order of subsequent dynamic observation.

Gynecology. 2020;22(3):49-54
pages 49-54 views

Endometrial polyps in postmenopausal women: results of a comparative analysis of clinical features after hysteroscopic polypectomy

Klinyshkova T.V., Frolova N.B., Tsertsanova E.A., Saponenko I.I.


Aim. To evaluate the clinical features of endometrial polyps (EP) in postmenopausal patients based on a comparative analysis of symptomatic and asymptomatic forms.

Мaterials and methods. A retrospective cohort study was conducted with the inclusion of 92 postmenopausal women who underwent hysteroscopic polypectomy in the gynecological Department of the Clinical Hospital of Russian Railways-Medicine Omsk in 2018–2019. Тhe аverage age of patients was 60.35±6.56 years. Two groups of patients were identified: group 1 included patients with asymptomatic EP (n=64), group 2 – women with EP associated with uterine bleeding (n=28).

Results. Postmenopausal EP patients had: asymptomatic (69.6%), uterine bleeding (30.4%), recurrent EP (14.3%), concomitant tamoxifen treatment (5.4%), single (77.2%) and multiple (22.8%) EP. In group 1, patients with late postmenopausal stage (73.4%) with single EP (76.6%) of various localization, glandular-fibrotic type (78.1%, p<0.05) prevailed. Group 2 was dominated by patients with early postmenopausal stage (60.7%, p<0.05) with single EP (78.6%, p>0.05) of various localization, having glandular (50%, p<0.01), glandular-fibrotic (46.4%, p<0.01) EP and adenomatous EP with malignancy (3.57%, p<0.05). Hyperplasia of endometrium was observed in both groups (1.56 and 3.57% in group 1 and 2, respectively), and adenocarcinoma – in group 1 (1.56%).

Conclusion. In patients with postmenopausal EP, along with a benign course, the disease occurs against the background of atypical hyperplasia and endometrial cancer (in the polyp or endometrium) in 3,3% of cases, including the asymptomatic nature of the disease.

Gynecology. 2020;22(3):55-58
pages 55-58 views

Endothelial dysfunction in the first trimester of pregnancy

Mironov A.V., Umakhanova M.M., Zhukocky A.V.


Relevance. Endothelial pathology is an important factor in the development of obstetric complications. Endothelial dysfunction means a violation of vascular homeostasis and leads to critical changes in the microcirculatory system. These changes in early pregnancy disrupt the processes of trophoblast invasion, determining obstetric complications.

Aim. To improve the diagnosis of fetoplacental system disorders by examining endothelial function in the first trimester of pregnancy.

Materials and methods. 180 pregnant women in the first trimester were examined: 90 women who were diagnosed with a failed miscarriage and had an instrumental removal of the fetal egg, as well as 90 somatically healthy pregnant women who had an instrumental abortion at will. Endothelial status was diagnosed in the groups: concentrations of C-reactive protein, von Willebrand factor and apoptosis protein p53 in serum, albumin in urine were determined, and desquamated endothelial cells were counted in peripheral blood. After instrumental removal of the fetal egg in all pregnant women studied, morphometry of fetal chorion vessels was performed: the average wall thickness of the primary vessel, the average diameter of the vessel lumen, the average area of the vessel lumen, and the Kernohan index were determined. The obtained results were subjected to statistical analysis.

Conclusions. The study of endothelial function in the first trimester of pregnancy can be used as a test for detecting vascular disorders in pregnant women, being an important criterion for early diagnosis of obstetric complications.

Gynecology. 2020;22(3):59-64
pages 59-64 views

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