Vol 22, No 6 (2020)

REVIEW
Irregular menstrual cycle in women of reproductive age as part of metropolitan syndrome
Andreeva E.N., Sheremetyeva E.V.
Abstract

Life in a modern metropolis is not only an interesting and eventful life, but also a source of numerous features for human life: imperfect environmental conditions, dietary habits, sleep disturbances and circadian rhythms, changes in psychological status (stress, depression, aggression, apathy) and reproductive health problems, especially in women. As defined by the World Health Organization, reproductive health is a state of complete physical, mental and social well-being, and not simply the absence of disease in all areas related to the reproductive system, its functions and processes. Life in a big city for a woman of the reproductive period is often accompanied by a violation of the menstrual and ovulatory function, which can be attributed to the symptoms of the megalopolis syndrome. Since the 1980s, the frequency of menstrual irregularities has increased by more than 7 times. The doctor – clinician, to whom a woman of the reproductive period with an irregular menstrual cycle first turns, should not only draw up a plan for examining a woman and exclude the presence of endocrine-gynecological disorders, but also collect a detailed history, including physical status (for example, calculating body mass index, analyzing fluctuations weight), dietary habits, sports history, medication intake, first assess the role of the psychosomatic factor. The correct pathogenetic approach in this situation will determine the correct therapeutic tactics for managing a woman.

Gynecology. 2020;22(6):6-10
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The role of survivin in the pathogenesis of genital endometriosis, current application possibilities (literature review)
Misharina E.V., Yarmolinskaya M.I., Ivashchenko T.E., Andreyeva N.Y.
Abstract

In the structure of gynecological diseases, genital endometriosis takes the third place, and its frequency tends to increase. Endometriosis occurs in 5–10% of women of reproductive age, in 35–50% of patients with infertility and in 70–80% of women with chronic pelvic pain. The frequency of spontaneous abortion in endometriosis ranges from 10 to 50%. Noteworthy is the fact that the delay in diagnosing and starting treatment is 5 to 10 years. The disadvantages of surgical treatment are the high relapse rate (up to 50% after 5 years from the start of treatment). Hormonal treatments are effective, but they also have serious side effects that limit them in the long run. Naturally, the great practical and social importance of genital endometriosis induced numerous studies on the etiology and pathogenesis, which, however, have not yet been fully elucidated. The widespread prevalence of genital endometriosis necessitates the search and development of new effective methods of diagnosis and treatment. The article presents data on survivin, which is one of the members of the family of apoptosis inhibitors encoded by the BIRC5 gene. Survivin is involved in the pathogenesis of endometriosis and may be one of the early markers of the disease. Apoptosis is an important last step that determines the fate of the cell. Given recent developments in the search for targeted therapy for endometriosis, antagonists of apoptosis inhibitor proteins, including survivin, are considered as a potential target. Influence on the processes of programmed cell death can be a rather promising direction in the treatment of endometriosis. The purpose of this review is to evaluate the significance of surviving expression in the pathogenesis and diagnosis of endometriosis. 43 literature sources (domestic and foreign) were analyzed using various database (PubMed, PubMed central, Google Scholar, UpToDate).

Gynecology. 2020;22(6):11-15
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Genitourinary syndrome of menopause: a modern approach to treatment
Mazitova M.I., Mardieva R.R.
Abstract

Life expectancy over the past half century has increased significantly and by 2025 approximately one in six people on Earth will be over 60 years old, thus, age-related diseases become even more relevant, this also applies to menopausal syndrome in postmenopausal women. The average age of menopause is 50–52 years. In the world 25 million women annually experience menopause and only 10% of them have no pathological manifestations. Genitourinar menopausal syndrome is the second most common marker of menopause. Urogenital disorders are a fairly common nosology, which is confirmed by numerous studies, but not every woman considers it necessary to report a problem to a doctor, considering this a natural course of aging. The increase in life expectancy and rejuvenation of the population is undoubtedly associated with socio-social development and the achievement of medicine, the purpose of which is also to increase the extension of the term of a healthy and quality life. Studies conducted in recent decades to study atrophic hypoestrogenic changes in the urogenital tract will allow us to reconsider our attitude to genitourinar menopausal syndrome and to select appropriate treatment for various groups of patients. But the inability of women, at times, to declare their symptoms associated with vulvovaginal atrophy, and the lack of active interest in this issue by doctors, especially gynecologists, leaves this problem unresolved.

Gynecology. 2020;22(6):16-20
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Anti-Mullerian hormone and its predictive value for assessing oocyte quality
Aleksandrova N.V.
Abstract

The article systematizes information on the diagnostic capabilities of modern clinical and laboratory markers of ovarian reserve. The diagnostic capabilities of anti-Müllerian hormone (AMH) as a marker of ovarian reserve are discussed, which make it possible to adjust the dose of hormonal drugs and predict the response of the ovary to stimulation in programs of assisted reproductive technologies. This paper discusses for the first time the role of AMH in assessing the quality of oocytes and subsequent embryos. Despite insufficient literature data, further study of AMH, as well as full-scale research in this direction, seems to be extremely promising.

Gynecology. 2020;22(6):21-26
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Multyparametric MRI in differential diagnosis of epithelial ovarian tumors
Nosova J.V., Solopova A.E., Khabas G.N.
Abstract

Systematic analysis of publications concerning differential diagnosis of epithelial ovarian tumors has been done. Review includes articles published in MEDLINE, PubMed, Cochrane Collaboration Registry of Controlled Trials over the last 10 years. The objective of this study was to evaluate the ability of MRI with quantitative perfusion (DCE) and diffusion analysis (DWI) for preoperative differential diagnosis of indeterminate ovarian tumors. DCE-MRI parameters and ADC may represent imaging biomarkers for predicting the nature of ovarian tumors. Authors now recommend that for complex cystic or cystic-solid masses, both DWI and DCE MRI are used, if available.

Gynecology. 2020;22(6):27-31
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Endometriosis and adhesion process: what we know and what we can
Dubrovina S.O., Berlim Y.D., Alexandrina A.D., Bogunova D.U., Lesnoy M.N.
Abstract

Endometriosis is disease connected with inflammatory process in the peritoneum area, which leads to the development of the chronic pelvic pain and adhesion process. Frequency of small pelvic organs adhesion within several weeks following the operation makes up from 25 till 92%. A number of factors that influence the development of adhesion process, namely the degree of seriousness of endometriosis, decision on the type of surgery, technique and the amount of surgery. Formation of adhesions caused by endometriosis can be prevented through to joint measures taken in proper time and after the operation. In this literature review the estimation rate of adhesion is represented as well as the ways of its treatment and prevention at women with endometriosis.

Gynecology. 2020;22(6):32-37
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LECTURE
Folate contraception and clinical practice
Prilepskaya V.N., Bostandzhian L.L.
Abstract

Since the «first pill», there has been a significant evolution of hormonal contraception: low- and micro-dose drugs have appeared, drugs with components as close as possible to endogenous hormones have been developed, new dosage regimens and routes of contraceptive administration have been created. Modern combined oral contraceptives are not only used to prevent unwanted pregnancies, but are also widely used to treat a number of gynecological and non-gynecological diseases. In recent years, two new combined oral contraceptives with folate supplementation have been developed. The main purpose of adding folate to contraceptives is the prevention of fetal malformations, which is ensured by an increase in the level of folate in the body of women of reproductive age against the background of contraception and after its withdrawal.

Gynecology. 2020;22(6):101-107
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ORIGINAL ARTICLE
Evaluation of glycan expression in endometrial epithelial structures as a predictive factor for endometrial receptivity
Ziganshina M.M., Dolgushina N.V., Kulikova G.V., Fayzullina N.M., Dovgan A.A., Abdurakhmanova N.F., Shchegolev A.I., Asaturova A.V., Sukhikh G.T.
Abstract

Aim. To evaluate the endometrial glyotype in the «implantation window» in patients with infertility in assisted reproductive technologies (ART) programs and to develop criteria for assessing endometrial receptivity based on the analysis of complex changes in the functional groups of glycans in the main endometrial epithelial to use in clinical practice.

Materials and methods. The study included 32 infertile patients who took part in ART programs. Pipelle endometrial biopsy was performed during the «implantation window» in the cycle preceding the cycle of ovarian stimulation and embryo transfer. Using lectin histochemistry and immunohistochemistry, glycans levels in the glycocalyx of endometrial surface epithelium (SE) and glandular epithelium (GE) was studied.

Results. Differences in the expression of mannose-rich glycans in SE and N-acetylgalactosamine--terminated glycans in the GE of the endometrium were revealed, as well as the link between the expression of lectin staining glycans: ConA, VVL, UEA-I, SNA, MAL-II, ECL and monoclonal antibodies: anti-MECA -79 mAb and anti-LeY mAb in SE and GE of the endometrium was assessed in patients with infertility, depending on the outcome of the ART program. The estimated threshold levels in glycan expression and the odds ratio for pregnancy occurrence allow to characterize the diagnostic value for the studied glycomarkers and to develop criteria for assessing endometrial receptivity.

Conclusion. Based on a comprehensive evaluation of glycans in the main endometrial epithelial structures in the cycle preceding the ART cycle, criteria for assessment of the likelihood of pregnancy have been developed, which can increase the effectiveness of ART programs in patients with infertility.

Gynecology. 2020;22(6):38-43
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Results of infertility treatment using ART methods in patients who underwent myomectomy: risk factors for repeated unsuccessful ART programs
Kozachenko I.F., Smolnikova V.Y., Adamyan L.V.
Abstract

Aim. To evaluate the results of treatment of patients with uterine fibroids and infertility with ineffective art programs in the anamnesis and to identify possible risk factors for repeated art failures.

Materials and methods. 510 patients with uterine fibroids and infertility were examined and surgically treated prior to the ART program. Myomectomy was performed using various approaches: laparoscopic access in 250 patients, laparotomic access in 70 patients, hysteroscopic myomectomy in 100 patients, and combined access (laparoscopic and hysteroscopic) in 90 women.

Results. Primary infertility was observed in 38.0%, secondary – in 62.0% of patients. The average duration of infertility was 4.4±1.9 years. ART had in history 54.5% of patients. During the follow-up period up to 2 years, 24.3% of women had recurrent uterine fibroids. After carrying out of surgical treatment and the following ART pregnancy was achieved in 44.3% of patients. Pregnancies ended in childbirth in 58.8% of cases, which exceeded the total share (41.6%) of adverse pregnancy outcomes (ectopic pregnancy, abortions, spontaneous miscarriages at various times) by 1.4 times.

Conclusion. Risk factors for repeated ART failures in patients who have undergone myomectomy are: age over 40 years; duration of infertility for more than 5 years and the presence of 3 or more ineffective IVF attempts in the history; the presence of previous surgical interventions such as uterine artery embolization and FUS-ablation; the presence of submucous fibroids, a dominant node located close to the uterine cavity and myoma with signs of blood supply disorders; the combination of uterine fibroids with external genital endometriosis and chronic endometritis.

Gynecology. 2020;22(6):44-49
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Contraception: awareness and choice of young users
Aganezova N.V., Aganezov S.S., Gugalo T.V.
Abstract

Aim. To determine awareness about family planning and contraceptive preferences among young people.

Materials and methods. Internet questioner about knowledge, preferences, personal experience of contraception usage. 1010 responders (935 from Russia, 75 from other countries) were processed by statistical methods in the IBM® SPSS Statistics program. The group was a simple random sample.

Results. 92.5% of foreign and 54.2% of Russian respondents with medical specialties do not consider a stroke as a contraindication to combined oral contraceptives – COCs (p<0.001); 45.3 and 42.2% respondents have similar views about breast cancer in the anamnesis. Uncomplicated varicose veins and uterine fibroids are mistakenly considered contraindications to COCs by 26.4 and 20.8% of foreign participants and 54.5 and 44.4% of Russian participants, respectively. 25.1% healthcare providers from Russia consider hormonal contraception (HC) a possible cause of infertility. Only 4% of Russians of non-medical specialties know about strokes and heart attacks as complications of COCs, 13.8% – about arterial hypertension; almost half of foreign participants have such knowledge (p<0.05). Every second respondent from Russia and every third from other countries does not know about the timing of use of emergency contraception. Russian and foreign participants, when they were using HC, respectively noted: decreased libido (29.1 and 13%), increased body weight (15.0 and 34.8%), headache (21.8 and 17.4%), mastalgia (20.6 and 13.0%). Every fifth participant did not want to have periods of menstrual bleeding when using HC. 86 women have had pregnancies before, from those 62.2% of Russian and 75% of foreign participants had unplanned pregnancies; 40.2% of respondents from Russia and 25% of foreign participants terminated pregnancy. The most popular contraceptive method among Russian and foreign respondents is male condom (92.7 and 84.6%; p=0.037). Second most popular in Russia is coitus interruptus (57.7%), in third place are COCs (33.1%); among foreign participants COCs are in second place (38.5%).

Conclusion. Family planning awareness among young people is insufficient, which is reflected in their contraceptive preferences. Knowledge of family planning and highly effective methods of contraception should be popularized.

Gynecology. 2020;22(6):50-55
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Modern approach to tactics of management of patients with cervical intraepitital neoplasia of easy degree
Tkachenko L.V., Sviridova N.I., Kostenko T.I., Gritsenko I.A., Shishimorova S.G.
Abstract

Aim. Evaluate the effectiveness of management tactics for patients with mild cervical intraepithelial neoplasia.

Materials and methods. A comprehensive clinical and laboratory examination of 72 patients aged 18 to 35 years with morphologically verified CIN I was performed. The main group consisted of 36 patients who, along with active observation, were prescribed vaginal suppositories diindolylmethane at a dose of 200 mg per day for 3 months. The comparison group included 36 patients who, according to clinical recommendations, had chosen the tactics of active observation.

Results. An analysis of the outcomes of mild squamous intraepithelial lesions after 12 months showed that in the main group CIN I regression was observed in 91.7% of patients, persistence in 8.3% of cases, while in the comparison group CIN I regression was noted in 69. 4% of cases, persistence in 25% of patients, and progression to CIN II in 5.6% of cases.

Conclusion. The results of the study suggest that the inclusion of diindolylmethane, which has multi-target antitumor activity, in the treatment of pre-invasive diseases of the cervix in young women.

Gynecology. 2020;22(6):56-61
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Immunocytochemical characteristic of the endometrial mucosa HIV-infected women
Vorobtsova I.N., Tapilskaya N.I., Orlova E.S., Rukhlyada N.N., Proshin S.N., Glushakov R.I.
Abstract

Relevance. Human immunodeficiency virus (HIV) infection is an independent factor in reduced fertility and a risk factor for miscarriage. There are some date an endometrial receptivity of HIV-infected patients has changed that plays an important role in embryo invasion, but the true reasons for the decrease in fertility rate in HIV infection remain unknown.

Aim. Study of the expression of CD20, CD56 and TLR9 antigens on uterine epithelial cells of HIV-infected patients and the effectiveness of treatment for chronic endometritis by sodium nucleospermate.

Materials and methods. This parallel-group study was done at two centres in the Russia. Participants were adults women aged 26 to 49 years (mean age 33.35±2.9 years), who were HIV-infected (n=12) and HIV-negative (22). An immunocytochemical study of endometrial biopsies taken on the 7–10th day of the menstrual cycle before and after treatment was done. The course of treatment with sodium nucleospermate was 42 days.

Results. The expression level of CD56 and TLR9 in HIV-infected patients was 7.64±0.92% and 0.33±0.18%, respectively, and significantly differed from the expression levels in HIV-seronegative patients. There was a decrease in the expression levels of CD20 and CD56 and an increase in the expression levels of TLR9 in all groups of patients after treatment with sodium nucleospermate.

Conclusion. A decrease TLR9 expression on uterine epithelial cells in HIV-infected patients showing lack of ability of innate immunity to eliminate pathogens associated with subclinical inflammation and it correlates with an increase in the expression of markers of chronic endometritis.

Gynecology. 2020;22(6):62-67
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Bioelectric activity of the women’s brain with vulvar lichen sclerosus
Loginov V.V., Vartanov A.V., Feigin S.A., Sokolova A.V., Apolikhina I.A.
Abstract

Aim. To study the characteristics of bioelectric activity of the brain in patients with vulvar lichen sclerosus (VLS), as well as the interaction between certain structures of the brain and their relationship with the manifestations of VLS.

Materials and methods. 102 patients aged 21 to 78 years (average age 50.57±13.92 years) were questioned about the VLS symptoms, the quality of sleep and presence of phobias, of which 30 patients aged 21 to 72 years (average age 46.07±15.42 years) after signing informed consent underwent electroencephalographic (EEG) study. Inclusion criteria were patients aged 18 and older, vulvar lichen sclerosus in the acute stage, confirmed by histological examination.

Results. The common complaint was itching in external genitalia (73.3%), which was statistically evident in the analysis of brain activity. Itching of external genitalia in patients with VLS could account for systemic changes in the activity and interactions of such structures as the brain stem and globus pallidus, ventral striatum, islet, parietal cortex, field 40 according to Broadman (supramarginal gyrus), as well as areas of the primary visual cortex (field 17 according to Broadman).

Conclusion. VLS is often accompanied by itching in the external genitalia (73.3%), and has an average score of 5.6 on a ten-point scale. EEG is recommended with a disease duration of more than 6 years and an itch level of 5–6 points or more. The main feature of brain bioelectric activity in patients with VLS is evident signs of organic brain damage. The disease is accompanied by impairment of the visceral regulatory mechanisms of the brain, which leads to the formation of a low-complementary “viscerom” and neurodegenerative signs in the EEG. A frequent combination of disorders in the central nervous system and immune system gives reason to consider VLS associated with chronic fatigue syndrome.

Gynecology. 2020;22(6):68-73
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Papillomaviral infection and cervical diseases in pregnant women. Risk factors of social status, reproductive and contraceptive behavior
Bebneva T.N., Dikke G.B.
Abstract

Aim. To determine the risk factors for human papillomavirus of high carcinogenic risk (HPV HCR) and cervical diseases (CD) in pregnant women associated with the social status, reproductive and contraceptive behavior.

Materials and methods. Design: open-label comparative non-interventional cohort study in parallel groups. The total number of patients – 330 people, of whom 148 women were negative for HPV and 182 women were positive. They were divided into 4 groups depending on the presence or absence of CD. Methods: analysis of anamnesis data, general clinical, test “Kvant-21” to determine HPV, cytological examination, extended colposcopy.

Results. The most significant risk factors for HPV HRS infection were identified: history of mycoplasma infection (OR 5.9) and BV (OR 5.3), alcohol consumption (OR 4.0). A history of STIs (trichomoniasis and chlamydial infection), as well as more than 3 sexual partners (OR 2.7) were also significant. The most significant risk factors for CD in HPV-infected women were: age over 35 years (OR 3.8), a history of bacterial vaginosis (OR 3.0), and lack of regular screening (OR 2.4). The coitarche earlier than 16 years old (OR 2.2) also mattered. There were also found factors indicating a low risk of HPV infection – the use of condoms (OR 0.3), and a low risk of CD was indicated by age under 25 years (OR 0.2) and regular screening (OR 0.3).

Conclusion. HPV infection with HRS and the prevalence of CMC in pregnant women against the background of HPV infection is associated mainly with social risk factors, to a lesser extent – with factors of reproductive and contraceptive behavior.

Gynecology. 2020;22(6):74-79
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The value of azoximer bromide for optimization of therapy for HPV-associated cervical precancerous diseases
Kononova I.N., Dobrokhotova Y.E., Shmakova N.A., Kareva E.N., Chistyakova G.N.
Abstract

A significant increase in human papillomavirus-associated cervical oncological diseases, a high rate of recurrence of the process (48–62.4%) after surgical treatment, changes in the local immune microenvironment in cervical biopsy specimens with (HSIL) created the prerequisites for studying the clinical efficacy of local immunocorrection in complex HSIL therapy.

Aim. To study the clinical efficacy of local immunocorrection of azoximer with bromide in the complex therapy of cervical intraepithelial neoplasias.

Materials and methods. Examination and treatment of 40 patients with HSIL was carried out. The study of the effectiveness of azoximer bromide in complex therapy in patients with cervical intraepithelial neoplasias of a high degree of oncogenic risk was carried out on the basis of an immunohistochemical study of cervicobioptates to markers CD3, CD56, CD20, CD138, M-CSF.

Results and discussion. It was revealed that cervical intraepithelial neoplasias of a high degree of oncogenic risk are accompanied by changes in the local immune microenvironment in the epithelium and stroma of neoplastic altered tissues, which may contribute to the development of neoplasia progression. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times relative to the comparison group.

Conclusion. 1. In cervico-biopsy specimens of patients with HSIL, there is an increase in the proportion of cells with expression of receptors CD20, CD3, CD138 (in stromal cells) and a decrease in epithelial infiltration with M-CSF, which indicates significant changes in immune homeostasis in cells of the affected epithelium. Based on the results obtained, at the stage of preparation for surgical treatment of patients with HSIL, it is advisable to include local immunocorrection to improve the outcome of therapy. 2. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times, which dictates the need for complex immunomodulation in the treatment of HSIL at the stage of preparation for surgery.

Gynecology. 2020;22(6):80-83
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Results of treatment with myo-Inositol and D-chiro inositol combination in ratio 5:1 in women with polycystic ovary syndrome
Oboskalova T.A., Vorontsova A.V., Zvychainyi M.A., Gushchina K.G., Maitesian M.M.
Abstract

We conducted an observational descriptive study evaluating the effectiveness of therapeutic modification of lifestyle with adding of 1000 mg of myo-inositol and 200 mg of D-chiro inositol combination (ratio 5:1) for nutritional support in 104 women of reproductive age with polycystic ovary syndrome (classic phenotype and nonclassical phenotypes in the presence of hyperandrogenism) for 6 months. Revealed changes in anthropometric parameters (decrease in body mass index by 0.89 kg/m2; p<0.05 and waist circumference by 3.0 cm; p<0.05), skin status (decrease in the incidence of acne from 96.2 up to 58.6%; p<0.05 and seborrhea from 34.6 to 5.8%; p<0.05), hormonal profile (statistically significant change in all studied parameters; p<0.05: decrease in total testosterone to 1.27 nmol/L and a free androgen index up to 4.12% under an increase in globulin binding sex hormones), carbohydrate metabolism (normalization of glucose tolerance without the development of hypoglycemia) and restoration of menstrual cycle (MC) parameters (regular MC in 76.9 %; p<0.05, MC duration 33.4 days; p<0.05) indicate a significant role of stage I therapy in patients with polycystic ovary syndrome and the possible benefits of 1000 mg of myo-inositol and 200 mg of D-chiro inositol combination as a nutritional support.

Gynecology. 2020;22(6):84-89
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CLINICAL CASE
Pregnancy and childbirth with Shereshevsky–Turner syndrome, established at 12 years of age
Mikhaylin E.S., Ivanova L.A., Shilo M.M., Berlev I.V.
Abstract

The article presents a personal observation of the course of pregnancy and childbirth in a patient with a typical form of gonadal dysgenesis (Shereshevsky–Turner syndrome, karyotype 45,X0/46,XY in the ratio of clones 1:1). The diagnosis was established at 12 years of age during an examination for growth retardation and lack of signs of puberty. Given the presence of a 46,XY clone in the karyotype, a high risk of malignization of dysgenetic gonads, laparoscopy and gonadectomy were performed at 12 years of age. Pregnancy occurred after preparation of the endometrium with estrogens and progestogens, as a result of the first in vitro fertilization attempt with a donor egg and her husband’s sperm, occurred against the background of hormonal support with the threat of termination of pregnancy and hypercoagulation. At 34 weeks, there was a premature detachment of placenta, in connection with which she was delivered by cesarean section.

Gynecology. 2020;22(6):90-92
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The scattered puzzle effect: implantation disorders in chronic endometritis
Radzinsky V.E., Orazov M.R., Toktar L.R., Mihaleva L.M., Semenov P.A., Orehov R.E., Lagutina E.V., Silantyeva E.S.
Abstract

Chronic endometritis (CE) is defined as a state of inflammation localized in the endometrium, accompanied by edema, dissociated maturation of epithelial cells and fibroblasts, increased stromal density and the presence of plasma cell infiltrate in it. The connection between chronic inflammation in the endometrium and infertility deserves special attention. Inadequate response of immunocompetent endometrial cells, including impaired synthesis of proinflammatory cytokines, dysreceptiveness, disorders of proliferation and differentiation processes are the main links in the formation of infertility in patients with CE. Despite the fact that the presence of a normocenosis of the uterine cavity today is not in doubt – this is a physiological norm, persistent bacterial infection of the endometrium is still called the main etiopathogenetic factor of CE and, therefore, the main point of application of therapeutic agents. Nevertheless, a number of works have emphasized the special role of not bacterial, but viral etiology of endometritis, especially in the context of infertility developing against this background. It seems that the role of viral endometrial infection in adverse pregnancy outcomes and in vitro fertilization programs is underestimated. Further research is needed to clarify the relationship of viral infection as a trigger of implantation failure in infertile women with CE.

Gynecology. 2020;22(6):93-100
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IN AID OF THE CLINICIAN
Preparing for childbirth in HPV-compromised women
Sakaniia L.R., Gurguliia A.A., Korsunskaia I.M.
Abstract

Today, human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections. However, this way of transmission is not the only one. Newborns can get an infection at birth from an HPV-positive mother. Some data suggest that up to 79% of day-old children can be infected during childbirth. Not always polymerase chain reaction test for HPV in a child will be positive immediately after childbirth, since the incubation period can last up to 10 years. Studies shows correlation between the mother’s HPV status during pregnancy and postpartum period and the child’s risk for HPV infection. The standard therapy for HPV cannot be given to pregnant women. For them, there are alternative therapies, in particular, topical glycyrrhizic acid-containing drugs. This substance has long been known for its antiviral properties and can be safely used both during pregnancy and lactation. Our own observations of a small sample of 26 patients and 27 children over a period of 1.5 years show that the use of a glycyrrhetinic acid-containing drug a week before the expected childbirth helps prevent transmission of the virus to offspring. Also, the use of the drug after destructive therapies for vaginal papillomatosis allows to prevent rapid relapse of infection. These findings require further research. However, it can certainly be argued that patients with a history of HPV-positive status should be regularly examined, despite the fact that the effect of glycyrrhizic acid therapy persists for a long period of time.

Gynecology. 2020;22(6):108-110
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Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence
Lapina I.A., Dobrokhotova J.E., Taranov V.V., Chirvon T.G.
Abstract

Normal vaginal microflora consists of a wide range of microorganisms that maintain optimal vaginal milieu, preventing the development of infectious and inflammatory diseases of the vulva and vagina. However, the use of drugs, changes in hormonal status, urinary incontinence and pelvic floor dysfunction can disrupt the optimal balance of the vaginal microbiota, which leads to the development of dysbiotic pathological processes. The first-line treatment for stress urinary incontinence is the installation of suburethral slings. If incontinence is combined with a cystocele, it is advisable to perform reconstructive surgery for anterior vaginal wall, which has high both anatomical and functional efficacy. Surgical correction of genital prolapse and stress urinary incontinence requires bladder catheterization, which further increases the risk for dysbiotic and inflammatory diseases of the urogenital tract. The widespread use of antibiotic therapy leads to the formation of resistant strains of microorganisms and is not always fully realized, especially in the presence of post void residual urine in the postoperative period. Vaginal Zalain suppositories are highly sensitive to Candida species, and the use of Zalagel Intim gel is associated not only with antifungal, but also anti-inflammatory effect. Complex therapy with Zalain suppositories and Zalagel Intim gel is highly effective in the treatment of cytolytic, bacterial vaginosis, vulvovaginal candidiasis, and can also be used as the prevention of infectious complications after corrective interventions for pelvic organ prolapse and stress urinary incontinence.

Gynecology. 2020;22(6):111-114
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