Vol 23, No 3 (2021)


Vaginal microbiota during the menopausal transition: the role of lactobacilli

Dobrokhotova Y.E., Shadrova P.A., Komagorov V.I.


Physiological loss of ovarian function during the menopausal transition often leads to the development of unfavorable symptoms associated with vulvovaginal atrophy, recurrent urinary tract infections and dyspareunia. Currently, the scientific community is actively discussing the risks and benefits of prescribing menopausal hormone therapy to relieve the consequences of estrogen deficiency. The study of vaginal microbiota in dynamics made it possible to take a deeper look at the development of genitourinary menopausal syndrome and associate several microorganisms with specific undesirable manifestations. The link between recurrent urinary tract infections during menopause and physiological replacement of microbiota by opportunistic flora with the development of unpleasant symptoms resolves doctors to resort to irrational courses of antibiotic therapy. The review is devoted to the generalization of information on microbiological changes in the vagina during perimenopause, the possibilities of choosing the optimal hormone therapy for the correction of symptoms, the use of new promising methods, including management by modulating the vaginal microbiota.

Gynecology. 2021;23(3):214-221
pages 214-221 views

Optimization of the micronutrients sufficiency of feeding women and children on exclusively breastfeeding by enriching of the woman diet

Kodentsova V.M., Risnik D.V., Pavlovich S.V., Ladodo O.B.


A significant part of pregnant and lactating women have a lack of several micronutrients at once (vitamin D, group B, iodine, iron, etc.). The secretion of vitamins A, E, D, C, B1, B2, B6, B12, iodine and selenium into breast milk decreases with their insufficient consumption and insufficient provision of the nursing mother. The content of folates, calcium, magnesium, phosphorus in breast milk is maintained even if they are insufficient in the mother, however, enriching the diet with them during breastfeeding, improving the status of the mother, prevents the depletion of reserves in her body. The iron and zinc content in breast milk is determined by the mother’s status during pregnancy. The intake of vitamin-mineral supplements or food products enriched with micronutrients during the pregravid period, during pregnancy and lactation leads to an improvement in the provision of a woman and her child by increasing the content of vitamins, iodine and selenium in breast milk. The use of vitamin-mineral supplements is an effective way not only to eliminate multiple micronutrient deficiencies in the diet and improve the status of a lactating woman, but also to optimize the vitamin composition of breast milk and the provision of an exclusively breastfed baby.

Gynecology. 2021;23(3):222-227
pages 222-227 views

Interpretation and significance of the definition of anti-Mullerian hormone in the practice of juvenile gynaecologist

Kumykova Z.K., Uvarova E.V., Batyrova Z.K.


The article presents an overview of the physiological role of anti-Mullerian hormone (AMH) during person’s lifetime, the fluctuations of its values from birth to the reproductive period in women, the significance of its determination in the diagnosis and prognosis of treatment outcomes for many gynecological diseases. AMH is produced mainly by preantral and early antral follicles and decreases during the final maturation and luteinization. AMH plays a potential role in preserving the ovarian reserve by performing dual actions. AMH inhibits the initial recruitment of follicles, preventing the influence of stimulating growth factors for recruitment (KIT-ligand, the main fibroblast growth factor). From the moment of puberty, AMH reduces the sensitivity of primary follicles to the follicle-stimulating hormone, reducing the likelihood of their cyclic recruitment. The systematic review data presented the characteristics of the ovarian reserve in a healthy female population aged 0 to 19 years. At birth, very low AMH values were noted with an increase in its level in the first 3 months of life, followed by a monthly increase of 31%. A significant increase in AMH secretion was revealed by the beginning of puberty, then most authors noted a constant level of serum AMH in the adolescent period. The level of AMH in the blood serum decreases with an increase in chronological age by 6–8% annually and varies during the menstrual cycle. AMH is an important diagnostic tool in pediatric practice when differentiating various causes of puberty disorders, virilization and menstrual cycle disorders in girls.

Gynecology. 2021;23(3):230-235
pages 230-235 views

Risk factors and prevention of placenta-associated diseases

Minaeva E.A., Shmakov R.G.


The review presents modern data on the preventive effect of antiplatelet and anticoagulant therapy of placenta-associated diseases. The review includes data from foreign and Russian articles published over the past 15 years on the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, Pubmed databases. In recent years, there have been reports of the effectiveness of low molecular weight heparins in the prevention of placenta-associated complications. M. Rodger et al. In their study (2016), report on the effect of low molecular weight heparins on the development of placenta-associated complications. Patients whose previous pregnancy was complicated by preeclampsia or fetal growth restriction were randomized into 2 groups. The first group of pregnant women began to receive injections of low molecular weight heparins at an early stage of pregnancy (before 12 weeks), the second group did not receive low molecular weight heparins. Thus, only 19% of women receiving low molecular weight heparin therapy and 43% of women not receiving it developed placenta-associated complications, which may indicate the effectiveness of low molecular weight heparins. This data shows the urgency of the problem of placenta-associated complications, and the development of effective methods of early prevention of these diseases can improve the outcomes of the pregnancy.

Gynecology. 2021;23(3):236-240
pages 236-240 views


The structure of cervical diseases in women suffering from pelvic floor dysfunction

Orazov M.R., Toktar L.R., Karimova G.A., Aryutin D.G., Apata O.M., Mullina I.A.


Background. The prevalence of pelvic floor dysfunction (PFD) is soaring steadily. The protrusion of the cervix beyond vaginal opening when exposed to environmental factors can lead to the development of dystrophic, sclerotic and neoplastic processes of the cervix, which are mediated by changes in the pH, biocenosis of the vagina and environmental factors.

Aim. To study the pathogenesis of cervical diseases in patients with PFD.

Materials and methods. The study design is an open-label prospective observational study. The study included 40 patients of reproductive age: 26 patients with cervical disease with PFD (PFD group), 14 patients without cervical disease and PFD made up the second group.

Results. The patients included in the study were comparable in terms of age and body mass index. Pap smear analysis revealed that the average number of leukocytes is significantly higher in patients with PFD compared to patients in the group without PFD – 5.5 (1.5–20.0) and 1.5 (1.5–6.5) respectively (p=0.040). In PFD group, a high prevalence of the following conditions was observed: cervical leukoplakia (15%), CIN1 (38.5%), CIN2 (8%), chronic cervicitis (38.5%). Onco-cytological test results reviewed where the high prevalence of parakeratosis and hyperkeratosis (15%), ASCUS (15%), LSIL (23%) and HSIL (8%) were also noteworthy. It was observed that human papillomavirus type 16 was predominant in PFD patient group.

Conclusion. The data obtained indicates an increased risk of developing cervical diseases in patients with PFD.

Gynecology. 2021;23(3):241-244
pages 241-244 views

Features of the management of girls with anomalies of the genitourinary system

Akhapkina E.S., Batyrova Z.K., Сhuprynin V.D., Uvarova E.V., Kumykova Z.K., Kruglyak D.A.


Aim. To study the clinical and anamnestic, and surgical features of patients with genitourinary system malformations.

Materials and methods. A retrospective analysis of data from 252 medical records of patients with genitourinary system malformations who were admitted for examination and treatment to the Department of Pediatric and Adolescent Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation from 2012 to 2019. During analysis, special attention was paid to the data of surgical treatment, clinical and anamnestic data and the intraoperative picture.

Results. Developmental anomalies of the genital system are combined with urinary system malformations in 21.1% of cases. Genital malformations in adolescent girls are characterized by a high rate of various complications: hematocolpos (53.6), hematocervix (30%), hematometra (26.2%), hematosalpinx (15.1%), endometriosis (19.2%), masses (16.4%) and adhesions (25.4%).

Conclusion. Genital system malformations are often associated with anomalies of the urinary system and are characterized by a high risk of complications, therefore, timely identification and multidisciplinary management of such patients from an early age is extremely important.

Gynecology. 2021;23(3):245–249
pages 245–249 views

Possibilities of using platelet-rich autoplasm in the complex treatment of patients with intrauterine synechiae

Martynov S.A., Adamyan L.V., Arakelyan A.S., Fyodorova T.A., Bystrykh O.A.


Aim. To increase the effectiveness of complex treatment of women with intrauterine synechiae (IS) through intrauterine administration of platelet-rich plasma (PRP).

Materials and methods. The authors studied the complex treatment results of 60 women with second and third degree intrauterine synechiae: 20 patients in the active treatment group, after hysteroscopic destruction of intrauterine synechiae, underwent intraoperative subendometrial administration of PRP followed by irrigating the uterine cavity with PRP on the 2nd and 3rd days after the operation, along with complex postoperative treatment (antibacteria and cyclic hormone therapy, physiotherapy); 40 patients in the comparison group underwent only complex postoperative treatment without PRP administration. The authors conducted comparative assessments of menstrual function, endometrial thickness and uterine cavity during check-up hysteroscopy procedure.

Results. Two months after the treatment, a statistically more significant increase in the thickness of endometrial tissue was found with the use of PRP compared with patients treated without PRP (p=0.03 and 0.04). Statistically more significant changes in the state of the uterine cavity were revealed when using PRP in the group of patients with the second-degree process severity (p=0.00005), while in patients with the third-degree process severity there were no statistically significant differences identified depending on the method of treatment used. The authors confirm high safety and reliability of the method as well as no adverse reactions to parenteral and intracavitary administration of autologous PRP.

Conclusion. The study confirmed applicability and prospects of using PRP as a stage in complex treatment of IS patients.

Gynecology. 2021;23(3):250-254
pages 250-254 views

COVID-19 in pregnant and non-pregnant women of early reproductive age

Belokrinitskaya T.E., Frolova N.I., Shapovalov K.G., Kolmakova K.A., Anohova L.I., Avrachenkova A.V., Prejmak S.V., Grigor'ev A.V., Filyova T.Y., Gorbunova A.N., Dunaev D.A., Serbina K.S.


Aim. To identify confounding factors, features of the clinical course and outcomes of COVID-19 in pregnant and non-pregnant patients of early reproductive age who have no known risk factors and premorbid background.

Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (18–35 years), social status, parity, body mass index, had no known risk factors for COVID-19; those who got sick were treated simultaneously.

Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%; p<0.001) or had a mild course of the disease (58.9% vs 24%; p<0.001). In non-pregnant patients, the course of infection was more often moderate (61% vs 14.7%; p<0.001) or severe (10% vs 3.1%; p=0.038). Clinical manifestations of new coronavirus infection (NCV) in pregnant women were dominated by anosmia (87.7% vs 40%; p<0.001), drowsiness (68.7% vs 17%; p<0.001), dyspnea, even with a mild lung lesion (68.1% vs 19%; p<0.001), headache (41.7% vs 24%; p=0.006), arthralgia (29.4% vs 16%; p=0.021), while fever above 38 °C (7.4% vs 28%; p<0.001) and cough (38.7% vs 61%; p<0.001) were much less common. With computed tomography, pneumonia in pregnant women was diagnosed several times less often (21.4% vs 87.4%; p<0.001). In the non-pregnant group, there was one death (1% vs 0%; p=0.201) associated with late hospitalization for severe NCI with grade 4 pulmonary involvement as shown on computed tomography.

Conclusion. Confounders of COVID-19 in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat subpopulation, and smoking. In pregnant women, the main clinical symptoms of SARS-CoV-2 infection, with the exception of loss of smell, were nonspecific and characteristic of the physiological course of late gestation: drowsiness, dyspnea, joint pain. The predominance of mild or asymptomatic forms of infection, the lower incidence of pneumonia, and the absence of deaths in pregnant women suggests a more favorable course of COVID-19 NCI.

Gynecology. 2021;23(3):255–259
pages 255–259 views

Comprehensive management of patients with pelvis organ prolapse and metabolic syndrome

Lapina I.A., Dobrokhotova Y.E., Taranov V.V., Chirvon T.G., Volkova P., Malakhova A.A.


Background. Genital prolapse (GP) and stress urinary incontinence (SUI) are characterized by a failure of connective tissue skeleton of the pelvic floor structures, and there are many risk factors in their pathogenesis. Metabolic syndrome (MS), which includes obesity and abnormalities in the lipid and carbohydrate profile, contributes to the initiation of pelvic organ prolapse (POP) due to increased intra-abdominal pressure and the presence of comorbidities. Endothelial dysfunction associated with MS aggravates the existing metabolic disorders, resulting in the formation of a vicious circle and an increase in the likelihood of recurrence of genital prolapse symptoms and НМ during tension in the postoperative period.

Aim. The search for rational algorithms for the comprehensive management of patients with POP and MS.

Materials and methods. A comparative analysis of effectiveness of treatment with the use of surgical method or drugs which affect the metabolic profile in patients with GP and SUI was carried out.

Results. Drugs which contribute the restoration of lipid and carbohydrate profiles, and microcirculatory vasculature normalization, attenuate negative effects of MS components on the integrity of pelvic floor structures. Comprehensive management of patients with POP and MS with surgical correction of GP and SUI, as well as the use of drugs affecting metabolism, is highly effective and predictive in regard to POP severity and the risk of recurrence of clinical symptoms in the postoperative period.

Conclusion. Adequate restoration of the endothelial layer in patients with pelvic floor muscle incompetence and endothelial dysfunction reduces the likelihood of developing mesh-associated complications after the surgical stage of treatment.

Gynecology. 2021;23(3):260–266
pages 260–266 views


Opportunities of treatment for primary dysmenorrhea in young women. Case report

Buralkina N.A., Batyrova Z.K., Kumykova Z.K.


Primary dysmenorrhea is one of the most common causes of pelvic pain in women. It can reduce quality of life and interfere with daily activities. The use of combined oral contraceptives in young women with primary dysmenorrhea is an effective and safe treatment option. The article presents a clinical case of the effective use of combined oral contraceptives containing drospirenone in a young woman with primary dysmenorrhea and severe pain syndrome, which is not relieved by analgesics and antispasmodics and significantly reduces the patient's quality of life.

Gynecology. 2021;23(3):267–269
pages 267–269 views

The birth of a healthy child in the assisted reproductive technologies program after autologous co-culture of embryo with cumulus cells and a new CAT transfer technology. Case report

Asfarova G.R., Smol'nikova V.I., Makarova N.P., Drapkina I.S., Sysoeva A.P., Lobanova N.N., Kalinina E.A.


Cumulus cells are essential during oocytes growth and development, as well as during their maturation and fertilization. Research results have shown that embryo co-cultivation with autologous cumulus cells increases the frequency of blastocyst formation, and also improves the effectiveness of ART programs. Embryo transfer in such programs is recommended to be carried out using the CAT technology (Cumulus-Aided embryo Transfer), which includes embryo cultivation on a layer of cumulus cells and embryo transfer with a certain amount of diluted cumulus cells. Patient G., 38 years old, came to the department with infertility for 15 years and recurrent implantation failure in history. The patient had ART program with autologous co-cultivation of embryos with cumulus cells and a new CAT transfer technology. The patient fell pregnant and gave birth to a healthy child. Autologous cumulus cells can be a source of biologically active substances and improve embryological parameters and implantation rate in ART programs. Embryo co-cultivation with cumulus cells is especially important for patients with recurrent implantation failure. This technique can become an alternative for optimizing human embryos culturing.

Gynecology. 2021;23(3):270-274
pages 270-274 views

A successful pregnancy outcome after surgical treatment for a bicornuate uterus. Case report

Yashchuk А.G., Naftulovich R.А., Maslennikov А.V., Popova E.M., Gazizova G.K.


This article presents a clinical case in a woman with a full two-legged uterus. This pathology in the patient was revealed by ultrasound examination in 2013. There is one spontaneous miscarriage in the anamnesis; later, the patient did not become pregnant with regular sexual activity without contraception. A comprehensive examination of the patient was carried out. It was decided to conduct a hysteroscopy, during which one cervical canal was identified, in the area of the internal pharynx, a division into two hemipolostas was visualized. In the future, the patient underwent Strassmann’s reconstructive plastic surgery, which is the “gold standard” for this pathology. Laparatomic metroplasty is a safe and effective procedure for women with a bicornuate uterine malformation. The postoperative period was uneventful. A year later, the patient became pregnant in the natural cycle. Pregnancy proceeded without complications, culminating in the birth of a healthy child.

Gynecology. 2021;23(3):275–277
pages 275–277 views

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