Vol 23, No 6 (2021)

REVIEW

Gynecological conditions related to the perianal area and coloproctology

Khryanin A.A., Markaryan D.R., Agapov M.A., Bocharovav V.K.

Abstract

This review is addressed to the specialists who treat and correct pathologies of the perianal area and pelvic floor. The pelvic floor area is a space in which the organs of different systems have a common origin and a common framework, therefore they are located in close contact with each other. In view of these features, all specialists working with pelvic floor dysfunction should be aware of the possible combination with disorders from neighboring organs and systems. The article discusses the most urgent and common proctological and urological problems of pregnant women and maternity women, including perineal damage during vaginal childbirth with the development of anal incontinence and urinary incontinence, rectocele, prolapse and prolapse of pelvic organs. The paper presents a detailed description of all anatomical structures involved in the pathological process, as well as their gradual embryonic development. The article presented in details the disorders, which are lying in the base of pelvic organ dysfunctions, from the point of view of modern anatomical data, and discussed different diagnostic protocols and tactical approaches to the choice of treatment. Special attention is paid to the points of interaction of related specialists (urologists and proctologists) and the need for their joint participation in the medical and diagnostic process. Colorectal surgeons should be aware of the frequently associated gynecological pathologies described in this article. The cooperation of related specialists in the field of working with pelvic floor pathology is necessary to exchange experience and improve the quality of care for this category of patients. The article is illustrated with original drawings and clinical examples “before and after”.

Gynecology. 2021;23(6):472-479
pages 472-479 views

Anti-adhesive barriers in clinical practice: personalized patient management

Orazov M.R., Radzinsky V.E., Khamoshina M.B., Mikhaleva L.M., Ismailzade S.Y.

Abstract

The adhesive process is an urgent problem of operative gynecology. The number of women suffering from complications of the adhesive process is growing every year, not to mention the deaths associated with this problem. Polygenic etiology, low efficiency of treatment of the adhesion process determined the priority of searching for methods to prevent the process of adhesion formation or, at least, to reduce the severity of postoperative adhesion, at least a decrease in the severity of postoperative adhesion. The review presents the current paradigm of the pathogenesis of the formation of postoperative adhesions and the possibility of preventing adhesive disorders in gynecological patients.

Gynecology. 2021;23(6):480-484
pages 480-484 views

The role of the immune system in the pathogenesis of endometriosis

Kabanova O.O., Melkumian A.G., Krechetova L.V., Menzhinskay I.V., Pavlovich S.V.

Abstract

The review presents a critical analysis of data on the role of immune factors in the pathogenesis of endometriosis. The research results accumulated by now convincingly demonstrate that an abnormal subclinical inflammatory response and disorders in the immune control system play a significant role in the onset, progression and persistence of endometriosis. In spite of the fact that many studies are concentrates on particular components of immune disorders in the pathogenesis of endometriosis, there is still no overall picture summarizing these data. Further research is needed to find immunological parameters that can be used as markers for clinical use in non-invasive diagnosis of this disease. The search for specific immune markers that could be used for target immunotherapy of endometriosis also remains relevant.

Gynecology. 2021;23(6):485-492
pages 485-492 views

Neurophysiological mechanisms of pain and its quantitative assessment in endometriosis

Loginov V.V., Vartanov A.V., Feigin S.A., Pavlovich S.V.

Abstract

The solution of many clinical problems, including the issues of the origin of pain as a component of individual pathologies, lies in the plane of quantitative objectification of the underlying disease and elucidation of the role of pain syndrome (PS) in it. The analysis of literature data on methods of pain assessment, including quantitative scales and questionnaires, biochemical and instrumental studies, was carried out. Various PS correlates used in fundamental and applied research are considered. The neurophysiological mechanisms of pain formation and specific methods for assessing PS in endometriosis were studied.

Gynecology. 2021;23(6):493-498
pages 493-498 views

ORIGINAL ARTICLE

Comparative characteristics of the vaginal and endometrial microbiome in patients with secondary infertility associated with a uterine scar niche after cesarean section

Kurtser M.A., Egikyan N.M., Savelyeva N.A., Sinitsyna O.V., Vatagina M.A., Kutakova Y.Y.

Abstract

Aim. To compare the vaginal and endometrial microbiome in patients with cesarean scar niche (both in the presence of specific complaints of secondary infertility in combination with a niche with stagnant contents, and in the absence of such).

Materials and methods. The prospective study included 67 female patients of reproductive age who had a uterine scar after caesarean section that met the inclusion criteria. Depending on the presence or absence of clinical complaints of secondary infertility, ultrasound and/or magnetic resonance imaging of the pelvic organs to visualize stagnant content in the projection of the niche, the patients were divided into two groups: group 1 (n=40) – patients with secondary infertility in combination with stagnant contents in the projection of a niche (main group), group 2 (n=27) – patients without clinical complaints, with a formed scar on the uterus, without signs of a niche (control group). All patients underwent a comparative study of the vaginal samples and the endometrial samples. The species and quantitative composition of the microbiome was analyzed using real-time polymerase chain reaction. Statistical research was carried out using the IBM SPSS Statistica v22 software (IBM Corp., USA).

Results. Various microbiological communities were found in the analysis of samples of the vagina and endometrium in patients with stagnant content in the projection of the niche (group 1, main) and without it (group 2, control). Lactobacillus spp. was found most often in vaginal discharge samples (more than 50% of cases) both in group 1 and in group 2, however, their level was statistically significantly higher in group 2 (57.5 and 88.9%, respectively), p=0.005. When comparing endometrial samples from patients of groups 1 and 2, it was revealed that in group 1, in the presence of liquid content in the projection of a niche, opportunistic microorganisms were most often detected (more than 50% of cases): Enterobacteriaceae (65%) p<0.0001, Streptococcus spp. (60%) p<0.0001, Staphylococcus spp. (52.5%) p<0.0001, and Gardnerella spp. (22.5%) p=0.0342 and there was a deficiency of Lactobacillus spp. (25%), on the contrary, in group 2, Lactobacillus spp. prevailed (66.7%) p=0.008. Comparative analysis of vaginal samples and endometrial samples of the niche projection in group 1 revealed the predominance (more than 50% of cases) of Lactobacillus spp. in the vagina (57.5%) p=0.003, on the contrary, in the uterine cavity there is a predominance of opportunistic microbiota, p<0.001. Comparative analysis of vaginal samples and endometrial samples of the uterine cavity in group 2 revealed a statistically significant predominance of Lactobacillus spp. both in the vagina (88.9%) and in the uterine cavity (66.7%), p=0.0497. In patients with secondary infertility associated with the presence of stagnant content in the projection of the niche, compared with the control group, there was a higher alpha-diversity both in the samples of vaginal discharge (Shannon's index 2.017±0.093 vs 1.060±0.044; p=0.0120), and in endometrial samples (Shannon's index 3.448±0.267 vs 1.020±0.040, р=0.00008; Simpson's index 1.109 vs 0.003; p=0.00006). When analyzing beta-diversity, there were no statistically significant differences between groups.

Conclusion. In the structure of the microbiome of the vagina and uterine cavity in women without scar defect on the uterus Lactobacillus spp. predominate. The presence of stagnant content in the projection of a niche is associated with an increase in the frequency and quantitative content of opportunistic microbiota of the uterine cavity, especially Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Gardnerella spp. Also, in patients with stagnant contents in the projection of the niche, a higher biodiversity was revealed both in the vaginal discharge samples and in the endometrial samples. These results highlight the importance of assessing the endometrial microbiome in women with cesarean section scar, especially those faced with the problem of secondary infertility.

Gynecology. 2021;23(6):499-503
pages 499-503 views

Cervical diseases after subtotal hysterectomy (modern aspects of diagnosis and tactics of management)

Karanasheva A.K., Dobrokhotova Y.E.

Abstract

Aim. To study the state of the cervical stump after subtotal hysterectomy (STGE) without uterine appendages with and without excision of the endocervix in patients with myoma to justify the choice of a rational volume of surgical operation.

Materials and methods. Examination and treatment of 140 women was carried out with the formation of three groups: 1st – 40 patients after laparoscopic STGE with excision of the endocervix; 2nd – 38 patients after laparoscopic STGE without excision of the endocervix; 3rd (comparison group) – 62 patients with uterine myoma that do not require surgical treatment.

Results. The study of the state of the cervical stump was carried out 5.1±0.3 years after surgery. The number of patients with cervical pathology after STGE with excision of the endocervix (in group 1) was 1.8 times less in percentage terms than after STGE without excision of the endocervix (in group 2), and 3.2 times less than in patients with uterine fibroids who do not require surgical treatment (in the 3rd comparison group).

Conclusion. Out of 3 (3.8%) patients after surgical treatment with diagnosed HPV type 16.1 (1.3%) in the STGE group without endocervical excision was diagnosed with grade II intraepithelial neoplasia (CIN II). In patients with uterine myoma, STGE can be performed only after a comprehensive preoperative examination, including: diagnosis and treatment of urogenital infections, DNA typing of HPV of high oncogenic types, cytological and colposcopic examination of the cervix, targeted biopsy of the cervix with histological examination of the material. If a subtotal hysterectomy is performed, it must be supplemented with excision of the endocervix. In the future, these women require careful follow-up to improve early diagnosis and treatment of underlying and precancerous diseases and reduce the risk of developing cervical stump cancer.

Gynecology. 2021;23(6):504-508
pages 504-508 views

The role of chronic cervicitis and disorders of local immunity of the cervix in the etiology of undeveloped pregnancy

Fedorova A.I., Novikov E.I., Grin E.A., Myagkov A.E., Koptelova A.I.

Abstract

Aim. To determine the role of chronic cervicitis and violations of local immunity of the cervix in the etiology of miscarriage of the first trimester, as well as to justify the necessary scope of examination for timely therapeutic and preventive measures.

Materials and methods. The results of a prospective and retrospective study of 225 women with undeveloped pregnancy who were admitted to a gynecological hospital are presented. All women received microscopic, cultural, and molecular genetic (PCR), studies of vaginal and cervical canal discharge, cytological studies of scrapings from the cervical canal and cervix, studies of the structure of cervical mucus and its immunoglobulin A, and pathomorphological studies of the fetal egg. According to the results of the pathomorphological examination of the abortion material in combination with the clinical data, the examined patients were divided into 2 groups. Group 1 included 95 women with bacterial infection of the fetal egg, group 2 – 90 women with viral infection of the fetal egg. As a control group, 40 women with normal progressive pregnancy were taken, who were admitted for its artificial termination.

Results. Inflammatory diseases of the lower genital organs in the group of women with bacterial infection of the fetal egg are significantly more common than in the group of viral infection of the fetal egg and the control group, and correlate with the results of pathomorphological studies in more than 86.7% of cases. In the group of women with bacterial infection, according to the results of the study of the structure of cervical mucus and the level of secretory IgA, a decrease in local immunity of the cervix was revealed.

Conclusion. The analysis of the research results allows us to confirm the concept of ascending infection of the fetal egg in the bacterial etiology of undeveloped pregnancy, which deserves the practical attention of obstetricians and gynecologists and further study for the timely treatment of at hospital phase dysbiotic and inflammatory diseases of the lower parts of the female genital organs during pregravidar preparation.

Gynecology. 2021;23(6):509-515
pages 509-515 views

Expression of estrogen and progesterone receptors in the endometrium in women with impaired reproductive function with different functional activity of the corpus luteum of the ovary

Aganezov S.S., Kuzmina A.V., Ellinidi V.N., Gogichashvili K.E., Aganezova N.V.

Abstract

Aim. To assess the expression of estrogen (ER) and progesterone receptors (PR) in the endometrium during the implantation "window" in women with impaired reproductive function with low (16.1<30 nmol/l) and high (P≥30 nmol/l)) functional activity of the corpus luteum of the ovary.

Materials and methods. A prospective single-center cohort comparative study. The main group included patients with infertility (n=93) and miscarriage (n=47) of unclear reason in the anamnesis, the control group – 16 healthy fertile women. In all cases, vacuum-aspiration endometrial biopsy was performed on the 6–8 days after ovulation with simultaneous collection of a peripheral blood sample to determine the levels of estradiol and progesterone. Endometrial samples were studied by histological and immunohistochemical (ER, PR expression) methods.

Results. Women of the main (1) and control (2) groups had an ovulatory menstrual cycle. The serum estradiol (E2) level was 691.3±26.5 pmol/l (1) and 707.4±66.1 pmol/l (2); progesterone (P) – 46.1±1.8 nmol/l (2) and 39.1±4.9 nmol/l (2). Mid-secretory endometrium (results of histological examination) was determined in all healthy women (n=16) and in 46% (n=64) of the patients of the main group. All women in the control group had adequate hormone-receptor characteristics of the endometrium, in women in the main group – in 45% (n=63). Comparative analysis of the expression of ER, PR in the endometrium in patients with different functional activity of the corpus luteum of the ovary was carried out in the groups 1 and 2, in women with different reproductive dysfunctions in the anamnesis (without significant differences; p>0.05); subgroup analysis was performed in cohorts of women with normal (63 women in group 1 and 16 in group 2) and inadequate (77 patients in group 1) hormone-receptor status of the endometrium. There were no significant differences in the expression of ER, PR in the endometrium with low/high functional activity of the corpus luteum of the ovary with similar morphological characteristics of the endometrium (p>0.05). Correlation analysis did not reveal significant relationships between the level of P in the blood and indicators of endometrial expression ER, PR (p>0.05).

Conclusion. In the studied cohorts, the prognostic significance of the functional activity of the corpus luteum of the ovary for the adequate expression of estrogen and progesterone receptors has not been established. To clarify the presence/absence of endometrial dysfunction in women with a history of reproductive failures, a morphological examination of the endometrium of the middle secretion phase should be carried out.

Gynecology. 2021;23(6):516-523
pages 516-523 views

Prophylaxis of rhesus-sensitization of pregnant women. Experience of anti-rhesus immunoglobulin Rhesogam® N using

Nuriev N.R., Gabidullina R.I., Galautdinova D.I.

Abstract

Aim. Retrospective assessment of the efficiency and safety of the anti-rhesus Rh (D) immunoglobulin Rhesogam® N in preventing isoimmunization in Rh-negative women during pregnancy.

Materials and methods. An analysis of medical records of 196 Rh-negative patients who received anti-Rh immunoglobulin Rhesogam® N in the period 2019–2021 was performed. The indications for the drug were the aspiration of chorionic villi, amniocentesis and prenatal prophylaxis in women with negative level of anti-Rh antibodies and in the case of Rh-positive husbands.

Results. In total, 227 doses of the anti-rhesus immunoglobulin Rhesogam® N were administered, including those women who underwent invasive procedures (aspiration of chorionic villi, amniocentesis). There were no adverse events, including anaphylaxis or drug-related events. 172 rhesus-positive babies were born. No cases of hemolityc disease of the newborns were reported. Anti-Rh antibodies were not found in their mothers after childbirth.

Conclusion. The study confirmed the efficacy and safety of the antiresus Rh (D) immunoglobulin Rhesogam® N for the prevention of Rh isoimmunization.

Gynecology. 2021;23(6):524-528
pages 524-528 views

Possibilities of quadripolar radiofrequency therapy as a method of rehabilitation after surgery for pelvic organ prolapse

Dobrokhotova Y.E., Igor I.I., Il'ina I.I., Kareva E.N., Zalesskaya S.A., Nagieva T.S., Komagorov V.I., Grishin A.I., Shadrova P.A., Azimova A.I.

Abstract

Background. This article is devoted to a topical topic in gynecology – genital prolapse and methods of preventing recurrence in the postoperative period. Despite the surgery in the field of correction of genital prolapse, up to 13% of patients require repeated surgical treatment of this pathology in the postoperative period.

Aim. At present, a unified algorithm for rehabilitation after operations to eliminate this pathology has not yet been developed. We proposed a technique for using quadripolar radiofrequency therapy in patients operated on for pelvic organ prolapse in the postoperative period in order to improve the rehabilitation period.

Materials and methods. To achieve our goals, histological material was collected from 60 patients with pelvic organ prolapse before and after surgical treatment to assess the strength of collagenogenesis and reparative processes in the connective tissue of the vagina based on changes in the expression of the RNA matrix of collagen types I and III, genes encoding vascular endothelial growth factor VEGF-A, transforming growth factor TGF-B1 and decorin by polymerase chain reaction. The FSFI-19 questionnaire was used to analyze the quality of the patients' sexual life. We also calculated the vagina health index of patients suffering from this disease.

Results. In the course of the study, it was revealed that when using this method, complete re-epithelization of tissues occurs by 90 days after the operation, metabolic and trophic processes in the tissues of the urogenital tract intensify, and an increased degree of patient satisfaction with the quality of sexual life.

Conclusion. All the results obtained confirmed the therapeutic effect of radiofrequency therapy in the postoperative period, which makes it possible to use the technique as a rehabilitation program after surgical treatment for genital prolapse.

Gynecology. 2021;23(6):529-535
pages 529-535 views

Endometriomas: the effectiveness of combination treatment

Artymuk N.V., Zotova O.A., Vaulina E.N.

Abstract

Aim. Evaluate the effectiveness of combined treatment and establish the frequency of recurrence of the ovarian endometrioma.

Materials and methods. The prospective observational study evaluating the effectiveness of combined treatment of endometriomas, established the frequency of relapse after treatment. 186 patients with an established diagnosis of endometriosis of the ovaries were monitored, who underwent operative treatment in the volume of laparoscopic cystectomy. 95.0% of patients received anti-relapse hormonal treatment.

Results. Against the background of treatment, positive dynamics were noted: dyspareunia, hyperspolymenorrhea and pre- and postmenstrual bloody discharge were stopped in 98.7% of cases, dysmenorrhea – in 97.4% of cases, chronic pelvic pain – in 94.8% cases. Pregnancy occurred in 11.7% of cases (1.3% of which when using assisted reproduction). The recurrence rate of endometriomas after 2 years was 1.4%, after 3 years – 3.7%.

Conclusion. Combination treatment was effective in reducing the severity or completely cured the symptoms of endometrioid ovarian cysts in 95% of women. The recurrence rate of endometriomas after 2 years was 1.4%, after 3 years – 3.7%.

Gynecology. 2021;23(6):536-541
pages 536-541 views

Prognostic value of determination of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 in follicular fluid in patients in vitro fertilization programs

Marinova O.A., Trubnikova L.I., Albutova M.L.

Abstract

Aim. To determine the prognostic significance of matrix metalloproteinase-1 (MMP-1) and tissue metalloproteinase-1 inhibitor (TIMP-1) in the follicular fluid (FF) in patients with infertility to improve the effectiveness of in vitro fertilization (IVF) programs.

Materials and methods. A study of MMP-1 and TIMP-1 in the FF was conducted in 38 patients with infertility in IVF programs. According to the genesis of infertility, the patients were divided into 2 groups. The 1st (control) group included 20 patients with tubal-peritoneal infertility (code N97.1 according to the International Classification of Diseases of the 10th revision – ICD-10). The 2nd group (the main one) included 18 patients with tubal-endocrine infertility (ICD-10: N97.1, N97.0, N97.8). The choice of the ovulation stimulation protocol was made taking into account the anamnesis, previously applied protocols, control over the outcome and final result of IVF programs was developed: a protocol with gonadotropin-releasing hormone agonists was used in 20 patients, and a protocol with gonadotropin-releasing hormone antagonists was used in 18 patients. The effectiveness of IVF programs was 26.3%, the frequency of live births was 26.3%. During the puncture of the follicles, FF was taken and the levels of MMP-1 and TIMP-1 were determined in it by the method of quantitative solid-phase enzyme immunoassay of the sandwich type on an automatic flatbed photometer MultiskanFC (2012). The obtained information was subjected to statistical analysis using the Statistica 10.0 application program.

Results. The level of MMP-1 and TIMP-1 in the FF is an individual indicator and is associated with clinical and anamnestic characteristics. The average level of MMP-1 is 4.9 ng/ml. With negative IVF outcomes, it was 6.1±1.3 ng/ml, with positive outcomes – 1.4±0.1 ng/ml. The content of MMP-1 in women with tubal-peritoneal infertility genesis of 7.9±1.7 ng/ml indicates a residual inflammatory process in the follicle. The average level of TIMP-1 was 2462.2±64.3 ng/ml. The indicator increases: with age (2535.0±125.7 ng/ml), duration of infertility (2611.5±126.7 ng/ml), due to surgical interventions on the reproductive organs (2800±122.7 ng/ml) and in patients with tubal-endocrine genesis of infertility (2550±126.7 ng/ml), which indicates fibrosclerotic changes in the follicles and ovarian tissue.

Conclusion. The level of MMP-1 in the range of 1.3–1.4 ng/ml should be considered a criterion for the successful onset of pregnancy in IVF programs. The criterion of subclinical damage to the collagen matrix in the FF is the level of MMP-1 6.1 ng/ml or higher; it can be considered as an unfavorable prognostic factor for the outcome of IVF. The level of TIMP-1 in the range of 2400–2450 ng/ml should be considered a criterion for the successful onset of pregnancy in IVF programs. The probability of a negative outcome of IVF is in the range of 1500–2300 ng/ml (inability to level the effects of MMP-1 with these indicators), while the level of 2696 ng/ml and higher in tubal-endocrine genesis of infertility reflects a high degree of fibrosclerotic changes in ovarian tissue and can be considered as an unfavorable prognostic factor of IVF outcome.

Gynecology. 2021;23(6):542-547
pages 542-547 views

The role of mutations in the PI3K/AKT/mTOR signal pathway in decreasing ovarian reserve in reproductive patients with deep infiltrative endometriosis

Melkozerova O.A., Okulova E.O., Mikhelson A.A., Tretyakova T.B.

Abstract

Aim. To study the effect of deep infiltrative endometriosis on the state of the ovarian reserve in patients of reproductive age, as well as to evaluate the spectrum of mutations in the PIK3CA gene among patients with infiltrative form of external genital endometriosis.

Materials and methods. The main group of the study included 50 patients of reproductive age with deep infiltrative endometriosis, in 18 of whom deep infiltrative endometriosis was combined with ovarian endometriomas. The comparison group included 25 patients of reproductive age who underwent laparoscopic metroplasty of an inconsistent uterine scar from a cesarean section. All patients underwent determination of the level of anti-Müllerian hormone, follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles in the ovaries during transvaginal ultrasound examination. The search for activating mutations of the PIK3CA gene was carried out by sequencing a new generation of DNA in tissue samples of ovarian endometriomas in patients with a combination of infiltrative endometriosis and endometrioid ovarian cysts (n=18), as well as in biopsies of healthy ovarian tissue in all patients of the main group (n=50) and comparison groups (n=25).

Results. When assessing the state of the ovarian reserve in the patients of the two groups, it was found that the anti-Müllerian hormone level in the patient with the infiltration form of external genital endometriosis was 2.6±2.2 ng/ml, while in the comparison group it was 3.6±3.5 ng/ml, however, the difference did not reach statistical significance, p>0.05. The number of antral follicles according to transvaginal ultrasound was significantly lower in the main group (8.5±4.5) than in the comparison group (12.2±4.1), p=0.001. This difference was statistically significant both for patients with ovarian endometriomas (6.0±4.2, p<0.001) and for patients without ovarian endometriomas (9.8±4.2, p=0.04). Our study did not reveal PIK3CA gene mutations in any of the ovarian endometrioma tissue samples from patients with a combination of infiltrative endometriosis and endometrioid ovarian cysts, as well as in none of the healthy ovarian tissue biopsies from patients of the main group and the comparison group using the new generation DNA sequencing method.

Conclusion. The presence of deep infiltrative endometriosis is associated with a decrease in ovarian reserve in patients of reproductive age, regardless of the presence of endometrioid ovarian lesions. Population studies are needed to identify mutations of this gene in endometriosis, as well as to study mutations of other genes encoding proteins regulating the antiapoptotic signaling pathway PI3K/AKT/mTOR, to identify the mechanism of ovarian reserve depletion in infiltrative form of external genital endometriosis.

Gynecology. 2021;23(6):548-553
pages 548-553 views

Polymorphism of the maternal EGF gene is associated with the fetal growth retardation: a prospective comparative study

Golovchenko O.V., Ponomarenko I.V., Churnosov M.I.

Abstract

Aim. To study the involvement of polymorphism of growth factor genes and their receptors in the formation of fetal growth retardation (FGR).

Materials and methods. In this prospective comparative study, genetic analysis of five polymorphic loci of growth factor genes and their receptors (rs4444903 EGF, rs833061 VEGFA, rs2981582 FGFR2, rs6214 IGF1, rs1800469 TGFß1) was performed in 196 pregnant women with FGR and 324 pregnant women in the control group. For genotyping single-nucleotide polymorphism, the polymerase chain reaction method was used. The biomedical mechanisms underlying the identified associations were evaluated using modern bioinformatic resources: GTExportal (effect on gene transcription) and HaploReg (regulatory potential).

Results. The allelic variant G rs4444903 of the EGF gene determines an increased risk of FGR in the following genetic models: allelic (OR 1.28, 95% CI 1.00–1.65; рperm=0.033), additive (OR 1.33, 95% CI 1.02–1.75; рperm=0.039) and dominant (OR 1.62, 95% CI 1.06–2.47; рperm=0.031). The polymorphism rs4444903 of the EGF gene has a significant epigenetic potential (in the field of promoters, enhancers, "open chromatin", transcription regulatory proteins), determines the expression of the EGF and GAR1 genes and alternative splicing of the GAR1 gene in organs and tissues (placenta, fetal and adult brain, etc.), which are significant for the pathophysiology of FGR.

Conclusion. The associations rs4444903 of the EGF gene with the FGR are shown.

Gynecology. 2021;23(6):554-558
pages 554-558 views

Obstetric aspects of hemolytic disease of the newborn with ABO-isoimmunization

Dudareva I.A., Gureva V.A., Rucheikina N.I.

Abstract

Background. Currently the problem of immunological conflict, due to incompatibility in the ABO system and the development of hemolytic disease (HD) of the newborn, does not lose its relevance. Unlike Rh isoimmunization, with ABO incompatibility, the development of HD of the fetus/newborn is possible during the first pregnancy and there is no specific prophylaxis.

Aim. To establish prognostically unfavorable obstetric predictors in mothers whose newborns had HD according to the ABO system.

Materials and methods. A retrospective cross-sectional study included 40 newborn-mother pairs. The main group consisted of 17 newborns with a confirmed diagnosis of HD according to the ABO system and their mother, the control group included 23 newborns without HD of the fetus according to the ABO system and their mothers. The medical documentation was studied, which made it possible to evaluate the anamnestic, clinical data and contained a full range of general clinical, laboratory, functional research methods.

Results. When assessing the state of the newborns of the main group, it was revealed that mild HD was detected in 58.8±4.2% of cases (icteric form), in 41.2±5.2% – moderate severity (anemic form – 11.8%, icteric form – 29.4%). Reproductive losses in women of the main group were revealed 1.8 times more often than in the control group (38.6 and 20.9%, respectively; p=0.003). In the main group, 75.5% of patients had one or another acute infectious process during pregnancy. Mothers who gave birth to children with hypertension had high titers of antibodies (anti-A) in the blood and there was no correlation with the severity of HD of the newborn.

Conclusion. According to the existing regulatory documents, it is not recommended to routinely examine all pregnant women with blood group 0(I) for the determination of immune antibodies. It is necessary to identify patients at high risk for the development of HD according to the ABO system and send them to the determination of immune anti-A and anti-B antibodies at 36 weeks.

Gynecology. 2021;23(6):559-562
pages 559-562 views

Development and testing of a verified scale for assessment of insufficiency of omega-3 polyunsaturated fatty acids in women of reproductive age

Torshin I.Y., Tapilskaya N.I., Tetruashvili N.K., Limanova O.A., Malyavskaya S.I., Gromova O.A.

Abstract

Aim. Sufficient provision of women of reproductive age with omega-3 polyunsaturated fatty acids (PUFA), vitamins and microelements is an important factor in optimizing the course and outcomes of pregnancy. Therefore, in therapeutic practice, methods of non-invasive and rapid assessment of the supply of омега-3-PUFAs in women: docosahexaenoic (DHA), eicosapentaenoic (EPA) acid and synergistic micronutrients are in great demand.

Materials and methods. Collection and analysis of data from a cross-sectional study of Russian women of reproductive age (18–35 years old, n=1368).

Results. A verified 100-point scale for a non-invasive rapid assessment of a woman's status by омега-3-PUFA is proposed. This scale, based on the established correlations between the omega-3 index (% EPA + % DHA in the blood), makes it possible to identify patients with normal values of the omega-3 index in the blood (more than 4%) with a sensitivity of 65% and a selectivity of 88%. Score values less than 60 correspond to an insufficient value of the omega-3 index (sensitivity – 81%, selectivity – 65%).

Conclusion. The correlations established in this study between the reduced supply of omega-3-PUFAs and other micronutrients (vitamins E, K, A, B1, B2, PP, B6, folates, magnesium, selenium, copper and iron) suggest the presence of combined micronutrient deficiencies in women with low value of the score on the developed scale.

Gynecology. 2021;23(6):563-570
pages 563-570 views

Sexual disorders in chronic salpingo-oophoritis as a variant of the biopsychosocial model

Konovalov V.G., Mendelevich V.D.

Abstract

Background. Modern gynecology uses all the latest achievements of other medical, basic natural sciences and medical technologies. However, sexopathology in women with gynecological diseases, due to the complexity of etiopathogenesis, remains poorly understood.

Aim. Development of a diagnostic algorithm and identification of the structure of sexual disorders (SD) in chronic salpingo-oophoritis (CSO).

Materials and methods. We examined 100 gynecological patients aged 18–38 (on average 27.3±1.2) years with a diagnosis of CSO (N70.1 according to ICD-10), 67% of whom had sexual dysfunctions. Research methods: clinical-psychopathological, psychometric, experimental-psychological, sexological, gynecological, statistical.

Results. SD which are present in 67% of women with CSO, are more often (40.3%) of a mixed nature. Neurotic disorders are represented by somatoform (F45) – 29.9%; anxiety-phobic (F40) – 22.4%; conversion (F44) – 14.9% disorders and neurasthenia (F48.0) – 7.5%.

Conclusion. The severity of the course of CSO does not always correspond to the level of manifestations of sexual dysfunction; the predominant sexual dysfunction is dyspareunia (54%). Somatogenic asthenia, which according to ICD-10 refers to mental disorders, is reduced by purely somatic (gynecological) therapy. The tactics of gynecologists to identify sexual dysfunctions in women with gynecological diseases have been determined. An in-depth analysis of SD in CSO has been carried out in two main directions (“sexo” ↔ “gyneco”) in the domain of science (“logy”) as a variant of the modern biopsychosocial model proposed in ICD-11.

Gynecology. 2021;23(6):571-577
pages 571-577 views

Results of a clinical study of the drug efficacy and safety for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis

Zaitsev A.V., Arefeva O.A., Sazonona N.A., Melnikov V.D., Kim Y.A., Shiryaev A.A., Vasilyev A.O., Gritskov I.O., Govorov A.V., Pushkar D.Y.

Abstract

Background. Urinary tract infections remain one of the urgent problems in the aspect of qualified medical care. The causative agents of nosocomial infections are becoming more and more resistant to the drugs used, while the rate of new drugs synthesis is lower than the rate of development of antibiotic resistance. Routine and empirical prevention of recurrent urinary tract infections is often ineffective.

Aim. To study the efficacy and safety of intravesical application of the drug based on bacteriophages in therapy in patients with chronic recurrent cystitis.

Materials and methods. A clinical study was carried out to study the efficacy and safety of the drug for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis. The study included 75 patients who were divided into 3 groups in a 1: 1: 1 ratio. In the main group, the drug for intravesical administration based on bacteriophages, as well as rectal suppositories with bacteriophages were used; in the control group – only a drug for intravesical administration based on bacteriophages or rectal suppositories with bacteriophages. On visits 1-4, all patients underwent a clinical blood test, general urine analysis, bacteriological urine analysis, as well as urine analysis by the polymerase chain reaction method. The analysis of the patients condition in groups was carried out according to the dynamics of main clinical symptoms changes, data from validated scales for assessing pelvic pain and urgency/frequency of urination and assessment of symptoms of acute cystitis (Acute Cystitis Symptom Score – ACSS), as well as the dynamics of changes in objective parameters of laboratory studies and possible changes in sensitivity uropathogens to antibacterial drugs.

Results. The average age of the patients included in the study was 50.6 years. In all 3 groups, bacteriological examination of urine showed a predominant growth of Escherichia coli (3×104 CFU/ml). In the course of the study, there was a good tolerance to therapy, a decrease in clinical symptoms, as well as a significant decrease in the total score according to the pelvic pain scale and urgency/frequency of urination and the ACSS scale in all patients.

Conclusion. The emergence of a large number of microorganisms resistant to various antibiotics and their rapid spread in the environment has led to an increase in scientific interest in bacteriophage therapy as an alternative method of treatment. The overall subjective effectiveness of the therapy in our study was more than 80%, safety - 100%. Further research will allow for a personalized approach to the treatment of infectious diseases of the urinary system.

Gynecology. 2021;23(6):578-585
pages 578-585 views

IN AID OF THE CLINICIAN

Possibilities of drug therapy for uterine leiomyoma in reproductive age

Orazov M.R., Radzinsky V.E., Leffad L.M.

Abstract

Uterine leiomyoma, along with endometriosis, occupies a leading position in the structure of gynecological diseases associated with hyperproliferation. The disease can negatively affect the reproductive potential, gynecological health, somatic status and quality of life of women. The only radical "cure" for the disease is hysterectomy. Therefore, clinical research and assessment of the effectiveness of drug therapy for uterine leiomyoma is one of the most important tasks of modern gynecology, primarily for the health improvement of young women striving to preserve reproductive function. From the point of view of world demography (declining birth rates in the world and depopulation in European countries), the search for new pharmacological agents for the treatment of fibroids is not only a medical problem, but also a global socio-economic problem

Gynecology. 2021;23(6):586-591
pages 586-591 views

Relationship between COVID-19 and iron deficiency anemia in pregnant women

Sinchikhin S.P., Stepanyan L.V., Atueva L.M., Nasri O., Sinchikhina E.S.

Abstract

Huge resources of the health system and economies of all countries of the world are devoted to combating the COVID-19 pandemic (Coronavirus disease 2019). It is important to formulate effective measures to prevent the spread of a new coronavirus infection and the development of its postcoid complications. For this, it is necessary to study in depth not only the etiopathogenesis, clinical manifestations of the disease, but also to assess the influence of another pathology on the course of the development of the disease. Particular attention should be paid to pregnant patients with COVID-19. To clarify the relationship between COVID-19 and iron deficiency anemia. The information material includes data from scientific articles available in Pubmed and Internet resources on this topic, as well as data from our own observations. Timely diagnosis and treatment of iron deficiency anemia in pregnant women helps not only to prevent the development of obstetric and perinatal complications, but also to prevent the development of a severe course of COVID-19.

Gynecology. 2021;23(6):592-596
pages 592-596 views

CLINICAL CASE

Spontaneous pregnancy in a patient with premature ovarian failure after ovarian platelet-rich plasma injection. Case report

Kraevaya E.E., Makarova N.P., Babayan A.A., Kalinina E.A.

Abstract

The authors have described a clinical case of a spontaneous pregnancy in a patient with decreased ovarian reserve, secondary infertility and a history of an in vitro fertilization failure. Based on literature data and their own experience, the authors believe that intraovarian administration of platelet-rich plasma can increase the ovarian reserve and improve reproductive potential.

Gynecology. 2021;23(6):597-600
pages 597-600 views

LECTURE

Pathogenesis of vaginal prolapse with the formation of rectocele: a review

Radzinsky V.E., Orazov M.R., Mikhaleva L.M., Krestinin M.V., Lologaeva M.S.

Abstract

To carry out a systematic analysis of the data available in the modern literature on the pathogenesis of the formation of vaginal prolapse with the formation of rectocele rectum. The failure of the pelvic floor, namely its posterior compartment with the formation of a rectocele against the background of the lowering of the posterior vaginal wall, continues to be one of the most common gynecological diseases. This article presents an analysis of current literature data on the pathogenesis of pelvic organ prolapse with the formation of rectocele. Analyzing the above-mentioned data, it can be noted that the research data of recent years have significantly expanded the understanding of the etiology and pathogenesis of pelvic organ prolapse in its posterior compartment. However, the issues of etiology and pathogenesis of genital prolapse in patients of reproductive age, the role of individual risk factors and their combinations, pathogenetic mechanisms of development are still far from being resolved. Unfortunately, none of the above theories fully explains all the reasons for the formation of pelvic organ prolapse in its posterior compartment.

Gynecology. 2021;23(6):601-604
pages 601-604 views

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