Vol 24, No 3 (2022)


Non-invasive diagnosis and non-surgical treatment of endometriosis: A review

Podzolkova N.M., Fadeev I.E., Mass E.E., Poletova T.N., Sumyatina L.V., Denisova T.V.


Endometriosis is a hormone-dependent condition occurring in women of predominantly reproductive age. It has an extremely diverse localization, clinical course and outcomes. The need for organ-sparing treatment to preserve and/or restore fertility, the negative effects of radical surgery for endometriosis on ovarian reserve and the effectiveness of assisted reproductive technologies, and the benign nature of the disease, which tends to self-limitation after menopause, lead to the search for effective methods of non-surgical treatment and the need for noninvasive diagnosis of endometriosis. The article presents the current principles of non-surgical management of patients with endometriosis.

Gynecology. 2022;24(3):167-173
pages 167-173 views

Current status of transvaginal mesh implants use in the surgical treatment of stress urinary incontinence and pelvic prolapse

Shakhaliev R.A., Shulgin A.S., Kubin N.D., Kuzmina I.N., Suchkov D.A., Shkarupa D.D.


The use of synthetic implants in stress urinary incontinence and pelvic prolapse surgery is being actively debated today, not only among experts in the field but also in the media, the patient community, and even in legal and political set. Such response has had a natural effect on the clinical application of the technology. An absurd situation is observed in some countries: the bans imposed by the authorities have directly or indirectly restricted patients' access to the most sophisticated technologies with proven efficacy. This literature review aims to systematize the perspectives of the scientific and regulatory communities in leading countries on the use of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic prolapse.

Gynecology. 2022;24(3):174-180
pages 174-180 views


Clinical and economic analysis of the effectiveness of pre-implantation genetic testing in patients with various types of infertility in assisted reproductive technology programs

Kulakova E.V., Mikhailov I.A., Makarova N.P., Drapkina J.S., Kalinina E.A., Nazarenko T.A., Trofimov D.I.


Introduction. A clinical and economic study was carried out to assess the effectiveness of infertility treatment using assisted reproductive technology programs with preimplantation genetic testing (PGT) in patients with various reproductive disorders.

Materials and methods. Twenty models representing discrete-time Markov processes are developed. A total of 10 possible paired scenarios for couples undergoing infertility treatment using assisted reproductive technology, depending on reproductive disorders and the use of PGT, were considered in the study.

Results. The most cost-effective scenarios from the simulation results should be the use of PGT in the group of females aged 37–42 years and in the group of females under 35 years with missed abortion. These scenarios are not only resource-efficient in terms of the willingness-to-pay threshold, but they also preserve compulsory health insurance funds still with meaningful clinical efficiency. The remaining scenarios are characterized by significant clinical efficacy and low cost per added live birth, except for the PGT use in the group of males with teratozoospermia, which is characterized by a minimum of added live births and a maximum cost per added live birth.

Conclusion. The study results indicate the most optimal and economically feasible scenarios of PGT in patients depending on the infertility factor for implementation in the practical healthcare system of the Russian Federation.

Gynecology. 2022;24(3):181-185
pages 181-185 views

Expression of pituitary gonadotropic hormone and sex hormones receptors in endometrial cellular components during menstrual cycle

Magnaeva A.S., Tregubova A.V., Tsitrina A.A., Asaturova A.V., Shamarakova M.V., Tabeeva G.I., Ezhova L.S., Kalinina E.A., Bozhenko V.K.


Introduction. The main function of the endometrium is to create the optimal environment for embryo implantation, controlled by multicomponent signaling pathways. They are modulated by progesterone and estradiol acting through related estrogen receptors (ER) and progesterone receptors (PR). Alteration in steroid hormone, follicle-stimulating hormone (FSHR), and luteinizing hormone (LGHR) receptor expression are underlying factors in the development of various reproductive disorders. Therefore, understanding the physiological features of receptors’ expression and localization in tissues is extremely important for a proper comprehensive assessment of the endometrial condition.

Materials and methods. The expression of ER, PR, FSHR, and LGHR in endometrial samples of healthy females from different menstrual periods, who applied for assisted reproductive technologies (ART) due to male infertility, was assessed by immunofluorescence.

Results. The increase in immunoreactivity of ER, PR, FSHR, and LGHR in the glands and stroma of the endometrium is initiated during the early proliferation stage and reaches its maximum during the late proliferation stage. Subsequently, ER expression in the glands and stroma gradually decreases throughout the early and middle stages of secretion; PR immunoreactivity in the stroma and FSHR and LGHR in all endometrial components persists throughout the secretion stage.

Conclusion. The correspondence between the change of the studied receptors' expression and endometrium structural features at different stages of the menstrual cycle was demonstrated. The increased expression of ER, PR, FSHR, and LGHR in the endometrium at the proliferation stage coincides with the growth period of the uterine body mucosa, and the increased immunoreactivity of PR, FSHR, and LGHR during the secretion stage is associated with its decidual transformation and seems to create conditions for successful implantation and embryo development if pregnancy occurs.

Gynecology. 2022;24(3):186-192
pages 186-192 views

Reproductive health of adolescent girls born prematurely: new forecasting opportunities

Malyshkina A.I., Batrak N.V., Fomina M.M., Kiseleva O.Y., Shepelev D.V.


Background. Premature delivery remains one of the most pressing issues in obstetrics.

Aim. To assess the reproductive health of 16-year-old adolescent girls born prematurely to develop an algorithm to optimize its state.

Materials and methods. A total of 180 adolescent girls aged 16 years were evaluated. The study group consisted of 120 adolescents born at a gestational age of 27–36 weeks. Subgroup 1 consisted of 18 girls born at a gestational age of 27–33 weeks, and subgroup 2 consisted of 102 adolescent girls born at 34–36 weeks of gestation. The comparison group consisted of 60 girls born at term. The study material was peripheral venous blood. Hormonal and ultrasonic examination of the internal genital organs were performed.

Results. In the main group vs. comparison group, an increase in serum leptin levels was observed: 9.4 (6.1; 15.5) and 6.9 (4.2; 9.2) ng/ml (p<0.01). The leptin blood concentration in subgroup 2 showed a positive correlation with the body mass index (p=0.001). A more frequent increase in the number of antral follicles (>10 in each ovary) was recorded in adolescents born prematurely. When assessing the results of correlation analysis, a positive direct correlation between the number of antral follicles and serum leptin concentration in adolescent girls born prematurely (p<0.001) was observed. It was found that with a leptin level >15.8 ng/ml, there is an increase in the number of antral follicles, which may be the cause of reproductive disorders.

Conclusion. Premature delivery and its long-term consequences (obesity and metabolic syndrome) contribute to hyperleptinemia, leading to ovarian function suppression in adolescents. Therefore, it is necessary to include leptin level measurement in the algorithm of examining adolescent girls for timely diagnosis and subsequent treatment of possible reproductive disorders.

Gynecology. 2022;24(3):193-197
pages 193-197 views


Relevance of abnormal uterine bleeding issue in young women and its comprehensive solution considering 2021 Russian Guidelines

Chernukha G.E.


Abnormal uterine bleeding is a common problem in gynecology. It is a general term to describe menstrual disorders, including frequency, regularity, duration, and bleeding volume in non-pregnant women. Up to 1/3 of women experience this condition during their lifetime. Heavy menstrual bleeding not related to structural abnormality can be a serious health problem for many young women. It has a profound adverse impact on many aspects of their lives and increases the risk of iron deficiency anemia. However, up to half of these women consider the volume of menstrual blood loss normal, and physicians do not ask the relevant questions during counseling. The Russian Clinical Guidelines "Abnormal Uterine Bleeding" provide physicians guide to the assessment, management, and choice of treatment for women with heavy menstrual bleeding.

Gynecology. 2022;24(3):198-205
pages 198-205 views

Current state of COVID-19 in pregnancy

Sinchikhin S.P., Bragina G.S., Parshina O.V., Stepanyan L.V., Nasri O., Sinchikhina E.S., Berkalieva A.R.


There is still a risk of a new wave of coronavirus infection in the general population and among pregnant women. Considering the possible adverse impact of COVID-19 on gestation, it is necessary to update information on the course, prevention, and treatment of the disease in this group of patients. The article includes data from foreign and domestic studies published recently on COVID-19, describing the emergence of new strains of the virus and gestational changes that increase the risk of infection and severe complications, demonstrating the importance of preventive measures. The information provided will contribute to the physicians' awareness, including obstetricians and gynecologists, of COVID-19.

Gynecology. 2022;24(3):206-211
pages 206-211 views

Scleroatrophic lichen: current view and hypotheses

Khryanin A.A., Sokolovskaia A.V., Bocharova V.K.


Scleroatrophic lichen (SL) is a chronic inflammatory skin disease of unknown etiology characterized by scar formation. The most frequent localization of SL is the anogenital area. In females, the most common anogenital symptoms are pain, itching, dysuria and dyspareunia. Male patients often present with complaints of a white rash on the penile skin, itching, painful erections and urination, and bleeding or ulceration during intercourse. Although clinical descriptions of SL date back to the mid-20th century, the pathophysiological mechanism remains unclear to this day. The main hypotheses of the pathophysiology of SL are infectious, autoimmune, and chronic irritation theories (occlusive exposure to various irritants, such as urine, leads to chronic skin injury that causes the disease). It is assumed that SL quite often goes undiagnosed for a long time. However, sometimes dermatoses such as eczema in the anogenital area are misdiagnosed by specialists as SL. In this article, the authors discuss in detail the existing hypotheses of SL development, its clinical manifestations, and current methods of diagnostics and therapy.

Gynecology. 2022;24(3):212-218
pages 212-218 views


Diagnostic efficacy of transperineal sonography in the verification of pelvic floor muscular and fascial defects. Case report

Orazov M.R., Khamoshina M.B., Gevorgian D.A.


Pelvic floor insufficiency (PFI) is one of the most common and understudied gynecological diseases. PFI is a major public health problem that will steadily increase due to population aging. The issues of early diagnosis remain unresolved. Physical examination remains the primary method of evaluating PFI, but manual examination alone is not enough to diagnose hidden pelvic floor (PF) defects. Topical verification of muscular and fascial PF defects is necessary to route patients for non-surgical or surgical treatment. 2D/3D transperineal sonography is a non-invasive, simple, and the most common method of imaging PF structures.

Gynecology. 2022;24(3):219-222
pages 219-222 views

A rare case of endometritis after caesarean section. Case report

Sinchikhin S.P., Pavlov R.V., Telegina I.V., Ashikhmina O.I., Berkalieva A.R.


The article describes a rare case of endometritis after abdominal delivery. Attention is drawn to the possibility of developing ischemia and necrosis of the uterine tissue when using the Reverden suture, as well as the development of a significant local inflammatory response due to the individual reaction to the suture material used. A case of non-surgical integrated approach to the treatment of endometritis with local tissue rejection is presented. A positive outcome of organ-preserving therapy of endometritis in terms of ischemic and necrotic changes in the area of the postoperative suture on the uterus was shown. Conservative therapy included the use of a beta-lactam class carbapenem and an antimicrobial peptide complex.

Gynecology. 2022;24(3):223-228
pages 223-228 views

Meshless sacrocolpopexy for post-hysterectomy vaginal vault prolapse: vascularized flap technique. Case report. Video case**

Kubin N.D., Shkarupa D.D., Basos A.S., Shulgin A.S., Labetov I.A., Shakhaliev R.A., Suchkov D.A.


The absence of rigid fixation point, tissue atrophy and multi-compartment defects make post-hysterectomy vaginal vault prolapse a real challenge for the surgeon. The gold standard for treatment of post-hysterectomy vaginal vault prolapse is sacrocolpopexy. Unfortunately, this approach does not allow to perform reliable long-term meshless reconstruction in the anterior and posterior compartments. Moreover, the use of a mesh is associated with the risk of erosion. Aim – to show the possibility of replacing a standard mesh with a vaginal flap during laparoscopic sacrocolpopexy. A 60-year-old patient with post-hysterectomy prolapse stage III underwent meshless laparoscopic vaginal-assisted sacrocolpopexy. The duration of the surgery was 105 min (35 min vaginal part and 70 min LS part). Intraoperative blood loss was 55 ml. No intraoperative and early postoperative complications were recorded. According to the ultrasound postvoiding residual was 35 ml, hematomas in the operation area were not visualized. During the exam in 12 months after the surgery, no signs of POP (Aa -2 Ba -3 C -8 Ap -3 Bp -3 tvl 9 gh 4 pb 3), erosion and any pain were detected. The results of the questionnaires were as follows: PFDI-20 – 22,92, PISQ-12 – 31 and ICIQ-SF – 1. According to ultrasound the volume of residual urine was 0 ml. This approach allows to eliminate completely the risk of erosion and create a unified plastic natural construction from the vaginal cuff and tailored flap.

Gynecology. 2022;24(3):229-232
pages 229-232 views

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