Vol 18, No 3 (2016)

This review presents the current published data on the epidemiology, etiology, pathogenesis, diagnosis and treatment of pelvic inflammatory disease (PID). Medical and social consequences of PID associated with the negative impact on women's reproductive health, emphasize the need for early antimicrobial therapy aimed at eradication of all potential etiotropic agents of the inflammatory focus. In the article the comparative analysis of the advantages and some limitations of conventional therapeutic strategies designed for use in situations with PID on Russian territory, the United States and Europe. Given the ubiquity of fluoroquinolone antibiotic resistance, insufficient sensitivity to first-line antibiotics (doxycycline) in the individual agents (in particular, Mycoplasma genitalium) treating PID in the circuit along with II-III generation cephalosporin, metronidazole, and it is desirable to recommend inclusion of azithromycin as an antibacterial drug first selection.

Aim: to evaluate the quantitative and qualitative composition of cervical human papillomavirus (HPV) infection in chronic cervicitis (CC). Materials and methods. The study included 102 patients with cervical HPV infection, mean age 33,9±1,1 years. The 1st group (main) consisted of patients with CC (n=39), 2nd group (comparison) - the patients with cervical intraepithelial neoplasia - CIN (n=50), group 3 (comparison) - patients with cervical cancer (n=13). Complex diag-cer nostics included liquid cytology, colposcopic, and histological examination of cervical biopsies and endocervical samples, advanced screening for high risk HPV DNA (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types) and low risk (6, 11 types) with viral load detection, screening for chlamydia and mycoplasmas DNA. Statistical analysis of data was performed using STATISTICA-6, functionality of MS Excel. Results. The prevalence of the same HPV type (56% and 64% respectively), two types (26 and 22%), three or more types (18 and 14%) in the 1st and 2nd group had no significant difference respectively. In the 1st group 45, 52 relative prevalence of HPV types was found in comparison with CIN, in which the predominance of 33 and 35 types of HPV (p<0.05) was marked. First group patients are characterized by the more frequent detection of clinically insignificant (<3 lg×105) level of high risk HPV viral load (49%) compared with CIN (32%) at which threshold progression exceeding (>5 lg×105) was observed significantly more frequently (p<0.05). Conclusion. Among patients with СC an absence of differences in mono - and combined HPV infection prevalence, in detection rate of 16, 18, 31, 51, 56, >58, and 59 HPV types was shown in comparison with CIN, except for the viral load level.

Despite the fact that the study of uterine fibroids has been widely discussed, the problem still remains unsolved. Uterine fibroids are the most common benign neoplasm of female genital system. Increasingly diagnosed in recent decades, uterine fibroids in women planning a pregnancy, which is associated primarily with the social factor: modern women tend to postpone the time of childbirth until a stable material and social status, which often occurs close to the late reproductive age, when the prevalence of uterine fibroids naturally increases. The link between uterine fibroids and fertility disorders ambiguous, but, without a doubt, the presence of uterine fibroids should be taken into account in women with infertility and habitual miscarriage. The optimal solution, but today, in addition to surgical treatment task of restoring fertility in women with uterine fibroids do not exist, there is a possibility of conservative management of these patients. Advantages and disadvantages of surgical and conservative tactics restore fertility in patients with uterine myoma should undergo evaluation and further development.

Vitamin D is an essential component of nutriceutical support for female reproductive health. Vitamin D is involved in the regulation of ovulation, endometrial proliferation and ovarian functions as well as supports high sensitivity of these tissues to hormonal influences. The date shows the importance role of vitamin D for women reproductive health.

Objective: systematic review to determine the role of assisted hatching in the IVF cycles. Materials and methods. We searched the MEDLINE base (2005 to February 2016) and included all articles related to the question. Results. Possible mechanisms and efficiency of assisted hatching in embryo implantation are described below as well as possible factors that influence the efficiency of spontaneous hatching. Conclusions. The included trials provided insufficient data to investigate the role of different types of the assisted hatching in clinical pregnancy rate, live birth rate and development of multiple gestations.

Objective - to expand the conception of molecular and biochemical changes in genital prolapse (GP) based on the study of morphological and immunohistochemical features in connective tissue structures of the ligamentous apparatus of the pelvic floor and their dependence on genetic polymorphisms MMP/TIMP. Materials and methods. The study involved 178 women aged 35 to 65, 134 of them with GP relapses (after hysterectomy by vaginal access because of a total and partial uterus and vaginal walls prolapse). Patients were randomized into the following groups: 1 - with manifestations of undifferentiated connective tissue dysplasia - CTD (11.7 points on average; n=86); 2 - with no CTD signs (n=48). Control group 3 consisted of healthy women without any GP signs (among 15 patients abdominal hysterectomy was performed in connection with uterus hyperplastic processes); n=44. Used. Morphological method of studies, immunohistochemical (to assess tissue biopsies of sacrum-uterine and round uterine ligaments), the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs), genotyping by polymerase chain reaction of MMP/TIMP polymorphisms. Results. The morphological study of women’s ligamentous apparatus in cases with GP revealed significant fibrosis, coarser collagen septa among bundles of smooth muscle fibers and degenerative changes in individual smooth muscle cells. The group with GP and CTD features showed diffuse atrophy, hyaline or mucinous degeneration of smooth muscle tissue and evident edema of extracellular matrix in 65% of samples. Pathobiochemical disorders in cases of pelvic descencia were determined by an imbalance in collagen type I and III content, with the predominance of the latter, less durable; a decrease in elastin levels and its considerable fragmentation. The greatest expression of tissue degradation was observed among women with GP and CTD manifestations on account of increased MMP-1 and -2 levels; TIMP-1 content was lowest in the group. Associations with GP development have been established among women with CTD signs for genetic polymorphisms: rs3918242 СT gene MMP9 (0.54) (p=0.007; OR 3.2; 95% CI 1.3-7.6), rs17576 AG gene MMP9 (0.62 vs. 0.32, p=0.01; OR 2.9; 95% CI 1.2-7.0); rs3025058 5A6A gene MMP3 (0.52 vs. 0.45, p=0.009; OR 3.7; 95% CI 1.3-10.1); rs2285053 (rs2285052) CT gene MMP2 (0.44 vs. 0.27, p=0.007; OR 3.2; 95% CI 1.3-7.5). Statistical significance for the groups was preserved after the correction for multiple comparisons. Conclusion. The data obtained reveal pathogenetic aspects of genital prolapse - the prevalence of extracellular matrix degradation in a dysplastic morphogenesis. Genetic predictors of pelvic floor remodeling including the formation of its insolvency were established, allowing to extend the range of diagnostic possibilities of the disease progression at early stages or detection the risk of recurrence after surgical treatment. Personification of high-risk groups conducting provides for the exclusion or modification of all the factors predisposing to the development of the disease and performing timely treatment and preventive measures.