Vol 20, No 5 (2018)

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According to the materials of the XIX All-Russian Scientific-Educational Forum "Mother and Child"

Objective - to evaluate the health-related Quality of life the women with “lesser” abnormalities of cervical epithelium and patients with high grade squamous intraepithelial lesions (HSIL) associated with human papillomavirus (HPV) infection. Materials and methods. The investigation was performed 274 women of reproductive age, divided into two main groups: HPV infection (“lesser” abnormalities 202 patients and with HSIL - 20) and healthy women - 20. All the studied women of health-related quality of life by using the EQ-5D-5L. Results. Revealed a significant reduction in the level of health-related quality of life in the psychological and emotional components of the patients with “lesser” abnormalities of cervical epithelium and patients with HSIL associated with HPV infection (p<0.005). Conclusions. In most cases, patients with HPV infection was involved psychological component of health-related quality of life, anxiety, fear of further fertility affects the overall well-being of patients.

The article presents the algorithms of patient management, depending on the results of smear on oncology and in accordance with the age of the patient.

Issues of treatment and rehabilitation patients with pelvic's inflammatory diseases are still remain highly relevant, so relapses and chronic inflammation processes are worsen the prognosis for generative function in women, which is an important social and economic problem in modern time. Purpose of the study. Monitoring the effectiveness of therapeutic measures of rehabilitation step in chronic forms of this disease. Materials and methods. We examined 110 patients who handled to the clinic for women with complaints about the absence of pregnancy, of which a survey group was formed. The duration of pelvic inflammatory desiase (PID) in patients of the examination group did not exceed 2 years. The age of the patients was 25-35 years old. In patients of the examination group, according to clinical, laboratory and ultrasound ultrasound, laparoscopy, hysteroscopy and morphological findings, PID was verified including the presence of chronic endometritis and other endometrial pathology (for example, endometrial polyp, simple endometrial hyperplasia). Results. The rehabilitation stage of treatment (6 months) in patients with PID was aimed at restoring the morphofunctional potential of the tissue and eliminating the effects of secondary injuries, which include the restoration of hemodynamics and activity of the endometrial receptors. This stage of treatment is extremely important, especially for reproductive disorders. At this stage, the patients of the examination group were given hormone therapy and treatment with vasoactive drug (dipyridamole). The obtained results testified to the significance of the restoration of the vascular blood flow of the uterus and the functional layer of the endometrium. Conclusion. Rehabilitation therapy in patients with PID was primarily aimed at restoring the functional ability of the endometrium. Hormone therapy was a priority role, but at modern time, role of the vasoactive drugs that affect the blood flow in the uterus is emphasized. One of these drugs is dipyridamole, which contributes to the formation of collaterals (bypass paths) in ischemic zones. The results indicate that at the end of the 6-month rehabilitation phase, than of a three-layer endometrium was diagnosed (according to ultrasound on day 8-10 of the cycle) in 85 (77.27±4.00%) patients in the examination group.

Introduction. The chronic, progressive, recurrent nature of the endometriosis results new avenues of targeted therapy for genital endometriosis with high therapeutic efficacy and minimal side effects must be explored. Nowadays, the standard of prolonged specific therapy for endometriosis is the dienogest 2 mg daily, which has already been proven to be effective in vitro, in vivo and in clinical practice. Purpose: to evaluate the effectiveness of new types of targeted pathogenetic therapy for endometriosis on the model of endometriosis in rats compared to dienogest and without treatment. Materials and methods. Endometriosis was induced on 69 Wistar rats by autotransplantation of uterine fragments onto the inner surface of the abdominal wall. After 14 days, the heterotopies had been measured by laparoscopy and then rats were randomized of into one of 6 experimental groups (dienogest, letrozole, cabergoline, metformin, vitamin D, melatonin) or a control group. All drugs were administered daily orally for three weeks, after which an autopsy and re-measuring of the size of endometrial implants were performed. Results. The most pronounced decrease in the size of endometrial implants was observed in the group of animals treated with dienogest (complete resorption - 48%, regression - 48%, without dynamics - 4%) and letrozole (complete resorption - 44%, regression - 56%) without the statistically significant difference between groups. In other groups, a significant decrease in the size of endometrial implants was demonstrated compared with the control, without a statistically significant difference between the groups. Findings. The presented study confirms the absence at the present time of oral drugs for the treatment of endometriosis, comparable in efficacy and safety with dienogest. Further research are needed to evaluate the different combinations of dopamine agonists, biguanides, vitamin D, melatonin as the supplement to the classic hormone-modulating therapy for endometriosis or as monotherapy in patients with contraindications to standard hormone therapy.

Turner syndrome (TS) is the most common chromosomal abnormality in females. TS is associated with partial or complete loss of the second X-chromosome in phenotypic females and is associated with increased morbidity and mortality. There are many controversial issues of monitoring, management and counseling of patients with TS. This review emphasizes the need for a multidisciplinary approach to the study of this pathology to enable the realization of reproductive function in patients with TS.

Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.