Vol 22, No 4 (2020)

Aim. To develop a predictive model to calculate the probability of placental abruption development in patients with initially low obstetric risk by using a multidimensional mathematical analysis of anamnestic, clinical, and genetic data.

Materials and methods. This logistic model is based on 212 observations. This study included two groups of healthy women aged 18–35 years without a history of spontaneous abortion, preterm labor, stillbirth, preeclampsia, or other complications. The first group was comprised of 112 women with a history of a placental abruption (patient group), and the second group consisted of 100 women with non-complicated pregnancy (control group). Gene polymorphisms were detected using the polymerase chain reaction-real time technique. The data was analyzed using binary and multifactorial statistical mathematics. Our analysis of the predictive models was performed by using logistic regression. To determine the diagnostic value of the predictive models used, the ROC-curve is followed by determining the area under it (AUC).

Results. The 24 anamnestic, clinical, and genotypic characteristics were examined as placental abruption predictors using multifactorial analysis. We were able to determine what the nine most informative predictors of placental abruption were according to Wald Chi-Square criteria (÷², р): fetal growth restriction (13.143; р<0.001), placental insufficiency (9.629; р=0.002), male sex of the fetus (6.965; р=0.008), preeclampsia (6.779; р=0.009), combination of genotypes PAI-1-5G4G/FV-1691GA (6.613; р=0.010) or PAI-1-5G4G/MTHFR-677CT (6.158; р=0.013), pathology of amnion (4.497; р=0.034), infectious diseases in pregnancy (4.277; р=0.039), tobacco smoking (3.963; р=0.047). ROC analysis identified a high specificity (82.64%) and sensitivity (77.42%) of the model, and the integral index of the effectiveness of predictive markers (AUC=0.836), according to the expert scale of values which is indicative of a very high quality model.

Conclusion. It is recommended to use this elaborated predictive model in clinical practice for the purpose of individual risk assessment of placental abruption in healthy patients with initially low obstetric risk.

Background. The structure of lower urinary tract infections has clear sex-based differences. The vaginal microbiota is a key factor in the pathogenesis of lower urinary tract infections: aerobic vaginitis predisposes to infection and increases the incidence of cystitis by 2.9 times.

Aim. To determine the effectiveness of Nifuratel as monotherapy in patients with chronic cystitis and concomitant bacterial vaginosis (BV).

Materials and methods. Study design: an open-label, non-comparative, pilot, single-center, prospective study, which included 23 patients with recurrent cystitis and BV. All women received monotherapy with Nifuratel (Macmiror manufactured by Doppel Farmaceutici S.r.l., Italy) in tablets of 200 mg 3 times a day for 7 days. Control visits were performed in 7.90 and 180 days.

Results. BV was diagnosed in all patients; 19 (82.6%) women also had vaginal candidiasis. At the end of therapy, 17 (73.9%) patients showed an excellent outcome, 4 (17.4%) – a significant improvement, 2 (8.7%) – no effect. After the end of three-month therapy, 18 (81.8%) out of 22 patients who left in the study had no complaints of urinary disorders or vaginal discharge. Their urinalyses were normal. Molecular genetic analysis of the vaginal biocenosis showed moderate dysbiosis; Candida spp. was revealed only in 3 (13.6%) cases. 18 patients came for the 4th visit. Within six months after the end of monotherapy with Nifuratel, the patients had no complaints. They all achieved the recovery of vaginal normocenosis with a sufficient amount of Lactobacillus spp.

Conclusion. Monotherapy in patients with recurrent cystitis and BV is highly effective for both diseases: 73.9% of women achieved stable normalization of urine and vaginal microbiota analyzes, removal of bacteriuria. The bi-directional action of Nifuratel allows to avoid polypharmacy in this category of patients.

Relevance. Empirical treatment of vaginitis is indicated due to its polymicrobial etiology and limited microbiological analysis. The aim of the study was to study the combination of ornidazole–neomycin–prednisolone–econazole (ONPE, Elzhina^®) as a first-line drug for local treatment of patients with various forms of non-specific vaginitis.

Materials and methods. The study included 55 non-pregnant women aged 18 to 50 years (38±1.5 years) who had clinical and laboratory signs of acute vaginitis.

Results. All patients at the initial treatment complained of pathological discharge, 47 (85.5%) noted itching, burning, pain in the genital area of various degrees of severity, 17 (30.9%) – discomfort when urinating, 9 (16.4%) – unpleasant smell, 8 (14.5%) – dyspareunia, 4 (2.2%)– complained of sensations of a foreign body in the vagina. The clinical and laboratory effectiveness of treatment was 89.1% (49). In 6 (10.9%) patients, clinical improvement was noted, with the remaining laboratory signs of aerobic vaginitis.

Conclusion. The new combination of ornidazole–neomycin–prednisolone–econazole (ONPE, Elzhina^® ) has a good efficacy and safety profile and can be used to initiate empirical treatment of non-specific inflammatory diseases of the lower genital tract.

Introduction. Patients with surgical menopause have a risk for osteopenic syndrome (OS). Menopausal hormone therapy (MHT) in combination with calcium and vitamin D promotes increase in bone mineral density (BMD). The expression level of vitamin D receptor in mononuclear fraction cells (MNFC) of blood can be considered as a predictive marker of effectiveness of OS therapy.

Aim. To search a molecular predictive marker of the effectiveness of OS treatment.

Materials and methods. The study included 100 women aged 40–55 years with a duration of surgical menopause from 12 months to 6 years. The criterion for including patients in the study was the absence of contraindications to the use of MHT. The subject of the study was the determination of BMD by dual-energy X-ray absorptiometry, polymerase chain reaction diagnostics of the level of expression of vitamin D genes, estradiol and progesterone receptors, determination of 25-OH vitamin D in the blood.

Results. Analysis of 12-month OS therapy effectiveness evaluated with a surrogate marker BMD. The increase in BMD up to 3–4% per year was treated as absence of negative dynamics, more than 4% per year as positive one. Significant effect of combination therapy compared with MHT on BMD in patients with surgical menopause with a low baseline level of BMD (due to hypovitaminosis D) is associated with the anti-inflammatory, bone-protective effect of vitamin D. In both groups of patients not responding; to the prescribed therapy we were able to conduct a comparative analysis of expression level of the target molecules in the MNFC before the start of treatment. The efficacy of MHT and combination therapy for BMD disorders is positively associated with the expression level of vitamin D receptors in MNFC before treatment. Therefore, the vitDR mRNA level is a potential predictive marker of the effectiveness of OS treatment. The expression levels of nuclear estradiol beta receptor and membrane receptor for progesterone in MNFC before treatment showed an upward trend in women responding to therapy.

Conclusion. The expression level of the vitamin D receptor in MNFC of blood is significantly lower in the group of women with no/insufficient effect on 12-month combined therapy. This indicator can be considered as a predictive marker of the effectiveness of OS therapy.

Aim. To evaluate the effectiveness of combination therapy of pathological endometrial processes (benign forms) based on the determination of one of the variants of etiopathogenesis in patients of perimenopausal age and in postmenopause.

Materials and methods. The examination included 34 patients with a diagnosis of endometrial hyperplastic processes in the perimenopausal period and in postmenopause. To verify the diagnosis, in addition to the results of a clinical examination (general and gynecological), the patients underwent laboratory (microscopic and molecular biological studies using real-time polymerase chain reaction method of aspirates from the uterine cavity), diagnostic (ultrasound, hysteroscopy) and morphological examination methods.

Results. Conducting combined antimicrobial and antiviral therapy in patients with endometrial hyperplastic processes, endometrial polyp in combination with chronic endometritis, allowed us to eliminate microbial agents from the endometrium before starting hormonal therapy. A positive result of the combined approach showed the absence of recurrence of endometrial hyperplastic processes within 2 years in 91.17% of patients of the examination group.

Conclusion. In our study, we evaluated the effectiveness of the combined treatment of endometrial hyperplastic processes in patients in the perimenopausal period and in postmenopause, against a background of chronic endometritis, using systemic therapy with antibiotics and antiviral drugs, followed by hormonal therapy. A clinical study allows us to formulate recommendations on the management of patients with endometrial hyperplastic processes, endometrial polyps in the perimenopausal period and in postmenopause.

Aim. To investigate the modern condition of the problem of adenomyosis and its impact on women’s reproductive function.

Material and methods. The article presents a systematic literature review on the results of research search in electronic databases MEDLINE, PubMed, EMBASE, Cochrane Library and Elibrary.

Results. Adenomyosis is a common but insufficiently studied disease. Modern imaging methods, such as transvaginal ultrasound and MRI, make it possible to diagnose adenomyosis at the early stages of the disease and perform the organ-preserving surgery. A medical treatment of adenomyosis requires to develop a lifelong management plan, the choice depends on the woman’s age, reproductive status and clinical symptoms. Currently, there is evidence of a negative impact of adenomyosis on fertility and pregnancy outcomes. Dienogest, a 19-norsteroid derivative, is a progestin with high selectivity to progesterone receptors, it exerts a hypogonadotropic effect and an antiproliferative effect on the endometrium. A mild regime of supression of ovarian function provides adequate conditions for blood supply to the uterus before planning a pregnancy. The immunomodulating effect of progestin may be useful for implantation and fetal protection to pregnancies occurring after treatment. Dienogest treatment increases the effectiveness of IVF cycles for adenomyosis of varying severity.

Conclusion. The review summarizes the aspects of prevalence, comorbidity, risk factors, classification, mechanism of pathogenesis, clinical manifestations, diagnosis, treatment of adenomyosis, impact on fertility and pregnancy outcomes.

At present, bacterial biofilms play a significant role in chronic endometritis. In our clinical case, a patient with a history of infertility has had no sex life for several years, but bacterial vaginosis recurs monthly. Ascending bacterial infection with chronic endometritis was confirmed by immunohistochemistry data (detection of CD138), as well as microbiological data (detection of anaerobic microorganisms, including Gardnerella vaginalis and Atopobium vagine, in the endometrium). To treat chronic endometritis, we used antibiotic moxifloxacin, followed by administration of bovhyaluronidase azoximer (Longidaza^®) in the form of rectal suppositories. As a result of complex therapy, the patient’s endometrium improved (CD138 and anaerobic bacteria revealed), subsequent repeated insemination with donor sperm led to the onset of progressive pregnancy.

The article shows the possible use of sulodexidi in a patient with primary infertility of unknown origin associated with an excess of the plasminogen activator type 1 inhibitor. This method illustrates the possibility of pregnancy when taking sulodexidi at the stage of pregravidar preparation in a woman with hypofibrinolysis.

Lower genital tract inflammatory diseases, caused by opportunistic and pathogenic microorganisms (vulvovaginitis), occupy a leading place among gynecological diseases and are one of the most common reasons for women to consult an obstetrician-gynecologist. Vulvovaginitis is rarely caused by a single pathogen. In recent years, lower genital tract inflammatory diseases are characterized by the predominance of mixed infections, which, on the one hand, can lead to a more severe and prolonged course, frequent relapses, an ascending infection, and, on the other hand, can be asymptomatic, till the development of complications, and represent certain difficulties in the diagnosis and choice of therapy. Opportunistic pathogens and anaerobes-bacteroides play a major role in manifestations of mixed infections. Currently, in the treatment of mixed vulvovaginitis, preference is given to combined drugs that have an effect on a wide range of pathogenic microorganisms. One of them is Metromicon-Neo^®, which features of action and our experience of its use along with the features of mixed vulvovaginitis are summarized in the article.