Vol 19, No 6 (2017)

The aim of the study was to evaluate the effectiveness of treatment of women with opportunistic vaginal infections during pregnancy. Materials and methods. A prospective cohort study included 330 pregnant women, of whom 151 were diagnosed with bacterial vaginosis (BV), 37 had aerobic vaginitis (AB), 109 had vulvovaginal candidiasis (VC), 20 had a combination of VC + BV. When carrying out antibiotic therapy in the early stages of pregnancy, the principle of local treatment was observed. Results. Most often (46.0%), vaginal infections were detected when women were treated early in pregnancy. In the treatment of BV in the early stages of pregnancy with antiseptic chlorhexidine, a positive result of therapy was noted in 97.6% of women. Therapy with metronidazole or clindamycin BV in women who applied in the II and III trimesters, gave a positive result, respectively, in 90.0% and 89.5% of cases. The course of therapy with chlorhexidine pregnant women with AB was effective in 91.7% of cases with treatment in the first trimester and 92.0% in treatment in the II and III trimesters. In the treatment of VC in early pregnancy, natamycin was effective in 95.0% of women. In the II and III trimesters, econazole treatment was successful in 88.2% and 88.6%, respectively. In the treatment of combination of BV + VC in early gestation, the complex course of chlorhexidine + natamycin was effective in 76.5% of women, in II and III trimesters Neo-Penotran Forte was effective in 93.8% of pregnant women. Relapses of vaginal infections were observed in 34 pregnant women (10.3%). Superinfection with fungi was noted in 9.3% of cases of BV treatment and in 8.1% of pregnant women with AB. Among women observed from early pregnancy, there were no cases of premature birth, manifestations of intrauterine infections were noted in 5.3% of newborns. At treatment in the II and III trimesters, premature birth was in 6.5% and 13.5% of women, and manifestations of intrauterine infections - in 15.3% of newborns. Thus, microbiological monitoring of timely detection and treatment of opportunistic vaginal infections in pregnant at-risk groups showed the advisability of treating these infections in early gestation.

The aim of the study was to evaluate the effectiveness of the use of letrozole as an inducer of ovulation in women with polycystic ovary syndrome (PCOS) and anovulatory infertility and to determine possible clinical and laboratory predictors of the effect of therapy. Materials and methods: 61 women with anovulatory infertility and PCOS (mean age 28.5 ± 3.3 years, mean body mass index - BMI 21.8 ± 2.7 kg / m2) were included in the study. In order to induce ovulation, the patient received letrozole at a dose of 2.5-5 mg / day from day 3 to 7 of the menstrual cycle under the control of folliculometry, ultrasound m / pelvis on the 20-24 day cycle and the level of progesterone in the blood. Results: the frequency of ovulation per cycle was 77.2% (146/189), 98.4% for women, 24.9% for conception (47/189), 77% for women (47/61) , in 6 (12.8%) women the pregnancy was biochemical, in 1 (2.1%) ectopic, multiple pregnancy took place in 2 (5%) women with progressive uterine pregnancy, spontaneous abortion in the period up to 12 weeks of gestation occurred in 5 (12.5%) women, there was no case of ovarian hyperstimulation syndrome or other side effects. Comparative analysis revealed higher levels of BMI, the percentage of total adipose tissue by densitometry, and the number of antral follicles in the volume of the ovaries in the group with no pregnancy. Conclusion: letrozole is an effective medication for induction of ovulation and pregnancy in the treatment of infertility in patients with PCOS, characterized by good tolerability, low risk of multiple pregnancies and the absence of cases of ovarian hyperstimulation syndrome.

По материалам симпозиума «Женское здоровье и контрацепция» В сентябре 2017 г. состоялся ставший традиционным XVIII Всероссийский научно-образовательный форум «Мать и дитя». Специалисты со всей России и их иностранные коллеги встретились для обсуждения самых острых и насущных проблем акушерства и гинекологии: были разработаны основные направления работы по снижению материнской и младенческой заболеваемости и смертности, затронуты принципы лечения патологий беременности, представлены новые хирургические технологии и пр. Большое внимание практикующие врачи уделили вопросам демографии и репродуктивного здоровья женщин: планированию семьи, репродуктивному поведению молодежи и, конечно, принципам назначения контрацепции.

Purpose: to study the molecular biological basis of genital prolapse, its determination by the carrier of polymorphisms of laminin, collagen, estrogen receptor and vascular endothelial growth factor. Materials and methods: 178 women aged 35-65 years were examined, 134 of them with relapses of prolapse genital (PG) after hysterectomy with vaginal access due to complete and incomplete prolapse of the uterus and vaginal walls were randomized into groups: 1 - with manifestations of undifferentiated connective dysplasia tissue (DST), 11.7 points on average (n=86); 2 - without signs of DST (n=48). The control group 3 consisted of healthy women without signs of PG (n=44). The morphological method of investigation along with the immunohistochemical method was used to evaluate the biopsy specimens of the uterosacral ligaments (USL) and round ligaments of the uterus (RLU), the genotyping by polymerase chain reaction of polymorphisms LAMC1 3054 C>T, COL3A1 2092 (2209) G>A, ESR1 351 G>A [XbaI], VEGFA 634 G>C with isolation of DNA samples from whole blood. Results: morphological features of the structural components of the USL and RLU were realized in the predominance of excessive fibrosis of the connective tissue on the background of disunity and loosening of collagen fibers and myocyte dystrophy. Expressed dysplastic changes with loss of elasticity of fibers due to increased fragmentation of elastin, excessive synthesis of the least strong type III collagen in comparison with type I, perivascular edema were traced in the group with signs of DST (in 65% of women). The decrease in tissue strength in the imbalance of synthesis and degradation of collagens in patients with PG was correlated with the excess production of type III protein - high in USL and moderate - in RLU. Healthy women were distinguished by the prevalence of type I collagen (5.5 and 4.2 points respectively) - one and a half times more than in pelvic descent (3.2 and 2.7 points respectively). The increased degradation of elastic fibers in PG determined the fragmentarity of their distribution in the ligamentous apparatus of the uterus in comparison with the uniform one - along the collagen fibers, in the extracellular matrix and fibroblasts, the walls of the arterioles of the USL and RLU in healthy women. The genetic determinateness of molecular-biological features of connective tissue structures with PG is determined, which allows to predict the risk of the disease development at the preclinical stage. The carriage of "risky" alleles of the genes COL3A1 2092 (2209) G>A (rs1800255) (45.8% vs 29.5%) in the presence of DST manifestations indicated associativity with PG. The frequency of the allele GC of the VEGFA gene with PG was equally increased: in the absence of signs of DST - by one and a half times (59.3% vs 36.4%, p=0.002, OR=9.9, 95% CI 1.6-7.6), in the presence of collagenopathies - in two (35.4% versus 15.9%, p=0.01, OR=2.9, 95% CI, 1.1-6.9) with a comparable occurrence of heterozygotes (36.9% on average). The absence of associative links was established for laminin LAMC1 (connective tissue) (50% versus 31.8%) and estrogen receptor ESR1 -351 G> A [XbaI] (43.4%). Representatives with collagenopathies distinguished the high carrier burden of the mutant polymorphism rs3918242 - twice as much compared to the control group (35.4% vs 15.9%, p=0.01, OR=2.9, 95% CI 1.1-6.9) with a comparable occurrence of heterozygotes (36.9% on average). The conclusion. The determinism of pathobiochemical features of connective tissue is revealed - the imbalance of synthesis and degradation of its components, the formation of an abnormal structure of fibers and the expressed polymorphism of polymorphisms of genes that control the safety of tissue architectonics of the pelvic ligaments. Expansion of PG prediction capabilities is most likely in the presence of signs of DST predetermining the systemic nature of its lesion and variety of symptoms, with a particular manifestation in the form of pelvic floor insufficiency in the presence of "risky" polymorphisms of the genes LAMC, COL3A1 and VEGFA. Determination of genes predisposing to PG allows us to formulate the concept of its pathogenesis, with the identification of risk groups not only of development, but also the relapse of the disease after surgery, by choosing the most optimal method of surgical correction.

The article presents modern literature data on the stimulation of ovulation in programs of assisted reproductive technologies in women over 40, the advantages and disadvantages of conventional ovarian induction schemes, the clinical and economic effectiveness of the use of coryphollitropine-a for folliculogenesis.