Vol 23, No 1 (2021)

Aim. To assess the effectiveness of a comprehensive examination of women of different ages in the diagnosis of benign breast diseases and breast cancer (BC).

Materials and methods. Retrospective analysis of medical records (600 cases), questionnaires of 300 women, prospective analysis of the results of a comprehensive examination of 300 patients.

Results. The link between low screening coverage and insufficient activity and awareness of the population has been established. The significance of various risk factors, including reproductive history, lifestyle, use of hormone therapy and heredity, for benign breast diseases and BC, has been clarified. It was shown that breast diseases are often combined with endometrial hyperplastic processes, uterine myoma, menstrual dysfunctions, severe lesions of the cervical epithelium and neuroendocrine diseases. The diagnostic efficiency of different examination methods and their combined use for the timely identification of BC and differential diagnosis of benign and malignant breast diseases has been clarified. A high frequency of faults in the preparation of primary medical documentation was revealed, that impedes adequate assessment of risk factors and the formation of group for dispensary follow-up.

Conclusion. It is necessary to correct measures for the secondary prevention of BC, including the formation, registration and dynamic follow-up of a cohort of women with a high risk for BC. One of the options for solving the issue of inadequate diagnosis for breast tumors can be a complex multiparametric approach to assessing the reproductive system, including the assessment of risk factors, the combined use of ultrasound and X-ray examination methods, which makes it possible to increase the accuracy of primary and differential diagnostics, and the development of a personalized follow-up algorithm for women with high risk for benign breast diseases and BC.

Aim. To study the effectiveness of the use of Neovir (sodium oxodihydroacridinyl acetates) as immunomodulatory and antiviral drug in the comprehensive treatment of various grade cervical intraepithelial neoplasia (CIN). Study design: prospective comparative study.

Materials and methods. The study included 60 patients (mean age 34.7±8.2 years) with morphologically verified various grade CIN, who were received comprehensive treatment, including the use of Neovir (sodium oxodihydroacridinyl acetate) as the drug with immunomodulatory and antiviral activity, 250 mg/2 ml intramuscularly every 48 hours, 10 injections before (group 1) or after (group 2) multi-stage radiosurgical diagnostic and treatment procedure or only a similar surgical intervention (group 3). All patients underwent complete clinical, morphological and laboratory examination with monitoring for the presence of high-risk human papillomavirus (HPV) in the cervical scraping and the dynamics of peripheral blood lymphocyte subpopulations.

Results. Dynamic follow-up showed that in a month after surgery, patients who were treated with radiosurgical resection as monotherapy (group 3) had the lowest rate of complete epithelialization of the cervical stump – 30.0% vs 55.0 and 65,0% in the group 1 and group 2 respectively. In this group, the proportion of patients with persistent viral infection was 1.5–2 times higher than in the groups where an antiviral drug was used in combination with radiosurgical intervention – 35.7% vs 17.6 and 22.2% in the group 1 and group2, respectively. In 6 months, elimination of high-risk HPV in groups with comprehensive treatment reached 94.5 in the group 1 and 94.1% in the group 2 (p>0.05) vs 78.6% in the group 3. The lowest number of TNK- and NK-cells was found in the group of patients who received radiosurgical treatment as monotherapy, which correlated with the highest incidence of high-risk HPV persistence after treatment in this group.

Conclusions. In patients with various grade CIN, the use of an immunomodulatory drug with antiviral activity in combination with radiosurgical intervention promotes early epithelialization of the cervix and elimination of high-risk HPV, which is confirmed by significant changes in the lymphocyte subpopulations which provide antiviral immunity.

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it.

Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group – 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers.

Results. The duration of laparoscopic operations performed using plastic containers «main group» was 85.69±25.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time «control group» – 88.75±30.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.69±67.50 ml in the main group, 125.00±99.54 ml in the control. The duration of hospitalization in the main group was 4.66±1.76 days, in the control group 5.79±3.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%).

Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

Aim. To review the current publication highlighting the features of pregnancy and childbirth outcomes in patients with endometriosis.

Materials and methods. The analysis of 45 foreign and domestic publications on this topic has been carried out.

Results. Patients with endometriosis have fertility problems, and when pregnancy occurs, it was characterized by a higher risk of preeclampsia, placenta previa, gestational diabetes, miscarriage and preterm labor, as well as delivery by caesarean section. Newborns in women with endometriosis have an increased risk of prematurity and small for gestational age. Probably, in addition to the presence of endometriosis, the risk of obstetric and neonatal complications is influenced by the localization and severity of the disease, as well as the use of assisted reproductive technologies.

Conclusion. The results obtained indicate that patients with endometriosis have a high risk of perinatal complications and require additional antenatal monitoring and care.

The article analyzes and presents data for the last 70 years from the PubMed database on endometrial hyperplasia (EH), which is one of the leaders in the structure of gynecological diseases and the main predictor of endometrial cancer (EC). The chronicle of the EH classification is highlighted with a focus on changing the designation and relevance of adenomatous EH. It is shown how the current classification of EH, due to the fact that a large number of synonyms is limited by two options, allows to maximize the reproducibility of the diagnosis, improve the interaction of the obstetrician-gynecologist with the pathologist and reduce the treatment inefficiency. The results of modern studies on the prevalence and risk factors of EH and EC differ from previously accepted ones and destroy “the Bohman triad”. The risks of EH development with tamoxifen and menopausal hormone therapy are determined. The data of current research methods aimed at the diagnosis of EH and EC are indicated. The differences in etiopathogenesis, prevalence, diagnosis, risk factors for development and progression to the malignant process presented in the review represent two types of EH (without atypia and with atypia) as completely different endometrial diseases included in the same classification.

The article presents the results of recent studies on the effectiveness, safety and duration of menopausal hormone therapy (MHT). The main cardio-metabolic risk factors for cardiovascular diseases are formed in women precisely during the transition to menopause and are clearly associated with the appearance of vegetative menopausal symptoms and the development of endothelial dysfunction, which is a predictor of future serious health problems, especially cardiovascular diseases. The results of a number of epidemiological studies have shown that in women with severe climacteric manifestations, especially with hot flashes, the overall risk of developing cardiovascular diseases is increased. The need for early initiation of MHT is an indisputable truth and is not disputed by anyone, but the formed tendency to discontinue treatment in 5–6 years raises many questions among patients and their doctors. However, recent guidelines from the International Menopause Society state that there is no reason to arbitrarily limit the duration of MHT. This paper presents current evidence on the indications and benefits of low and ultra-low doses of MHT. In view of the high efficacy and safety of low doses of MHT, they seem to be the most acceptable starting doses of oral MHT for most women. In addition, women with early menopause should also receive higher doses of estrogens, as they are more physiological for them. The choice in favor of starting MHT in a postmenopausal woman with a low or ultra-low dose in each case should be selected individually.

Aim. To assess the incidence, clinical course, outcomes of a novel coronavirus infection (NKI) COVID-19 for mother and child in the population of pregnant women in the Far Eastern (FEFD) and Siberian Federal Districts (SFD).

Materials and methods. The study design: a population-based epidemiological prospective study. We analyzed operative information on NKI COVID-19 incidence and features of clinical course in pregnant women, women in labor and parturient women as well as maternal and perinatal outcomes for March 11 to December 25, 2020 which were provided by the FEFD and SFD chief obstetricians-gynecologists. Mathematical analysis included methods of descriptive statistics, analysis of contingency table, where the value of ÷², the achieved level of significance (p) was estimated.

Results. In the FEFD and SFD, over the COVID-19 2020 epidemic, the SARS-CoV-2 virus was revealed in 8485 pregnant women, women in labor and postpartum women (5.9% of pregnant women subjected to regular medical check-up; 1.71% of the sick entire population). The incidence rate in pregnant women was 3.0 times higher than in the entire population: 5933,2 vs 1960,8 per 100 thousand (p<0.001). Among SARS-CoV-2 infected patients, 27.4% (2324) were asymptomatic, 52.7% (4471) have mild, 16.6% (1388) – moderate, 2.5% (210) – severe 0,5% (39) – extremely severe clinical course. In the intensive care and anesthesiology departments, 3.57% of pregnant women and 2.24% of the entire population (p<0.001) have been treated. Rate of using invasive artificial lung ventilation in pregnant women was lower than in the population: 0.48% vs 1.05% (p<0.001). 27.97% (2373) of women with confirmed NKI COVID-19 completed pregnancy. 81,7% of mothers delivered on time, 18.3% – prematurely. Cesarean delivery was performed in 42,0% of women, operative vaginal delivery (vacuum extraction, obstetric forceps) was registered in 0.2% of cases. 12 (0.14%) mothers died. The maternal mortality rate was 505.69 per 100 thousand live births (0.51% of patients with COVID-19 who gave birth). Mortality rates and the proportion of deaths in the entire population were statistically significantly higher: 1948.93 per 100 thousand sick population and 1.95% (p<0.001), respectively. 37 (1.56%) cases of perinatal losses were registered, of which 31 (1.30%) – stillbirths, 6 (0.26%) – early neonatal mortality. The SARS-CoV-2 virus was revealed in 148 (6.2%) newborns with the observance of anti-epidemic measures and separation of the mother and child immediately after delivery.

Conclusion. The rate of revealing SARS-CoV-2 virus in pregnant women, women in labor and parturient women in Siberia and the Far East was 3.0 times higher than in the entire population, while clinical course of infectious process was less severe (less need for invasive mechanical ventilation, lower mortality rate). In mothers with COVID-19, preterm birth rate was 3.0 times higher, caesarean delivery rate –1.4 times higher compared with the average population indicators. Reveling SARS-CoV-2 virus RNA in 6.2% of newborns suggests the possibility of vertical transmission of the infection.

Chronic endometritis (CE) is a disease of continuous and invisible inflammation characterized by infiltration of plasma cells in the stromal region of the endometrium. Numerous studies have proven that CE leads to repeated implantation failures. While it is believed that the etiology of CE is mainly associated with microorganisms, the key links in pathogenesis are yet not fully understood, although there is a modern evidence that CE causes local immune disorders and impaired endometrial decidualization. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistant pathogens, or in the case of viral chronic endometritis, regimens with additional treatment that affect other etiopathogenetic pathways of CE development and maintenance are necessary. One of the methods that affects etiopathogenesis of CE is a cytokine therapy. In this review, the authors tried to consider CE with special emphasis on the etiology, epidemiology, clinical features, pathophysiology, and treatment of CE and reproductive disorders in women in association with repeated implantation failures. The review ends with a description of the clinical case.

According to experts of the World Health Organization, cervical cancer is the only cancer that can be completely prevented through the introduction of mass screening and educational information in the population. One of the activities of the obstetrician-gynecologist is the conduct of health education. However, for a variety of reasons, a practical doctor may have difficulty preparing for informational and educational meetings with patients.

Aim. To prepare a clinical lecture for the obstetrician-gynecologist, which can be used in educational work with the population on the prevention of human papillomavirus infection and cervical cancer.

Materials and methods. The information material includes data from foreign and domestic scientific articles available at PubMed on this topic and published over the past 10 years.

Results. A systematic analysis of the data contained in the modern literature on human papillomavirus, human papillomavirus infection and cervical cancer has been carried out. Information is presented on the prevalence of diseases, diagnostic methods, and features of the course of human papillomavirus infection, the role of human papillomavirus in the development of cervical cancer. Attention is drawn to the importance of preventive examinations. Part of the information is presented in the form of answers to patients’ questions, which makes the information presented especially memorable.

Conclusion. It is hoped that the prepared lecture will be useful for the educational work of the obstetrician-gynecologist and will increase the educational information of the population on the prevention of cervical cancer.

Pelvic organ prolapse is a pathology that extremely worsens the quality of life of a woman at any age. Usually, this pathology is encountered in patients of the older age group, where the correction of the pathology is reduced to improving the quality of life. Other challenges are pelvic organ prolapse in women of reproductive age, and especially in combination with pregnancy. The task of obstetricians and gynecologists in this situation is not only to preserve and prolong pregnancy, to choose an adequate method of delivery that is optimal for the mother and newborn, but also to correct the anatomical location of the genitals, which requires certain surgical skills. The given clinical observation demonstrates the course of pregnancy and childbirth in a patient with pelvic organ prolapse of stage II according to the POP-Q classification, contains brief judgments on the management of pregnancy at the outpatient stage.

Urogenital fistulas are common complication of obstetric and gynecological surgery; the most common are vesicovaginal fistulas. Vesicouterine fistulas are rare, which explains the difficulties in diagnosis and treatment. The literature review and own clinical case presented in article. A 43-years-old female patient was consulted with complaint of urinary leakage from vagina, which appeared 1 month after the cesarean section and vesicouterine fistula has been diagnosed. Successful laparoscopic treatment of vesicouterine fistula was performed at the Avicenna Medical Center after 3 months. The urethral catheter was removed 7 days after surgery. At control examination after 1, 3 and 6 months, ultrasound examination of the pelvic organs confirmed the consistency of the scar on the uterus. Urination remained free and painless, the patient did not notice urine leakage. This clinical observation shows the possibility of treating a vesicouterine fistula with a laparoscopic approach with a good result and the possibility of early rehabilitation.