Vol 24, No 1 (2022)
ORIGINAL ARTICLE
Association between vitamin D, VDR polymorphism and IVF outcomes
Abstract
Aim. To analyze the outcomes of assisted reproductive technology (ART) cycles in patients with different levels of vitamin D.
Materials and methods. The study included 100 infertile patients who applied for ART. Vitamin D levels were determined by mass spectrometry. The VDR polymorphism was evaluated using real-time PCR.
Results. 50% of patients (n=50) had a sufficient level of vitamin D (group 3), 36% of patients (n=36) had an insufficient level of vitamin D (group 2), 14% of patients (n=14) had a deficiency of vitamin D (group 1). The level of vitamin D was not associated neither with baseline patients characteristics nor with embryological stage of the cycle. The clinical pregnancy rate was lower in the group 1 (vitamin D deficiency), but the difference was not significant. There was a trend to an increase of miscarriage rate in the groups of patients with vitamin D insufficiency and deficiency: 66.7% in group 1, 26.3% in group 2, and 13.6% in group 3. The live birth rate was higher in the groups of patients with normal and insufficient levels of vitamin D compared with the group of vitamin D deficiency: 46.0 and 38.9% compared to 7.1%, p=0.0821. In multivariate analysis clinical pregnancy rate was influenced by vitamin D deficiency and the genetic characteristics of the VDR gene: the presence of the G allele (FOKI-rs2228570).
Conclusion. The vitamin D deficiency impairs the effectiveness of ART cycles.
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Restoration of reproductive function in women with a history of miscarriage of the first trimester of bacterial etiology
Abstract
Aim. To form diagnostic and therapeutic complexes in women with a history of miscarriage of the first trimester of bacterial etiology at the outpatient stage for the restoration of reproductive function.
Materials and methods. The present study included 80 women after inpatient treatment in the gynecological department of Dzhanelidze Saint Petersburg Institute of Emergency Care for miscarriage of the first trimester. At the outpatient stage after 1–3 months these women were examined in the St. Petersburg City Оutpatients' clinic №44, Saint-Petersburg Maternity Clinic No. 5, Saint-Petersburg Maternity Clinic No. 19 and Medical Center "Academic Medicine".
Results. Cervicitis was detected in 85% of patients, the correlation with the diagnosis made in the hospital was 96%. Non-specific vaginitis, candida vaginitis, and bacterial vaginosis were mostly combined with cervicitis and chronic endometritis. Chronic endometritis was verified in 62 women. A survey of permanent sexual partners showed that most of them (66.1%) had an inflammatory process in the urogenital tract. The comparability of the results of detection of bacterial associations was 82%. All women received comprehensive treatment and pre-gravidar training, as well as treatment for a permanent sexual partner. After the treatment, the reproductive function of the women studied was monitored for 24 months. The results of the retrospective analysis showed that pregnancy occurred in 59 (73.8%) cases in the patients of the study group.
Conclusion. Complex diagnostics of inflammatory diseases of the lower genital organs should include clinical, microscopic, bacteriological, cytological and PCR methods, colposcopy. The frequency of detection of cervicitis and chronic endometritis in women at the outpatient stage of management of women with miscarriage of the first trimester is highly correlated with each other. The proposed complex therapy of inflammatory diseases of the lower genital tract contributes to the restoration and preservation of the reproductive function of women with an miscarriage of the first trimester of bacterial etiology in the anamnesis.
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Preservation of reproductive material using the in vitro maturation method in patients with oncological diseases
Abstract
Background. Improving the quality of life of cancer patients is one of the priority tasks of the medical community. In the structure of oncological morbidity, the proportion of patients of fertile age accounts for up to 7–10% of all malignant neoplasms. About 30% of them have not realized their reproductive function by the time of the disease and need to preserve the genetic material due to the necessary gonadotoxic treatment. Taking into account the limited time before the start of surgery, as well as hormone-dependent variants of some tumors, the maturation of oocytes in vitro maturation (IVM) is a promising method.
Aim. To evaluate the quantity and quality of oocytes obtained by IVM in a small sample of patients.
Materials and methods. We conducted a prospective study, which included 5 patients of reproductive age. All patients were fully examined, the level of anti-muller hormone and the number of antral follicles were determined. After transvaginal puncture, oocytes were isolated and cultured from the obtained follicular fluid by embryologists in the laboratory for 5–6 days.
Results. A total of 46 immature oocyte-cumulus complexes were obtained; 28 hours after oocyte culture in IVM medium, 30 (46%) oocytes at the metaphase II stage, 14 (22%) oocytes at the metaphase I stage and 12 (18%) oocytes at the prophase I stage were obtained. After additional cultivation, after 24 hours, another oocyte reached the metaphase II stage. As a result, 30 oocytes and 4 embryos were vitrified.
Conclusion. The IVM method makes it possible to preserve the genetic material of patients with oncological diseases in a short time, without delaying the start of treatment with gonadotoxic therapy, allowing them to carry out their reproductive function in the future. Given the small number of studies and the lack of reliable protocols for using IVM, additional research in this area is needed.
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Expediency of immunocytochemical study as a marker of proliferative activity in cervical intraepithelial neoplasia
Abstract
Aim. To assess the feasibility of using immunocytochemical studies as a marker of proliferative activity in cervical intraepithelial neoplasia.
Materials and methods. A comprehensive examination of 78 women, aged 25 to 45 years, with the presence of cervical intraepithelial neoplasia was carried out. Verification of the diagnosis was carried out on the basis of data from clinical, cytological, colposcopic, histological studies. Human papillomavirus typing was carried out using the polymerase chain reaction method (Kvant 21 test).
Results. The results obtained in our study indicate that in patients with CIN II, III, chronic cervicitis associated with human papillomavirus (HPV) is an obligatory background pathology. Regardless of the severity of cervical dysplasia (CIN II–III), among the various types of HPV, HPV type 16 and associations of various HPV types of high oncological risk prevailed (41.03 and 25.64%, respectively). The HPV load result was expressed in decimal logarithms (Lg). Co-expression of p16ink4a oncoprotein and proliferative activity marker Ki-67 in epithelial cells was observed at viral load parameters of 3–5 Lg in 64.10% of cases, and at values of >5 Lg – in 100% of cases.
Conclusion. Our data indicate the need for wider use of non-invasive determination of markers р16ink4a and Ki-67 during primary screening, which will improve the tactics of managing patients with cervical precancer. Persistent course of human papillomavirus in patients with cervical intraepithelial neoplasia II in the presence of signs of coexpression of p16ink4a and Ki-67 dictates the inexpediency of performing cervical excision with subsequent control after 6 months.
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Clinical and anamnestic predictors of stress urinary incontinence in women
Abstract
Aim. To study clinical and anamnestic predictors of stress urinary incontinence in postmenopausal women.
Materials and methods. A retrospective cross-sectional study in which 89 women participated. Group 1 (main) included 57 women with stress urinary incontinence. Group 2 (comparison group) included 32 women who do not suffer from SUI. Statistical processing was carried out using a package of applied programs, Excel, SPP Statistics 22.0. For indicators characterizing qualitative signs, the absolute value and the relative value in percent were indicated; the chi-square test was used to test statistical hypotheses. Statistical hypotheses about the absence of intergroup differences for quantitative traits with a normal distribution were tested using the Student's t test. The data obtained indicate that active sports (gymnastics, weightlifting, rowing, tennis), leading to an increase in intra-abdominal pressure, are one of the main reasons for the development of SUI.
Results. A statistically significant higher BMI value was found in women with SUI than in women in the comparison group. According to the chi-square test and Spearman's coefficient, a tendency was revealed for an increase in the proportion of women with urinary incontinence with an increase in the number of births of more than two. Predictors of the development of SUI are previous births through the vaginal birth canal, their number is more than three, births weighing more than 4000 grams and complicated by obstetric injuries. When evaluating comorbidities, it was found that patients with SUI were statistically significantly more likely to suffer from diseases of the cardiovascular and respiratory systems, as well as from disorders of carbohydrate metabolism.
Conclusion. The data obtained indicate the need and extreme importance of taking anamnesis, questioning women according to questionnaires, and clinical examination. The above measures should be paramount in the diagnostic search along with routine instrumental and laboratory diagnostics of stress incontinence.
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Obstetric perineal trauma: a modern view of the problem. A prospective study
Abstract
Trauma to the perineum during childbirth is still a common obstetric problem. The question of etiology and risk factors is still extremely debatable. The high risk of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of this complication of childbirth, which seems to be the main reserve for reducing future pelvic floor insufficiency and associated pathological conditions.
Background. Perineal trauma during childbirth is still a common problem in obstetrics. Also, a high percentage of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of perineal trauma during childbirth, which is relevant today.
Aim. To identify the main predictors of the risk of developing obstetric perineal injury.
Materials and methods. We conducted a prospective randomized study between September 2020 and January 2022, which included 110 pregnant women. The observation of the patients began from the day of the first visit to the antenatal clinic and throughout pregnancy and the postpartum period, much attention was paid to a comprehensive perineological examination.
Results. In group 1, a large number of grade I and II tears (n=37, 33% and n=24, 29%) were noted, and grade III tears were completely absent. In group 2, there were grade III perineal tears, the frequency was (n=5, 2.1%), but still their number was inferior to grade I and II tears (n=10, 26% and n=15, 14%). In group 3, the analysis showed a low frequency of perineal tears of I and II degrees (n=8, 11% and n=17, 18%) and a number of tears of degree III comparable to group 2 (n=8, 2.6%). Episiotomy in all groups was carried out in the range from 7 to 9%, strictly according to obstetric indications.
Conclusion. According to the data obtained, the most significant clinical and anamnestic predictors of obstetric perineal trauma were: frequent abortions in anamnesis, chronic diseases of the ENT organs and the urinary system, vaginal dysbiosis (nonspecific vaginitis, bacterial vaginosis), changes in the pH of the vaginal environment, low tone of the perineum, the presence of scar on the perineum.
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New approaches in the study of risk factors and treatment of implant-associated complications in pelvic organ prolapse
Abstract
Aim. To assessment of risk factors for erosion of the vaginal mucosa after the use of mesh prostheses to correct genital prolapse.
Materials and methods. The authors of this article evaluated modifiable and unmodifiable risk factors for erosion of the vaginal mucosa after the use of a mesh implant to correct pelvic prolapse. The analysis of the relationship between the indicators of obstetric-gynecological, somatic anamnesis in women with an implant-associated complication (erosion of the vaginal mucosa, n=25) and in women with successful surgical treatment of genital prolapse using a mesh prosthesis (n=58) was carried out. The STATISTICA 10.0 and EViews 12.0 software packages were used for statistical processing of the obtained results.
Results. Statistical analysis revealed the relationship of vaginal erosion after the use of a mesh prosthesis in the surgical correction of genital prolapse with the presence of factors such as: premenopausal age at the time of surgery (p=0.002; odds ratio – OR 4.7, relative risk – RR 2.79), vaginal delivery over the age of 35 years (p=0.003; OR 6.35, RR 2.78), episiotomy in the anamnesis (p<0.0001; OR 11.2, RR 6.19), perineal ruptures III degrees in anamnesis (p<0.0001; OR 19.7, RR 6.57), hypertension (p=0.049; OR 2.79, RR 2.19), type 2 diabetes mellitus (p=0.007; OR 4.99, RR 1.82).
Conclusion. The formation of a high-risk group for erosion of the vaginal mucosa will allow us to develop a set of preventive measures and improve the outcomes of surgical treatment of genital prolapse.
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REVIEW
Receptivity at different endometrial thickness in women of reproductive age (literature review)
Abstract
Overcoming infertility and reducing miscarriage are important challenges in obstetrics and gynecology. In the Russian Federation, the frequency of infertile couples reaches 24%; the percentage of miscarriage does not decrease, accounting for up to 20% of all desired pregnancies. The endometrial factor plays an important role in the causes of gravidar losses. Inadequate phase transformation of the endometrium is a predictor of fetal egg implantation failures. An integral part of endometrial cyclic transformations is the full proliferation of the mucous membrane of the uterine body. However, there is a cohort of women who, due to the insufficiency of proliferative processes in the endometrium, have a syndrome of “thin” endometrium. The pathogenesis of the formation of a hypoplastic endometrium in women with normal characteristics of hormonal factors is still poorly understood. Particular attention is paid to determining the function of proteomic markers (leukemia inhibiting factor, Forkhead box-protein family, etc.) in the genesis of the hypoplastic endometrium. This review presents an analysis of modern Russian and foreign sources on the receptivity of the endometrium, including the syndrome of “thin” endometrium in women of reproductive age.
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Risk factors and mechanisms of uterine scar defects formation after caesarean section: A review
Abstract
The objective of the review was to summarize information and analyze the literature regarding the risk factors for scar defects formation on the uterus after сaesarean section, as well as features of tissue repair after surgery. The frequency of сaesarean section throughout the world continues to increase and is accompanied by a high level of scar defects formation leading to many gynecological and obstetrical complications. Studying causes and mechanisms of defects formation is important as it facilitates the development of preventive measures and optimal approach for managing patients with сaesarean section scar defects in the future.
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Pathophysiological aspects of pain syndrome in endometriosis: A review
Abstract
Endometriosis is a chronic and debilitating disease with chronic pelvic pain and infertility. This pathology affects 1 in 10 women worldwide. Chronic pelvic pain is the main complaint of patients with endometriosis, which causes the most discomfort and has a strong impact on the quality of life. Today, the main generally accepted criterion for the severity of pain is the volume of the affected tissue, but most often it does not correspond to the real pain sensations of the patients. In this review of the literature, we have identified and compared the main pathophysiological mechanisms of the development of pain in endometriosis, which help to answer some urgent questions. We have identified 6 mechanisms that sequentially activate and reinforce each other's action, leading to the formation of persistent pain syndrome. There are still gaps in the pathophysiological mechanisms described by us, which requires additional clinical studies. A better understanding of the pathophysiology of pain in endometriosis will help improve diagnostic capabilities, as well as treatment that will be directed at each link in the pathological process.
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Insufficient fetal growth: fetal growth restriction or small for gestational age fetus? The difference between these conditions, what is known about diagnosis, prevention and treatment: A review
Abstract
The difference between the fetal growth restriction and the small-for-gestational-age fetus was analyzed in this article. The article describes the most complete definition of the fetal growth restriction according to ultrasound data. Information about possible ethology and pathogenesis of the fetal growth restriction, the modern classification of this condition was also summarized in the article. We provide classifications which were used in Russia and all over the world earlier. The article contains information about possible methods of diagnosing the fetal growth restriction with accents on key indicators of dopplerometry and cardiotocography. According to the latest data, the management of patients changes depending on the gestation period. There are significant differences between early and late fetal growth restriction. Futhermore, we tried to research universal methods of prevention and treatment of the fetal growth restriction. We also included data from Russian Society of obstetricians and gynecologists guidelines. The analyzed information shows that the problem of the fetal growth restriction has many unsolved problems and great potential for the further research.
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-63961 от 18.12.2015.