Implementation of the idea of a precision approach in the preoperative preparation of patients before hysteroscopy. An prospective study

Background. Currently, hysteroscopy is considered the "gold standard" for the diagnosis and treatment of intrauterine pathology. Diagnostic and surgical hysteroscopies are one of the most common interventions in gynecology. Despite the recognized safety of hysteroscopy, the procedure is not without risks, which does not allow it to be considered a simple operation. Therefore, the safety issues of hysteroscopy remain relevant.

Aim. To assess the benefits of preoperative preparation with a topical antimicrobial for the prevention of infectious and inflammatory complications after hysteroscopy.

Materials and methods. The study was conducted at the clinical bases of the Department of Obstetrics and Gynecology of the Pavlov Ryazan State Medical University and the Group of Companies "MEDSI" clinics in the period from February 2023 to August 2024. The prospective study included 143 women aged 18 to 45 years admitted to gynecological departments for diagnostic hysteroscopy due to abnormal uterine bleeding and infertility. Microscopic examination in all patients showed an intermediate type of smear combined with absolute or conditional normocenosis according to real-time polymerase chain reaction data. Patients were randomized into two groups. The experimental group included 72 patients receiving a combined topical gynecological antimicrobial agent, Elgina, in the preoperative period to prevent infectious and inflammatory complications after hysteroscopy. The control group included 71 patients who did not receive this therapy. Elgina (vaginal tablets with applicator, JSC WERTEKS, Russia) was administered intravaginally, 1 vaginal tablet daily for 6 days before bedtime. Elgina contains neomycin sulfate, ornidazole, prednisolone sodium phosphate, and econazole nitrate.

Results. No cases of infectious and inflammatory postoperative complications were reported in the group of patients who underwent preoperative correction of vaginal microbiocenosis with Elgina. In the control group, 5 (7%) patients received anti-inflammatory, antimicrobial, infusion, transfusion, and desensitization therapy due to the development of pelvic inflammatory complications after hysteroscopy.

Conclusion. A personalized approach to the preoperative preparation of patients before hysteroscopy can prevent infectious and inflammatory complications after the procedure. The study demonstrated the benefits of preoperative use of Elgina (vaginal tablets with an applicator) in patients with an intermediate type of smear combined with absolute or conditional normocenosis according to polymerase chain reaction.