Vol 20, No 4 (2018)
Articles
Abnormal uterine bleeding: we diagnose and choose treatment
Abstract
Abnormal uterine bleeding (AUB) is one of the most common frequent reasons for contacting a gynecologist and conducting intrauterine interventions. AUB causes iron deficiency anemia and a decrease quality of life of women, which in turn is the reason of their social and clinical significance. Based on the analysis of literature and international data recommendations, the review outlines the basic principles of AUB diagnosis, non-hormonal and hormone therapy Advantages of continuous regimen for the administration of progestogens, in particular the LNG-IUS, and COCs containing estradiol valerate, to reduce menstrual flow blood loss are presented in the article. The need for a differentiated approach of choosing the therapy based on age, causes of bleeding, and balance benefits and risks of medicines.
Gynecology. 2018;20(4):4-8
4-8
Cancer of the vulva: genetic aspects of pathogenesis
Abstract
The review is devoted to genetic research in cancer of the vulva. In genetic changes, the mutation irreversibly changes the nucleotide sequence of DNA, or the number of copies of chromosomes changes per cell. In epigenetics, the nucleotide sequence remains unchanged, but gene activity is regulated by methylation of DNA or modification of histones. Most of the studies analyzed are devoted to the study of mutations in the TP53 gene. Many studies indicate that somatic mutations are more common in HPV-negative than in HPV-positive patients. Epigenetic studies in the main devoted to hypermethylation. The gene CDKN2A is most often studied in epigenetic terms. For most of the studied genes, hypermethylation occurs more often in squamous cell carcinoma of the vulva than in the precursors.
Gynecology. 2018;20(4):9-11
9-11
Disorder of the structure and vascularization of the villi of placenta at the preeclampsia
Abstract
Preeclampsia is considered one of the most serious diseases of pregnancy and cause serious complications in the mother and fetus. The emergence and development of preeclampsia is due to the violation of placental processes. The literature data on microscopic changes in the structure and vascularization of placental villi in preeclampsia are analyzed. Violations of the structure and vascularization of villi placenta in preeclampsia are noted. This, undoubtedly, indicates their role in the development and progression of this complication of pregnancy. Lower values of the extent, surface area and volume of villi, as well as their degree of vascularization, are registered in observations of early preeclampsia. The ambiguity of the data of morphometric and stereo metric indices of villi, which are available in the literature, is most likely due to the investigation of placentas at various stages of gestation and with varying degrees of severity of preeclampsia. An important link in the pathogenesis of preeclampsia and a factor in violations of the villi development is a change in the levels of pro-angiogenic and anti-angiogenic factors, mainly the vascular endothelial growth factor and its receptors. For a complete analysis of the causes and characteristics of preeclampsia is necessary to conduct a comprehensive macroscopic and microscopic examination of the placenta.
Gynecology. 2018;20(4):12-18
12-18
Efficacy of Elevit® Vitamin-Mineral Complex Pronatal from early pregnancy for improvement of obstetric and perinatal outcomes
Abstract
The goal is to justify the principles of prevention and correction of micronutrient deficiency in mother and child on the basis of a comparative analysis of the health status of pregnant women and newborns in different conditions of provision with vitamins and minerals. Materials and methods. A comparative analysis of the clinical and biochemical results of a survey of 376 mothers and their children in the period of newborns. The study of the content of the main micronutrients in the blood and breast milk, ioduria in mothers, comparison obstetric and perinatal outcomes depending on the availability of women with vitamins and microelements during pregnancy. Results. Data on high frequency of polyhypovitaminosis (72.6%), hypo-microelementosis (19.4-45.2%), iodine deficiency in pregnant women, low concentration vitamins A, B1, B2, C, b-carotenoids, iodine, iron, zinc, selenium in breast milk in lactating, not receiving vitamin-mineral preparations. It is proved that the intake of women from the early stages of pregnancy is a balanced vitamin-mineral complex Elevat® Pronatal and potassium iodide at a dose of 250 mcg/day normalizes their micronutrient supply and significantly reduces the incidence of complications pregnancy, delivery in mothers, diseases and pathological conditions in newborns (in 1.3-3 times, p<0.05). The conclusion. The undoubted effect of a regular supplementation of a balanced vitamin and mineral preparation on the indicators of micronutrient maintenance of pregnant women was obtained, which led to an improvement in obstetric and perinatal outcomes.
Gynecology. 2018;20(4):19-25
19-25
Combined oral contraceptives in the prevention of recurrence of typical endometrial hyperplasia of endometrium
Abstract
Changes in consideration of etiology and pathogenesis of hyperplastic endometrial processes allowed to claim that their preventive maintenance using modern hormonal contraceptives may significantly reduce the frequency and volume surgical treatment. The main protections are ovulation suppression COC mechanism and suppression folliculogenesis, i.e. monthly do not always adequately cyclic processes in endometrium.
Gynecology. 2018;20(4):26-28
26-28
Effect of inosine pranobex on p16, Ki-67 expression in patients with HPV-associated cervical intraepithelial neoplasia
Abstract
The aim of the study - to determine the dynamics of expression of р16, Ki-67 in patients with HPV-associated cervical intraepithelial neoplasia (CIN) in the complex treatment with inosine pranobex. Materials and methods. The study included 62 patients with cervical HPV infection, the main group consisted of 47 patients with confirmed CIN 1 and CIN 2-3 associated to HPV high-risk, the comparison group - patients with latent HPV infection and 13 women of the control group. At the 2nd stage, a group of women with CIN 2-3 was divided into two groups: 2A (n=17) included patients who received excision treatment in combination with inosine pranobex; 2B group (n=9) patients after excision treatment (LEEP or LLETZ) without inosine pranobex. Traditional methods of examination of cervical pathology were used, including HPV genotyping, and dynamic immunocytochemical examination to determine p16, Ki-67. Results. Comparative analysis (n=75) allowed to establish the absence of differences in the expression of р16, Ki-67 and co-expression in HPV-associated CIN 1 relative to the comparison and control group. CIN 2-3 was characterized by a predominance of the levels of biomarkers in comparison with CIN 1 and latent infection (p<0.05). After treatment in group 2A there was a 9-fold decrease in the number of patients with p16/Ki-67 ex * pression (p<0.05), in group 2B treatment resulted in a 1.3-fold decrease in p16/Ki-67 ex * pression (p>0.05). Summary. Among patients with CIN 2-3 associated with HPV high-risk, increased frequency of expression of p16/Ki-67 in contrast to patients with CIN 1. Complex treatment of patients with CIN 2-3 using Isoprinosine helps to reduce the expression of p16/Ki-67 in the cervical epithelium in contrast to patients after excision treatment.
Gynecology. 2018;20(4):29-34
29-34
Androgen deficiency in women with adrenal insufficiency. Dehydroepiandrosterone. Review
Abstract
It is known that adrenal insufficiency (AI) is a severe life-threatening disease due to the exceptional role of glucocorticoids and mineralocorticoids in the human body. At the same time, according to some reports, the deficit of androgens synthesized by the adrenal cortex (dehydroepiandrosterone - DHEA and dehydroepiandrosterone sulfate - DHEAS) is associated with an increased risk of death, including increased risk of adverse cardiovascular events, development of osteoporosis, diabetes mellitus and malignant neoplasms. The main source of DHEA and DHEAS in females are adrenal glands, so women with hypocorticism have significantly reduced (down to undetectable) levels of these hormones. However, due to lack of a reliable evidence and, accordingly, clinical recommendations, correction of androgen deficiency in patients with AI is usually not performed. The review discusses the accumulated data on the physiological significance of DHEA and DHEAS, their role in the development of various pathological conditions, as well as safety and efficacy of these drugs.
Gynecology. 2018;20(4):35-39
35-39
Menopausal hormone treatments and risk of cardiovascular diseases: modern view
Abstract
Estrogens have a multifactorial protective effect on various components of the cardiovascular system, and postmenopause in women is associated with an increased incidence of cardiovascular disease. Admission of menopausal hormone therapy helps to reduce the risk of cardiovascular events, but the perceived benefit far outweighs the risks in cases where women begin treatment no later than at the age of 60 or 10 years after menopause. Studies have shown that the combination of estradiol and drospirenone is effective and safe in terms of preventing cardiovascular diseases. The antiandrogenic effect of drospirenone has additional metabolic effects that may be preferable in certain groups of postmenopausal patients.
Gynecology. 2018;20(4):40-43
40-43
Pregravid preparation as the main method of preventing undeveloped pregnancy
Abstract
How to make a pregravid women with the stood pregnancy in the anamnesis is the key to success in the fight against miscarriage. The testing outside of pregnancy, the identification of reasons for stopping a previous gestation, adherence to medical recommendations in the programme of preparation for future conception and implantation is a required step in the management of women who have had non-developing pregnancy. Periconceptional prevention is effective only at its beginning 3 months before conception and in the early stages of development of the embryo and fetus (12 weeks).The purpose of the study was improvement profilakticheskih activities based on identified pathogenetic mechanisms of occurrence of missed abortion. Aim of the study: to perfect the features of pregravid preparation for pregnant with undeveloping pregnancy in anamnesis on the basis of the educed nosotropic mechanisms of origin of this pathology, her intercommunication with a folats deficit. Materials and methods. Research was conducted in a few stages. On the first stage retrospectively on the basis of analysis 90 hospital charts are educed the supposed risk factors. On the second stage the exposure of reliable risk and development of algorithms of prognostication of undeveloping pregnancy (factors was conducted in 2 groups - basic (90 pregnant with stopping beating pregnancy) and control (30 pregnant with normally aleak pregnancy). The methods of prophylaxis of this pathology offered in high-risk of origin of stopping beating pregnancy groups. One of them was application of folates, namely vitamin-mineral complex before and after conception. Results. On the basis of undertaken studies multifactor genesis of missed miscarriage was confirmed, and the basic etiologic factors of origin of this pathology are educed. Stopping beating of pregnancy at anomalous karyotype takes place for certain before (6.2±0.8 weeks) what at normal karyotype (8.7±1.2 weeks). Cross-correlation connection was set between frequency of development of chromosomal anomalies and level of homocysteine from МТНFR677ТТ, level correlation of Spirmena equaled 0.84 - direct cross-correlation connection. As a result of undertaken a study one of methods of preparation application of folates offered in a kind vitamin-mineral complex for 16 weeks to conception and 12 weeks after conception. Conclusion. High-frequency of МТНFR677ТТ of heterogeneous or homozygous carriers educed for women with undeveloping pregnancy. Application of folates is in a vitamin-mineral complex, can be one of the most effective methods in the prophylaxis of early reproductive losses.
Gynecology. 2018;20(4):45-47
45-47
Mixed urinary incontinence: a current view at the problem (review of clinical guidelines)
Abstract
He purpose of the review - presentation of basic clinical scientific data based on current evidence on the management of patients with mixed urinary incontinence. Material and methods. A review of Russian and foreign sources on the prevalence, etiopathogenesis, diagnosis and treatment of mixed urinary incontinence in women. Results. The review presents terminology, data on etiopathogenesis, clinic, diagnosis, phasing and treatment methods of mixed urinary incontinence in women at different age periods.
Gynecology. 2018;20(4):48-51
48-51
52-54
Features of genital herpes in women
Abstract
The paper presents a modern view of the current and the clinic of herpetic infection among women. The clinical manifestations and character of the course of atypical forms of herpes are described. The types of therapy of herpes simplex virus are considered and their own recommendations are given on the management of patients with recurrent genital herpes.
Gynecology. 2018;20(4):55-59
55-59