卷 21, 编号 5 (2019)
Articles
Obesity and women's health: from menarche to menopause
摘要
The review is devoted to the problem of the influence of overweight and obesity on the health of a woman in different periods of life, in particular, on reproductive disorders resulting from exposure to adipose tissue.
Gynecology. 2019;21(5):7-11
7-11
Modern molecular and biological aspects of endometriosis-associated infertility
摘要
There is currently no consensus on the etiopathogenetic nature of endometriosis. The causes of aggressive, progressive, infiltrative growth of endometrioid tissue also remain unclear. An important problem remains the high recurrence rate of endometriosis, despite the availability of modern drug and surgical methods of treatment. The study of the central signaling pathways and the search for new key molecules is of paramount importance for a better understanding of the pathogenesis of the disease, and is also an important step in the development of new strategies for the diagnosis, prevention and treatment of endometriosis.
Gynecology. 2019;21(5):12-15
12-15
Adenomyosis: focus on therapy
摘要
Adenomyosis have an extremely negative impact on a woman's reproductive health. In the absence of drug therapy, the likelihood of surgical treatment increases which could be very traumatic for the patient and lead to a decline in infertility and onset of early menopause. That is why it is extremely important to start therapy in a timely manner, the most important method of which is hormonal treatment. The article discusses the efficacy and safety profiles of progestin dienogest.
Gynecology. 2019;21(5):16-19
16-19
The role of vitamin D deficiency in the risk for uterine fibroids relapse after laparoscopic conservative myomectomy in women of reproductive age
摘要
Relevance. Due to the high prevalence of uterine fibroids in women of reproductive age and the negative impact on reproductive health, one of the priority tasks of specialists is to search not only for new therapeutic methods, but also for ways to prevent this disease. Aim. To determine the role of vitamin D deficiency in the risk of uterine fibroids recurrence after surgical treatment in women of reproductive age. Materials and methods. A comparative analysis of the recurrence rate of uterine fibroids in patients of reproductive age after surgical treatment. The study involved 49 women of reproductive age 20-39 years (average age 31.5±4.3 years) with unrealized reproductive plans. All underwent surgical treatment in the scope of laparoscopic conservative myomectomy for uterine fibroids with different symptoms. All patients were given vitamin D levels. Results. In 93.5% of cases, the risk of recurrence of uterine fibroids increases at vitamin D levels below 34.5 ng/ml, when reaching 38.6 ng/ml and above, the risk of reformation of nodes is minimal. Conclusions. When the vitamin D level exceeds 38.6 ng/ml, it is possible to minimize the risk of recurrence of uterine fibroids in women of reproductive age, thereby avoiding repeated surgical interventions and associated complications.
Gynecology. 2019;21(5):20-24
20-24
Vitamin-mineral complexes as a protector of obstetric and perinatal complications (review of literature)
摘要
Relevance. Despite the achievements of modern medicine, the problem of reducing complications of the gestational period and perinatal outcomes still does not lose its relevance. Lack of security and/or unbalanced consumption of vital micronutrients are factors of constant negative impact on health, growth, development and formation of organs and systemogenesis in all age periods. Unbalanced nutrition, in particular vitamin deficiency conditions, is considered by the World Health Organization as a problem of starvation, which has a direct impact on the incidence and mortality of the population. Aim. Analysis of literary sources to identify the effect of vitamin-mineral complexes on pregnancy and perinatal outcomes. Materials and methods. To write this review, we searched for domestic and foreign publications in Russian and international search engines (PubMed, eLibrary, etc.) over the past 30 years. The review included articles from peer-reviewed literature. Results. The review addresses balanced nutrition for pregnant women who receive close attention throughout the world. The optimal provision of vitamins and minerals for women during the gestational period, when the need for essential micronutrients is significantly increased, is a prerequisite for the physiological course of pregnancy and the full development of the fetus. This is especially important in the conditions of the northern and equivalent territories. The need for vitamins in women during pregnancy and lactation increases by 1.5 times, due to the intensive work of the endocrine system of women, the transfer of some nutrients to the fetus. Deficiency of certain vitamins is a risk factor for the development of birth defects, premature birth, and the birth of children with low body weight. Conclusions. The domestic combined vitamin-mineral preparation with micro and macro elements was created specifically taking into account the changing needs of the woman’s body for vitamins and minerals at different stages of pregnancy. Compatibility of components in 1 tablet is provided by special production technology.
Gynecology. 2019;21(5):25-33
25-33
Bacterial vaginosis in pregnancy: a current view on diagnosis and therapy (literature review)
摘要
Bacterial vaginosis (BV) is the most prevalent lower genital tract disease in women of reproductive age (both pregnant and non-pregnant) and the most common cause of vaginal discharge and foul odor from the genital tract. To date, there is a lot of literature describing many different approaches to the diagnosis and treatment of BV during pregnancy. BV is common, and its precise prevalence varies widely depending on the patient population. Studies confirm that the prevalence of BV among pregnant women is the same as in the population of non-pregnant women, and ranges from 6 to 32%. The link between BV and a patient’s ethnicity, smoking, sexual behavior and douching was established. BV is more prevalent among African American women, smokers, sexually active women compared to virgins and those who use douching. Diagnosis of BV is based on clinical symptoms and the results of microbiological examination. Diagnostic criteria are the same for pregnant and non-pregnant women. If BV is confirmed, treat-ment is indicated. In most international guidelines on sexually transmitted infections, the use of either metronidazole 500 mg orally 2 times a day for 7 days, or clindamycin 300 mg orally 2 times a day for 7 days are recommended for the prevention of adverse obstetric outcomes. BV is considered as the risk factor for adverse obstetric outcomes, such as premature birth, premature rupture of membranes, spontaneous abortion, chorioamnionitis and postpartum infections, such as endometritis and infectious compli-cations in the area of the postoperative wound after cesarean section. Pregnant women with symptoms of BV are advised to be screened and treated to eliminate the symptoms. Treatment with oral or local antibiotics is acceptable to achieve recovery (cure) in pregnant women with a symptomatic course of BV and a low risk of adverse obstetric outcomes. Women without symptoms of BV and women without identified risk factors for preterm birth should not be routinely screened and treated for BV, while patients with an increased risk for premature birth may benefit from routine screening and treatment for BV.
Gynecology. 2019;21(5):30-34
30-34
Pelvic inflammatory disease
摘要
The term "pelvic inflammatory disease" (PID) referred to an entire spectrum of inflammatory processes in the upper (above the internal os) part of female reproductive system. PID take the leading position in the structure of gynecological morbidity: 0-65% of outpatients and more than 30% of inpatients. It is difficult to determine the exact rate and prevalence of PID, as well as to diagnose PID because they often are asymptomatic or have diverts clinical manifestations. The issues of treatment and rehabilitation of patients with PID are still relevant, since cases of relapse and chronic inflammatory processes significantly worsen the prognosis for reproductive function, which is an important social and economic problem.
Gynecology. 2019;21(5):39-44
39-44
The use of Dimia for the treatment of premenstrual syndrome in adolescent girls
摘要
Today, premenstrual syndrome (PMS) remains one of the relevant issues of adolescent gynecology. The difficulty in treatment of PMS in adolescent girls is associated with a large number of factors. The combination of hormonal, neuro-vegetative, metabolic, mental and emotional deviations requires a comprehensive and more differentiated approach to the treatment of this disease. Aim. Assessment of clinical efficacy and safety of using drospirenone 3 mg and ethinylestradiol 20 µg combination for the treatment of PMS in adolescent girls aged 14-18. Outcomes and methods. The study included female 50 patients who met the criteria: age of 14 to 18 years, no severe extragenital pathology, the menstrual cycle duration within 6 months - 25-32±2 days. Based on examination data, all patients were prescribed a drug containing 3 mg of drospirenone and 20 μg of ethinylestradiol. The duration of therapy was 6 months. Results. Under the drug therapy, a significant decrease in the intensity of PMS manifestations occurred. Conclusions. The use of drospirenone 3 mg and ethinylestradiol 20 µg combination for 3 months in patients with PMS has a beneficial effect on the autonomic nervous system, significantly reduces the rate of pain before and during menstruation, helps to decrease the number and intensity of menstrual flow and ultimately significantly improves the quality of patient life.
Gynecology. 2019;21(5):45-48
45-48
Chronic endometritis: the state of the problem examination
摘要
Chronic endometritis is a clinical morphological syndrome that develops as a result of a self-sustaining pathological process, which is based on a violation of the production of pro-inflammatory cytokines initiated by an infectious factor. The article presents the clinical and etiological classification of endometritis, the pathogenesis of development in terms of involvement of immunocompetent cells, standards for diagnosis and therapy.
Gynecology. 2019;21(5):49-52
49-52
Correlation between indicators of hemostasis system activity and antiphospholipid antibodies levels in women with miscarriage
摘要
Aim. To study the correlation between the activity indicators of the blood coagulation system and the content of antiphospholipid antibodies in women with miscarriage, depending on the number of reproductive losses. Materials and methods. 137 cards of women with a history of pregnancy termination were analyzed, divided into 2 groups according to the principle of presence/absence of plasmapheresis in the treatment regimen at the stage of pregravid preparation, followed by ranking into 2 subgroups according to the principle of presence/absence of TORCH infection activity. Results. The highest correlation was found for the presence of autoantibodies against cardiolipin with the severity of antiphospholipid syndrome. Antibodies to b2-glyco-protein-1 were the second parameter in the level of correlation with the number of reproductive losses. The negative effect, diagnostic and pathogenetic value, first of all, of IgG is proved in comparison with IgM, IgG to cardiolipin, IgG to annexin V, IgG to cardiolipin and lupus anticoagulant. The main exogenous cause of antibody formation in AFL is an infectious agent. A key endogenous factor in antibody formation is recognized as a violation of endothelial hemostasis. Conclusion. The correlation relationships between the initial level and the dynamics of the content of antiphospholipid antibodies, the number of gestational losses, as well as a number of parameters of the hemostasis system were revealed and interpreted. An independent negative effect on the laboratory parameters of the antiphospholipid syndrome of gestational losses in an amount of more than two was revealed.
Gynecology. 2019;21(5):53-58
53-58
Diagnostic and prognostic potential of the use of ultrasound and three-dimensional endo-visualization in women with pelvic varicose veins
摘要
Aim. To study the diagnostic and prognostic potential of the complex use of ultrasound and 3D laparoscopy in women with pelvic varicose veins (PVV). Outcomes and methods. The study included 100 women who were divided into two groups: the main group (39 patients with various severity PVV) and the control group (61 women with no venous system disorders). All patients had a complete clinical examination with the selection of pairs that had the most significant factors for the disease prognosis: average age over 35 years, history of varicose veins, pain in the lower abdomen, dysmenorrhea and dyspareunia. Examination of the small pelvis venous system included duplex angioscanning and retrograde endoscopic functional test controlled by the three-dimensional image. Multivariate analysis (logistic regression) was used to identify normative phlebological parameters. Results. Predictors of early PVV are the following rations: Vmax in the cava-ovarian segment / Vmax in the right ovary portal ≥ 8.3 and Vmax in the reno-ovarian segment /Vmax in the left ovarian portal ≥ 8. The severity of PVV is determined by a progression of alterations in hemodynamic parameters in the main ovarian veins and a spreading venous congestion in the small pelvis plexuses. Conclusions. Criteria of small pelvis phlebohemodynamics make it possible to predict a development of PVV and a severity of the pathological process. Ovarian varicose veins are characteristic of early PVV and venous plethora of all pelvis venous plexuses is characteristic of late PVV.
Gynecology. 2019;21(5):59-64
59-64
Therapeutic non-contraceptive properties of the drug containing ethinylestradiol 0.03 mg and drospirenone 3 mg
摘要
Aim. To compare effects of the drug containing ethinylestradiol (EE) 0.03 mg and drospirenone (DRSP) 3 mg and the drug containing EE 0.02 mg and DRSP 3 mg on the skin and anthropometric parameters. Materials and methods. A prospective comparative randomized study included 40 women of reproductive age who didn’t have contraindications to use of combined oral contraceptive (COCs). The first group consisted of 20 women who were administrated EE 0.03 mg and DRSP 3 mg in the 21/7 regimen according to a prescribing information; the 2nd group included 20 patients who were administrated EE 0.02 mg and DRSP 3 mg in the 24/4 regimen according to a prescribing information. The study protocol included 8 visits: at the 0th visit, the inclusion and exclusion criteria were evaluated, at the 1st visit patient were randomized (envelope method) to receive one or another drug, at the 2nd - 7th visits (once a month) blood pressure was measured, anthropometric parameters were determined including body weight, height, waist, hips as well as body mass index, a degree of hirsutism (with Ferriman-Gallwey scale), skin and hair skin oiliness, acne (with a 10-point visual scale) were evaluated. Results. The use of EE 0.03 mg and DRSP 3 mg for 6 months did not significantly affect the body weight and body mass index, waist and hips. In the 6th month, the use of EE 0.03 mg and DRSP 3 mg lead to a statistically significant decrease in skin oiliness, severity of acne and hirsutism, which was comparable to a clinical effectiveness of EE 0.02 mg and DRSP 3 mg. Conclusions. EE 0.03 mg and DRSP 3 mg has a similar effect on skin oiliness, severity of acne and hirsutism with EE 0.02 mg and DRSP 3 mg, without significantly affecting the main anthropometric parameters. It is likely that the effect of DRSP-containing COCs on androgen levels and adipose tissue is due precisely to the effect of DRSP, and not to the dose of EE.
Gynecology. 2019;21(5):65-68
65-68
Evaluation of implant-associated complications after mesh-implants setting in pelvic floor reconstruction
摘要
Relevance. According to world data, nowadays prevalence of pelvic floor dysfunction and pelvic organ prolapsed reaches 28%. Most specialists relate pregnancy and delivery to main factors of pelvic prolapse development. Due to lifespan growth frequency of pelvic organ prolapse development increases. According to FDA data annually in the world is made more than 100 000 surgeries with synthetic implants, herewith heavy complications occur in 3.4% and mild complications occur in 14.8% of all cases. About 58% of surgeries are made to women under the age of 60, 13% of patients needs re-intervention during next 5 years. It should be noted that in cases of relapse more than 30% of women need re-intervention. Aim. Evaluate implant-associated complications after mesh-implants setting. Materials and methods. We have made retrospective analysis of mesh-implant use in 458 patients with pelvic organ prolapse in 2018-2018 yy. on the base of Bashkir State Medical University clinic. In order to assess quality of life after mesh-implant setting, we used the following questionnaires: Incontinence Questionnaire Short Form (ICIQ-SF), and also Female Sexual Function Index (FSFI). In order to assess blood microcirculation indices after surgery, we used laser Doppler flowmetry evaluation from anterior vaginal wall. Results. All in all, there were revealed 13 (2.84%) implant-associated complications. In 4 patients ICIQ-SF points were from 3 to 15, which indicates manifestation of urgent urine incontinence signs. According to FSFI questionnaire, sexually active women have 31.5 points. Basic factor, which provokes pelvic floor muscles dysfunction is delivery. Besides, in group of women of reproductive age, pelvic floor muscles dysfunction (PFMD) is associated with the presence of concomitant gynecologic diseases (uterine myoma, endometriosis, ovarian tumors). In the group of women older than 45 years with the presence of somatic pathology - obesity and impaired blood circulation. According to LDF data from anterior vaginal wall women with PFMD have low blood circulation indices, herewith the lowest indices are registered in the group of women older than 45 years.
Gynecology. 2019;21(5):69-73
69-73