Characteristics of hysteroscopy findings in women veterans who have suffered injuries with unqualified reproductive function

Abstract

Today, more than 50,000 women serve in the Armed Forces of Ukraine. According to statistical data, the number of people with post-traumatic stress disorder is 27.7% among military personnel who took part in active combat operations. Post-traumatic syndrome is a frequent predictor of various conditions with changes in the hormonal background, and morpho-functional changes of the endometrium, which in turn has a negative impact on women’s reproductive health. In our study, the diagnostic value of hysteroscopic examination of the uterine cavity in women who have suffered a contusion was studied and evaluated. This study proves the need to increase the effectiveness of hysteroscopic diagnosis and treatment of the uterine cavity in women of reproductive age who participated in combat operations and suffered contusions. Research aim: to determine the diagnostic value of hysteroscopic examination of the uterine cavity to assess the state of the endometrium in women with an unfulfilled reproductive function who have suffered a contusion. The objective: to determine the diagnostic value of the data obtained during hysteroscopic examination of the uterine cavity to assess the state of the endometrium in women who have suffered a concussion, and to develop an algorithm for the management of this category of women. Materials and methods. A prospective study was conducted on concussed women with unrealized reproductive functions. The study of the features of the hysteroscopic picture was carried out on 457 women of reproductive age who participated in combat operations and suffered a concussion and underwent a comprehensive examination on the 21st day of the menstrual cycle (MC). Of these women, 246 patients (the comparison group) of reproductive age with a history of trauma without post-concussive syndrome and 211 in the main group, women of reproductive age who have consequences of concussion in the form of the post-concussive syndrome (F7.02 за МКХ-10).30 conditionally healthy civilian women of reproductive age served as controls. The average age of the examined was 37.08±42.31 years. The period of stay in the combat zone is60.26±42.21 months, and the time since receiving a traumatic brain injury (concussion) is 18.81±9.211months. Symptoms of the consequences of a concussion at the time of examination were determined according to the Cicero questionnaire. Patients self-assessed their own symptoms with regard to the present. The PCL questionnaire (military version) was used to screen for PTSD. The study of the state of autonomic regulation was carried out by filling out a questionnaire for the subjective assessment of dystonia according to A. M. Wayne’s questionnaire. Results. Hysteroscopy was performed on 457 patients of reproductive age who took part in combat operations and suffered a concussion. Of the examined 457 patients who suffered a contusion in only 48 (16.11%) cases, the endometrium did not have any pathology. Intrauterine pathology was detected in 409 (83.89%) patients. According to the frequency of chronic endometritis and polyps, the examined groups with post-concussion syndrome and women with a history of concussion without post-concussion syndrome did not statistically differ. In patients with a mismatch in the secretion phase, the endometrium was of uneven thickness, the vascular pattern was not visualized, and only in some areas, the folds of the uterine mucosa were determined. Conclusions. Based on the results of the study, it can be stated that in patients with the postconcussion syndrome, compared to patients without post-concussion syndrome, there is1.72 times more frequent mismatch of the endometrium with the MC phase, 3.11 times more intrauterine synechiae, 2.01 times more SNGE. The conducted research showed the high diagnostic significance of hysteroscopy in women of reproductive age who participated in combat operations and suffered contusions, which allows recommending the inclusion of this technique in the management algorithm of women of the above-mentioned category.