Prevention of reproductive disorders in women with female genital tract malformations

Abstract

Summary. Reproductive health is a priority in today’s global health care system. Among the factors of reproductive health disorders are female genital tract malformations. This pathology is mostly diagnosed with the onset of reproductive disorders at different ages of women, negatively affecting not only the reproductive but also the sexual functions of women, absorbing the quality of her life. The objective: to develop measures for the prevention of reproductive disorders in patients with female genital tract malformations based on the assessment of clinical manifestations and the frequency of reproductive disorders. Materials and methods. A retrospective assessment of reproductive disorders in 84 patients with a verified diagnosis of abnormalities in the development of the female genital organs was performed. The diagnosis was based on complaints, anamnestic data, the results of objective examination, clinical, laboratory and instrumental methods. The control group consisted of 25 women without abnormalities in the development of the female genitalia. Results. The mean age of the surveyed women was 27.6 ± 3.8 years. The duration of verification of the diagnosis of female genital tract malformations from the moment of the first visit to the gynecologist took an average of 3.1 ± 1.3 years. Of all the abnormalities in the development of the female reproductive system, 14.3 % were so-called «obstructive» abnormalities associated with impaired menstrual blood flow. Therefore, their clinical manifestation was earlier and more pronounced than in other patients and was manifested primarily by severe dysmenorrhea. Deviations in the age of onset of menarche occurred in 25 % of patients (OR =8; 95 % CI 1,019 – 62,798). In 73.8 % of women, the first reproductive disorders began during puberty. Dys menorrhea of varying severity occurred in 69.1 % of patients (OR = 7,064; 95 % СІ 2,527 – 19,744), of whom 70.6 % used medical treatment. The share of infertility among the women with anomalies in the development of the reproductive system was 19.1 %, pregnancy loss – 40.5 %. It was found that the risk of miscarriage in patients with congenital pathology of the female genitalia increases significantly (OR = 3,570; 95 % CI 1,125 – 11,325). 34.5 % of patients were diagnosed with genital endometriosis (OR = 6,064; 95 % СI 1,335 – 27,540). In 21.4 % of cases, abnormalities in the development of the female genitals were combined with congenital kidney disease. Conclusions. Prevention and predictability of reproductive disorders in patients with female genital tract malformations should begin with the pubertal period of the girl. A separate risk group consists of girls with pathology of the kidneys diagnosed prenatally. The basis for the prevention of reproductive health disorders in women with female genital tract malformations is the timely verification of congenital pathology and the development of a personalized system of management. The results of our research and the literature suggest that verification of the diagnosis of female genital tract malformations in women usually begins when patients have lost pregnancy or are experiencing infertility, while dysmenorrhea, menstrual irregularities that may occur in adolescence, often do not alert and do not become the basis for exclusion of congenital anomalies. That is why we believe that screening ultrasound examination of the pelvic organs in the presence of these disorders, it is advisable to conduct girls during puberty, if necessary – using 3D ultrasound and/or MRI.