Cervical Ectopy Research Articles

CERVICAL INSUFFICIENCY: ANAMNESIS, PREGNANCY AND CONSEQUENCES OF PREGNANCY (RETROSPECTIVE ANALYSIS)

Cervical insufficiency (CI) remains one of the leading causes of miscarriage and premature birth. Purpose of the study: to determine the frequency of CI, the characteristics of the anamnesis, the course of pregnancy, childbirth, the state of the newborn and the identification of potential risk factors. Material and research methods. 8728 birth histories were analyzed, among which 166 (1.9%) stories of women whose pregnancy was complicated by CI were found. The main group consisted of 166 pregnant women with CI, the control group included 55 women without CI and other severe obstetric- gynecological and somatic pathologies. The results obtained and their discussion. The incidence of CI on average over 5 years was 1.9%. With CI, there is a significantly lower percentage of young women, and at the age of 35 and over - 27.1% of pregnant women versus 10.9% in the control group. Only one third (33.7%) of women with CI can be considered somatically healthy. The morbidity structure is dominated by endocrine pathology (30.7%), among which metabolic syndrome / obesity (19.9%) and diseases of the urinary excretory system (27.7%) are distinguished. High frequency of pathology of the cardiovascular system (21.1%) and autonomic dysfunction syndrome (25.9%), hepatobiliary pathology (15.1%), gastrointestinal diseases (19.3), allergic manifestations (16.9%). A third of patients (28.9%) have a combination of two or more somatic diseases. Every fourth woman has a history of an infectious pathology of the urinary excretory sphere (25.9). In 27.7% of patients - a combination of several infectious pathologies. Half of the patients (53.0%) had a complicated gynecological history: cervical ectopy (33.7%), chronic infectious diseases of the genital area (16.3%) and PCOS: (13.9%), synechiae of the uterine cavity (6.6 %) and congenital malformations of the genitals (3.0%). The combination of several gynecological pathologies was observed in 18.1% of women. Every fourth woman underwent an excision of the cervix (25.9%), 42.8% - intrauterine interventions with the expansion of the cervical canal, 59.2% of them two or more times. According to the obstetric anamnesis, spontaneous miscarriages and medical abortions in 27.7% and 33.7% of women, in 18.1% - a missed pregnancy, every fourth patient has premature birth (25.9%), and every 10th patient has suffered injuries cervix. With a current pregnancy, the threat of premature birth is most often noted (51.2%), in second place is an exacerbation of infection of the genitourinary sphere (41.0%) and the threat of premature birth (38.0%). High incidence of placental dysfunction (30.7%), gestational diabetes (13.9%), fetal growth retardation (12.0%) and preeclampsia (7.3%). Premature birth in 38.0% of cases, in 31.9% - premature rupture of membranes, delivery by cesarean section in 19.3% of cases. Noteworthy is the high frequency of intrauterine infection (13.9%). Conclusion. Based on the results of a retrospective analysis, after a more detailed assessment of possible risk factors for CI, the most informative ones will be identified and proposed for use in clinical practice.

Efficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study

Efficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study

Цитологические признаки вовлеченности крипт при цервикальной интраэпителиальной неоплазии

Objective. To determine the cytological criteria of crypt lesion by cervical intraepithelial neoplasia (CIN). Patients and methods. The retrospective cohort study included 76 women who underwent a comprehensive medical evaluation after screening tests: cervical cytology test, colposcopy, biopsy and histological examination of the cervix, polymerase chain reaction (PCR) test for human papillomavirus (HPV). Cytological material was obtained using an endocervical brush (Cytobrush); it was stained by the Pappenheim method and examined by light microscopy; the Bethesda system was used. Results. Cytological examination of the cervical smears (cervical ectopy and endocervix) in 59 (78%) women revealed squamous epithelial cells with features typical for dysplasia of different severity: mild – LSIL (low-grade squamous intraepithelial lesions) and severe – HSIL (high-grade squamous intraepithelial lesion). Smears of 31 (53%) women also showed cylindrical (glandular) epithelial cells with signs of pronounced proliferation: 2 (9.5%) with LSIL and 29 (76.3%) with HSIL. Histological examination of the cervix in all 59 women revealed dysplasia of varying severity. Features of endocervical crypt involvement were detected in 28 women: 1 (4.8%) with LSIL and 27 (71.1%) with HSIL. The sensitivity and specificity of cytological diagnosis of cervical crypt involvement in LSIL were 100 and 95%, in HSIL – 87 and 67%, respectively. Conclusion. The cytological feature of crypt involvement by CIN is the presence in cervical mucus smears of clusters and papillary structures of proliferating, immature cylindrical epithelial cells, partially with cellular and nuclear polymorphism. Key words: crypts, cervical intraepithelial neoplasia, cytological examination

Efficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study

Efficacy of Unani Formulation in Cervical Ectopy (Quruhal Rahim) - An Open Observational Study

The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function. Impact statement What is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion. What do the results of this study add? Although the patients’ quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy. What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

Clinical Study of Tranexamic Acid in Treatment of Cervical Ectopy-AnInstitutional Experience

Background: Cervical ectopy is a common entity among women attending gynaecological OPD for various complaints which itself could be the cause or present otherwise. The treatment modalities currently available are electrocoagulation, cry cauterization, laser cauterization, and drug treatment. Most of these procedures require a high learning curve, associated with side-effects, and are costly. Furthermore, routine treatment for ectopy has long been debated and there are no current guidelines for the same. Tranexamic acid, with its easy applicability, availability, and minimal costs could be an effective alternative. Objective: To evaluate the therapeutic effectiveness and safety of topical tranexamic acid for the treatment of cervix erosion. Methodology: A total of 75 cases of cervical erosion were taken who satisfied the inclusion and exclusion criteria of the study. Patients were randomized into two groups. Local application of tranexamic acid (Group A, n=38) or povidone-iodine solution (Group B, n=37) for 5 minutes were applied with the patient position kept constant for 15 minutes and daily dosage were given for 10 days. All the patients were followed up at the end of 2nd and 4th week and after 3 months for complete healing, relief of symptoms like chronic pelvic pain, recurrent vaginitis, contact bleeding, and vaginal discharge, and possible side effects. Results: In group A, all 7 and 20 patients complaining of chronic pelvic pain and contact bleeding respectively were cured of it (100% cure). For the other symptoms such as recurrent vaginitis and vaginal discharge, cure rates were 81.25% and 87.5% respectively. In group B, the cure was seen only in vaginal discharge with 12 patients getting cured out of 33 (36.36%) and no response in other symptoms. Side effect in the form of vaginal irritation was found only in group B in 17 patients (45.94%) whereas none were observed in group A who received the tranexamic acid application. We observed a positive correlation between cervical erosion and tranexamic acid application in terms of healing and side effects. Conclusion: Tranexamic acid application is a promising new treatment modality of cervical erosion in symptomatic women.

Clinical Study of Tranexamic Acid in Treatment of Cervical Ectopy-AnInstitutional Experience

Background: Cervical ectopy is a common entity among women attending gynaecological OPD for various complaints which itself could be the cause or present otherwise. The treatment modalities currently available are electrocoagulation, cry cauterization, laser cauterization, and drug treatment. Most of these procedures require a high learning curve, associated with side-effects, and are costly. Furthermore, routine treatment for ectopy has long been debated and there are no current guidelines for the same. Tranexamic acid, with its easy applicability, availability, and minimal costs could be an effective alternative. Objective: To evaluate the therapeutic effectiveness and safety of topical tranexamic acid for the treatment of cervix erosion. Methodology: A total of 75 cases of cervical erosion were taken who satisfied the inclusion and exclusion criteria of the study. Patients were randomized into two groups. Local application of tranexamic acid (Group A, n=38) or povidone-iodine solution (Group B, n=37) for 5 minutes were applied with the patient position kept constant for 15 minutes and daily dosage were given for 10 days. All the patients were followed up at the end of 2nd and 4th week and after 3 months for complete healing, relief of symptoms like chronic pelvic pain, recurrent vaginitis, contact bleeding, and vaginal discharge, and possible side effects. Results: In group A, all 7 and 20 patients complaining of chronic pelvic pain and contact bleeding respectively were cured of it (100% cure). For the other symptoms such as recurrent vaginitis and vaginal discharge, cure rates were 81.25% and 87.5% respectively. In group B, the cure was seen only in vaginal discharge with 12 patients getting cured out of 33 (36.36%) and no response in other symptoms. Side effect in the form of vaginal irritation was found only in group B in 17 patients (45.94%) whereas none were observed in group A who received the tranexamic acid application. We observed a positive correlation between cervical erosion and tranexamic acid application in terms of healing and side effects. Conclusion: Tranexamic acid application is a promising new treatment modality of cervical erosion in symptomatic women.

The efficacy of the use of vaginal suppositories API-NORM® in patients after surgical treatment of cervical ectopy associated with HPV

The aim of the study is to improve the effectiveness of rehabilitation measures after surgical treatment of ectopic cylindrical cervical epithelium in women of reproductive age associated with HPV. In order to increase the effectiveness of rehabilitation measures after surgical treatment, 70 women of reproductive age with an ectopia of the cylindrical epithelium of the cervix associated with HPV were examined. According to rehabilitation measures after surgical treatment, they were divided into two groups. The main group included 52 women who, after surgical treatment for rehabilitation, received vaginal suppositories containing activated propolis extract, beeswax, St. John's wort extract, marigold and sea buckthorn oil (API-NORM), once a day for 10 days. The comparison group included 28 women treated with suppositories containing 500 mg of methyluracil. Analysis of the data obtained was carried out using the program “STATISTICA 5.5” (owned by the Central Scientific Research Institute of National Pirogov Memorial Medical University, Vinnytsya, license No.AXXR910A374605FA) using non-parametric methods for assessing the results. It was determined that the use of this method of rehabilitation after electroexcision treatment of cervical pathology made it possible to reduce the period of regeneration of the wound surface by 2.4 times and reduce the bleeding rate to 1.9% in the postoperative period. The appointment of API-NORM vaginal suppositories for the purpose of postoperative rehabilitation helps to reduce the recurrence rate of the disease and coagulated cervical syndrome to 3.8% and 1.9%, respectively, and gives us the full cervical epithelization in 94.2% of cases. This proves the high efficiency of the proposed method of rehabilitation.

Treatment of uterine cervical ectopy with acupuncture and analysis of risk factors in the metaplastic process

Objective: To evaluate acupuncture as a therapeutic method for uterine cervical ectopy with analysis of risk factors that interfere with the metaplastic response. Materials and Methods: From November 2010 to December 2015, the authors selected 51 healthy women with ectopy, reproductive age, no previous therapy, and negative conventional cytology Pap smear (CPS) for malignancy in the study group (S), treated with ten acupuncture sessions, weekly, and control group (C) with expectant management. The authors conducted anamnesis directed to Traditional Chinese Medicine (TCM), collection for liquid-based cytology (LBC), and colposcopy with photographs at study inclusion and follow-up at 90 days. The authors evaluated the therapeutic response by means of computerized planimetry in the images with 3% acetic acid solution (aa), considering the differential of the percentages of the areas of ectopy (ΔPe). The data were analyzed statistically. Results: Group S had 23 women and group C had 28. The mean age was 25.6 years, predominantly Caucasian, symptomatic, and non-smokers (100%). Group S presented a later age for first sexual intercourse (p < 0.001) and used less hormonal contraceptives (p < 0.001). LBC confirmed benignity and found no deviation of flora for bacterial vaginosis (BV). Group S presented higher ΔPe than C (p < 0.001). Conclusions: The authors observed a favorable therapeutic effect of acupuncture on the metaplastic process. The use of hormonal contraceptives and age of first sexual intercourse were the relevants risk factors, the same did not occur in smoking subjects and in the deviation of flora to BV.

Cryotherapy as a Method for Relieving Symptoms of Cervical Ectopy: A Randomized Clinical Trial.

ObjectivesBenign cervical ectopy (CE) may cause chronic or recurrent symptoms leading to women repeatedly being referred to gynecology clinics. We aimed to present a safe and effective method for relieving symptoms of CE.MethodsThis double-blind clinical trial was conducted among 164 women with CE who complained of persistent or recurrent symptoms of cervicitis in the last six months. Patient’s demographic data, medical history, symptoms, and vaginal examination results were recorded. Normal co-test or Pap smear was required to enter the study. Participants were divided into two groups; the intervention group received cryotherapy and the control group underwent cryo-placebo (inserted the probe without true cryotherapy). The outcomes including improvement of symptoms and CE were monitored one, three, and six months later.ResultsThe prevalence of symptoms in the two groups were not significantly different (p > 0.050). Symptom improvement was significantly higher with cryotherapy: vaginal discharge (p = 0.006), itching (p < 0.001), dyspareunia (p = 0.005), post-coital bleeding (p = 0.023), and pelvic pain (p = 0.009). If the symptoms did not disappear, their severity was lower after cryotherapy, comparatively (p < 0.050). Examination showed more improvement of CE following cryotherapy (p < 0.001). Cryotherapy showed no remarkable side effects and was associated with more satisfaction (p < 0.001).ConclusionsCryotherapy is a safe, effective, fast-acting, and cost-benefit therapy that can be considered for the treatment of symptomatic CE.

The use of Platelet-Rich Plasma in the Gynaecological Clinical Setting. A review

Reports on clinical use of platelet-rich plasma (PRP) have dramatically increased in the last decade. PRP is a natural product where a high level of platelets is concentrated with growth factors concentration 3 to 5 times greater than plasma. In their alpha granules, platelets contain a cocktail of chemical mediators that trigger tissue regeneration, both through the promotion of angiogenesis and the initiation of cell regeneration. Such bioactive factors include platelet derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), insulin growth factor (IGF). In the gynaecological setting, PRP has been shown to facilitate wound healing and has been proposed as an effective treatment for the treatment of disorders such as Lichen Sclerosus (LS) or cervical ectopy. Evidence of PRP effectiveness in conditions of pelvic organ prolapse and urinary incontinence has also been reported. Recent publications have shown its positive effects in promoting endometrial and follicular growth and gestation in assisted reproduction cycles. PRP administration in the ovarian tissue has resulted in rejuvenation as evaluated by the relevant biochemical markers as well as reactivation of folliculogenesis. Other researchers have showed effective use in improving pregnancy outcomes in patients with repeated implantation failure. For managing repeated failures, several methods have been attempted, but recently PRP appears as effective in inducing endometrial development in patients with thin, poor endometrium. Another possible mechanism of PRP to endometrium is through its anti-inflammatory actions. PRP is an innovative therapeutic modality, as it is simple, easily performed, and effective, with minimal risk as it is an autologous product. The employment of regenerative medicine approaches will continue to grow in the gynaecological setting and the future trials should be carefully designed in order to facilitate the clinical translation.

Detection and localization of the hemoglobin and collagen distribution of the uterine cervix

Changes of the blood vessels and collagen are associated with the development of abnormal cervical cells. Recently, optical coherence tomography and Mueller polarization images were used to provide information regarding the presence of collagen fibers in the cervical tissue. However, most of these methods need a lot of time for image recording and are expensive. In addition, the general survey on the absorption and distribution characteristics of collagen and blood in the cervical is still lacking. In this study, we developed a colposcopy combining cross-polarized image and image processing algorithm with an efficient analytical model to map the distribution of blood and collagen in the uterine. For this system’s proof of concept, we captured and processed the case of cervical ectopy and Nabothian cyst. The results show that the distribution of blood and collagen maps matched with anatomical and physiological when compared with Lugol’s iodine images. This technology has some advantages, such as low cost, real time, and can replace the use of acetic acid or Lugol’s iodine in the future.

Reactional changes in short-term levonorgestrel-releasing intrauterine system (lng-ius) use

To evaluate endocervical and vaginal environment changes in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). A quasi-experimental study included sixty women who had an LNG-IUS inserted in the Family Planning Clinic of UNICAMP between April and November of 2016. Women in reproductive age, non-pregnant, without the use of antibiotics and contraceptives seeking for LNG-IUS insertion were selected for this study. All women were evaluated with regard to vaginal and endocervical pH, vaginal and endocervical Gram-stained bacterioscopy, and Pap-smear before and two months after LNG-IUS insertion. Clinical aspects such as cervical mucus, vaginal discharge, and cervical ectopy were also observed. After LNG-IUS insertion, there was an increase in the following parameters: endocervical pH>4.5 (p=0.02), endocervical neutrophil amount (p<0.0001), vaginal cytolysis (p=0.04). There was a decrease in vaginal discharge (p=0.01). No statistically significant changes were found in vaginal pH, neutrophils amount in the vaginal mucosa, vaginal discharge appearance, vaginal candidiasis, bacterial vaginosis, vaginal coccobacillary microbiota, cervical mucus appearance, or cervical ectopy size. Short-term LNG-IUS use did not increase vulvovaginal candidiasis or bacterial vaginosis, and led to diminished vaginal discharge. Notwithstanding, this device promoted reactional changes in the vaginal and endocervical environment, without modification on cervical ectopy size.

Oncology cytology and HPV DNA testing in women with cervical ectopy

Oncology cytology and HPV DNA testing in women with cervical ectopy

Association of Sexually Transmitted Diseases With Cervical Ectopy: A Systematic Review.

The aim of this study was to review the available literature to explore evidence indicating an association between cervical ectopy and sexually transmitted diseases, which could help in the decision to treat or not to treat this condition. A review of the literature was conducted using the PubMed, EMBASE and clinicaltrials.gov databases on ectopy of the cervix using the terms "ectopy OR ectropium AND cervix" filtered only by language, without limit of date. A total of 71 studies were found in the initial selection, of which 56 were deleted by title, abstract, or full text. The remaining 15 articles were analyzed in this study. Cervical ectopy showed a positive association with human papillomavirus, human immunodeficiency virus, bacterial vaginosis, cervical epithelial atypia, postcoital bleeding, and desquamative inflammatory vaginitis. High-quality studies reported no association between ectopy and chlamydia infection. It was also not associated with gonococcal infection and herpes simplex. Cervical ectopy shows a probable association with increased acquisition of some sexually transmitted diseases. Additional studies are required to confirm the possible beneficial effects of treatment and to evaluate the possible complications of these treatments.

EVALUATING THE CHANGES IN SEXUAL QUALITY OF WOMEN WITH LOWER GENITAL TRACT INFECTION AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: The rate of reproductive tract infections was high. It had a significant impact on the quality of women of life. Sexual disorders were taken interest all over the world. Aim: To evaluate the changes in sexual quality of women with lower genital tract infection at Hue Hospital of Medicine and Pharmacy. Method: A cross study was conducted on 289 women, from 06/2016 to 12/2017 at Hue University of Medicine and Pharmacy Hospital, based on the questionnaire assessment of sexual function in women SQoL-F. Result: Cervicitis (22.5%); hypertrophy in the cervical muscle (10.7%); cervical ectropion (16.3%); Nabohthian cysts (11.1%), polyp (0.1%). The changed character in vulvitis of low sexual quality of life (SQoL) was 19.2% while the percentage of medium and high group were 80.8% and 0.0%, respectively. In vaginitis group, the low SQoL-F was 41.5%; medium SQoL was 58.5% and high SQoL was0.0%. The changed in cervicitis group of low SQoL was 35.4%, while the rate of medium and high group were 64.6%, 0.0%. The percentage of low and medium and high SQoL in inflammation of many positions group were 34.7%, 65.3% and 0.0%. The percent of lost psychosexual feelings of vulvitis group of low SQoL was 43.6%, medium group was 65.4% and 0.0% of low SQoL. While the rate of low, medium and high sexual quality of life in the vaginitis group were 45.2%, 54.8% and 0.0% respectively. In the cervicitis group, the proportion were respectively 39.2%, 60.8% and 0.0% for from low to high levels the levels of SQoL. For the inhited sexual activity, the rate of vulvitis group of low SQoL was 11.5%, medium group (88.5%). While the rate of low and medium and high sexual quality of life in the vaginitis group were 45.2%, 52.8%, 2.2% respectively. In the cervicitis group, the proportion were respectively 42.9%, 57.1% and 0.0% for from low to high levels of SQoL. The rate of inflammation of many positions group of low SQoL was 34.7%; medium (65.3%); high (0.0%). Conclusion: The problem of sexual dysfunction in women was needed more attention. Key words: Vulvitis, Vanginitis, Cervicitis, sexual quality of life, SQoL

Computer-Aided Diagnosis of Label-Free 3-D Optical Coherence Microscopy Images of Human Cervical Tissue.

Objective:Ultrahigh-resolution optical coherence microscopy (OCM) has recently demonstrated its potential for accurate diagnosis of human cervical diseases. One major challenge for clinical adoption, however, is the steep learning curve clinicians need to overcome to interpret OCM images. Developing an intelligent technique for computer-aided diagnosis (CADx) to accurately interpret OCM images will facilitate clinical adoption of the technology and improve patient care.Methods:497 high-resolution 3-D OCM volumes (600 cross-sectional images each) were collected from 159 ex vivo specimens of 92 female patients. OCM image features were extracted using a convolutional neural network (CNN) model, concatenated with patient information (e.g., age and HPV results), and classified using a support vector machine classifier. Ten-fold cross-validations were utilized to test the performance of the CADx method in a five-class classification task and a binary classification task.Results:An 88.3±4.9% classification accuracy was achieved for five fine-grained classes of cervical tissue, namely normal, ectropion, low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL), and cancer. In the binary classification task (low-risk [normal, ectropion and LSIL] vs. high-risk [HSIL and cancer]), the CADx method achieved an area-under-the-curve (AUC) value of 0.959 with an 86.7±11.4% sensitivity and 93.5±3.8% specificity.Conclusion:The proposed deep-learning based CADx method outperformed four human experts. It was also able to identify morphological characteristics in OCM images that were consistent with histopathological interpretations.Significance:Label-free OCM imaging, combined with deep-learning based CADx methods, hold a great promise to be used in clinical settings for the effective screening and diagnosis of cervical diseases.

Оцінка стану біоценозу піхви у пацієнток з рецидивом ектопії циліндричного епітелію шийки матки в умовах інфікування вірусом папіломи людини

Cervical ectopy is one of the most common benign processes, characterized by relatively high recurrence rate, and in the case of vaginal microbiota violations in the conditions of HPV infection combination deserves the aimed attention, particularly in the context of reproductive health care and cancer prevention. The objective: to study the vaginal microbiota features in patients withcervical ectopy relapsein the conditions of HPV infection. Materials and methods. The study included 98 women of reproductive age (18 to 46 years). Three groups were formed: a control group (n=30), in which conditionally healthy women were included, group 1 (n=33) – patients with firstly diagnosed cervical ectopy, group 2 (n=35) – patients with cervical ectopy relapse. All women wereexamined with a bacterioscopic, cytological, microbiological study of the vaginal biocenosis, as well as a determination of the vaginal environmentpH level. Results. In patients with cervical ectopy relapse the pH of the vaginal environmentwas significantly higher than that in women of the control group (p&lt;0.001) and of the group 1 patients (p&lt;0.05). About 9% of patients in both study groups had signs of bacterial vaginosis; in about 70% of group 2 patients the signs of mild and moderate severity aerobic vaginitis were found, significantly (p&lt;0.05) more often than in patients with firstly diagnosed cervical ectopy. In group 2 patients a significant polymorphism of infects was detected in 40.00±8.28% of cases, the associations of 3 or more microorganisms determined simultaneously were significantly (p&lt;0.001) more often foundin group 2 in comparison with patients with firstly diagnosed cervical ectopy. Сonclusion. The use of the short-term test system A.F.GENITAL SYSTEM (Liofilchem®, Italy) has a number of advantages for clinical practice: results being ready in short time, the detection of a wide range of infections, the possibility of quantifying M. hominis and U. urealyticum, and then determining the sensitivity to the most frequently used antibacterial drugs. Recurrent cervical ectopy often occurs in the conditions of colpitis, vaginitis, vaginal microbiota disorders with significant polymorphism of microorganisms and alkalization of the vaginal environment, which complicates the processes of ectopy epithelialization and can predispose to its recurrence. The observed cytological features in this cohort of patients suggest that long-term violations of the vaginal biocenosis in combination with the inflammatory processes of the vagina and cervix create favorable conditions for the realization of dysplastic changes caused by HPV. When determining the tactics of treatment of recurrent cervical ectopy, in particular in the conditions of HPV infection, first of all it is necessary to achieve both the cytological norm and the normalization of the vaginal biocenosis before any intervention, if necessary. Key words: relapse of cervical ectopy, vaginal biocenosis, vaginitis, cervicitis, HPV.

Plasma levels and diagnostic utility of macrophage-colony stimulating factor, matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 as tumor markers in cervical cancer patients.

Macrophage-colony stimulating factor, matrix metalloproteinase-9, and tissue inhibitor of metalloproteinase-1 may play an important role in malignant processes. The aim of this study was to investigate the diagnostic power of those parameters (serological biomarkers) in comparison to cancer antigen 125 and squamous cell carcinoma antigen in cervical cancer patients and in relation to the control groups. The study included 100 cervical cancer patients, 50 patients with cervical ectropion and 50 healthy women. Plasma levels of tested parameters were determined by enzyme-linked immunosorbent assay, cancer antigen 125, and squamous cell carcinoma antigen by chemiluminescent microparticle immunoassay. Plasma levels of all parameters in the total cancer group showed statistical significance (in all cases p < 0.05). In stage I of cancer only medial supraclavicular fossa and tissue inhibitor of metalloproteinase-1, in stage II all the tested parameters and cancer antigen 125, and in stage III + IV macrophage-colony stimulating factor, matrix metalloproteinase-9, and cancer antigen 125 showed statistical significance when compared to the healthy volunteers group. Macrophage-colony stimulating factor showed the highest value of sensitivity from all tested parameters (I: 56.25%, II: 72.73%, III + IV: 77.14% and 69% in total cervical cancer group). The highest specificity was obtained by matrix metalloproteinase-9 (94%). Positive predictive values were highest also for matrix metalloproteinase-9 (I: 82.35%, II: 84.21%, III + IV: 88% and 94.55% in total cervical cancer group), negative predictive values for macrophage-colony stimulating factor (I: 75.44%, II: 82.69%, III + IV: 87.5% and 58.11% in total cervical cancer group) and tumor markers. In the total cervical cancer group, all tested parameters showed statistically significant areas under receiver operating characteristic curve, but maximum range was obtained for the combination macrophage-colony stimulating factor + squamous cell carcinoma antigen (0.8723). The combined analysis of tested parameters and tumor markers resulted in an increase in sensitivity and areas under receiver operating characteristic curve values, which provides hope for developing new panel of biomarkers that may be used in the diagnosis of cervical cancer in the future.

Особливості тактики ведення пацієнток з ектопією шийки матки на тлі аеробного вагініту

Dysbiotic processes in the vagina, in particular aerobic vaginitis, are closely related to the local immune status violations, interfere the cervical epithelium physiological metaplasia, and also create favorable conditions for sexually transmitted infections accession, in particular the human papillomavirus. This complex of disorders is one of the determining factors for both the prolonged complicated course of cervical ectopy and its recurrence. The objective: was to optimize the treatment tactics in patients with cervical ectopy complicated by aerobic vaginitis. Materials and methods. It was carried out a comprehensive examination and treatment of 70 women of reproductive age (18–49 years) with cervical ectopy complicated by the aerobic vaginitis presence. All patients were questioned with a study of the reproductive anamnesis, bacterioscopic, cytological examination, simple and advanced colposcopy, pH-metry of vaginal environment, vaginal microbiota investigation. Depending on the treatment regimen, the patients were randomly divided into 2 groups. Group 1 (main group, n=35) – included patients treated according to the proposed scheme: on the first stage patients were prescribed vaginal suppositories containing dexpanthenol and chlorhexidine bigluconate – 1 suppository intravaginally twice a day and a complex multi-strain probiotic – 1 capsule twice a day for 2 weeks. On the second stage the patients were prescribed pessaries containing Triticum vulgare according to the scheme – 1 pessary intravaginally at night for 10 days a month (with the start of the use immediately after the next menstruation end) for 3 months. Group 2 (comparison group, n=35) – women who received treatment according to the current recommendations of the Ministry of Health of Ukraine. Group 3 (control group, n=30) included conditionally healthy women who have applied for routine preventive gynecological examination. Results. Clinical evaluation of the treatment first stage effectiveness showed a reduction in the complaints in patients of both study groups in 100% of cases. Both after the first and after the second stage of the proposed treatment scheme effective vaginal mucous membranes decontamination was revealed, conditionally pathogenic bacteria were not found in diagnostically significant titers, the number of leukocytes and the vaginal secret pH were normalized, and the average score on the Donders G. et al. scale showed no signs of aerobic vaginitis in the patients of the main group. The cytological norm of Pap-smear was reached by 91.43±7.43% of main group and 71.43±7.64% of the comparison group women (p&lt;0.05); and in case of evaluation using the Bethesda system (2001) – 97.14±2.82% of group 1 and 80.00±6.76% of group 2 patients (p&lt;0.05). After the second stage of treatment the average size of cervical ectopy significantly (p&lt;0.05) decreased in the patients of the main group compared to group 2 (by 32.68% compared to the average area before treatment). In 5 (14.29%) patients of the main group and 2 (5.71%) patients of the comparison group after the treatment cervical ectopy was not found during the control colposcopy. Сonclusion. In the part of women physiological cervical ectopy with the onset of sexual activity is complicated by the development of the vaginal dysbiotic processes and vaginitis, which create unfavorable conditions for the cervix epithelization and simultaneously increase the risk of sexually transmitted infections, in particular the human papillomavirus infection. Therapeutic measures aimed at normalizing the vaginal microbiota, recolonization of its lactoflora and the creation of favorable conditions for the physiological cervix epithelization are pathogenetically substantiated in this case. The proposed treatment scheme (complex application of vaginal antiseptic in combination with probiotic and on the next stage – of the reparative action drug) made it possible to reduce the complaints, eliminate the signs of aerobic vaginitis, normalize the vaginal microbiota state, reduce the cervical ectopy area, and in 14.29% cases – to achieve complete cervical epithelization. Key words: cervical ectopy, aerobic vaginitis, vaginal microbiota, vaginal suppositories, probiotic.