Chronic Salpingo-oophoritis Research Articles

Dynamics of inflammatory response markers in comprehensive treatment of chronic salpingo-oophoritis

Dynamics of inflammatory response markers in comprehensive treatment of chronic salpingo-oophoritis

Modern concepts of the pathogenesis of fertility disorders in women of reproductive age with chronic salpingo-oophoritis

Modern concepts of the pathogenesis of fertility disorders in women of reproductive age with chronic salpingo-oophoritis

Obstetrical and perinatal consequences of birth in women depending on the term of gestation

The objecticve: to analyze peculiarities of pregnancy course, childbirth and the condition of newborns in women, depending on the gestation period on the basis of clinical and statistical analysis.Materials and methods. An analysis of pregnancy course, childbirth and perinatal outcomes has been carried out in 137 pregnant women. Patients were divided into 2 groups depending on the gestational age: 41 patients (I group) delivered in 37–40 weeks of gestation and 96 patients (II group) – in 41-42 weeks of pregnancy. Functional assessment of the fetal condition was performed using a cardiotocographic examination with cardiomonitors «Oxford Team 8000» and Hewlett Packard according to the generally accepted method, ultrasound examination – by ultrasound machine «Biomedica Au-530» with a linear sensor of 3.5 MHz frequency. Variational and statistical processing of the results has been carried out using licensed standard packages of multivariate statistical analysis application programs «STATISTICA 13».Results. An evaluation of anamnestic data allowed to establish that the majority of patients in the II group (53.13 %) had extragenital pathology that was in 2 times more than in the I group (24.39 %). The frequency of chronic salpingo-oophoritis was also significantly higher in the II group compared to the I one (12.50 % and 2.44 %, respectively), and such pathology as uterine leiomyoma (7.29 %) and cervical dysplasia (4.17 %) were diagnosed only among the women in the II group.A higher rate of pregnancy loss, anemia during pregnancy and disorders of uteroplacental bloodflow in patients in the II group was determined. The frequency of obstetric complications in the II group was in 4 times higher compared to the I group. This had a direct impact on the increase in the rate of cesarean section and vacuum extraction of fetus. Thus, fetal distress during childbirth was diagnosed in 13.54 % of women in the II group and in 7.32 % in the I group, and the weakness of labor activity (8,3 %) and clinically contracted pelvis (5.21 %) were determined only in the II group. Trauma of the birth canal was found in 37.5 % of women in the II group, which was almost 4 times higher than in the group I (9.76 %). The frequency of postpartum bleeding was also higher in the group II (15.6 %) and exceeded the indicator in the I group (4.88 %) in 3 times.The signs of prolonged pregnancy were found in 7.32 % newborns in the I group and 13.54 % – in the II group. It should be noted that the clinical features of early adaptation, which are characterized by a low Apgar score at birth, as well as higher morbidity, including high frequency of damage to the nervous system were determined in the newborns in the II group.Conclusions. Results of the study indicate the importance of constitutional and age characteristics, as well as concomitant somatic pathology and genital inflammatory diseases in women with a delivery date of 41–42 weeks of pregnancy, which can increase the probability of postterm pregnancy in these women. According to the results of the comparative analysis in the research groups, depending on the date of delivery, the predominance of obstetric and perinatal complications was established in women who delivered at 41–42 weeks of pregnancy compared to women who had labor at 37–40 weeks. A high rate of obstetric complications (anomalies of uterine activity in labor, fetal distress, clinically contracted pelvis) had a direct impact on the increase in a percentage of operative delivery (vacuum extraction of a fetus and caesarean sections). Babies born at 41–42 weeks had clinical features of early adaptation, characterized by a low Apgar score, higher morbidity and frequent damage of the nervous system compared to newborns with gestation period of 37–40 weeks.

Comparative Assessment of Hormonal, Echographic and Spectral Parameters in Chronic Endometritis and Chronic Salpingo-Oophoritis

The purpose of the study was to assess the effectiveness and clinical significance of the use of spectral analysis of molecular markers for an objective assessment of the clinical course of chronic endometritis and salpingo-oophoritis. Materials and methods. The paper presents survey data of 100 women aged 18-47 years with a diagnosis of chronic endometritis and chronic salpingo-oophoritis. Laboratory methods of blood tests were carried out according to the generally accepted methods when patients were admitted for examination. The assessment of the hormonal status was carried out using standard kits from the company "Immunotec" (Czech Republic) on a radioisotope analyzer "Gamma-800" (Narcotest). All subjects underwent ultrasound of the pelvic organs using the Voluson E8 apparatus, using transabdominal transducers of 11 Hz and 18 Hz and a transvaginal transducer with a frequency of 20 Hz and 31 Hz. To study molecular markers, we used the method of molecular Raman spectroscopy. We used a standard two-beam infrared spectrometer "SPECORD-75 IR" in the frequency range of 4000-400 cm-1. Statistical data processing was carried out using Microsoft Excel 2000 and SPSS 10.0.5 software. Results and discussion. The results of our research showed that the use of hormonal and echographic studies, although they are informative methods in the diagnosis of chronic endometritis and salpingo-oophoritis, are not specific enough. One of the important points of pathogenesis, both for acute and chronic inflammatory diseases of the genitals, is the development of endogenous intoxication. A manifestation of acute inflammation against the background of intoxication is a change in the biosynthesis of "acute phase proteins". Spectral analysis of molecular markers allows detecting chronic endometritis / salpingo-oophoritis with higher accuracy (98%), sensitivity (99%) and specificity (97%). Stretching and bending vibrations of -CO and its derivatives are most intensely manifested. At the same time, depending on the pathological process, a shift in the position of the maxima in the absorption spectra was noted. The magnitude of the shift between the wave numbers obtained in patients with endometritis and salpingo-oophoritis was 1000/1500 cm-1, which is important for the identification and differentiation of components in the mixture. Conclusion. For samples of the spectrum of blood plasma in patients with chronic endometritis, characteristic bands with maxima are located in the region of 1510 cm-1, 1520 cm-1, 1535 cm-1. The absorption spectrum corresponds to 0.13-0.18. In patients with chronic salpingo-oophoritis, 1720cm-1 is characteristic for the 1600/1750cm-1 band, but 3420cm-1 for the 3300/3680cm-1 band. In this case, the absorption of waves during this process has significant differences – 0.16-0.25 for the first band and 0.06-0.20 for the second, on average 0.11

Structure of Gynecological Diseases and Comorbidity in Women with HIV Infection and Reproductive Disorders

Background: The increase in the number of HIV-infected women of fertile age, as well as their reproductive plans to have healthy children, was the reason for studying the features of reproductive health disorders and comorbid conditions in women with HIV infection. Methods and Results: Women meeting the inclusion criteria were divided into two groups: Group 1 included 27 HIV-infected women (average age of 30.8±2.9 years) with reproductive disorders; Group 2 included 23 HIV-infected women (average age of 31.4±7.1 years) without reproductive disorders. In study groups, the main route of HIV transmission was sexual contact. When assigning women to a particular category (fertile or infertile), the WHO classification of fertility was used: fertile, presumably fertile, primarily infertile, secondarily infertile, women with unknown fertility. There was a statistically significant difference in the incidence of medical abortion in the HIV-infected women with secondary infertility [14(60.9%)], compared to Group 2 [8(29.6%)] (P=0.026). There were no statistically significant differences in the incidence of chronic co-morbidities (ENT disorders, gastritis/duodenitis, pancreatitis, cystitis, viral hepatitis (B, C), papillomavirus infection) in Groups 1 and 2 (P>0.05). The incidence of pelvic inflammatory diseases was 2 times higher in Group 1 than in Group 2. No statistically significant differences in the incidence of uterine myoma, chronic cervicitis, chronic endometritis, vulvovaginal candidiasis,, and cervical dysplasia were found. A significant prevalence of chronic salpingo-oophoritis, secondary dysmenorrhea, secondary amenorrhea, opsomenorrhea, and secondary oligomenorrhea was detected significantly more frequently in Group 1 than in Group 2. The syndrome of hyperprolactinemia was also 2.6 times more frequent in Group 1 than in Group 2. Reproductive disorders in HIV-infected women were associated with a high incidence of STI combinations (trichomoniasis, gonorrhea, syphilis, chlamydia). Conclusion: Early detection of menstrual dysfunctions, prevention of abortion and sexually transmitted diseases, and timely treatment of infertility, are essential for women living with HIV.

Sexual disorders in chronic salpingo-oophoritis as a variant of the biopsychosocial model

Background. Modern gynecology uses all the latest achievements of other medical, basic natural sciences and medical technologies. However, sexopathology in women with gynecological diseases, due to the complexity of etiopathogenesis, remains poorly understood.
 Aim. Development of a diagnostic algorithm and identification of the structure of sexual disorders (SD) in chronic salpingo-oophoritis (CSO).
 Materials and methods. We examined 100 gynecological patients aged 1838 (on average 27.31.2) years with a diagnosis of CSO (N70.1 according to ICD-10), 67% of whom had sexual dysfunctions. Research methods: clinical-psychopathological, psychometric, experimental-psychological, sexological, gynecological, statistical.
 Results. SD which are present in 67% of women with CSO, are more often (40.3%) of a mixed nature. Neurotic disorders are represented by somatoform (F45) 29.9%; anxiety-phobic (F40) 22.4%; conversion (F44) 14.9% disorders and neurasthenia (F48.0) 7.5%.
 Conclusion. The severity of the course of CSO does not always correspond to the level of manifestations of sexual dysfunction; the predominant sexual dysfunction is dyspareunia (54%). Somatogenic asthenia, which according to ICD-10 refers to mental disorders, is reduced by purely somatic (gynecological) therapy. The tactics of gynecologists to identify sexual dysfunctions in women with gynecological diseases have been determined. An in-depth analysis of SD in CSO has been carried out in two main directions (sexo gyneco) in the domain of science (logy) as a variant of the modern biopsychosocial model proposed in ICD-11.

Features of the morphological structure of the placenta in pregnant women with preeclampsia

To study morphological features of the placenta in women in labor, pregnancy which complicated by preeclampsia we studied 26 placentae, of which 17 were from pregnant women with mild to moderate preeclampsia (basic group) and 9 from healthy women (control group). Histologically the study was conducted with methodically recommendations of T.D. Zadorozhnaya et al. for light microscopy.
 During the study of morphological features of the placenta in women in labor with preeclampsia were installed morphological changes in the placenta, which reflect a tendency to develop compensatory-adaptive reactions following their stress and exhaustion, which is a sign of placental insufficiency. Received data allow claiming a high frequency of development placental insufficiency in pregnant women with risk factors such as chronic salpingo-oophoritis, anemia, late preeclampsia, and inflammation diseases kidney.

Reproductive aspects of long-term consequences of ovarian apoplexy

The objective: to determine the long-term consequences of surgical treatment of ovarian apoplexy, taking into account the risk factors of this urgent pathology. Materials and methods. The study included 112 women (main group, n=112), who underwent surgery for ovarian apoplexy, and 40 patients in the control group (n=40), who had no history of this pathology. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in age (mean age was 23,6±4,2) and statistically comparable. Results. Based on the analysis of clinical and anamnestic data of patients who underwent surgical treatment of ovarian apoplexy, we identified the main risk factors for this pathology: chronic diseases of the urinary, respiratory and digestive systems, genital infantilism, ovarian retention cysts, chronic salpingo-oophoritis, menstrual disorders by type of hyperpolymenorrhea and/or algodysmenorrhea, family thrombophilic history, bleeding of various localizations in the anamnesis, artificial abortions, weight loss, smoking. Our proposed comprehensive two-stage rehabilitation system included treatment and prevention measures from the acute period of ovarian apoplexy to the time of reproductive function. The first stage of the treatment complex (early postoperative period) helped to eliminate the effects of ovarian injury, pain relief and hypercoagulable changes in the blood coagulation system, improving the quality of life during inpatient treatment. The second stage (2 months after surgery) provided the restoration of ovarian function and balance of the hemostasis system, thus preparing a woman’s reproductive system for future pregnancy and childbirth. In the remote postoperative period, the complex stage of rehabilitation in 23 treated patients resulted in the birth of healthy children and the absence of obstetric complications in 22 of them. Conclusion. Identification and structuring of risk factors for ovarian apoplexy is an important step for comprehensive treatment and prevention of recurrence of this disease. Eliminating or reducing the impact of these factors will help restore the reproductive system and improve quality of life. A comprehensive assessment of the state of the whole organism in the remote postoperative period indicates the need for rehabilitation measures aimed at increasing the natural resistance of the macroorganism and the effective restoration of reproductive function.

Prevention of complications of pregnancy and childbirth of patients with a burdensome gynecological anamnesis

The objective: determination of the effectiveness of prevention and medicinal correction of placental dysfunction in pregnant women with chronic salpingo-oophoritis.Materials and methods. The study included 100 pregnant women (basic group) with chronic salpingo-oophoritis, of these, I group (50 women) included patients who received proposed treatment and prevention approach, II group (50 women) received a common set of treatment and prevention measures. The proposed treatment-and-prophylactic approach included prophylactic administration to pregnant women with chronic salpingo-oophoritis from the 8th to the 10th and from the 16th to the 18th week inclusive of natural micronized progesterone at a dose of 100 mg intravaginally twice a day for two weeks. Venotonik and angioprotector were prescribed prophylactically at dose 600 mg from 18 weeks to 37-38 weeks of pregnancy. For therapeutic purposes (blood flow disorders in the uterine arteries and vessels of the umbilical cord that are determined by Doppler), the drug was prescribed at dose 600 mg twice a day for 3–4 weeks.Results. A lower frequency of obstetric and perinatal complications was found in the women in I group than in the patients in the II group. Thus, the rate of placental dysfunction was 6.0±3.36% vs. 34.0±6.7%, respectively, oligohydramnios – 6.0±3.36% and 12.0±4.59%, polyhydramnios – 10.0±4.24% and 22.0±5.86%, fetal distress during childbirth – 6.0±3.36% and 14.0±4.91%, cesarean section – 12.0±4.6% and 24.0±4.27%. In the group of patients with treatment-and-prophylactic approach, the mean of the body weight of newborns was 3486.7±312.71 g, and in women who received a common set of treatment-and-prophylactic measures – 3099.8±295.69 g. The mean of the assessment of the condition of newborns by the Apgar scale at the 1st minute – 7.92±1.54 and 6.81±1.16 points, respectively.Conclusions. The use of micronized natural progesterone and the drug diosmin 600 mg in pregnant women with a history of chronic salpingo-oophoritis reduces the rate of obstetric and perinatal complications during pregnancy.

Effect of laser therapy on the immune status of patients with chronic salpingoophoritis of chlamidial etiology

Aim.Justify the use of low-frequency laser radiation (LFLR) treating chronic salpingoophoritis of chlamydial etiology, taking into account the assessment of the immune status.Material and methods.The study included 110 women, of which 80 women had chronic salpingo-oophoritis of chlamydial etiology, and 30 were practically healthy. In addition to conventional methods, patients underwent examinations like immunological analysis, ultrasound examination of the pelvic organs, enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR) analysis.Results and discussion.When comparing changes in the immune status in patients after LFLR and who underwent traditional therapy in the group of patients with sexually transmitted infections (STIs), there was a slight increase in the number of T-lymphocytes and T-helpers, as well as a decrease in the number of T-suppressors. Also, in these patients, there is a slight decrease in the number of IgA and IgM against the background of an increase in IgG and an increase in the phagocytic activity of neutrophils. In patients with traditional therapy, the above-described changes persisted, while an aggravation of the disturbed T-cell balance was observed.Conclusions.Thus, according to the results of a comparative analysis of the obtained data on changes in the immune status in patients with chronic salpingo-oophoritis after the use of laser therapy, a statistically significant increase in the number of T-lymphocytes, an increase in subpopulations including T-helpers, a decrease in the number of T-suppressors, an increase in immunoglobulin G and an increase in phagocytic activity of neutrophils was observed.

Long-term consequences of surgical treatment of ovarian apoplexy

The objective: to determine the long-term consequences of surgical treatment of ovarian apoplexy, taking into account the risk factors of this urgent pathology.Materials and methods. The study included 112 women (main group, n=112), who underwent surgery for ovarian apoplexy, and 40 patients in the control group (n=40), who had no history of this pathology. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in age (mean age was 23,6±4,2) and statistically comparable.Results. Based on the analysis of clinical and anamnestic data of patients who underwent surgical treatment of ovarian apoplexy, we identified the main risk factors for this pathology: chronic diseases of the urinary, respiratory and digestive systems, genital infantilism, ovarian retention cysts, chronic salpingo-oophoritis, , menstrual disorders by type of hyperpolymenorrhea and/or algodysmenorrhea, family thrombophilic history, bleeding of various localizations in the anamnesis, artificial abortions, weight loss, smoking.Our proposed comprehensive two-stage rehabilitation system included treatment and prevention measures from the acute period of ovarian apoplexy to the time of reproductive function. The first stage of the treatment complex (early postoperative period) helped to eliminate the effects of ovarian injury, pain relief and hypercoagulable changes in the blood coagulation system, improving the quality of life during inpatient treatment. The second stage (2 months after surgery) provided the restoration of ovarian function and balance of the hemostasis system, thus preparing a woman’s reproductive system for future pregnancy and childbirth. In the remote postoperative period, the complex stage of rehabilitation in 23 treated patients resulted in the birth of healthy children and the absence of obstetric complications in 22 of them.Conclusion. Identification and structuring of risk factors for ovarian apoplexy is an important step for comprehensive treatment and prevention of recurrence of this disease. Eliminating or reducing the impact of these factors will help restore the reproductive system and improve quality of life.A comprehensive assessment of the state of the whole organism in the remote postoperative period indicates the need for rehabilitation measures aimed at increasing the natural resistance of the macroorganism and the effective restoration of reproductive function.

The combined application of transvaginal collagenase electrophoresis and pulsed magnetic therapy to improve the quality of life of patients with chronic salpingo-oophoritis

Chronic salpingo-oophoritis (CSO) is one of the most common diseases among the entire gynecological pathology, the frequency of which reaches 65-68%. Despite the progress made in the treatment of CSO, there is a serious problem due to the steady growth and complications leading to infertility, ectopic pregnancy and the development of chronic pelvic pain syndrome, which significantly reduces the quality of life of patients. In this regard, the development of promising pharmaco-physiotherapeutic methods with pronounced analgesic, anti-inflammatory, immunomodulatory and bacteriological effects to increase the therapeutic effectiveness and improve the quality of life of patients with salpingo-oophoritis is an important task of modern gynecology and physiotherapy. Objective: To study in a comparative aspect the effect of the combined use of transvaginal electrophoresis of the collagenase complex and pulsed magnetic therapy and their mono-effects on the quality of life of patients with chronic salpingo-oophoritis. Materials and research methods. The study included 77 patients aged 18 to 42 years (median age was 26,7±2,8 years) with a diagnosis of chronic salpingo-oophoritis of non-specific etiology. More than half of the patients (59,7%) were women under 25 years of age. All patients were divided into three groups that were comparable according to the main clinical and anamnestic data, somatic and obstetric-gynecological status: group 1 — the main group — included 28 patients who received a course of combined application of transvaginal electrophoresis of the collagenase complex and pulsed magnetic therapy; group 2 — comparison group 1 — included 25 patients who received acourse of transvaginal electrophoresis of the collagenase complex; group 3 — comparison group 2 — included 24 patients who received a course of pulsed magnetic therapy. The quality of life was assessed by the indicators of the Quality of Life Index (QOL), which takes into account the three most important and informative aspects of patients’ lives: physical condition and its dynamics, mental (psychological) health and daily functioning. The results of the study. Based on the obtained results, it was proved that the most pronounced results were achieved in patients of the main group who received a course of transvaginal electrophoresis of the collagenase complex in combination with pulsed magnetic therapy, where the quality of life improved by 89,3% according to the QOL index, compared to the monotherapy with transvaginal electrophoresis and pulsed magnetic therapy — 75,7% and 73,1%, respectively.

Доброкачественные опухоли и опухолеподобные поражения яичников: структура, методы диагностики, тактика оказания медицинской помощи

Relevance of the study. Benign ovarian tumors (hereinafter referred to as BOT) and tumor-like lesions of the ovaries are an acute problem in gynecology, since they develop mainly in women of childbearing age (75-87%) and cause a decrease in reproductive potential. The aim of the study was to study the structure of the BOT and tumor-like lesions of the ovaries, to identify defects in the treatment. Research materials: in compliance with the legislation on the protection of personal data, with the preservation of medical secrecy, the medical records of 350 women who underwent inpatient treatment in 2017-2020 in the gynecological department of Maternity Hospital No. 3 in Tyumen were studied. Results of the study. Only 151 (43%) patients were admitted with complaints, the main complaint was nagging pain in the lower abdomen. The structure of the pathology: corpus luteum cyst – 95 (27%), follicular cyst – 63 (18%), benign endometrioma – 77 (22%). More rare cases: benign cystadenoma – 36 (10%), paraovarian cyst – 30 (9%), benign teratoma – 28 (8%), paratubar (inflammatory) cyst – 21 (6%). There were no statistically significant differences in the frequency of localization (right, left ovaries). The accuracy of ultrasound diagnostics was 99%. Conservative treatment was used in 89 (56%) patients with tumor-like ovarian formations (follicular cyst, corpus luteum cyst). The gynecological history of patients is characterized by a high frequency of inflammatory diseases of the pelvic organs, including chronic salpingo-oophoritis (22%), chronic metroendometritis (10%), inflammatory disease of the cervix (27%). The infertility rate was 7%. Normal CA-125 values were in 83%, increased in 17%. In the tactics of surgical treatment of various forms of BOT and tumor-like lesions of the ovaries, laparoscopy (73%) and Pfannenstiel laparotomy (25%) prevailed. Conclusion. The corpus luteum cyst and follicular cyst are the most frequent nosological form of pathological processes of the ovaries, they require careful diagnosis and, if necessary, the timely appointment of conservative treatment. Surgical treatment in the absence of indications for that or due to inappropriate therapy at the prehospital stage is considered as a defect in the provision of gynecological care.

Peculiarities of pregnansy and childbirth in patients with a burdened gynecological anamnesis

The objective: to study the features of pregnancy, childbirth, postpartum period, fetal status and newborns in patients with a history of chronic salpingo-оophoritis.Materials and methods. Conducted a retrospective study of 150 birth histories and neonatal development maps. All patients were divided into two groups. The main group includes 100 patients with chronic salpingo-оophoritis, for which they received anti-inflammatory treatment from 1 to 3 times before pregnancy. The control group included 50 pregnant women who did not suffer from chronic salpingo-оophoritis.Results. Our analysis of pregnancy, childbirth, fetal and neonatal status in women with chronic salpingo-оophoritis indicates that such patients have a complicated obstetric and gynecological and somatic history, which forms an unfavorable basic condition of organs and systems, imperfect adaptation to pregnancy, high risk of failure of adaptive reactions. The result is a violation of the formation and development of the mother-placenta-fetus system and, as a consequence, a high level of complications during pregnancy, childbirth and perinatal pathology.Conclusion. Patients suffering from chronic salpingo-oophoritis should be considered at high risk of possible complications during pregnancy and childbirth. This category of women needs quality preconception training and careful monitoring during pregnancy.

Clinical characteristics of women with recurrent pregnancy loss and chronic endometritis

Annotation. The purpose of the work is to analyze the gynecological, somatic, reproductive history, as well as to determine the risk factors and etiopathogenetic factors of miscarriage on the background of endometritis. We examined 98 women of childbearing age who applied to the Innomed Clinic in Vinnytsia during 2019–2020. Patients were divided into two groups: the main group – 68 women (the average age was 27.25±0.29) with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women (the average age was 26.74±0.18) without previous pregnancy loss. Statistical processing, as well as analysis of the obtained data was performed using the program “Microsoft Excel” using the methods of mathematical statistics. Statistical evaluation was performed using the Student’s test. The obtained results were considered reliable at a reliability factor p <0.05 (95% significance level). Distribution of patients of the main group by number of reproductive losses was as follows: twice – 45 women, three times – 15 women, 4 and more – 8 women. Structural distribution of pregnancy losses in women of the main group (n=68) was next: miscarriage – 41, missed abortion – 21, anembryonic pregnancy – 6. The number of reproductive losses in the first trimester was 71.7%. Reproductive losses detected during 13–22 weeks reached 28.3%. Concomitant impressions of extragenital organs and systems were found in 46 (67.6%) women of the main group and 7 (23.3%) women of the control group. The leader of somatic morbidity was endocrine pathology. Among gynecological pathology, chronic endometritis was observed in 100% (n = 68) of the examined women of the main group. In addition, 55 patients (80.9%) of this group in the structure of gynecological pathology had other lesions, among which a significant indicator belongs to chronic salpingo-oophoritis (22 (32.4%)) and various menstrual disorders (18 (26.5%)). The vast majority of women in the main group had a history of instrumental revision of the walls of the uterine cavity for various pregnancy losses in the anamnesis (28 (41.2%)). That is why the qualitative analysis of clinical data of women with habitual miscarriage and chronic endometritis is an important area of research, as it allows to carry out adequate treatment and prevention measures at the stage of pre-pregnancy training.

Complicated chronic salpingo-oophoritis in young women. Possibilities of conservative therapy

Purpose of the study: to improve the scheme of conservative treatment of chronic salpingo-oophoritis complicated by hydrosalpinx in young women.Materials and methods. The study included 65 patients with chronic salpingo-oophoritis complicated by hydrosalpinx. The mean age of patients was 28 ± 5.9 years. Women were randomized into 2 groups depending on the therapy scheme. Group I (33 women) in addition to the standard complex were prescribed Distreptaza® suppositories rectally for a period of 15 days. Group II (32 women) received a standard complex, which included an antibacterial drug and a symbiotic. The diagnostic complex carried out in the treatment dynamics included a general clinical, gynecological examination, microbiological studies. Ultrasound and determination of luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol and progesterone in plasma were performed before therapy and 1 month after.Results. Faster regression of pain in patients receiving treatment with Distreptaza® was accompanied by no sonographic signs of distal occlusion in fallopian tube in 48.48% patients; standard therapy was effective in 21.87% women. Microbiocenosis of the genital tract was restored in most patients of the examined groups after a month of treatment. There was a significant (p <0.05) 3-fold increase in progesterone levels in the second phase of the menstrual cycle after the end of antibacterial therapy in the first group. This is indicated the resumption of ovulatory cycles. This is makes it appropriate to use the selected drugs combination in young patients (up to 35 years) with unrealized reproductive plans.Conclusions. Treatment of chronic salpingo-oophoritis complicated by hydrosalpinx in young women should be comprehensive and include in the first stage empirical antibacterial, anti-inflammatory and antifungal therapy, symbiotics and polyenzyme drugs. Organ-preserving methods should be preferred among surgical methods№ 4

Immune-Metabolic Therapy of Purulent Inflammatory Diseases

Introduction: Inflammatory diseases of the female genital organs rank among the leading ones in the total number of women of reproductive age. This results from a decrease in immunity, early sexual activity, neglect of personal hygiene, abortions, birth complications, etc.
 Materials and Methods: The study included 100 patients suffering from exacerbated chronic salpingo-oophoritis and its combination with bacterial vaginosis. In the study, all the patients were randomly divided into five groups, with 20 patients each. The patients were treated in the prescribed regimens and doses, according to the standards of specialized medical care. An immunomodulator immunomax and an antioxidant hypoxene were chosen as additional treatment options. Clinical and laboratory parameters were measured in all the patients before and after the treatment. The effec­tiveness of the treatment was evaluated 10-14 days later. In 18 people, the procedure was repeated after 2-3 months.
 Results and Discussion: It was found that the standard therapy to treat exacerbated chronic salpingo-oophoritis re­duced inflammatory manifestations after 10-14 days; however, the risk of complications and relapse of the disease remained. Immunomax provided satisfactory second-order normalization of the immunological and metabolic parame­ters, ultimate normalization of pro-inflammatory parameters and absolutely no positive effect on the clinical parameters in patients with chronic salpingo-oophoritis in the acute stage, when compared with the standard treatment. A complex therapy of salpingo-oophoritis with bacterial vaginosis by means of immunomax and hypoxene aimed to normalize most clinical and laboratory parameters was absolutely positive; a moderate level of parameters was revealed only in cellular-humoral immunity.
 Conclusion: After 10-14 days, the standard treatment of patients resulted in normalization of the pro-inflammatory and immunological parameters, rather than the clinical and metabolic parameters. The administration of immunomax con­tributed to the correction of metabolic, immunological and pro-inflammatory markers, and the complex administration of an immunomodulator with an antioxidant favorably affected all the laboratory parameters.

OPTIMIZATION OF TREATMENT OF PATIENTS WITH CHRONIC SALPINGOOPHORITIS

Inflammatory diseases of the pelvic organs occupy the first place in the structure of gynecological morbidity, the most common of which are lesions of the uterine appendages, and is one of the causes of dysfunction not only reproductive organs but also various systems of the female body, infertility, reduced quality of life. Vaginal dysbiosis can be considered as the initial stage in the formation of an endogenous infection.The aim is to study the effectiveness of complex therapy of chronic salpingo-ophoritis and its consequences.Materials and methods of research. 60 women of reproductive age with chronic salpingoophoritis were examined, 30 of them received our recommended complex therapy (group 1), the other 30 received antibacterial therapy (group 2). 20 healthy women were included in the control group. All subjects underwent general clinical, cytological, bacterioscopic, bacteriological studies, PCR, ultrasound of the pelvic organs, general clinical and biochemical blood tests, hemostasiogram. The intensity of the pain syndrome was assessed by a visual analog scale and a pain map.The results of the study and their discussion. The study of the dynamics of the clinical status of patients showed the presence of aching pain after the treatment in patients of group 1 in 13.3%, in group 2 - in 23.3%. According to Doppler ultrasound, signs of inflammation as a result of treatment in group 1 were found in 13.3%, in group 2 - in 20.0% of cases. The immediate and long-term results of treatment of chronic salpingo-oophoritis, in laboratory examination, showed the normalization of the vaginal microflora during bacteriological examination after 3-6 months in group 1 - in 90%, in group 2 - 53.01% of patients; an increase in the level of lymphocytes by 1.9 times and monocytes by 1.6 times in the hemogram of women in group 1 against the absence of changes in the level of lymphocytes and an increase in the level of monocytes by 1.4 times in women in group 2; no significant difference between the indicators of the hemostasis system in patients of the control group and patients in group 1. The effectiveness of treatment in patients of group 1 of the study was 86.7%, in group 2 - 76.7%. Conclusions. The combination of the use of complex antibiotic therapy, an enzyme preparation of local action based on streptokinase and streptodornase, followed by the administration of drugs that restore the normal vaginal microflora, is pathogenetically justified in the treatment of patients with chronic salpingo-oophoritis. The results of the clinical efficacy of the proposed therapy were confirmed by a decrease in the intensity of the pain syndrome and a positive dynamics of ultrasound indicators after treatment by 1.5 times in patients of group 1 than in group 2. A stable restoration of microbiocenosis in the examined patients was established 1.6 times more often in group 1 than in group 2 already 14 days after treatment, faster normalization of hemogram parameters (increase in the level of lymphocytes by 1.9 times, monocytes by 1.6 times) , as well as the absence of a significant difference between the indicators of the blood coagulation system in comparison with the control group, which indicates the absence of the proteolytic effect of the drug.

DIAGNOSIS AND PHARMACOTHERAPY OF PELVIC INFLAMMATORY DISEASES IN WOMEN

The article is devoted to modern issues of etiology, in particular, the theory of biofilms as the most promising direction of research. Biofilms are most often represented by the association of microorganisms in which they, through coexistence in close contacts, acquire new properties, expressed in an atypical clinical picture. This determines problems of rapid diagnosis and pathogenesis, in which both the local and systemic secondary immunodeficiency state is put in the forefront, autoimmune inflammation and reactions of free radical oxidation. The most typical symptoms and signs of inflammatory diseases of the pelvic organs include, in particular, chronic salpingo-oophoritis - a common nosological item from this group, which has important social and demographic significance, since the most affected group, according to statistics, are women of reproductive age. The emphasis was placed on approaches to diagnosis using not only data from the collected history and physical examination but also methods based on modern instrumental and minimally invasive methods. Special attention was paid to measures aimed at correcting risk factors and preventing this disease, etiotropic therapy with the presentation of a specific scheme of the most rational antibiotic therapy, pathogenetic and symptomatic treatment to alleviate the condition before the eradication of the pathogenic microorganism or their association in the composition of biofilms and cure patients, and correction such unpleasant complications as vaginal dysbiosis, which can develop against a background of powerful antibiotic therapy and is not a measure of inadequate treatment and change of the selected regimen.

ВНЕМАТОЧНАЯ БЕРЕМЕННОСТЬ И ОСТРЫЙ АППЕНДИЦИТ ВО ВРЕМЯ БЕРЕМЕННОСТИ, НАСТУПИВШЕЙ ПОСЛЕ ЭКСТРАКОРПОРАЛЬНОГО ОПЛОДОТВОРЕНИЯ (клинический случай)

The paper presents a clinical case of the Patient T., 34 years old, who underwent the treatment in the Department of
 ART of the Regional Perinatal Center for tubal peritoneal infertility for seven years. In the anamnesis: one spontaneous
 uterine pregnancy, culminating in medical abortion for up to 12 weeks, treatment for chronic salpingo-oophoritis, tu-
 bectomy on the right side for a progressing ectopic pregnancy. The patient denied the presence of Chlamydia infection
 in the anamnesis. Studies on sexually transmitted infections before the IVF program were negative. During laparo-
 scopic tubectomy, no endometriotic foci were found. There were four programs of ART in anamnesis: in 2009, 2012,
 2014, 2016. During the fourth ART program in 2016, two embryos were transferred to the uterine cavity, resulting in
 a uterine pregnancy in combination with an ectopic pregnancy diagnosed in the ultrasound study at 4 to 5 weeks of
 gestation, in the absence of clinical symptoms. The patient underwent emergency laparoscopic tubectomy on the left,
 the course of the postoperative period proceeded without complications. Later, in the period of uterine pregnancy of
 7–8 weeks, with a clinical picture of acute appendicitis, the woman was hospitalized in the surgical department where
 she underwent laparoscopic appendectomy. Later the pregnancy proceeded without complications, at 39 weeks the
 planned cesarean section was performed, a girl weighing 3480 grams, 51 cm long with an Apgar score of 9–10 points
 was extracted on the operation. The course of the early postoperative period without complications, the patient was
 discharged with the child on the 4th day.