Gynecologic Centers Research Articles

Altered Vaginal pH Value and Enterobacteria as a Risk Factor in the Development of Precancerous Lesions of the Cervix

Background: Vaginal microflora plays an important role in cervical carcinogenesis. An increase in vaginal pH is associated with the severity of squamous intraepithelial lesion (SIL) and a decrease in the number of lactobacilli. Microbial dysbiosis contributes to the damage of the epithelial barrier, as well as the reprogramming of immune and metabolic signaling. Dysbiotic bacteria cause damage to the epithelial barrier, immune dysregulation and genotoxicity and create a tumor-permissive microenvironment. Objective: The aim of this study was to determine the presence of risk factors (abnormal colposcopic and microbiological status, elevated pH of the vaginal environment) in regular Pap tests and LSIL. Methods: Retrospective prospective study 2021-2022. 90 women with pap smears were analyzed: 40 with LSIL at the Gynecological Center “Dr. Mahira Jahić” Tuzla and 50 with normal findings at the Tesanj Health Center. General data such as: age of the subjects, reproductive status, contraception, smoking and data on colposcopic examination, microbiological findings and vaginal pH value were analyzed. Statistical data processing was done in the SPSS program. Results: The average age of the test subjects is 39.94, in normal Pap 41.20 years, and in LSIL 38.38 years. The vital characteristics of the subjects did not differ significantly, except for smoking, where in LSIL findings, they consumed cigarettes significantly more often. Abnormal colposcopic examination were found in 85% (N-34) of women with LSIL. In subjects with LSIL, a positive microbiological test for enterobacteria was found in 47.5% (N-19) and a normal pap test in 12% (N-6). Statistically significant difference p=0.00523 p<0.05, E faecalis and E coli had the highest prevalence in LSIL. The mean pH value of the vaginal environment in LSIL is 5.38, and 4.96 in a regular pap test. Subjects with LSIL in 10% (N-4) had a normal pH test, and 48% (N-24) had a normal Pap test. P=0.00129 p < (0.05). A normal pH value was significantly more common in subjects with a normal Pap test. Microbiological flora, especially enterogenic bacteria, are more common in LSIL than in women with a regular pap test. Conclusion: when monitoring women with LSIL, special attention should be paid to the elimination of present enterobacteria (E.faecalis and E.coli) as a possible risk factor in the development of precancerous lesions (SIL) and cervical cancer.

Проградиентное наращивание объема энтерального кормления у недоношенных новорожденных: предварительные результаты мультицентрового проспективного сравнительного рандомизированного исследования

Objective. To assess safety and effectiveness of gradual advancement of enteral feeding in preterm newborns with a gestational age of ≤32 weeks and compare it with conventional feeding strategy. Patients and methods. This multicenter prospective randomized study is still ongoing in V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia and Moscow Regional Perinatal Center. This pilot study included 36 patients with a gestational age of 28/0-32/6 weeks and birth weight 836 g to 2210 g treated in these two institutions between June and December 2020. Study participants were randomly assigned to either experimental or control group. Newborns in the experimental group received enteral nutrition with gradual advancement at each feeding, while newborns in the control group were fed according to a standard scheme with the advancement made twice a day. The daily rate of enteral feeding advancement was 30 ml/kg/day. Results. Gradual advancement of enteral feeding in the experimental group (n = 17) allowed its participants to reach the targeted daily volumes of 100 and 160 mL/kg faster than controls (n = 19) without any increase in the incidence of necrotizing enterocolitis and gastrointestinal dyskinesia. This ensured shorter (1.5 times) duration of central venous catheter use and length of stay in the intensive care unit among newborns with a birth weight <1500 g. Conclusion. Preliminary results of our study suggest safety and effectiveness of gradual advancement of enteral feeding compared to traditional feeding strategy in newborns with a gestational age of 28/0-32/6 weeks. Since our sample was rather small, the benefits and safety of gradual feeding advancement should be further investigated. Key words: preterm newborn, enteral nutrition, feeding, very low birth weight, extremely low birth weight, necrotizing enterocolitis

Cumulative Recurrence Rate and Risk Factors for Recurrent Abdominal Wall Endometriosis after Surgical Treatment in a Single Institution.

PurposeThis study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment.Materials and MethodsA retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected.ResultsEighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6–106). The median age was 37 years (range, 22–48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment.ConclusionThe recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.

Quality of life of adolescents with menstrual problems in Klang Valley, Malaysia: a school population-based cross-sectional study

ObjectiveTo describe the prevalence of menstrual problems (heavy menses bleeding, dysmenorrhoea and oligomenorrhoea) and its impact towards quality of life among adolescents in Klang Valley, Malaysia.DesignCross-sectional study.SettingAdolescent girls at secondary...

Clinical characteristics of patients with reproductive dysfunction and benign ovarian neoplasms

The study reports on the analysis of the anamnestic data of2044 women with reproductive disorders who underwent operative interventions for tumors and tumorlike masses of the ovaries during the period of 1989-1999 in the Research Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences. A high incidence rate о f complicated anamnesis and the coexisting somatic and extragenital diseases was revealed. The data are presented concerning the status of menstrual and reproductive function of the patients examined.

Gynecological aspects in the trends in morbidity and mortality from cancer of the reproductive system

The article discusses the incidence rates of cancer of the reproductive system organs (mammary gland, endometrium, ovaries, cervix) in Moscow in 1999, analyzes the trend of these indicators over the past 10 years, substantiates the need to revise the principles of the primary care of the obstetric and gynecological service (female consultations), a model of a gynecological diagnostic center is proposed

Molecular genetic predictors of metastatic lesions of regional lymph nodes in patients with breast cancer

Objective: to identify molecular genetic predictors of metastatic spread to regional lymph nodes in patients with breast cancer (BC) based on the analysis of gene expression profile of the primary tumor.Materials and methods. The study included 358 patients with BC who underwent surgical treatment in breast cancer department of Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. Among all included into the study patients, 132 (36.9 %) had metastases in at least one axillary lymph node. Molecular genetic examination of the tumor tissue was carried out using reverse transcription polymerase chain reaction; the diagnostic panel consisted of 45 functional and 3 reference genes. Results. Patients with metastases to regional lymph nodes were generally younger (p = 0.006), had larger primary tumor (p<0.001) and higher total malignancy score (p<0.001). The groups were also significantly different in tumor location (p = 0.005). Comparative analysis of transcriptome tumor profiling revealed statistically significant differences between groups in the level of expression of three genes: TMEM45A (p = 0.016), CCND1 (p = 0.019), and MIA (p = 0.046). Based on the data obtained we used mathematical modeling and created a predictive model, which with a high degree of probability (AUC = 0.791) allowed to predict the presence of regional lymph nodes metastases in patients with BC.Conclusion. TMEM45A, CCND1 and MIA gene expression in the primary tumor were the markers of lymph node involvement in BC. The developed predictive genetic signature can become an additional diagnostic tool to predict the risk of lymph node metastases at the point of planning the volume of axillary surgery in patients with BC.

Comparative study of surgical site infection with or without post cesarean prophylactic oral antibiotics; a single-blinded randomized clinical trial

Introduction: Surgical site infection (SSI) is caused by cesarean section in the hospital and its prevalence in the studies is up to 16%. Objectives: This study aimed to compare the rate of infection in women undergoing cesarean section. Oral clindamycin and cefalexin were administered for 48 hours as prophylactic antibiotics. Patients and Methods: In this clinical trial study, women with emergency cesarean section were divided into two groups. Intervention was oral administration of cefalexin 500mg every 6 hours and clindamycin 300 mg every 6 hours for 48 hours. All participants were referred to the gynecology center on day 7–10, at the time of removal of the sutures, and within 30 days after cesarean section, to assess the presence or absence of wound infection after surgery during 30 days. Results: In this clinical trial study, 462 pregnant women undergoing cesarean section were enrolled in the intervention and control groups. Of 231 patients in the intervention group, 15 women (6.5%) had cesarean section infection (13 cases with superficial, and 2 cases with deep infection). In the control group, 45 cases (19.5%) had cesarean section infection (31 cases with superficial, 10 cases with deep, and 4 cases with developed pelvic infection) (P = 0.001). Age, pre-cesarean length of stay, pre-term incision, type of incision, discharge longer than 18 hours after cesarean section, and maternal diabetes were significantly different regarding cesarean section infection in both groups. The frequency of cesarean section infection was less in the intervention group (P <0.001). Conclusion: Administration of prophylactic antibiotic can have a significant role in reducing cesarean section infection. Trial Registration: Registration of trial protocol has been approved in Thailand registry of clinical trials (identifier: TCTR20201204002, http://www.clinicaltrials.in.th/index.php?tp=regtrials & menu=trialsearch & s-menu=fulltext & task=search & task2=view1 & id=7120, ethical code; IR.UMSU.REC.1397.323).

The Combined Measurement of Pelvic Organ Mobility and Hiatus Area Improves the Sensitivity of Transperineal Ultrasound When Detecting Pelvic Organ Prolapse.

Objective: To evaluate whether the combined measurement of pelvic organ mobility and levator hiatus area improves the sensitivity of transperineal ultrasound (the index test) for diagnosing pelvic organ prolapse (POP).Methods: We retrospectively recruited women who had been examined in a tertiary gynecological center for symptoms of lower urinary tract incontinence and/or POP between January 2017 and June 2018. We excluded patients who had undergone hysterectomy previously or those who had received corrective surgery. All subjects underwent a standardized interview, POP quantification (POP-Q) examination (a reference standard for patients and controls), and ultrasound measurements of the levator hiatus area at rest (rHA), on contraction (cHA), and on Valsalva (vHA). We also determined the mobility of the bladder neck (BNM), cervix (CM), and rectum ampulla (RAM). Receiver operating characteristic (ROC) curve analyses were performed to determine cut-off values for diagnosis. Diagnostic performance was assessed by sensitivity, specificity, and area under curve (AUC).Results: A total of 343 women were eligible for analysis, including 247 POP patients (stage 2–3 by POP-Q) and 96 controls. Compared with controls, POP cases had significantly higher values for rHA, vHA, cHA, BNM, CM, and RAM. Each parameter was identified as a significant discriminator for POP and controls, as determined by ROC curve analysis, although the cut-off value varied slightly between different parameters. The combination of rHA, vHA, and cHA (with any HA that was ≥ the cut-off) improved the sensitivity from 64–89 to 89–93%. The combination of pelvic organ mobility with rHA, vHA, and cHA, further increased the sensitivity from 89–93 to 95–97%.Conclusion: The combination of levator hiatus area and pelvic organ mobility improved the sensitivity of transperineal ultrasound in the diagnosis of POP, whether used as a frontline test to assist POP-Q grading or to monitor the effect of pelvic floor exercise programs.

Incomplete surgical staging in clinical early-stage ovarian cancer: guidelines versus daily practice

BackgroundIncomplete surgical staging of patients with early-stage epithelial ovarian cancer (EOC) has been reported in up to 98% of cases, when based on the International Federation of Obstetrics and Gynecology (FIGO) staging procedure. The aim of the present retrospective study was to clarify the reasons for incomplete staging. MethodsThe PRISMA (Prevention Recovery Information System for Monitoring and Analysis) technique was used to evaluate cases with FIGO I-IIa EOC based on incomplete staging from five gynecologic oncologic center hospitals in the Netherlands in the period 2010–2014. ResultsFifty cases with an incomplete surgical staging of EOC according to national guidelines were included. The most common reasons for incomplete staging were insufficient random biopsies of the peritoneum (n = 34, 68%), and less than ten lymph nodes being resected and/or found at pathology (n = 16, 32%). The most mentioned reason for not performing biopsies was, besides forgetting to do so, believing that after careful inspection and palpation, taking biopsies is irrelevant and/or already are being taken while performing a hysterectomy (peritoneum of cul-de-sac, bladder). The value of contralateral pelvic lymph node dissection in case of a unilateral ovarian malignancy was also doubted, influencing the number of lymph nodes resected. ConclusionsThe most important reasons for incomplete staging in EOC are, besides omitting elements by accident, questioning the importance of obligatory elements of the staging procedure. A structured list of staging steps during surgery and more evidence-based consensus concerning these obligatory elements might increase the number of complete staging procedures in EOC.

OC16.03: Fertility‐sparing surgery and borderline ovarian tumours: oncological and fertility outcomes from a UK London gynecological oncology centre

OC16.03: Fertility‐sparing surgery and borderline ovarian tumours: oncological and fertility outcomes from a UK London gynecological oncology centre

Diagnostic Performance of International Ovarian Tumor Analysis Logistic Regression Model LR2 for Adnexal Masses Classification at a Tertiary Gynecology Center in Singapore

Background: The International Ovarian Tumor Analysis (IOTA) LR2 model has been shown to provide a reasonably accurate preoperative classification of ovarian tumors. The purpose of this study was to evaluate the diagnostic performance of the IOTA LR2 model in distinguishing benign and malignant adnexal masses in the Singapore population. Methods: This was a retrospective study in a tertiary referral center. Women who attended the Gynecology Unit at Singapore General Hospital with evidence of adnexal tumor on ultrasound examination were evaluated using the IOTA LR2 protocol. The LR2 model was then used to calculate the probability of malignancy. Likelihood ratio of malignancy greater than 10% classifies the mass as malignant. The preoperative diagnosis of women who underwent surgery within 120 days of ultrasound examination was correlated with the final histopathological result. Results: Of the 353 women included in the final study population, 223 had benign disease, 29 had borderline malignant, and 101 had invasive cancer. The IOTA LR2 model had a sensitivity of 79.2% (95% confidence interval (CI), 71.2-85.8%) and a specificity of 79.4% (95% CI, 73.5-84.5%). The area under the receiver-operating characteristics curve was 0.84 (95% CI, 0.80 - 0.89). Conclusions: The IOTA LR2 model maintained its overall diagnostic accuracy when used in our local population. Although it is useful as a first-step test for triaging women with ovarian masses for surgery, a second-stage test would be required to minimize the number of women with benign disease being offered surgery for suspected ovarian malignancy. J Clin Gynecol Obstet. 2021;10(3):67-72 doi: https://doi.org/10.14740/jcgo758

The impact of COVID-19 pandemic on the rate of newly diagnosed gynecological and breast cancers: a tertiary center perspective

PurposeThe aim of the present study was to assess the impact of postponed screening examinations and lockdown measures on gynecological and breast cancer diagnoses throughout the year 2020 in a gynecological oncological center in Austria.MethodsData of 889 patients with either newly diagnosed gynecological or breast cancer between January 2019 and December 2020 were collected. Clinical parameters including symptoms, performance status, comorbidities and referral status were compared in patients, who were newly diagnosed with cancer in the period of the first lockdown from March 2020 to April 2020 and the second lockdown from November 2020 to December 2020 and compared to the same period in 2019.ResultsOur results showed a strong decline in newly diagnosed cancers during the lockdown periods: −45% in gynecological cancer and -52% in breast cancer compared to the same period in 2019. Compared to the analogue period of 2019, breast cancer patients reported significantly more tumor-associated symptoms (55% vs. 31%, p = 0.013) during and in between (48% vs. 32%, p = 0.022) the lockdowns. During the lockdown, periods in the group of breast cancer patients’ tumor stage varied significantly compared to 2019 (T2–T4; p = 0.047).ConclusionBoth lockdowns led to a strong decrease in newly diagnosed gynecological and breast cancers. Treatment delays in potentially curable disease could lead to inferior clinical outcomes, with the risk of missing the optimal treatment window. As the COVID-19 pandemic will be a challenge for some time to come, new strategies in patient care are needed to optimize cancer screening and management during the pandemic.

COVID-19 Risk Perception of Pregnant Women and its Relationship with their Protective Behaviors

Aim: This study aimed to assess COVID-19 risk perception of pregnant women and its relationship with their protective behaviors. Methods: A descriptive-correlational design was used to conduct this study at an obstetric and gynecologic center at Mansoura University Hospitals, Egypt, involving 233 pregnant women, who were selected using the convenient sample technique. A self-administrated structured questionnaire was used to assess women's demographic characteristics, obstetrics history, COVID-19-related risk perception, and protective behaviors. Results: The age of the pregnant women ranged from 18- to 35 years with a mean of 27.3 ± 5.0 years and nearly half (46.4%) of them were in their third trimester. Social media were a major source of COVID-19-related information (57.1%). Among the pregnant women included in this study, 37.8% were in contact with COVID-19 positive patients. Meanwhile, 78.5% had a high level of risk perception related to COVID-19 and 45.1% had a moderate level of protective behaviors. A significant positive correlation was observed between the risk perception of COVID-19 and the protective behaviors of the pregnant women under study (r =0.147; P=0.025). Conclusion: Most of pregnant women had a high level of risk perception and less than half of them had moderate level of protective behaviors related to COVID-19. The educational level and history of COVID- 19 infection had a statistical significant predictive effect on protective behaviors against COVID-19. This study recommended that maternity nurses should establish virtual training classes and counseling to enhance the protective behaviors among pregnant women against COVID-19

EVALUATION OF THE OPPORTUNITIES FOR PREVENTION OF THE PERIODONTAL DISEASES AMONG THE PREGNANT WOMEN IN TBILISI

Task:Although the periodontal inammatory diseases are very often during the pregnancy, little is known about the riskfactors that increase the frequency of periodontal disease incidence and affect its development during the pregnancy. This descriptive study assesses the prevalence of the periodontal diseases among the pregnant women in Tbilisi, the impact of their socio-economic status, hygiene habits and level of knowledge to their periodontal status. Methods: This was an observational, cross-sectional study conducted among pregnant women. The respondents were distributed by Gynecological Centers and districts in Tbilisi. The survey was conducted at 24 Gynecological Centers. The target group of the study were 385 pregnant women aged 18 to 45 actually living in Tbilisi. The tool used in this study is a Structured Electronic Questionnaire. The oral health of the target group representatives was assessed by periodontal indexes, the CPITN-index and OHI-Jack R.Vermillion's oral hygiene index. Data entry and statistical analysis was carried out using a statistical program SPSS 23,0. Results: The current pregnancy for most of respondents 37,9%(146) is the second, 50,6%(195) of the pregnant women are in the second trimester of the pregnancy, 47,8%(184) of the respondents are the bachelors' student or have completed a bachelor's stage of study. Due to the employment status, 39,5%(152) of them are housewives, and 64,2%(247) evaluate their economical condition as satisfactory; 30,9%(119) of the respondents have dental insurance and only 56,9(45)% uses this insurance for this purpose. 74,5%(287) of the pregnant women addresses the dentist only in case of pain or discomfort, 70,3%(270) of them have bleeding gums, 63,6%(245) of them feel pain or discomfort in the oral cavity and 59,7(230) of them have a swelling/pain in their gums. Only 11,7%(45) of gynecologists recommend their patients to plan a visit to the dentist. Pregnant women's awareness about the safety of dental manipulations is also quite low and it is 29,1%(112). The statistical testing of the difference due to the qualitative variables was carried out using the Pearson's chi-square method; index of signication (p), which was less than 0,05, at (p<0,05) was considered as statistically signicant.

Diagnostic Performance of International Ovarian Tumor Analysis Logistic Regression Model LR2 for Adnexal Masses Classification at a Tertiary Gynecology Center in Singapore

Diagnostic Performance of International Ovarian Tumor Analysis Logistic Regression Model LR2 for Adnexal Masses Classification at a Tertiary Gynecology Center in Singapore

Evolution of laparoscopic myomectomy and description of two hemostatic techniques in a large teaching gynecological center

ObjectiveTo provide a description of laparoscopic myomectomy and the two hemostatic techniques performed over the last 11 years in a single reference center for gynecology and obstetrics and to evaluate the factors associated with favorable surgical outcomes. Study DesignWe retrospectively analyzed 625 who underwent laparoscopic myomectomy from January 2009 to December 2019. ResultsOf 625 patients, 437 (69.8%) were symptomatic. The most common symptoms were heavy uterine bleeding (33.2%). 188 patients (30.1%) were asymptomatic but were operated in 77 cases (12.3%) for rapid fibroid growth, 32 (5.1%) for uterine cavity distortion and, in 45 cases (8.6%), the myomectomy was indicated during a surgery for other medical reason due to its accessibility. In 173 cases (27.9%) intramyometrial adrenaline was injected and in 246 cases (39.7%) a temporary blockage of the uterus blood supply was performed.Only 35 (5.6%) patients presented complications, of which, 14 (40%) were hemorrhagic. These hemorrhagic complications were more frequent when intramyometrial adrenaline was used (5,8%) than after the temporary clipping of the uterine arteries and infundibulopelvic ligaments (0,8%; p < 0,001).In the multivariate logistic regression model, the only factor statistically associated with favorable surgical outcome was the use of temporary clipping of the uterine arteries at their origin and infundibulopelvic ligaments as hemostatic technique during the surgery. ConclusionLaparoscopic myomectomy was generally safe with a high level of favorable outcomes. The temporary clipping of uterine arteries and infundibulopelvic ligaments presented fewer intraoperative bleedings compared with injecting intramyometrial adrenaline.

Study on the feasibility of improving menopausal syndrome using the one-day outpatient based continuous management model

To explore the mode of"one-day outpatient"based continuous management and examine its feasibility and preliminary effects for improving menopausal syndrome and mood among menopausal women.Clinical intervention study was conducted in Obstetrics and Gynecology Center of the Third Affiliated Hospital of Chongqing Medical University from May 2020 to May 2021.The continuous management mode of "one-day outpatient service" for menopause was constructed in terms of multidisciplinary resources, including offline "one-day outpatient" health education, online 7-week group continuous intervention on "healthy lifestyle" and offline half-day focus group interview. Pre-and post-scores of the modified Kupperman scale and the positive/negative emotional scale (PANAS) were measured to compare the status of menopausal syndrome and emotional experience of Seventy-eight female participants (40-60 years old), meanwhile, before and after comparison of the blood lipid and body composition indexes of participants were also performed. Paired t test or Wilcoxon signed rank test were used.Results show that the pre-and post Kupperman scores were 14.65±8.51 vs 10.26±5.83 (t=-5.59, P<0.01), and the positive emotional scores (pre- 28.53±5.85 vs post- 30.13±6.30) were improved (t=2.59, P=0.012) and negative emotional scores [pre- 20.5(10) vs post- 17.0(7)] were decreased (Z=-5.09, P<0.01). The triglyceride level of participants declined from (1.27±0.54) mmol/L to (1.09±0.38) mmol/L (t=-2.45, P<0.05). In addition, the body mass index(pre- 22.52±2.34 vs post- 22.06±2.22), percentage of body fat (pre- 31.72±6.22 vs post- 30.91±6.52)and Visceral fat area(pre- 83.96±30.26 vs post- 79.66±29.71) were all improved (t=-3.58,t=-2.57,t=-2.59, P<0.05). Therefore,the mode of"one-day outpatient"based continuous management can effectively improve menopausal syndrome and adverse mood, reduce patients' blood lipid, improve the body composition, and maybe contribute to the prevention of long-term chronic diseases.

Cut‐offs for defining uterine prolapse using transperineal ultrasound in Chinese women: prospective multicenter study

ABSTRACTObjectiveTransperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine descent on ultrasound in Chinese women is still poorly defined. We aimed to determine the optimal cut‐off to define abnormal uterine descent on transperineal ultrasound in Chinese women.MethodsThis prospective multicenter study recruited women who were examined in tertiary‐level gynecological centers, due to symptoms of lower urinary tract and/or pelvic floor dysfunction, between February 2017 and September 2018. All recruited women underwent a standardized interview, pelvic organ prolapse quantification (POP‐Q) examination, and four‐dimensional transperineal ultrasound examination. On ultrasound, uterine descent was measured relative to the posteroinferior margin of the symphysis pubis during maximum Valsalva maneuver. The optimal cut‐off value for definition of abnormal uterine descent was selected as the value with the highest Youden index and the diagnostic performance of this cut‐off for the prediction of prolapse symptoms and POP‐Q stage was assessed and compared by means of the area under the receiver‐operating‐characteristics curve (AUC).ResultsIn total, 538 Chinese women, with a mean age of 39.4 (range, 18–81) years, were enrolled into the study. Both uterine descent on transperineal ultrasound (P &lt; 0.001) and POP‐Q stage (P &lt; 0.001) were associated strongly with presence of prolapse symptoms. Uterine descent on ultrasound was associated significantly with POP‐Q stage for apical compartment prolapse (P &lt; 0.001). The optimal cut‐off value for the definition of abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver in the prediction of prolapse symptoms was 4.79 mm above the symphysis pubis (AUC, 0.75 (95% CI, 0.71–0.78)), while the optimal cut‐off values in the prediction of prolapse of POP‐Q Stage ≥ 1 and POP‐Q Stage ≥ 2 were 6.63 mm above the symphysis pubis (AUC, 0.83 (95% CI, 0.80–0.86)) and 8.42 mm below the symphysis pubis (AUC, 0.85 (95% CI, 0.82–0.88)), respectively.ConclusionsThe optimal cut‐off value to define abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver for the prediction of prolapse symptoms in this population of Chinese women was 4.79 mm above the symphysis pubis, close to that for predicting apical compartment prolapse of POP‐Q Stage ≥ 1 (6.63 mm above the symphysis pubis). These are somewhat different from values described previously in mainly Caucasian populations. Ethnic differences should be taken into account in the evaluation of pelvic organ prolapse using transperineal ultrasound. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

Плазмолифтинг как метод выбора при лечении атрофического вагинита у женщин в состоянии климактерического периода

Данное исследование, проведенное в гинекологическом центре «Жамиля» (г. Семей, Казахстан), показывает эффект применения метода плазмолифтинга у женщин в состоянии климактерического периода, имеющих симптомы атрофического вагинита.