Gynecology Medicine Research Articles

Endometriosis centers of expertise in the Netherlands: Development toward regional networks of multidisciplinary care.

Endometriosis centers of expertise in the Netherlands: Development toward regional networks of multidisciplinary care.

Factors Influencing Job Satisfaction Among Recently Qualified Resident Doctors: A qualitative study

Introduction: Public health systems throughout the world are constantly being confronted with serious shortages of doctors. The Saudi health system acknowledges the risks involved in its heavy dependence on non-Saudi doctors and has gradually expanded its efforts to nationalize its medical staff by improving the capacity of the medical education system through increasing the number of medical colleges. The objective of this study was to explore the most crucial factors that influence job satisfaction among recently qualified resident doctors in Saudi Arabia. Methods: The study used a qualitative approach, with in-depth interviews that were conducted with recently qualified resident doctors to gather information on the factors that were the most critical in affecting their job satisfaction early in their careers. Twenty-five qualified resident doctors were purposively selected for interviews. The participants were selected from various areas of specialization, such as internal medicine, surgery, pediatrics, obstetrics, gynecology, and emergency medicine. Results: This study emphasized the importance of improving the satisfaction levels of recently qualified resident doctors with respect to a range of job-related factors. The following seven themes emerged from the data: education and development, recognition and respect, professionalism, workload, healthcare facilities, patient adherence, and salary. Conclusion: An increased investment in medical education is recommended to improve educational outcomes. The satisfaction that recently qualified resident doctors have with regard to their salaries should be monitored continuously, and further evidence is needed to determine whether modifications are required. Improving the satisfaction levels of the resident doctors in the seven specific areas of their jobs can result in greater retention.

Exploring the mechanism of Buxue Yimu Pill on hemorrhagic anemia through molecular docking, network pharmacology and experimental validation.

Buxue Yimu Pill (BYP) is a classic gynecological medicine in China, which is composed of Angelica sinensis (Oliv.) Diels, Leonurus japonicus Houtt, Astragalus membranaceus (Fisch.) Bunge, Colla corii asini and Citrus reticulata Blanco. It has been widely used in clinical therapy with the function of enriching Blood, nourishing Qi, and removing blood stasis. The current study was designed to determine the bioactive molecules and therapeutic mechanism of BYP against hemorrhagic anemia. Herein, GC-MS and UPLC/Q-TOF-MS/MS were employed to identify the chemical compounds from BYP. The genecards database (https: //www.genecards.org/) was used to obtain the potential target proteins related to hemorrhagic anemia. Autodock/Vina was adopted to evaluate the binding ability of protein receptors and chemical ligands. Gene ontology and KEGG pathway enrichment analysis were conducted using the ClusterProfiler. As a result, a total of 62 candidate molecules were identified and 152 targets related to hemorrhagic anemia were obtained. Furthermore, 34 active molecules and 140 targets were obtained through the virtual screening experiment. The data of molecular-target (M-T), target-pathway (T-P), and molecular-target-pathway (M-T-P) network suggested that 32 active molecules enhanced hematopoiesis and activated the immune system by regulating 57 important targets. Pharmacological experiments showed that BYP significantly increased the counts of RBC, HGB, and HCT, and significantly down-regulated the expression of EPO, IL-6, CSF3, NOS2, VEGFA, PDGFRB, and TGFB1. The results also showed that leonurine, leonuriside B, leosibiricin, ononin, rutin, astragaloside I, riligustilide and levistolide A, were the active molecules closely related to enriching Blood. In conclusion, based on molecular docking, network pharmacology and validation experiment results, the enriching blood effect of BYP on hemorrhagic anemia may be associated with hematopoiesis, anti-inflammation, and immunity enhancement.

Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman.

ObjectivesThis study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women.MethodsA cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist.ResultsA total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each).ConclusionThe prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections.

Investigating Fetuin-A and Paraoxonase-1 Activity as Markers in Polycystic Ovary Syndrome Based on Body Mass Index: A Prospective Case-Control Study.

IntroductionPolycystic ovary syndrome (PCOS) may have an increased risk for the development of systemic and metabolic pathogenesis such as cardiovascular diseases, insulin resistance (IR), diabetes mellitus (DM) and dyslipidemia. However, there is no reliable marker to show the relation. Fetuin-A is an adipokine whereas paraoxonase-1 (PON-1) is a high-density lipoprotein-linked enzyme to demonstrate oxidative stress. This study aimed to evaluate serum fetuin-A and PON-1 levels in infertile PCOS women based on body mass index (BMI).MethodsA prospective case-control study in a university setting was designed. A total of 88 patients admitted to the Giresun University Faculty of Medicine Gynecology Clinic between February and April 2021 were included in the study. The subjects were divided as follows: PCOS-low-BMI (BMI≤25) vs. Controls-low-BMI (BMI≤25) and PCOS-high-BMI (BMI>25) vs. Controls-high-BMI (BMI>25). Those who had at least two criteria of the 2003 Rotterdam Consensus were diagnosed with PCOS. Serum fetuin-A and PON-1 levels were compared.ResultsThe mean levels of fetuin-A were not significantly different in the groups (p=0.955). Serum PON-1 levels were lower in the PCOS group (109.1±61.4 vs. 140.1±80.0; p=0.040), but it lost significance with adjusted values for covariants as age and BMI. Although PON-1 was not significantly different in the PCOS group of BMI<25 kg/m2 subgroup, it was significantly lower in the PCOS group of BMI≥25 kg/m2 subgroup (p=0.820 vs. p=0.048).ConclusionSerum fetuin-A activity did not differ with PCOS. Serum PON-1 might be a promising and research-worthy marker, especially for obese PCOS patients.

Improving referrals to survivorship: A patient-driven initiative.

44 Background: Patients often feel lost in the transition from cancer patient to survivor. As cancer treatment improves, the number of survivors in the US is expected to approach 22 million by the year 2029. Smaller increases in the MD workforce coupled with long-term effects of new treatments necessitate the creation survivorship clinics led by advanced practice providers (APP) who are disease-specialized and specifically trained to manage unique survivor needs. Although the institutions Survivorship program was established more than a decade ago, the average referral rate to the program is only 30%. Given the high levels of patient satisfaction with the program, we sought to understand and address clinician awareness and referral obstacles. Methods: Based on patient input, members of our Patient &amp; Family Advisory Council for Quality (PFACQ) put forth a proposal aimed at increasing referrals to the Survivorship program. A multidisciplinary working group comprising patients, clinicians, administrators and process engineers was assembled. Process Improvement training was conducted, and a primary goal was developed: increase Survivorship referrals by 25%. Central to the approach was engagement with referring physicians and APPs on a service-by-service basis. A four-question survey was developed to address timing of initial discussion, challenges to referring, knowledge of visit elements, and materials needed to support referrals. A customized ‘roadshow’ presentation was created and delivered by a PFACQ member at a faculty meeting. Highlights included: the importance of Survivorship care to patients and details of the visit, survey responses, and additional faculty discussion and input. Results: Four roadshows were completed from August 2020-June 2021: Gynecologic Surgery, Endocrine, Breast Medicine and Lymphoma. Based on survey responses and dialogue with providers, new material to support patient discussions and education have been developed: a patient-facing brochure, clinician- &amp; patient-facing video, and clinician talking points. Methods to facilitate identifying eligible patients were also discussed, as well as automatic referrals to Survivorship for selected services. Data reveal a significant increase in referral rates from GYN and Endocrine services (follow up &gt; 6 months) of 63% and 228%, respectively. (Breast Medicine and Lymphoma with shorter follow up will be reported.) Engagement with other services is underway. Conclusions: Results have exceeded the goal of increasing referral rates to the program. This process suggests that ongoing engagement with referring clinicians is essential to achieving and maintaining higher referral rates. The patient voice throughout this process has been a powerful tool in raising clinician awareness of their experiences and expectations for comprehensive follow up care, which can be delivered on a greater scale by survivorship providers.

The hemostatic parameters in pregnant women with different types of diabetes mellitus

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough.AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age.MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed.RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications.CONCLUSIONS: Diabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

A new approach to regenerative medicine in gynecology.

To evaluate the efficacy of the injection of microfragmented adipose tissue in the treatment of women with genitourinary syndrome of menopause (GSM). This observational cohort study included 12 women who received one session of multiple injections of microfragmented adipose tissue using the SEFFIGYN™ medical device. Symptoms such as burning, itching, dryness, pain on penetration, pain during deep intercourse, and pain on urination were assessed before the patient's treatment (T0), after 15days (T15), and after 5months (5Mo) using the Numerical Rating Scale (NRS). An improvement of vulvar trophism was clinically evident already 2weeks after treatment; all symptoms were notably attenuated compared with the initial visit, as demonstrated by statistically significant reductions of the NRS scores (P=0.003 for itching, P=0.008 for pain on urination, and P<0.001 for the other symptoms, Sign test). Moreover, all symptoms continued to improve over time. All patients reported a positive change in their quality of life and a resumption of sexual life. The use of microfragmented adipose tissue in GSM is promising. Nevertheless, more studies will be fundamental to exclude a potential placebo effect and better understand the underlying molecular mechanism of action.

Analyzing the biochemical, clinical, and hormonal characteristics of patients with polycystic ovary syndrome

To analyze the biochemical, clinical, and hormonal characteristics of patients with four phenotypes of Polycystic ovary syndrome (PCOS). A total of 225 patients admitted to Medistate Kavacık Hospital Gynecology and Obstetrics outpatient clinic and Giresun University Faculty of Medicine Gynecology and Obstetrics clinic between January 2019 and January 2020 diagnosed as PCOS and healthy controls were included in the study. The revised Rotterdam criteria were applied to diagnose PCOS. The patients with PCOS were divided into Type I classic, Type II classic, Ovulatory and Normoandrogenic PCOS. Biochemical, clinical, and hormonal values were compared. The mean age of the participants is 28 (±5.7) and the mean body mass index (BMI) is 26.15 (±5.36). The mean Ferriman Gallwey Score (FGS) is 7.4(±5.4), which is normal. There is a statistically significant difference between the four PCOS groups and control group in terms of age (p-value=0.000), BMI (p- value=0.000), Luteinizing hormone / Follicle stimulating hormone (LH/FSH) (p-value=0.000), and fasting blood sugar (p-value=0.01). There is a statistically significant difference among the four phenotypes in terms of BMI (p-value =0.002), LH/FSH (p-value =0.000), LH (p-value =0.000), free T4 (p-value =0.01), fasting insulin (p-value =0.001), total testosterone (p-value =0.000), FGS (p-value =0.000), etc. Age, BMI, LH/FSH, FSH, LH, fasting blood sugar, and hirsutism are good predictors of PCOS.

Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors

PurposeThe aims of this study were to determine the incidence of intraoperative and postoperative complications of laparoscopic gynecological interventions and to identify risk factors for such complications.MethodsAll patients who underwent laparoscopic interventions from September 2013 to September 2017 at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital were identified retrospectively using a prospectively compiled clinical database. Binary logistic regression analysis was used to identify independent risk factors for intra- and postoperative complications.ResultsData from 3351 patients were included in the final analysis. Overall, 188 (5.6%) intraoperative and 219 (6.5%) postoperative complications were detected. On multivariate analysis, age [odds ratio (OR), 1.03; 95% confidence interval (CI) 1.01–1.04], surgery duration (OR, 1.02; 95% CI 1.02–1.03), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00), and surgical indication (all p ≤ 0.01) were independent risk factors for intraoperative and duration of surgery (OR, 1.01; 95% CI 1.01–1.02; p ≤ 0.01), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00; p ≤ 0.01), hemoglobin drop (OR, 1.41; 95% CI 1.21–1.65; p ≤ 0.01), and ASA status (p = 0.04) for postoperative complications.ConclusionIn this large retrospective analysis with a generally low incidence of complications (5.6% intraoperative and 6.5% postoperative complications), a representative risk collective was identified: Patients aged > 38 years, surgery duration > 99 min, benign or malignant adnex findings were at higher risk for intraoperative and patients with surgery duration > 94 min, hemoglobin drop > 2 g/dl and ASA status III at higher risk for postoperative complications.

Особенности состояния коагуляционного и сосудисто-тромбоцитарного звена гемостаза у беременных с различными типами сахарного диабета

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough. AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age. MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed. RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications. CONCLUSIONS: D iabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

A study on prospective monitoring of adverse drug reactions associated with hematinics at a tertiary care teaching hospital

Introduction: Adverse reactions are the documented hazards of drug treatment and they can happen with any class of drugs and several studies exposed that the incidence is increasing with blood and blood products.&#x0D; Objectives: The main aim of this study is to identify and analyze Adverse Drug Reactions with Hematinics in a tertiary care hospital.&#x0D; Methods: This prospective observational study was conducted for a period of 6 months.&#x0D; Results: A total of 29 ADRs were reported during the study period with a female high proportion (79.31%), more amounts of ADRs were from Obstetrics &amp; Gynecology and General Medicine in which the mainly affected organ systems were the skin (86.20%) and the GIT (13.79%). The hematinics mostly accounted were Iron sucrose (44.82%) followed by ferric carboxy maltose (37.93%) and Iron dextran (17.24%) in which type B reactions were more compared to type A and 72.41% of them were unpredictable. The severity assessment revealed that the majority of them were moderate reactions (62.06%). Out of the reported reactions, 58.62% were definitely preventable and a causality assessment was done which showed that 68.96% of the reactions were probable, possible (20.68%) and conditional (10.34%). Most of the patients (65.51%) were treated with Antihistamines &amp; corticosteroids, with only anti-histamines (24.13%) and no treatment (10.34%).&#x0D; Conclusions: The study concludes that Adverse Drug Reactions with Hematinics are increasing in recent days. Better vigilance is necessary for the implementation of safe and effective treatment with hematinics for each and individual patient.

A comparison of the efficacy and safety of traditional Chinese medicine in preconditioning patients with diminished ovarian reserve that would undergo In Vitro fertilization: A network meta-analysis protocol.

Background:Diminished Ovarian Reserve (DOR) is a common disease in reproductive-age women in the diagnosis and treatment of infertility. The incidence of DOR increased quickly in recent years and had became one of the most important factors that made the quality of women life decline. Gynecology and reproductive medicine professors have made great efforts to explore good treatment methods all over the world. Traditional Chinese Medicine has made some achievement in treating DOR as a kind of complementary and alternative therapy In Vitro Fertilization (IVF) in recent years, it is indispensable to propose a network meta-analysis (NMA) protocol to discuss the efficacy and safety of TCM in IVF.Methods:A literature search will be conducted in 8 electronic databases.Results:The efficacy and safety of traditional Chinese medicine in preconditioning patients with diminished ovarian reserve that would undergo In Vitro Fertilization will be evaluated.Results:The systematic review will evaluate the efficacy and safety of TCM in IVF.Conclusion:The result of this study will provide reliable evidence of the use of TCM in IVF.INPLASY registration number:INPLASY2020110062.Ethics and dissemination:This review does not require ethical approval.

Expert report on the Elina Sushkevich case

Per request of MD, Dr Sci Med, Professor, Academician of RAS Nikolay N. Volodin, President of Russian association of specialists in perinatal medicine (RASPM) one of leading specialists in obstetrics, gynecology and perinatal medicine in the world prof. Gian Carlo Di Renzo have prepared the Expert Report on the Elina Sushkevich case. Taken into account the importance of this case for healthcare professionals, we publish the full text in the original and translated into Russian.

Влияние терапии низкомолекулярными гепаринами на уровень плодовой ДНК при проведении неинвазивного пренатального ДНК-скрининга

Study Objective: To evaluate the effect of low molecular heparin (LMH) therapy on non-invasive prenatal DNA screening (NIPS) for chromosomal pathologies. Study Design: cross-sectional study. Materials and Methods. We have examined two groups of pregnant women: group I included 49 patients with constantly low foetal DNA (twice lower than 4%) selected out of 1,505 women examined at Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia during the last 2 years. 17 women were administered LMH and 32 women did not receive it. Group II included 113 pregnant women with a normal foetal DNA fraction (at least 4%), that were selected randomly out of patients who were examined during the same period. 56 pregnant women were administered LMH and 57 were not. Next Generation Sequencing was used as an NIPS method. In order to determine the foetal DNA level, we amplified DNA loci with single nucleotide polymorphisms. Study Results. In group I (low foetal DNA fraction), where no LMH therapy was initiated, median values were 3.5% (3.2–3.8%); if LMH was administered, these values made 3.6% (3.4–3.9), while in group II — 7.7% (6.1–9.5%) and 7.9% (6.0–10.5%), respectively; no significant differences (p = 0.29 and p = 0.7, respectively) were recorded in both cases. Conclusion. Use of LMH does not affect NIPS; therefore, it is not necessary to adjust the LMH therapy in pregnant women prior to NIPS. Keywords: non-invasive prenatal DNA screening, heparin, anticoagulants, low molecular heparins, habitual abortion, pregnancy complications.

Features of the course of pregnancy in women with polycystic ovary syndrome

Polycystic ovary syndrome is one of the most common pathologies in the practice of an obstetrician-gynecologist. Overcoming infertility characteristic of this syndrome is an important problem of endocrinology, gynecology, and reproductive medicine. Innovative therapeutic and surgical methods of treatment can correct hormonal and metabolic disorders, induce ovulation and achieve a long-awaited pregnancy. Early gestation periods in patients with polycystic ovary syndrome often occur with miscarriage, and the risks of developing gestational diabetes mellitus, cervical insufficiency, gestational arterial hypertension, preeclampsia, and placental insufficiency increase. We have analyzed modern ideas about the effect of various pathogenetic links of polycystic ovary syndrome on the course of pregnancy.

Leonurine, a potential drug for the treatment of cardiovascular system and central nervous system diseases.

Leonurus japonicus Houtt., a traditional Chinese herbal medicine, is often used as a gynecological medicine with the effect of promoting blood circulation, regulating menstruation, clearing heat, and detoxificating. As the most important alkaloid in L. japonicus, leonurine has a wide range of biological activities, such as antioxidation, anti‐inflammation, and anti‐apoptosis. Cardiovascular system and central nervous system diseases are arrogant killers that threaten human lives and health around the world, but many drugs for treating them have certain side effects. This paper reviews the potential therapeutic effects of leonurine on cardiovascular system and central nervous system diseases, summarizes the previous research progress, and focuses on its therapeutic effect in various diseases. Although leonurine plays a prominent role in the treatment of cardiovascular system and central nervous system diseases, there are still some shortages, such as low bioavailability, weak transmembrane ability, and poor fat solubility. Therefore, the structure modification of leonurine may solve these problems and provide reference value for the development of new drugs. At present, leonurine is in clinical trial, and it is hoped that our summary will help to provide guidance for its future research on the basic science and clinical application.

TUBAL FACTOR AS ONE OF THE LEADING FACTORS OF FEMALE INFERTILITY

Infertility is one of the most urgent problems of today, as this condition makes it impossible for a mature organism to produce offspring. The issue of restoring and maintaining reproductive health is one of the priority issues of modern gynecology and reproductive medicine. The article adduces the main etiological and pathogenetic links of tubal-peritoneal infertility, as well as briefly presents modern views on the diagnosis and treatment of women in this group.&#x0D; Conclusion. The analysis of current data on the treatment of tubal obstruction will provide an opportunity to more rationally address the issue of choosing to restore their patency.

Pregnancy and labour likelihood after breast cancer (a review)

Background . Oncological diseases are the major challenge in modern medicine. This is explained, on the one hand, by a growing number of such patients, changes in the morbidity structure, higher mortality rates and clinical complications. On the other hand, new diagnostic methods and improved therapeutic protocols appear that help save lives, health and fertility of patients. Breast cancer is the most prevailing cancer in reproductive age and pregnant young women, which identifi es its priority in oncology, obstetric gynaecology and reproductive medicine. Objectives . Assessment of pregnancy likelihood, its course and outcome in women with breast cancer in history. М ethods . Publication records were mined in Scopus, Web of Science, MedLine, Eliibrary and PubMed under the search depth of 10 years. The query terms were: breast cancer [рак молочной железы], infertility [бесплодие], pregnancy [беременность], preimplantation genetic diagnosis [предимплантационная генетическая диагностика]. Content analysis and descriptive analytics were employed as research tools. Results . We analysed 94 records, mainly from Scopus, PubMed and Elibrary, and selected 38 publications presenting a structured content analysis of current standards in assessing the likelihood of pregnancy and labour in women with breast cancer in history. The pregnancy likelihood was found to depend on the course of cancer, treatment regimen, female age and basic ovarian reserve. Breast cancer in history was shown to likely incite various obstetric and perinatal complications. Pregnancy scheduling optimal in this female cohort, as well as current approaches to induced termination of pregnancy, have been described. Conclusion . Pregnancy can be successful with malignant history, including breast cancer, provided an optimal choice of modern treatment settings for minimising the long-term risk of infertility, specialised medical counselling for effective egg and embryo preservation, full pregravid preparation and optimal post-treatment pregnancy scheduling. According to European and American research, no conclusive rationale exists for induced abortion in women having breast cancer during pregnancy or one year after delivery.

In vitro fertilisation in patients with variant treatment for uterine fi broids (A Review)

Background. Uterine fi broids is a highly prevalent gynaecological disease affecting 30–35% of reproductive age women and twice as many beyond this age, according to various sources. Uterine fi broids are diagnosed in 25–27% of infertile women. According to the American Society of Reproductive Medicine, this disease causes infertility in 2–3% of the cases.Objectives. A prognostic assessment of recovering fertility after treatment for uterine fi broids, outlining a comprehensive strategy for successful in vitro fertilisation after variant organ-preserving treatment for uterine fi broids.Мethods. Publication records were mined in the PubMed, Elibrary, Web of science and Cyberleninca databases under the search depth of 7 years. The query terms were: uterine fi broids, in vitro fertilisation, myomectomy, uterine artery embolisation, myomectomy and pregnancy, uterine artery embolisation and pregnancy, uterine fi broids and in vitro fertilisation.Results. We analysed 105 records and selected 32 for review. Many sources suggest that the putative pathogenetic mechanisms of a reduced in vitro fertilisation success in uterine fi broids comprise: abnormal circulation and receptor apparatus; abnormal uterine blood fl ow, venous stasis, vascular changes; local infl ammation; abnormal endometrial morphology, distortions of the uterine cavity with submucosal and large interstitial fi broids, continuity between endometrium and myometrium, subendometrial thickening; local nodal oestrogen/progesterone imbalance. Clinical data on the impact of uterine fi broids in assisted reproductive technology trials are multitude but ambiguous. Submucosal and intramural fi broids distorting the uterine cavity are commonly considered for resection due to their signifi cant negative impact on the pregnancy success rate with assisted reproductive strategies.Conclusion. Uterine fi broids pose an acute persistent challenge in gynaecology and reproductive medicine aggravated by the lack of a unifi ed strategy for patient management and reproductive life planning. Various aspects of the uterine blood fl ow diagnosis, treatment for uterine fi broids, pregravid preparation, long-term management of in vitro fertilisation protocols and pregnancy in this pathology require further detailed studies.