Gynecologic Pathology Research Articles

Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy.

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.

Levels of anxiety and depression in patients with endometrial hyperplastic processes and extragenital pathology in the perimenopausal period.

Aim: The aim of the study was to determine the level of anxiety and depression in patients with endometrial hyperplastic processes and somatic pathology in the perimenopausal period. Materials and Methods: Overall, 150 women who were split into 2 groups, participated in this study and answered on questionnaires that were conducted according to the Hospital Anxiety and Depression Scale (HADS) to assess the degree of anxiety and depressive symptoms in patients. PHQ-2 and PHQ-9 questionnaires were used to study the level of anxiety and depression. Results: Analysis of the results obtained using the HADS scale revealed that both anxiety and depressive symptoms in patients of the main group were more pronounced than in women of the control group. Identification of psycho-emotional disorders is the result of adverse effects of somatic diseases and gynecological pathology. Conclusions: The results of the study indicate the need to correct psycho-emotional disorders and take them into account when choosing a method of treatment in such patients.

Acute gynecologic pathology in patients with COVID-19

Acute gynecologic pathology in patients with COVID-19

Can We Trust a Compact Bacteriological Screening Test to Identify the Common Vaginal Pathogens?

Objectives: The objective of this study was to evaluate the performance of the A.F. Genital System® in the detection of vaginal pathogens in patients with obstetrical and gynecological pathologies. Materials and Methods: A total of 197 vaginal swab samples were collected from patients presenting with various obstetrical and gynecological pathologies. The A.F. Genital System® and vaginal culture/traditional methods were used for pathogen detection. Results: The A.F. Genital System® demonstrated a detection rate of 68% for single vaginal infectious agents, outperforming the vaginal culture/traditional methods (52.8%). However, differences in detection rates were observed for specific pathogens, such as E. coli, Gardnerella vaginalis, Staphylococcus aureus, and Pseudomonas spp. Conclusions: Despite lower sensitivity for specific pathogens, the A.F. Genital System® showed a high correlation with reference tests, suggesting its potential utility as a diagnostic tool for identifying common vaginal pathogens in clinical settings.

Современный взгляд на проблему генитального пролапса через призму факторов риска.

Introduction. Pelvic organ prolapse (POP) is one of the varieties of pelvic floor hernias and has a significant impact on the quality of life of a modern woman. The prevalence of POP is quite high, and the peak values of its occurrence reach 5% in women aged 60 to 69 years. The current trend in the world towards an increase in the occurrence of POP is associated with an increase in the life expectancy of women, the participation of women in the production process, the presence of concomitant somatic pathology, the identification of risk factors in the detection of a small degree of prolapse allows identifying risk groups for rapid progression of POP and timely implementation of therapeutic measures. Aim. To identify new modern risk factors for POP. Materials and methods. The study is a cohort retrospective non-randomized. The main group consisted of 110 patients with grade II-IV POP according to the POP-Q classification. The control group consisted of 34 women without established gynecological diseases. Results. Women with PОР were significantly more likely to live in rural areas, had a higher average body weight than patients without gynecological pathology, they were in postmenopause for a longer time. Patients with POP were significantly more often observed for diseases of the chronic tonsillitis, the cardiovascular system, as well as for varicose veins of the lower extremities. The patients of the main group had more abdominal operations in the anamnesis and higher parity than in the control group. Conclusion. The risk factors for POP were the duration of postmenopause, high parity (natural childbirth) and overweight. The risk factors for PОР are diseases of the cardiovascular system, varicose veins of the lower extremities, chronic tonsillitis and surgical interventions on the abdominal organs.

Predictors of late spontaneous miscarriages depending on the phenotype of abortion

The aim. Assessment of risk factors for late miscarriages depending on the clinical phenotype of abortion.Materials and methods. The study included 156 women. The main group consisted of 66 patients with late spontaneous abortion at a gestational age of 12,0–21,6 weeks, 47 of them with miscarriage on the background of isthmic-cervical insufficiency or premature rupture of amniotic fluid, 19 with late miscarriage against the background of blood discharge. Control group – 90 patients whose pregnancy ended in term delivery.Results. Analysis of the prevalence of extragenital pathology revealed a high incidence of anemia (31,8 %; p = 0,000), obesity (12,12 %, p = 0,013), and gastrointestinal diseases (12,12 %; p = 0,004) in women with late miscarriage. When analyzing gynecological pathology, it was revealed that surgical treatment of the cervix was 9,6 times more common in patients of the main group compared to the control group (10,6 and 1,1 %; p = 0,008; OR = 10,68 CI 1,28–89,04), the frequency of abnormalities in the development of the uterus – 7,5 times more often in the group with bleeding compared to the group of patients with isthmic-cervical insufficiency (15,8 and 2.1 %; p = 0,035; OR = 8,63 CI 0,84–88,97). Significant risk factors for late miscarriages are preterm birth (18,2 %, p = 0,000), non-developing pregnancy (18,2 %; p = 0,026), medical abortions (42,6 %; p = 0,003). When analyzing the course of pregnancy, prognostically unfavorable markers of miscarriage were identified: the threat of termination of a real pregnancy (53,0 %; p = 0,000), isthmic-cervical insufficiency (19,1 %: p = 0,000) and violations of the vaginal biocenosis (71,2 %, p = 0,000).Conclusion. Thus, the presence of extragenital pathology, aggravated obstetric anamnesis and complicated course of pregnancy is typical for patients with late spontaneous abortions, which requires monitoring of this category of patients at the stage of preconception preparation, treatment of extragenital pathology, as well as timely prevention, diagnosis and treatment of complications at different stages of pregnancy.

Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding: A Retrospective Analysis of a 100 Women.

Abnormal uterine bleeding (AUB) is a common gynaecological complaint affecting around 10-30% women during reproductive years. It adversely affects a woman's life, leading to psychological, medical, social and sexual problems. We aim to study the efficacy of a levonorgestrel intrauterine system (LNG-IUS) in 100 women suffering from AUB. A retrospective study was carried out at a private nursing home in Mumbai over a period of 4years. A total of 100 patients aged 30years to 50years (average age = 42.9years) who underwent LNG-IUS insertion for abnormal uterine bleeding were studied. Cases were evaluated according to clinical findings, hemogram and transvaginal ultrasound. The women were called for follow-up at 1week, 1month, 6months, 1 and 2years to analyse type and amount of bleeding and development of amenorrhea. At the end of 6months, 75% patients experienced decreased menstrual blood loss. Five patients underwent removal of the LNG-IUS at the end of 6months as they experienced no relief of symptoms. At the end of 2years, 95% patients were fully satisfied with the LNG-IUS insertion. A levonorgestrel intrauterine system significantly reduces bleeding in menorrhagia due to benign causes and is found to be highly effective in the management of various gynaecological pathologies such as endometrial polyps, adenomyosis and endometrial hyperplasia when insertion perfomed after dilatation and curettage/polypectomy. It has proven to be superior to various surgical and other non-surgical treatment modalities.

Surgical treatment of genital prolapse in combination with endometrial hyperplastic processes in postmenopausal women

Aim. To study the long-term results of surgical treatment of postmenopausal patients with genital prolapse III and IV according to the POP-Q classification in combination with endometrial hyperplastic processes and to assess their quality of life.
 Materials and methods. Fifty one elderly and senile patients with grade III–IV prolapse according to the POP-Q classification in combination with endometrial hyperplastic processes. 2 groups were formed: 1st – 21 patients after one-stage vaginal extirpation of the uterus with appendages and unilateral sacrospinous fixation of the vaginal stump with a synthetic endoprosthesis-tape in combination with reconstruction of II and III levels of pelvic floor support according to DeLancey; 2nd – 30 patients after one-stage vaginal extirpation of the uterus with appendages and median colporrhaphy using the Lefort and Neugebauer technique.
 Results. The study was evaluated 1–7 years after surgical treatment. The average age of patients at the time of surgery in group 1 was 63.12±4.32 years, in group 2 – 74.2±3.28 years. The number of women with somatic pathology in the 1st group was 1.7 times less in percentage terms than in the 2nd. The disappearance of symptoms of an overactive bladder after surgery was noted by 4 (50.0%) of 8 patients of the 1st group and 4 (26.7%) of 15 women of the 2nd. Uroflowmetry after surgical treatment showed an increase in the maximum flow rate (Qmax) and a decrease in the volume of residual urine (Vom) in both groups (p0.001). Recurrence of genital prolapse was detected in the apical region in 1 (4.8%) woman, prolapse of the anterior vaginal wall in 1 (4.8%). There were no recurrences of genital prolapse in the 2nd group. A significant improvement in the quality of life after surgery, according to the results of processing the PFDI-20 questionnaire, was noted by 19 (90.5%) women in the 1st group and 29 (96.7%) – in the 2nd.
 Conclusion. The long-term results of the proposed operational benefits have shown satisfactory results and can be successfully used in the elderly and senile age. The choice of the volume of surgery taking into account age, sexual activity, concomitant gynecological and somatic pathology reduces the number of complications and improves the results of surgical treatment in this category of patients.

Molecular features for timely cancer diagnosis and treatment - tumors of the ovary, fallopian tube and endometrium.

Gynecologic pathology has moved, within only a few years, from being a diagnostic area devoid of molecular testing into a diagnostic discipline in which such analyses are becoming routine. The direct relevance of molecular characterization to the choice of treatment of patients with carcinomas originating in both the uterus and adnexae makes it likely that such testing will only expand along with our understanding of the molecular make-up of these tumors. As a consequence, gynecologic pathologists have become an integral part of patient management, rather than lab personnel providing external services.In parallel, molecular testing is expanding as a tool for diagnosing rare tumors affecting these organs, including soft tissue tumors, sex cord-stromal tumors and germ cell tumors, as well as other rare entities. Increased knowledge in this area bears directly on the ability to diagnose these tumors in a reproducible manner, as well as recognize and consult on genetic diseases. Hopefully, despite the inherent difficulty in studying rare cancers, it will also translate into new therapeutic options for the malignant ones among these rare cancers.

Inhalation of heated oxigen-helium mixture in treating obstetrtic and gynecological pathology: prospective experimental study

INTRODUCTION. The heated oxygen-helium mixture has found application in treating acute respiratory failure in patients with the exacerbation of chronic obstructive pulmonary disease, postextubation stridor, croup and viral bronchiolitis in children, acute respiratory distress syndrome in newborns. The article presents the results of own study according to the results of applying inhalations of the heated oxygen-helium mixture (oxygen 30%, helium 70%) in order to improve reparative processes in postoperative gynecological cases (after myomectomy) and to treat placental insufficiency in pregnant women with diseases of the bronchopulmonary system.
 OBJECTIVE. То estimate efficacy of the heated oxygen-helium mixture on the reproductive health of pregnant women with bronchopulmonary pathology and gynecological cases with patients of reproductive age after myomectomy.
 RESULTS. Against the background of the treatment, there was an increase in blood oxygen saturation, normalization of indicators of fetoplacental hemodynamics and hormonal function of fetoplacental complex in pregnant women. Inhalations of the heated oxygen-helium mixture in gynecological cases after myomectomy led to an increase in blood flow velocity in the area of ligatures.
 CONCLUSION. The study has shown that the method of inhalation through the heated oxygen-helium mixture (70% helium, 30% oxygen) is effective, safe and prospective for applying in obstetric and gynecological practice.

The Multidisciplinary Approach to Vaginal Leiomyosarcoma, an Extremely Rare Diagnosis - Case Report

Primary vaginal sarcoma is an extremely rare malignant condition within the field of gynecological pathologies. We present the case of a 53-year old patient with no history of gynecological issues or associated comorbidities who presented to our clinic with recurrent vaginal bleeding during menopause. We want to emphasize the importance of diagnostic management, going through all the necessary steps from local gynecological examination to vaginal biopsy, optimizing results with advanced imaging techniques. Once the histopathological diagnosis of vaginal leiomyosarcoma was established, the therapeutic approach was discussed within a multidisciplinary committee consisting of a gynecologist, surgeon, and oncologist. As a result, the patient underwent tailored surgical intervention relatively quickly after presentation, followed by referral to the oncology department, where she is currently undergoing her third course of adjuvant chemotherapy. Our current objective is the long-term follow-up of the patient and the acquisition of data regarding her survival and quality of life. These facts may contribute in the future to the implementation of standardized therapeutic guidelines for such a rare condition

Endometrial pathologies in clinical follow-up of patients with hormone receptor-positive/negative breast cancer

Background/Aim: Breast cancer is the leading cause of cancer-related fatalities in women. Tamoxifen, a selective estrogen receptor modulator (SERM), is frequently employed for chemoprevention in hormone receptor (HR)-positive breast cancer patients due to its anti-estrogenic impact on breast tissue. Nevertheless, tamoxifen exhibits agonistic effects on the endometrium, particularly in postmenopausal women. This study aims to assess gynecological issues and endometrial pathologies that emerge during the treatment and follow-up phases of women diagnosed with HR-positive/negative breast cancer. Methods: This cohort study involved a data review from 857 breast cancer patients diagnosed over a decade at a tertiary center. Histopathological endometrial findings were evaluated for 166 patients who underwent gynecological consultations before breast cancer treatment with normal examination results and underwent invasive assessments due to gynecological symptoms that arose during treatment and follow-up. The study encompassed cases culminating in total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO). Results: The study analyzed 166 cases meeting the inclusion criteria. The mean age at breast cancer diagnosis was 48 years with a standard deviation of 8.4 years, and the average follow-up duration was 4.1 (3.8) years. The predominant histopathological type was invasive ductal carcinoma (75.3%). Of the cases, 68.6% occurred during premenopausal and 31.4% during postmenopause. HR positivity was identified in 136 cases (81.9%), while 30 (18.1%) exhibited negative HR status. Among HR-positive cases, 113 (83.0%) received tamoxifen treatment, while 23 (17.0%) were treated with letrozole. Common clinical findings during and after treatment encompassed increased endometrial thickness (ET) and abnormal uterine bleeding (AUB). Histopathological evaluation of invasive procedures prompted by increased ET indicated the following frequent endometrial findings: proliferative endometrium (33.1%), endometrial polyp (20.5%), and endometrial hyperplasia (EH) without atypia (9%). The histopathological outcomes of invasive procedures prompted by AUB included atrophic endometrium (11.4%), proliferative endometrium (3.6%), and endometrial cancer (1.8%). Among the endometrial malignancies, three occurred in the premenopausal phase and four in the postmenopausal phase. Notably, three of the seven endometrial malignancies were observed in the tamoxifen hormone therapy group, all HR-positive. Four cases were from the non-tamoxifen hormone therapy group with negative HR status. Conclusion: Globally, breast cancer ranks as the most prevalent malignancy in women. Tamoxifen, a frequently utilized adjuvant therapy post breast cancer surgery, can exert diverse effects on gynecological organs, encompassing benign pathologies like increased ET and malignant pathologies like uterine neoplasia. There is a rising suspicion that etiopathogenetic factors contributing to breast cancer progression might also precipitate uterine cancer, irrespective of tamoxifen use. Vigilant patient monitoring is paramount for detecting uterine neoplasia and other gynecological pathologies.

Deep endometriosis of ileocecum complicated by acute intestinal obstruction: a case report

Endometriosis is a frequent gynecological pathology. Digestive localization complicated by acute intestinal obstruction is exceptionally rare. We herein report a case involving a 48-year-old woman who had a long-term history of endometriosis symptoms. She was diagnosed with endometriosis by ultrasound 1 month before her admission to the emergency room with acute intestinal obstruction. The diagnosis was confirmed by histopathological examination following surgical resection. Further medical management resulted in a satisfactory outcome.

Role of hysteroscopy in the diagnostics of endometrium pathology and in the application of auxiliary reproductive technologies

Abstract. The introduction of endoscopic technologies made it possible to significantly expand diagnostic possibilities and clarify the nature of intrauterine pathology when using assisted reproductive technologies. Hysteroscopy allows you to take material for examination from the uterine cavity, and also ensures the carrying out of this procedure for diagnostic purposes as much as possible. Treatment of infertility by hysteroscopy plays a very important role in restoring a woman's reproductive function. The aim of the study was to improve the diagnosis of endometrial pathology through the use of hysteroscopy and targeted biopsy in the restoration of fertility and the use of assisted reproductive technologies. Materials. A clinical and statistical analysis of the results of 88 operative hysteroscopies in patients with infertility, which were divided into two groups, was carried out. The first group included 80 patients (90.91 %) with genital and extragenital pathology. The second group included 8 patients (9.01 %) who did not have concomitant gynecological and extragenital pathology. Hysteroscopy was performed with the equipment and tools of the «KARL STORZ» company. Monopolar and bipolar coagulation was used for hemostasis. Taking into account that pathology of the uterine cavity and endometrial are frequent causes of impaired reproductive function, it was proposed to use hysteroscopy to restore reproductive function. The results. The condition of the mucous membrane of the uterus with the help of hysteroscopy was studied in all clinical observations, since this method of instrumental research allows primarily to examine and evaluate the structural features of the endocervix and endometrial. In observation groups I and II, hysteroscopy was performed in all 88 patients: group 1 in 80 patients (90.91%) with pathological changes of the uterine mucosa and group 2 – in 8 patients (9.01 %) without pathology of the uterine mucosa. At the same time, 4 (3.52 %) women of 2 groups were diagnosed with extragenital pathology, and gynecological pathology was eliminated. The most common were endometrial polyps, chronic endometritis, cervical canal stenosis, and synechiae in the uterine cavity. Endoscopic technologies have expanded the diagnostic capabilities of investigating intrauterine pathology at the stage of fertility restoration and preparation for in vitro fertilization (IVF) and overcoming the causes of infertility. Conclusions. Hysteroscopy with morphological examination of the endometrial remains the main method of diagnosing intrauterine pathology. The obtained data will help the clinician to make the correct diagnosis in a timely manner and develop optimal and individual patient management tactics.

PROBLEM ISSUES OF THE DEVELOPMENT OF POSTPARTUM SEPTIC COMPLICATIONS IN PREGNANT RISK GROUPS

The article provides an analysis of literature data on the occurrence of postpartum septic complications. The postpartum period is the most dangerous from the point of view of the development of infectious complications, which is due to such features as a change in the anatomical and functional state of the genitals and other body systems during pregnancy and childbirth; a change in the nature and virulence of microorganisms against the background of a reduced immunological status accompanying pregnancy; manifestation of obstetric and gynecological pathology during pregnancy. The urgency of the problem of postpartum purulent- septic diseases is determined primarily by their frequency, severity of the course and adverse outcome for patients. The analysis of literary sources showed the ambiguity of information regarding the problem of the postpartum septic process, which indicates the need for further research into this pathology.

Визначення особливостей перебігу вагітності та пологів, стану плода і новонародженого у вагітних після застосування допоміжних репродуктивних технологій (дані ретроспективного аналізу)

The rapid growth in the number of infertile couples leads to the development of assisted reproductive technologies (ART). Among the most common forms of infertility are tubo-peritoneal, endocrine, and caused by the male factor, and prevention of pregnancy complications caused by ART treatment cycles becomes one of the main tasks of practicing clinicians. Purpose - to determine the features of the course of pregnancy and childbirth; to assess the condition of the fetus and newborn in pregnant women after the application of ART to improve the perinatal outcomes of pregnancy and childbirth. Materials and methods. A retrospective clinical and statistical analysis of 334 histories of pregnancy and childbirth of women, as well as medical records of newborns from women, was conducted over the past five years, which formed the ART group - 221 history of pregnancy and childbirth, and the group of spontaneous pregnancy - 113 history of pregnancy and childbirth. Results. The structure of the subjects was statistically significant dominated by pregnant women over the age of 35 years and pregnant women in late reproductive age. The main characteristics of women after the ART application were a statistically significant predominance of somatic and gynecological pathology. The structure of pregnancy complications in women after ART application was dominated by threatening late spontaneous miscarriages, isthmic-cervical insufficiency and vaginitis, and in the structure of labor complications - anomalies of labor activity and premature rupture of fetal membranes. Among newborns from women in the ART group, perinatal mortality was 18.0%. Conclusions. The revealed features of somatic and gynecological anamnesis, as well as aspects of the course of pregnancy and childbirth and the condition of newborns in women after ART application are the basis for an in-depth examination of this category of pregnant women in order to improve approaches to predicting, diagnosing and optimizing preventive measures, as well as to improve the perinatal consequences of pregnancy and childbirth. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. No conflict of interests was declared by the authors.

The impact of COVID-19 pandemic on the indications of non-COVID-19 obstetric and gynecological admissions to the intensive care unit (ICU) and its overall consequences

Since COVID-19 outbreak caused a substantial reduction in intensive care unit (ICU) bed capacity, a significant change in triaging ICU admissions has become necessary for obstetric and gynecologic (OG) patients, as well. In the present study, we aimed to analyze the patients admitted to ICU for non-COVID-19 OG pathologies to understand the probable effects of the pandemic on demographics, admission rates and indications, complications, and the overall outcome. Medical records of patients who were admitted to ICU for OG diseases between 2018 and 2022 were reviewed. This four-year time was divided into two equal periods; Group I (March 2018 to March 2020, before the pandemic starts) and Group II (March 2020 to March 2022, during pandemic). Demographics, indications for admissions to ICU, length of stay, acute physiology and chronic health evaluation II (APACHE-II) scores and the factors contributing to their morbidity and mortality were recorded. Chi-square Kolmogorov-Smirno and Shapiro–Wilk tests were used to compare the variables. p < 0.05 was considered statistically significant. 511 patients were in Group I (61.94%) and 314 in Group II (38.06%). Between 2020 and 2022, our ICU admitted 38.56% fewer OG inpatients, compared with the pre-pandemic period (p < 0.05). While number of patients with gynecological pathologies increased (50 vs 57%), obstetric patients’ admission to ICU decreased (49 vs 42%). In gynecologic patients, postoperative complications and sepsis showed a significant rise (57 vs 69% and 7 vs 12%, p < 0.05), and most were after oncological operations (81%). There was a significant rise in numbers of pregnancy-induced hypertension and placental pathologies (29 vs 36% and 41 vs 58%, p < 0.05). Outcome of obstetric patients in ICU was good (99% survival rate). Mortality was higher in gynecologic patients (4 vs 9%, p < 0.05), correlated with the increased APACHE-II score (8 vs 10, p < 0.05). Older age and oncologic operations were the primary factors increasing mortality. Length of stay in ICU prolonged in these patients, as well (1 vs 3 days, p < 0.05). Selection of priority patients by gynecologists and intensive care specialists in cooperation, and meticulous implementation of the rule of only accepting patients with strict indications may explain the change in OG admissions during the outbreak. These findings will question the accuracy of wider indications for ICU admissions in pre-pandemic period, and help in planning the policy for future post-pandemic days.

ASSESSING THE EFFICACY OF LONG-PROTOCOL OVULATION STIMULATION USING GONADOTROPIN-RELEASING HORMONE AGONIST IN WOMEN EXPERIENCING INFERTILITY AND COMORBIDITY OF LEIOMYOMA AND CHRONIC ENDOMETRITIS

Introduction. Nowadays infertility is one of the global medical and social issues worldwide. Assisted reproductive technologies, including in vitro fertilization, is one of the main techniques for restoring fertility. Among the main stages of IVF are controlled ovarian stimulation (COS), the optimal method of which is chosen depending on a numerous factor, such as the patient's age, the ovarian reserve, and the presence of concomitant gynecological or extragenital pathology. The prevalence of various combinations of gynecological pathologies, for example, the comorbidity of uterine leiomyoma and chronic endometritis, can affect the results of IVF in different ways, so scientists around the world are increasingly studying the management of such patients. The aim of the study is to compare controlled ovarian stimulation long-protocol parameters and its effectiveness in the therapy of infertile patients with the comorbidity of uterine leiomyoma and chronic endometritis. Methods and participants. We performed retrospective comparative analysis of anamnestic data of 130 women with infertility who underwent infertility treatment with assisted reproductive technologies. The patients were divided into three groups. In all groups, stimulation of superovulation was carried out following a long protocol with a GnRH agonist; p&lt;0.05 was considered statistically significant during the statistical data processing. Results. The study has revealed that higher starting dose of gonadotropins, as well as higher total gonadotropin consumptions are required for the patients of the second study group with uterine leiomyoma and chronic endometritis, compared to the first study group and the control group. The number of retrieved oocytes, including mature ones, were the lowest as well as the number of immature, deeply immature and degenerative oocytes were the highest in the second study group. The lowest rate of normal fertilization (2pn) and, as a result, a lower blastocyst yield is recorded in the same group. The highest frequency of aborted pregnancies among achieved clinical pregnancies is observed in the group of infertile women with uterine leiomyoma and chronic endometritis. Conclusions. The presence of the uterine cavity pathology combined with persistent chronic inflammation of the uterine mucosa, as well as the absence of proper preparation for IVF-ET cycles are the main reasons for the negative infertility treatment outcomes in such patients. This justifies the need for appropriate optimal preparation and elimination of the identified negative factors before or during the infertility treatment.

EMPIRICAL VERIFICATION OF THE STRUCTURAL MODEL RELATING EQUILIBRIUM VALUES OF COSTS, QUALITY, AND COMFORT OF MEDICAL SERVICES WITH INDIVIDUALIZED ELASTICITIES OF DEMAND

The healthcare system in Ukraine is moving to flexible mechanisms to support the quality and comfort of medical services, in particular through the introduction of co-payments. The following necessitates the development of theoretical background and econometric models to support the process evaluation and optimization.&#x0D; Aim. The research aims at performing empirical verification of the structural model relating equilibrium values of costs, quality, and comfort of medical services with individualized elasticities of demand.&#x0D; Material and Methods. We have performed a combined (retrospective + prospective) study of the cases of uterine fibroids and/or ovarian cysts treated surgically in three city gynecological hospitals/centers in Vinnytsia, Ukraine. An econometric model of D. Dranove and M. Satterthwaite was used as the theoretical basis, the one that describes the dynamic equilibrium of cost, quality, and comfort of medical services together with demand elasticities. Importantly, the system of structural equations models joins moves of equilibrium of the price, quality, and comfort of medical services given shifts in the elasticities of demand. This is of use to analyze factors of efficiency and responsiveness to the demand of health care provision. Unfortunately, we did not find any practical use of this promising theoretical model, possibly due to the lack of empirical verification.&#x0D; Results and Disscusion. Therefore, we analyzed 150 case histories of women with uterine fibroids and/or ovarian cysts treated surgically. The data on the costs, quality, and comfort of inpatient care are studied to enable empirical verification of the model. The modern Monte Carlo Markov Chain (МСМС) methods of structural modeling and power analysis were used to estimate the required sample size.&#x0D; Conclussion. As a result of the study, the system of structural equations accompanying the theoretical model has been empirically verified for the first time and proved to be valid for ascertaining rational ways to optimize inpatient servicing of women with given gynecological pathology, in particular through the management of demand elasticities.

Transvaginal natural orifice endoscopic surgery (vNOTES) for elderly patients.

To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients 70 years and over. The study consisted of eleven patients aged 70 and over who underwent vNOTES for a variety of gynaecological indications at a tertiary referral hospital. The medical and surgical data were noted: age, parity, history of comorbidity, number and type of previous surgeries, body mass index (BMI), operating time, the requirement of intraoperative conversion, the presence of intra- or postoperative complication, estimated blood loss, pre-and postoperative hemoglobin levels, visual analog scale (VAS) pain scores at 6th, 12th and 24th hours, length of hospital stay, and the final pathology results. vNOTES surgery was performed safely and successfully in eleven patients. There were no intra- and postoperative complications or instances of conversions to conventional laparoscopy or laparotomy. The mean age of patients was 75.91 ± 6.47 (range 70-93), and the mean BMI was 42.49 ± 8.77 kg/m2 (range 30.2-56). Seven cases of endometrioid adenocarcinoma, two cases of uterine leiomyoma, one case of complex atypical hyperplasia, and one case of postmenopausal uterine bleeding due to atrophic endometrium were diagnosed. All endometrial carcinomas were early stage; no adjuvant therapy was needed. vNOTES seems to be a safe and feasible approach for the treatment of gynecologic pathologies in elderly patients. This study suggests that vNOTES become a viable treatment option for existing minimally invasive procedures since it offers better surgical outcomes in various gynecologic surgeries.