Gynecologic Pathology Research Articles

Global Research Trends in Endometrial Hyperplasia (2002–2021): A Bibliometric Analysis and Visualization Study

Abstract Objectives This article quantifies the research contribution related to endometrial hyperplasia (EH). Methods We searched the Scopus database in 2002 to 2021. Results A total of 6,422 were retrieved; 1,906 were open access; 5,602 in English. The number of published papers showed rising productivity over the last 20 years ranging from 261 to 425. There were 5,034 research articles and 1,388 reviews. The most prolific authors were Zullo, F (30), Mirkin, S (28), Archer, DF (27), and Insabato, L (26). The top involved journals were the Gynecologic Oncology Journal (144), European Journal of Gynaecological Oncology (114), and International Journal of Gynecological Pathology (105). The United States was the most dominant country, with 1,592 articles, followed by China (601) and Italy (435). The most actively involved institutions were the University of Texas MD Anderson Cancer Center (77), followed by Fudan University (63) and Harvard Medical School (62). The top funding sponsors were the National Cancer Institute (178), the National Institutes of Health (177), and the National Natural Science Foundation of China (107). The top three most cited articles received 1,182, 746, and 600 citations, respectively. Conclusion This study defines the prolific researchers, institutions, journals, and countries as a good starting to bridge gaps in research activity.

Frequency of HER2 protein overexpression and HER2 gene amplification in endometrial clear cell carcinoma

HER2 (ERBB2) overexpression and/or HER2 gene amplification has been well established in several tumors types and when present HER2 directed therapy may be to be efficacious. While recent findings suggests that HER2 overexpression and HER2 amplification are a relatively common in serous endometrial carcinoma, similar data regarding clear cell endometrial carcinoma (CCC) is difficult to interpret due to issues such as diagnostic criteria, sample type and HER2 interpretation criteria. Our goals were to study HER2 expression and HER2 copy number status in hysterectomy specimens from a large series of patients with pure CCC to determine the frequency of HER2 overexpression and HER2 amplification and evaluate applicability of current HER2 interpretation criteria. Pure CCC specimens derived from hysterectomy specimens from 26 patients were identified. All diagnoses were confirmed by two gynecologic pathologists. Immunohistochemistry for HER2 protein and fluorescence in situ hybridization (FISH) studies for HER2 were performed on whole-slide sections from all cases. Results were interpreted according to the 2018 ASO/CAP HER2 guidelines for breast cancer and International Society of Gynecologic Pathologists (ISGyP) HER2 guidelines for serous endometrial carcinoma. Additional testing was performed when indicated by the guidelines. HER2 expression by immunohistochemistry was 3+ in 4% and 0% of cases, and 2+ in 46% and 52% of cases, by 2018 ASCO/CAP and ISGyP criteria, respectively, while the remaining cases were negative. HER2 testing by FISH showed a positive result in 27% of tumors with 2018 ASCO/CAP guidelines, while 23% were positive with the ISGyP criteria. Our findings indicate that HER2 overexpression and HER2 amplification occur in a subset of CCC. Therefore, additional study into the potential benefit of HER2 targeted therapy in patients with CCC is warranted.

A New Advanced and Validated Method for the Determination of Potentially Toxic Metals and Trace and Ultra-Trace Elements in Peritoneal Fluid to Assess the Health Risks of Women with Gynecological Pathologies.

Toxic metals found in the environment have been linked to female infertility and gynecological illnesses. Reliable analytical methods, such as inductively coupled plasma tandem mass spectrometry (ICP-MS/MS), are necessary to determine the elemental composition of biological samples. Currently, the multielemental profile of peritoneal fluid (PF) samples has not yet been established. Due to the complexity of the PF matrix, an ICP-MS/MS-based method has been optimized to mitigate matrix effects and spectral interferences. A dilution factor of 1:4 was the best option to mitigate matrix effects while keeping sensitivity at an appropriate level. A collision gas (He) was useful to lower the extent of spectral interferences for 56Fe, 52Cr, 63Cu, and 68Zn. An intermediate validation test was performed to evaluate accuracy, achieving recoveries ranging from 90 to 110%. The method was validated in terms of intermediate precision, reproducibility, and trueness, with an expanded uncertainty lower than 15%. Afterward, it was applied to perform the multielemental analysis of 20 PF samples. The concentrations for major analytes were up to 151 µg L-1. Meanwhile,209Bi, 111Cd, 52Cr, 55Mn, 95Mo, 60Ni, 208Pb, 118Sn, and 51V were present at concentrations included within the 1-10 µg L-1 range, while 59Co and 139La were found at concentrations below 1 µg L-1.

Retrospective examination of endometrial sampling results in women with abnormal uterine bleeding

<b>Background: </b>Abnormal uterine bleeding (AUB) is among the most significant and frequent causes of admission to the gynecology outpatient clinic. AUBs may manifest as the earliest sign of endometrial cancer. For the early detection and treatment of endometrial cancer, careful examination of AUBs is crucial.<br /> <b>Aim: </b>The study was conducted to retrospectively evaluate the histopathological results of probe curettage materials applied to women who applied to the gynecology clinic for AUB and were hospitalized with the complaint of AUB.<br /> <b>Material and Methods: </b>In the retrospective study planned between 2020 and 2021, all endometrial biopsies from 638 women with AUB reported to the gynecology clinic were reviewed and analyzed. The data were obtained from the archives of our hospital's gynecology and obstetrics clinic and pathology clinic.<br /> <b>Results:</b> 638 cases were analyzed. The mean age of the patients was 47.94±9.53 years. Malignant pathology was detected in 20 cases (3.13%). Nineteen of these cases were seen in postmenopausal women. The most common pathology was found to be benign polyps at a rate of 19.91%. It was the most common benign pathology in women pre- and postmenopausal. Adenocarcinoma was detected in 13 (2.03%) postmenopausal cases while in only 1 (0.16%) of the premenopausal women.<br /> <b>Conclusion:</b> Since more malignant pathologies are observed in postmenopausal women, women with asymptomatic or AUB complaints should be carefully monitored, and endometrial evaluation should not be skipped. Endometrial biopsies are valuable in the early detection of pre-cancerous and cancerous endometrial lesions, especially in postmenopausal women.

Аналитический обзор состояния репродуктивного здоровья девочек и девушек Московской области. Анализ работы

Introduction. The protection of the reproductive health of the younger generation is one of the most significant problems due to the steady growth of various gynecological diseases, including those that are asymptomatic, which has a significant impact on the reproductive potential of the young population. Purpose to reveal the prevalence of gynecological pathologies among girls in the Moscow region. Material and methods. We have analyzed the main gynecologic diseases among patients aged 0–17 years according to the results of preventive examinations and data of visits to the pediatric gynecologist in the outpatient clinic for the year 2021. Results. Recent analytical data on the prevalence of gynecological morbidity of girls and young women in Moscow region showed that in children aged 0–4 years and 5–9 years, inflammatory diseases of the vulva and vagina (vulvitis) and labia minora adhesions predominate. In patients aged 10–14 years gynecological pathology is represented by various menstrual cycle disorders, dysmenorrhea, inflammatory diseases of the vulva and vagina (vulvitis), non-inflammatory ovarian diseases (follicular cysts and cysts of the yellow body of the ovary) and also mammary gland diseases. The predominant gynecological pathology in girls aged 15–17 is inflammatory diseases of the vulva and vagina, menstrual disorders, non-inflammatory ovarian diseases (follicular cysts, cysts of the corpus luteum), fallopian tubes and the vagina, breast diseases, and sexually transmitted infections are also frequent. Conclusion. We can talk about the general trends in the prevalence of gynecological morbidity among girls and young women in Moscow region and in the whole territory of the Russian Federation. Following the order of the Russian Ministry of Health of 20.10.2020 № 1130n «On approval of the Order of medical care in the profile „obstetrics and gynecology“», we can achieve a reduction in gynecological morbidity among girls and young girls in the Moscow region by improving specialized gynecological care

Uterine Leiomyofibroma in the Gynecological Pathology of the Emergency County Clinical Hospital Saint Andrew the Apostle Constanta

Abstract Benign pelvic-abdominal tumor formations are an important part of female pelvic pathology. Uterine fibroids occupy an important place in gynecological benign pathology, among pelvic-abdominal tumors, A retrospective study was performed for a period of 5 years (2015-2019) on a number of 1505 patients admitted to the Clinical Emergency Hospital St. Andrew the Apostle Constanta, on the two departments of Obstetrics-Gynecology OG I and OG II. The patients were followed according to the following criteria: age, origin, symptoms, and the type of surgery performed.

Gynecological prerequisites for the development of chronic pelvic pain syndrome – diagnosis and treatment (Literature review)

Chronic pelvic pain syndrome is a complex process and mostly includes several organ systems. The gynecologic aspects of chronic pelvic pain syndrome can be divided into four distinct components: intra-abdominal pain, vaginal pain, pelvic floor pain, and sexual pain. The сommon gynecological causes of chronic pelvic pain are endometriosis, adenomyosis, vulvovaginal pain syndrome, pelvic floor muscle dysfunction, and sexual pain in women.This article describes the gynecological examination of patients with chronic pelvic pain and discusses the most common gynecological diseases and methods of their treatment. A review of the literature was conducted, which included the recommendations of the International Society for Urinary Incontinence, the European Association of Urology, and the International Association for the Study of Pain.Gynecological examination of patients with chronic pelvic pain begins with a history taking and physical examination. Laboratory tests, imaging examinations, and diagnostic procedures can be used additional methods to make a more accurate diagnosis. Treatment methods include physical therapy, medication, trigger point injections, and surgery.Because the diagnosis and treatment of chronic pelvic pain can be complex, it is important that physicians know the various aspects of this syndrome to be able to provide appropriate care for patients. Detailed history taking and physical examination for identifying the cause of the pain can help to determine the next step in evaluation and treatment. However, gynecological pathology is one of many, but not the only, that can be associated with chronic pelvic pain. This, it is necessary to perform a multimodal and multidisciplinary approach in the management of patients with chronic pelvic pain.

Features of the management of reproductive aged women with adenomyosis in the post-COVID period

Objectives: development of an algorithm for managing women of reproductive age with adenomyosis of I–IV degrees of severity after COVID-19 by studying anamnestic, clinical, laboratory indicators, results of instrumental and hardware research and determining personalized therapy and prevention.Materials and methods. We monitored 120 reproductive aged women with adenomyosis after COVID-19, who were divided into group B (60 women with adenomyosis of the I–II degree of severity) and group C (60 women with adenomyosis of the III–IV degree of severity). Groups B and C were divided into 2 subgroups: subgroups B1 and C1 received the proposed therapy; subgroups B2 and C2 received standard therapy.All women underwent a clinical and laboratory examination, which included the study of the general condition, clinical and biochemical parameters, examination of biological fluids (blood, urine, vaginal contents), histomorphological study of the tissues of uterus, ovaries, hardware and instrumental methods of examination. The results were evaluated before treatment, after 3, 6 and 12 months of therapy, comparing between groups B and C.Results. The effectiveness of the proposed algorithm is confirmed by a significant difference (p < 0.05) in the reduction of the frequency of complaints, symptoms of exacerbation of extragenital and gynecological pathology, stabilization of indicators of general blood test, functional liver tests, lipid and cholesterol metabolism, reduction of indicators of hypercoagulation, activity of biological markers of inflammatory processes, increase the vitamin D and magnesium values, positive changes in the vaginal biocenosis, a decrease in the frequency of herpes simplex virus types 1 and 2 detection, an increase in the number of Lactobacillus sp., positive dynamics of uterine ultrasound parameters, including the state of blood flow in a. uterus in the observation dynamics after 3, 6 and 12 months.Conclusions. Women of reproductive age with adenomyosis of various degrees of severity after suffering from the COVID-19 disease are subject to personalized dispensary supervision, which includes diagnostic, therapeutic, preventive measures in the dynamics of observation. The definition of the measures of such algorithm should be based on the results of proven pathological changes in the body, namely: exacerbation of extragenital diseases, combined gynecological pathology, blood hypercoagulation and microcirculation disorders, activity of biological markers of inflammation, levels of sex hormones, vitamin D, magnesium, state of vaginal biocenosis.

Hormonal status in women of reproductive age with nonspecific vaginitis

Bacterial vaginosis and aerobic vaginitis are the most common problems among gynecological pathology in women of reproductive age. The share oh nonspecific vaginitis is affected by stress, which affects the state of a woman’s hormonal system. However, the relationship between hormonal changes, exposure to chronic stress and nonspecific vaginitis has not been fully estab­lished, which is up-to-date task. Aim of study is to study changes in the levels of gonadotropic and sex hormones, as well as cortisol in women of reproductive age with aerobic vaginitis and bacterial vaginosis. 160 women (100%), divided into 2 clinical groups with subgroups were examined: the main group – 94 (58.8 %) patients with nonspecific vaginitis, who received treatment according to developed clinical diagnostic algorithms and schemes. The comparison group included 66 (41.2%) patients with nonspecific vaginitis, who received treatment according to known protocols. In the process of examining groups, the following research methods were used: general (collection of complaints and anamnesis, gyneco­logical examination, assessment of microscopy of vaginal smears according to the Amsel, Nugent and Donders criteria), laboratory (method of determining the level of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, cor­tisol), statistical. According to the study results it was found that women of reproductive age with nonspecific vaginitis are likely to have elevated levels of follicle-stimulating, luteinizing hormones, prolactin, cortisol and significantly reduced estradiol levels compared to healthy individuals. In conclusion, the results indicate changes in gonadotropic and sex hor­mones in women with nonspecific vaginitis towards the increased levels of follicle-stimulating, luteinizing hormones, prolac­tin, cortisol and decreased levels of estradiol. Such hormonal changes indicate depletion of the hypothalamic-pituitary-genital system, which occurs under the influence of chronic stress on the body of women of reproductive age with nonspecific vaginitis.

Pathogenic role of Twist-1 protein in hydatidiform molar pregnancies and investigation of its potential diagnostic utility in complete moles

BackgroundComplete and partial moles (PM) are the most common gestational trophoblastic diseases. Due to some overlapping morphological findings, ancillary studies may be necessary.MethodsIn this cross-sectional study, 47 cases of complete mole (CM) and 40 cases of PM were randomly selected based on histopathological criteria. Only those cases that were agreed upon by two expert gynecological pathologists and confirmed by the P57 IHC study were included. The expression level of the Twist-1 marker in villi stromal cells, as well as syncytiotrophoblasts, was evaluated quantitatively (percentage of positive cells), qualitatively (staining intensity) and as a total comprehensive score.ResultsExpression of Twist-1 is higher and more intense in villous stromal cells of CMs (p < 0.001). Moderate to strong staining intensity in more than 50% of villous stromal cells, can differentiate CM and PM with 89.5% sensitivity and 75% specificity. In syncytiotrophoblasts of CM, Twist-1 expression was significantly lower than PM (p < 0.001). Negative or weak staining intensity in less than 10% of syncytiotrophoblasts, can distinguish CM and PM with 82.9% sensitivity and 60% specificity.ConclusionA higher expression of Twist-1 in villous stromal cells of hydatidiform moles is a sensitive and specific marker for the diagnosis of CMs. An elevated expression of this marker in villous stromal cells suggests another pathogenic mechanism for more aggressiveness of CMs in addition to the characteristics of trophoblast cells. The opposite result was obtained in the expression of Twist-1 in the syncytiotrophoblasts, compatible with defects in the process of formation of these supportive cells in CMs.

Особливості диференціювання хірургічної патології органів черевної порожнини і тазових органів у дівчат за допомогою ультразвукового дослідження

The issue of acute appendicitis remains extremely relevant today, as it is the most common inflammatory disease of the abdominal cavity. Despite significant advances in pediatric surgery in recent decades, when mortality from acute appendicitis is an exceptional event, the number of complicated forms in children is observed in 26.4% of cases, and morphologically unconfirmed appendectomies in 8.8% of cases. In girls, the rates are higher at the age of ≤10 years. Acute appendicitis has been and remains a very common disease in underdeveloped countries. In industrialized countries, the incidence of acute appendicitis ranges from 4-6% to 12-23%, in Ukraine - 20-21 cases per 10 thousand population, mostly young people. Purpose - to state the peculiarities of differentiation of surgical pathology of the abdominal cavity and pelvic organs in girls using ultrasound examination; to develop an algorithm for diagnosing surgical pathology in girls. Materials and methods. The study was conducted on the basis of the at the Vinnytsia Regional Children's Clinical Hospital, National Pirogov Memorial Medical University (Vinnytsia, Ukraine) for the period 2019-2021. For visual differential diagnosis, girls aged 4-16 years were involved in the study: 100 healthy children (the Group 1), 100 children diagnosed with acute phlegmonous appendicitis (the Group 2), 100 children with bulky uterine appendages of various types of pathology (the Group 3). Results and conclusions. The following advantages of ultrasound have been established: high specificity of the study, low cost and absence of ionizing radiation. Ultrasound of the abdominal cavity makes it possible to diagnose acute surgical and gynecological pathology, as well as to carry out differential diagnosis of diseases simulating acute appendicitis. An algorithm for diagnosing surgical pathology in girls has been developed. Such an algorithm increases the effectiveness of ultrasound of acute appendicitis and neoplasms of the pelvic cavity, and this allows the doctor to establish the correct diagnosis in time and choose the appropriate treatment tactics. 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. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Study on the Role of Diagnostic Laparoscopy in Undiagnosed Chronic Abdominal Pain- Prospective Study

Patients with chronic abdominal pain is the most difficult to diagnose and treat. Potentially it can be unrewarding for both patients and treating physicians. Thereby affecting patients both physically and mentally. Chronic abdominal pain is associated with poor quality of life and the onset of depressive symptoms. Most patients in this group have already undergone numerous diagnostic procedures, including upper and lower gastrointestinal endoscopies, Ct scans, and screening for undetected carcinomas, apart from routine blood investigations. This is the time when the surgeon is approached when all other non-invasive investigations have failed to reach a satisfying conclusion. Clearly diagnostic laparoscopy is an important intermediate option between refusing to explore a patient's abdomen and performing laparotomy. Diagnostic Laparoscopy with advances in optics gives the perfect visual of the whole abdomen and further gives therapeutic advantages as well, which include target biopsies, staging of cancers, and various gynaecological pathologies. Laparoscopy is as much a surgical procedure as an exploratory laparotomy, often just as informative, and a skilled laparoscopic surgeon affords a better view of the entire peritoneal cavity than usual exploratory laparotomy. Achieving a high rate of positive diagnosis from laparoscopy requires much more than trained hands, it requires a thorough background in surgery, sound clinical knowledge, and a perception of abdominal pathologies. Most importantly it avoids unnecessary negative laparotomy in many cases. Moreover, early recovery and ambulation of patients help them get back to daily chores and are a source of delight for treating doctors.

Is Serum Human Epididymis Protein HE4, More Specific than Cancer Antigen 125 in Patients with Benign Gynecological Diseases?

Background: The cancer antigen 125 “CA125” and Human Epididymis protein 4 “HE4” are among some well worked out markers for recognition of malignancy in ovarian tumors. Their different cutoffs are determined and reported by various studies and mostly used recommended cutoffs are 35.0 U/mL for CA125 and 140pmol/L for HE4. They are both reported to recognize the malignancy well, but how specific they are for benign gynecological diseases is still needed to be worked out. Aim: To determine and compare the performance of CA125 and HE4 for benign gynecological pathologies. Methodology: A cross-sectional study was performed at Gajju Khan Medical College in collaboration with Armed forces Institute of pathology (AFIP). A total of 76 women of age above 18 years age, with benign ovarian pathology, confirmed through histological evaluation were enrolled. All these were examined on both markers, i.e. CA125 and HE4. Standard cutoffs of CA125 &gt;35.0 U/mL and HE4&gt;140 pmol/L were used to see if the case was labeled malignant, incorrectly. SPSS 20.0 was used to manage and analyze the data. Performance of the two markers were compared by using some descriptive analysis and using chi-square test. P-value ≤0.05 was considered significant. Results: The median age of these women was 40 years ranging between 18 and 71. Majority (86.8%) was premenopausal, The CA125 had no difference between pre and post-menopausal women but HE4 had a significant difference with p-value 0.029. there were 10.5% incorrect labeling of malignancy when evaluated for CA125, while only 2.6% incorrect on HE4. This difference was found statistically significant between two markers with p-value 0.05. Conclusion: HE4 is better and more specific marker for benign gynecological pathologies as compared to CA125 Keywords:Benign Ovarian Epithelial, Human epididymisprotein (HE4), Cancer Antigen 125 (CA125), Specificity

Results of surgical correction for cervical elongation with vaginal wall prolapse in patients of reproductive and premenopausal age

BACKGROUND: The problem of cervical elongation is becoming increasingly important due to the rising prevalence of pelvic organ prolapse. In Russia, descent and prolapse of pelvic organs account for 39% of all gynecological pathologies.&#x0D; AIM: This study aimed to compare the immediate and long-term results of surgical treatment for cervical elongation in combination with vaginal wall prolapse in patients of three clinical groups.&#x0D; MATERIALS AND METHODS: A total of 105 patients aged 30 to 55 years with a combination of cervical elongation and vaginal wall prolapse of degrees III were followed up. The patients were divided into three clinical groups based on the implemented surgical techniques, including group 1 (n=36) with Moscow surgery, group 2 (n=35) with modification of the Manchester surgery using synthetic implants, and group 3 (n=34) with Manchester surgery.&#x0D; The patients underwent a comprehensive clinical examination, surgical treatment, and follow-up in the early and long-term postoperative periods (1, 6, 12, 24, and 36 months). The efficacy of surgical treatment was assessed using a questionnaire. During dynamic monitoring, a gynecological examination with a Valsalva maneuver, and transperineal, and transvaginal echography were performed.&#x0D; RESULTS: During the first month after the surgery, patients noted irregular dragging pains in the perineum and/or inguinal region every second. A frequent urge to urinate was reported in 16.7%, 17.1%, and 17.6% of patients in groups 1, 2, and 3, respectively. A further survey revealed that the surgical treatment results were satisfactory, as it had a positive effect on the quality of life and mood and contributed to an increase in social and sexual activity. According to the physical examination, there were no signs of prolapse recurrence and mesh-associated complications. Erosion of the anterior vaginal wall over the polypropylene endoprosthesis was detected 6 months after the surgery in 3 (8.6%) patients of group 2.&#x0D; Genital prolapse recurrence was diagnosed after 1236 months in 7 (20.6%) patients of group 3. After 36 months, degree I prolapse of the posterior (n=1) and anterior (n=1) walls of the vagina was revealed in patients of groups 1 and 2, respectively.

Consensus based recommendations for the diagnosis of serous tubal intraepithelial carcinoma: an international Delphi study.

Reliably diagnosing or safely excluding serous tubal intraepithelial carcinoma (STIC), a precursor lesion of tubo-ovarian high-grade serous carcinoma (HGSC), is crucial for individual patient care, for better understanding the oncogenesis of HGSC, and for safely investigating novel strategies to prevent tubo-ovarian carcinoma. To optimize STIC diagnosis and increase its reproducibility, we set up a three-round Delphi study. In round 1, an international expert panel of 34 gynecologic pathologists, from 11 countries, was assembled to provide input regarding STIC diagnosis, which was used to develop a set of statements. In round 2, the panel rated their level of agreement with those statements on a 9-point Likert scale. In round 3, statements without previous consensus were rated again by the panel while anonymously disclosing the responses of the other panel members. Finally, each expert was asked to approve or disapprove the complete set of consensus statements. The panel indicated their level of agreement with 64 statements. A total of 27 statements (42%) reached consensus after three rounds. These statements reflect the entire diagnostic work-up for pathologists, regarding processing and macroscopy (three statements); microscopy (eight statements); immunohistochemistry (nine statements); interpretation and reporting (four statements); and miscellaneous (three statements). The final set of consensus statements was approved by 85%. This study provides an overview of current clinical practice regarding STIC diagnosis amongst expert gynecopathologists. The experts' consensus statements form the basis for a set of recommendations, which may help towards more consistent STIC diagnosis.

Contribution of the uterine cavity microbiota to the development of pathological endometrial processes

Introduction. In the structure of gynecological morbidity intrauterine pathology occupies a leading position because of its high frequency and negative impact on the reproductive health of a woman. Endometrial pathology is numerous and includes endometrial hyperplasia and polyps, endometrial cancer, abnormal uterine bleeding and dysmenorrhea, endometriosis and Asherman's syndrome. Pathological changes of the endometrium in women with reproductive problems, such as infertility, habitual miscarriage, are particularly relevant.The aim of the work is to estimate the contribution of endometrial microbiota in the development of endometrial pathological processes and identify possible pathogens for the development of this process on the basis of scientific literature data.Materials and methods. Data analysis and systematization were performed on the basis of scientific publications in the PubMed, Google scholar, and Scopus databases for the period 2010–2021. For the final scientific review 65 sources were selected.Results and discussion. This article presents findings on the role of the uterine cavity microbiota and its contribution to endometrial pathology such as endometrial polyps and hyperplasia, adenomyosis and uterine bleeding, infertility and intrauterine synechiae. The correction of an altered microbiota opens up new insights into the development of uterine diseases and new therapeutic options.Conclusion. Numerous studies of the uterine cavity microbiota show its undoubted role in the development of uterine cavity pathology. However, the data obtained are quite contradictory. Further study of the uterine microbiota is necessary for a deeper understanding of the pathogenesis of endometrial pathological processes.

AMH producing purely cystic virilizing adult granulosa cell tumor in 17 years old girl: a case report and review of literatures

BackgroundAndrogen-producing granulosa cell tumor in adolescent girl is rare condition and clinical characteristics are not fully elucidated.Case presentationSeventeen years old girl complained of secondary amenorrhea was referred to our out-patient consultation. Markedly elevated serum testosterone, LH, and AMH levels were noted. Mild hirsutism and clitoromegaly were presented. Transabdominal ultrasonography and MRI revealed cystic mass occupied pelvic cavity probably originated from left ovary. Right ovary showed polycystic appearance. Laparoscopic left ovarian cystectomy was performed. After the surgery, her menstruation resumed along with normalized hormonal parameters, and clinical hyperandrogenism were improved. Since the scarcity of cellular lining of inner cyst wall, definitive pathological diagnosis was difficult. After the consultation with gynecological pathologist, the tumor was diagnosed as sex cord stromal tumor, highly suspicious for adult granulosa cell tumor. Residual left salpingo-oophorectomy was performed by additional laparoscopic surgery. Her serum testosterone and AMH levels were remained low with regular menstrual cycles and no evidence of recurrence.ConclusionsAndrogen-producing cystic granulosa cell tumor is rare gynecological disorders, which need both gynecologic oncological and endocrinological approach. Its clinical manifestations may bring some clues to the pathogenesis of ovulatory dysfunctions, such as polycystic ovary syndrome.

TREATMENT TACTICS FOR GENITAL PROLAPSES IN WOMEN WITH ABNORMAL UTERINE BLEEDING AND THYROID GLAND PATHOLOGY

Introduction. Patients with genital prolapse have various extragenital pathologies, in particular thyroid pathology, which affects the regulation of the menstrual cycle both in the reproductive and perimenopausal periods of a woman's life. Abnormal uterine bleeding caused by hormonal disorders, functional and organic changes in the thyroid gland is reported as a common problem of perimenopausal age. The aim of this study is to optimize the treatment of genital prolapse in women with abnormal uterine bleeding and thyroid pathology. Materials and methods. 49 perimenopausal women with genital prolapse who had thyroid pathology were examined and treated. They were divided into the main group (29 women with abnormal uterine bleeding) and the comparison group of 20 patients with genital prolapse without abnormal uterine bleeding. 20 women without signs of gynaecological and extragenital pathology made up the control group. Results. The presence of significant deviations in the serum content of steroid hormones in women with thyroid dysfunction allows us to confirm the relationship between proliferative processes in the endometrium and the functioning of the thyroid system. The examination revealed a significant relationship between thyroid dysfunction and the cause of abnormal uterine bleeding. Depending on the treatment method, the women of the main group were divided into 2 subgroups: the first subgroup included 19 patients who underwent vaginal extirpation of the uterus and simultaneous correction of genital prolapse with additional sacrospinal fixation of the vaginal stump using a mesh implant fragment. 10 patients were included in the second subgroup, which underwent hysteroresectoscopy due to abnormal uterine bleeding, and surgical treatment of genital prolapse was performed after a certain period of time (after 0.5-3 years, on average after 21-24 months). In the comparison group, planned vaginal extirpation of the uterus was performed. Conclusion. The improvement of the treatment of genital prolapse in women with abnormal uterine bleeding and thyroid pathology consists in combining vaginal removal of the uterus followed by strengthening of the vaginal dome through the use of sacrospinal fixation and/or a mesh implant in order to prevent recurrences and improve the economic indicators of the medical institution and the quality of life of patients.

Medicaid coverage and access to obstetrics and gynecology subspecialists: findings from a national mystery caller study in the United States

Previous research suggests that access to healthcare may influence the diagnosis and treatment of obstetrical and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no study has assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type (Medicaid vs commercial). This study aimed to evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid vs commercial insurance. Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Of note, 800 unique physicians were randomly selected from the directories (200 per subspecialty). Of the 800 physicians, each physician was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility. From 800 physicians initially contacted, 477 responded to at least 1 call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 business days (standard deviation, ±18.6). A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio, 1.44; 95% confidence interval, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (P<.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time than commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid-insured patient wait times were still longer than commercial-insured patient wait times. Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.

Stillbirth and fetal growth restriction

Aim: to estimate the rate of early-onset and late-onset fetal growth restriction (FGR) in stillbirth, identify features of placentaassociated complications and determine respective risk factors of stillbirth (especially at early gestational age).Materials and Methods. There were retrospectively studied 61 stillbirth cases in 2016–2019 that occurred in the III level obstetric hospitals: 32 early (23–31 weeks of gestation) and late (32–39 weeks) cases; 156 live births with 8–10 Apgar scores delivered at 36–41 weeks of gestation used as controls. Quantitative parameters were compared using the mean values and standard deviation; nominal parameters were analyzed using odds ratio (OR) and adjusted OR (aOR) with 95 % confidence interval (CI).Results. More than half of stillbirths are associated with FGR with almost 60 % of early-onset phenotype of this pathology. Both in stillbirths and live births, 2/3 of FGR have extremely low weight (OR = 1.8; 95 % CI = 0.6–6.9); 1/3 of growth restricted fetuses were detected shortly before delivery (OR = 1.3; 95 % CI = 0.7–2.4); 1/4 of pregnancies complicated by placental insufficiency are not associated with FGR (OR = 1.4; 95 % CI = 0.7–2.7). Risk factors of stillbirth in pregnancy complicated by FGR are the early-onset growth restriction phenotype (aOR = 3.2; 95 % CI = 1.0–10.3), maternal age over 28 years (aOR = 6.0; 95 % CI = 1.2–29.4), miscarriages and multiple induced abortions (aOR = 3.6; 95 % CI = 1.1–11.2), non-compliance in regular clinics visiting and correction of threatening conditions (aOR = 10.9; 95 % CI = 1.3–91.6), toxoplasma infection (aOR = 6.0; 95 % CI = 1.5–24.5). Early stillbirth with FGR is associated with an older mother's age (aOR = 5.8; 95 % CI = 1.0–34.4), greater parity (aOR = 3.3; 95 % CI = 1.0–10.4), uterine diseases including endometrial polyps, endometriosis, cervix cervicitis, cervix dysplasia (aOR = 4.0; 95 % CI = 0.9–17.2), diabetes mellitus (aOR = 3.1; 95 % CI = 0.8–13.2) and preeclampsia.Conclusion. The rate of early-onset FGR in stillbirth comprises almost 60 % that is twice higher than in live birth, with the rate of late-onset phenotype being less than 30 %. In late stillbirths the early-onset phenotype also prevails. There are no prominent features for stillbirths with FGR compared to previously known risk factors regardless of hypotrophy. Early vs. late stillbirth with FGR is more associated with gynecological pathologies as well as with diabetes mellitus and preeclampsia.