Gynecological Morbidity Research Articles

Illuminating the "Black Box" of Progesterone-Dependent Embryo Implantation Using Engineered Mice.

Synchrony between progesterone-driven endometrial receptivity and the arrival of a euploid blastocyst is essential for embryo implantation, a prerequisite event in the establishment of a successful pregnancy. Advancement of embryo implantation within the uterus also requires stromal fibroblasts of the endometrium to transform into epithelioid decidual cells, a progesterone-dependent cellular transformation process termed decidualization. Although progesterone is indispensable for these cellular processes, the molecular underpinnings are not fully understood. Because human studies are restricted, much of our fundamental understanding of progesterone signaling in endometrial periimplantation biology comes from in vitro and in vivo experimental systems. In this review, we focus on the tremendous progress attained with the use of engineered mouse models together with high throughput genome-scale analysis in disclosing key signals, pathways and networks that are required for normal endometrial responses to progesterone during the periimplantation period. Many molecular mediators and modifiers of the progesterone response are implicated in cross talk signaling between epithelial and stromal cells of the endometrium, an intercellular communication system that is critical for the ordered spatiotemporal control of embryo invasion within the maternal compartment. Accordingly, derailment of these signaling systems is causally linked with infertility, early embryo miscarriage and gestational complications that symptomatically manifest later in pregnancy. Such aberrant progesterone molecular responses also contribute to endometrial pathologies such as endometriosis, endometrial hyperplasia and cancer. Therefore, our review makes the case that further identification and functional analysis of key molecular mediators and modifiers of the endometrial response to progesterone will not only provide much-needed molecular insight into the early endometrial cellular changes that promote pregnancy establishment but lend credible hope for the development of more effective mechanism-based molecular diagnostics and precision therapies in the clinical management of female infertility, subfertility and a subset of gynecological morbidities.

Cervical cytology and associated factors among tribal women of Karnataka, India

BackgroundReproductive well-being is a crucial element of women’s health. Due to the asymptomatic nature of gynaecological morbidities, women rarely seek medical advice in the initial period leading to delayed diagnosis and poor prognosis of subsequent disease. The present study aimed to explore the cervical cytology and its associated risk factors among women from tribal communities of the southern part of coastal Karnataka, India.MethodsPapanicolaou (Pap) smear test was performed among 1140 women from three tribal populations, to detect cervical lesions, infections and reactive changes. A semi-structured questionnaire was administered to collect data on socio-demographic and reproductive characteristics of the study population.ResultsThe most predominant gynaecological complaint among the participants was severe lower back ache (77.6%), followed by white discharge per vagina (29.0%) and menstrual irregularities (25.9%). Of the 1140 women screened, 12.4% showed cervical microbial infections, 23.6% were reported to have reactive changes, and 0.2% had epithelial cell abnormalities in the cervix. Cervical microbial infections were found to be associated with younger age group, low socio-economic status and younger age at sexual debut.ConclusionMost of the symptoms suggestive of gynaecological morbidities reported in this study are preventable or treatable. Strengthening ongoing cervical cancer screening programme and implementation of health education programmes among tribal population would be the right policy approach to prevent, detect and treat these symptoms at an early stage and to achieve acceptable health outcomes among tribal women.

Structural Changes in the Fallopian Tubes in Patients With Ectopic Pregnancy

Relevance.Ectopic (extrauterine) pregnancy (EP) occupies a leading place in the structure of urgent gynecological morbidity. This pathology poses a threat to the health and life of a woman, being one of the leading causes of maternal mortality during pregnancy during the first trimester. Among emergency gynecological operations, surgical interventions for EP make up about 50%, and in recent years, most operations have been performed by the laparoscopic method. However, up to now, the pathomorphological changes in the fallopian tubes in patients with EP remain poorly understood.Purpose of the study. To study the features of pathomorphological changes in the fallopian tubes in women with tubal pregnancy, operated on by the laparoscopic method, to substantiate the volume of surgery in patients with this pathology.Material and methods. Morphological examination was performed in 100 women operated on for tubal pregnancy using the laparoscopic method. A comprehensive morphological study of the fallopian tubes removed during the operation was carried out.Results and discussion. The implantation of the ovum in the fallopian tube led to significant changes in its macro- and microstructure, which were caused by the invasion of chorionic villi and involved all layers of the tube wall, differing only in the depth of penetration and prevalence. The anatomical features of the structure of the fallopian tubes contributed to the deep invasion of the ovum into the myosalpinx and subserous parts of the tube, creating the possibility of wall rupture in this area.Conclusions. 1. In all cases of ectopic pregnancy, implantation of the ovum was accompanied by invasion of cytotrophoblast and syncytiotrophoblast, and it involved all layers of the tube wall, differing only in depth and prevalence. The invasive properties of the cytotrophoblast lead to the development of pronounced degenerative changes in the tube wall, which leads to functional inferiority of the tube after the onset of tubal pregnancy in it.2. The chronic productive endomyosalpingitis diagnosed in most patients with ectopic pregnancy with deformation of the tube lumen against the background of changes in the tube wall caused by cytotrophoblastic invasion is an indication for tubectomy. Performing organ-preserving operations on an anatomically and functionally altered fallopian tube is impractical, since it is a high risk factor for recurrent tubal pregnancy in this tube.

A Prospective Ultrasound Study of Plasma Polychlorinated Biphenyl Concentrations and Incidence of Uterine Leiomyomata.

Uterine leiomyomata, or fibroids, are hormone-dependent neoplasms of the myometrium that can cause severe gynecologic morbidity. In previous studies, incidence of these lesions has been positively associated with exposure to polychlorinated biphenyls (PCBs), a class of persistent endocrine-disrupting chemicals. However, previous studies have been retrospective in design and none has used ultrasound to reduce disease misclassification. The Study of Environment, Lifestyle, and Fibroids is a prospective cohort of 1,693 reproductive-aged Black women residing in Detroit, Michigan (enrolled during 2010-2012). At baseline and every 20 months for 5 years, women completed questionnaires, provided blood samples, and underwent transvaginal ultrasound to detect incident fibroids. We analyzed 754 baseline plasma samples for concentrations of 24 PCB congeners using a case-cohort study design. We used multivariable Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals for the association between plasma PCB concentrations and ultrasound-detected fibroid incidence over a 5-year period. We observed little association between PCB congener concentrations and fibroid incidence. The HR for a one-standard deviation increase in log-transformed total PCBs was 0.94 (95% CI = 0.78, 1.1). The PCB congener with the largest effect estimate was PCB 187 (HR for a one-standard deviation increase in log-transformed exposure = 0.88, 95% CI = 0.73, 1.1). Associations did not seem to vary strongly across PCB groupings based on hormonal activity. In this cohort of reproductive-aged Black women, plasma PCB concentrations typical of the contemporary general population were not appreciably associated with higher risk of fibroids.

Гинекологическая заболеваемость девочек в Московской области в период проведения программы вакцинопрофилактики папилломавирусной инфекции

Study Objective: To assess gynaecological morbidity in girls aged 10 to 17 years old over a 12-year period of the program for vaccination prevention of HPV-associated diseases in Moscow region; and to compare the data on vaccinated regions with the information on the regions where no human papilloma virus (HPV) vaccination was undertaken. Study Design: retrospective study. Materials and Methods. We used the information from annual statistical reports prepared by children gynaecologists and Moscow regional Medical Information and Analytical Centre. Gynaecological morbidity was analysed for the period from 2008 to 2019; it involved assessment of the prevalence of HPV-associated diseases — anogenital warts, pelvic inflammations, precancer cervical lesions, menstrual disorders. We have also analysed the number of pregnancies and outcomes in adolescents. Study Results. Since the program was launched, there has been a steady reduction in the number of anogenital wart cases in girls in Moscow region where vaccination was undertaken: from 14.2 to 1.8 per 100k in 2008 and 2019, respectively. Genital inflammations were more frequent (not statistically significantly, though) in areas where preventive vaccination was not performed. Over the previous 10 years, we have seen a more marked increase in the number of genital inflammations in girls of 10–17 years old vs. areas where girls were vaccinated. Due awareness promotion during vaccination, over the 12-year period the number of adolescent pregnancies dropped from 697 to 127, while pregnancy terminations reduced from 38.9% to 21.4%. Conclusion. HPV vaccination campaign among adolescents in Moscow region resulted in reduced prevalence of anogenital warts and a positive trend in the reduction of cervical cancer prevalence in young women of 15–24 years old. Gynaecological morbidity rates were not statically different in analysed areas; thus, HPV vaccination does not have any negative impact on the reproductive health of girls. Keywords: gynaecological morbidity, reproductive health, papilloma virus infection prevention, vaccination, anogenital warts, human papilloma virus.

МЕДИКО-ДЕМОГРАФИЧЕСКАЯ СИТУАЦИЯ В УДМУРТСКОЙ РЕСПУБЛИКЕ: РЕПРОДУКТИВНЫЙ ПОТЕНЦИАЛ

Significance. The demographic crisis in Russia, registered since 2016, has deteriorated again and the forecast remains unfavorable, substantiating the need for reserves to protect the reproductive potential. Assessment of medical and demographic processes and the possibility of managing them is an important scientific and practical task, the solution of which is relevant for the Udmurt Republic against the background of the existing unfavorable trends in the socio-economic situation. Purpose of the study. To evaluate medical and demographic situation in the Udmurt Republic. Material and method. Medical and demographic indicators for 2012-2019 were studied on the basis of the Rosstat official statistics and materials of the Territorial Body of the State Statistics Service of the Udmurt Republic (according to the information support schemes approved by the Ministry of Health of the Udmurt Republic). Data of the federal statistical observation forms No. 13 for the period 2012 - 2019 were used as the research material. To compare the analyzed indicators in the Udmurt Republic, the Volga Federal District and the Russian Federation as a whole, the authors used materials available from the website of the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation (https://mednet.ru). To assess dynamics in the analyzed indicators, the growth rate index (%) was calculated. Results. The study has analyzed and evaluated major health and demographic indicators of the Udmurt Republic and compared them with similar indicators of the Russian Federation and the Volga Federal District. Results of the study include as follows: a steady decline in the Republic population; the reproduction indicators in the Republic are below the replacement level; low level of health across all age groups; the gynecological morbidity among females is 1.5-2-fold higher than in Russia and the Volga Federal District; high morbidity among females during pregnancy, childbirth and the postpartum period.

Современные подходы к терапии урогенитальных расстройств у женщин в перименопаузе

In modern gynecology, hormone-dependent pathology is one of the most significant problems. The importance of solving this problem is due to the significant prevalence of this pathology, its long-term recurrent course and the presence of a medico-social task of preserving the reproductive function of patients. The age of women who develop dyshormonal diseases is already 30–35 years old, which leads to premature loss of reproductive function, an increase in the frequency of surgical interventions. The systemic nature of the lesion in dyshormonal pathology is due to the common links of pathogenesis. The leading factor in the pathogenesis of hormone-dependent pathology is absolute or relative hyperestrogenism. Menstrual disorders (MD) is one of the most overlooked problems in modern gynecology. Over the past decade, an increase in the frequency of MD in women of reproductive age has been noted in the world by almost 11 times. In the structure of gynecological morbidity, according to most authors, MD s account for about 60% of all dyshormonal disorders, which often lead to an underestimation of future not only reproductive, but also general somatic problems: from miscarriage and infertility to the formation of both benign and malignant tumors in the female organism. Keywords: hormone-dependent pathology, menstrual disorders, estrogens, progesterone, treatment, indole-3-carbinol, rod extract, Agidol.

Эффективное фармакотерапевтическое влияние индол-3-карбинола и экстракт прутняка в составе препарата Агидол

In modern gynecology, hormone-dependent pathology is one of the most significant problems. The importance of solving this problem is due to the significant prevalence of this pathology, its long-term recurrent course and the presence of a medico-social task of preserving the reproductive function of patients. The age of women who develop dyshormonal diseases is already 30–35 years old, which leads to premature loss of reproductive function, an increase in the frequency of surgical interventions. The systemic nature of the lesion in dyshormonal pathology is due to the common links of pathogenesis. The leading factor in the pathogenesis of hormone-dependent pathology is absolute or relative hyperestrogenism. Menstrual disorders (MD) is one of the most overlooked problems in modern gynecology. Over the past decade, an increase in the frequency of MD in women of reproductive age has been noted in the world by almost 11 times. In the structure of gynecological morbidity, according to most authors, MD s account for about 60% of all dyshormonal disorders, which often lead to an underestimation of future not only reproductive, but also general somatic problems: from miscarriage and infertility to the formation of both benign and malignant tumors in the female organism. Keywords: hormone-dependent pathology, menstrual disorders, estrogens, progesterone, treatment, indole-3-carbinol, rod extract, Agidol.

Pathogenetic effects of antibiotic resistance on a woman’s reproductive health

Background. Over the last decade, women in many countries around the world have seen an increase in the number of urogenital infections, which occupy the first place in the structure of obstetric and gynecological morbidity. Risk factors for the development of inflammatory diseases include the invasive procedures and irrigations, sexual activity, unreasonable treatment, refusal to restore eubiosis after antimicrobial and antifungal therapy, the presence of intrauterine devices, etc.
 Objective. To characterize the influence of the spread of antibiotic-resistant pathogens on the course of gynecological diseases.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Peculiarities of the vaginal infections course’ nowadays include prevalence of self-treatment, uncontrolled antibiotics (AB) use, the development of AB resistance, and the presence of extragenital pathology. Pelvic inflammatory disease (PID) comprise 75 % of all gynecological diseases. PID cause such complications as chronic pelvic pain syndrome, purulent tubo-ovarian tumors, cervical neoplasia, and infertility. The risk of the latter increases depending on the number of episodes of PID. Principles of PID treatment include comprehensiveness, etiopathogenetic orientation, individualization and recurrence prevention. Antibacterial therapy (ABT), nonsteroidal anti-inflammatory drugs, infusions, transfusions, detoxification therapy, medications aimed at the improvement of hemodynamics and microcirculation, immunotherapy, and topical therapy are used in the treatment of PID. The consequences of irrational ABT include an increase in the resistance of pathogenic flora, disruption of the normal body biocenosis, increased risk of adverse reactions, impaired immune function and increased treatment costs. Macrolides, cephalosporins, fluoroquinolones and aminoglycosides are the main groups of AB used for the systemic ABT in PID. Tobramycin (one of the latter group) is active against 83.4 % of pathogens that cause urogenital infections. Other advantages of tobramycin include synergism with β-lactams and high activity against Pseudomonas aeruginosa – a bacterium with a high and dangerous potential for AB resistance. In turn, fluoroquinolones are active against 94 % of pathogens that cause urogenital infections; they are able to penetrate cell membranes and have a low potential for the formation of AB resistance. The combination of fluoroquinolone levofloxacin with ornidazole (Grandazole, “Yuria-Pharm”) can improve the general condition and reduce pain on the 3rd day of treatment of PID, normalize the temperature, reduce hospital stay. Co-administration of levofloxacin and ornidazole as part of an infusion solution is more rational than their separate use. Such treatment minimizes the risk of allergic reactions and side effects. For local sanitation of vagina and vulva, it is advisable to use decamethoxine (Dekasan, “Yuria-Pharm”) – a basic antiseptic that acts on various types of bacteria, viruses, fungi and protozoa. Additional benefits are anti-inflammatory, desensitizing and antispasmodic action. Decamethoxine also effectively reduces the adhesion of staphylococci and Escherichia coli. One of the main advantages of decamethoxine is the lack of effect on human cells.
 Conclusions. 1. PID are the most common diseases in the field of obstetrics and gynecology. 2. Care should be taken when choosing a drug for ABT. 3. The combination of levofloxacin and ornidazole can effectively treat PID, reducing the duration of inpatient treatment. 4. For local sanitation of the vagina and vulva, it is advisable to use decamethoxine.

Prevalence of Dysmenorrea and its Effect on Student’s Quality of Life

Background: Dysmenorrhea is the leading cause of gynecological morbidity in women of reproductive age and it was found to have significant effect on day-to-day activities. Present study aimed to assess prevalence of dysmenorrea and its effect on Student’s Quality of Life at Faculty of Nursing Beni-Sueff University. Subjects and Methods: This study was exploratory descriptive, A convenient sample was selected from 516female students at faculty of Nursing Beni-suef University Data collection tools:1) Socio-demographic Questionnaire 2) verbal multidimensional scoring system 3) Pediatric quality of life Generic Core Scales. The results of the study revealed that the majority of the studied students suffered from dysmenorrheal in different grads, most of them experienced grade 1, more than one third experienced grade 2 and eighty percent of them experienced grade 3. Forty had moderate level of quality of life in physical health while more than one third experienced low level in psychological health, less than half experienced low level in social health and more than half experienced low level in academic performance and there was highly statistical significant correlation between dysmenorrheal and quality of life. The study concluded that the majority of the studied students suffered from dysmenorrheal & it had negative effect on quality of life, leading to absenteeism, reduced physical activity, loss of concentration, and poor social relationship. So study recommended to conduct better quality population-based longitudinal studies on the natural history of dysmenorrhea and on the effect of its risk factors across the reproductive life course.

Analysis of the Structure and Dynamics of Gynecological Morbidity and Extragenital Pathology in Rural Women

Background . The reproductive health of women is an important aspect of health that affects the reproduction of the population and its quality and is of great importance in maintaining the stable development of society, normal fertility and demographic growth of the population. The unfavorable situation concerning reproductive health of rural women requires more attention and detailed socio-hygienic and medico-demographic study. Aim of the research. To study the structure and dynamics of gynecological morbidity in rural women on the example of women living in Ekhirit-Bulagatsky district of the Irkutsk region over a period of 2015–2019, and of extragenital pathology in pregnant women. Materials and methods . The analysis of the structure and dynamics of gynecological morbidity in women (n = 1044), and of extragenital pathology in pregnant women (n = 1314) was carried out in the Regional Hospital N 2 of the UstOrdynsky settlement in 2015–2019. Statistical data processing was carried out using standard techniques. Results . Gynecological morbidity in the female population in this rural area over a period from 2015 to 2019 tended to increase. The relationship between this growth and the coverage of the population with preventive medical examination was studied. The correlation between these factors is direct, strong and statistically significant (r xy = 0.963; p > 99 %). In the structure of extragenital pathology of pregnant women, anemias and diseases of the endocrine system occupy a special place. Conclusion . The greater the percentage of female population covered by preventive medical examination, the higher the rate of gynecological morbidity. In the structure of gynecological morbidity in rural women, erosion is in the first place, endometriosis is in second, and uterine myoma is in third. In the structure of extragenital pathology among pregnant women, anemia, thyroid diseases, and diabetes mellitus prevail. The results indicate the need for a differentiated treatment and diagnostic approach to the management of pregnancy, as well as the development and implementation of comprehensive programs aimed at the formation of reproductive health.

Gynaecological morbidities among married women and husband's behaviour: Evidence from a community-based study.

AimTo determine the association between gynaecological morbidities and IPV among married women specifically, with attention to the attitudes of the husband and the degree of satisfaction in a marital relationship.DesignCross‐sectional study design.MethodsData were collected using face‐to‐face interviews with married women aged 15–49 years, living in selected communities. Information was collected on demographic characteristics, gynaecological morbidities and IPV using a self‐developed tool. Descriptive and inferential statistics were used to analyse the data.ResultsLogistic Regression showed a significant association between physical violence and burning micturition, increased urinary frequency, constant dribbling of urine, genital ulcers, lower abdominal pain, vaginal discharge and painful coitus (OR: 1.41–1.84). A significant association between sexual and psychological abuse was also found with burning micturition (OR: 1.41) and dribbling of urine (OR: 0.12). Since gynaecological morbidities can have a serious effect on the psychological, physical well‐being, and the social status of women in Pakistan; effective interventions are imperative in dealing with their symptoms and decreasing their emergence.

Соціально-демографічні аспекти становища жінок в Україні в світлі Конвенції ООН про ліквідацію всіх форм їх дискримінації (CEDAW)

This paper dwells upon the demographic features and some peculiarities of women’s social situation in Ukraine in the context of CEDAW’s requirements. It also reviews the implementation of these requirements in recent years. The study focuses on general issues (changes in the number of women and their age structure as well as the situation with gender statistics), the specifics of the marriage and family situation and health problems. Such trends are highlighted based on the results of the analysis: the fastest reduction rates of the number of women in working and reproductive age against the increase of the older women’s share; reduction of early nuptiality and adolescent fertility; not sustained decline of infant mortality, decrease of venereal morbidity. The latest changes in gynecologic cancer morbidity and mortality are ambiguous in Ukraine. The maternal mortality has begun to rise in recent years; cases of obstetric violence are common; the situation with HIV/AIDS is still unfavourable (and the share of women among AIDS patients increases). Now the improvement of the reproductive health of women in Ukraine is complicated by the absence of state social program on reproductive and sexual health. Due to a more significant share of elderly and other factors women have greater needs for medical care and social support, they are incredibly vulnerable to the current COVID-19 pandemic and its consequences. At the same time, women suffer, mainly due to the low accessibility of high-quality medical care in Ukraine. The paper also deals with gender statistics in Ukraine. The current state of gender statistics is analyzed, and some recommendations for its improvement are proposed in order to form a proper information basis for the development of policies in the field of elimination of discrimination against women in Ukraine.

Analysis of gynecological morbidity and the trend of development of stationary gynecological care in the Russian Federation

Background: Due to a quantitative decrease in the demographic reserve and a qualitative decrease in the reproductive potential of the country, protecting the reproductive health of women in Russia has now become an emergency situation. The obstetric and gynecological service is of major importance in maintaining reproductive health and conducting a comprehensive demographic policy. This study aimed to assess the dynamics of gynecological morbidity in the Russian Federation, the Central Federal District, the city of Moscow, and the organization of stationary gynecological care. Material and methods: The official statistics of the Federal State Statistics Service and the Ministry of Health of Russia for 20092018, as well as data from copies of the medical records (medical history, records of patients discharged from the hospital) of patients who received treatment in a gynecological day patient facility between 2015 and 2017. Results: A decrease in the number of gynecological beds by 32.2% over 10 years was noted. At the same time, the level of primary and general incidence of inflammatory diseases of the female pelvic organs did not decrease; between 2014 and 2018, there has been an increase in the incidence of primary female infertility. Non-inflammatory diseases of the female genital organs prevail (76.6%) as reason for admission in the day patient facility. Conclusion: The gynecological day patient facility manages female health; however, the nationwide and regional incidence rate of gynecological morbidity follows a negative trend and is increasing annually.

A retrospective study on histomorphological spectrum of ovarian lesions in a tertiary care hospital

Introduction: Gynecological morbidity is defined as any condition, disease, or dysfunction of thereproductive system which is not related to pregnancy, abortion, or childbirth. A significant numberof ovarian lesions have been known to cause Gynecological morbidity among most females. With theincreased use of screening modalities, ovarian lesions have increasingly been encountered forpathological analysis. It is important to evaluate the pattern of clinical presentation, corroboratingwith histological diagnosis. Purpose: The present study was carried out to evaluate thehistomorphological spectrum of various ovarian lesions among women in Puducherry. Material andMethods: This retrospective study was conducted on 350 ovarian samples received for five years inthe Department of Pathology, of our tertiary teaching hospital. Clinicopathological data wereretrieved from the hospital records. The histomorphological analysis was reviewed and neoplasticand non-neoplastic ovarian lesions were segregated according to the World Health Organizationclassification. Results: Based on histology, the predominant ovarian lesions diagnosed were non-neoplastic conditions including simple and follicular cyst, corpus luteal cyst, corpus hemorrhagiccyst, and cystic follicles constituting 40.6% on the right side and 34% on the left side. Malignancywas predominant on the right side (1.7%) while the same was 0.6% on the left side. Conclusion:The present study has identified that non-neoplastic lesions are more common in ovaries thanneoplastic lesions and it has identified that serous cystadenomas are the most common ovarianneoplastic lesions.

Сучасний погляд на проблему рецидивних гіперпластичних процесів ендометрія

A review of current data on the problem of recurrent endometrial hyperplasia, presented in modern domestic and foreign literature, its place in the structure of gynecological morbidity, the impact on reducing fertility among women of childbearing age and the growth of cancer. The issues of existing classifications, their relevance and ease of use are considered. The main etiological factors and clinical and anamnestic factors of endometrial hyperplastic processes, prognostic influence of urogenital infections on endometrial pathology are highlighted. Possible mechanisms of pathogenesis are described, including disturbances of hormonal regulation, factors of local humoral and cellular immunity and molecular mechanisms of cellular regulation. The important role of biomolecular markers in the pathogenesis of hyperplastic processes and the correspondence of their degree of activity to morphological changes of the endometrium, because understanding the basics of induction of cell growth, especially in tumor tissue transformation, is an integral part of a competent approach to the management of patients with hyperplasia. The role of genetic research to assess the risk of malignancy and, accordingly, the choice of conservative or operative treatment tactics is considered. Modern morphometric diagnostic criteria are presented. Emphasis is placed on the need to collect endometrial biopsies under the control of a hysteroscope as the gold standard in the diagnosis of endometrial conditions. A separate role in the diagnosis at the present stage is given to immunohistochemical method; conducting not only histological examination of the removed endometrium, but also its receptor activity provides the ability to select the necessary pharmacological correction and predict the development of neoplastic changes. Variants of hormone therapy schemes of endometrial hyperplastic processes are described, and the order of their appointment, depending on the woman’s reproductive plans, concomitant diseases, age and constitutional features. Particular attention is paid to women with metabolic syndrome and the feasibility of including the correction of metabolic disorders in the treatment of such patients. The duration and frequency of observation of women during treatment are indicated. The presented data demonstrate the lack of a clear algorithm in the tactics of diagnosis and treatment of recurrent hyperplastic processes, which determines the relevance of in-depth scientific study in this area. Keywords: endometrial hyperplasia, recurrence, hysteroscopy, endometrial receptors

OPTIMIZATION OF TREATMENT OF PATIENTS WITH CHRONIC SALPINGOOPHORITIS

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

MODERN VIEWS ON THE TREATMENT OF NON-SPECIFIC VULVOVAGINITIS OF MIXED ETIOLOGY

In the structure of gynecological morbidity, nonspecific vulvovaginitis of mixed etiology is becoming the most common pathology. Polymicrobial associations with varying degrees of etiological significance of the components are represented by both pathogenic and, mainly, opportunistic microorganisms. In 78% of cases with nonspecific vulvovaginitis, 2 or more pathogens are sown, which are capable of forming poly-species biofilms, which determines their high resistance to antibiotic therapy.The aim of the study was to evaluate the effectiveness of the modern antiseptic agent Ginodek in the treatment of nonspecific vulvovaginitis of mixed etiology.Material and research methods. There were 58 patients under observation with a verified diagnosis of nonspecific vulvovaginitis of mixed etiology. The exclusion criteria from the study were the detection of specific infections (gonorrhea, chlamydia, etc.). All women underwent clinical examination, bacterioscopic and bacteriological examination, and the pH of the vaginal secretion was determined. Patients with verified vulvovaginal infection received Ginodec - vaginal gel 5 ml once a day for 7 days. The effectiveness of treatment was assessed according to the data of clinical examination before treatment and on the 7th day of observation, as well as laboratory (bacterioscopic, bacteriological) data before and after treatment. The criteria for the effectiveness of treatment were complete clinical and bacterial sanitation: the absence of subjective clinical symptoms, inflammatory changes in the vaginal mucosa, and a negative result of microbiological examination of vaginal contents.Research results and their discussion. Bacteriological analysis of the microbial spectrum of the vagina of the examined women showed a different combination of 2 or more microorganisms. In addition, the overwhelming majority of patients (84.5%) had a sharp decrease in the number of lactobacilli (103 CFU / ml). After treatment with Gynodek vaginal gel, 5 ml once a day for 7 days, the objective and subjective symptoms of the inflammatory process of the vagina were completely arrested at the end of therapy. The results of bacteriological examination 2 weeks after the treatment also confirmed the effectiveness of using the Ginodek vaginal gel in most (94.8%) women, and lactobacilli in the amount of 107 CFU / ml were found in 86.2% of the examined.Conclusions. The drug Ginodec is highly effective against the main causative agents of nonspecific vulvovaginitis of mixed etiology, which makes it the drug of choice for local therapy. Gynodek does not affect the functional activity of lactobacilli, provides a comfortable pH of the environment, which contributes to the rapid restoration of the normal vaginal biotope.

Assessing physical development and immunological parameters in adolescent girls with altered menstrual cycle

Gynecological morbidity particularly formation of menstrual function poses an important task because menstrual irregularities comprise a lead pathology among adolescent girls and considered as a marker of adverse environmental impact on female body [1, 2, 3]. The territories of the Orenburg Region [4] are known to be coupled to profound environmental and hygienic issues. We acknowledge the influence of anthropogenic stress on physical development and health in childhood by recording deviated physical development most frequently in children living in ecologically unfavorable territories [5]. Previously, we published the data on gynecological morbidity pattern in adolescent girls living in the Orenburg Region in territories with differed 7 year-monitored (from 2010 to 2016) anthropogenic stress [6]. Here we present the data on surveying girls aged 15-17 years with menstrual irregularities (MIs) living in the regions of the Orenburg region with varying anthropogenic stress assessed for their physical development, hormonal and immunological parameters. 2010- 2019 primary gynecological morbidity data were assessed based on available annual reports for various territories of the Orenburg Region. Subjects residing in the Western, Central and Eastern territories of the Orenburg Region were assesed based immune status data such as parameters of cell-mediated immunity, phagocytic indices, serum immunoglobulin class A, M, G as well as circulating immune complex levels. Hormone status was analyzed by assessing serum level of thyroid and sex hormones. It was found that oligomenorrhea in MIs was prevalent that tended to result in leptosomy and pachisomy in physical development. Most changes in adolescent girls were found in relative frequency of peripheral blood CD3+, CD4+ and CD19+ lymphocytes, phagocytic index as well as IgM, estradiol, progesterone, testosterone levels, LH, 17-OH-progesterone and cortisol. Our study demonstrated that adolescent girls living in the West and East of the region were featured with dominant oligomenorrhea in MIs associated with physical development tended to leptosomy and pachisomy. Assessing parameters of physical development in adolescent girls is of great importance and should be performed to diagnose potential menstrual irregularities. Thus, our data underline importance of negative impact of anthropogenic burden on gynecological health in adolescent girls.

Analysis of Miscarriage Occurrence per Population Group

Miscarriage is a fairly relevant pathology in obstetric and gynecological practice, as it contributes not only to an increase in the number of reproductive losses, but also negatively affects the health of a woman. A study of the prevalence of this nosology will allow us to assess the need for therapeutic and preventive measures among women at risk. Purpose: Conducting a retrospective medical and epidemiological analysis according to obstetric and gynecological hospitals in Moscow for 2014-2018 and data of the Perinatal Center of the M. P. Konchalovsky City Clinical Hospital. Materials and methods: archival materials of gynecology hospitals in the city of Moscow have been used (including the Perinatal Center of the M. P. Konchalovsky City Clinical Hospital). The number of charts with RM cases has been 2017. For statistical analysis, in the case of comparing two dependent (paired) samples of parameters, paired Student t-test has been used. Where the compared sets of unrelated samples go against the law of normal distribution, the Mann-Whitney criterion has been used to compare them. The critical level of reliable significance of the analyzed statistical hypotheses is taken as a value of less than 0.05, since it is at this level that the probability of differences between the studied parameters is more than 95%. An analysis of the results is presented as M ± σ. Results: The obtained data indicates a tendency toward increased occurrence of RM in Moscow (per 100 live and stillbirths) from 11.6 to 14.2 cases in 2017 and to 13.5 cases in 2018. The total reproductive loss, according to data provided by the Perinatal Center in 2018, grew up to 618.6 thousand, i.e. more than by a quarter (25.2%) The data on fertility loss due to spontaneous abortions in 2018 in Moscow is higher (412400) than across the Russian Federation (223154). Conclusion: The retrospective medical and epidemiological analysis based on the data provided by gynecology hospitals has demonstrated a rather high proportion of RM in the structure of gynecological morbidity both in the Russian Federation and in the city of Moscow (using the data provided by the M.P. Konchalovsky Perinatal Center).