Patients Of Reproductive Age Research Articles

Evaluation and Management of Early Pregnancy: A Flipped Classroom Case for OB/GYN Clerkship Students.

Evaluation and management of an early pregnancy diagnosis are clinically pertinent to multiple specialties that will encounter reproductive-age patients. We designed an interactive, small-group, flipped classroom session teaching concepts related to early pregnancy for obstetrics and gynecology clerkship students. Students received advance preparation materials prior to joining the small group facilitated by clinical educators in the OB/GYN department. Following each 2-hour session, students and facilitators were asked to voluntarily complete a satisfaction survey. Over six clerkships, which occurred across 9 months, 116 students participated. Eighty-three students completed the satisfaction survey, with 98% agreeing that the session was helpful in applying learned principles to patient care. A very high rate of students (average: 93%) self-reported that they achieved the session's learning objectives after completing the prework and interactive small-group teaching. Eleven clinical instructors completed the survey, with 91% agreeing that they were able to facilitate active learning using the materials and 82% agreeing that the curriculum reduced their personal preparation time to teach compared to traditional didactics. This interactive flipped classroom session achieves specified learning objectives and helps students apply learned concepts in the evaluation of early pregnancy while standardizing clerkship education and reducing the burden on clinical educators.

Semen quality changes during infection and recovery phases of mild-to-moderate COVID-19 in reproductive-aged patients: a prospective case series

BackgroundDespite the documented effects of the coronavirus disease 2019 (COVID-19) on spermatogenesis, the reversibility of these effects is uncertain. We aimed to assess the changes of sperm quality between the infection and recovery phases of COVID-19 in reproductive-aged men. The semen quality of men with mild-to-moderated COVID-19 (defined by the degrees of symptoms and chest involvement on computed tomography) was studied during October, 2020–May, 2021 at our hospital. Two semen samples were analyzed at timings estimated to represent spermatogenic cycles during the infection and recovery phases of COVID-19.ResultsA total of 100 patients were included with mean ± SD (range) age of 24.6 ± 3.3 (21–35) years. During infection, 33% of patients had abnormal semen quality. However, a significant reduction was found in this abnormality from 33 to 11% (P < 0.001) after recovery from infection. In a comparison of the two semen analyses, there were significant improvements in the mean values of sperm progressive motility (P =0.043) and normal morphology (P < 0.001). However, the mean sperm concentration showed a statistically insignificant increase (P = 0.844).ConclusionsIn reproductive-aged patients with mild-to-moderate COVID-19, the effects on seminal quality were recoverable, represented by significant improvements in the means of progressive sperm motility and normal morphology between the infection and recovery phases of COVID-19.Trial registrationClinicalTrials, NCT04595240.

ASSESSMENT OF THE MICROBIOTA STATE OF THE REPRODUCTIVE TRACT IN PATIENTS WITH HYPERPLASTIC PROCESSES OF THE ENDOMETRIUM

Hyperplastic processes of the endometrium, in the structure of gynecological pathology, occupy from 15.0% to 50.0% in women of reproductive age, disrupting the reproductive function, manifested by infertility, miscarriage, long, irregular, painful menstruation, high frequency of chronic adnexitis (73.9 %), uterine leiomyomas (45.8%), genital endometriosis (17.7%), cervical erosion (26.0-34%). The development of the disease is associated both with inadequate treatment of the acute altering process and with the primary chronicity of inflammation with a violation of local mechanisms of anti-infective protection. We cannot ignore the important role of inflammatory diseases of the pelvic organs, which causes the increase in the fate of chronic endometritis to 70.0%, and the chronicity of the process, inadequate therapeutic options and resistance to medical measures cause a change in women's field, which, undoubtedly affects the implantation processes.&#x0D; The question of the role of an infectious factor in endometrial hyperplasia remains incompletely elucidated and understudied, which preserves the expediency of detailing the pathogenetic mechanisms of endometrial hyperplastic processes.&#x0D; The aim of the study: to evaluate the microbiocenosis of the vaginal mucosa in patients with hyperplastic processes of endometrium.&#x0D; Materials and methods. A comprehensive clinical and laboratory examination of 80 patients of reproductive age with endometrial hyperplastic processes was performed: 40 patients with endometrial hyperplasia without atypia (group 1), 40 patients with endometrial polyps (group 2). The control group consisted of 30 healthy women without gynecological pathology.&#x0D; All patients underwent diagnostic and therapeutic hysteroscopy followed by morphological and immunohistochemical examination. Bacterioscopic and investigation of biomaterial of the reproductive tract was carried out using the "Femoflor" test system in real time. The TORСH-group pathogens were verified by the DNA-PCR method.&#x0D; Research results. A significant proportion of menstrual cycle disorders (AUB - 55.0 %, algodismenorrhea - 41.3 %), generative function (infertility - 36.9 %, spontaneous abortions - 18.8 %, missed abortion- 8.8%) and also transferred inflammatory processes of the genitals (dysbiosis, PID, exo-endocervicitis - 75.0%).&#x0D; Based on the results of DNA-PCR data evaluation, the following were found: Chlamydia trachomatis — in 24 (30.0%) cases, Mycoplasma genitalium — in 21 (26.3%), Ureaplasma urealyticum — in 17 (21.3%), Candida albicans — in 18 (22.5%), in 37 (46.3%) cases – genital herpes (HSV) types 1 and 2, cytomegalovirus (CMV) and human papillomavirus type 16.18 (HPV) in 23 (28.8%) ), as well as viral (32.5%) and viral-bacterial associations (51.3%). According to the results of the evaluation of the microbiocenosis of the vagina in the examined women with impaired reproductive function against the background of endometrial hyperplasia and endometrial polyps, pronounced dysbiosis prevailed (47.5% and 62.5%, respectively).&#x0D; Conclusions. The obtained results confirm the scientific position regarding the important role of an infectious factor in the development of hyperplastic processes of endometrium, and the normalization of the microbiocenosis of the genital tract contributes to the effectiveness of treatment and the prevention of possible relapses.

The impact of COVID-19 on select considerations in patients of reproductive age: Brief talking points for pharmacists

The coronavirus disease 2019 (COVID-19) pandemic has elicited many health concerns, including the impact of the infection and vaccine on reproductive health. Although robust evidence demonstrates the safety of all available COVID-19 vaccines, misinformation and disinformation related to the vaccine continue to circulate. As accessible and essential health care workers, it is crucial that pharmacists are informed of the evidence related to effects of the COVID-19 infection and vaccinations on reproductive health care. Menstrual cycle changes have been noted owing to COVID-19 infection, pandemic stress, and COVID-19 vaccination. COVID-19 infection and vaccination have not been shown to influence female fertility, pregnancy rates, and lactation. The use of exogenous estrogen may further contribute to an increased risk of thromboembolism with COVID-19 infection, and differences in the risk of cerebral venous sinus thrombosis appear to exist between the types of vaccines. The benefits of COVID-19 vaccination outweigh any risks. Shared decision-making is necessary when discussing vaccination with patients. Pharmacists play a vital role in dispelling misinformation and disinformation related to the impact of COVID-19 illness and vaccination on reproductive health care.

Effect of comorbid pathology on the outcome of gastric cancer with Krukenberg metastases in a patient of reproductive age: clinical case

Objective. To determine the features of the influence of comorbid pathology on the outcome of metastatic gastric cancer in a patient of reproductive age.&#x0D; Materials and methods. A prospective analysis of a clinical case was carried out on the basis of the Department of Antitumor Drug Therapy № 1 of the Medical Center "Medical City", Tyumen.&#x0D; Results. The patients case, taking into account the data of instrumental examinations, objective examination, general condition of 40 % on the Karnofsky Scale, ECOG-3 (Eastern Cooperative Oncology Group), diagnosis, morphology and complications, was diagnosed as incurable; special methods of antitumor treatment were not indicated. In the current clinical situation, there was used the post-syndrome therapy, prolongation of antiretroviral therapy, examination for searching an infectious agent in the liquor and blood.&#x0D; Conclusions. Treatment of stage IV gastric cancer is aimed at prolonging the patient's life and improving its quality, stabilizing the disease; its goal is to achieve the same result in terms of quality of life and overall survival as in HIV-negative patients.

Трехмерная эхография в оценке морфофункционального состояния эндометрия у пациенток после односторонней аднексэктомии

Objective. To study the morphological and functional characteristics of the endometrium in patients of reproductive age before and after unilateral adnexectomy using a three-dimensional (3D) ultrasound imaging. Patients and methods. A total of 113 patients after unilateral adnexectomy were examined. The mean age of patients was 32.85 ± 4.01 years. Two patient groups were identified: group 1 (n = 51) consisted of patients with mature teratomas; group 2 (n = 62) included patients who underwent surgery for epithelial ovarian tumors (endometrioid (30; 48.4%), serous (21; 33.9%), and mucinous (11; 17.7%) cystadenomas). The 3D ultrasound examination of pelvic organs was performed in the middle luteal phase of the menstrual cycle before surgery and at 6, 12 months after it. The endometrial thickness, volume, and ultrasound pattern were studied, as well as volumetric vascularity indices: vascularization index (VI), flow index (FI), and the vascularizationflow index (VFI). Based on the ESHRE consensus (2022), the ovarian reserve was assessed. Results. The improvement of endometrial perfusion was noted at 12 months after surgery. In patients with ovarian teratomas, compensatory restoration of morphological and functional properties of the ovary and endometrium was recorded. The opposite pattern was observed in the group of patients with epithelial tumors. Thus, patients operated on for ovarian endometriomas had an extremely thin endometrium (3.5 ± 0.1 mm), whose values were 1.5 times lower compared to those of patients with serous and mucinous cystadenomas; the glandular layer volume was expectedly low (1.1 ± 0.9 cm3). Conclusion. The minimum effective restoration period for the collateral ovary after unilateral adnexectomy is at least 6 months. The qualitative and quantitative parameters of 3D Doppler velocimetry can be used as predictors of the endometrial morphological and functional state in patients of reproductive age. Key words: 3D ultrasound, mature teratomas, cystadenomas, endometrium, endometrioid cysts, VOCAL

Клинические и фенотипические признаки недифференцированной дисплазии соединительной ткани при интрамуральной миоме матки как маркеры прогнозирования инфертильности

Objective. To examine associations between clinical and phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) and uterine leiomyoma, as well as fertility and infertility in case of intramural uterine leiomyoma. Patients and methods. In this retrospective cross-sectional study, 400 patients were included and divided into two groups. The study group consisted of 370 patients with intramural leiomyoma, including 240 infertile and 130 fertile patients (70 women in the first trimester of pregnancy and 60 women delivered less than 12 months ago, in whom leiomyoma was diagnosed before and/or during pregnancy). The control group consisted of 30 patients without leiomyoma and infertility who referred for a preventive examination. Results. The frequency of clinical and phenotypic signs of UCTD was significantly higher (2.5-fold) in patients with leiomyoma compared to healthy controls. A number of UCTD signs were significantly associated with infertility in intramural leiomyoma (De Quervain syndrome, mitral valve prolapse, hematomas due to minor trauma, hyperpigmentation, history of uterine appendage torsion, scoliosis, varicose veins, iron-deficiency anemia). Based on the findings, significant diagnostic coefficients and informativeness coefficients for several UCTD signs, expressed in rounded scores, were obtained using mathematical calculations, which allows their use as prognostic criteria for fertility/infertility in intramural leiomyoma. The identified clinical symptoms are apparently both systemic (manifested as UCTD signs) and localized (leiomyoma formation and infertility). Conclusion. A high frequency of the combination of clinical and phenotypic signs of UCTD with infertility in intramural uterine leiomyoma was established. The present study allowed us to determine significant signs of UCTD, the presence of which is associated with a high risk of infertility. The results of the study and the risk score can be used to assess potential fertility in intramural leiomyoma in patients of reproductive age and to choose treatment tactics. Key words: uterine leiomyoma, undifferentiated connective tissue dysplasia, infertility, infertility risk prediction

Комбинированные оральные контрацептивы как метод лечения пациенток репродуктивного возраста с обильными менструальными кровотечениями

Background: heavy menstrual bleeding (HMB) is one of the unsolved problems in gynecological practice. The frequency of HMB is exactly unknown, which can be most likely related to an individually perceived blood loss volume. Patients with HMB are at high risk of iron deficiency and anemia. The main problem remains the lack of a single treatment algorithm for the HMB in female patients of reproductive age. Medical specialists should actively and, at the same time, effectively solve this clinical problem. Aim: to evaluate the efficacy of combined oral contraceptive (COC) containing 0.03 mg of ethinylestradiol and 2 mg of chlormadinone acetate in patients of reproductive age with HMB. Patients and Methods: the study involved 87 female patients aged 22–43 y.o. with complaints of HMB. After a complete clinical and laboratory examination, all patients were prescribed COC (0.03 mg ethinylestradiol and 2 mg chlormadinone acetate) for 6 months with subsequent efficacy evaluation. The following parameters were evaluated: menstruation duration, RBC, hemoglobin and ferritin count. Results: initially, hemoglobin count was 78.4±0.5 g /L, RBC count — 2.9×1012/L, and ferritin count — less than 29 mg/dL in the setting of normal hemoglobin count were observed in 31 (35.6%) female patients. COCs prescription demonstrated efficacy in blood loss volume decrease during menstruation, which was noted by 85 (97.7%) female patients. Thus, it contributed to the iron content normalization in 29 (93.5%) of 31 patients. The frequency of side effects, which were manifested by discomfort in the mammary glands, nausea, headache, did not exceed 17%. All manifestations associated with drug intake did not require its cancellation or additional treatment. Conclusion: COC containing 0.03 mg of ethinylestradiol and 2 mg of chlormadinone acetate is an effective drug for the treatment of HMB in female patients of reproductive age, allowing to reduce the frequency of latent iron deficiency forms. KEYWORDS: combined oral contraceptives, heavy menstrual bleeding, ethinylestradiol, chlormadinone acetate, iron deficiency anemia, menstrual cycle control, hormonal contraception. FOR CITATION: Manukhin I.B., Manukhina E.I., Safaryan I.R., Ovakimyan M.A. Combined oral contraceptives as a treatment method for female patients of reproductive age with heavy menstrual bleeding. Russian Journal of Woman and Child Health. 2023;6(3):253–257 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-6.

Корреляции между клинико-лабораторными показателями и маркерами ангиогенеза и фиброза в операционном материале при миомэктомии

Introduction. The search for the relationships between clinical features of patients with uterine fibroids (uterine myoma, leiomyoma) and the characteristics of their myomatous nodules is relevant for identifying prognostic markers. Aim. In patients of reproductive age with uterine fibroids, to identify the presence of correlations between clinical laboratory parameters and markers of inflammation and fibrosis in the surgical specimens. Materials and methods. Myomectomy was performed in 226 female patients with myomatous no¬dules. Examination of patients included clinical investigations (ultrasound, magnetic resonance imaging), extragenital abnormalities were assessed. Samples of the dominant myomatous nodules and myometrium were examined using enzyme-linked immunosorbent assay (ELISA) for the content of baseline and stimulated by polyclonal activators (PA) vascular endothelial growth factor (VEGF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in the incubation medium. The expression of progesterone receptors (PgR) and VEGF using immunohistochemistry (IHC) was assessed. Results. The combination of uterine fibroids with endometriosis in reproductive-aged women influenced a number of histological and molecular characteristics of the dominant myomatous nodule: positively – on the grade of fibrosis (p &lt; 0.0001), negatively – on the PA-induced production of GM-CSF and VEGF (p = 0.0054 and p = 0.0016, respectively). Patients with adenomyosis had more myomatous nodules (p = 0.0192) compared with patients without any form of endometriosis, while the largest nodule diameter and the degree of fibrosis were in women without adenomyosis (p = 0.0397 and p = 0.0344, respectively). PA-induced VEGF production in the nodule is greater in adenomyosis (p = 0.0326), while PgR expression in the perifocal myometrium is less (p = 0.045). In patients with uterine myoma, the body mass index had a weak positive correlation with VEGF expression in the perifocal myometrium. The number of myomatous nodules had weak positive correlation with the stimulation index of PA (SIPA) which reflects their influence of the VEGF production in the dominant nodule in vitro. The degree of fibrosis of the dominant nodule was characterized by moderately positive correlation with the expression of VEGF in the perifocal myometrium according to IHC. Conclusion. The results of the study reflect the systemic nature of myomatous transformation with multifocal myometrium tumor growth and the potential for the formation of new myomatous nodules, especially in women with elevated body mass index.

Opportunities to improve the effectiveness of complex therapy for endometriosis and chronic pelvic pain in patients of reproductive age

Opportunities to improve the effectiveness of complex therapy for endometriosis and chronic pelvic pain in patients of reproductive age

Трехмерная эхография в оценке степени облитерации полости матки

Objective. To improve treatment outcomes for intrauterine adhesions (IUA) in reproductive-aged patients by implementing an algorithm of three-dimensional (3D) ultrasound diagnostics. Patients and methods. This study included 146 women with suspected IUA. The mean age of patients was 30.7 ± 3.4 years. All patients were retrospectively divided into 5 groups: Group 0 (n = 27) – patients with thin endometrium; group I (n = 29) – patients with grade 1 IUA; group II (n = 22) – patients with grade 2 IUA; group III (n = 37) – patients with grade 3 IUA; group IV (n = 31) – patients with grade 4-5 IUA. The control group consisted of 20 healthy women. Algorithms for using different functions and modes of 3D ultrasound to assess the degree and architectonics of IUA were practiced. Results. Qualitative (polygonal shape of the uterine cavity, invagination of myometrium into the endometrium, fragmentary/total endometrial absence) and quantitative (dynamic examination of endometrial volume) ultrasound criteria defining the degree of IUA in 3D ultrasound according to the ESGE classification were developed. Conclusion. Based on the developed 3D ultrasound criteria, the algorithm and criteria for diagnosing the degree of IUA were established. The analysis of intrauterine architectonics allowed prediction of the course and choice of adhesiolysis technique and to reduce the number of intraoperative complications. Key words: 3D ultrasound, intrauterine adhesions, myomectomy, Asherman’s syndrome, uterine artery embolization, echohysterography

Оценка уровней экспрессии различных субъединиц никотиновых ацетилхолиновых рецепторов при эндометриозе яичников в рамках поиска новых перспективных методов таргетной терапии эндометриоза

Objective. To study and evaluate the expression patterns of different subunits of nicotinic acetylcholine receptors (nAChRs) in reproductive-aged patients with ovarian endometriosis. Patients and methods. This study included 60 patients who were divided into two groups: group 1 – women with ovarian endometriosis, group 2 – control group. During surgical treatment, all patients underwent ovarian biopsy followed by RNA isolation, reverse transcription, real-time polymerase chain reaction, obtaining primary endometriosis cell cultures with further assessment of nAChR functional activity by the patch-clamp technique. Results. The study revealed a clinically significant expression of certain nAChR subunits, which was elevated specifically in biopsy samples obtained from endometriosis patients (α7, α9, α6, α4) compared to the control group. Furthermore, an increase in the expression of α4 and β2 subunits was detected for the first time, demonstrating the presence of heteromeric α4β2 receptors on endometriosis cells, the functionality of which was tested and confirmed by the patch-clamp technique. Conclusion. It was shown that the genes encoding these receptors are expressed at high levels, and the receptors themselves have good functional activity, which allows us to consider them as potential therapeutic targets for suppressing the production and secretion of pro-inflammatory cytokines in ovarian endometriosis. Key words: nicotine acetylcholine receptors, reverse transcription, real-time polymerase chain reaction, ovarian endometriosis, patch-clamp technique

Факторы формирования неопластических процессов в шейке матки

Aim: Review the literature data on the pathogenetic aspects of the formation of squamous intraepithelial lesions and the role of immunological mechanisms in the formation of this group of cervical diseases. Key Points. Cervical cancer (CC) is a multi-stage process that is often preceded by human papillomavirus (HPV)-associated intraepithelial lesions. The establishment of causal interactions between the virus and malignancy, as well as the study of epidemiological data, leads to the formation of models of cervical carcinogenesis: infection, persistence, progression to the precancerous stage, and finally, cervical cancer. Despite the clear and obvious path of malignancy, as well as the availability of generally available diagnostic methods in the arsenal of a practicing obstetrician-gynecologist, the assessment and prediction of the further development of cervical pathologies in patients of active reproductive age remains difficult. In general, cervical cancer can be considered an excellent model for understanding the staging of malignancy processes, which will be primarily associated with the impact of human papillomavirus infection and changes in the immunological aspects of endo-and exo-cervix. Conclusion. An analysis of sources published in the Cochrane Librare, Google Scolare and PubMed systems was carried out. In recent years, the understanding of human papillomavirus-associated tumor interaction with the host immune system has improved, so the development of new approaches targeting immune checkpoints has sparked interest in the use of immunotherapy in cervical cancer. CC is curable if detected at an early stage. However, reliable diagnostic and prognostic markers related to the physiological and pathological regulation of cervical cancer are currently not available. Therefore, the approach to the treatment of cervical cancer has remained unchanged for several decades, and new diagnostic strategies are currently required, due to the interaction of the immune system and the virus. Keywords: genotyping, apoptosis, cervical neoplasia, polymerase reaction, interleukin-18, tumor necrosis factor alpha, viral load.

Bacterial vaginosis - diagnostic dilemma and implications

Background/Aim. Bacterial vaginosis (BV) is one of the most common microbial dysbiosis, characterized by a decrease of Lactobacillus spp. with an increase of other anaerobic bacteria species [Gardnerella (G.) vaginalis, Atopobium (A.) vaginae, Prevotella spp, Mobiluncus spp, etc.] causing serious gynecological and obstetric complications. There-fore, it is particularly important to have accurate and reliable diagnostic standards. The aim of this study was to compare the results of various diagnostic methods for detecting BV, such as Amsel, Nugent, and Ison and Hay criteria, as well as multiplex quantitative real-time polymerase chain reaction (mqRT-PCR) test. Methods. This study involved vaginal swabs from 235 patients of reproductive age. Nugent criteria were used as the ?gold standard? compared with Amsel and Ison/Hay criteria as well as mqRT-PCR test based on the detection and quantification of G. vaginalis, A. vaginae, Lactobacillus spp., and total concentration of bacterial DNA. The kappa coefficient was employed to measure agreement between tests. Results. Our analysis demonstrated excellent agreement between Ison/Hay criteria and Nugent scores (kappa = 0.95), good agreement between Amsel and Nugent criteria (kappa = 0.78), while between Nugent criteria and mqRT-PCR test agreement was moderate (kappa = 0.59). Total agreements of Ison/Hay, Amsel, and mqRT-PCR against Nugent scores were 94.9%, 90.2%, and 74%, respectively. Nugent methods classified the highest number of intermediate patients - 60 (25.2%). The largest number of BV patients was detected by the mqRT-PCR method, while the largest number of healthy patients was detected by Amsel criteria. Conclusion. The mqRT-PCR is the best choice for BV diagnosis because it is more efficient at differentiating patients with intermediate results. Compared to Amsel and Nugent methods that group patients into 2 or 3 categories, the mqRT-PCR method recognizes other conditions of vaginal flora important for correct diagnoses and application of better therapeutic approaches, as well as preventing possible clinical consequences of this dysbiosis.

Outcomes of Fertility Preservation for Female Cancer Patients in a Single Tertiary Center.

To report our experience of fertility preservation (FP) in female cancer patients. We retrospectively analyzed the medical records of female who underwent elective oocyte or embryo cryopreservation before cancer treatment between January 2015 and December 2020 at Asan Medical Center. We analyzed the type of cancer, the rate of reuse of cryopreserved oocytes or embryos, and fertility outcomes such as the resumption of menstruation or pregnancy. A total of 174 patients underwent 182 oocyte retrieval cycles after controlled ovarian stimulation for oocyte or embryo cryopreservation. The median age of patients was 33.0 (range 19-46) years, and the patients were most unmarried female (65.52%). The majority of patients were diagnosed with breast cancer (78.16%), and the remaining were diagnosed with gastrointestinal (6.33%) and hematologic malignancies (5.75%). The maturation rate of oocyte cryopreservation was 83.33%, and the fertilization rate of embryo cryopreservation was 72.07%. Of the 57 patients currently not undergoing cancer treatment, 34 resumed menstruating and 19 (33.33%, 19/57) returned to attempt a pregnancy. Among them, five patients succeeded in natural pregnancy. Eleven patients received frozen-thawed embryo transfer, and four patients succeeded in becoming pregnant (36.36%, 4/11). Only 6.3% of patients returned to use their gametes, and 93.7% of gametes are still in storage. FP in cancer patients should be considered before cancer treatment. Through continuous research on oncofertility, it is necessary to consider how to increase the return rate and provide appropriate information to cancer patients of reproductive age.

Возможности сохранения репродуктивной функции у пациенток с атипической гиперплазией и начальным раком эндометрия

Due to the childbearing shift to the fourth decade of life, the probability of detecting endometrial cancer (EС) in female patients who did not have time to realize their reproductive life plan increases. If cancer is detected in female patients of reproductive age and they want to realize their fertility in the future, this option should be considered at the stage of treatment planning. Discussion concerning the admissibility and safety of conservative EC treatment is extremely relevant in the current demographic conditions. The article considers the decision-making algorithm on the conservative therapy indication in the cancer manifestation in a female patient of reproductive age with unrealized fertility, as well as the protocol when making such a decision. Data on the frequency of pregnancy in female patients after conservative treatment of EC are given. The accumulated experience showed that drug treatment of atypical hyperplasia and initial EC is effective, and upon condition of subsequent pregnancy does not aggravate the oncological prognosis. KEYWORDS: endometrial cancer, uterine cancer, atypical hyperplasia, pregnancy, assisted reproductive technologies, conservative therapy. FOR CITATION: Serova O.F., Dobrokhotova Yu.E., Borovkova E.I., Charkhifalakyan A.V. Possibilities of preserving reproductive function in female patients with atypical hyperplasia and endometrial cancer at an early stage. Russian Journal of Woman and Child Health. 2023;6(4):352–361 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-5.

Оценка эффективности применения радиочастотного воздействия в лечении вульвовагинальной слабости

Aim: to study the effiacy and safety of the vulvovaginal laxity treatment using non-ablative radiofrequency — dynamic quadripolar radiofrequency (DQRF™). Patients and Methods: the study included 79 female patients of reproductive age (35 to 42 y.o.) who were diagnosed with second-degree uterine prolapse according to the POP-Q system after a preliminary examination. The female patients were divided into 2 groups. Main group included 47 female patients who underwent the continuous DQRF™ to the internal genital organs four times with an interval of 7 days using the EVA™ device with intravaginal and external attachments. Comparison group included 32 female patients who performed a set of Kegel exercises for 4 months to correct vulvovaginal laxity. DQRF™ efficacy is due to thermal and oscillatory effects on tissues. Under the DQRF™, the temperature of the vaginal mucosa rises evenly to 40–42 °C, fibroblasts are activated and new connective tissue fibers are formed. The radio waves effect on microcirculation promotes the collateral formation and increases tissue blood flow, providing the metabolism acceleration in the cells of the mucous membrane, including fibroblasts. Results: 4 months after the treatment in the group 1, the trend of changes in the studied indicators turned out to be more statistically significant versus the group 2: patients less commonly noted the foreign body sensation, pollakiuria, dyspareunia, constipations. The incidence and severity of vaginal symptoms, manifestations of pelvic floor dysfunction (PFDI-20) in patients decreased, and the condition of the pelvic diaphragm (PFIQ-7) with the quality of sexual life (PISQ-12) improved. The treatment effect persisted for a year. Therapy was not accompanied by the adverse events: burns in the area of radiation, pain and/or discomfort. Conclusion: the method of non-ablative radiofrequency treatment of vulvovaginal laxity is clinically effective and safe. KEYWORDS: vulvovaginal laxity, pelvic organ prolapse, non-ablative radiofrequency, pelvic floor dysfunction, dyspareunia. FOR CITATION: Kalimatova D.M., Dobrokhotova Yu.E. Efficacy evaluation concerning radiofrequency treatment of vulvovaginal laxity. Russian Journal of Woman and Child Health. 2023;6(4):347–351 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-4.

Варианты сохранения фертильности у пациенток с пограничными опухолями яичников

Aim: To study the main strategies for maintaining fertility in patients with borderline ovarian tumors (BOT). Key points. A detailed systematic analysis of modern domestic and foreign literature on BOT and preservation of fertility in patients was carried out. The study used data hosted on such electronic resources as eLIBRARY, Scopus, PubMed, MEDLINE, ScienceDirect and Cochrane Library (from January 2010 to 2022). This article discusses current views on the management of patients of reproductive age with BOT in order to implement the reproductive function. Since BOTs often develop in women of reproductive age, one of the main goals in their treatment is to preserve fertility, but with minimizing the risk of recurrence. Conclusion. One of the central tasks in the management of patients with BOT is the preservation of fertility. The key approaches to its solution are organ-preserving interventions (including conservative ones), cryopreservation of embryos, and the use of assisted reproductive technologies (ART). Nevertheless, taking into account the rather high risk of tumor recurrence, further studies are required to evaluate the efficacy and safety of ART in patients with BOT. Keywords: borderline ovarian tumors, tumors of potentially low malignancy, assisted reproductive technologies, fertility preservation.

Особенности вегетативного статуса и качества жизни у пациенток репродуктивного возраста с недифференцированной дисплазией соединительной ткани

The purpose — to study the features of vegetative status and quality of life in female patients of reproductive age with UCTD. Material and methods. We examined 88 female patients (average age 25.0 ± 6.5 years) with UCTD. The control group consisted of 100 practically healthy women without signs of UCTD (average age 26.6 ± 5.4 years). All patients with UCTD had a deficiency of 25(OH)D. In the group of women with UCTD, a significant decrease in the magnesium content in blood serum and oral fluid was diagnosed in comparison with the control group (p = 0.001). The patients were treated with Magnerot (Worwag Pharma, GmbH&amp;Co., KG, Germany) and Fortedetrim (MEDANA PHARMA, SA, Poland) for 8 weeks. After 8 weeks of therapy with Fortedetrim, vitamin D content (25 (OH)D) in blood serum reached reference values and amounted to 36.2 ± 5.2 ng/ml (p = 0.001). After 8 weeks of treatment with Magnerot, the magnesium content in blood serum and oral fluid also reached reference values and amounted to 0.95 ± 0.04 mmol/l and 0.62 ± 0.06 mmol/l, respectively (p = 0.001). Results and discussion. The obtained results testify to a statistically significant decrease in the level of personal anxiety, manifestations of depression, autonomic disorders and improvement in QOL and values of the questionnaire of childbearing role orientations against the background of treatment with Magnerot and Fortedetrim for two months (p &lt; 0.05). Conclusion. The results obtained indicate the need to include magnesium and vitamin D preparations in the program of medical rehabilitation of women of reproductive age with UCTD and its mandatory combination with psychological rehabilitation, taking into account the fact that stressful states and depressive disorders are accompanied by magnesium deficiency. The health protection of such patients becomes especially significant under the catastrophic demographic situation in the Russian Federation («demographic pitfall»).

Возможности медикаментозной коррекции климактерического синдрома у больных онкологическими заболеваниями органов репродуктивной системы

Aim: To assess the severity of menopausal symptoms and quality of life in patients with iatrogenic menopause depending on the therapy. Design: A randomised parallel group clinical study. Materials and methods. The study enrolled 60 patients of reproductive age with iatrogenic menopause following bilateral ovariectomy who had a history of reproductive tumours. The patients were randomised into 2 groups. Group 1 (n = 34) was treated with escitalopram as follows: 5 mg once daily — 7 days, 10 mg once daily — 2 weeks, then 10 mg daily (subgroup 1а) or 20 mg daily (subgroup 1b) — 12 weeks. A dose of 20 mg daily was used where the frequency and severity of menopausal symptoms did not fall below 50 % in 3 weeks with a dose of 10 mg daily. Group 2 patients (n = 26) were prescribed an herbal product called cimicifuga racemosa essence (BNO 1055) at a dose of 6.5 mg 1 tablet once daily for 15 weeks. The patients' condition was assessed using a daily hot flash questionnaire; Quality of Life Questionnaire SF-36; Greene Climacteric Scale; and Insomnia Severity Index. Results. The number of hot flushes reduced in all subgroups; however, the reduction was statistically significant only in subgroup 1a. Greene Climacteric Scale showed that following 15 weeks of therapy in subgroup 1a there was significant reduction in the intensity of menopausal symptoms, anxiety and depression, improved somatic signs, reduced severity of vasomotor symptoms, and improved libido vs. baseline. Subgroup 1b patients demonstrated statistically significant reduction in menopausal symptoms and anxiety. Group 2 had marked reduction in menopausal symptoms and depression. Intergroup comparison demonstrates that the most marked effect from the therapy on menopausal symptoms, anxiety, depression and severity of vasomotor symptoms was observed in subgroup 1а vs. subgroup 1b and group 2. Quality-of-life assessment showed significant improvement in the physical component in group 2 patients, while psychological improvements were better in subgroup 1а after 15 weeks of therapy. Subgroup 1a patients had significant reduction in Insomnia Severity Index, while subgroup 1b and group 2 patients did not demonstrate any significant reduction in this parameter. Conclusion. Patients, for whom hormonal menopause therapy is contraindicated, including patients with hormone-driven malignancies, require therapy to improve their quality of life, manage their menopausal syndrome, correct psychoemotional state and improve sleep. The study demonstrated efficacy both of non-hormonal antidepressant escitalopram (a selective serotonin reuptake inhibitor) and BNO 1055 essence (a medicinal product). In mild and moderate menopausal syndrome, it is recommended to use BNO essence, while severe cases should be treated with 10 mg escitalopram daily, and therapy efficacy should be assessed after 3 weeks of therapy. Key words: menopause, malignancies, menopausal syndrome, selective serotonin reuptake inhibitor, antidepressants, cimicifuga racemosa, BNO 1055.