GYNECOLOGY

Published by MediaMedica
Print ISSN: 2079-5696
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Aim. To compare effects of the drug containing ethinylestradiol (EE) 0.03 mg and drospirenone (DRSP) 3 mg and the drug containing EE 0.02 mg and DRSP 3 mg on the skin and anthropometric parameters. Materials and methods. A prospective comparative randomized study included 40 women of reproductive age who didn’t have contraindications to use of combined oral contraceptive (COCs). The first group consisted of 20 women who were administrated EE 0.03 mg and DRSP 3 mg in the 21/7 regimen according to a prescribing information; the 2nd group included 20 patients who were administrated EE 0.02 mg and DRSP 3 mg in the 24/4 regimen according to a prescribing information. The study protocol included 8 visits: at the 0th visit, the inclusion and exclusion criteria were evaluated, at the 1st visit patient were randomized (envelope method) to receive one or another drug, at the 2nd - 7th visits (once a month) blood pressure was measured, anthropometric parameters were determined including body weight, height, waist, hips as well as body mass index, a degree of hirsutism (with Ferriman-Gallwey scale), skin and hair skin oiliness, acne (with a 10-point visual scale) were evaluated. Results. The use of EE 0.03 mg and DRSP 3 mg for 6 months did not significantly affect the body weight and body mass index, waist and hips. In the 6th month, the use of EE 0.03 mg and DRSP 3 mg lead to a statistically significant decrease in skin oiliness, severity of acne and hirsutism, which was comparable to a clinical effectiveness of EE 0.02 mg and DRSP 3 mg. Conclusions. EE 0.03 mg and DRSP 3 mg has a similar effect on skin oiliness, severity of acne and hirsutism with EE 0.02 mg and DRSP 3 mg, without significantly affecting the main anthropometric parameters. It is likely that the effect of DRSP-containing COCs on androgen levels and adipose tissue is due precisely to the effect of DRSP, and not to the dose of EE.
 
The frequency of structural chromosomal transpositions can range from 1.8 to 8% among patients with reproductive disorders. There are several types of the rarest chromosomal abnormalities: insertion (insertion of a chromosomal region) and inversion (rotation of a chromosome region). This article describes a clinical case of the infertility treatment using assisted reproductive technologies in a woman with a rare chromosomal abnormality: simultaneous insertion and inversion of chromosomes 46, XX, ins (13;4)(q34;p14p15.3), inv(4)(p14q12). The structure and frequency of chromosomal aberrations were determined by high-throughput sequencing in preimplantation embryos. The result of the sequencing analysis showed that unbalanced variants for a known pathology were detected in 9 (56.3%) out of 16 observations, while in 6 (37%) only for a pathology known in the karyotype and in 3 (19%) they were presented simultaneously with the pathology of other chromosomes or with mosaicism. According to the results of the study, in preimplantation embryos, where one of the parents had chromosomal abnormalities, in addition to unbalanced variants, there is aneuploidy of other chromosomes not involved in the known pathology. They are described in 3 (21%) out of 14 observations of all identified pathology. In this regard, patients with aberrations in the karyotype are recommended, whenever possible, to carry out preimplantation genetic testing of structural rearrangements by methods allowed to analyze all chromosomes simultaneously. For example, high-throughput sequencing on the Illumina platform may become an alternative for prenatal diagnostics, which is performed in fertile couples with high risk of having a child with hereditary or congenital disorders. In the case of detection of chromosomal changes in the fetus, patients are faced with a number of ethical issues related to the necessity for medical abortion, which may contradict their religious and moral convictions.
 
The article describe a rare clinical observation of a giant paraovarian cyst in a teenage girl with laparoscopic removal. The presence of giant cyst in the abdominal cavity in adolescent girls requires a multidisciplinary approach, taking into account visual diagnostic methods, preference for MRI, followed by the participation of experienced teams of highly qualified specialists in order to conduct a minimally invasive organ-preserving treatment.
 
Vasomotor symptoms, including hot flushes (HF), are the most common symptoms of menopause, requiring treatment with estrogen and/or progestogen. Recent international guidelines recognize the need to use the lowest effective dose of hormone replacement therapy. Drospirenone (DR) in combination with 17-estradiol (E) is used as hormone therapy (HT) for relief the symptoms and prevention of postmenopausal osteoporosis.The aim of this review is a meta-analysis of studies examining the efficacy and safety of low-dose DR and E for the treatment of vasomotor symptoms inpostmenopausal women.The review presents data of 2 large randomized controlled studies that evaluated the lowest effective dose combination DR/E, the safety of this dose for endometrium, identified features of its pharmacodynamics and pharmacokinetics, depending on various factors.In the first, a study of the lowest effective doses of DR/E for the treatment of HF in postmenopausal women was made. It led to the conclusion that the com-bination of DR 0,25 mg/E of 0,5 mg is the minimum effective dose. Efficacy of low doses of DR/E correlated with exposure DR and E in serum, while smoking had a negative impact on the Efficacy of treatment.Another study assessed the risk of endometrial hyperplasia and bleeding pattern in patients receiving 0,25 mg DR/E of 0,5 mg for 12 months. At the end of the study no evaluable women in the DR/E2 group had an endometrial biopsy result of hyperplasia or worse, which endometrial confirmed the safety of receiving DR 0,25 mg/E of 0,5 mg.Thus, the minimum effective dose for the relief of HF without causing any significant impact on the endometrium is DR of 0,25 mg/E of 0,5 mg. According to the results of the pharmacokinetic study a correlation between effectiveness of low dose DR/E with DR and E exposure levels was showed, and smoking reduces the effectiveness of hormonal therapy. This drug not only copes with moderate to severe hot flashes, but also reduces the incidence of symptoms of vulvovaginal atrophy, improving quality of life.
 
Course and outcome of COVID-19 in pregnant woman during 1-2nd and 3rd waves of epidemic
Aim. To compare risk factors, features of COVID-19 course and outcomes in pregnant women during epidemic increase in incidence in 2020 and 2021. Materials and methods. The study included 163 pregnant women with laboratory-confirmed SARS-CoV-2 infection within May December 2020 (1st2nd waves of the epidemic) and 158 pregnant women who had new coronavirus infection within May August 2021 (3rd wave of the epidemic). Patients in all groups were comparable in age (1835 years), social status, parity, body mass index, and had no known risk factors for COVID-19. Results. Iron deficiency anemia, smoking, belonging to the Buryat ethnic group were recognized as persistent risk factors for COVID-19 in pregnant women. Over the 1st year of the pandemic, in pregnant women, the following clinical manifestations of novel coronavirus infection were commonly seen: anosmia (87.7%), somnolence (68.7%), shortness of breath even with a mild lung damage (68.1%). In the 3rd wave of the 2nd year of the pandemic, the leading signs and symptoms were cough (70.3% vs 38.7%, p0.001), runny nose (46.2% vs 3.7%, p0001), sore throat (367% vs 37%, p0.001); an increase in body temperature above 38C (19.6% vs 7,4%, p=0.006), pneumonia detected by computed tomography (61.4% vs 21.4%; p0.001). There was a significant increase in the incidence of severe lung lesions (with computed tomography 34: 17.7% vs 4.9%; p0.001) and admissions to intensive care units (11.4% vs 6.4%; p= 0041). There was a need for invasive mechanical ventilation (1.89% vs 0%; p=0.118). There was 1 death (0.63% vs 0%; p= 0.492), which was associated with the fulminant course of COVID-19. Conclusion. Persistent COVID-19 confounders in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, smoking, and belonging to the Buryat ethnic group. The clinical course of SARS-CoV-2 infection has changed and became more unfavorable: symptoms of acute respiratory disease (cough, runny nose, sore throat) began to prevail, the rate and severity of pneumonia and rate of mortality increased.
 
The objective of the study was to evaluate an epidemiological characteristic and the course of COVID-19 in pregnant women from the Far East and Siberian Federal Districts of Russia. Materials and methods. The analysis of operational information on the incidence of COVID-19 and the its features in pregnant women and after childbirth provided by the chief obstetrician-gynecologists of the Far Eastern Federal District and Siberian Federal District on May 25, 2020 and August 25, 2020 is carried out. Mathematical analysis included descriptive statistics methods, analysis of contingency tables, where the 2 value, the achieved significance level (p) Results. On August 25, 2020, 2010 cases of COVID-19 in pregnant women were detected in two subjects, including 134 active cases. In the population, the proportion of pregnant women among cases of COVID-19 was 1.45%. Pneumonia in pregnant women was registered in 44.8% of cases, severe course of the disease - in 3.7%, hospitalization in RAW - in 1.9% of cases, mechanical ventilation - 0. In the population, pneumonia was registered in 24.4% of cases, hospitalized in RAW - 2.1%, on mechanical ventilation - 0.77%. The incidence in pregnant women was 1464.7 per 100000 (in the population - 591.8 per 100 000). 23 (1.76%) COVID-19 (+) newborns were identified, despite preventive measures and separation of mother and child immediately after childbirth, which does not exclude vertical transmission of the disease. Maternal mortality was 2 cases (0.1%) vs population mortality 1.49%. Perinatal mortality was 7 cases (0.35%). There were 5 (0.25%) stillbirths. Early neonatal mortality was 2 (0.1%) cases. Conclusion. The incidence of COVID-19 in pregnant women in the Far East and Siberia is higher than in the general population with a higher incidence of pneumonia, but a milder course: less need for ICU, mechanical ventilation and mortality. 23 cases of SARSCoV-2-positive newborns, despite the separation of mother and child, do not exclude the possibility of vertical transmission of infection. Keywords: COVID-19, pregnancy, epidemiology, incidence, pneumonia, mortality
 
Aim. To identify confounding factors, features of the clinical course and outcomes of COVID-19 in pregnant and non-pregnant patients of early reproductive age who have no known risk factors and premorbid background. Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (1835 years), social status, parity, body mass index, had no known risk factors for COVID-19; those who got sick were treated simultaneously. Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%; p0.001) or had a mild course of the disease (58.9% vs 24%; p0.001). In non-pregnant patients, the course of infection was more often moderate (61% vs 14.7%; p0.001) or severe (10% vs 3.1%; p=0.038). Clinical manifestations of new coronavirus infection (NCV) in pregnant women were dominated by anosmia (87.7% vs 40%; p0.001), drowsiness (68.7% vs 17%; p0.001), dyspnea, even with a mild lung lesion (68.1% vs 19%; p0.001), headache (41.7% vs 24%; p=0.006), arthralgia (29.4% vs 16%; p=0.021), while fever above 38 C (7.4% vs 28%; p0.001) and cough (38.7% vs 61%; p0.001) were much less common. With computed tomography, pneumonia in pregnant women was diagnosed several times less often (21.4% vs 87.4%; p0.001). In the non-pregnant group, there was one death (1% vs 0%; p=0.201) associated with late hospitalization for severe NCI with grade 4 pulmonary involvement as shown on computed tomography. Conclusion. Confounders of COVID-19 in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat subpopulation, and smoking. In pregnant women, the main clinical symptoms of SARS-CoV-2 infection, with the exception of loss of smell, were nonspecific and characteristic of the physiological course of late gestation: drowsiness, dyspnea, joint pain. The predominance of mild or asymptomatic forms of infection, the lower incidence of pneumonia, and the absence of deaths in pregnant women suggests a more favorable course of COVID-19 NCI.
 
Aim. To assess the incidence, clinical course, outcomes of a novel coronavirus infection (NKI) COVID-19 for mother and child in the population of pregnant women in the Far Eastern (FEFD) and Siberian Federal Districts (SFD). Materials and methods. The study design: a population-based epidemiological prospective study. We analyzed operative information on NKI COVID-19 incidence and features of clinical course in pregnant women, women in labor and parturient women as well as maternal and perinatal outcomes for March 11 to December 25, 2020 which were provided by the FEFD and SFD chief obstetricians-gynecologists. Mathematical analysis included methods of descriptive statistics, analysis of contingency table, where the value of 2, the achieved level of significance (p) was estimated. Results. In the FEFD and SFD, over the COVID-19 2020 epidemic, the SARS-CoV-2 virus was revealed in 8485 pregnant women, women in labor and postpartum women (5.9% of pregnant women subjected to regular medical check-up; 1.71% of the sick entire population). The incidence rate in pregnant women was 3.0 times higher than in the entire population: 5933,2 vs 1960,8 per 100 thousand (p0.001). Among SARS-CoV-2 infected patients, 27.4% (2324) were asymptomatic, 52.7% (4471) have mild, 16.6% (1388) moderate, 2.5% (210) severe 0,5% (39) extremely severe clinical course. In the intensive care and anesthesiology departments, 3.57% of pregnant women and 2.24% of the entire population (p0.001) have been treated. Rate of using invasive artificial lung ventilation in pregnant women was lower than in the population: 0.48% vs 1.05% (p0.001). 27.97% (2373) of women with confirmed NKI COVID-19 completed pregnancy. 81,7% of mothers delivered on time, 18.3% prematurely. Cesarean delivery was performed in 42,0% of women, operative vaginal delivery (vacuum extraction, obstetric forceps) was registered in 0.2% of cases. 12 (0.14%) mothers died. The maternal mortality rate was 505.69 per 100 thousand live births (0.51% of patients with COVID-19 who gave birth). Mortality rates and the proportion of deaths in the entire population were statistically significantly higher: 1948.93 per 100 thousand sick population and 1.95% (p0.001), respectively. 37 (1.56%) cases of perinatal losses were registered, of which 31 (1.30%) stillbirths, 6 (0.26%) early neonatal mortality. The SARS-CoV-2 virus was revealed in 148 (6.2%) newborns with the observance of anti-epidemic measures and separation of the mother and child immediately after delivery. Conclusion. The rate of revealing SARS-CoV-2 virus in pregnant women, women in labor and parturient women in Siberia and the Far East was 3.0 times higher than in the entire population, while clinical course of infectious process was less severe (less need for invasive mechanical ventilation, lower mortality rate). In mothers with COVID-19, preterm birth rate was 3.0 times higher, caesarean delivery rate 1.4 times higher compared with the average population indicators. Reveling SARS-CoV-2 virus RNA in 6.2% of newborns suggests the possibility of vertical transmission of the infection.
 
Huge resources of the health system and economies of all countries of the world are devoted to combating the COVID-19 pandemic (Coronavirus disease 2019). It is important to formulate effective measures to prevent the spread of a new coronavirus infection and the development of its postcoid complications. For this, it is necessary to study in depth not only the etiopathogenesis, clinical manifestations of the disease, but also to assess the influence of another pathology on the course of the development of the disease. Particular attention should be paid to pregnant patients with COVID-19. To clarify the relationship between COVID-19 and iron deficiency anemia. The information material includes data from scientific articles available in Pubmed and Internet resources on this topic, as well as data from our own observations. Timely diagnosis and treatment of iron deficiency anemia in pregnant women helps not only to prevent the development of obstetric and perinatal complications, but also to prevent the development of a severe course of COVID-19.
 
Aim. To evaluate the effectiveness of the anti-adhesive barrier in the form of a gel based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg with various techniques of surgical treatment of ectopic tubal pregnancy. Materials and methods. A randomized study was conducted on 98 women who underwent laparoscopic resection of the ampulla of the fallopian tube, together with a embryo, followed by neostomatoplasty or salpingostomy with or without an anti-adhesive barrier. The primary outcome of the study was the incidence of uterine pregnancy and its outcomes at 18 months of follow-up; secondary outcomes were the frequency of adhesions in the pelvis, the frequency of patency of the operated fallopian tube according to second look laparoscopy with chromohydrotubation by 3 months of follow-up. Results. At 3 months of follow-up, the use of an anti-adhesion barrier reduced the incidence of postoperative adhesions in the area of the operated fallopian tube and the degree of adhesions in the pelvis; increased the frequency of patency of the operated fallopian tube when performing laparoscopic resection of a portion of the ampulla of the fallopian tube, followed by neostomatoplasty. By the 18th month of observation, no statistically significant difference in the incidence of spontaneous pregnancy and its outcomes in the studied women was detected. Conclusion. Use of 5 mg carboxymethylcellulose and 2.5 mg sodium hyaluronate anti-adhesive barrier with various organ-preserving methods of surgical treatment of ectopic tubal pregnancy reduces the frequency and extent of postoperative adhesions in the area of the operated fallopian tube, in the small pelvis, but does not increase fertility in the postoperative period.
 
Aim. Conduct a comparative assessment of the main indicators of the incidence of cervical cancer in Khabarovsk Krai (20092019) аnd the prevalence of types of human papillomavirus among the female population. Materials and methods. A comparative analysis of the data of the official statistics of the Ministry of Health of Khabarovsk Krai, using the Rosstat database for the period 20092019, taking into account the incidence, mortality, prevalence of types of human papillomavirus, was carried out. The dynamics trend was determined in the process of graphical analysis of the diagram and by modeling trends. The results of the studies were subjected to the methods of statistical information processing. Results. The results revealed in our study indicate that the increase in the incidence of cervical cancer in Khabarovsk Krai from 2009 to 2019 was 44.4% (with an average annual growth rate of 4.5%). Most often, cervical cancer in Khabarovsk Krai is detected in urban residents. The share of urban women with this pathology in 2019 reached 77.2%. The proportion of stage III cancer detected exceeds the proportion of stage IIIIV cancer by 2.5 times. Mortality in patients with cervical cancer in Khabarovsk Krai exceeds that in the Russian Federation. Of the 1617 residents of the city of Khabarovsk of reproductive age, 883 (54%) women had the presence of human papillomavirus. For our region, most often, women had highly oncogenic types of human papillomavirus 16, 56, 51. Conclusion. Statistical analysis based on the results of diagnosing early and advanced stages of cervical cancer, mortality from this nosological form, and the spread of the human papillomavirus remain among the most important criteria. The data obtained make it possible to assess the effectiveness of the chosen tactics in the regions and take timely corrective measures aimed at both early detection of cervical cancer and a decrease in the persistence of the human papillomavirus in women with background cervical pathology.
 
Abnormal uterine bleeding is a common problem in gynecology. It is a general term to describe menstrual disorders, including frequency, regularity, duration, and bleeding volume in non-pregnant women. Up to 1/3 of women experience this condition during their lifetime. Heavy menstrual bleeding not related to structural abnormality can be a serious health problem for many young women. It has a profound adverse impact on many aspects of their lives and increases the risk of iron deficiency anemia. However, up to half of these women consider the volume of menstrual blood loss normal, and physicians do not ask the relevant questions during counseling. The Russian Clinical Guidelines "Abnormal Uterine Bleeding" provide physicians guide to the assessment, management, and choice of treatment for women with heavy menstrual bleeding.
 
Combined oral contraception is known as a reliable method of birth control that can provide additional benefits to health and quality of life . Reliability and the main characteristics of combined oral contraceptives do not differ significantly. At the same time, there is a group of women with special medical needs who have questions when choosing hormonal medications, safety and additional benefits issues should be treated with special care. Among these potential users with special needs, no doubt, are teenagers , and among the various problems that reduce the commitment of contraception - the likely problem of weight gain stands out. Given the propensity for uncontrolled weight gain , due to inherent physiological insulin resistance of puberty period , it is necessary to use drugs with optimal metabolic profile for the girls who are prone to being overweight or already are overweight . Among these medications the combinations containing drospirenone and ethinyl estradiol microdozes can be found.
 
Background. The high contagiousness and susceptibility of a pregnant woman's body to a new coronavirus infection requires study not only of etiopathogenesis, but also of developing methods to prevent the development of this disease. Aim. To evaluate the preventive effectiveness of the use of a drug containing recombinant interferon alfa-2b (IFN-a2b) and an antioxidant complex in pregnant women during their stay in the family focus of a new coronavirus infection. Materials and methods. 75 pregnant women were under observation, in whose family there were patients infected with the virus that causes a new coronavirus infection. Treatment of sick relatives was carried out at home, as the disease in them proceeded in an uncomplicated form. The main group was formed by 37 pregnant women who treated the nasal mucosa with a preparation containing recombinant IFN-a2b in the amount of 5000 IU and an antioxidant complex (alpha-tocopherol acetate, citric and benzoic acids). The comparison group was formed by 38 pregnant women who did not use any drugs for prophylactic purposes. All patients observed generally accepted rules of personal hygiene and behavior. The duration of prophylactic use of the indicated medicinal product depended on obtaining a negative result for the causative agent of a new coronavirus disease, an infected family member. A smear from the nasopharynx and oropharynx was examined to detect SARS-CoV-2 RNA by PCR once every 57 days. Results. COVID-19 vaccination did not exclude infection with the SARS-CoV-2. Preventive treatment of the nasal mucosa with an IFN-a2b containing drug reduced the risk of infection with this viral agent in vaccinated patients who were in household contact with a patient with COVID-19 by 6 times. Asymptomatic and mild course of a new coronavirus infection was observed in 3 (25%) and 7 (58.3%) patients of 12 infected women from the main group and in 8 (22.9%) and 18 (51.4%) patients of 35 infected women from the comparison group, respectively. Further local use of the drug containing recombinant IFN-a2b and an antioxidant complex contributed to a decrease in the duration of infection and the course of the disease. Progression of COVID-19 was observed in unvaccinated patients with concomitant somatic pathology (diabetes mellitus, iron deficiency anemia, cardiovascular diseases, etc.): 2 (16.7%) and 9 (25.7%) people in groups, respectively. Conclusion. The use of recombinant IFN-a2b with an antioxidant complex in pregnant women with a family focus of new coronavirus infection is clinically appropriate and highly effective.
 
Anomalies of brain development is one of the first places in the structure of malformations in the fetus. The analysis of the volume of intracranial lesions of the brain using 3D/4D ultrasound techniques. Shown a poor prognosis in the presence of true brain tumors in fetuses. 3D/4D multipledata the technique of scanning is a highly informative approach for the differential diagnosis of intracranial neoplasms in the fetus.
 
Search for potential predictors of diagnosis of overactive bladder led to the study of polymorphism of the serotonin 5HT1A receptor genes 5HT2A and women with overactive bladder. The results showed differences in frequencies of alleles HTR1A -1019 (1016) C>G (rs6295) and HTR2A 102 C>T (S34S) (rs6313) between the core group (with OAB) and the control group was found.
 
Aim. To assess the reproducibility of cytological diagnoses in evaluating liquid cervical smears and immunocytochemical co-expression of p16/Ki-67 using manual and automatic methods. Materials and methods. Cytological smears prepared using the liquid cytology method on the Becton Dickinson device (SurePath technology) were studied. An immunocytochemical study was carried out using a Ventana BenchMark Ultra automatic immunostainer with a commercial CINtec kit (determination of p16/Ki-67 co-expression). In total, 100 cytological slides (50 pairs of Pap-smears and immunocytochemical slides) were studied. The diagnostic kit was reviewed by five cytologists independently, and the cytologic slides were evaluated using four categories according to the Bethesda system (2014) and according to the categories of normal/abnormal. The co-expression of p16/Ki-67 was assessed per the manufacturer's recommendations (Roche) using the manual method (light microscope) and the automatic Vision Cyto Pap ICC system. Statistical processing of the results was performed using the SPSS software package version 26.0.0.0 with the calculation of the reproducibility indices of Cohen's kappa and Fleiss' kappa. Results. When assessing the reproducibility of four categories of cytological diagnoses according to the Bethesda system (2014), Cohen's kappa was 0.0480.265. The overall Fleiss' kappa between all cytologists was 0.103. When only two categories (normal/abnormal) were used, the reproducibility ranged from 0.058 to 0.377. When assessing the co-expression of p16 and Ki-67, Cohen's kappa reproducibility was from 0.196 to 0.574, while the overall Fleiss' kappa was 0.407. When comparing the evaluation results of each of the cytologists with the neural network, Cohen's kappa reproducibility ranged from 0.103 to 0.436. Conclusion. The reproducibility of cytological diagnoses according to the Bethesda system (2014) and two categories (normal/abnormal) based on the Pap smear study was low. Such results are primarily due to a large number of abnormal smears in the study. The immunocytochemical method has diagnosis reproducibility three times higher, indicating the need to measure the co-expression of p16 and Ki-67 to increase the sensitivity and specificity of the cytological method. Similar reproducibility when comparing the manual and automatic evaluation of the "double label" suggests that the neural network algorithm can currently help in decision support rather than replace the cytologist at the diagnostic stage.
 
Aim. To evaluate the results of an immunocytochemical study of p16/Ki-67 double staining in the cervical epithelium of patients with cervical intraepithelial neoplasia (CIN) associated with high-risk human papillomavirus (HPVhr) in comparison with patients without cervical pathology. Materials and methods. The comparative study included the results of examination of 75 patients divided into 4 groups. Patients with CIN1 comprised the 1st main group (n=21), women with CIN2CIN3 the 2nd main group (n=26), the comparison group consisted of patients with latent HPV infection (n=15) and the control group (n=13). The average age of women with cervical HPV infection was 26.46.13 years. Methods of investigation: liquid cytology, colposcopic, histological examination; methods for determining HPVhr DNA; immunocytochemical examination for determining double staining of p16/Ki-67 markers, statistical analysis. Results. A positive p16/Ki-67 double staining test prevailed among patients with CIN (31.9%) compared to patients without cervical pathology (3.6%) (p=0.003) and correlated with the severity of colposcopic signs (rs=+0.397, p=0.0004). In the 1st main group of patients with verified CIN1 and in the comparison group of patients with latent infection, isolated cases of a positive test of double staining of p16/Ki-67 markers in the epithelium were recorded without significant differences between the groups (9.5 и 6.6%, p0.05). In the 2nd main group of patients with verified CIN2, CIN3, a positive test of double staining of p16 and Ki-67 was observed in every second case, dominating relative to the 1st group, the comparison group and the control group (p=0.003, p=0.005, р=0.001 respectively). In the control group, a negative double staining test was established in all cases. Conclusion. Every second patient with CIN2+ associated with HPVhr has a positive test of double staining of the cervical epithelium, with CIN1 it is observed in 9.5% of cases (p=0.003). Among patients with CIN1, there were no differences in the expression of p16/Ki-67 in epithelial cells compared to women without cervical pathology. The data of the immunocytochemical study of p16/Ki-67 in the cervical epithelium of HPVhr positive patients with CIN should be taken into account when choosing a differentiated management strategy.
 
The aim of the study – to determine the dynamics of expression of р16, Ki-67 in patients with HPV-associated cervical intraepithelial neoplasia (CIN) in the complex treatment with inosine pranobex. Materials and methods. The study included 62 patients with cervical HPV infection, the main group consisted of 47 patients with confirmed CIN 1 and CIN 2–3 associated to HPV high-risk, the comparison group – patients with latent HPV infection and 13 women of the control group. At the 2nd stage, a group of women with CIN 2–3 was divided into two groups: 2A (n=17) included patients who received excision treatment in combination with inosine pranobex; 2B group (n=9) patients after excision treatment (LEEP or LLETZ) without inosine pranobex. Traditional methods of examination of cervical pathology were used, including HPV genotyping, and dynamic immunocytochemical examination to determine p16, Ki-67. Results. Comparative analysis (n=75) allowed to establish the absence of differences in the expression of р16, Ki-67 and co-expression in HPV-associated CIN 1 relative to the comparison and control group. CIN 2–3 was characterized by a predominance of the levels of biomarkers in comparison with CIN 1 and latent infection (p
 
Уважаемые коллеги! Вот уже пятнадцать лет с нами нет академика Владимира Ивановича Кулакова. Мне выпала большая честь неоднократно посвящать свои выступления Владимиру Ивановичу: и в его звездные, и в его траурные дни. То, как его провожали в последний путь, какой скорбью утраты был наполнен наш Центр, трудно передать словами. Мне кажется, что аура его присутствия до сих пор сохраняется в аудиториях, в благодарных сердцах коллег, учеников, пациентов, а с 2008 г. и в названии Центра.
 
Objective. To comparatively assess treatment and prevention methods for endometrial changes in postmenopausal patients taking tamoxifen. Subjects and methods. One hundred twenty three tamoxifen-treated women with breast cancer who had the endometrium more than 5 mm by USG. All the examinees were postmenopausal. The study evaluated the effectiveness of the coagulation hysteroresectoscopic endometrial ablation. Results. The results of treatment were assessed at 12 months. Patients of the first group recurrence of endometrial pathology detected in 1,4% of cases, while in the second group 60%. Conclusion. Thus, by analyzing the results of hysteroresectoscopic endometrial ablation and only diagnostic hysteroscopy in patients with endometrial pathology receiving adjuvant therapy for breast cancer, it was demonstrated that the efficiency of ablation is much higher than hysteroscopy and curettage (98,6 and 40% respectively).
 
The purpose of research was a comparison of the effect of a three-phase combined oral contraceptive (COC) containing estradiol valerate and dienogest in dynamic mode and single agent containing dienogest, to reduce menstrual blood loss on the background of adenomyosis.Materials and methods. Women aged 18-50 years, with a diagnosis of adenomyosis and pain hospitalized for abnormal uterine bleeding. Hysteroscopy and curettage of the uterus were performed on all the patientsw. After discharge, and the results of histological examination, patients of group 1 (no need of hormonal contraception), dienogest monotherapy was administered at a dose of 2 mg per day continuously for 6 months. Group 2 patients (who needed effective contraception) were administered three-phase COCs containing estradiol valerate and dienogest (2 days 3 mg estradiol valerate, 5 days estradiol valerate 2 mg/2 mg dienogest, 17 days estradiol valerate 2 mg/3 mg dienogest, 2 day 1 mg estradiol valerate and 2 days of placebo); 3 groip patients (not need for contraception) were treated with antifibrinolytic drug tranexamic acid at a dose of 1000 mg per day orally. Evaluates the performance of blood coagulation.Conclusions. Against the background of monotherapy a significant and reliable reduction of menstrual blood loss and the severity of pain was shown that demonstrates its effectiveness in the treatment of abnormal uterine bleeding associated with adenomyosis.
 
Aim. Effect of daily use of the combination of myoinositol and D-chiroinositol with manganese and folic acid (Dikirogen) on the onset of a regular menstrual cycle, ovulation, pregnancy, tolerance and satisfaction of the study participants. Materials and methods. The study involved 60 women aged 40 years and younger, the average age was 30,933,79 years. Duration of taking Dikirogen was 1703 days, participants observation was 1803 days. Body mass index, waist circumference (WC), ultrasound of the pelvic organs and ovaries, assessment of hirsutism (Ferryman-Gallway scale), acne severity (Cook questionnaire), depressive symptoms (Hamilton scale), quality of life (SF36 questionnaire) were performed during the study. Results. The pregnancy rate at the end of the study was 31.7%. During the daily using of the Dikirogen, there was a decrease in WC (p=0,007), the severity of acne (p=0,002) and the number of points on the Hamilton scale (p=0,04). Also there was a increase in the number of points on the SF36 questionnaire (p=0,0001). 93.33% of the woman has been reported that the Dikirogen was well tolerated. Conclusion. Dikirogen is an optimal doses chemical composition, selected taking into account the synergism of the components and the daily requirement, and it is effective in treatment for women with anovulatory infertility.
 
Abnormal uterine bleeding (AUB) is one of the most common indications for hysteroscopy. Most of the AUB cases occur due to endometrial or myometrium pathology. Among it, endometrial polyps (EP) and chronic endometritis (CE) prevalent in reproductive age, while endometrial hyperplasia (EH) and EP dominate in perimenopause. It was determined that EP and CE are characterized with menorrhagia and metrorrhagia approximately equally, whereas EH reveals AUB with oligomenorrhoea. Verification of exact endometrial pathology by ultrasound examination is hindered, that results in deviations of ultrasound and histological diagnosis. The usage of ultrasound data and AUB’s characteristics may improve the diagnostic accuracy on preadmission period.
 
Background. Abnormal uterine bleeding (AUB) occurs in one-third of women of reproductive age and has a significant impact on women's lives, causing anemia, impaired social adaptation and professional activity. AUB-O (ovulatory dysfunction) is often caused by an excessive body mass (BM) and obesity (especially visceral). The most effective option for restoring menstrual cycle (MC) in obese women is BM reduction. There is evidence that the combination of inositols myoinositol (MI) and D-chiroinositol (DCI) has a beneficial effect on BM loss, ovulation frequency and getting pregnant in women with polycystic ovary syndrome. Aim. To study the effect of MI and DHI in a 5:1 ratio in combination with diet and exercise on the regulation of MC in overweight and obese women. Materials and methods. The study has been conducted in clinics of Moscow, Kazan and Tyumen for 20202021. It is a descriptive study assessing an efficacy of lifestyle modification (diet and exercise) plus a nutritional support with a combination of 1000 mg MI and 200 mg DCI (ratio 5:1) for 24 months in 353 women of reproductive age with AMK-O and overweight or obesity. Efficacy criteria include: MC regularity, BM index (BMI), waist circumference (WC), levels of serum glucose, free testosterone, follicle-stimulating hormone, luteinizing hormone. Results. The study showed a significant shortening of MC to its physiological duration 3112.04 days (vs 4419.51 days at the 1st visit; p=0.001), a decrease in the rate of heavy bloody vaginal discharge by 2.57 times (p=0.001), an increase in the rate of moderate bloody vaginal discharge by 1,62 times (p=0.001), an increase in the proportion of patients with regular MC by 2.69 times (p=0.001). These changes were accompanied by a decrease in BM (-3 kg; p=0.001), a decrease in WC (-2.5 cm; p=0.001). Laboratory tests revealed a decrease in serum glucose (-1.3 mmol/L; p0.05), free testosterone (-0.4 pg/L; p0.05), luteinizing hormone (-0.8 mIU/ml; p0.05), and an increase in follicle-stimulating hormone (+0.1 mIU/ml; p0.05) levels. Conclusion. The results obtained (a decrease in BM, a decrease in BMI, WC, as well as MC restoration; p0.05) make it possible to recommend Dikirogen containing MI and DCI in a 5:1 ratio as a part of comprehensive therapy for overweight and obese women with AUB-O.
 
Abnormal uterine bleeding (AUB) is one of the most common frequent reasons for contacting a gynecologist and conducting intrauterine interventions. AUB causes iron deficiency anemia and a decrease quality of life of women, which in turn is the reason of their social and clinical significance. Based on the analysis of literature and international data recommendations, the review outlines the basic principles of AUB diagnosis, non-hormonal and hormone therapy Advantages of continuous regimen for the administration of progestogens, in particular the LNG-IUS, and COCs containing estradiol valerate, to reduce menstrual flow blood loss are presented in the article. The need for a differentiated approach of choosing the therapy based on age, causes of bleeding, and balance benefits and risks of medicines.
 
Aim. Optimization of management tactics for patients with abnormal uterine bleeding on the background of benign endometrial and myometrial hyperplastic processes (BEMH) using systemic enzyme therapy. Materials and methods. 90 female patients with BEMH were included. They were divided into three groups: group 1 – women with endometrial hyperplasia, group 2 – women with uterine myoma of small size (6–8 weeks) in combination with endometrial hyperplasia and group 3 – women with endometrial hyperplasia in com-bination with endometriosis. Systemic enzyme therapy drug was used. Results and conclusions. BEMH are accompanied by inhibition of cellular immunity (pronounced suppression of T-lymphocytes) and excessive activation of humoral im-munity. Therefore, an immunomodulatory effect of systemic enzyme therapy at hyperplastic processes is the basis for its prescription for comprehensive treatment of pa-tients with combined endometrial and myometrial hyperplastic processes.
 
Abnormal uterine bleeding (AUB) is a common pathology at the confluence of different specialties, mainly occurring in women of reproductive age. There are two main groups of AUB causes: the structural pathology of the female reproductive system and the functional changes, which include the pathology of the hemostatic system, among other things. Regardless of the severity of manifestations, for the efficacy of the treatment, it is important to establish the certain cause of AUB and to choose the precision therapeutic strategy. However, there are universal therapeutic approaches to provide the hemostatic effect, regardless of the etiology of the process. Fibrinolysis inhibitors, in particular, tranexamic acid, are the basis of this approach.
 
Background. After an episode of abnormal uterine bleeding, it is of critical importance to restore endometrial receptivity to prevent the recurrence of abnormal uterine bleeding and implement reproductive plans. Aim. To study endometrial steroid receptor expression in women of reproductive age after an episode of abnormal uterine bleeding due to ovulatory dysfunction during micronized progesterone or combined oral contraceptive therapy with bioidentical estrogen and dienogest. Materials and methods. A cohort prospective study was conducted. The study included 70 females aged 1840 years who were observed with abnormal uterine bleeding due to ovulatory dysfunction at the Department of Obstetrics and Gynecology of Ural State Medical University based at the Yekaterinburg Municipal Hospital №40 from 2016 to 2018. After a bleeding episode, the patients received a combined oral contraceptive with bioidentical estrogen and dienogest or micronized progesterone. Results. During therapy, variable changes in the expression of estrogen and progesterone receptors in the stromal and glandular components of the endometrium during the 6-month follow-up were observed. Discussion. Changes in steroid receptor expression and endometrial receptivity during hormone therapy are similar, although certain trends are identified which can guide the choice of hormone therapy. Conclusion. Due to the lack of complete recovery of steroid receptor expression and endometrial receptivity, even 6 months after hormonal treatment, short courses of hormonal rehabilitation after abnormal uterine bleeding due to ovulatory dysfunction are not sufficient, and permanent hormonal contraception or periodic courses of progestogens are required to prevent a relapse of the endometrial proliferation.
 
Aim. To assess the frequency of human papillomavirus (HPV) occurrence according to the IARC classification in patients with lesser abnormalie of cervical epithelial lesions and analyze their role in the formation of SIL. Materials and methods. The study included 129 HPV-positive women aged 1845 years (average age 34 to 11 years) with cytological conclusion NILM, ASCUS or LSIL. Patients are divided into 3 groups depending on the results of the cytological smear: 1 group (NILM/HPV) 66 (51.2%), 2 group (ASCUS/HPV) 28 (21.7%), 3 group (LSIL/HPV) 35 (27.1%). During dynamic observation for 24 months. A comprehensive clinical-laboratory examination was carried out, including HPV-typing, cytological examination, extended colposcopy every 6 months, sighting biopsy of the cervix (according to the indications). Results. According to the results of the pathomorphological study, squamous intraepithelial lesions neoplasia (cervical intraepithelial neoplasia CIN+) was verified in 59 (71.9%) of the results of the study: LSIL (CIN I) 53 (64.6%), HSIL (CIN IIIII) 6 (4.6%). The morphological diagnosis of LSIL (CIN I) was established in 1 group (NILM/HPV+) in 20 (55.6%), 2 groups (ASCUS/HPV+) 9 (32%), 3 group (LSIL/HPV) 24 (68.6%); HSIL (CIN IIIII) in group 1 2 (5.6%), in 2 group 3 (10.7%) and in the 3 group 1 (2.9%). Conclusions. In patients with lesser abnormalies of cervical lesions in the formation of CIN+ participated HPV group 1 in 79.1%, groups 2A in 5.5%, groups 2B in 15.4% of cases. The HPV high carcinogenic risk (group 1) was involved in the formation of HSIL (CIN IIIII). The neoplastic transformation of the cervical epithelium of the studied patients was caused by the persistence of HPV 16, 58, 39, 18, 51, 68, 56, 82, 35, 52, 53, 35 types.
 
In recent years a large amount of data on a varied effect of the adipose tissue on a female reproductive system was accumulated. Molecular mechanisms of regulation reproductive function by hormones of the adipose tissue are discussed in the article. It describes the mechanisms of development different variants of reproductive function abnormalities with the obesity.
 
In this review we observed the role of high risk HPV types in the development of epithelial lesions of the cervix. Modern data on the role of molecular genetic methods in the diagnosis of HPV-associated diseases are represented here. We analyze the literature on modern molecular biomarkers that shows the risk of proliferative processes in the transformation to neoplasia.
 
Metric values for ResNet18
Background. Neural networks are actively used in digital pathology to analyze histological images and support medical decision-making. A common approach is to solve the classification problem, where only class labels are the only model responses. However, one should understand which areas of the image have the most significant impact on the model's response. Machine learning interpretation techniques help solve this problem. Aim. To study the consistency of different methods of neural network interpretation when classifying histological images of the breast and to obtain an expert assessment of the results of the evaluated methods. Materials and methods. We performed a preliminary analysis and pre-processing of the existing data set used to train pre-selected neural network models. The existing methods of visualizing the areas of attention of trained models on easy-to-understand data were applied, followed by verification of their correct use. The same neural network models were trained on histological data, and the selected interpretation methods were used to systematize histological images, followed by the evaluation of the results consistency and an expert assessment of the results. Results. In this paper, several methods of interpreting machine learning are studied using two different neural network architectures and a set of histological images of breast abnormalities. Results of ResNet18 and ViT-B-16 models training on a set of histological images on the test sample: accuracy metric 0.89 and 0.89, ROC_AUC metric 0.99 and 0.96, respectively. The results were also evaluated by an expert using the Label Studio tool. For each pair of images, the expert was asked to select the most appropriate answer ("Yes" or "No") to the question: "The highlighted areas generally correspond to the Malignant class." The "Yes" response rate for the ResNet_Malignant category was 0.56; for ViT_Malignant, it was 1.0. Conclusion. Interpretability experiments were conducted with two different architectures: the ResNet18 convolutional network and the ViT-B-16 attention-enhanced network. The results of the trained models were visualized using the GradCAM and Attention Rollout methods, respectively. First, experiments were conducted on a simple-to-interpret dataset to ensure they were used correctly. The methods are then applied to the set of histological images. In easy-to-understand images (cat images), the convolutional network is more consistent with human perception; on the contrary, in histological images of breast cancer, ViT-B-16 provided results much more similar to the expert's perception.
 
Background. Currently the problem of immunological conflict, due to incompatibility in the ABO system and the development of hemolytic disease (HD) of the newborn, does not lose its relevance. Unlike Rh isoimmunization, with ABO incompatibility, the development of HD of the fetus/newborn is possible during the first pregnancy and there is no specific prophylaxis. Aim. To establish prognostically unfavorable obstetric predictors in mothers whose newborns had HD according to the ABO system. Materials and methods. A retrospective cross-sectional study included 40 newborn-mother pairs. The main group consisted of 17 newborns with a confirmed diagnosis of HD according to the ABO system and their mother, the control group included 23 newborns without HD of the fetus according to the ABO system and their mothers. The medical documentation was studied, which made it possible to evaluate the anamnestic, clinical data and contained a full range of general clinical, laboratory, functional research methods. Results. When assessing the state of the newborns of the main group, it was revealed that mild HD was detected in 58.84.2% of cases (icteric form), in 41.25.2% moderate severity (anemic form 11.8%, icteric form 29.4%). Reproductive losses in women of the main group were revealed 1.8 times more often than in the control group (38.6 and 20.9%, respectively; p=0.003). In the main group, 75.5% of patients had one or another acute infectious process during pregnancy. Mothers who gave birth to children with hypertension had high titers of antibodies (anti-A) in the blood and there was no correlation with the severity of HD of the newborn. Conclusion. According to the existing regulatory documents, it is not recommended to routinely examine all pregnant women with blood group 0(I) for the determination of immune antibodies. It is necessary to identify patients at high risk for the development of HD according to the ABO system and send them to the determination of immune anti-A and anti-B antibodies at 36 weeks.
 
The article presents the indications, contraindications, specific techniques for using various physical factors in various, individually controlled and differentiated ways, in patients after abortion up to 12 weeks by different methods. Physical factors are used at all in order to prevent possible complications, as well as for the treatment of already established complications in women with a history of somatic and gynecological diseases in combination with drug therapy. Displaying differential use of medical factors, depending on the age of patients, parity, type of abortion, individual response to physiotherapy.
 
More than 600 thousands abortions are performed annually in Russia. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. Immediate administration of combined OCs after abortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, and reduce the risk of complications and unintended pregnancies. Сombination of ethinylestradiol 30 g + drospirenone 3 mg demonstrates the advantages of a low estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drugs significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. Сombination of ethinylestradiol 30 g + drospirenone 3 mg and Metafolin has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. The article presents the results of the latest studies about using of combined OCs (ethinylestradiol 30 g + drosperinone 3 mg and Metafolin) after abortion.
 
Despite all prevention and education campaigns, the rate of unintended pregnancies is 40% of the more than 200 million pregnancies occurring worldwide. About half of them end in abortion. Women in the 2030 age group, where abortions peak, have not yet fulfilled their reproductive plans. The lack of competent post-abortion rehabilitation for women, including contraception counselling, results in one in three choosing a less effective method, and one in four not using any contraceptive methods at all. According to the The World Health Organization Guidelines for Safe Abortion, all women should use hormonal contraception after spontaneous or induced abortion. Combined oral contraceptives (OCs) with 30 mcg ethinyl estradiol in combination with drospirenone, which has strong antigonadotropic activity, can effectively suppress hypothalamic-pituitary-ovarian axis excitability after abortion. OCs can be used to prevent neural tube defects in the case of pregnancy after withdrawal of OCs. The use of folate-containing OCs is a sensible means of folate supplementation in women of reproductive age that may guarantee a future healthy pregnancy and overall health.
 
Objective: To evaluate the efficacy and safety methods for termination of pregnancy in the late period of congenital fetal malformation incompatible with life. Materials and methods. A randomized comparative study in 2 stages (retrospective and prospective). On stage, I conducted a retrospective analysis of the termination of pregnancy in 150 women who were divided into 2 groups: Group A - 75 women who underwent transvaginal method of transcervical amniocentesis. Under the prospective study (II stage) was 195 pregnant women were divided into 2 groups. The main group - 98 women with the combined method (medical combined with kelp); comparison group - 97 women (WHO scheme). Results. The efficiency of abortion (I stage) by amniocentesis was 93.3%, with prostaglandins - 92%. The effectiveness of the methods used abortion at stage II was 99.0% in the intervention group and 96.9% - in the comparison group. With a decrease in the length of time from the beginning of the method to the induction of late induced abortion in both groups there was a decrease in complications. The greatest number of complications observed in women with a duration of late induced abortion 24 hours or more. Conclusion. The advantages of the combined method has a shorter duration of time from the start of the method prior to uterine activity, due to the mechanical action of kelp on the cervix. A smaller dose of mifepristone (3 times) and a lower dose of misoprostol (2-fold) in the combined process has reduced adverse events (4.2 times).
 
Materials of the prevalence of abortion in the federal districts of Russia.
 
Materials and methods. This logistic model is based on 212 observations. This study included two groups of healthy women aged 18–35 years without a history of spontaneous abortion, preterm labor, stillbirth, preeclampsia, or other complications. The first group was comprised of 112 women with a history of a placental abruption (patient group), and the second group consisted of 100 women with non-complicated pregnancy (control group). Gene polymorphisms were detected using the polymerase chain reaction-real time technique. The data was analyzed using binary and multifactorial statistical mathematics. Our analysis of the predictive models was performed by using logistic regression. To determine the diagnostic value of the predictive models used, the ROC-curve is followed by determining the area under it (AUC). Results. The 24 anamnestic, clinical, and genotypic characteristics were examined as placental abruption predictors using multifactorial analysis. We were able to determine what the nine most informative predictors of placental abruption were according to Wald Chi-Square criteria (χ², р): fetal growth restriction (13.143; р<0.001), placental insufficiency (9.629; р=0.002), male sex of the fetus (6.965; р=0.008), preeclampsia (6.779; р=0.009), combination of genotypes PAI-1-5G4G/FV-1691GA (6.613; р=0.010) or PAI-1-5G4G/MTHFR-677CT (6.158; р=0.013), pathology of amnion (4.497; р=0.034), infectious diseases in pregnancy (4.277; р=0.039), tobacco smoking (3.963; р=0.047). ROC analysis identified a high specificity (82.64%) and sensitivity (77.42%) of the model, and the integral index of the effectiveness of predictive markers (AUC=0.836), according to the expert scale of values which is indicative of a very high quality model. Conclusion. It is recommended to use this elaborated predictive model in clinical practice for the purpose of individual risk assessment of placental abruption in healthy patients with initially low obstetric risk.
 
Aim. To evaluate the expression of steroid receptors (estrogen [ER] and progesterone [PR]) in the endometrium during the implantation window in females with a history of fertility disorders in "thin" and "absolutely thin" endometrium versus healthy females. Materials and methods. A prospective comparative study was conducted. The study group (n=42) included patients with "thin" endometrium (7 mm M-echo 5 mm at cycle days 1113 according to ultrasound); the comparison group (n=10) included females with "absolutely thin" (5 mm according to ultrasound in the pre-ovulatory days) endometrium (females in both groups had a history of infertility and miscarriage of unclear reasons in the anamnesis); the control group included 16 healthy fertile females. A Pipelle biopsy of the uterine mucosa was performed on day 68 after ovulation, and a peripheral blood sample was obtained to measure the concentration of sex steroids (estradiol [E2] and progesterone [P]). Endometrial samples were examined by histological and immunohistochemical methods (ER, PR expression). Results. All study participants had an ovulatory cycle of P16.1 nmol/L (day 68 after ovulation) and normal estrogen levels (E2, pmol/L). E2/P was similar in all cohorts (p0.05 for all measures). ER and PR expression in the endometrium similar to those in healthy females was detected in 20% of patients in the study and comparison groups (M-echo = 4.83.1 mm): 21% (9/42) and 20% (2/10), respectively. ER and PR expression in the endometrial glands and ER expression in the endometrial stroma were significantly different (p0.05) from healthy females in 79% (41/52) of patients with "thin" endometrium and 80% (8/10) of patients with "absolutely thin" endometrium. No differences in the ER or PR expression in the endometrium in females with hypoplastic endometrium were found (p0.05). Conclusion. The M-echo value does not accurately determine endometrial hormonal-receptor abnormalities: 20% of the study participants with hypoplastic endometrium had ER and PR expression comparable to those in healthy females. No differences were found in the expression of endometrial estrogen and progesterone receptors in females with "thin" and "absolutely thin" endometrium.
 
Fast track (FT) surgery - a comprehensive treatment program, including training in the preoperative phase, the use of minimally invasive techniques of surgical intervention and active management of the postoperative period, in order to reduce the timing of hospital treatment, the time rehabilitation and patients as quickly as possible to return to normal life.For the first time the principles of FT programs were formulated in the late twentieth century. Henrik Kehlet and initially introduced in cardiac surgery, coloproctology and oncology, but gradually began to gain recognition in other surgical areas.Own experience of FT-protocols in gynecologic patients has shown that they can improve during the early postoperative period, no adverse effects on long - term outcomes and readmission rates, can significantly reduce the time of recovery after the operation and increase the satisfaction of patients of the treatment.
 
The review focuses on evaluating the effectiveness and acceptability of a vaginal ring and combined oral contraceptives (COC) in a comparative aspect. It is shown that the vaginal ring has high efficiency, comparable to COC, has better cycle control, fewer side effects, is convenient to use, there is no need for daily monitoring of the pill.
 
The aim of the work is to conduct a systematic analysis of the available research results on the possibility of using menopausal hormone therapy (MHT) in patients who successfully completed the treatment of endometrial cancer (EC). Materials and methods. The review includes data from foreign articles published in PubMed and Medline, and domestic works published on elibrary.ru over the past 40 years. Results. The results obtained allow us to consider MHT as an independent method of medical rehabilitation for women who have undergone EC. A clear patient profile should be established, allowing the use of this method, with strict adherence to health monitoring. Conclusion Patients who have successfully completed the treatment of EC require the creation of special rehabilitation conditions in the interests of maintaining health and quality of life and should be under the close attention of the doctor. Argumented approaches to the appointment of MHT in such patients will avoid complications associated with estrogen deficiency after surgery, radiation with or without systemic (cytostatic) treatment methods.
 
The results of 153 hysterectomies performed using minimally invasive approaches (laparoscopically assisted vaginal and vaginal), and 110 hysterectomies, of traditional laparotomy access were analyzed. Using a differentiated approach to the choice of the method of radical surgical treatment of uterine fibroids and applying advanced techniques of minimally invasive hysterectomy separate stages, we managed to reduce the number of complications in laparoscopically assisted vaginal hysterectomy compared with conventional hysterectomy (1,04% for laparoscopically assisted vaginal hysterectomy versus 3,64% for abdominal hysterectomy) by three, though they were not noted in vaginal hysterectomy. The reduction of the number of postoperative complications: from 4,5% for abdominal hysterectomy to 1,75% for vaginal hysterectomy was noted as well; as for the reduction of the number of postoperative complications, it dropped from 4,5% for abdominal hysterectomy to 1,75% for vaginal hysterectomy.
 
Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim – to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.
 
Microscopic examination of discharge from the vagina, cervical canal, urethra
Background. Pathological vaginal discharge is the most common disorder in women after giving birth who have vaginal relaxation syndrome and vaginal wall prolapse, as well as in women during menopause. To date, there are no clear treatment regimens for mixed vulvovaginal infections, and the use of only drug therapy in patients with pelvic organ prolapse and genitourinary syndrome of menopause in combination with diseases which are accompanied by pathological vaginal discharge does not give a long lasting result and is characterized by frequent relapses. In this regard, the use of laser methods in combination with drug therapy may lead to the recovery of vaginal microbiocenosis and a decrease in the number of relapses of diseases which are accompanied by pathological discharge from the genital tract. Results. Description. This article presents a clinical case and description of the experience of using a neodymium laser for the treatment of a patient with recurrent mixed vulvovaginitis, 2nd- degree vaginal wall prolapse, loss of pelvic floor muscle tone, vaginal relaxation syndrome and sexual dysfunction using neodymium laser. The woman received 3 procedures of exposure to a neodymium laser with an interval of 2830 days. After 3 procedures of exposure to a neodymium laser, the patient has a good clinical efficacy in the recovery of vaginal microbiocenosis. Conclusions. An innovative technique of exposure to Nd:YAG neodymium laser in the practice of a gynecologist has shown high clinical efficiency in the treatment of not only pelvic floor dysfunction, but also mixed vulvovaginitis. And, despite this aspect of the use of laser technologies requires further study, we can use a neodymium laser in combination with traditional drug therapy to treat diseases which are accompanied by pathological discharge from the genital tract in cases of ineffective drug monotherapy and frequent relapses.
 
Top-cited authors
T.E. Belokrinitskaya
  • Chita state medical academy, Chita
Ivan Torshin
  • FIC IU RAS
Svetlana Olegovna Dubrovina
  • Rostov State Medical University
Viktor Radzinskiy
  • Peoples' Friendship University of Russia