A Survey Research on the Willingness of Gynecologists to Employ Mobile Health Applications

In gynecological care, mHealth (mobile health) technology may play an important role. Medical professionals’ willingness to use this technology is the key to its acceptance. Most doctors utilize mobile health technology; however, there is still room for improvement in the use of mHealth. Gynecologists were asked to participate in this research to see how open they were to use mobile health technologies. In this descriptive-analytical investigation, the researchers determined the average scores for each variable. The overall mean for preparedness to embrace mobile medical technology is 1.8 out of 2, as shown in Table 1. When it came to their desire to embrace mobile health technology, doctors’ years of experience correlated negatively with their age. According to our findings, the amount of interest in mobile health technology is high. Patients’ private information must be protected throughout the usage of this technology though. Mobile health technology may effectively reach patients in remote areas, but it is not a substitute for face-to-face encounters with medical professionals.

Emergency Gynecological Care during the Spread of Coronavirus Infection

The article examines the features of providing emergency gynecological care during the spread of coronavirus infection. The author comes to the conclusion that the majority of urgent gynecological cases are complex, and a significant part of them requires urgent surgical care. Also, an important role in this process is played by the organization of environmental safety and disinfection, competent management of medical waste. All of the above will optimize the process of diagnosis and treatment of emergency gynecological patients and reduce the risk of exposure to infectious pathogens on medical personnel as part of the application of planned measures for the prevention and control of COVID-19.

ANALYSIS OF THE PLATELET HEMOSTASIS AMONG PREGNANT WOMEN WITH IMMUNE THROMBOCYTOPENIA

Relevance: Thrombocytopenia is a common hematological problem that accompanies pregnancy. From 5% to 12% of pregnancies are complicated by thrombocytopenia. Gestational thrombocytopenia is the leading cause of complications (70-85%). Immune thrombocytopenia (ITP) is the most frequent reason among pre-pregnancy causes of thrombocytopenia and is responsible for 1-4% of all thrombocytopenia cases during pregnancy. Investigation of the functional potential of the thrombocyte link of hemostasis in conditions of a reduced number of thrombocytes is relevant. The purpose of the study was to analyze the platelet link of hemostasis in pregnant women with ITP of varying severity by the method of light aggregometry. Materials and Methods: Eighty-eight women with gestational and 28 with immune thrombocytopenia were undergoing treatment and delivery at the Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine (Kyiv, Ukraine) from September 2018 to February 2021. The platelet link of hemostasis was studied in a group of women with immune thrombocytopenia; six (21.4%) of them had severe thrombocytopenia. Results: In mild and moderate immune thrombocytopenia, we noted a decrease in spontaneous and induced platelet aggregation; in severe immune thrombocytopenia, there was no spontaneous and a decreased induced platelet aggregation. This indicated a reduced potential of platelets to perform their direct function – the formation of a thrombus. Conclusion: Immune thrombocytopenia accounts for most pre-pregnancy conditions causing thrombocytopenia in pregnant women. Light aggregometry is a relevant and indicative way to analyze the aggregative ability of platelets. A multidisciplinary team consisting of an obstetrician-gynecologist, hematologist, anesthesiologist, and neonatologist should be involved in the management of such cases to provide effective obstetric care for this category of pregnant women. Risks for the mother and the fetus/newborn should be assessed throughout the pregnancy, considering clinical and laboratory aspects. Delivery of pregnant women with severe thrombocytopenia should be managed at institutions providing the highest level of obstetric and gynecological care.

Мodern opportunities of organizing complex obstetric and gynecological care using hospitalreplacing technologies

The authors analyzed their 25-year experience in organizing obstetric and gynecological care in outpatient settings of the branch clinical and diagnostic center of PJSC Gazprom using inpatient replacement technologies. Effective use of modern clinical, laboratory and instrumental methods of examination allows at the stage of primary treatment in the shortest possible time to establish a clinical diagnosis and determine the plan of invasive diagnostic and therapeutic measures. Cost-effectiveness of hospital-replacing forms of care delivery involves a significantly lower cost of services in day hospital, as well as a shorter average length of treatment in comparison with a day and night facility. Social efficiency is determined by the fact that treatment in a day hospital has a significant “deontological” advantage, most of the time the patient is at home, in a familiar comfortable environment, surrounded by the family which increases satisfaction with health care. Medical effectiveness of hospital-replacing forms of care delivery is determined by continuity of inpatient and outpatient care, ensuring continuity of the entire treatment process. Reduction of temporary disability in the patient, reduction of postoperative complications, nosocominal infections are high efficiency of the developed model of organization. The experience accumulated over 25 years in the organization of surgical gynecological care allowed us to reach the level when the patient’s age, the presence of several concomitant chronic diseases, compensated diabetes mellitus type 2, obesity of any degree, cicatricial adhesion of any prevalence have ceased to be absolute and relative contraindications for laparoscopic benefits under general anesthesia and sling operations for genital prolapse under general or regional anesthesia in the surgical day care center of the clinic of high medical technologies of the clinical diagnostic center.

Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function

Objective To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function. Methods A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish. Results Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6. Conclusion The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.

Integration of obstetrics and gynecology services into primary health care

In the historical dimension in Ukraine, family medicine (SM) was founded as a pilot project in the Lviv region in 1987. In 1992, after the successful introduction of the elements of the SM, a decision was made to reorganize the district service in the SM. This process was designed for several years and its implementation was planned in 5 stages: Stage I - UT (local therapist) perform the functions of doctors whose specialization is as close as possible to therapy; Stage II - UT replace doctors of narrower specialties; Stage III - UT provide not only primary health care (PTD), but also monitor patients with chronic diseases; Stage IV - UT provide obstetric and gynecological care, and pregnant women seek help from a family doctor; Stage V - complete retraining of UT, who must become qualified general practitioners - family medicine (GP-SM).The introduction of obstetric and gynecological services in the medical department was planned at stage IV, this process was long-awaited and provided, first of all, the training of family doctors in obstetric and gynecological technologies and skills. And only in 2002, the sectoral Order of the Ministry of Health of Ukraine No. 503 of 28.12.2002 «On the improvement of outpatient obstetric and gynecological care in Ukraine» for the first time defined the features of the functions of a family doctor to provide obstetric and gynecological care, and the Order of the Ministry of Health of Ukraine dated 15.07.2011 No. 417 “On the organization of outpatient obstetric and gynecological care in Ukraine”, the functions of the GP-SM on obstetric and gynecological care were expanded.However, taking into account the results of the analysis, the integration of obstetric and gynecological services at the PHC level is extremely imperfect, which makes it inaccessible to the population, ineffective in the preventive direction, unattainable for organizing the treatment process in cases of gynecological diseases. In addition, there are legal conflicts between the sectoral order on PMP No. 504 «On the approval of the procedure for the provision of primary health care», which does not define examination and instrumental obstetric and gynecological technologies for GP-SM, and the designated clinical protocols approved by orders of the Ministry of Health of Ukraine which do not contribute to the integration of obstetric and gynecological services at the PHC level.

Analysis of the distribution of gynecologic diseases treated at a day gynecology unit

Background: A gynecological day hospital is an alternative to hospitalization enabling to improve accessibility and avoid hospitalizations. Our study investigated the most common gynecologic issues treated in a day gynecology clinic. Methods: The distribution of attendances to a gynecology day hospital was studied in the period from 2015 to 2017. Data collected from the gynecologic diagnoses (a total of 2,908 cases) were standardized according to the International Classification of Diseases in its tenth revision. Results: Over the period from 2015 to 2017, noninflammatory disorders of the female genital tract (N80–N99) were predominant in the distribution of gynecologic conditions treated on an outpatient basis, that is, 69.0% in 2015, 78.6% in 2016, and 82.3% in 2017 of the total number of admissions. Among non-inflammatory disorders of the female genital tract, the most common were as follows: polyp of female genital tract (N84); other non-inflammatory disorders of uterus (N85), which include endometrial glandular hyperplasia (N85.0) and endometrial adenomatous hyperplasia (N85.1); erosion and ectropion of cervix uteri (N86); female infertility (N97). Conclusions: Our findings correspond to data obtained in other countries. The main group of diseases is represented by non-inflammatory disorders of the female genital tract. Thus, the data can be used in planning and organizing gynecological care for women undergoing treatment in day facilities.