Modern approaches to the treatment of urogenital disorders in perimenopausal women

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

A modern view on the etiology, diagnosis, treatment and prevention of the adhesive process of the pelvic organs in women of reproductive age

The article presents a review of the literature in recent years on the problem of peritoneal pelvic adhesions in women of reproductive age. The main issues of etiology and pathogenesis of peritoneal pelvic adhesions as one of the leading causes of reproductive dysfunction, chronic pelvic pain and surgical complications in patients of reproductive age are highlighted. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. Peritoneal commissures have high health and social significance due to a wide range of surgical procedures causing peritoneal trauma and to a high frequency of adhesive process. Pelvic adhesion is a dynamic differentiated cell vascularized structure. Development of an active inflammatory process, which involving cells and proinflammatory mediators may be into a stage of tissue remodeling, collagen formation, that is the initial symptoms of adhesions. A vicious circle and a cascade of mutually supporting changes leads to adhesive disease and patients’ disability. Whatever reasons of adhesions are, ones are a major cause of pelvic pain, infertility and ovarian failure. Though the researches of the pathophysiological mechanisms of growth of adhesions are going on the attempts to determine effective methods to prevent adhesions do not rule to expected results. Keywords: peritoneal adhesions, adhesive disease, etiology, pathogenesis, prevention, treatment, reproductive age.

Assessment of risk factors for fetal growth retardation

The objective: to determine the risk factors for the development of ESRD in pregnant women with preeclampsia and anemia. Materials and methods. 97 pregnant women with preeclampsia with iron-deficiency anemia were monitored. The first group included 46 pregnant women with diagnosed ZRD, the second group-51 pregnant women who gave birth to children with normal body weight. Criteria of FGR is to reduce body weight and length of newborn at birth (less than 10 percentile of assessment tables in comparison with due to gestational age), morphological maturity index (a lag of 2 weeks or more from the true gestational age), disproportionate body, the signs of malnutrition and trophic disorders of the skin and mucous membranes. Results. A step-by-step elimination of the factors that contributed the least to the development of ARI in a combination of preeclampsia and anemia was performed. The results of multivariate analysis showed that in General, the following factors had the strongest influence on the development of RR in preeclampsia and anemia: arterial hypertension (RR= 2.055 [95% CI 1.31-3.20]), overweight/obesity (RR=1.646 [95% CI 1.03-2.62]), anemia in the anamnesis (RR=2.591[95% CI 1.56-4.28]),complicated labor in the anamnesis (RR=1.886 [95% CI 1.29-2.74]), habitual miscarriage (RR=1.850 [95% CI 1.21-2.82]), a history of preeclampsia (RR= 1.922 [95% CI 1.31-2.80]), a history of RR (RR=3.502 [CI 2.37-5.16]). Conclusions. The most significant clinical and anamnestic risk factors for the development of RRT are: arterial hypertension, overweight/obesity, anemia in the anamnesis, pre-eclampsia in the anamnesis, complicated labor in the anamnesis, habitual miscarriage, RRT in the anamnesis. Keywords: pregnancy, preeclampsia, anemia, fetal growth retardation, risk factors.

Features of the clinical course of vulvar precancer and cancer in women of reproductive age

Continuing increase of precancer, epithelial and invasive vulvar cancer rate significantly enlarges the proportion of this group of patients. Meanwhile, all the grounds to improve the system of early diagnosis and treatment of this pathology are given nowadays. No other localization of gynecological cancer proves such a close association with postmenopause and involute atrophic processes of this period of a woman’s life. The objective: is to study the features of the clinical course of cancer and precancerous lesions of the vulva in women of reproductive age. Materials and methods. From 2017 to 2020, 150 patients with dystrophic diseases, precancerous lesions and vulvar cancer were examined in the outpatient department of the National Cancer Institute. The age of patients in the study ranged from 18 to 49 years old (32±3.5). Menstrual function was unchanged in 98 (65%) of 150 women. The age of menarche varied from 11 to 18 years old (mean age – 14.5±0.3 years). The average duration of the menstrual cycle was 28±0.4 days. The doctor performed conservative treatment of «leukoplakia and kraurosis» for many months, and sometimes years, without histological clarification of the diagnosis. More than half (n=106; 71%) of patients underwent long-term and unreasonable anti-inflammatory or hormonal therapy with unsatisfactory results without cytological and / or histological examinations. Results. In the study of vulvar biopsies, the VIN diagnosis (28%) prevailed in comparison with the invasive tumor process (12%) and was asymptomatic in more than 50% of cases. Thus, the peak level of HPV was observed in young women (80%). HPV was represented by types of high oncogenic risk (16, 18, 31, 33) in 90% of cases and it was associated with a malignant process in 100% of cases. At the same time, the background disease in young patients is squamous cell hyperplasia, where the sequence of tumor development (VIN I - VIN II – VIN III) is more clearly traced and largely resembles the development of cervical cancer. It has been noted that in young women PVI is usually temporary, there is a faster spontaneous elimination of the virus and regression of existing HPV-associated pathology compared with menopausal women. Conclusion. Vulvar neoplasia is more common in the VIN form in women of reproductive age and in all cases, it is associated with human papillomavirus (HPV) of high oncogenic risk. Multicentric lesions are more typical for young patients. Keywords: vulva, cancer, precancer, anamnesis, vulvoscopy, histological examination.

Ultrasound diagnosis conditions of the uterus scar in pregnant and non-pregnant women

The dynamic increase in the number of caesarean section in Ukraine and around the world remains one of the main topics of discussion, which is intensively discussing by leading scientists. The traditional assessment of the ability of the uterus scar during pregnancy, based mainly on the analysis of clinical and anamnestic data, is not high informative, and the ambiguous conclusions of the sonographic study indicate the need for further detailed study. Therefore, there is reason to believe that the development of criteria for ultrasound assessment of the condition of the uterus scar after previous cesarean section will use them to predict the possibility of spontaneous delivery in the future and remains relevant. The objective: study the features of ultrasound diagnosis of the condition of the scar on the uterus in pregnant and non-pregnant women. Materials and methods. Observations and retrospective analysis of medical records of pregnant women and birth histories in 150 women with a scar on the uterus after a previous cesarean section for the period from 2014–2019. Results. In women who became pregnant up to a year after the previous cesarean section, the most pronounced changes in blood flow were in the uterine arteries, especially during gestation 28–34 weeks. Also, in women with a failed uterus scar, changes in blood flow were most often observed in the uterine arteries at all levels and were significantly higher, compared with women with a capable uterus scar and women from the control group. In women with an insolvent uterus scar, the most pronounced changes in the indices of vascular resistance was observed in the uterine arteries, in particular the right uterine artery. Conclusion. The peculiarities of blood flow and vascular resistance in different vessels of the myometrium depending on the gestation period and the timing of pregnancy after a previous cesarean section. The obtained detailed ultrasound examination and mathematical calculation of the results of ultrasound examination of the uterus and postoperative uterus scar after previous cesarean section in non-pregnant women allowed to create a scale for assessing the condition of the uterus scar after previous cesarean section in non-pregnant women. Keywords: cesarean section, uterus scar, ultrasound, pre-pregnancy preparation of women.

Current view оn protocols of controlled ovarian hyperstimulation in women of reproductive age with different ovarian reserve

Reproductology is one of the most dynamically developing branches of modern medical science. It becomes especially important in the context of changes of recent years in society, the main of which is the postponement of childbirth compared to previous generations. In addition, such an important and multifactorial problem as infertility encourages scientists to find different ways to overcome it, taking into account the number of etiological factors and different initial reproductive potential of each member of the couple. In vitro fertilization (IVF) can comprehensively solve the problem, as the procedure involves the reconstruction of the process of fertilization under the supervision of the specialist, «bypassing» the critical points that are often affected by pathological processes in male or female organism. One of the main parameters that determines the prospects of using of these assisted reproductive technologies and, in fact, the strategy of IVF cycles, is ovarian reserve, which characterizes the functional ability of the ovary to generate a follicle independently / in response to exogenous influences. In recent decades, many methods have been proposed to assess it and to predict the so-called poor, «bad» ovarian response to stimulation. It goes in accordance with the fact that for patients with reduced ovarian reserve, it is advisable to use adapted schemes of controlled ovarian hyperstimulation (COH), which takes into account the main pathophysiological properties of folliculogenesis in this category of women. Numerous studies show different data on the effectiveness of gonadotropic hormones (gonadotropins, HT) of different origin in women with different ovarian reserve. This article highlights modern ideas about controlled ovarian hyperstimulation using gonadotropic hormones of various origins, demonstrates the main clinical aspects of implementation of available markers of reduced ovarian reserve, analyzes data on the effectiveness of administration of gonadotropin of different origin in patients with different ovarian reserve and possible measures to increase the efficiency of IVF cycles in patients with reduced ovarian reserve. Keywords: in vitro fertilization, controlled ovarian hyperstimulation, ovarian reserve, gonadotropins.

Assessment of the quality of life in the dynamics of treatment in women with stressful urinary incontinence

The article reflects the results of a study of the quality of life in patients of perimenopausal age against the background of CO2-laser use on the eve and after complex treatment. Today in Ukraine, the number of women suffering from stress urinary incontinence is steadily growing, and the problem has moved from purely medical to the rank of medical and social. Stress urinary incontinence significantly reduces the quality of life of women, leading to discomfort, causes a woman to change her usual behavior, makes her more withdrawn, is accompanied by serious psychoemotional disorders (depression, psychological stress, depression), leads to severe physical and moral suffering, social maladaptation. That is why assessing the quality of life in women with stress urinary incontinence is considered extremely relevant. Today, conservative and surgical techniques are used to treat stress urinary incontinence. However, none of these methods contributes to the complete disappearance of symptoms of stress urinary incontinence, and the relapse rate after the disease is high, which forces a woman to long-term follow-up and treatment, significantly worsening her quality of life. The objective: to assess the quality of life before and after the use of a CO2-laser in the complex treatment of stress urinary incontinence in premenopausal patients. Materials and methods. 89 patients with stress urinary incontinence were examined. Depending on the prescribed therapy, it is divided into two groups. The main group included 44 women who were offered CO2-laser therapy in combination with local hormone therapy. The comparison group was formed by 45 women who were prescribed only topical estriol therapy. In order to assess the quality of life of women with stress urinary incontinence, a survey of patients was conducted using a specialized PFDI-20 questionnaire, and the FSFI questionnaire was used to assess the female sexuality index. The quality of life score and female sexuality index were determined before treatment and 6 and 12 months after the start of treatment. Results. According to the PFDI-20 questionnaire, 6 months after the start of treatment, there was no significant difference in the number of points in women in the study groups. After 12 months from the start of treatment, significant differences in the median scores were recorded (the main group – 18 points; the comparison group – 30 points; p<0.05). Evaluating the index of sexual function in the dynamics of treatment according to the FSFI questionnaire, a significant increase in this indicator was noted in women of the main group (median before treatment – 25 points; after 6 months from the start of treatment – 35 points; after 12 months from the start of treatment – 46 points; p<0.05). Evaluating the results of the UDI-6 questionnaire 12 months after the start of treatment, we drew attention to significant differences in the symptoms of urinary incontinence in women who received CO2-laser therapy in combination with local estriol therapy before treatment and compared to women who received only estriol locally. Conclusions. The inclusion of a CO2-laser in combination with local administration of estriol in the complex treatment of stress urinary incontinence can significantly reduce the manifestations of this complication, which is confirmed by a significant decrease in the median score from 55 to 18 in women of the main group according to the results of the PFDI-20 questionnaire (p<0.05). The index of sexual function in women who received the proposed complex based on the results of the FSFI questionnaire experienced a significant increase from 25 to 46 points (p<0.05). The results of a survey using the UDI-6 questionnaire indicate a significant reduction in the symptoms of stress urinary incontinence in women in the main group compared to women who received only local estriol therapy. Keywords: stress urinary incontinence, CO2-laser, estriol, quality of life.

Estimation of efficiency of complex cytoprotective therapy of pregnant women with fetal growth delay

The objective: estimate efficiency and influence of complex, cytoprotective therapy of pregnant women with fetal growth delay on biochemical indexes and results of delivery. Materials and methods. 93 women with monocyesis at term of 28-34 gestation weeks took part in the research. Group І includes 30 pregnant women with fetal growth delay (FGD). The pregnant women of the present group were prescribed with complex, cytoprotective therapy. It includes prescription of thiotriazolin in complex with L-arginine and diosmin. Group ІІ is presented by 33 pregnant women with FGD whose management of pregnancy and delivery is provided by valid orders of Ministry of Healthcare of Ukraine. Group ІІІ (the control one) consists of 30 pregnant women without FGD. Research of protein oxidative modification (POM) markers and level of stable nitrogen oxide metabolites (NO) were estimated in blood serum with spectrophotometric method. Reduced glutathione (GSH) was determined with calculation of its level according to the calibration curve. Results. Primary estimation of their content showed statistically valid (p < 0.05) lower GSH and NO in comparison of indexes of pregnant women without FGD (ІІІ group) with indexes of pregnant women with FGD (both І and ІІ groups). This fact indicates decrease of antioxidant protection and deficit of the main vessel dilator in the present group. Further estimation of biochemical indexes in dynamics of pregnancy permitted to determine considerable progress of imbalance between oxidants and antioxidants and absence of significant changes of NO level among pregnant women of II group. In pregnant women of I group who got the proposed complex cytoprotective therapy, on contrary, statistically valid (p < 0.05) decrease of POM indexes together with increase of GSH and NO level that indicates its positive influence were found. By means of analysis of special features of the pregnancy course in research group there was stated that the rate of habitual pregnancy non-carrying (HPN) in group II made 39.4% and considerably exceeded relevant indexes of І (20.0%) and ІІІ (16.7%) groups. Hypertensive disorders during pregnancy and labour are diagnosed only in pregnant women of І (6.7%) and ІІ (9.1%) groups. Average index of giving birth in І and ІІІ groups made 38.5±0.6 weeks and 39.4 ± 0.5 weeks correspondingly and in group ІІ it was lower 37.2±0.6 weeks. Index of preterm delivery (PD) rate in І group made 3.3% and was 6 times lower than appropriate index of ІІ group (21.2%). PD rate was absent in ІІІ group. Rate of the fetus distress in ІІ group (18.2%) was 2.7 times higher than the relevant index of І group (6.7%) and in ІІІ group it made 3.3%. Condition of newborns in research groups was estimated under Apgar scale. Both at the 1-st and 5-th minute the general index under appropriate scale was statistically valid (p < 0.05) and lower than in ІІ group as compared to indexes of І and ІІІ groups. During description of perinatal complications there was stated considerable percentage of neonatal encephalopathy and jaundice in ІІ group, namely 33.3% and 36.4% correspondingly. In І group their rate made 10.0% and 3.3%, correspondingly. In structure of perinatal pathology prematurity was in 21.2% of newborns of ІІ group that is 6 times higher than appropriate index of І group (3.3%). Mentioned complications were not determined in ІІІ group. In calculation under weight and height parameters of newborns the rate of FGD in ІІ group was the highest and made 88.6%. Mentioned index in І and ІІІ groups made 60.0% and 10.0%, correspondingly. Conclusion. The proposed complex cytoprotective therapy including combined use of thiotriazolin, L-arginine and diosmin (that considerably increases anti-ischemic, antioxidant and endothelium protective action of complex therapy) in women with fetal growth delay has the positive effect on oxidative-reductive hemeostasis and thiol-disulfide balance of mother-placenta-fetus system. Obstetric and perinatal results of delivery in the present group of pregnant women are characterized by statistically valid (р < 0.05) prevalence of estimation indexes under Apgar scale and correspondingly processes of adaptation as well as results of anthropomorphic measurements of newborns, their weight and height parameters and lower rate of neonatal encephalopathy and delivery of premature babies. Keywords: pregnancy, fetus growth inhibition, protein oxidative modification, antioxidant defense system, oxidative stress, obstetric and perinatal complications, cytoprotective therapy.

Effective pharmacotherapeutic effect of indole-3-carbinol and rod extract as part of the drug Agidol

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

Implantation capacity of endometry of veteran women, with contusion in anamnesis, with unrealized reproductive function

The objective: improving the efficiency of diagnosis and treatment of pathology and implantation ability of the endometrium in women of reproductive age who took part in hostilities and received concussions. Materials and methods. The study of endometrial pinopodia was carried out in 35 women of reproductive age who took part in hostilities and received concussions, who on the 21st day of the MC underwent operative laparoscopy and hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy. Of these women, 22 patients – a comparison group – of reproductive age with a history of trauma without post-concussion syndrome and 13 in the main group, women of reproductive age, have the consequences of contusion in the form of post-concussion syndrome. Served as control 10 samples of endometrium from civilian women of reproductive age. The average age of the surveyed was 27.08±4.23 years. The period of stay in the combat zone was 29.34±9.21 months, the time from the moment of receiving a slight traumatic brain injury (contusion) was 18.8±9.2 months. Results. In combatant-women with contusion in history, there are disturbances in the receptivity of the endometrium, manifested by abnormalities in the development of pinopodia and their microvilli during the implantation window: areas without pinopodia in 47.50% of cases (p<0.006), pinopodia of sizes – in 77.50% (p<0.01) and abundant microvilli – in 37.50% (p<0.02); a decrease in the frequency of the presence of developed pinopodia by 2.12 times (p<0.01), large pinopodia by 2.29 (p<0.01), and a small number of microvilli by 4.00 (p<0.0001), an increase in the occurrence of medium-sized pinopodia by 3.00 (p<0.02) times, and a moderate number of microvilli by 4.00 (p<0.0001). A characteristic feature of endometrial pinopodia in the above patients is the presence of mosaicism of their shape (65.00%) and size (67.50%). Conclusions. Women in the military who have been injured in combat are diagnosed with reproductive health problems caused by both the traumatic brain injury itself and the stressors associated with military service. Keywords: reproductive health, female veterans, post-contusion syndrome, receptive endometrial enlargement, office hysteroscopy.