Medical and social aspects in women of reproductive age with chronic pelvic pain

The objective: a study of the medical and social characteristics of women in reproductive age with chronic pelvic pain on the basis of retrospective analysis.Materials and methods. The analysis of medical documentation of 314 patients in reproductive age with a verified diagnosis of chronic pelvic pain (CPP) was performed on the basis of studying of case histories and outpatient cards. Data were analyzed: anthropometric data, age, body mass index, place of residence, gynecological pathology, duration and nature of the menstrual cycle, comorbidities, previous treatment, disease duration, pain intensity, bad habits, number of pregnancies and births, reproductive plans and other methods examination.Results. It was found that more than a third of women, who were treated for pathologies that cause CPP, need medical help again. 58 % of patients sought help for CPP for the first time, 42 % had already received treatment for CPP. Concomitant non-gynecological pathology is more often observed in such patients (48.7 %).The most commonly diagnosed were interstitial cystitis (42 %) and irritable bowel syndrome (34 %). The combination of gynecological, urological and surgical pathology was found in 22 % of patients. Patients with CPP had deficiency in vitamin D (68 % of the 162 patients tested for vitamin D) and had subjectively more severe pain. At the same time, the lack of routine examination of thyroid function and vitamin D status attracted attention. Simultaneously, women with CPP are much more likely than the general population to have infertility (56.4 %), and the incidence of miscarriage is twice as high as the population, with a tendency to recurrent pregnancy loss.Conclusions. Concomitant non-gynecological pathology, infertility, miscarriage, vitamin D deficiency and subjectively more severe pain are more common in women with chronic pelvic pain. However, the level of diagnosing thyroid pathology and determining the concentration of vitamin D in such patients is insufficient.

Optimization of diagnostic hyperplastic processes in the hormone-sensitiv organs (uterus, brest) during reproductive function reabilitation

The objective: a study of the condition of the mammary glands in women with uterine leiomyoma on the background of inflammatory diseases of the genital organs. Materials and methods. At the first stage of the research, a retrospective analysis of histories of 246 women with infertility and uterine leiomyoma on the background of inflammatory diseases and pathology of mamma glands, who were treated in the department of family planning and rehabilitation of reproductive function of State Institution “Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine” named after Academician OM Lukyanova in 2015-2019 was done. In the second stage, a screening ultrasound examination to detect pathology of the breast was performed on the 6th-11th day of the menstrual cycle. Results. The severity of clinical manifestations of dyshormonal dysplasia of the breast depends on the influence of the most significant risk factors associated with mamma glands diseases: late reproductive age, number of interrupted pregnancies (abortion, miscarriage), genital diseases, age of menarche, the parameters of the menstrual cycle, disorders and duration of menstruations, duration of infertility and lactation, comorbid somatic pathology, especially liver disease, thyroid disease, frequent stress and severe heredity.Conclusions. The high frequency of combination of uterine leiomyoma and dyshormonal dysplasia of the breast in women with infertility indicates the need for timely diagnosis and adequate correction of this pathology as one of the factors in the development of mamma gland diseases and the earliest use of methods of rehabilitation of reproductive function. This will increase the effectiveness of infertility treatment and prevention of uterine and mammological pathology.

Restoration and preservation of the vaginal ecosystem in postmenopausal women

The article is devoted to the problem of restoring the physiological conditions of vaginal contents with improving the degree of vaginal cleanliness and reducing atrophic manifestations of the vagina in postmenopausal patients, which reduces the recurrence of vaginal infections and improves the quality of life of menopausal women. The use of a combination of low concentrations of estriol and acidophilic lactobacilli, after the main etiotropic therapy allows to restore the vaginal ecosystem and reduce the manifestations of atrophic vaginitis in menopause.The objective: saving and recovering of the vaginal ecosystem after anti-inflammatory therapy and prevention of vaginal disorders in women in menopause; establishment of clinical effects of complex treatment of sexually transmitted infections, followed by normalization of vaginal flora using a combination of low doses of estriol with lactobacilli and lactose in the form of vaginal suppositories at menopause.Materials and methods. During the examination and treatment of women were divided as follows: I — the main group — 58 women with physiological menopause, who after a comprehensive treatment of colpitis with vaginal suppositorium with a combination of a minimum dose of estriol with lactobacilli and lactose (1 time per day for 12 days, then — 1 time per week for six weeks); ІІ — comparative — 29 patients who underwent only etiotropic therapy with no further correction of vaginal biocenosis.Results. The first control was performed 3–5 days after the end of the main therapy, the second control was performed two months later. After our proposed treatment, the percentage of women with pathological secretions in group I was 12% (7), in II — 66% (19). After 2 months in the main group there was no atrophic changes of the vagina in 39 (67,2%) patients, insignificant — 12 (20,7%), moderate — 6 (10,4%), pronounced — only in 1 (1,7%), and the absence of high atrophy. In the comparison group, the indicators remained unchanged. Conclusions. The combination of low doses of estriol, acidophilic lactobacilli and lactose contributes to sufficient population and maintenance of healthy vaginal flora, as well as the restoration of physiological properties of the vaginal mucosa in women during menopause, as evidenced by the reverse dynamics of atrophic disorders in the main group.

Reorganization of the structural elements of the venous wall in oncogenic pathology

The objective: an identification of changes and reorganization of structural elements of the venous wall, their correlation with cancer processes in the organism; the establishment of the relationship between structural changes in the wall of the venous vessels and thrombosis, with the following complications; the determination of the necessity of the preventive measures to avoid complications. Materials and methods. Histological, submicroscopic and polarization data of the research of the veins of the hind limbs of 12 sexually mature nonlinear male rats weighing 170–180 g on the 30th day of chronic neoplastic intoxication were analyzed. A retrospective analysis of the autopsy protocols of cancer patients (n=54), the largest incidences – pulmonary embolism, during 2014-2018 in the Ternopil Regional Clinical Oncology Center was performed. The average age of women who died was 61.93±1.51 years and 62.44±2.61 years – for men.Results. As a result of morphological examination of the veins of the hind limbs of rats with experimental neoplastic intoxication revealed mainly submicroscopic reorganization of endothelial cells and their desquamation, as well as platelet aggregation that can be one of the links in the pathogenesis of thrombosis.According to a retrospective analysis of the autopsy protocols, the proportion of pulmonary embolism was higher among women (61.1 %) than men (38.9 %). The structure of oncopathology in this group of patients: bronchial and lung cancer (18.5 %); neoplasms of the uterine body (22.2 %); rectum cancer (13.0 %), colon cancer (7.4 %), rectosigmoid junction cancer (5.6 %); bladder cancer (9.3 %); gastric cancer (7.4 %); ovarian cancer (7.4 %); prostate cancer (5.6 %); thyroid cancer (1.8 %); pancreatic cancer (1.8 %). In all cases of autopsy phlebothrombosis of the deep veins of the leg and thigh with impaired blood flow caused by occlusion by blood clots of various manifestations of the structural organization was revealed. In five cases, fresh red blood clots were found, which were closely connected with the intima by fibrin threads, in five other cases – red blood clots were freely located in the lumen of the vein, swelling of all layers of the vein, fibrous structure and diffuse neutrophil infiltration were found. In the remaining 44 cases, vein occlusion was detected by already organized thrombi with signs of fibrosis, recanalization, and revascularization.Conclusions. The study of the morphology of rat hind limb veins with experimental neoplastic intoxication mainly revealed changes in the shape, structure and function of endotheliocytes, their desquamation and changes in all three layers of the venous wall as well as platelet ligation. The relationship between the presence of changes in the venous wall as a result of cancer and the formation of thrombosis was found. The number of thromboembolic complications emphasizes the necessity to prevent thrombosis in cancer patients.

Causes and clinical picture of very early preterm birth

The objective: the determination of the risk factors, causes and clinical features of very early preterm birth.Materials and methods. The data of anamnesis, the course of pregnancy, childbirth and perinatal outcomes in 166 women of reproductive age with very early preterm birth at 22–27 weeks of gestation were analyzed. The fact of childbirth at these terms of pregnancy is the main criterion of inclusion. The patients were divided into two groups depending on the criteria of live birth: 1 group — 79 women, whose labor was regarded as late miscarriage (retrospective study); 2 group — 87 women with very early preterm (prospective study). Exclusion criteria: congenital malformations of the fetus. Results. The main risk factors for the development of very early preterm labor are urogenital infections (83.7 % and 78.9 % in 1 and 2 groups, respectively). A combination of pathogens was found in almost half of the subjects (43 % in 1 group, 44 % in 2 group). The patients in both groups had a complicated general and obstetric anamnesis, in particular, a significant frequency of inflammatory processes of the genital organs (50.0 % – in 1 group and 59.2 % – in 2 group), surgical interventions (50.0 % and 59.2 %, respectively), as well as hormonal disorders and related diseases (ovarian dysfunction – 27.8 % and 27.6 %, uterine fibroids – 16.4 % and 17. 2%, ovarian cysts – 11.4 % in both groups). 35.4 % of patients in 1 group and 28.7 % of patients in 2 group had a history of chronic foci of infections, pathology of the urinary system – 30.3 % and 28.7 %, respectively, of the digestive tract – 24 % and 22.98 %, hypertension – 32.9 % and 31 %. The main complications of gestation in pregnant women in both groups in the II trimester were the threat of abortion (43 % and 30 %, respectively) and dysfunction of the fetoplacental complex (22.7 % and 21.8 %). This caused fetal growth retardation in both groups – 66 % and 63 % of newborns, respectively.Conclusions. Analysis of the general and obstetric history, the presence of infectious factor in combination with extragenital pathology confirm the polyetiology of the causes that leads to very early preterm birth. Considering the main risk factors of preterm birth, a complete examination for urogenital infections in women before and during pregnancy, followed by treatment and restoration of normal vaginal biocenosis, as well as the study of fetoplacental system function from early pregnancy is neseccary.Preventive measures and timely treatment of fetoplacental disorders should prolong pregnancy for the terms in which there is the best way to improve perinatal outcomes.

Patient blood management» strategy in pregnant women with the risk of massive obstetric bleeding

The objective: a determination of the effectiveness of anemia treatment with intravenous iron (III) hydroxide sucrose complex in pregnant women with pathological placentation, as the first stage of “patient blood management” before delivery.Materials and methods. Among 86 pregnant women with placental pathology, 58 (70.7 %) had anemia. Severe anemia with a hemoglobin level <70 g/l was in 13 (22.4 %), moderate anemia with a hemoglobin level <90 g/l — in 19 (32.8 %). The first group included 18 (31.1 %) pregnant women with placenta previa with periodic blood loss during pregnancy. The second group consisted of 40 (68.9 %) pregnant women with invasive placenta. The gestation period in all women was 33+6 weeks. Anemia was treated by intravenous administering iron (III) hydroxide sucrose complex 3 times a week (5-7 injections).Results. The main factor that led to pathological placentation was the scar on the uterus. In pregnant women in the second group with invasive placenta, the scar on the uterus was in 38 (95 %) women. Severe anemia was present in 2 (11.1 %) pregnant women with placenta previa that was in 2.4 times less than in pregnant women with invasive placenta — 11 (27.5 %). Moderate anemia was present in 4 (22.2 %) women in the first group and in 15 (37.5 %) in the second group.In pregnant women with severe anemia, after 5–7 injections of the drug iron (III) hydroxide sucrose complex the level of hemoglobin increased significantly by 30 g/l, the number of erythrocytes increased to 2.8×1012/l, serum iron – in 2 times, the level of ferritin – to 19.6 μg/l and transferrin content decreased. For pregnant women with moderate anemia, 3–5 injections of the drug were sufficient to normalize the indicators. Normalization of blood parameters allowed to reduce the risk of bleeding, the number of blood transfusions and improve treatment outcomes.Conclusions. Timely diagnosis of the iron deficiency anemia in pregnant women with placental pathology is an important means of preventing massive blood loss and reducing the number of blood transfusions, as the first stage of the strategy “patient blood management”.Intravenous iron (III) sucrose complex hydroxide has demonstrated a high clinical efficacy in the treatment of iron deficiency anemia in pregnant women with placental pathology and can be recommended for widespread use in practical medicine.

Prevention of complications of pregnancy and childbirth of patients with a burdensome gynecological anamnesis

The objective: determination of the effectiveness of prevention and medicinal correction of placental dysfunction in pregnant women with chronic salpingo-oophoritis.Materials and methods. The study included 100 pregnant women (basic group) with chronic salpingo-oophoritis, of these, I group (50 women) included patients who received proposed treatment and prevention approach, II group (50 women) received a common set of treatment and prevention measures. The proposed treatment-and-prophylactic approach included prophylactic administration to pregnant women with chronic salpingo-oophoritis from the 8th to the 10th and from the 16th to the 18th week inclusive of natural micronized progesterone at a dose of 100 mg intravaginally twice a day for two weeks. Venotonik and angioprotector were prescribed prophylactically at dose 600 mg from 18 weeks to 37-38 weeks of pregnancy. For therapeutic purposes (blood flow disorders in the uterine arteries and vessels of the umbilical cord that are determined by Doppler), the drug was prescribed at dose 600 mg twice a day for 3–4 weeks.Results. A lower frequency of obstetric and perinatal complications was found in the women in I group than in the patients in the II group. Thus, the rate of placental dysfunction was 6.0±3.36% vs. 34.0±6.7%, respectively, oligohydramnios – 6.0±3.36% and 12.0±4.59%, polyhydramnios – 10.0±4.24% and 22.0±5.86%, fetal distress during childbirth – 6.0±3.36% and 14.0±4.91%, cesarean section – 12.0±4.6% and 24.0±4.27%. In the group of patients with treatment-and-prophylactic approach, the mean of the body weight of newborns was 3486.7±312.71 g, and in women who received a common set of treatment-and-prophylactic measures – 3099.8±295.69 g. The mean of the assessment of the condition of newborns by the Apgar scale at the 1st minute – 7.92±1.54 and 6.81±1.16 points, respectively.Conclusions. The use of micronized natural progesterone and the drug diosmin 600 mg in pregnant women with a history of chronic salpingo-oophoritis reduces the rate of obstetric and perinatal complications during pregnancy.

Obstetric and perinatal aspects of multiple pregnancy

The article presents epidemiological data, modern terminology, features of the course of gestation, as well as obstetric and perinatal outcomes of childbirth in women with multiple pregnancy. The relevance of study this problem is due to the fact that the course of multiple pregnancy in almost all patients is accompanied by various complications, and their prognosis and prevention are of paramount importance. Despite the attention paid to multiple pregnancy, the complication rate remains high. Their treatment should be carried out in III level of perinatal care facilities. Attention is focused on the features of childbirth of pregnant women in accordance with the procedure for providing medical care to women with multiple pregnancies. An important issue remains to determine the time and tactic of delivery in multiple pregnancy. The choice of childbirth method depends on the obstetric anamnesis, gestational age, position and presentation of fetuses, estimated weight and size of fetuses, chorionicity, fetal and maternal condition, and the presence/absence of indications for caesarean section also matters. The optimal delivery time for uncomplicated twins is 37 weeks of pregnancy (monochorionic diamniotic twins — 36–37 weeks, dichorionic — 37–38 weeks), since in this period of pregnancy, the risks of antenatal fetal death and early neonatal death are minimal. Delivery of women with monochorionic monoamniotic twins is performed at the full 32 weeks of pregnancy by caesarean section. Among other indications for caesarean section are triplets and a larger number of fetuses, as well as conjoined twins, transverse or breech presentation of the first fetus, twins in combination with a scar on the uterus, an unsuccessful attempt of external-internal rotation of the second fetus in a transverse position after the birth of the first fetus, and others. An analysis of domestic and foreign publications was carried out in the article, which indicates the need for in-depth research in this direction, namely the elucidation of new pathogenetic links in multiple pregnancies, depending on the type of placentation, the search for new ways of management and the development of diagnostic criteria for the childbirth of this contingent of women.

Some features of the hemostasis system in pregnant women at risk of developing preeclampsia

The objective: a study of the hemostasis system in pregnant women with a risk of preeclampsia development.Materials and methods. 100 pregnant women with the risk for preeclampsia (main group) were examined. The risk factors were determined according to the Guideline “Hypertensive Disorders During Pregnancy”, Order No. 676 of the Ministry of Health of Ukraine. The control group contained of 50 healthy women with physiological pregnancy. The groups were representative in age and reproductive history.The following indicators of hemostasis were studied: the platelet system (the number of platelets, their aggregation ability and the total platelet aggregation index (TPAI), the coagulation system (autocoagulation test, thrombin time, prothrombin index, fibrinogen concentration) and the state of the fibrinolysis system which was determined by such indicators: plasma level of free heparin, activity of antithrombin III, indicators of ethanol and protamine sulfate tests, concentration of soluble fibrin in blood plasma.Results. In pregnant women with a risk of preeclampsia, there are changes in platelet hemostasis indicators: a significant decrease in the number of platelets and a significant (p<0.05) increase in platelet aggregation ability, there is a tendency to an increase in TPAI indicators. In the main group a significant increase in the fibrinogen concentration, plasma lysis indicators and a tendency to an increase of the free heparin concentration, a decrease of antithrombin III and, in comparison with the indicators in healthy women, a 3-fold increase in the content of soluble fibrin (p<0.05) were found.Conclusions. In pregnant women with a risk of preeclampsia development, there are disorders in the vascular-platelet hemostasis, coagulation and fibrinolytic blood systems, namely, a significant tension in the platelet link of the system, an increase in thrombogenic potential, and a sharp inhibition of the fibrinolytic link of hemostasis.

Prevention of recurrence of endometrial polyps in women of reproductive age

The objective: the optimization of management of women in reproductive age after removal of endometrial polyps based on the study of the antioxidant status of the organism.Materials and methods. We examined 150 women in reproductive age with endometrial polyps, 65 (43.3%) patients of them were diagnosed with glandular polyp, 85 (56.7%) – with glandular fibrous polyps. 110 patients after polypectomy were divided into three clinical groups: the first group (32 (29.1%) women) did not receive anti-relapse therapy, the second group (36 (32.7%) persons) used dydrogesterone, the third group (42 (38.2%) women) – received complex drug anti-recurrence therapy (thioctic acid preparation, ascorbic acid, α-tocopherol acetate, indole-3-carbinol). In all women, the antioxidant indicators in blood and the presence of recurrent polyps were determined in 12 months after the treatment. Results. Before polypectomy in patients with endometrial polyps, a decrease of indicators of antiradical activity by 28.52%, restored forms of non-protein SH-groups – by 16.46%, protein SH-groups – by 25.31%, ascorbic acid – by 27.04%, α-tocopherol – by 21.62%, the value of the integral indicator of antioxidant protection – by 31.01% were found compared to the persons in the control group, as well as an increase in the concentration of malonic dealdehyde by 37.23%, non-protein SS groups – by 43.48%, protein SS-groups - by 29.43% and oxidized forms of ascorbic acid – by 29.68%.In 12 months after polypectomy, recurrence of the pathology was in 21.9% of patients of the first group, in 16.7% – of the second group, and no recurrence was detected in women in the third group.Conclusions. In patients with endometrial polyps there are a decrease in level of components of antioxidant protection in the organism and the expressed intensification of processes of free radical and peroxide oxidation of lipids. The use of a comprehensive approach that combines the polypectomy with the use of antioxidant drugs in the postoperative period, in such patients allows to prevent a recurrence of the pathology.