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No 4 (2016)

Articles

Genitourinary syndrome of menopause: The new term, rationale, and discussion

Smetnik V.P.

Abstract

The paper provides a rationale for and discussion about a change in the terminology of peri- and postmenopausal anatomic and functional disorders in the lower urinary tract. The new term genitourinary syndrome of menopause (GSM) was proposed, presented, and considered at an annual meeting of the North American Menopause Society and the International Society for the Study of Women’s Sexual Health. The term GSM was officially approved in 2014 by the respective committees of the above-mentioned societies and the International Menopause Society.
Obstetrics and Gynecology. 2016;(4):7-10
pages 7-10 views

Medically induced abortion at 12 to 22 weeks gestation: Indications, methods, and results

Kan N.E., Baranov I.I., Dikke G.B., Tyutyunnik V.L.

Abstract

Objective. To give an update on abortion procedures in the second trimester of pregnancy (at 12 to 22 weeks’ gestation). Subject and methods. Available literature sources published in Medline, Pubmed, and other databases were sought. A total of 107 sources dealing with different abortion procedures in the second trimester were found; 20 of them were included in this review. Results. Both surgical (dilatation and evacuation) and medical procedures are recommended to end pregnancy after 12 weeks. Their advantages, high efficiency, and possible complications of the medical procedure using mifepristone and misoprostol over other techniques are shown. Conclusion. The clinical experience of medically induced abortion in late periods (in the second trimester - at 12 to 22 weeks’ gestation) demonstrates that this technique is promising and safe.
Obstetrics and Gynecology. 2016;(4):11-15
pages 11-15 views

Current morphological classification of damages to the placenta

Shchegolev A.I.

Abstract

Objective. Analyze the current morphological classification and characteristics of major damages to the placenta. Subject and methods. The paper presents the data available in the literature on the international morphological classification of placental damages, designed by the Amsterdam Placenta Working Group (2014). Results. According to this classification, all placental changes are merged into 3 groups: vascular, inflammatory, and so-called other disorders. Vascular disorders are divided into two subgroups: maternal and fetal ones that are in turn subdivided into developmental, perfusion, and vascular integrity impairments. Inflammatory lesions are also divided into two groups: inflammatory-infectious and immune (idiopathic) ones. The group of other damages to the placenta includes abnormalities of placentation, placental shapes, and umbilical cord attachment. Conclusion. The main task of the morphological classification is noticed to make a consensus on the definition and characterization of major placental damages for their practical introduction in order to clarify the clinical significance and to develop targeted exposures. The current terminology of the placenta and its structures, which is given as a Russian-language version of the International Embryological Terminology, is also presented. The specific features of taking placental tissue samples for further histological examination are indicated.
Obstetrics and Gynecology. 2016;(4):16-23
pages 16-23 views

Cell metabolic reprogramming as a factor for induction and progression of cervical precancer and cancer

Khlebkova Y.S., Vysokikh M.Y., Mezhevitinova E.A., Vishnyakova P.A., Prilepskaya V.N., Sukhikh G.T.

Abstract

Objective. To carry out a systematic analysis of the data available in the modern literature on metabolic reprogramming of tumor cells and to search for clin ical and molecular markers for early diagnosis and prognosis of cervical precancer and cancer. Subject and methods. The review included the data of foreign and Russian papers published in the past 10 years and found in Pubmed on this topic. Results. The cell metabolic reprogramming mechanism and its role in the progression and regression of cervical precancer and cancer were described. The markers for their early diagnosis were identified. Conclusion. There is a need for further investigations of the role of cell metabolic reprogramming and its impact on the induction and progression of cervical precancer and cancer in order to develop early diagnostic techniques and to search for markers determ ining the prognosis of the disease.
Obstetrics and Gynecology. 2016;(4):26-35
pages 26-35 views

Pregravid preparation and pregnancy management in women with a history of antenatal fetal death

Strizhakov A.N., Ignatko I.V., Fedyunina I.A., Popova Y.Y.

Abstract

Objective: to stratify the risk of recurrent reproductive losses and to elaborate a differentiated approach to pregnancy management tactics on the basis of complex clinical, echographic, and laboratory examinations of the fetoplacental system in order to reduce perinatal morbidity and mortality in women with antenatal losses during previous pregnancy. Subjects and methods. The investigation included 340 women, which was conducted in 2 steps: 1) complex pregravid laboratory and instrumental examination of 90 women with a history of antenatal losses (a prospective group) and 60 women without an obstetric/gynecological history (a control group) to identify risk factors for recurrent antenatal losses; 2) analysis of the course of pregnancy, labor, delivery, and perinatal outcomes in 190 women from 3 groups. A study group of 70 women from the prospective group, whose pregnancy occurred during the investigation, underwent complex laboratory and instrumental examination and careful follow-up during pregnancy. A comparison group of 60 pregnant women with a history of antenatal fetal death (AFD) underwent standard follow-up and examination in the women’s health clinic. A control group consisted of 60 women with physiological monocyesis who had been examined at the first stage. Results. The differentiated approach to managing the next pregnancy in the women with a history of AFD versus the comparison group could lower the frequency of gestation complications: threatened miscarriage by 1.63 times, placental insufficiency (PI) by 1.33 times (40% versus 53.3%); preeclampsia was detected 1.2 times more infrequently and manifested as a mild form twice more commonly (mild preeclampsia in 85.7 and 43% in the study and comparison groups, respectively); there were no cases of chronic fetal hypoxia. Drug prevention of PI during early pregnancy could prevent the progression and development of severe PI. The study group was found to have only compensated PI (40%) that presented as grade 1 isolated hemodynamic disorders in 57% of cases and as that concurrent with grade 1 fetal growth restriction syndrome, oligohydramnios, and early placental maturation in 43%. Conclusion. Pregravid preparation, laboratory and instrumental examination, drug prevention of PI during early pregnancy, and elaboration of individual obstetric tactics in women with a history of AFD contributes to a reduction in the frequency and severity of gestational complications, to improvement of perinatal outcomes, and to a decrease in perinatal morbidity.
Obstetrics and Gynecology. 2016;(4):36-43
pages 36-43 views

Predictors for severe preeclampsia in the third trimester of pregnancy according to periorbital Doppler findings

Khramchenko N.V., Voevodin S.M., Zaretskaya N.V., Andronova N.V.

Abstract

Objective. To reveal predictors for severe preeclampsia (PE) in the third trimester of pregnancy according to periorbital Doppler (POD) findings. Subject and methods. POD data were compared in 100 women with manifestations of hypertension occurring during pregnancy, including 20 with severe PE, 35 with moderate PE, and 45 with gestational hypertension. A comparison group included 74 women with physiologic pregnancy. The investigators recorded hemodynamic characteristics, such as peak blood flow velocity (PBFV) and pulsatility index (PI) in the ophthalmic artery (OA) and PBFV in the ophthalmic vein. Results. Normative POD values were obtained in patients with physiological pregnancy and in those with various forms of hypertension before antihypertensive therapy. Regression analysis ascertained critical OA PI values that corresponded to those in severe PE (1.23-1.24) with high sensitivity (94% in the left GA)/(96% in the right OA) and high specificity (100% in both eyes). These indicators may be used as a predictor for severe PE. Conclusion. The low OA PI values found in patients with severe PE are a sign of orbital vasodilatation and point to orbital hyperperfusion. Ophthalmic Doppler findings are relevant and may be used as markers to identify severe PE from other forms of hypertension.
Obstetrics and Gynecology. 2016;(4):44-48
pages 44-48 views

The clinical and economic efficiency of direct electrocardiography with ST-segment analysis in the evaluation of fetal status

Eremina O.V., Dolgushina N.V., Baev O.R.

Abstract

Objective. To compare the clinical and economic efficiency of traditional cardiotocography (CTG) and its combined use with direct fetal electrocardiography (ECG) and automatic analysis of ST-segment changes for the early detection of intranatal fetal hypoxia. Subjects and methods. A prospective study of the course of pregnancy and delivery was conducted in 480 women at the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology. The authors designed a decisionmaking model (TreeAge Pro Inc), by which a cost-effectiveness analysis was used to compare 2 strategies: CTG and ECG in combination with direct ECG (with automatic ST-segment analysis) to determine the minimum cost of the birth of a baby without asphyxia. Results. With the use of traditional fetal CTG at birth, the chance of giving birth to a baby without severe asphyxia was 91% versus 97% with that of a combination of CTG and ECG (that was 70 and 82% during cesarean section and 96 and 98% during vaginal delivery, respectively). The mean cost of birth per healthy baby (without severe asphyxia and consideration of expenses on neonatal management and rehabilitation) was 54,645.78 and 42,903/72 rubles with the use of CTG and CTG + ECG, respectively. Conclusion. CTG in combination with direct fetal ECG with automatic ST-segment analysis makes it possible to effectively and timely monitor fetal status during an active delivery stage. The use of this procedure can substantially reduce the cost of labor induction.
Obstetrics and Gynecology. 2016;(4):49-55
pages 49-55 views

Molecular genetic predictors for the development of ovarian hyperstimulation syndrome in an IVF program

Strelchenko D.A., Perminova S.G., Donnikov A.E., Kadochnikova V.V., Abramov D.D., Korneeva I.E., Saroyan T.T., Abubakirov I.N.

Abstract

Objective. To estimate the contribution of molecular genetic markers as predictors for ovarian hyperstimulation syndrome (OHSS) in an IVF program. Subject and methods. At Step 1, clinical anamnestic data and the anatomical and functional status of the reproductive system were assessed in 152 patients who had asked for an IVF program. A study group comprised 30 patients with developed OHSS; a control group consisted of 122 patients who had not developed OHSS. To analyze the prognostic value of the generally accepted clinical and functional parameters, 152 patients included in this investigation were divided into two groups: 1) 36 patients with a normal ovarian response to stimulation; 2) 116 patients with a hyper-response. At Step 2, a wide panel of genetic markers potentially involved in the development and clinical manifestations of OHSS was examined. The frequency of various alleles of each candidate gene was analyzed in the two baseline groups (patients with developed OHSS and a control group). Results. 86.7% of the 30 patients with developed clinically significant OHSS were in a risk group at baseline, in this connection they underwent preventive measures whereas 13.3% of the patients had normal baseline ovarian reserve indicators (by anti-Müllerian hormone, the number of antral growing follicles); therefore OHSS was not prevented for lack of any risk for this complication. The performed analysis of a relationship of candidate genes to the development of clinically significant OHSS revealed a statistically significant association of VEGFA:936 C>T [rs3025039] and TSHR.2181 C>G (Asp727Glu) [rs1991517] polymorphisms with the development of OHSS. The presence of the TSHR:2181 C/C genotype according to the autosomal recessive model (р = 0.012; OR = 4.18 (95% CI, 1.25-13.96)) or that of the VEGFA:936T allele according to the autosomal dominant model (р = 0.022; OR = 2.26 (95% CI, 1.11-4.60)) predisposes to a risk for OHSS. Conclusion. The general accepted clinical markers for the risk of OHSS are not specific, which necessitates a search for predictors that are able to supplement the available panel of clinical and functional parameters. The TSHR and VEGFA genes may be a complement to a number of prognostic markers used in routine practice in the ART programs as a reliable test before ovarian stimulation in the IVF program.
Obstetrics and Gynecology. 2016;(4):56-63
pages 56-63 views

Significance of vitamin D deficiency correction in the combination treatment of metabolic disorders in patients with polycystic ovary syndrome

Matveeva M.V., Samoilova J.G.

Abstract

Objective. To assess 25(OH)D deficiency correction in the combination treatment of metabolic disorders in patients with polycystic ovary syndrome (PCOS). Subject and methods. A total of 44 patients aged 31.32±5.05 years with PCOS were examined and randomized into 2 groups: 1) patients who received combined oral contraceptives (COC), biguanides, and colecalciferol; 2) those who used COC and biguanides. A comparison group consisted of 22 healthy women matched for gender and age. PCOS was verified in accordance with the 2012 ESHRE/ASRM diagnostic criteria. 25(OH) vitamin D (ng/ml) was measured by enzyme immunoassay. Fasting glucose and insulin and HOMA insulin resistance index were investigated. The Beck Depression Inventory was applied. The data were processed using the R-system. Results. The patients with PCOS were found to have obvious 25(OH)D deficiency associated with hyperandrogenism, hyperglycemia, hyperinsulinemia, insulin resistance, and depression. The administration of colecalciferol led to better carbohydrate metabolism, alleviated the manifestations of PCOS, and reduced waist circumference, waist-hip ratio, and depression. Conclusion. Correction of 25(OH)D deficiency contributes to the improvement of metabolic and psychological parameters and fertility.
Obstetrics and Gynecology. 2016;(4):64-70
pages 64-70 views

Surgical treatment for infiltrating endometriosis of the urinary tract

Khachatryan A.M., Chuprynin V.D., Khilkevich E.G., Melnikov M.V., Gus A.I., Pavlovich S.V.

Abstract

The incidence of urinary tract endometriosis has recently increased from 0.3 to 12%. Objective. To study the specific features of surgical treatment for urinary tract endometriosis. Subject and methods. 61 patients were examined and surgically treated at the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology for infiltrating endometriosis involving the urinary tract. They were divided into two groups. Group 1 consisted of 23 patients with infiltrating endometriosis of the urinary tract who had sought medical advice for this disease for the first time. Group 2 included 38 patients with this condition who had been previously treated for endometriosis. The patient examination encompassed history data collection and complaint detailing, gynecological and somatic history data study, physical examinations, special gynecological examination, and special techniques (transvaginal ultrasonography, ultrasonography of abdominal organs, kidneys, and bladder, small pelvic magnetic resonance imaging, cystoscopy), and statistical methods. Results. Laparoscopic and laparotomic approaches were applied to 40 (65.6%) and 12 (19.7%) patients, respectively; conversion was done in 9 (14.7%) patients. Ureterolysis was carried out in 30 (49.1%) patients; bladder endometrioid infiltration was excised in 22 (36%); cystectomy was performed in 18 (29.5%), cystoscopy in 25 (41%), ureteric catheterization in 12 (19.6%), nephrectomy in 2 (3.5), and ureteral orifice resection and cystoureteral neostomy in 1 (1.6%) patient. The operated organs of the urinary tract showed no complications. Conclusion. Urinary tract endometriosis is rarely encountered; however, patients with this disease deserve meticulous attention. Patients with infiltrating endometriosis of the urinary tract need surgery. Operations for urinary tract endometriosis are technically difficult and require that a surgical team should have definite experience and skills.
Obstetrics and Gynecology. 2016;(4):72-78
pages 72-78 views

Overactive bladder in postmenopause: Prediction and early diagnosis

Amirova Z.S.

Abstract

Objective. To reveal the prevalence, pattern, and risk factors of the symptoms of overactive bladder (OAB) in postmenopausal women and to optimize diagnostic criteria. Subject and methods. The investigation included 503 women aged 45-70 years (mean age, 56.5±7.4 years) who had a postmenopausal duration of over 1 year (mean, 6.3±7.4 years). They were interviewed using a designed questionnaire to reveal the prevalence of symptoms of urination problems and to assess risk factors. Detailed clinical and laboratory examination was made in 70 women with symptoms of OAB; special methods encompassed complex urodynamic study (CUDS), assessment of the degree of vulvovaginal atrophy, ultrasound estimation of bladder and detrusor wall thickness. Results. Risk factors for urination problems were identified in the postmenopausal women. The latter were found to have more frequently pollakiuria and nocturia among the symptoms of OAB. All the patients in the study group had varying degrees of vulvovaginal atrophy, as well as a change in the major quantitative and qualitative CUDS measurements. Bladder ultrasonography established increases in bladder and detrusor wall thickness in the women with OAB. Conclusion. The findings confirm the relationship of the pathogenetic mechanisms of urinary and vulvovaginal disorders in postmenopausal women and may suggest the diagnostic value of ultrasonography in patients with symptoms of OAB.
Obstetrics and Gynecology. 2016;(4):80-84
pages 80-84 views

Prospective evaluation of the efficiency of treatment for cervical intraepithelial neoplasias associated with papillomavirus infection

Belokrinitskaya T.E., Belokrinitskaya T.E., Zolotareva A.A., Kotelnikova O.Y., Maltseva T.V., Frolova N.I.

Abstract

Objective. To optimize the treatment of young reproductive-aged patients with cervical intraepithelial neoplasias associated with papillomavirus infection (PVI). Subjects and methods. This was a prospective cohort study of 94 sexually active young reproductive-aged (18-35-year-old; mean age, 27.0±3.2 years) women who were infected with high-risk human papillomavirus (HPV) types and had cytologic and/or colposcopic signs of PVI and/or low-grade squamous intraepithelial lesions. Results. Group 1 (n = 34) took isoprinosine 1000 mg (2 tablets) thrice daily for 28 days; Group 2 (n = 38) received the drug for 14 days; Group 3 (n = 22) was not medically treated. Therapeutic effectiveness was evaluated from primary and secondary outcomes. The primary outcomes were HIV elimination or a considerably reduced viral load; normalization of cytologic findings and colposcopic patterns after 6 and 12 months. The secondary outcomes were the presence or absence of a recurrence within 2 years after treatment; the occurrence, course, and outcomes of pregnancy following treatment. Conclusion. Inosine pranobex used for 28 days, unlike that for 14 days and wait-to-see therapy, accelerated HPV elimination, promoted a rapider normalization of cytologic and colposcopic values, and ensured no disease recurrences during a 2-year further follow-up. The 28-day inosine pranobex regimen statistically significantly reduced the risk of ectopic pregnancy and increased the rate of full-term deliveries, which was due to the higher rate of complete recovery from cervical disease as a possible trigger of early miscarriage.
Obstetrics and Gynecology. 2016;(4):86-93
pages 86-93 views

Search for prognostic markers of the undesirable effects of mifepristone in the treatment of uterine myoma

Kareva E.N., Bekhbudova L.K., Gorenkova O.S., Samoilova T.E.

Abstract

Objective. To comparatively analyze the data of key molecular pharmacological and biochemical parameters in patients to reveal a potential marker for the risk of endometrial glandular dilatation (EGD) during therapy with mifepristone for its use in the individual choice of therapy for a specific female patient. Subjects and methods. The investigation enrolled 50 late reproductive-aged patients with myoma of the uterus, which corresponded to the size of that of 6-12-week pregnancy and the interstitial and interstitial-subserous sites of myomatous nodules. Peripheral blood mononuclear cells served as a material for molecular genetic tests; the expression of the sex steroid receptor genes in the mononuclear cell fraction was studied by RT-PCR. Results. EGD was detected in 11 (22%) of the 50 patients treated with mifepristone. The androgen receptor (AR) gene expression in the patients with EGD was shown to be 4 times lower than that in the patients without endometrial changes. Conclusion. Comparison of the expression of the AR gene and the presence of EGD in mifepristone-treated patients could reveal a negative correlation between these indicators. ROC analysis has shown the value of mRNA of the AR gene, the excess of which suggests that there is a low risk for mifepristone-induced EGD. A potential marker for the risk of EGD during mifepristone therapy has been revealed.
Obstetrics and Gynecology. 2016;(4):94-100
pages 94-100 views

Glucocorticoid therapy for nonclassic congenital adrenal hyperplasia in women

Tereshchenko I.V.

Abstract

Objective. To analyze the impact of glucocorticoid (GC) therapy on the reproductive system, the course of pregnancy and labor, fetal development in patients with nonclassic congenital adrenal hyperplasia (NCCAH). Subject and methods. Reproductive system diseases and hormonal status were investigated in 46 women with NCCAH. All the women were treated with GC. Jointly with gynecologists, the investigators monitored the course of pregnancy and labor and fetal status in 43 women during prednisolone therapy. Results. The patients with NCCAH were observed to have reproductive system diseases caused by hypersecretion of the adrenal androgen 17α-OH progesterone (17 OH-n). GC treatment restored fertility. Conclusion. Adrenal androgen hypersecretion in patients with NCCAH gives rise to reproductive disorders and infertility. It is necessary to initiate suppressive (and replacement) therapy with GC and to normalize blood 17-OH-n levels in such patients in adolescence. Prednisolone therapy is certain to be performed in pregnancy to prevent miscarriage. In this case, prednisolone has no effect on fetal development.
Obstetrics and Gynecology. 2016;(4):101-106
pages 101-106 views

Evidence-based medicine and a model for an algorithm to choose the best hormonal contraceptive

Rukhlyada N.N.

Abstract

Objective. To carry out a systematic analysis of the data that may predict the tolerability of various hormonal contraceptives in order to elaborate an algorithm to choose the best hormonal contraceptive. Material and methods. A meta-analysis of literature data on the tolerability of hormonal contraceptives was made. Results. A computerized MyContraception algorithm to choose hormonal contraception and a specific contraceptive was elaborated using a mathematical model of multivariate analysis of their tolerability, acceptability, and side-effectprofile. Conclusion. It is necessary to accumulate a knowledge base using the recipient-application feedback that will be able to dynamically improve the mathematical algorithm with consideration for information accumulation, as well as the possibility of complementing novel hormone-containing contraceptives to the knowledge base.
Obstetrics and Gynecology. 2016;(4):107-111
pages 107-111 views

Effect of a sibutramine/metformin combination on anti-Mffllerian hormone level, carbohydrate and lipid metabolisms in therapy for polycystic ovary syndrome in women with metabolic syndrome

Andreeva E.N., Grigoryan O.R., Volevodz N.N., Melnichenko G.A.

Abstract

Objective. To evaluate the clinical efficacy of reduxin met (Promomed, Russia) on anti-Müllerian hormone (AMH) level, carbohydrate and lipid metabolisms in patients with polycystic ovary syndrome (POS) and metabolic syndrome. Subjects and methods. Sixty patients aged 22 to 35 years (mean age, 28.7±5.2 years) with POS and verified metabolic syndrome (impaired tolerance glucose), were examined. The effects of different drugs on AMH level and carbohydrate and lipid metabolisms were comparatively analyzed. Results. During therapy with reduxin met, the values of AMH decreased from 8.8±1.6 ng/mg at baseline to 5.4±1.2 ng/ml after 3 months of therapy (p<0.01). This drug had a favorable effect on the blood lipid spectrum and carbohydrate metabolism following 3 months of its use, by reducing the level of total cholesterol and its atherogenic fractions and by normalizing carbohydrate metabolism. Conclusion. The decrease in AMH levels and the normalization of carbohydrate and lipid metabolisms in women with POS and metabolic syndrome during sibutramine/metformin hydrochloride combination therapy lead to the conclusion that this combination positively and effectively affects the above-mentioned parameters and ovulatory dysfunction through insulin-mediated mechanisms.
Obstetrics and Gynecology. 2016;(4):112-119
pages 112-119 views

Vitamin D and metabolic syndrome risk in patients with reproductive dysfunction

Maltseva L.I., Gafarova E.A.

Abstract

Objective. To estimate the blood level of 25(OH) D3 and its effect on the development of hormonal and metabolic disorders in women with polycystic ovary syndrome (PCOS) and reproductive dysfunction. Subject and methods. Forty-five with PCOS and 15 healthy women were examined. Physical examination, assessment of constitutional traits, and estimation of the degree of hirsutism, hormonal background, and carbohydrate metabolic parameters were done. Serum vitamin D metabolite levels were measured by enzyme immunoassay using a 25(OH) D2 and D3 DIA SOURCE kit. Results. All the women with PCOS were ascertained to have reduced blood 25(OH) D2 and D3 levels. Severe vitamin D deficiency (11.49±2.1 ng/ml) was detected in patients with hyperandrogenic phenotypes of PCOS; moderate deficiency (21.8±3.58 ng/mg) was observed in those without obvious hyperandrogenism. The PCOS women with 25(OH) D2 and D3 deficiency were found to have insulin resistance, hyperinsulinemia, abdominal obesity, and a three-fold increase in anti-Müllerian hormone. Conclusion. Blood vitamin D deficiency in patients with PCOS is attended by hormonal background changes, hyperandrogenism, and evolving symptoms of metabolic syndrome.
Obstetrics and Gynecology. 2016;(4):120-125
pages 120-125 views

Contraception among young people: Preferences and knowledge

Aganezov S.S., Morotskaya A.V., Aganezova N.V.

Abstract

Objective. To define preferences and the level of awareness about contraceptives among sexually active medical students in Russia and European countries. Subject and methods. A specially designed questionnaire was placed in the public networks. The group is a simple random sample. A total of 213 (156 Russian and 57 foreign) medical students took part. Results. Combined contraception is used by 86.5 and 29.3% of % of foreign and Russian female students, respectively. A dual method (combined contraception and a condom) is not used by 46.4 and 16.2% of Russian and foreign students, respectively. In Russia, young people choose lowly effective methods (only a condom, coitus interruptus) three times more often than in foreign countries; 16.7% of couples in Russia do not use contraception. The students’ knowledge of contraceptive methods depends on the availability of a specialized contraception course in the curriculum of higher educational establishments.
Obstetrics and Gynecology. 2016;(4):126-132
pages 126-132 views

Bacterial vaginosis: A new paradigm

Khryanin A.A., Reshetnikov O.V.

Abstract

Objective. To carry out a systematic analysis of the data available in the modern literature on bacterial vaginosis, its diagnostic criteria, and current therapeutic methods. Material and methods. The review involves the data of foreign and Russian articles published in the past 15 years on this topic. Results. The paper gives classical ideas on bacterial vaginosis and also shows new evidence on the existence of microorganisms as biofilms, on new microbial communities, and on the possibilities of combined local therapy for bacterial vaginosis. Conclusion. Combined local therapy for nonspecific vulvovaginitis should be used in mixed bacterial and fungal infections. Neo-penotran l is a drug showing a high clinical efficacy.
Obstetrics and Gynecology. 2016;(4):133-139
pages 133-139 views

Experience with a drug containing isoflavones used in the correction of psychosomatic disorders in women with climacteric syndrome

Chernichenko I.I., Voishnarovich A.V.

Abstract

Objective. To investigate the body’s associations, by which one can regulate dysfunctions of the hypothalamo-pituitary-adrenal axis, by affecting estrogen receptors with chemically similar plant components. Subject and methods. The efficacy of a phytoestrogen drug containing isoflavones (menoril plus) used to correct neuroautonomic and psychosomatic disorders was investigated in 96 perimenopausal women. Results. The phytoestrogen drug menoril plus, containing isoflavones, in perimenopausal women with different manifestations of climacteric syndrome is rather effective in eliminating or reducing the clinical manifestations of the disease. Conclusion. The use of menoril plus improves modified menopausal index, normalizes psychosomatic disorders and hormonal status in women, which stabilizes the function of the autonomic nervous system.
Obstetrics and Gynecology. 2016;(4):140-144
pages 140-144 views

Benign breast dysplasia and combined oral contraceptives

Novikova V.A., Penzhoyan G.A., Fedorovich O.K.

Abstract

Objective. To study current ideas on the role of combined oral contraceptives (COC) in the development of breast cancer. Material and methods. Key words were used to f ind sources on this topic in international databases; 24 sources were selected. Results. There is an update on the role of COC in the development of breast cancer, on the need to individually choose COC having an antiproliferative gestagenic component (dienogest, drospirenone) and on the possibilities to adjust an estrogen dose, without needlessly changing completely COC (ethinyl estradiol 30 or 20 pg), antirecurrent therapy, particularly in women after breast surgery (sector resection) or invasive diagnosis (puncture, biopsy). Conclusion. The timely preclinical diagnosis and targeted prevention of tumors, individual choice of COC, and a possibility to adjust an estrogen dose, as well as antirecurrent therapy are present-day actual measures to reduce female morbidity rates and to improve survival and quality of life.
Obstetrics and Gynecology. 2016;(4):145-150
pages 145-150 views

Monochorionic triamniotic triplet pregnancy in an assisted reproductive technology programs: A clinical case

Kalinina E.A., Vladimirova I.V., Sukhikh G.T.

Abstract

Background. In spite of tactics to reduce the number of transferred embryos and selective transfer of one embryo in assisted reproductive technology (ART) programs, multiple pregnancies continue to be a serious problem for both obstetricians/gynecologists, neonatologists, and specialists in other fields. Description. The paper describes a clinical case of monochorionic triamniotic triple pregnancy occurring after an ART program.
Obstetrics and Gynecology. 2016;(4):151-153
pages 151-153 views

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