No 6 (2019)

The review article covers the definition of vulvodynia, its possible causes, the pathogenetic mechanisms of development, and the specific principles of treatment. The main factors contributing to disease development are comorbidity, other pain syndromes in the history, chronic inflammation, pelvic floor muscle hypertonicity, genetic, neurological factors, and psychosocial problems. Due to the multivariate pathogenesis of vulvodynia in each patient, interdisciplinary and personalized approaches that affect the mechanism of disease development, as well as a search for new specific treatments should be considered as the principles of treatment. These methods are the application of botulinum toxin type A, platelet-rich blood plasma, hyaluronic acid, and placental preparations along with developing physiotherapy treatments.

The data available in the literature on the use of the health-resort stage of treatment have been analyzed in high-risk pregnant women. Open-access Russian publications for the last 15 years have been sought in the PubMed database. The article analyzes health-resort treatment for high-risk pregnant women, the current state of the problem, indications for and contraindications to this treatment for pregnant women, and the possibilities for using natural and preformed physical factors in pregnant women. Conclusion. The paper shows the feasibility of therapeutic and preventive activities of the sanatoriums that aim to work with pregnant women and the importance of this treatment for preserving the health of women and their offspring.

Objective. To clarify risk factors for fetal growth restriction (FGR), to determine the features of a genotype by the interleukin (IL)-10 A-1082G polymorphism and its effect on the production and secretion of IL-10 by peripheral blood monocytes in women with FGR. Subjects and methods. A total of209pregnant women were surveyed. The investigators assessed IL-10A-1082G gene polymorphism by a real-time polymerase chain reaction assay, the intracellular production of IL-10 by monocytes by means of flow cytofluorometry, and IL-10 levels in the 24-hour monocyte culture supernatants by enzyme immunoassay. Results. The IL-10-1082AA genotype was more common in women with FGR. Changes were found in the synthesis and production of IL-10 by monocytes in relation to the allelic variant of the IL-10 A-1082G polymorphism. Conclusion. The most significant risk factors for FGD are tobacco smoking, extragenital pathology, and a compromised obstetric and gynecological history. The results of the study may suggest that the L-10 A-1082G polymorphism is an additional factor regulating the immune balance during pregnancy when FGR develops.

Aim. To estimate the burden of gynecological diseases and determine the impact of behavioral indicators on adolescent girls’ reproductive health in Almaty using logistic regression. Material and methods. The study investigated the prevalence of gynecological diseases among girls aged 10-17 years in Almaty from 2013 to 2017, analyzed results of a social survey of667schoolgirls aged 11, 13 and 15, and assessed a relationship between behavioral indicators and menstrual disorders in school-age girls using binary logistic regression. Results. Annual incidence rates of gynecological diseases among girls in Almaty did not tend to decrease. The most common gynecological disease was abnormal uterine bleeding in puberty (32%), it was followed by pelvic inflammatory diseases (15.5%), and dysmenorrhea (9.9%). Logistic regression modeling identified behavioral indicators associated with menstrual disorders in school-aged girls including frequent consumption of sweets Conclusion. To improve adolescent reproductive health care for girls aged 10-17 years in Almaty, a multifactorial approach needs to be introduced aimed at correcting several risk factors.

Objective. Reduction of reproductive losses in women with uterine myoma. Materials and methods. 249 pregnant women with uterine myoma aged 21 to 44 years were examined and operated on. Group I-137patients who underwent myomectomy during this pregnancy (retrospective analysis). Group II-82 patients (prospective study). The comparison group (III) included 30 pregnant women with uterine myoma who were denied surgical treatment during gestation due to the absence of vital indications for surgery and high risk of fetal loss. Results. Analysis of the immediate and long-term results of reconstructive plastic surgery in uterine myoma during pregnancy indicates the effectiveness of this intervention. The importance of this operation is determined by the possibility of creating favorable conditions for pregnancy and reproductive function. Myomectomy during pregnancy, performed according to strict indications in compliance with surgical technology, allows to preserve reproductive function, to complete this pregnancy favorably in 80.3 % of pregnant women with uterine myoma and in 31.2% of women with a history of reproductive losses. Conclusion. Indications for myomectomy during pregnancy is not the presence of a node, even a large size, but a violation of the function of the abdominal cavity, due to myoma: persistent pain in the abdomen and pelvis; acute urinary retention as a result of mechanical compression of the nerve endings and necrosis of the node; giant size nodes that perform the abdominal cavity and prevent the prolongation of pregnancy. The reproductive prognosis is more favorable if the thickness of the intact myometrium between the lower pole of the node and the uterine cavity is not less than 5 mm, the location of the placenta on the node is not more than 1/3 of its site. Myomectomy, especially in women of the older age group, in which this pregnancy may be the last and often the only opportunity to have a child, is a method to realize this possibility.

Objective. To evaluate the efficiency of in vitro fertilization (IVF) programs during the transfer of blastocysts in a cryo-cycle with their zona pellucida (ZP) removal. Material and methods. An experimental group included 209 patients whose embryos before transfer were subjected to complete mechanical ZP removal; a control group consisted of222patients, in whom blastocysts with intact ZP were used for transfer. The rates of embryo implantation and clinical and progressive clinical pregnancy were estimated. Results. All clinical outcomes of the programs had no statistically significant differences in the group of embryos with the removed ZP and with the embryos in the control group, including subgroups of patients younger and older than 36 years of age. Conclusion. Complete zona pellucida removal from blastocysts prior to their transfer in a cryo-cycle does not affect the efficiency of IVFprograms.

Objective. To elaborate a pathogenetic approach to tocolytic therapy. Subjects and methods. A total of 146 patients with clinical presentations of preterm labor at 24 to 34 weeks’ gestation were examined. Results. In 71.9% of pregnant women, tocolysis with atosiban could prolong pregnancy for 48 hours or more. Pregnancy could be prolonged for an average of 13.1±3.5 days. Further examination revealed cervical canal infection in 71.2% of women. In addition, the study showed that the expression of toll-like receptor (TLR) in the cervical canal epithelium was enhanced in women without cervical infection. Conclusion. Our investigations have demonstrated that cyclooxygenase inhibitors should be the leading tocolytic agents and it is necessary to use antibacterial therapy to enhance the efficiency of tocolysis.

Currently, the development of inflammatory processes in the female urogenital tract is already clearly associated with a decline in the number of lactobacilli that are dominant in the vaginal microbiota in health. Lactic acid (LA) is the main metabolite of lactobacilli, which regulates their anti-inflammatory functions. Objective. To determine the antimicrobial activity of LA in combination with glycogen against various test cultures of opportunistic pathogenic microorganisms. To investigate morphofunctional changes in the cells of the opportunistic pathogenic bacteria S. aureus and E. coli and the microscopic fungus C. albicans in the presence of LA with glycogen in vitro. To develop an experimental model to study the effect of various pH values that mimic the inflammatory process on the growth of test cultures of probiotic lactobacilli, the main representatives of the vaginal microbiota in the presence of LA with glycogen. Materials and methods. The investigation was concerned with the associations of lactobacilli, the main representatives of the vaginal microbiota, Complex No. 1 (L. crispatus, L. rhamnosus, L. gasseri, L. jensenii), Complex No. 2 (L. gasseri, L. fermentum, L. plantarum), Complex No. 3 (L. crispatus, L. brevis, and L. acidophilus), and L. casei. The museum strains of S. aureus 65 and E. coli M17, as well as the museum strain of microscopic C. albicans 8 fungi from the collection of the N.F. Gamaleya Research Institute of Epidemiology and Microbiology were selected as opportunistic pathogenic bacteria. Lactagel, a vaginal gel containing LA 225 mg and glycogen, was used as a source of LA. The growth of the cultures and the morphological properties of the cells when exposed to LA were analyzed by microbiological and electron microscopic assays using transmission electron microscopy. Results. A model for carrying out experiments was developed to determine the ability of LA in combination with glycogen to stimulate the growth and development of probiotic lactobacilli at high pH values characteristic of inflammation. The effect of LA with glycogen on opportunistic pathogenic bacteria and microscopic fungi was manifested by inhibition of the growth of these microorganisms. An electron microscopic study of ultrathin sections of opportunistic pathogenic bacteria and fungi made it possible to establish destructive changes in their morphofunctional properties when exposed to LA in combination with glycogen. At the same time, LA did not adversely affect the morphological properties of lactobacilli and stimulated their growth. LA in combination with glycogen showed an average of 1.5-3.5-fold greater antimicrobial activity than probiotic lactobacillus strains against opportunistic pathogenic bacteria and fungi. Conclusion. An experimental model for conducting a fundamental study of the effect of LA in combination with glycogen on the growth and development of probiotic lactobacilli in vitro, by taking into account the pH value of a medium, was first described. The investigation established that LA in combination with glycogen might be used as the main factor regulating the natural composition of the vaginal microbiota.

Endometrial cancer remains one of the most important issues in gynecologic oncology, it requires timely diagnosis as well as prevention of adverse postoperative outcomes. Endometrial cancer is associated with high risk of developing venous thromboembolic complications, particularly in patients with obesity. Therefore, patients at high risk need rational prevention of thromboembolic complications. Objective. To determine the activation level of hemostasis system in patients with endometrial cancer for analyzing the effectiveness and safety of treatment with antithrombotic therapy when surgeries are performed. Materials and methods. The study included 80 patients diagnosed with a verified diagnosis of endometrial cancer, including 56 cases staged TlbNxMx, and 24 cases staged T2aNxMx. All patients underwent laparoscopic total hysterectomy, adnexal surgery and pelvic lymphodenectomy. In order to perform comparative analysis of hemostasis system and to study the effectiveness of antithrombotic therapy, the patients were divided into two groups according to pathogenetic patterns: patients with normal body weight (n = 40) and patients with obesity (n = 40). The main parameters of hemostasis system in both groups were analyzed, and mutation in genes affecting hemostasis in such patients was revealed. Forty women were healthy controls. Results. According to the study, the functional reserves of hemostasis system are more diminished in obese patients with endometrial cancer than in patients with normal body weight, therefore it is necessary to perform effective antithrombotic therapy. Preoperative anticoagulant therapy in combination with postoperative treatment with preparation Fluxum may prevent the development of venous thromboembolic complications even in patients at high risk. Conclusion. Taking into consideration the unstable hemostasis system in obese patients with endometrial cancer, the use of parnaparin-natrium (Fluxum) appeared to be highly effective in the prevention of thrombotic complications after surgery in patients with endometrial cancer.

The survey presents the possibilities of the therapy and of the efficiency in the use of antispasmodics, including m-cholinolytics from the example of metacinum iodide (methacin), in the treatment and in the prevention (prophylaxis) of the threat of termination of pregnancy. Distinctive characteristics of the medicinal drugs, the reduction (decrease) of the evidences of the adverse drug reactions, the additional positive effects are examined in this survey.

Catamenial pneumothorax (CP) is recurrent spontaneous pneumothorax that occurs in women during the reproductive period. According to its etiology, CP is a manifestation of the pulmonary forms of endometriosis (PE). Objective. To present clinical cases of PE-induced CP in the period 2015-2017 and the examination and management tactics elaborated by the authors for patients with this pathology Case reports. CP was detected and surgically treated in 3 patients because of PE only and that concurrent with genital forms of endometriosis. The paper gives the stages of a clinical diagnostic search for the diagnosis and identification of concurrent forms of endometriosis, surgical treatment, and drug therapy according to the patients’ reproductive plans. A multidisciplinary management approach is proposed to prevent the recurrence and progression of the disease within one-year follow-up after the onset of manifestation. Conclusion. The surgical management tactics for patients with CP due to PE involves thoracoscopy for pneumothorax, regardless of the presence or absence of evidence for bullous lung degeneration in reproductive- aged women, and removal of the cause of pneumothorax. The use of dienogest for medical correction in both pulmonary endometriosis only and that concurrent with pulmonary genital forms of endometriosis after surgical treatment is justified in order to prevent recurrent CP and progressive endometriosis. Dienogest is safe in its longterm use and the absence of severe side effects, which contributes to patient adherence to long-term treatment for the disease.