No 7 (2020)

Androgens play one of the key roles in the pahophysiology of women. The age-related decline in the synthesis of ovarian and adrenal androgens can substantially affect women’s health. Lower androgen levels are a result of diminished ovarian function and an age-related decrease in adrenal androgen synthesis. The relative androgen deficiency in pre- and postmenopausal women can cause deterioration in sexual function, libido, and mental and emotional health and cognitive decline, as well as it also affects the cardiovascular and musculoskeletal systems. The treatment options for reduced sex desire are multifaceted and should involve both menopausal hormone therapy and individual psychosocial therapy.

The authors have carried out a systems analysis of the data available in the literature on the possibilities of using the latest artificial intelligence (AI) techniques in the field of assisted reproductive technologies (ART). The review covers a number of foreign and Russian publications on this topic. The analysis of the literature has led to the conclusion that scientific collaborations in the field of ART and AI open up new opportunities for working with the biological material of infertile patients and increase their chances of becoming parents. A more accurate and standardized analysis of the structure and morphology will enable clinical embryologists to select the most viable embryos for transfer and to use the best sperm for fertilization in ART programs. Despite the fact that many methods in this area still remain experimental and require further studies and improvement; these will be able to create the assisted systems implementing decision support. However, reproductive centers need the systems. The relevance of these systems in modern medicine leaves no doubt: tools are often lacking; the health-disease borders are quite wide and may overlap; the final prediction is subjective.

Objective. To study clinical, anamnestic and laboratory risk factors of gestational diabetes mellitus (GDM). Materials and methods. The study included 220 women aged from 18 to 43 years. The patients were divided into two groups and subgroups: group I consisted of 118patients with GDM, group Ia - 94 patients with GDM on diet therapy, group Ib - 24patients with GDM on insulin therapy; group II included 102 women with uncomplicated pregnancy. Age indicators, history of somatic and gynecological diseases, reproductive history, characteristics of the current pregnancy, indicators of oral glucose tolerance test (OGTT), ultrasound parameters of fetal growth have been studied in detail. Results. GDM was significantly more common in multigravidas aged from 26 to 37 years. These patients were significantly more likely to have inherited type 2 diabetes mellitus, GDM in the previous pregnancy. They are characterized by an earlier age of menarche, uterine fibroids, infertility and a past history of artificial abortion. The course of pregnancy was complicated by the threatened miscarriage and dysbiotic disorders of the vaginal microbiota. The analysis of OGTT results showed the role of fasting hyperglycemia, as the most common reason for the insulin therapy. The tendency to higher fetal weight indicators in pregnant women with GDM starts at 18 weeks of gestation. Conclusion. The identified risk factors indicate the need for timely diagnosis of GDM to prevent pregnancy complications.

Objective. To analyze the prediction and prevention of preeclampsia using prenatal screening performed in the City Center for Family Planning and Reproduction. Materials and methods. A total of2374 case histories were analyzed. The study revealed 209 women at high risk for preeclampsia with likelihood of its developing 1:100 and higher. Additionally, 102 patients with a low risk for preeclampsia and 18 pregnant women who had severe preeclampsia at different gestation periods were identified. Results. The incidence of preeclampsia was 10.0%; it was 11.8% in the absence of preventive measures, and it was 9.7% in their presence (p=0.72). In case of hemodynamic disorders in the uterine arteries, the incidence of preeclampsia was 12.5%, in the absence of disorders it was 9.1%; the incidence was 6.7% with changes in pAPPA-A and 7.1% with changes in PLGF. Conclusion. The criteria proposed in the program are not absolute and finalized. For the prevention of preeclampsia, it is more appropriate to use a preventive complex including general hygiene measures, diet, treatment of extragenital pathology, and administration of medications depending on the detected changes.

Aim. To identify medical and social risk factors and investigate the condition of the endometrium in women with the early loss of current pregnancy and a history of recurrent early miscarriages. Materials and methods. The study prospectively evaluated the course of pregnancy and perinatal outcomes of184 women. The study group included 75 patients who experienced a current pregnancy loss in the first trimester and had a history of threatened and recurrent miscarriages of early pregnancy. The comparison group consisted of 73 women with a history of threatened and recurrent miscarriages of early pregnancy, but their current pregnancies progressed to 22 weeks. Results. The histopathology reports of patients with recurrent miscarriage showed an abnormal villous differentiation, chromosomal disorders in the form of avascular chorionic villi, lymphocytic inflammation, edema of the endometrial stroma, and foci of necrosis. In patients with spontaneous abortion, histopathology findings included focal sclerosis, stromal fibrosis, delayed differentiation of fibroblast-like cells into pre-decidual cells, focal perivascular and peritubular lymphoplasmohistiocytic stromal infiltration, and sclerosis of the spiral artery walls. Conclusion. Recurrent miscarriage is associated with impaired differentiation of chorionic villi accompanied by vascular abnormalities, which may be considered as a morphological confirmation of possible chromosomal disorders. Early pregnancy loss in the form of spontaneous abortion is caused by chronic endometrial inflammation. The study findings must be taken into account when planning antenatal care for these women.

Objective. To study the methylation profile of genes in the placenta and plasma of patients with preeclampsia. Materials and methods. The study included two groups of pregnant women. The main group consisted of 26 women with preeclampsia, 12 of them had moderate preeclampsia and 14 women had severe preeclampsia. The control group consisted of 26 women with normal pregnancy. The methylation level of 22 genes was determined. The study was conducted using Methylation-Sensitive High Resolution Melting curve analysis (MS-HRM). Results. The study of methylation of IGF2/H19 imprinting control region (ICR) showed a statistically significant decrease in the relative level of methylation in the placenta and blood plasma in patients with moderate and severe preeclampsia (p<0.05). There was a statistically significant increase in the level of the TLR2 gene methylation in the placenta and blood plasma in patients with severe preeclampsia in comparison with the patients with normal pregnancy (p<0.05). Conclusion. The results of the study indicate that the TLR2gene methylation and the IGF2/H19 ICR influence the development of a systemic inflammatory response in preeclampsia. The level of gene methylation in blood plasma correlates with the level of genes in the placenta and can be used as early non-invasive markers of preeclampsia.

Aim. To identify risk factors for the development of pelvic adhesions in women of reproductive age. Material and methods. The study retrospectively analyzed 500 clinical records of randomly selected patients who underwent gynecologic pelvic surgery for various indications. Of them, 290patients diagnosed with pelvic adhesions according to the R-AFS classification system were included in the main retrospective group. A retrospective comparison group was made up of 210 patients without pelvic adhesions. Continuous data were presented as median and the quartiles with differences between unpaired groups assessed by the Mann-Whitney U test. Qualitative variables were summarized as counts and percentages. The odds ratio (OR) and 95% confidence intervals (95% CI) to determine the risk factors for developing adhesions were calculated. Results. The study identified risk factors for developing postoperative pelvic adhesions. It showed that already known risk factors predisposing to the formation of pelvic adhesions should be added with such factors as non-gynecologic comorbidities (diseases of the cardiovascular and endocrine system), endocrine disorders (estrogen deficiency and hypersecretion of thyroxine), intraoperative blood loss > 1000 ml, and the time from the last surgery > 12 months. Conclusion. The study results showed that non-gynecologic comorbidities (diseases of the cardiovascular and endocrine system), endocrine disorders (estrogen deficiency and hypersecretion of thyroxine), intraoperative blood loss more than 1000 ml, and the time from the last surgery more than 12 months may be considered as risk factors for the formation of adhesions. These findings must be taken into account when developing preventive and therapeutic measures.

Objective. To determine the topography variants and quantity of the extraorganic anastomoses of the uterine artery (UA) in females with different somatotypes. Materials and methods. The study was carried out on 113 unf ixed female corpses (aged from 32 to 93 years). The method of somatotyping, intravascular injection, dissection method and statistical processing of the obtained data were used to achieve the aim of the study. Results. UA anastomoses were formed with other branches of the internal iliac artery in 21.2% of cases on the right and in 23.0% of cases on the left. It was found that two thirds of all UA anastomoses were located in its proximal third and one third was localized in its middle third. Extraorganic anastomoses of the UA were more frequently noted in the group of females of the dolichomorphic somatotype, and less commonly in females of the brachymorphic somatotype. Conclusions. The study showed that extraorganic anastomoses of the UA have a certain pattern of its origin.

Objective. To analyze fetoplacental hemodynamic parameters in women with fetal growth restriction (FGR) and to evaluate the impact of fetoplacental blood flow on neonatal outcomes. Materials and methods. A total of 138 labor and delivery records were analyzed in patients with FGR who delivered babies weighing up to 2000g. Results. An assessment of perinatal outcomes and their relationship to the severity of impaired fetoplacental blood flow revealed that critical fetoplacental hemodynamic disorders increased the risk of infant death three-fold in the neonatal period. Conclusion. The results of this study demonstrate the importance of regular Doppler studies of fetoplacental blood flow in the detection of FGR in order to monitor the intrauterine fetal status and to improve perinatal outcomes.

Nonspecific vaginitis (NSV) is an extremely common problem that is of great medical and social importance, especially in the population of women of childbearing age. It seems necessary to study the possibilities of using new topical combination drugs made in Russia for the treatment of NSV, which would not be inferior or superior to foreign analogues in efficiency, safety, and ease of use. Objective. To investigate the efficacy and safety of Targyfort in two parallel groups of 360 women aged 18 to 45 years with a clinical diagnosis of acute vaginitis specified by laboratory assays. The aim was to assess the frequency of complete recovery in the study group at 14 days after treatment completion. The duration of therapy was 10 days in both groups. Subjects and methods. The open-label comparative randomized multicenter clinical trial was conducted in the Russian Federation in 2017-2018. This evaluated the efficacy and safety of Targyfort vaginal suppositories (OAO “Avexima”, Russia) and Tergynan vaginal tablets (Laboratoires Bouchara-Recordati, France) in the treatment of vaginitides of various etiologies. Results. The investigation shows that the efficacy of the Russian drug Targyfort in a number of very important indicators that directly affect quality of life in patients is not lower (no pain (98.3%), burning (97.8%), and itching (98.9%) in the Targyfort group and 98.3, 97.8, and 95.4% in the Tergynan group), whereas the rate of disappearance of the symptoms of pain and burning (4.3 and 4.8 days) is statistically significantly higher than that of Tergynan (5.6 and 5.8 days). Conclusion. The results of the investigation make it possible to recommend Targyfort for the treatment of vaginitides of various etiologies in women of childbearing age as an effective and safe therapeutic drug that is convenient for self-use.

Objective. To study the detection rate of various fungal species of the Candida genus and their susceptibility to antifungal drugs over the period from 2010 to 2020. Material and methods. Species identification was performed using 1927 Candida strains isolated from patients with urogenital candidiasis and their susceptibility to amphotericin B, clotrimazole, miconazole, ketoconazole, itraconazole, and fluconazole was determined. Results. There was a decrease in the specific share of C. albicans in the total structure of identified fungi of the Candida genus (from 90.2% in 2010 to 66.7% in 2020) and a pronounced tendency to increase the detection rate of non-albicans Candida strains: C. glabrata from 6.5% to 16.7%, C. krusei from 2.2% to 7.4%, C. parapsilosis from 0 to 4.6%, C. tropicalis from 1.1% to 2.8%, and C. kefyr from 0% to 1.8%. C. albicans and C. glabrata showed a high susceptibility to amphotericin B (99.2-100% and 88.2-100%, respectively), ketoconazole (98.6- 100% and 93.7-100%), and clotrimazole (92.7-100% and 87.5-100%); more than 80% of other Candida species were also susceptible to these drugs. Over the study period, C. albicans displayed a reduction in the level of susceptibility to fluconazole from 100% to 73.6% and to miconazole from 98.8% to 79.2%. In 2010-2020, there was a marked increase in itraconazole resistance in Candida species: C. albicans from 14.5% to 52.9%, C. krusei from 0 to 37.5%, and C. parapsilosis from 0 to 60.0%; more than 50% of the C. glabrata, C. tropicalis, and C. kefyr isolates were resistant to itraconazole. Conclusion. A dynamic a change in the species pattern of urogenital candidiasis pathogens, which is characterized by an increase in the proportion of non-albicans Candida species and by a decrease in the susceptibility of Candida fungi to a number of azole drugs (fluconazole, itraconazole, miconazole), necessitate the monitoring of antimycotic resistance and, if necessary, the optimization of the recommended therapy regimens for urogenital candidiasis according to the values obtained.

Background. Globally, the number of clinical cases of parasitic fibroids is steadily rising, which is associated with rapid technological progress and the widespread availability of minimally invasive technologies in the treatment of patients with uterine fibroids. The predominant use of endoscopic technologies with the morcellation of myomatous nodes can potentiate the formation of parasitic fibroids. Case report. The paper describes a clinical case of retroperitoneal parasitic fibroids in a 49-year-old patient who was hospitalized in the Russian Center of Gerontology 6 years after laparoscopic myomectomy. The surgical treatment followed by histological verification confirmed the diagnosis of fibroleiomyoma. Conclusion. The clinical case shows that it is necessary to study and optimize management tactics and to develop a clinical protocol for physicians on the management of patients with parasitic fibroids at the prehospital stage and in the postoperative period.