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No 12 (2021)

Articles

Predictors of endometriosis in infertility

Ivshin A.A., Pogodin O.O., Gusev A.V.

Abstract

Endometriosis is a gynecological disease associated with infertility, affecting 6-10% of reproductive-aged women. The current objective diagnosis of endometriosis is based on a visual assessment of abdominal and pelvic organs with obligatory histological verification of surgical materials. Meanwhile, the need for invasive surgery to identify endometrioid heterotopias slows down the diagnostic search, and it takes an average of about seven years from disease onset to diagnosis. Delayed diagnosis of endometriosis is often accompanied by adverse consequences as progression of the disease and development of untreatable infertility. Thus, the identification of significant noninvasive predictors for endometrioid disease, which are associated with infertility, will be able to identify a group of high-risk patients for this pathology and to speed up its diagnosis. According to the literature data studied, the reliable prognostic signs of endometriosis in infertility are premenstrual spotting, primary infertility, the unfavorable course of dysmenorrhea, the presence of nodules in the region of the sacrouterine ligaments or posterior vault, age, the duration of infertility, body mass index, the length of the menstrual cycle, repeated abortions, dyspareunia, chronic pelvic pain, and a family history of endometriosis. The independent predictive factors of severe infertility-associated endometriosis are age, education, the duration of infertility, body mass index, amount of menstrual blood loss, the duration of menstruation, dyspareunia, chronic pelvic pain, and a family history of endometriosis. Conclusion: The design of special detailed questionnaires and diagnostic programs that are risk classif iers will contribute to the timely identification of patients having the greatest risk of developing endometriosis in infertility, who should mostly undergo immediate laparoscopy.
Obstetrics and Gynecology. 2021;(12):5-15
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The current concept of the role of papillomavirus infection in the development of cervical intraepitelial neoplasia

Beglaryan G.A., Arutyunyan A.G.

Abstract

Cervical cancer remains an important indicator of global health inequities. There are estimated 569,000 new cases and 310,000deaths annually, among which approximately 85% occur in low- and middle-income countries. In developing countries, cervical cancer is often the most common cancer in women and can account for about 25% of all cancers in them. In 1996, the World Health Association recognized human papillomavirus (HPV) as an important cause of cervical cancer. Materials and methods: The authors have analyzed the data available in the literature on studies of cervical cancer and HPV. The keywords have been used to search for data in international databases. A total of 31 sources were selected on relevant topics. Conclusion: It should be noted that the problem of human papillomavirus infection in gynecology is still far from being solved, and many issues are the subject of ongoing investigations. The complexity of the problem involves mainly the significant prevalence of infection, the emergence of new HPV genotypes and the presence of considerable differences in their malignant potency, as well as changes in the strength of the patient’s antiviral immunity that determines the stability of cure or the onset of relapse. The accumulated knowledge about the mechanism of viral carcinogenesis in the development of dysplasia and cervical cancer necessitates further investigation to develop the most effective etiopathogenetic treatment regimens that are able to have a point effect at the genetic level.
Obstetrics and Gynecology. 2021;(12):17-22
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Ovarian stimulation in the lutein phase of the menstrual cycle and in the double stimulation mode in patients with lower diminished ovarian reserve values

Krutova V.A., Golovko A.K.

Abstract

In vitro fertilization is still characterized by lower success rates in women who fail to respond adequately to controlled ovarian stimulation, also known as poor responders. To search for an effective treatment for this group of patients is an important problem. Objective: To provide up-to-date information on the use of protocols for ovarian function stimulation in the luteal phase of the menstrual cycle and in the double stimulation mode in patients with lower ovarian reserve values. Methods: Publications were sought for in the databases PubMed, eLibrary, Web of Science, Cochrane Library, and CyberLeninka. The search depth was 10 years. The systematic search used the following keywords: ovarian stimulation in the luteal phase, double stimulation, and diminished ovarian reserve; as well as double stimulations, luteal-phase ovarian stimulation, poor ovarian response, controlled ovarian stimulation, and second follicular wave in English-language publications. Results: The review included 42 of the 89 literature sources analyzed. This review of current studies has shown that ovarian stimulation can be safely and effectively initiated at any point in the menstrual cycle. Double ovarian stimulation is a promising protocol for patients, from whom the largest number of oocytes should be retrieved in the shortest possible time when one superovulation stimulation session is not enough or when the period for assisted reproductive technologies is limited. The literature data indicate that this strategy is a possible option to compensate for the inadequate ovarian response that sometimes occurs in assisted reproductive technology programs, especially in patients with lower ovarian reserve values. Conclusion: Ovarian function stimulation in the follicular and luteal phases of the menstrual cycle is a new strategy aimed at increasing the numbers of retrieved oocytes and obtained good-quality embryos. Just the same, there is a need for further investigation of the efficiency and safety of double stimulation in patients with diminished ovarian reserve
Obstetrics and Gynecology. 2021;(12):24-30
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Construction of an artificial ovary based on human preantral follicules

Menshikova N.K., Kirillova A.O., Mishieva N.G., Semenova M.L.

Abstract

The artificial ovary is a temporary construct suitable for transplantation in women, which consists of isolated follicles and possibly other cells encapsulated in a natural or artificial scaffold (Chiti, Dolmans, Donnez, & Amorim, 2017). This technology can help patients diagnosed with cancers to preserve and restore fertility when any other options (controlled ovarian hyperstimulation, followed by embryo or oocyte vitrification or ovarian tissue cryopreservation) are inaccessible to them. Currently, there are no routine fertility preservation methods in patients having malignant ovarian tumors and a risk of ovarian metastases. Cancer treatment-related infertility negatively affects quality of life in patients. The development of new fertility preservation methods in this group of patients is an extremely urgent and important task. This paper considers the concept of an artificial ovary and the history of this technology and its possible applications to preserve the reproductive potential of women. Particular attention is paid to necessary conditions for the functioning of a biofabricated ovarian construct, such as the cellular composition and source of follicles, and the characteristics of a scaffold. This paper is concerned with the latest world achievements in creating an artificial ovary. Animal models have been used to provide evidence for the artificial ovary concept and to obtain viable offspring. In vitro culture of human follicles, followed by xenotransplantation, has shown their ability to grow in ovarian constructs. Conclusion: Despite its complexity, the artif icial human ovary technology is developing successfully today. Owing to this new technology, in the future there may be successful therapeutic human transplantation of artificial ovaries created in vitro. The artificial human ovary technology can also have other important applications, for example, in the study of folliculogenesis and in the toxicological studies of the effect of different drugs on human reproductive function.
Obstetrics and Gynecology. 2021;(12):31-36
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Estrogen-like and antioxidant properties of resveratrol in clinical pharmacology and therapeutic use

Kareva E.N., Smetnik A.A.

Abstract

The article highlights the multi-target properties of trans-resveratrol which is a new generation of phytoestrogens with a high potential in the correction of menopausal disorders in women who cannot be prescribed menopausal hormone therapy. The article presents scientific data confirming that trans-resveratrol has a strong estrogenlike, antioxidant, cardioprotective action, as well as anti-aging and other effects. The clinical properties and mechanisms of resveratrol action are reviewed in terms of its use in gynaecology and clinical pharmacology. The article describes the effects of resveratrol on the manifestations of estrogen deficiency (vasomotor episodes, decreased bone mineral density, metabolic and psychoemotional disorders, and others). The pharmacokinetic properties of resveratrol which may limit its use in clinical practice are highlighted in the article; however, these problems can currently be solved due to the devlopment of new delivery systems. The paper shows the ways to increase the bioavailability of resveratrol which does not exceed 1% when ingested. When the medication is taken sublingually, absorption occurs quickly through the oral mucosa, thereby eliminating the effect on the intestines and metabolism in the liver during the initial passage. Due to the active component delivery systems developed with the help of modern pharmaceutical nanotechnology, it is possible to overcome the low solubility of resveratrol in water, which can significantly increase its absorbability through the oral mucosa and ensure its high bioavailability. Conclusion: The new medication Feminaspray in the form of a sublingual spray which contains trans-resveratrol, vitamin D3 and vitamin E leads to a statistically signif icant decrease in the main manifestations of menopausal disorders.
Obstetrics and Gynecology. 2021;(12):37-48
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Menopausal hormone therapy for rheumatic diseases: osteoarthritis

Panevin T.S., Yureneva S.V., Zotkin E.G.

Abstract

Osteoarthritis (OA) is one of the diseases of great sociomedical importance. Primary OA generally develops between the ages of40-45years, which corresponds to the onset of the menopausal transition and postmenopause in women. Women have a higher prevalence and incidence of OA than men over 50 years of age. Several studies have shown a higher incidence of joint pain and stiffness in postmenopausal women than in premenopausal women. The chronological association makes it possible to actualize the relationship between OA and age-related estrogen deficiency that develops with natural depletion of the ovarian reserve, as well as the possible positive effect of menopausal hormone therapy (MHT) on the course of this disease. The review presents current data on the effect of estrogens on the structural components of the joints, as well as on joint pain. It also considers the impact of MHT on the course and progression of OA. The biological effect of estrogens is produced by binding to one of two specific intracellular estrogen receptors that are expressed in chondrocytes, subchondral osteocytes, synoviocytes, as well as in fibroblasts of the ligaments and in myoblasts. In general, the effect of estrogens on articular structures can be characterized as anabolic. The presence of estrogen receptors and aromatase in the structures of the antinociceptive system is responsible for the potential analgesic effect. The results of studying the impact of MHT on the course of OA of different localizations are generally multidirectional and do not allow one to unambiguously recommend its use in the treatment of this disease. Conclusion: The impact of MHT on joint pain and on the regulation of cartilage tissue homeostasis is ambiguous and requires further investigation; however, the appearance of joint pain with the onset of menopause may be another argument in favor of considering the prescription of MHT.
Obstetrics and Gynecology. 2021;(12):50-57
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The breast and sex hormones

Smetnik A.A., Rodionov V.V., Kometova V.V., Burmenskaya O.V., Dardyk M.V., Sencha A.N., Ermakova E.I., Ashrafyan L.A.

Abstract

The breast is part of a woman’s reproductive system, a target organ for sex hormones, and a site of their local biosynthesis and metabolism. The risk of breast cancer (BC) in the presence of fibrocystic disease largely depends on the severity of breast tissue proliferative processes. Combined oral contraceptives (COCs) have some effect on the breast, which is usually levelled off by other positive effects of this type of therapy. The possible increase in BC risk, which is associated with menopausal hormone therapy (MHT), is small and similar to or lower than that related to decreased physical activity, obesity, and alcohol use. Micronized progesterone or dydrogesterone, as well as tibolone, bazedoxifene, and estrol, which are used in the therapy of menopausal disorders, may be associated with a lower BC risk. A family history of BC is not a contraindication to MHT. BRCA1/2 mutation carriers may benefit from MHT after risk-reducing salpingo-oophorectomy. BC is a contraindication to combined hormonal contraceptives, MHT, tibolone, and local hormone therapy. Conclusion: Thus, thorough breast examination before and during therapy, selection of patients from the low-risk BC group, and choice of drugs without proven significant effect on BC risks are the key when prescribing COCs or MHT
Obstetrics and Gynecology. 2021;(12):58-66
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Optimizing pre-pregnancy management of patients with post-cesarean section uterine scar

Kurtser M.A., Egikyan N.M., Savelyeva N.A., Vatagina M.A., Pisarskaya E.S., Platitsyn I.V., Kutakova Y.Y., Logunova A.O.

Abstract

Objective: To develop a strategy for pre-pregnancy management of patients with a post-cesarean section uterine scar. Materials and methods: A multicenter study including 209patients planning pregnancy naturally or by assisted reproductive technologies. The patients met the inclusion/exclusion criteria and were managed at a pre-pregnancy stage in clinical hospitals of the Mother and Child Group of Companies from 2018 to 2021 and. Baseline clinical evaluation included medical history taking, contrast sonohysterography on days 5-8 of the menstrual cycle, and pelvic magnetic resonance imaging on days 5-8 of the menstrual cycle. The statistical analysis was performed using the IBM SPSS Statistics v22 software (IBM Corp., USA). Results: We developed a scoring scale for grading scar niche severity. Based on this scoring scale, the patients were classified into three groups: in group I [n=107/209 (51.2%)] surgery at the pre-pregnancy stage is not recommended, in group II [n=36/209 (17.22%)] hysteroscopic uterine metroplasty is recommended, and group III [n=66/209 (31.58%)] laparoscopic uterine metroplasty is recommended. There were statistically significant differences between the groups of patients regarding the prevalence of clinical complaints, data on residual myometrium thickness, and niche volume. There was a high level of agreement between contrast sonohysterography and magnetic resonance imaging. Conclusion: The proposed scoring scale for grading scar niche severity helps a clinician choose the optimal managing strategy for the patient at the pre-pregnancy stage. Further clinical studies are needed to determine optimal threshold values of the uterine scar defect to select between a hysteroscopic and laparoscopic approach and evaluate the effectiveness of the proposed management strategy based on the results of prospective data regarding the elimination of gynecological symptoms, restoration of fertility, and assessment of obstetric complications.
Obstetrics and Gynecology. 2021;(12):68-75
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HLA-G expression in patients with missed miscarriages and a normal embryonic karyotype

Bakleicheva M.O., Bespalova O.N., Ivashchenko T.E., Tral T.G., Tolibova G.K., Tikhonov A.V., Petrova L.I., Dudkina V.S.

Abstract

The HLA-G gene has central functions in the processing and presentation of antigen, inhibits the NK-cell receptor (KIR2DL4, killer cell immunoglobulin-like receptor-2 DL4), resulting in reduced immune response at the maternal-fetal interface and providing maternal tolerance of fetal tissues. Based on this, many experimental studies have investigated the expression of the HLA-Ggene and its impact on the risk of pregnancy complications, such as early recurrent miscarriage, where immunological factors are believed to play a critical role. Objective: To investigate the expression of HLA-Gand KIR2DL4receptors in abortion materialfrom women with missed miscarriages (with normal fetal karyotype and polyploidy) and women with normal ongoing pregnancy (with induced abortion). Materials and methods: The study analyzed 115 samples of abortion material in two study groups with missed miscarriages (group 1 with 36 samples with normal fetal karyotype, group 2 with 35 samples with fetal karyotype by polyploidy type) and a control group with induced abortion ( group 3 with 44 samples with normal fetal karyotype). The samples were analyzed using cytogenetic and morphological (histological, immunohistochemical, and morphometric) methods. Results: An immunohistochemical analysis verified the expression of HLA-G in extravillous trophoblast cells and the expression of KIR2DL4 in chorionic villi (in cytotrophoblast and syncytiotrophoblast), in the glands, stroma, and superficial epithelium of the gravid endometrium in samples from women with and without missed miscarriages. In samples from women with missed miscarriages, the expression of HLA-G was statistically significantly lower than in the control group [37.7 (9.9), 36.4 (8.4), and 67.1 (5.6) in groups 1, 2, and control groups, respectively, p <0.001]. Conclusion: Patients with missed miscarriages had significantly lower HLA-G expression in the chorionic villus structures than patients in the control group. These findings suggest a role for HLA-G in pregnancy progression.
Obstetrics and Gynecology. 2021;(12):77-86
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Comparative analysis of the gut microbiome’s profile of mothers and newborns with preterm and timely birth

Gorina K.A., Khodzhaeva Z.S., Shubina J., Rogacheva M.S., Muminova K.T., Priputnevich T.V., Kutsar E.I.

Abstract

Objective: To study the gut microbiota profile in women with preterm and term infants using next-generation sequencing (NGS). Materials and methods: A prospective cohort study of 30 mother-infant pairs was conducted. The women and newborns were divided into two groups depending on gestational age (GA) at birth; group I consisted of 15 mother-infant pairs with spontaneous preterm birth (PTB), the median GA was 32.8 (2.08) weeks, and group II included 15 mother-infant pairs with term delivery (TD) at 39.5 (0.98) weeks of gestation. Fecal samples were analyzed using NGS. Results: Meconium of newborns in both groups was not sterile; the dominant microorganisms were Acinetobacter and Cutibacterium (Propionibacteriaceae). Members of Bifidobacterium (Actinobacteria) were the most common microbes in maternal gut microbiota. Comparative analysis of the gut microbiota profile in mothers and infants in both groups did not show statistically significant differences (p>0.05). Conclusion: Meconium was not sterile; it was antenatally colonized through maternal-fetal transmission, and a unique gut microbiota was formed. It should be interpreted as a new important factor of perinatal programming.
Obstetrics and Gynecology. 2021;(12):88-95
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The role of the folate cycle genes in development of uterine fibroids

Altukhova O.B., Radzinsky V.E., Polyakova I.S., Sirotina S.S., Churnosov M.I.

Abstract

Aim: To study association between polymorphic variants of the folate cycle genes and uterine fibroids. Materials and methods: 977 women were examined. Among them, 188 women had uterine fibroids alone, and 789 were included in the control group. Five polymorphic loci of the folate cycle genes were selected for the study: МТRR c.66А>G rs1801394, SHМТ1 c.1420С>Т rs1979277, ТYМS c.*19С>Т rs699517, ТYМS c.*89А>G rs2790, МТR c.2756А>G rs180508. The study was carried out using Thermal Cycler CFX96 Real- Time System for polymerase chain reaction. Results: Associations between molecular and genetic markers in genes SHМТ1 c.1420С>Т rs1979277, ТYМS c.*19С>Т rs699517, ТYМS c.*89А>G rs2790, МТR c.2756А>G rs180508 and formation of uterine fibroids alone were detected. The frequency of SHМТ1 rs1979277 C allele in patients with uterine fibroids was higher (70.92%) versus the control group (OR=1.30, р=0.04). Risk factor for development of uterine fibroids alone was combination of SHMT1 rs1979277 TT genotype and MTR rs180508 G allele (OR=0.29, р=0.01), as well as the combination of SHМТ1 rs1979277 СС genotype and of ТYМS rs699517 C allele (OR=1.41, р=0.02). The combination of SHMT1 rs1979277 TT genotype and TYMS rs2790 G allele was a protective factor for development of uterine fibroids alone (OR=0.26, р=0.03). Conclusion: Polymorphic loci of the folate cycle genes SHМТ1 c.1420С>Т rs1979277, ТYМS c.*19С>Т rs699517, ТYМS c.*89А>G rs2790, МТR c.2756А>G rs180508 are associated with development of uterine fibroids alone.
Obstetrics and Gynecology. 2021;(12):96-101
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The role of combined oral contraceptives in cervical intraepithelial neoplasia occurrence associated with human papillomavirus infection

Klyukina L.A., Sosnova E.A., Ischenko A.A.

Abstract

Aim: To study the incidence and course of cervical intraepithelial neoplasia (CIN) in women infected with highly oncogenic types of human papillomavirus (HPV) infection, who had indications for taking hormonal contraceptive pills in history. Materials and methods: The study included 163 women aged 19-45 years with high-risk HPV types (16, 18, 31, 33, 35, 51, 52, 56, 58). The physical status of HPV-16 was evaluated in 81 women with mono-infection. All women underwent examination in Treatment and Rehabilitation Center of the Ministry of Health of Russia in the period from 2020 to May, 2021. Results: 84 (51.5%) HPV-positive women who had indications for taking hormonal contraceptive pills in history were included in the main group; 79 (48.5%) HPV-positive women who never took hormonal contraception pills were included in the comparison group. It was found that continuous intake of hormonal pills effects the severity of CIN; respectively, in women who took hormonal contraception pills, severe cervical dysplasia was found most often (Н=18.352, р=0.001). Based on the results of the study of three forms of human papillomavirus infection occurrence: episomal, mixed and integrated, it can be assumed that continuous intake of hormonal contraception pills among women with HPV-16 infection in the form of mono-infection, may have effect on the physical status of HPV and accelerate the progression of human papillomavirus infection to the integrated form (Uemp.=88.5, р=0.001). Conclusion: Thus, it can be assumed that intake of oral hormonal contraceptives may have a negative effect on the course of papillomavirus infection and contribute to development and accelerated progression of CIN. Further studies on this issue will provide development of optimal management tactics for patients taking hormonal contraception pills with purpose of timely diagnosis and reduction of the risk of neoplastic progression and development of invasive forms of cervical cancer.
Obstetrics and Gynecology. 2021;(12):102-109
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Immune response in women with different morphological forms of chronic endometritis and impaired implantation

Mikhnina E.A., Davydova N.I., Kazantsev V.A., Ellinidi V.N., Bezhenar V.F.

Abstract

Objective: To investigate immune response in women with chronic endometritis and impaired implantation. Materials and methods: The study included 59 women with chronic endometritis managed for infertility and miscarriage and 48 healthy fertile women, previously examined in a separate study of local and systemic immunities. We used standard histological and immunoh istochem ical analysis of endometrial biopsy specimens to determine the number of lymphocytes carrying markers of HLA-DR+ activation and the number of lymphocytes expressing the B-cell marker CD20+. All women underwent immunological examination, including flow cytometry, DNA flow cytometry, and enzyme immunoassay. Results: There were local and systemic immunity changes in polypoid and lymphofollicular chronic endometritis, suggesting the autoimmune nature of inflammation in chronic lymphofollicular endometritis. Conclusion: Characteristic features of the local B-cell response in each group of chronic endometritis determine the nature of the inflammatory process. An aberrant immune-inflammatory response contributes to the restructuring of the endometrium, which is characteristic of polypoid or lymphofollicular types of chronic endometritis, causing the development of an autoimmune component in the lymphofollicular variant of chronic endometritis, alters the microenvironment of the blastocyst, and leads to impaired implantation and reproductive losses.
Obstetrics and Gynecology. 2021;(12):110-118
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Exome sequencing for diagnosing and predicting uterine and vaginal anomalies

Arakelyan A.S., Shubina J., Popryadukhin A.Y., Goltsov A.Y., Trofimov D.Y., Adamyan L.V.

Abstract

Objective: To identify genetic markers of uterine and vaginal malformations, including complex and rare combinations of other organs and systems abnormalities, by analyzing gene expression and methylation. Materials and methods: Exome sequencing was performed in 21 patients who underwent surgery for uterine and vaginal malformations at the V.I. Kulakov NMRC for OG&P from 2016 to 2020. Results: The study identified pathogenic, probably pathogenic variants, and variants of the unclear significance of the NPHP3, TMEM67, ROBO2, MYRF, TRP6, SRCAP, PROKR2, SPRY4, and GREB1L genes with a high degree of probability associated with the pathogenesis of uterine and vaginal malformations. Conclusion: The study findings suggest the role of genetic factors in the pathogenesis of uterine and vaginal malformations. Allelic variants of the discovered candidate genes associated with uterine and vaginal malformations can be used as markers to assess the risks of developing reproductive system anomalies. Further studies are required to identify the causes of uterine and vaginal malformations. Genetic studies of the patient's parents may provide additional information on the etiology of the disease.
Obstetrics and Gynecology. 2021;(12):120-127
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Experience in using ERA-test for diagnosis of endometrial receptivity in frozen embryo transfers in patients with endometriosis

Maeva N.K., Khabarov S.V.

Abstract

Objective: To evaluate the effectiveness of personalized embryo transfer taking into account the results of the ERA-test in cryopreservation protocols in patients with extragenital endometriosis. Materials and methods: The prospective study included 20 patients with extragenital endometriosis which was confirmed histologically and 42 patients with tubal and/or male factors of infertility. The time of optimal endometrial receptivity was determined using the ERA-test. We carried out a comparative assessment of the rate of displaced implantation windows in two groups and the rate of clinical pregnancy after personalized embryo transfer taking into account the results of the ERA-test. Results: The rate of displacement of the implantation window in the patients with a verified diagnosis of extragenital endometriosis was 55.0% compared to 28.5% in the control group (p=0.01). After the personalized embryo transfer with the analysis of individual variations in the timing of the implantation window, the rate of clinical pregnancy in patients with endometriosis was 63.2% and it did not significantly differ from this indicator in the control group (69.4%). Conclusion: Due to the high rate of displaced implantation windows in patients with extragenital endometriosis, the ERA-test may be recommended as a standard practice for preparing for embryo transfer in a cryopreservation protocol. According to the results of the ERA-test, personalized embryo transfer contributes to an increase in the pregnancy rate in this group of patients.
Obstetrics and Gynecology. 2021;(12):128-134
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Validation of the Russian-language version of the questionnaire for assessing chronic constipation severity

Fomenko O.Y., Morozov S.V., Morozov D.A., Shkoda A.S., Poryadin G.V., Kashnikov V.N., Popov A.A., Fedorov A.A., Apolikhina I.A., Chuprynin V.D., Kozlov V.A., Belousova S.V., Pimenova E.S., Nekrasov M.A., Achkasov S.I.

Abstract

Diagnosis of constipation severity and underlying pathophysiologic mechanisms, including in patients pelvic organ prolapse, is a challenging issue. However, validated and easy-to-use tools to guide constipation management are lacking. Objective: To validate a Russian-language version of the KESS questionnaire in patients with functional defecation disorders (FDD). Materials and methods: English version of the KESS questionnaire was translated and adapted. All patients in the study and control group underwent examination to exclude organic causes of constipation, as well as high- resolution anorectal manometry and X-ray defecography. The data obtained using the KESS questionnaire was compared with that using the previously registered questionnaire "The system of scoring of colon evacuation function disorders." Statistical analysis was performed using a nonparametric module of the SPSS (IBM, USA). Results: Data for the final analysis was available on 273 subjects (in 193 of them, FDD was confirmed by instrumental diagnostic investigations). The time to complete the KESS questionnaire was 3.5±0.76 minutes, the scores in the study and control groups were 18.4±3.1 and 2.7±0.9, respectively (p<0.001). The threshold score for differentiating patients with and without FDD was ≥10; diagnostic sensitivity was 100% [95% confidence interval (95% CI) 97-100%], diagnostic specificity was 100% [95% CI 71-100%]. The correlation of the results with the Scoring System was 0.748. No factors contributing to a possible decrease in the diagnostic value of the KESS questionnaire have been identified. Conclusion: The Russian-language version of the KESS questionnaire is a reliable tool for assessing constipation severity and making a differential diagnosis of the underlying pathophysiologic mechanisms.
Obstetrics and Gynecology. 2021;(12):136-145
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Changes in menstruation after COVID-19 and vaccination

Melekhova M.A., Boklagova Y.V.

Abstract

Objective: To study association between COVID-19, vaccination and severity of subjective sensations during menstruation. Materials and methods: 538 women were interviewed using questionnaire posted at social networks. Results: Intensification of unpleasant sansations during menstruation was reported by 19 % of patients who had COVID-19 and by 10.9% of women who were not infected with COVID-19 (p=0.017); the results of PCR tests for COVID-19 were positive in 24,6% of respondents, and unconfirmed coronavirus infection was in 9.9% (p<0.001); 20.3% of women had positive test results for SARS-CoV-2 antibodies, and 11.2% of respondents women had negative test results or did not undergo test for antibodies; 55.6% of women were hospitalized in the acute phase of COVID-19 infection, and 18.3% of women received outpatient treatment. The dynamics of unpleasant sensations in vaccinated and non-vaccinatedpatients did not differ significantly. The score assessment of the duration, intensity of menstrual bleeding and intensity of pain in women, who had COVID-19, did not find significant differences compared with women, who were not infected with COVID-19. The duration of the last menstruation was shorter in women vaccinated against COVID-19 than in women, who were not vaccinated: 5 (4-6) and 5 (5-6) days, respectively, (p=0,043). Conclusion: Despite the fact that women who were infected with COVID-19 infection reported on intensification of unpleasant sensations during menstruation more often compared with those who were not infected, detailed questionnaire survey did not confirm significant association betweem the disease and symptoms intensity. Any association between vaccination and intensity of unpleasant sensations during menstruation was also not found.
Obstetrics and Gynecology. 2021;(12):146-152
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Analysis of correlations between the results of diagnostic studies of diseases of the cervix uteri

Kazakova A.V., Lineva O.I., Kozupitsa G.S., Chechko S.M., Rustianova D.R.

Abstract

Objective: To identify relationships between age, cytological and histological findings, colposcopic patterns, and the presence of high-risk human papillomavirus (HPV) in patients with cervical disease. Materials and methods: The investigation enrolled 50 women aged 23 to 65 years. All the women underwent traditional and liquid-based cervical cytology. Their epithelial cells were scraped and examined for HPV by realtime PCR; their biopsy specimens underwent colposcopy and histology. Results: There was a high relationship between the histological f indings of CIN 3 and CIN 2 and the presence of HPV. The highest likelihood of being diagnosed with CIN 3 was found in HPV types 16 and 18 (52%). There were statistically significant positive correlations between colposcopic diagnosis and histological findings, as well as moderate negative correlations between colposcopic diagnosis and the type of transformation zone and weak negative ones between colposcopic diagnosis and age. Conclusion: There is a clear relationship between the histological findings of CIN 3 and the presence of HPV types 16 and 18. Colposcopic diagnosis of cervical diseases is most informative under 40 years of age and in the presence of Type I transformation zone.
Obstetrics and Gynecology. 2021;(12):153-158
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Office hysteroscopy and laser surgery in the treatment of cervical polyps

Shalina M.A., Khachaturyan A.R., Yarmolinskaya M.I.

Abstract

Background: Cervical polyps are usually an indication for surgical treatment. There is a vast variety of polyp removal techniques but all of them have such disadvantages as intravenous anesthesia, hospital admission, visualization difficulties and frequency of recurrence. Therefore, it is necessary to search for new effective and minimally invasive, but available cost-effective methods for both doctor and patient. Objective: To assess the effectiveness of the two-step method of the cervical polyp removal using the office-based hysteroscopic operation followed by laser destruction of the peduncle bed of the removed polyp. Materials and methods: Office hysteroscopy and the cervical polyp removal followed by laser destruction of the peduncle bed of the polyp were performed in 72 women aged 21 to 44 years (mean age is 32.9±1.4 years). The first step was to remove a polyp during office hysteroscopy using Betocchi’s method; it was followed by the laser destruction of the peduncle bed of the removed polyp under colonoscopic guidance using a semiconductor diode 9W-laser with radiation wavelength 940nm. This method was used in the removal of polyps located in the middle third of the cervical canal and closer to the external orifice of the uterus. Results: Seventy-two women of reproductive age underwent a two-stage cervical polyp removal which included removal of the polyp with scissors inserted into the biopsy canal. All of the patients noted lack of pain syndrome during the manipulation. The size of the removed polyps varied from 0.5*0.5 to 1.0*2.5 cm. The combination of cervical polyps with endometrial ones, which were also removed during hysteroscopy, was noted in 15 (20.8%) patients. The total duration of this manipulation depended on the size and localization of the polyp and the length of its peduncle, but it did not exceed 10 minutes. In all the cases the diagnosis was confirmed by histological examination. According to the morphological signs, there were fibrous polyps (65%) or glandular fibrous polyps (35%). No cases of recurrent cervical polyps were reported within 12 months after the manipulation. Conclusion: The combined two-stage method for the removal of cervical polyps localized in the middle and lower third of the cervical canal is highly effective. This method does not require hospitalization or intravenous anesthesia; it minimizes cervical canal injuries and prevents recurrences; it also reduces invasiveness, labor intensity and economic costs.
Obstetrics and Gynecology. 2021;(12):160-166
pages 160-166 views

Opportunities for antimicrobial therapy of diseases accompanied by pathological discharge from the genital tract: results of the multicenter observational Prospectus program

Apolikhina I.A., Guschin A.E., Efendieva Z.N., Tyulenev Y.A.

Abstract

Objective: To study the etiological pattern of diseases accompanied by pathological discharge from the genital tract in reproductive-aged women and to evaluate the efficacy and tolerability of Macmiror Complex (nifuratel + nystatin) in the treatment of these diseases in in the context of modern clinical practice. Materials and methods: The prospective multicenter observational Prospectus program was implemented in 11 centers of 10 cities of the Russian Federation (Moscow, Saint Petersburg, Nizhny Novgorod, Voronezh, Stavropol, Kazan, Ufa, Novosibirsk, Yekaterinburg, and Vladivostok). To establish the etiology of diseases accompanied by pathological discharge from the genital tract, such as bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis, a molecular biological study was conducted using a procedure based on real-time PCR AmpliPrime-Floroscreen (NextBio LLC). The combined drug nifuratel + nystatin (Macmiror Complex, Polichem, Italy) as vaginal capsules was used for etiotropic therapy and the patients were followed up at 10, 30 and 90 days after the therapy. At 10-day follow-up, the clinical efficiency was evaluated using the clinical data (namely, relief of the signs and symptoms of the disease). Molecular biological control of the treatment was carried out at 30-day follow-ups. The drug’s tolerability (frequency of adverse events) and the number of relapses after a therapy cycle in the next three months were also analyzed. Results: The investigation enrolled 93 patients with the established etiology of diseases accompanied by pathological discharge from the genital tract by PCR using the AmpliPrime-Floroscreen tests. The patients’ mean age was 32.9±7.7years. The etiological pattern included diseases, such as bacterial vaginosis (35/93 (38%)), vulvovaginal candidiasis (21/93 (22%)), aerobic vaginitis (9/93 (10%)), and mixed vaginitis (28/93 (30%)). The clinical efficiency of the therapy was achieved in 94.6% of cases. During 3 months of follow-up, clinical relapses occurred in no more than 8.3% of cases. The molecular biological evaluation of the efficiency of treatment showed a positive result in 87.5% of cases. Excellent and good tolerances of Macmiror Complex were noted in 85.3% of cases; no allergic reactions were seen in 100% of cases. Conclusion: The pattern of diseases accompanied by pathological discharge from the genital tract exhibits a high proportion of mixed diseases. Macmiror Complex has demonstrated high eff iciency and good tolerance and therefore can be recommendedfor active clinical application in patients with diseases accompanied by pathological discharge from the genital tract, including mixed vaginitis.
Obstetrics and Gynecology. 2021;(12):167-176
pages 167-176 views

Subcapsular liver hematoma as a complication of HELLP syndrome

Fatkullin U.F., Egamberdieva L.D., Fatkullina L.S., Shmakov R.G., Pyregov A.V.

Abstract

Background: HELLP syndrome is a complication of severe preeclampsia, in which there may be subcapsular hematoma and rupture of the liver. The approaches to managing and treating this formidable and rare complication are ambiguous. The issues of drug prevention and treatment of thromboembolic events in the presence of extensive hematoma remain difficult. Case report: The paper describes a clinical case of conservative management of a puerpera with a large subcapsular liver hematoma and inferior vena cava thrombosis with a favorable course in a multidisciplinary hospital. Conclusion: The accumulation of clinical experience and the development of treatment policy will undoubtedly help avoid critical conditions and fatal outcomes.
Obstetrics and Gynecology. 2021;(12):178-181
pages 178-181 views

A rare case of disseminated uterine arteriovenous malformation

Syrkashev E.M., Akinfiev D.M., Kozlova A.V., Bychenko V.G.

Abstract

Background: Uterine arteriovenous malformation (AVM) is a fairly rare disease that occurs mainly among reproductive-aged women. The clinical symptoms of uterine AVM are variable: from incidental ultrasound findings to profuse uterine bleeding as a result of spontaneous rupture of altered vessels. The feature of this bleeding is the lack of effect of medical treatments. Case report: Female patient S., born in 1971, was admitted to the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology to receive organ-sparing treatment for AVMs in the uterus and right iliac region. It follows from her medical records that the patient was diagnosed to have an elevated human chorionic gonadotropin level after a right-sided tubal pregnancy in 2006. She was also diagnosed with trophoblastic disease. At further gynecological follow-up, the patient had dilated uterine and pelvic vessels, as evidenced by echo color Doppler sonography. In 2013, there was an episode of massive menometrorrhagia. Control ultrasound suspected uterine vascular malformation. The diagnosis was verified by CTangiography. Based on the examination results, an angiosurgeon carried out a consultation; a technically successful bilateral embolization of the uterine arteries (UAE) and branches of the internal iliac arteries was performed. Control angiograms indicated a sharply reduced blood supply to the pathological vascular plexus. Conclusion: UAE is presently a priority treatment for uterine AVM, which allows hysterectomy to be avoided in reproductive-aged women.
Obstetrics and Gynecology. 2021;(12):182-186
pages 182-186 views

Endometriosis-associated pneumothoraxes

Ermakova E.I., Miroshina E.D., Ivanov I.A., Smetnik A.A.

Abstract

Background: Endometriosis involves the pelvic organs in the vast majority of cases; the extragenital location of endometrioid tissue is found more rarely, in nearly 12.9% of cases. One of the most common and simultaneously life-threatening forms of extragenital endometriosis is thoracic endometriosis (TE) that includes the foci localized on the pleura, diaphragm and in lung tissue. Case report: A 48-year-old female patient P. complained of recurrent catamenial pneumothorax. She underwent pleural drainage, video-assisted thoracoscopy, resection of the tendon center of the diaphragm, and costal pleurectomy. Endometriosis of the diaphragm dome was diagnosed on the basis of the histological findings; gonadotropin-releasing hormone agonists were used for 6 months, followed by a switch to dienogest until menopause. A 37-year-old female patient D. underwent chest and abdominal MRI for recurrent chest pain and dyspnea on the days of menstruation; however, no signs of endometriosis were found. Subsequent thoracoscopy revealed pleural endometriosis. When she joined the ART program, the patient was decided not to receive hormonal therapy because recurrent pneumothorax occurred after 3 months. Conclusion: TE is a rare disease, the prevalence and pathogenesis of which are not fully understood. Since the diagnosis of the disease is often difficult; its treatment may be delayed; in view of that life-threatening pneumothorax may recur. A high clinical suspicion by therapists, pulmonologists, surgeons, and gynaecologists/ endocrinologists is needed for timely diagnosis and better quality of life in patients with TE.
Obstetrics and Gynecology. 2021;(12):187-193
pages 187-193 views

Novikov Yuri Ivanovich. On the occasion of the 100th anniversary of his birth

Bezhenar V.F., Korsak V.S., Aganezov S.S., Mozgovaya A.O.

Abstract

The article dedicated to the 100th anniversary of the birth of Yuri Ivanovich Novikov, an outstanding Soviet obstetrician/gynecologist, scientist, educator, public figure, professor, Corresponding Member of the USSR Academy of Medical Sciences, highlights his biography, scientific, pedagogical, and medical activities. Being in due time the Head of the Department of Obstetrics and Gynecology, Acad. I.P. Pavlov First Leningrad Medical Institute and the Research Institute of Obstetrics and Gynecology, USSR Academy of Medical Sciences, Yu.I. Novikov made a great contribution to the development of these famous educational and research institutions of the country.
Obstetrics and Gynecology. 2021;(12):194-198
pages 194-198 views

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