No 7 (2019)

The data available in the literature on the use of ultrasound elastography (echo elastography) in obstetrics and gynecology were analyzed. The review included data from studies and meta-analyses available in Pubmed on this topic. Searches were carried out using keywords. Echo elastography is used to diagnose female reproductive tract neoplasms (including malignant ones), ectopic pregnancy, to evaluate the uterine scar, placenta and cervix in various pregnancy complications, and to predict spontaneous preterm birth and outcomes of labor induction. Echo elastography is a method for qualitative and quantitative analysis of the mechanical properties of tissues, which is increasingly being used in everyday obstetric and gynecologic clinical practice.

The authors have studied the basic principles of the concept of anemia-polycythemia syndrome, the pathogenesis of this pathological condition in monochorionic multiple pregnancies, the key signs of diagnosis based on Russian and foreign articles published on this topic in 2009 to 2018 and put in the PubMed database. The review considers distinctive signs between specific complications that occur in monochorionic twins as a result of intertwin transfusion - anemia-polycythemia syndrome (APS, English TAPS - an anemic-polycythemia transfusion sequence) and oligo-polyuria syndrome (OPS, English TOPS - oligo-polyuria transfusion syndrome), current methods for therapy and correction of APS, as well as pregnancy outcomes in women with different types of anemia-polycythemia syndrome or concurrent with OPS.

Objective. To study the characteristics of pregnancy course and analyze maternal and perinatal outcomes in patients with lymphomas, based on anticancer treatment during pregnancy. Materials and methods. An analysis of the evolution of approaches to pregnancy management resulting from a 31-year observation experience of 70 women with lymphomas has been carried out. There were 46 women with Hodgkin lymphoma (LH) and 24 women with non-Hodgkin lymphoma (NHL). Patients were divided into three groups based on the time and tactics of their treatment: group 1 - without lymphoma treatment during pregnancy (n=7); group 2 - chemotherapy during pregnancy and mostly preterm delivery at 34-35 weeks gestation (n=26); group 3 - chemotherapy during pregnancy and mostly term delivery (n=37). Results. Chemotherapy was performed in 35pregnant women (50%), and 27 patients (38.6%) were not treated. The most common complication of pregnancy in patients who received treatment was anemia (71.4% vs. 44.4%, p=0.03). Six treated patients (37.5%) with NHL and one patient with LH (5.3%) had a pregnancy complicated by catheter-associated thrombosis. In patients with NHL, the frequency of preterm labor was statistically significantly higher than in patients with HL (twofold, p=0.03). In 80% of cases, the cause of preterm labor was iatrogenic (the need to start or continue the treatment). The comparative analysis of the frequency of preterm birth showed a significant decrease of it over the past five years (from 57.7% to 27.8%, p=0.02). Premature delivery significantly affected the health of newborns and in 2/3 of cases, premature-born children needed treatment under the ICU conditions. Conclusion. There was no correlation between the health status of the newborn and the chemotherapy received by mother, the morbidity of children at birth was mainly due to their prematurity. The radical change in the management of patients over the past five years has reduced the frequency of premature births by two times (p=0.02), which accordingly contributed to the reduction in the morbidity of newborns.

Aim. To investigate the effect of combined oral contraceptives (COC) containing ethinyl estradiol/drospirenone (EE/DRSP) and estradiol valerate/dienogest (EV/DNG) on the endocrine and metabolic profiles of patients with polycystic ovary syndrome (PCOS). Materials and methods. One hundred patients with PCOS were randomized into two groups to receive either EV/ DNG (group I, n=50, 24.1±2.8 years) or EE/DRSP (group II, n=50, 25.6±2.1 years). All patients underwent clinical, laboratory, and diagnostic investigations at baseline and after 12 months of treatment. Results. Both EE/DRSP and EV/DNG were effective in improving clinical and biochemical HA. Mean levels of TT decreased by 17% and 20%, FT - by 19% and 29% in group I and II, respectively (p> 0.05). There was a 17% and 28% reduction in the levels of A in group I and II, respectively (p> 0.05). Mean levels of SHBG showed a 2.2 and 5.7 fold increase in group I and II, respectively (p <0.05). In the absence of a negative effect on most metabolic parameters, EV/DNG reduced the rates of impaired glucose tolerance (IGT) and hyperinsulinemia (HI) by 12% and 14%, respectively; EE/DRSP occasionally caused HI and IGT. There was an increase in mean TG levels by 16% and 29% in patients of group I and II, respectively (p <0.05). Conclusion. The study findings suggest the feasibility of a differential approach to the administration of COCs. In patients with metabolic disorders and thrombotic risk (in the absence of high-risk thrombophilia), the treatment of choice may be EV/DNG. In PCOS patients with signs of hyperandrogenism but without significant metabolic disorders, EE/DRSP should be preferred.

Aim of study: To evaluate the effectiveness of autoplasma enriched with platelet-derived soluble factors in IVF cycles in patients with chronic endometritis in history. Materials and methods: The study took place in the period from 2017 to 2018. In IVF cycle autoplasma was not injected into the patients in Group I (n=43); on the 6th-10th day of the stimulated cycle, autoplasma enriched with platelet-derived soluble factors was injected into uterus in patients in group II (n=94). Inclusion criteria: the patients of reproductive age with infertility and chronic endometritis in history. Exclusion criteria: the patients with poor embryo quality. Results: Intrauterine injection of autologous plasma enriched with platelet-derived soluble factors increases up to 25% the success rate of embryo implantation during IVF procedure, as compared to traditional protocols.

Aim. To investigate the role of magnetic resonance imaging (MRI) in evaluating the effectiveness of neoadjuvant chemotherapy in patients with locally advanced cervical cancer. Materials and methods. The study comprised 67 patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy followed by radical hysterectomy in those, who achieved a response. Clinical evaluation included general clinical examination and MRI. Results. The reduction of the tumor volume in patients with different cancer stages ranged from 23.2 to 52.1% according to clinical examination and MRI. Fifty-nine patients (88.1%) underwent surgery after neoadjuvant chemotherapy, including all 17patients with stages IB2/IIA2, and 31 (91.2%) and 11 (68.8%) patients with stage IIB and IIIB cervical cancer, respectively. Conclusion. Neoadjuvant chemotherapy for locally advanced cervical cancer results in the tumor response that allows radical surgery to be undertaken. MRI can be used to obtain objective data on changes in the cervical tumor volume during neoadjuvant chemotherapy.

To assess the results of using a careHPV test kit as a quick screening test in the organized cervical cancer (CC) screening program in the Republic of Ingushetia. Human papillomavirus (HPV) testing was carried out in 1000 women aged 30 to 60 years to identify 14 high-risk HPV types, by using the hybrid capture assay. High-risk HPV was detected in 107 (10.7%) women. All the women (n = 107) were referred to visual inspection with acetic acid; and 81 (75.7%) women of them underwent a cytological examination of cervical smears for suspected dysplasia. Fifteen (1.5%) women with cytologically verified CIN II-III were sent to the Republican Oncology Dispensary for cervical excision with histological examination of biopsy specimens.Taking into account that HPV infection is a major etiological factor for the pathogenesis of CC, in order to reduce its morbidity and mortality, it is recommended that HPV testing should be introduced into the algorithm of the organizational form of early CC diagnosis among the republic’s female population aged 30 to 60 years.

The necessity and possibility of using of hormonal drugs for women over 40 may could be associated with certain difficulties. On the one hand, they have the possibility of conceiving and unwanted pregnancy. On the other hand, after 40 years, the percentage of uterus pathology increases, as well as extragenital pathology which complicates the use of hormonal therapy. Another important question is the duration of the use of combined oral contraceptives (COCs) and for the transition to menopausal hormone therapy.

The paper provides an overview of current global approaches to pharmacotherapy for chronic recurrent cystitis, including non-antibacterial treatments. The urgency of this problem is associated with the extremely high prevalence of the disease in Russia and worldwide. The antimicrobial resistance in uropathogens has increased dramatically over the past two decades. In cases of recurrent cystitis, the routine management tactics for patients is to increase the time of, doses or to expand antibiotic therapy regimens, despite the lack of evidence supporting this treatment strategy. The lowest resistance of E. coli, the main pathogen of urinary tract infections, is noted for fosfomycin (0-2.9%), nitrofurans (0-4.4%) and mecillinam (0-4%).

Until the present day, massive obstetric hemorrhage has remained the most formidable and serious complication of pregnancy and childbirth, directly affecting the time course of changes in female disability and maternal mortality rates. One of the causes of this complication is uterine arteriovenous malformation. The paper describes a clinical case and early delivery of a patient with uterine arteriovenous malformation in placenta previa centrala. The federal research institute performed Russia’s first abdominal delivery using aortic endovascular balloon occlusion, which allowed for organ-sparing surgery in the patient, preventing massive blood loss. The use of the new technique to prevent massive obstetric hemorrhage during abdominal delivery is a promising round in preserving the reproductive health of women with the pathological architectonics of the uterus during pregnancy.