Vol 26, No 6 (2019)

Background. According to the literature, sexual dysfunction after vaginal childbirth in women leads to a decrease in libido and frequency of orgasm. This pathology is perceived by a woman as hard, significantly affects the marital climate, and as a result, social maladjustment occurs. Objective. Improvement of sexual satisfaction in women with pelvic floor dysfunction (PFD) after childbirth. Methods. The study included 135 puerperas with various symptoms of PFD. In group I (n=45), a gynecological pessary was used after delivery; in group II (n=45) - the pelvic floor muscle training (Kegel exercises); in group III (n=45) patients did not receive treatment. All women completed the FSFI questionnaire at 3 and 12 months after delivery. Results. A statistically significant increase in the overall index of sexual function was observed in groups I and II at12 months after delivery (p<0.001), differing for the better in comparison with group III (pi-iii<0.001, pii-iii<0.001). Conclusion. A significant increase in the sexual function index after 12 months with the use of pessaries or pelvic floor muscle training indicates a high efficiency of PFD prevention immediately after childbirth in women with risk factors for the development of this disease.

Background. One of the current problems of modern obstetrics is miscarriage; its frequency is 10-20% and has no tendency to decrease, despite the achievements in the field of diagnosis and prevention of recent years. Objective. Evaluation of the long-term dynamics of the main indicators of pregnancy loss, and the probability of miscarriage effect on the demographic situation. Methods. The official statistics of the Population Census and Demographic Statistics Departments of ROSSTAT and PERMSTAT were used to assess the demographic situation. Also, an analysis of the official statistical forms characterizing the loss of pregnancy was carried out. Results. Analysis of the birth rate showed that over the past 26 years, there has been a positive trend in the Russian Federation and in the Perm Territory, but the indicators returned to the level of the early 1990s only by 2012. In 2016, the birth rate has been falling again, and this tendency is likely to continue in the next 5-10 years, as the generation of the 1990s entered the period of reproductive age, and this period was marked by a low birth rate. The structure of miscarriage included cases of spontaneous miscarriage and non-developing pregnancy. The analysis showed an 8-fold increase in the number of miscarriages in the structure of pregnancy interruptions, which may be associated with a decrease in the number of medical abortions, on the one hand, and with an direct increase in miscarriages, on the other hand. Conclusion. Preventive measures aimed at maintaining each pregnancy, especially wanted pregnancy, are fundamental in terms of medical and organizational measures in conditions of reducing reproductive potential, as evidenced by the study,.

Background. Protocols for accelerated rehabilitation after surgery are used throughout the world, but are not widespread in Russia. We conducted a study to determine the effectiveness and safety of the Fast Track approach in our country. Objective. Comparison of various parameters of course of the postoperative period and rehabilitation between female patients included in the ERAS protocol and traditional postoperative management. Methods. The prospective, non-randomized study included 2 groups of female patients (I - n=29, II - n=27) awaiting planned gynecological surgery. Patients of group I were managed according to the Fast Track protocol, and traditional approaches were used for perioperative management of group II. The primary end point was the number of hours spent in the hospital. Secondary end points included the incidence of complications in the postoperative period (fever, nausea, vomiting, the number of repeated admissions and operations), the pain level. Results. In group I, the mean hospital stay was 5.9±0.9 hours, while in group II - 163.6±12.3 hours (p<0.001). The pain level according to MS was lower in group I during the first 2 days. 48 hours after surgery, the pain was equally in both groups. Postoperative vomiting occurred in 3.6% of patients in group I and in 18% of patients in group II (p<0.001). There were no significant differences in the frequency of other complications. Conclusion. The Fast Track protocol can be safely embedded in Russian healthcare service. This study has shown that it allows to accelerate the rehabilitation of patients without increasing the complication frequency.

Background. The pelvic floor dysfunction (PFD) refers to a multifactorial disease, including pelvic prolapse (PP), urinary incontinence (UI), fecal incontinence (FI) and sexual dysfunction (SD). The development of PFD with any manifestation leads to a decrease in the quality of life, disability, as well as social maladjustment of women of all age groups. Objective. Assessment of the effectiveness of pelvic floor muscle training (PFMT) after childbirth in reducing symptoms of pelvic organ dysfunction. Methods. Study design: prospective, single-center, open, randomized study. The study was approved by the Ethics Committee of Kemerovo State Medical University. Eighty women were randomly assigned to two groups12 weeks after childbirth. Randomization was carried out by the sealed code envelope method. Patients of group I (n=34) received daily trainings for 20 minutes using the EmbaGYN apparatus (United Kingdom) for 4 weeks; patients of group II (n=36) - using Magic Kegel Master (China). Before inclusion in the study, an anonymous survey of women was conducted using the PFDI-20 questionnaire (Pelvic Floor Distress Inventory Qestionnaire) and the FSFI questionnaire (Female sexual function index). The strength of the PFM was measured using pneumoperineometry with the iEASE XFT-0010. Statistical analysis of the research results was carried out using the Statistica Version 10. Results. After 4 weeks, a statistically significant decrease in complaints about the symptoms of PP, UI, FI in both groups was registered. The frequency of SD, however, significantly decreased only in group II: 25.0 vs 69.4% (р=0.001). After treatment, there was a significant decrease in the number of women with symptoms of urge UI from 35.3% to 8.8% (р=0.009), as well as with loss of urine associated with coughing, sneezing or laughing (from 41.2 to 11,8%; р=0.006) and the loss of a small amount of urine not related to exercise (from 23.5 to 5.9%; р=0.040) in the group I. Conclusion. Thus, training with the use of physical methods of rehabilitation for 4 weeks helps to reduce the frequency of symptoms of pelvic organ dysfunction. Furthermore, the use of EmbaGYN was more effective in reducing the symptoms of UI, and the Magic Kegel Master - in reducing the symptoms of SD.

Background. In modern obstetric practice, programmed labor is increasingly becoming an alternative to operative delivery. Algorithm for its management is especially important for an ever-increasing group of patients with a burdened somatic and obstetric and gynecological history. Objective. Evaluation of the results and outcomes of programmed labor in patients with preeclampsia (PE), gestational diabetes mellitus (GDM) and a high perinatal risk. Methods A retrospective cohort study included 160 women with a high perinatal risk, singleton pregnancy, full-term gestational age (38-41 weeks) who underwent programmed labor, and their newborns. The patients were divided into 2 groups: the 1st group - with GDM (n=120), the 2nd one - with GDM in combination with PE (n=40). Results. As a result of programmed labor in patients with high perinatal risk and GDM and in the high-risk group - combination of GDM and PE, satisfactory perinatal outcomes were recorded, the incidence of neonatal morbidity decreased by 1.5 times. Conclusion Programmed labor in pregnant women with high perinatal risk serves as an alternative to operative delivery in patients with GDM and patients with GDM in combination with PE.

Background. In the light of the transformation of scientific views on the problem of polycystic ovary syndrome (PCOS), the evaluation of the relationship between the mental and physical condition of patients, including in planning a pregnancy, take on great importance. Objective. Evaluation of the frequency and features of mood disorders in patients with PCOS seeking medical attention at the center of reproduction. Methods. The full-design descriptive two-phase study was conducted. Patients with PCOS (ESHRE/ASRM) seeking medical attention at the center of reproduction were examined by a psychiatrist, and 2 years later they were re-interviewed. The qualification of the condition was carried out on the basis of a clinical conversation in accordance with the ICD-10 criteria. Results. 116 patients of reproductive age were examined. Mental disorders were found in 76 (65.5%) women, 45 of them (38.8%) had mood disorders (affective disorders). 63 (54.3%) women took part in the second stage of study; 30 (47.6%) of them had a pregnancy ended in childbirth during the control period. Among 26 women diagnosed with the first stage of mood disorders, 18 (69.2%) had a relapse within two years. 15 women had a manifestation of depression in the same period. At least one episode of depression was detected in the same period in 15 patients who became pregnant for two years, 10 of them had depression in the postpartum period (33.3%, n=30). Conclusion. Patients with PCOS are highly susceptible to depression, characterized by a relapsing course and a tendency to increase in incidence over time. There is a high incidence of postpartum depression. All above mentioned demonstrates the need to develop approaches to the management of women with PCOS by multidisciplinary teams.

Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in women of reproductive age and is characterized by a high recurrence rate after standard therapy. The article presents a review of the literature on the problem of treating BV, analyzes key possible mechanisms in the pathogenesis of recurrent BV. The modern methods of treatment are considered, taking into account pathogenetic disorders, the role of the step-wise therapy of this pathology using antibacterial, antiseptic, pH-lowering drugs and probiotics is emphasized.

In the article, the authors provide epidemiological data on the frequency of anemia and iron deficiency (ID) in the female population of the Russian Federation. The global impact of these factors on the health of women and children is described. The current view on the etiology and pathogenesis, and world recommendations for the prevention and treatment of iron deficiency and anemia of pregnant women are discussed in detail. The authors give a detailed account of the features of the approach to their treatment, taking into account their own clinical experience.

Background. The increase in the number of patients with infertility and the lack of ovarian reserve contributed to the development of a new trend in reproductive medicine - in vitro fertilization (IVF) with donor oocytes. Description of the clinical case. A clinical observation of a 50-year-old female patient who applied for an IVF program due to secondary infertility due to a lack of ovulation as a result of persistent physiological menopause, as well as a male factor is presented. Given the inability to obtain her own oocytes, it was decided to conduct an IVF program with donor oocytes. At the first stage, cyclic hormone therapy was prescribed to restore the menstrual cycle. After 3 months, an IVF program with donor oocytes was performed. Fertilization of 4 donor oocytes by the seminal fluid of the spouse by the PICSI method (intracytoplasmic injection of a spermatozoon selected on a physiological basis) was performed. Preparation of the endometrium in the embryo transfer cycle was carried out using estrogens and gestagens. The IVF program ended with the onset of clinical pregnancy and timely delivery. Conclusion The IVF program with donor oocytes allows for the implementation of reproductive function in various categories of patients, including with persistent menopause.

Background. The incidence of HELLP syndrome over the past decade has not decreased, making a significant contribution to maternal and perinatal morbidity and mortality. As a rule, bleeding as a result of DIC is the cause of maternal mortality in this case. Radical treatment is emergency delivery, leading to an increase in the frequency of preterm birth and not always improving the condition of the woman in the short term. To reduce the likelihood of uterine bleeding in such patients, the authors proposed to use the prophylactic compression sutures on the uterus during operative delivery. Description of the clinical case. The 33-years-old pregnant patient with a gestational age of 34 weeks, twins after in vitro fertilization, complained of epigastric pain. The criteria for the diagnosis of HELLP syndrome included laboratory data: hemolysis, thrombocytopenia over time, lactate dehydrogenase, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase blood levels, proteinuria. Taking into account the development of HELLP syndrome, the patient was delivered in an urgent order by caesarean section under endotracheal anesthesia. In order to prevent bleeding, B-Lynch compression suture and 2 circular sutures were put on the body of the uterus. Stabilization of the patient’s condition after delivery occurred by the 4th day. During this time, she received antihypertensive, magnesial, antibacterial therapy, transfusion of platelet concentrate, erythrocyte suspension, fresh frozen plasma, glucocorticoid therapy, and from 3rd day - low-molecular heparins to prevent thromboembolic complications. 10 days after admission, the main laboratory parameters returned to normal values, and the patient was discharged in a satisfactory condition home. Conclusion. Preventive compression sutures on the uterus can reduce blood loss during and after delivery and thus break the vicious circle: massive blood loss - compensatory infusion of fluid - risk of pulmonary edema, and increase the likelihood of a favorable outcome for the woman, while preserving her reproductive function.