Vol 27, No 6 (2020)

This literature review is a sketch of the history of the development of hormonal contraception since the idea of pregnancy prevention appeared and then, for 60 years, from the release of the first contraceptive “pill" to the present day.

This review is aimed to the discussion of the current and future possibilities of medicine in the prevention of preeclampsia (PE) and placenta-associated pregnancy complications (PAPC). PE remains one of the significant causes of maternal and perinatal morbidity and mortality, and lead to a lot of preterm births. The relevance of the problem of PE and PAPC is determined primarily by the lack of effective treatment for advanced clinical symptoms, as well as the need to terminate the pregnancy in such cases, regardless of gestational age and prognosis for the fetus. In this regard, PE prevention is of great importance for clinical practice. The review presents a modern concept of the pathogenesis of PE, highlights the key points of disorders in the hemostatic system, leading to the development of clinical symptoms and PE. It is also shown that the imbalance between the thromboxane and endothelial prostacyclin levels, as well as between the number of pro- and antiangiogenic factors in pregnant women with PE can be considered as a therapeutic target in the prevention and treatment of PE, and it is reasonable to prescribe antiplatelet agents and anticoagulants for the prevention of PE. Modern systematic reviews and a meta-analysis have shown a certain effectiveness of antiplatelet agents and anticoagulants in the prevention of PAPC. The review highlights the role of deficiency of certain nutrients in the development of PAPC and administration of folate for their prevention. The data presented indicate that today there are PARC prevention methods that can significantly reduce their probability by 17-30% in pregnant women with a high risk of this obstetric pathology. However, a complete prevention and effective treatment of PAPC at the stage of advanced clinical symptoms has not been developed to date, which leads to abortion in the early stages, to perinatal morbidity and mortality. Therefore, the development of new treatments that completely prevent or cure PE would be a major achievement for practical obstetrics. The review presents the main directions of research in this direction, in particular, clinical studies of drugs that can reduce the secretion of sFlt-1 and soluble endoglin, thus curing endothelial dysfunction in PE.

The article presents modern approaches to the treatment of cervicitis associated with HPV, mild cervical intraepithelial neoplasia (CIN 1) based on modern ideas about the etiology and pathogenesis of this disease. It is noted that inflammation is a risk factor for HPV persistence, in addition, expression and the increased estrogen 16α-hydroxyestrone level mutually reinforce each other, accelerating the processes of tumor transformation in the cervical epithelium. It has been established that the level of abnormal epigenetic modifications, in particular, the level of promoter DNA methylation of antitumor defense genes, is steadily increasing with the progression of CIN and is characteristic of an integrative or transforming form of HPV infection. Searching for gentle treatment methods, for CIN 1 revealed that the substance diindolylmethane is able to simultaneously block many molecular mechanisms in HPV-transformed cervical epithelial cells that mediate pathological cell proliferation and subsequent carcinogenesis. The results of the studies have demonstrated the effectiveness and safety of the cervicon-DIM preparation containing diindolylmethane, targeting inflammation, the CIN pathogenesis and the mechanisms of further tumor transformation. Thus, a new therapeutic approach based on the use of diindolylmethane, acting on infected cells, apoptosis, and key molecular mechanisms of pathological processes in the tissues of the cervix uteri, will significantly reduce the number of poor outcomes and prevent the transformation of CIN into cervical cancer.

Objective. Improvement of the results of preop erative preparation of women with III-IV stage genital prolapse and trophic disorders of the vaginal and cervical mucosa. Methods. A prospective, observational, non-interventional, non-comparative clinical included 51 patients with III-IV grade pelvic organ prolapse (POP) with the presence of decubital ulcers of the vaginal and cervix mucosa. The POP degree was determined according to the POP-Q classification. For complex treatment, perforated cubic Dr Arabin pessaries with individual size selection were used. Decubital ulcers were treated by irrigation with cavitated solutions, in some cases using argon plasma coagulation (once), a gel with chlorhexidine/allantoin and an estriol-containing cream. Results. The participants’ age was 34-87years, mean age 66.9±12.7 years. Complete epithelization of ulcerative defects was achieved in all cases (100%), the average healing time for ulcerous defects was 11.3±2.4 days. The frequency of replacing the size of the pessary was 23.5% within 1 month. The incidence of side effects was 1.1%. After ulcer healing, 47.1% of patients underwent surgery, the rest chose a pessary for further use. Conclusion. Comprehensive treatment using irrigation with cavitated solutions of aniseptics, pessaries, estriol and agents with an epithelizing effect is an integral part of the preoperative preparation of patients with severe prolapse and decubital ulcers, which allows achieving a fairly quick positive effect in 100% of cases and makes it possible to carry out surgical treatment in conditions of normal tissue trophism.

Background. It is known that sex hormones, incl. estrogens, affect the immune system in a complex way, and play an important role in the pathophysiology of autoimmune diseases. Three quarters of all patients with autoimmune diseases are women. Despite this, autoimmune diseases are rarely discussed as a women’s health problem. Objective. Comparison of the differences in the course of autoimmune hepatitis (AIH) in women of the reproductive, perimenopausal and postmenopausal periods: clinical, biochemical, serological and morphological parameters, as well as the response to immunosuppressive therapy (1ST). Methods. A retrospective study included 67 patients with AIH diagnosed according to the simplified AIHG criteria (2008). A comparative analysis of three groups of patients at different stages of reproductive aging was based on the clinical, laboratory and instrumental data obtained. Results. 67 patients were retrospectively analyzed for clinical, biochemical, immunological, morphological features, as well as the response to 1ST. When comparing 3 groups of AIH women of the reproductive (21 [31.3%]), perimenopausal (19 [28.3%]) and postmenopausal periods (27 [40.3%]), significant differences in clinical manifestation were revealed: in reproductive age an active debut, represented by the clinical and laboratory manifestation, was observed in 71.4% (15/21 patients), while in the group of perimenopausal and postmenopausal periods, disease symptoms were detected in 36.8% (7/19) and 29.6% (8/27) cases, respectively. When comparing the average values of alanine aminotransferase, Y-glutamyl transpeptidase, total bilirubin, and immunoglobulin G levels, patients of the 3 groups had differences, which manifested themselves in a significant decrease in the level of biochemical activity in the perimenopausal and further postmenopausal periods. By the number of seropositive patients, all 3 groups had no significant differences; antibodies were detected in 50-60% of cases. Among patients of perimenopausal and postmenopausal periods, AIH at the stage of hepatic cirrhosis (HC) was detected in 26.3% (5/19 patients) and 33.3% (9/27) versus 9.52% (2/21) women of reproductive age. Among the patients of the study group who were on IST, 61.9% (13/21) responded to IST in the reproductive age group, 68.4% (13/19) - in perimenopausal, and 66.7% (18/19) - in postmenopausal group. The number of cases of relapse was equal in all three groups. The presence of concomitant autoimmune-associated conditions was observed in an equal percentage of cases among perimenopausal and postmenopausal patients - 42.1 versus 40.7%, and 28.6% among women of the reproductive age. Conclusion. The analysis revealed a number of features in perimenopausal women with AIH: a more frequent indolent course of the disease and a greater number of patients diagnosed with AIH at the stage of HC at the time of diagnosis; histological and biochemical activity is lower than in the group of the reproductive age. In this group, a relatively more frequent detection of an atypical histological picture was observed. All postmenopausal patients on IST achieved the remission of the disease, but relapse was more common after end of the treatment. There was also a more frequent incidene of immuno-associated diseases in postmenopausal women. The variety of clinical manifestations of AIH depending on the hormonal background and age requires further evaluation.

Background. In gynecological practice, in order to reduce the severity of inflammatory processes in the lower genital tract, surgical intervention requires more careful preparation, since all measures are aimed at restoring the woman's reproductive function in the future. In clinical trials, the effectiveness of the anti-inflammatory solution used in addition to the standard preparatory regimen in the preoperative period has been proved in patients with inflammatory pathologies of the lower genital tract. Objective. Evaluation of the effectiveness of topical application of the vaginal solution of ibuprofen isobutylammonium for the prevention of local and systemic inflammation during surgical treatment of pelvic diseases. Methods. A randomized comparative clinical study included 60 patients aged 20 to 65 years hospitalized for surgical pelvc pathology with concomitant genital tract inflammation. Patients were diveded into 2 groups of 30 people. In the control group, patients underwent standard 2-day preoperative preparation. In the main group, patients received vaginal solution of ibuprofen isobutylammonium once a day in the morning for two days (the solution was poured into the vagina for 3-5 minutes) in addition to the standard preoperative preparation. To assess the dynamics of the clinical signs of inflammation and symptoms, we used the somatic symptom scale (SSS) and the adapted visual analogue scale (VAS). Evaluation was performed before treatment and after 2 days of treatment. Results. The characteristics of the patients registered before the start of treatment did not statistically significantly differ. The reasons for hospitalization and subsequent surgical treatment included inflammatory pelvic diseases in 27 (45%) patients, uterine fibroids - in 24 (40%), pelvic organ prolapse - in 6 (10%), pathological changes in the endometrium - 7 (12%); 6 (10%) patients had a combination of several main pathologies. Inflammation of the lower genital tract, which was evaluated according to three objective criteria, was strongly pronounced in all patients. In the main group, the additional use of vaginal solution of ibuprofen isobutylammonium compared with standard therapy significantly decreased (by 47-70%) the inflammation of lower genital tract, 1.5 times more effectively reduced the severity of disturbing patients with vaginal symptoms, and provided 2-12 times more rapid disappearance of these symptoms. There were no adverse reactions with the use of this preparation. Conclusion. The vaginal solution of ibuprofen isobutylammonium can be used as a convenient adjuvant preparation in the management of patients with surgical pelvic pathology.

The review presents modern data on the currently used methods of emergency contraception (EC) (non-pharmacological and hormonal), the features of their use and effectiveness. Levonorgestrel-containing tablets (Escapel) is the most popular EC product, it provides a contraceptive effect with a probability of pregnancy of only 1.1%. The safety of a single dose of 1.5 mg of levonorgestrel is confirmed by the results of numerous studies. In the Emergency Contraception Consortium, this regimen is recommended as a first-choice method.

Timely and adequate prescription of anticoagulants in obstetrics is a multidisciplinary area with intensive development. Prevention and treatment of thrombotic complications in pregnant, parturient and puerperal women are discussed from the standpoint of the choice of drugs, dosage regimen, the possibility of drug replacement and identification of patients in various clinical situations. Currently, low-molecular-weight heparins are the drug of choice for the prevention and treatment of venous thrombotic complications during pregnancy and the postpartum period.

Drug-induced diseases (DIDs) are a variant of undesirable drug reactions that can increase mortality and/or morbidity and/or cause symptoms that force the patient to seek medical attention or lead to hospitalization. There are certain approaches to the management of patients that can improve the efficiency of diagnosis and prevention of DIDs. One of the key moments is accuracy in the pharmacological history taking. The pharmacological history should be accumulated from various sources: from the patient, relatives or guardian, caregiver; inspection of containers with medicines (drugs), blisters, packaging of drugs; various medical documents (extracts, conclusions of consultations of specialists, results of laboratory and instrumental studies), etc. Information in the medical history should include patient’s demographic data, social habits, allergic history; detailed information should be collected about all prescription and over-the-counter drugs taken by the patient during the previous 6 months, including those that he is no longer taking at the moment. A mandatory assessment of laboratory test data is also required. The main task in the diagnosis and differential diagnosis of DIDs is to determine the possible causal relationship between taking the drug and the development of an undesirable side reaction. For these purposes, special scales and algorithms are used, for example, the Naranjo algorithm. The main principle of the correction of DIDs is the cancellation of the inducer drug or its replacement with another drug that does not have such side effects. The training of patients, the timely detection of adverse drug reactions by medical personnel and the spontaneous reporting of their development to the relevant executive authorities (pharmacovigilance) as required by law are critical for the prevention of the development of DIDs in the future.