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Vol 10, No 4 (2023)

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Reviews

Mitochondrial diseases: causes and solutions (literature review)

Ivanova E.D., Belousova V.S., Skorobogatova O.V., Bogomazova I.M., Timokhina E.V., Pesegova S.V.

Abstract

The discovery of mitochondrial desoxyribonucleic acid (DNA) mutations and the association of these mutations with the development of severe, sometimes, fatal diseases led to new forms of reproductive technologies, i.e., mitochondrial replacement therapy. Currently, researchers are investigating three main methods of mitochondrial replacement therapy: pronuclear transfer, maternal spindle transfer, and polar body genome transfer. Thanks to these methods, the transmission of faulty mitochondrial DNA from the mother to the next generation can be prevented, with the main goal of developing a healthy offspring free of genetic disorders and lethal mitochondrial diseases. However, the implementation of these technologies has raised several moral, social, and cultural concerns, as it marks the emergence of a child with genetic material from three parents for the first time. This review presents an objective summary of the causes of mitochondrial disorders and various techniques employed in mitochondrial replacement therapy, along with their outcomes.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):243-251
pages 243-251 views

Comparison of the use of different accesses for sacrocolpopexy in women with apical prolapse: A literature review

Bakhtiyarov K.R., Evstratova K.D., Virivskaya E.V., Zvyagintseva M.R.

Abstract

Interest in the issue of genital prolapse is increasing worldwide. The prevalence varies across countries and is higher in resource-limited ones. In countries where systematic statistics are available, the prevalence of pelvic organ prolapse ranges from 3 to 50%. Conservative and surgical methods for correcting this issue are extensively covered in Russian and foreign literature. Sacrocolpopexy is one of these methods, which is commonly used to correct apical prolapse. This review aimed to compare and evaluate the outcomes of abdominal, robotic, and laparoscopic accesses for performing this surgical procedure and assess the advantages and disadvantages of each method. Each surgical approach is analyzed regarding the incidence of postoperative complications, surgical duration, and satisfaction of patients with their quality of life in the postoperative period. Pelvic organ prolapse is an increasingly pressing issue, given the increase in life expectancy and its earlier detection. According to statistical projections, by 2050, 9.2 million women worldwide will have this disease.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):253-259
pages 253-259 views

Original study articles

Debate on the oncologic potential of sex steroid preparations

Klyukina L.A., Sosnova E.A., Ishchenko A.A., Davydov M.M.

Abstract

Background. Thanks to numerous worldwide studies, the significant contribution of the hormonal component to the oncological risks of the organs of the female reproductive system is beyond doubt. Of great interest is the analysis of world research on the oncological potential of hormonal drugs, namely COCs and MGT, since this issue continues to be one of the most complex and controversial.

Aim. This study aimed to contribution of hormonal factors to the development of cancer of the female reproductive system, namely breast, cervical, endometrial and ovarian cancers.

Materials and Methods. The study was conducted on the basis of the Center of Gynecology and Reproductive Technologies of the FSAU “National Medical Research Center “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation, the Department of Oncogynecology of the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University. The analysis of medical documentation for the period from January 2015 to December 2021 was carried out. The study included 1842 patients with verified oncological disease of the female reproductive system, who had a history of taking hormonal drugs of the following pharmacological groups: hormonal contraceptives, menopausal hormone therapy drugs. The age of all patients ranged from 26 to 83 years (mean age 51.98±10.3 years). The control group consisted of 611 patients without oncological diseases, who have a history of indications for taking hormonal drugs of these pharmacological groups.

Results. When assessing the effect of the duration of MGT intake on the risk of developing breast cancer, it was found that MGT intake for a total of more than 6 years was associated with a higher risk of developing breast cancer (HR 1.18; CI 1.02–1.36; p <0.001). Using the Wald method, we found that the probability of developing breast cancer is associated with a BMI of more than 25 kg/m2 and long-term intake of combined MGT for a total of more than 6 years. When assessing the effect of the duration of MGT intake on the risk of developing RTM, it was found that MGT intake for a total of more than 6 years was associated with a higher risk of developing RTM (HR 1,432; CI 1,172–1,750; p <0.001). Using the Wald method, we found that the probability of developing RTM is associated with the presence of a BMI of more than 25 kg/m2, prolonged MGT intake for a total of more than 6 years and the presence of endometrial hyperplastic processes, adenomyosis, hypertension in the anamnesis. When assessing the effect of the duration of COC intake on the risk of developing breast cancer, it was found that taking COC for a total of more than 7 years was associated with a higher risk of developing breast cancer (HR 1.68; CI 1.1–2.5; p=0.010). According to the Wald method, it was revealed that the probability of developing breast cancer is associated with the presence of HPV type 16, a BMI of more than 25 kg/m2 and prolonged intake of COCs for a total of more than 7 years. When assessing the effect of the duration of MGT intake on the risk of developing PC, it was found that MGT intake for a total of more than 9 years was associated with a higher risk of developing PC (HR 1.65; CI 1.2–2.3; p=0.010). Using the Wald method, we found that the probability of developing RYA is associated with the presence of a BMI of more than 25 kg/m2, MGT intake and the presence of endometrial hyperplastic processes in the anamnesis.

Conclusions. With prolonged use of sex steroids, there is a tendency to increase the risk of developing cancer of the female reproductive system. Careful follow-up and limitation of the duration of taking sex steroids in risk groups will reduce carcinogenic risks.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):261-276
pages 261-276 views

Current possibilities of ultrasonography in diagnosing local spread of endometrial cancer

Zuzieva K.B., Mitina L.A., Vostrov A.N., Mukhtarulina S.V., Stepanov S.O.

Abstract

Background. The incidence of oncologic pathology in the female reproductive system is continually rising, highlighting the importance of finding new methods for early and precise diagnosis. This study aimed to determine the invasion depth of endometrial cancer through contrast-enhanced ultrasonography.

Materials and methods. The study included 38 patients who were confirmed to have endometrial cancer. All patients underwent complex ultrasound examinations in real-time and grayscale mode. The qualitative assessment of vascularization in color and energy Doppler mapping modes was performed using contrast enhancement with the assessment of qualitative and quantitative parameters of contrast.

Results. The results were compared with histological examination results from postoperative materials. The study identified contrasting qualitative parameters that are most indicative of endometrial cancer and quantitative parameters that are statistically significant and reliably distinguished the myometrium affected by the tumor from the unaffected myometrium (including peak intensity, time to peak intensity, and contrast half-life).

Conclusions. Contrast enhancement increases the effectiveness of comprehensive ultrasonography in determining the invasion depth of endometrial cancer.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):277-285
pages 277-285 views

Long-term outcomes of surgical interventions for different types of pelvic organ prolapse

Ishchenko A.I., Asambaeva A., Ishchenko A.A., Khokhlova I.D., Dzhibladze T.A., Malyuta E.G., Aleksandrov L.S., Gorbenko O.Y., Tevlina E.V., Ageev M.B., Baburin D.V., Moskvicheva A.P., Khalyavka E.D., Ivanova V.V.

Abstract

Background. The study aimed to comparatively analyze the nature and frequency of complications and the severity of recurrences among patients with different forms of pelvic organ prolapse (POP). These factors will be examined depending on the surgical technique employed.

Materials and methods. The study involved a thorough clinical evaluation, surgical intervention, and outpatient monitoring (at 1, 6, 12, 24, and 36 months) of 523 participants, aged 32–80 years, categorized into four main groups and 3–4 subgroups depending on the type of POP and surgical method used. Group 1 comprised 161 women (30.8%) presenting with grade I–III cervical elongation combined with grade I–II anterior vaginal wall prolapse. Group 2 consisted of 207 (39.6%) patients with grade II–III anterior vaginal wall prolapse, whereas group 3 included 107 patients (20.5%) with complete uterine prolapse. Group 4 was made up of 48 women (9.1%) with grade II–III posterior vaginal wall descent.

Results. Based on the acquired data, synthetic implant extrusion commonly took place 6–12 months after the surgical procedure. Of the 158 patients who received polypropylene endoprostheses, 20 (12.7%) experienced extrusion and required repeated hospitalizations for partial or complete excision, followed by restoration of vaginal wall integrity. POP recurrences typically occurred 12–36 months after surgical treatment and were detected in 69 (13.2%) of 523 patients. The reappearance of symptoms of pelvic organ descent was most commonly identified in patients who underwent surgery using their tissues (26.6%), less frequently with synthetic implants (12.7%), and extremely rarely with titanium endoprostheses (1.6%).

Conclusions. The results revealed that patients, who underwent surgery using original techniques, employing titanium-made mesh implants and anchors, experienced the fewest complications and postoperative POP incidence. Conversely, the use of synthetic implants increases the likelihood of mesh-associated complications and disease recurrence, necessitating partial or complete excision. The use of autologous tissue for POP surgery is related to a higher likelihood of recurring prolapse symptoms.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):287-297
pages 287-297 views

Surface-enhanced Raman spectroscopy in women with benign and malignant endometrial diseases

Zuev V.M., Lystsev D.V., Artem’ev D.N., Bratchenko L.A., Kukushkin V.I., Fedorova T.A., Bystrykh O.A., Ishchenko A.A., Gilyadova A.V.

Abstract

Background. This study aimed to enhance early detection of endometrial cancer in women and distinguish benign conditions from endometrial cancer using surface-enhanced Raman scattering (SERS) analysis of blood plasma, thus increasing diagnostic efficacy.

Materials and methods. The study of blood plasma from 95 female patients aged 22–79 years was performed. The patients were divided into four groups: group 1 included 29 women with endometrial adenocarcinoma, group 2 included 31 patients with endometrial polyp, group 3 included 10 women with endometrial hyperplasia, and the comparison group consisted of 25 healthy women. Blood plasma was analyzed via SERS, with three Raman spectra recorded per sample. Spectral measurements of the SERS substrate were assessed using dried samples on an experimental bench equipped with the spectrometric system RL785 (LLC “Foton-Bio”, Russia), incorporating a CCD detector, laser radiation source with a wavelength of 785 nm, and ADF U300 microscope (ADF, China). A silver substrate composed of dried silver colloid was used to demonstrate the enhancement effect on the Raman signal from the surface of the blood plasma.

Results. Spectral and specific features that distinguish adenocarcinoma, polyps, and endometrial hyperplasia were identified and evaluated. Spectral and quantitative differences specific to each condition, which are crucial for the differential diagnosis of pathologic tissues, were also identified. The accuracy rates of the optical diagnostics in distinguishing endometrial adenocarcinoma from the control group and endometrial hyperplasia were 87% and 85%, respectively, for the calibration and verification spectral sets (where the sensitivity and specificity were 66% and 92% for the spectral verification set, respectively). The accuracy rates of distinguishing control from endometrial hyperplasia and endometrial adenocarcinoma were 86% and 85%, respectively, and the accuracy of distinguishing endometrial hyperplasia from control and endometrial adenocarcinoma was 81% for the calibration and verification sets of spectra. In addition, the study demonstrated improved accuracy in differentiating adenocarcinoma from hyperplasia, including polyps. The accuracy rate was 93% in the calibration set of spectra, with sensitivity and specificity of 96% and 90%, whereas in the validation set, it was 91%, with sensitivity and specificity of 93% and 88%, respectively.

Conclusions. The study demonstrated the potential use of SERS for differentiating expression patterns in endometrial cancer from those in benign conditions.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):299-310
pages 299-310 views

Experience with clindamycin and lactic acid in the treatment of bacterial vaginosis

Minakova A.D., Dzhibladze T.A., Zuev V.M., Khokhlova I.D., Ageev M.B.

Abstract

Background. Currently, the search for the most effective methods to treat bacterial vaginosis remains relevant because of the high recurrence rate and resistance of the associated bacteria to antimicrobial drugs, along with the potential side effects of antibiotic therapy. This study aimed to assess the effectiveness and tolerability of using clindamycin and lactic acid sequentially, in comparison to lactic acid monotherapy, for women with bacterial vaginosis.

Materials and methods. An open, randomized, comparative clinical study was conducted with 20 women (aged 18–45 years) who had bacterial vaginosis diagnosed according to R. Amsel criteria. The patients were randomly allocated into two groups, each comprising 10 patients. Group 1 took lactic acid, whereas group 2 employed clindamycin and lactic acid. After 14 days, clinical and laboratory efficacy was assessed based on Amsel criteria.

Results. Objective and subjective symptoms such as vaginal discharge of whitish-gray color with unpleasant odor were not observed in both groups 2 weeks after the end of treatment. Positive dynamics of vaginal pH was recorded in both groups; however, a more pronounced effect was observed in women who used clindamycin and lactic acid.

Conclusions. Both sequential clindamycin and lactic acid monotherapy demonstrated high clinical efficacy and good tolerability. Posttreatment pH values did not differ significantly between the two groups; however, a greater pH deviation was observed in the clindamycin and lactic acid sequential group. Further evaluations of long-term results are necessary.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):311-316
pages 311-316 views

Clinical case reports

Clinical experience with postpartum treatment of a patient with arteriovenous malformation of uterine vessels

Busygina L.A., Serova O.F., Garaeva L.R., Bakhtiyarov K.R., Isaev A.К., Barinova I.V., Abdullazhonov A.O.

Abstract

Uterine arteriovenous malformation is a rare vascular dysplasia where the uterine veins communicate with the branches of arteries of varying calibers. Patient K., a 37-years-old patient, presented with genital tract bleeding. Her medical history included operative labor at 37 weeks with dichorionic diamniotic twins, with the placental site on the posterior uterine wall exhibited firm attachment. The uterine cavity walls were scraped, and the bleeding vessel in the placental site was sutured. The blood loss amounted to 750 mL, and reinfusion was conducted. Fourteen days after giving birth, a heavy bloody discharge with blood clots from the genital tract occurred. The blood tests revealed no abnormalities. Echography detected multiple tubular structures that were anechoic on the posterior wall of the uterus, from the endometrium to the serosa, with the CDC mode blood flow. Magnetic resonance angiography revealed hypervascularization with premature arteriovenous discharge. Superselective embolization was performed on uterine artery afferents, and complete blood flow reduction was achieved, leading to the cessation of bleeding. On postoperative day 17, the patient experienced considerable bloody discharge from the genital tract, causing the hemoglobin level to decrease to 88 g/L. The presence of an arteriovenous malformation in the uterine vessels accompanied by ineffective embolization necessitated uterine extirpation. The postoperative phase was uneventful, and the patient was discharged from the hospital in satisfactory condition, with no evidence of anemia (hemoglobin, 115 g/L).

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):317-323
pages 317-323 views

Unusual clinical case: Pharmabortion in a patient with a donor kidney

Sinchikhin S.P., Nagaeva O.E., Sinchikhina E.S., Mustafaeva M.D.

Abstract

The study presents an algorithm for drug-induced abortion and prevention of complications after the procedure, with a clinical efficacy rate of 99.7%. In addition, a unique case is presented, involving the use of drugs to terminate a short-term pregnancy in a patient with chronic glomerulonephritis that affecting her kidney and chronic pyelonephritis in a previously transplanted second kidney. Given the lack of urinary organ dysfunction and the absence of clinical worsening of any somatic pathology at present, the medical consilium has determined that pharmabortion is permissible under dynamic monitoring of the patient. A single oral dose of 600 mg of mifepristone, followed by twice-daily administration of 400 mcg of misoprostol (per os) 36 h later, effectively terminated the unwanted pregnancy without adverse effects on extragenital diseases. Administering the gestagenic drug during the second phase of the menstrual cycle after abortion prevented ovarian dysfunction and endometrial hyperplasia.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(4):325-331
pages 325-331 views


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