Journal of obstetrics and women's diseases

BACKGROUND: Fetal growth restriction and preeclampsia are some of the main causes of perinatal and maternal morbidity and mortality all over the world. Placental insufficiency underlies the pathogenesis of these conditions.

AIM: The aim of this study was to investigate the effect of vaginal microbiota in the first trimester of pregnancy on the formation of the chorion and the risks of placental insufficiency.

METHODS: The study included 396 patients without a burdened obstetric-gynecological anamnesis and extragenital pathology. Using polymerase chain reaction diagnostics, we assessed the levels of placental proteins [human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A)] in the first prenatal screening, multiples of the median (MoM) for these levels, and the vaginal microbiota in the first trimester of pregnancy.

RESULTS: The patients were divided into two groups: group 1a included pregnant women with PAPP-A levels <0.5 MoM (n = 82) and group 2a consisted of patients with PAPP-A levels ≥0.5 MoM (n = 314). The same patients were divided into two other groups depending on the MoM for hCG levels: group 2a included patients with hCG levels <0.5 MoM (n = 33) and group 2b consisted of patients with hCG levels ≥0.5 MoM (n = 363). In group 1b, normal microbiota and conditionally normal microbiota were more common, whereas moderate mixed dysbiosis, severe anaerobic dysbiosis, and severe mixed dysbiosis were less common than in group 1a. Depending on the MoM for hCG levels, in group 2b, severe aerobic dysbiosis and severe anaerobic dysbiosis were less common than in group 2a. In group 1a, the number of Staphylococcus spp., Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp., Eubacterium spp., Megasphaera spp. / Veillonella spp. / Dialister spp. was higher than in patients in group 1b. We found no differences in the number of microorganisms in the vaginal microbiota depending on the MoM for hCG levels. The decision tree method revealed that if the concentrations of opportunistic microorganisms in the vaginal microbiome are as follows: Sneathia spp. / Leptotrichia spp. / Fusobacterium spp. >10^3.85, Staphylococcus spp. >10^3.45, Peptostreptococcus spp. ≤10^4.85, Candida spp. ≤10^3.9, and Staphylococcus spp. ≤10^3.95; as well as Sneathia spp. / Leptotrichia spp. / Fusobacterium spp. >10^3.85, Staphylococcus spp. >10^3.45, and Peptostreptococcus spp. >10^4.85, then the PAPP-A levels may be predicted to be <0.5 MoM. The presented inequalities reflect the absolute values of DNA copies of microorganisms in the form of decimal logarithms (genome equivalents per milliliter).

CONCLUSION: In patients with reduced levels of placental proteins, according to the first prenatal screening, the vaginal microbiota is characterized by higher numbers of opportunistic microorganisms compared to patients with normal values of placental proteins. Timely correction of the vaginal microbiota at the pregravid stage and in early pregnancy can be an important source of prevention of placental insufficiency.

BACKGROUND: The reduction of ovarian reserve following ovarian cystectomy remains a key challenge in reproductive medicine, limiting fertility. Clinical studies are needed to evaluate the long-term efficacy and safety of autologous platelet-rich plasma as a method to stimulate residual folliculogenesis through the activation of growth factors (vascular endothelial growth factor, epidermal growth factor, and platelet-derived growth factor).

AIM: The aim of this study was to assess the efficacy of intraovarian administration of platelet-rich plasma in restoring ovarian reserve in women following cystectomy for benign ovarian cysts.

METHODS: The study included patients aged 18–37 years with benign ovarian tumors who underwent cystectomy with or without intraovarian administration of platelet-rich plasma. Ovarian reserve assessment involved measuring anti-Müllerian hormone levels and antral follicle count before surgery, as well as 3 and 6 months post-intervention.

RESULTS: 49 patients who underwent surgery were divided into two groups: the main group (n = 24) receiving intraovarian platelet-rich plasma administration and the control group (n = 25). 3 months post-surgery, the main group demonstrated an increase in antral follicle count, which persisted for 6 months. Anti-Müllerian hormone levels remained stable in the both study groups.

CONCLUSION: The findings suggest that intraovarian platelet-rich plasma administration is associated with an increase in antral follicle count following cystectomy, without affecting anti-Müllerian hormone levels. These data highlight the potential role of platelet-rich plasma therapy in the restoration of ovarian function. However, further studies with larger sample sizes and extended follow-up periods are required to confirm the observed effects and assess their clinical significance.

BACKGROUND: The developing embryo secretes a wide range of cytokines that are essential for establishing a “dialogue” between the embryo and the endometrium, as well as for autocrine effects on the embryo. Non-invasive assessment of the embryo using the study of its secretome is of great interest in reproductive medicine, as it can be used for early selection of the most viable embryos in assisted reproductive technology programs.

AIM: The aim of this study was to determine the prognostic significance of cytokine levels in media after embryo culture and their impact on endothelial function in achieving clinical pregnancy in assisted reproductive technology protocols, as well as the effect of these media on endothelial function.

METHODS: The presence of cytokines [interleukin-1b, -4, -5, -6, -8, -10, growth factors (granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor)] in embryo-conditioned culture media was determined in patients undergoing infertility treatment using assisted reproductive technology. To detect cytokine levels below the sensitivity threshold, we studied the effect of conditioned culture media on the proliferation and migration of endothelial cells.

RESULTS: The patients were divided into 2 groups: in group 1 (n = 34), no cytokines were found, whereas in group 2 (n = 14), at least one of the studied interleukins or growth factors was detected. Patients in group 2 had more oocyte-cumulus complexes, 2PN2PB zygotes, embryos on day 3 of culture, embryos of quality ≥ 6B on day 3 of culture, blastocysts, and blastocysts of quality ≥ 3BB. Additionally, the effective doses of gonadotropins per oocyte and per embryo were lower in group 2. The clinical pregnancy rate was also higher in group 2. We found no differences in endothelial cell proliferation and migration parameters.

CONCLUSION: A higher concentration of cytokines in media after embryo culture may indicate greater implantation potential; therefore, cytokine assessment in culture media could be used as an additional non-invasive method for embryo evaluation.

BACKGROUND: This article presents the second stage of the study to evaluate the efficacy and tolerability of new directions of drug therapy for adenomyosis based on an experimental model of the disease. This stage is necessary for the further implementation of innovative therapy regimens into clinical practice.

AIM: The aim of this study was to evaluate the efficacy of treating adenomyosis in Wistar rats with the phytoalexin resveratrol, the oxytocin receptor inhibitor atosiban, and the biguanide metformin.

METHODS: We compared the efficacies of adenomyosis treatment options between female Wistar rats with experimentally tamoxifen-induced adenomyosis treated with atosiban, or resveratrol (trans-form) at different doses, or metformin, or dienogest, and without treatment, and healthy rats given water. Histological examination and a hot plate test were performed.

RESULTS: Out of 83 female Wistar rats, 51 animals with experimentally tamoxifen-induced adenomyosis (main group) were divided into 5 subgroups. The rats of the 1st subgroup were administered atosiban intraperitoneally at a dosage of 0.35 mg/kg/day for 21 days (n = 15). The 2nd subgroup orally received resveratrol at a dosage of 15 mg/kg/day for 30 days (n = 16). The 3rd subgroup orally received resveratrol at a dosage of 45 mg/kg/day for 30 days (n = 8). The 4th subgroup orally received metformin at a dosage of 300 mg/kg/day for 30 days (n = 5). And the 5th subgroup orally received dienogest at a dosage of 1 mg/kg/day for 30 days (n = 7). In addition to the main subgroups, 2 comparison subgroups were created (n = 32): the 6th subgroup included rats with tamoxifen-induced adenomyosis without treatment (n = 24) and the 7th (control) subgroup of healthy rats received water (n = 8).

Based on the results of histological examination and the hot plate test, the greatest efficiency in the treatment of adenomyosis was demonstrated by therapy using atosiban and resveratrol at a dosage of 45 mg/kg/day, the data obtained being comparable with the result of using dienogest. Thus, the percentage of adenomyosis cure according to the morphological study was 93% when using atosiban, 88% when using resveratrol at a dosage of 45 mg/kg/day, 86% when using dienogest, 75% when using resveratrol at a dosage of 15 mg/kg/day, and 60% when using metformin. In addition, the parameters in the main group differed from the corresponding data in the subgroup of animals with adenomyosis that did not receive treatment and in the control subgroup (p < 0.05).

CONCLUSION: Our findings demonstrate using alternative methods in the treatment of adenomyosis. Therapy using atosiban and resveratrol in a higher dosage showed an effect similar to that using dienogest, in both relieving pain and curing adenomyosis, which was confirmed histologically. Perhaps, the use of resveratrol and metformin in combination with therapy registered for the treatment of adenomyosis may potentiate the effect of the drugs, increasing their effectiveness. In turn, intolerance and the presence of side effects when using registered hormone-modulating drugs justify the consideration of these alternative methods as monotherapy. The revealed dose-dependent effect of trans-resveratrol gives grounds to assume the prospects for its use in clinical practice, which requires further research to prescribe treatment to patients with adenomyosis.

The article provides an overview of recent studies on the effect of uterine leiomyoma on fertility and pregnancy outcomes. We performed this work in accordance with international standards for systematic reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) with the analysis of data obtained across PubMed, Cochrane, Google Scholar, and other databases. The reference search method was also used to select articles. The search strategy did not include restrictions on language and source type.

The review examines the mechanisms through which uterine leiomyoma disrupts reproductive function, including mechanical barriers to conception, changes in the endometrial microenvironment, as well as impaired angiogenesis and uterine contractility. Special attention was paid to the impact of uterine leiomyoma on the results of assisted reproductive technology treatments.

Studies show that submucosal and intramural leiomyomas may reduce implantation and pregnancy success, especially in in vitro fertilization. However, the results remain contradictory, which indicates the need for further research. The work focuses on current treatment options for uterine leiomyomas in women of reproductive age, including drug therapy, myomectomy, and minimally invasive interventions such as uterine artery embolization and focused ultrasound ablation. Although minimally invasive interventions do not appear to affect ovarian function or worsen pregnancy outcomes, more randomized controlled trials are needed to recommend these methods for the treatment of uterine leiomyoma in patients with reproductive plans. Promising developments in the treatment of the disease are currently pathogenetic therapy with gonadotropin-releasing hormone antagonists and agonists, as well as selective progesterone receptor modulators, which affect not only symptoms but also sizes of uterine leiomyoma. However, conclusions about this therapy before surgery are debatable. The work highlights the importance of a comprehensive approach to uterine leiomyoma treatment and the development of personalized strategies for women with uterine leiomyoma planning pregnancy.

Colposcopy is an important method for diagnosing benign and malignant diseases of the vulva, vagina and cervix, which allows for a significant impact on the timely detection of oncological pathology of the reproductive organs.

This review article describes the stages of formation and development over 100 years, as well as the current state of colposcopy. Herein, a bibliographic search was performed with the study of Russian and foreign scientific literary publications devoted to colposcopy and the creators of the method.

The article discusses the key stages in the development of colposcopy, its introduction into clinical practice, and modern aspects of the use of this method for diagnosing benign and malignant diseases of the female reproductive organs. Currently, the colposcopic diagnostic method, which was developed in the first half of the 20th century by the German doctor Hans Hinselmann and has an interesting history, has become basic in the practical activities of obstetricians and gynecologists all over the world. The result of domestic developments was the creation of the first Russian mobile digital colposcope.

Colposcopy is one of the most important diagnostic methods in gynecology, which has significantly expanded the possibilities of early detection of cervical intraepithelial neoplasia and cervical cancer.