卷 70, 编号 6 (2021)

BACKGROUND: Vulvovaginitis is a common gynecological problem in prepubertal girls and is most likely caused by an imbalance in the vaginal microbiota. A number of studies have been carried out to determine the vaginal microflora of healthy prepubertal girls and girls with vulvovaginitis using traditional bacteriological methods. However, until now, a comparative study of the composition of the vaginal microflora in prepubertal girls using molecular methods has not been performed.

AIM: The aim of this study was to conduct a comparative assessment of the composition of the parietal microflora of the vagina in healthy girls and girls with vulvovaginitis in the neutral period of sexual development.

MATERIALS AND METHODS: This study included 168 prepubertal girls aged 3–6 years, of which 70 girls with vulvovaginitis made up the main group and 98 girls without symptoms or signs of vulvovaginitis comprised the comparison group. All girls were assessed for the parietal microflora of the vagina by real-time PCR (Lactobacillus spp, Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Gardnerella vaginalis / Prevotella bivia / Porphyromonas spp., Eubacterium spp., Sneathia spp. / Leptotrihia spp. / Fusobacterium spp., Megasphaera spp. / Veillonella spp. / Dialister spp., Lachnobacterium spp. / Clostridium spp., Mobiluncus spp. / Corynebacterium spp., Peptostreptococcus spp., Atopobium vaginae, Mycoplasma hominis, Ureaplasma (urealyticum + parvum), Candida spp., and Mycoplasma genitalium) using the Femoflor 16 REAL-TIME PCR Detection Kit (DNA-Technology Research & Production, Moscow, Russia).

RESULTS AND CONCLUSIONS: In healthy prepubertal girls, the vaginal microflora is mainly composed of obligate anaerobes. With vulvovaginitis in the vaginal biotope of girls, the total bacterial mass of microorganisms (p = 0.005) decreased, both the biodiversity (the Shannon’s index, p = 0.001; the Simpson’s index, p = 0.004) and the number of obligate anaerobes (p = 0.006) decreased, while the number of facultative anaerobes increased (p = 0.043). The frequency of obligate anaerobes in vulvovaginitis, despite their prevalence in general, was significantly lesser: Peptostreptococcus spp. (p = 0.002), Mobiluncus spp. + Corynebacterium spp. (p = 0.048), Megasphaera spp. + Veillonella spp. + Dialister spp. (p = 0.004); while the frequency of Atopobium vaginae increased (p = 0.002). The concentrations of Peptostreptococcus spp. (p = 0.002); Megasphaera spp. + Veillonella spp. + Dialister spp. (p = 0.002), Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp. (p = 0.006), and Eubacterium spp. (p =0.006) significantly decreased; while the absolute concentration of Sneathia spp. + Leptotrichia spp. + Fusobacterium spp. (p = 0.042), and Mobiluncus spp. + Corynebacterium spp. (p = 0.012) increased. The frequency of facultative anaerobes remained unchanged (p = 0.067) against an increase in the concentration of the family Enterobacteriaceae (p = 0.026). The concentrations of Streptococcus spp. and Staphylococcus spp. remained unchanged, with Lactobacillus spp. not detected in any girl in both study groups.

BACKGROUND: Uterine anomalies are a cause of female reproductive failure. Originally, malformations of the Müllerian ducts are believed to be the main reason for uterus abnormalities. There is an assumption that anti-Müllerian hormone (AMH) or AMH receptor (AMHR2) gene mutation may lead to alterations in the formation of the Müllerian ducts in female fetuses resulting in uterine anomalies.

AIM: The aim of this study was to assess the AMHR2 expression in the endometrium of patients with uterine anomalies and a history of reproductive failure.

MATERIALS AND METHODS: The present study included 112 women, of whom 92 patients were diagnosed with uterine anomalies (main groups): arcuate uterus (n = 30), septated uterus (n = 30), bicornuate uterus (n = 12), unicornuate uterus (n = 10), didelphys uterus (n = 10); and 20 patients had normal uterine anatomy (control group), with the secretory phase (n = 10) and the proliferative phase (n = 10) of menstrual cycle evaluated. Histological and immunohistochemical studies of the endometrium were carried out according to the standard technique with an assessment of AMHR2 marker expression in the biopsy samples.

RESULTS: The AMHR2 area expression in the endometrial stroma was significantly lower in patients with septated uterus compared to those with arcuate uterus (р < 0.001). The same tendency was noted when compared to other uterine anomalies and healthy controls. AMHR2 expression in the endometrial stroma of patients with arcuate uterus was significantly higher compared to unicornuate uterus (p < 0.05).

CONCLUSIONS: The data obtained suggest that morphofunctional characteristics of the endometrium in patients with uterine anomalies have no specific pathognomonic features. The decline in AMHR2 expression in the endometrial stroma seems to be related to chronic endometritis, as an inverse correlation exists between the AMHR2 area expression and chronic endometritis, compromising pregnancy occurrence.

BACKGROUND: Prelabour rupture of the membranes (PROM) is a common obstetric pathology, the incidence of which reaches 20%. There is evidence that PROM is the main risk factor not only for abnormal labor, but also for postpartum hypotonic bleeding. Meanwhile, the etiology and pathogenesis of this complication have not been finally determined until now.

AIM: The aim of this study was to create a model that allows for predicting PROM, based on a comprehensive assessment of risk factors.

MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the prospective analysis of 213 cases of labor was carried out. The total sample was divided into two study groups: group 1 included 142 cases of labor with timely rupture of membranes; group 2 included 71 cases of labor, complicated by PROM. The groups were comparable in terms of nationality, age, material and social living conditions of women, frequency of genital pathology, gestational age and gender distribution of newborns. On the eve of labor (1-2 days), all patients underwent a general clinical examination and clarification of the anamnesis. Ultrasound examination was carried out both the day before and during labor in order to clarify fetal position. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 program.

RESULTS: Risk factors for PROM are: the presence of posterior view of the occipital presentation (RR = 2.67 (95 % CI 1.13-6.31), p = 0.02) and varicose veins (RR = 3.2 (95 % CI 1.09-9.43), p = 0.04), distantia cristarum more than 28.5 cm (RR = 1.99 (95 % CI 1.12-3.54), p = 0.02), distantia trochanterica more than 30.5 cm (RR = 2.15 (95 % CI 1.09-4.23), p = 0.03), and conjugata externa more than 20.5 cm (RR = 1.84 (95 % CI 1.01-3.37), p = 0.046). Oligohydroamnion is a protective factor in relation to PROM (RR = 0.31 (95 % CI 0.11-0.85), p = 0.02). This predictive model, which takes into account such factors as the type of fetal head presentation, the presence of oligohydramnios and varicose veins, and the size of distantia cristarum, allows for predicting PROM with much effect.

CONCLUSIONS: The comprehensive assessment of risk factors, despite its simplicity and availability, allows for predicting the timeliness of rupture of the membranes with an accuracy of 71.0%. Application of the developed model makes it possible to identify a risk group subject to preventive preinduction, which in the future will help to reduce the frequency of abnormal labor and associated complications.

BACKGROUND: There are currently no uniform standards for adenomyosis diagnosis, so the search for the most informative methods is an urgent task. This article presents modern views on the diagnosis of adenomyosis and the role of ultrasound in its diagnostics.

AIM: The aim of this study was to determine the diagnostic capabilities of ultrasound in the diffuse form of adenomyosis.

MATERIALS AND METHODS: This study included 164 patients aged 22 to 43 years old, who had a comprehensive ultrasound examination done. The points were calculated and the presence or absence of adenomyosis, as well as its severity, were determined using the developed scale. The sequential implementation of six ultrasound techniques were used for a comprehensive ultrasound assessment of adenomyosis: assessment of the myometrium echostructure homogeneity; assessment of the ratio of the anterior and posterior uterine wall thicknesses; compression elastography; assessment of the junctional zone in the 3D mode; assessment of the uniformity of the junctional zone thickness along uterine walls; vascularization of the myometrium in the Power Doppler 3D Glass Body mode.

RESULTS: We have developed the comprehensive ultrasound method of adenomyosis diagnostics. The sensitivity of the method was 95%, and the specificity was 100%. The positive predictive value was 100%, and the negative predictive value was 90%. The accuracy of the method was 97%.

CONCLUSIONS: The developed scoring system for the comprehensive assessment of adenomyosis allows for an independent assessment of the myometrium for each criterion, summarizing the scores and, therefore, assessing the presence and severity of adenomyosis more objectively and reliably. The high sensitivity and specificity of this technique allows recommending it for use by ultrasound specialists.

Omega-3 and omega-6 polyunsaturated fatty acids are among the nutrients essential for the vital functions of the human body. Fundamental cellular functions of omega-3 and omega-6 polyunsaturated fatty acids affect both physical and reproductive health. Based on the principles of personalized medicine, early detection of polyunsaturated fatty acid deficiency is necessary for its prompt correction and prevention of further diseases. We present a literature review on the effects of polyunsaturated fatty acids on female and male fertility. The brief information on biochemical aspects, current data on diagnosis, and possible methods for correction of polyunsaturated fatty acid deficiency are described in this article.

Oxytocin is a pleiotropic peptide hormone that plays a leading role in the implementation of the tonomotor activity of the myometrium during labor. Over the past decade, significant progress has been made in understanding the complex neurobiology of the oxytocin system, including oxytocinergic pathways, local release patterns and distribution of oxytocin receptors in the brain, and intra-neuronal oxytocin receptor signaling. This article presents the view of modern researchers on the biological functions of the hormone, including its participation in onco- and immunogenesis, as well as in the implementation of adaptation, reproduction and social behavior in humans.

This article overviews modern literature data on vulvar dystrophies. The increase in the number of patients with dystrophic diseases of the vulva, a pronounced tendency towards rejuvenation, the complexity of diagnosis, frequent recurrence of the disease and low effectiveness of therapy make this issue extremely urgent. Until now, morphologists have not developed a single classification, and among clinicians, a specific etiopathogenetic concept of development of vulvar dystrophies has not been determined. There are many theories of the disease development. The process starts asymptomatically and is not diagnosed in a timely manner, and due to the localization in the intimate area, it is characterized by low circulation and an increase in the number of neglected cases. Only a comprehensive, timely started treatment with the right choice of drugs and methods of activating reparative processes will prevent development of the disease and reduce the duration of the main symptoms and the likelihood of relapses, exacerbations, and complications.