V.F.Snegirev Archives of Obstetrics and Gynecology

Malignant neoplasms of the reproductive system are the most common form of oncological morbidity in women, accounting for over 30% of all cancer cases. Most antineoplastic agents act by inducing DNA damage in highly proliferating cancer cells, resulting in oocyte death. Ovarian toxicity is the most common side effect of cancer treatment in young women. Both chemotherapy and radiotherapy have been shown to be toxic to the ovaries, increasing the risk of premature ovarian failure, early menopause, endocrine disorders, and infertility. Patients who have undergone cancer treatment have severe follicular atresia, even if they have a regular menstrual cycle.

Currently, the most effective methods of preserving fertility in cancer patients include cryopreservation of oocytes and embryos after ovarian hyperstimulation. Other fertility preservation methods include ovarian tissue cryopreservation, follicle or embryo maturation in vitro, ovarian transposition, ovarian suppression, and adjuvant therapy.

Despite promising fertility prospects, iatrogenic infertility is one of the most undesirable adverse effects of cancer therapy for young women. Timely referral to a gynecologist prior to chemotherapy or radiation therapy is key to successful fertility preservation. Women should be aware of the available opportunities of assisted reproductive technologies, along with potential risks and failures with regard to their age, stage of disease, and treatment method. At this stage, it is necessary to develop well-defined and effective algorithms for oncologists, obstetrician-gynecologists, fertility specialists, and embryologists.

Bacterial vaginosis (BV) is one of the most common vaginal microbiome abnormalities worldwide and a risk factor for various obstetric and gynecological complications.

Despite years of exploration, existing and quickly emerging clinical, laboratory and instrumental diagnostic methods, and progressive development of science in general, the etiology and pathogenesis of BV remain poorly understood. This is evidenced by the high incidence of chronic and/or recurrent course. There are standard therapeutic approaches aimed to eradicating the causative agent, but the level of efficacy remains questionable due to recurrent episodes. Therefore, further studies of this problem are warranted. Actually, it is evident that G. vaginalis forms polymicrobial biofilms on urogenital tract mucosa.

Biofilms represent associations of microorganisms that are adhered to the surface of the epithelium and connected together in the polymer matrix. Biofilms change the properties of the microorganisms involved into their structural frame and provide beneficial conditions for their interactions. This results in the increase of the existing pathogenic properties of bacteria associated with BV, as well as in the appearance of new features. Thus, the microorganisms become less susceptible to previously effective antibiotics and to aggressive media. Finally, this contributes to the recurrent course of the disease.

In most cases, treatment of BV is based on the immediate effect on the microorganisms, but in patients with confirmed biofilm-associated BV this strategy is not effective and is associated with BV recurrences. Thus, currently relevant issues include exploration of the causes of recurrent BV, development of anti-biofilm agents able to disrupt their matrix and release bacteria from their carcass, and introduction of these agents into clinical practice. This will increase the effectiveness of treatment.

BACKGROUND: Despite the existence of a considerable number of techniques for surgical correction of genital prolapse, patients and doctors cannot be always sure regarding the efficacy of surgical treatment in achieving satisfactory results. As was the case many years ago, the issues of improving the efficacy, reliability and safety of surgical treatment of genital prolapse, as well as the intent to generate individual treatment approach, taking into account the type of prolapse and medical condition of women, remain pertinent.

AIM: The objective of this study is to develop surgical techniques for patients with complex types of pelvic organ prolapse, including women with unfavourable general medical condition.

MATERIAL AND METHODS: A comprehensive clinical examination and surgical treatment of 20 patients with II–IV stage pelvic organ prolapse according to the POP-Q classification, who exhibited similar nosological forms of prolapse but disparate comorbidity status, was conducted. Group 1 included 11 patients with complex pelvic organ prolapse who underwent combined laparoscopic pectopexy. Due to the presence of decubitus changes of the cervix and adverse general status, a two-staged strategy was chosen for nine patients of the Group 2, i.e. laparoscopic correction of apical prolapse — uterine suspension with the use of titanium tapes — at the first stage, and modified Manchester (Moscow) operation with the use of titanium tape, colpoperineorrhaphy with levator ani muscles plication — at the second stage.

RESULTS: The results of the questionnaire indicated that all patients reported a notable improvement in their quality of life and social integration. In all patients, the symptoms of pelvic organ prolapse significantly improved, and no signs of disease recurrence were present.

CONCLUSION: The findings suggest that the proposed surgical techniques for treating pelvic organ prolapse are a viable, efficacious and secure option. They offer swift recuperation and reliable rehabilitation. These techniques have the potential to improve both the physical and social well-being of patients. The described surgical techniques help to restore the normal anatomical position and functions of the organs.

BACKGROUND: With increasing life expectancy, the need to improve the quality of life in elderly and senile women has become more urgent. Pelvic organ prolapse is a significant concern, particularly because this pathology tends to progress in the postmenopausal period. Surgical treatment of pelvic organ prolapse using only the patient’s own tissues often results in recurrence of the disease. This highlights the need for developing new surgical techniques that utilize durable and biologically inert materials, such as titanium implants.

AIM: The objective of this study is to analyze the effectiveness and reliability of surgical correction of complete uterine or vaginal prolapse after hysterectomy in elderly and senile women.

MATERIAL AND METHODS: A total of 65 women, aged between 65 and 86 years old, were examined and underwent surgery using two newly developed original surgical techniques. Group I (31 patients) underwent surgery with the use of a titanium mesh implant, while Group II (34 patients) underwent surgery with the use of a combination of the aforementioned mesh implant with two non-absorbable ligatures.

RESULTS: The outpatient follow-up was carried out on Months 1, 6, 12, 24, 36 and 48 after surgery. The comprehensive examination, comprising questionnaires, gynecological examination and transperineal post-surgery ultrasound, demonstrated that the surgical treatment was satisfactory, as evidenced by an improvement in the women's quality of life. During Month 1 after the surgery, 32 patients (49.2%) reported intermittent perineal pain and/or aches in the area of the inguinal folds, while 15 patients (65.0%) experienced frequent attempts to urinate. These symptoms abated with time. No recurrences of the disease or mesh-associated complications were recorded during the follow-up period.

CONCLUSION: The study demonstrates the efficacy and reliability of newly developed surgical techniques for treating complete uterine and vaginal prolapse after hysterectomy in elderly and senile women. The accumulated clinical experience attests to the fact that severe pelvic organ prolapse in elderly patients with concomitant somatic diseases can be successfully treated via surgical intervention. This has the potential to relieve women from the range of symptoms associated with the disease and normalize the functioning of pelvic organs. The introduction of such surgeries into clinical practice will improve the quality of life of elderly and senile patients.

BACKGROUND: Uterine myoma is one of the most prevalent gynecological diseases. Data concerning the effects of the medicinal agents used in patients with uterine leyomyomas, are both scientifically and practically important.

AIM: This study aims to assess the clinical, laboratory, and instrumental effectiveness of 5-year use of micronized oral contraceptive containing estrogen and progestogen, intrauterine levonorgestrel-releasing system and progesterone receptor modulator in patients with uterine myoma.

MATERIAL AND METHODS: Patients aged from 21 to 40 years old were assigned to 3 arms in accordance with the treatment regimen. Group 1 included 42 women with myomas ≤2 cm in diameter. These patients received combined oral contraceptive pills containing ethinylestradiol 20 mcg and desogestrel 150 mg according to the conventional contraceptive regimen, i.e. one pill daily, 21-day courses with following 7-day pauses. Group 2 included 34 women with uterine myoma and concomitant uterine endometriosis. In this group, the intrauterine devices containing levonorgestrel were inserted. Group 3 included 33 patients treated with the progesterone receptor modulator in order to reduce the diameter of uterine myomas. They received oral mifepristone at a dose of 50 mg daily for three months, followed by a 3-month pause and subsequent 3-month course of treatment. During the year, two cycles that included 3-month treatment course and 3-month treatment-free period, were repeated. All patients underwent standard clinical, laboratory and instrumental gynecological examination. Statistical processing was performed in the basis of Statistica 12.0 software.

RESULTS: In Group 1, 80.9% of patients exhibited unchanged mean diameters of uterine myomas all over the course of treatment with contraceptive drugs, 16.7% of patients demonstrated growth of myoma (by 15%), while in 2.4% of patients myoma reduction (by 5%) was observed. In Group 2, the increase in the diameter of leiomyoma ranged from 20 to 30 percent was observed following the insertion of intrauterine levonorgestrel-releasing system in 58.8 percent of patients. In contrast, 35.3 percent of patients exhibited no change in myoma size, while a decrease by 15 percent was observed in only 5.9 percent of patients. In Group 3, 10 intermittent 3-month courses of mifepristone (50 mg) resulted in the reduction of uterine myoma by 40%–50% of the baseline diameter in 97.0% of patients. In general, the study drugs demonstrated beneficial effects and safety in patients with leiomyoma.

CONCLUSION: The long-term use of low-dose oral contraceptives generally leads in the stabilization of the size of uterine myomas, while intrauterine levonergestrel-releasing system prevents their intensive growth. Nevertheless, the use of a drug belonging to the progesterone receptor modulator class, has proven to be the most effective approach to reducing the size of myomas.

The article presents a clinical case of Wernicke encephalopathy occurring as complication of excessive pregnancy-related vomiting (hyperemesis gravidarum). This disorder has developed due to thiamine (vitamin B1) deficiency. The correct diagnosis is challenging due to the similarity of clinical manifestations with several other disorders. Timely diagnosis and early treatment reduce the risk of severe course and irreversible complications that can lead to the potentially adverse outcome. This case is remarkable due to the appearance of the disease in a 32-year-old pregnant woman with excessive vomiting. The patient demonstrated the classic symptom triad found in only 16% of patients with Wernicke encephalopathy. Primarily ataxia and nystagmus appeared, and later memory impairment with confabulations was recorded. Magnetic resonance imaging of the brain revealed bilateral symmetrical areas with increased MR signal intensity in T2 (SE and FLAIR) sequences in the mediodorsal nucleus (MD) of thalamus, subependymal microglia of the III ventricle, and periaqueductal gray. The treatment of Wernicke encephalopathy was immediately initiated with the use of intravenous thiamine 200 mg 3 times daily. The beneficial treatment effect was reported. Further pregnancy proceeded unremarkably and resulted in the birth of a live term girl. During the postpartum period, the patient reported persisting instability when walking, which increased with closed eyes, and non-systemic dizziness.