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Reproductive Endocrinology
Number of Followers: 1  Open Access journalISSN (Print) 2309-4117 - ISSN (Online) 2411-1295 Published by Trilist Publishing  [1 journal]
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- Endometriosis. Guideline of European Society of Human Reproduction and
Embryology – 2022
Authors: Reproduct Editor
Pages: 8 - 19
Abstract: The European Society of Human Reproduction and Embryology (ESHRE) developed the current clinical practice guideline, to provide clinical recommendations to improve the quality of healthcare delivery within the European field of human reproduction and embryology. This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained.
This document is the second update of the ESHRE Guidelines on Endometriosis (2014). However, there still remain many unanswered questions for which no, or only poor quality or little data are available.
The aim of clinical practice guidelines is to aid healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients.
The guideline covers the care provided by secondary and tertiary healthcare professionals who have direct contact with, and make decisions concerning, the care of women with endometriosis. Although primary healthcare providers are not the main target users of this guideline, it may be of interest for them too.
This guideline offers best practice advice on the care of women with suspected and confirmed endometriosis. Recommendations are provided on diagnosis and treatment for both relief of painful symptoms and for infertility due to endometriosis.
Specific recommendations are provided on management of patients in whom endometriosis is found incidentally (without pain or infertility), adolescents and menopausal women with endometriosis.
Information on risk factors for endometriosis and associations with other diseases is provided, with recommendations on prevention and monitoring.
PubDate: 2022-12-13
DOI: 10.18370/2309-4117.2022.66.8-19
- New approaches to early detection of polycystic ovary syndrome in obese
women
Authors: V.V. Artyomenko, V.I. Velychko, D.O. Lahoda
Pages: 20 - 25
Abstract: Objectives: development of an algorithm for the early detection of comorbid pathology polycystic ovary syndrome (PCOS) in obese women.
Materials and methods. The study included 56 women aged 28.02 ± 2.25 years with a diagnosis of obesity who had no history of PCOS. The examination was carried out by a multidisciplinary group of doctors consisting of a family doctor, a gynecologist and an endocrinologist.
The patient’s history of life and diseases was studied, an anthropometric еxamination and a survey according to the modified Ferriman–Gallwey scale were performed with a further ultrasound examination and a gynecologist consultation.
Results. The majority of patients (55.36%) had acne, hirsutism and seborrhea occurred in 41.07 and 26.76% of women, respectively, and 14.29% of patients had alopecia. Often, the patient had not one, but several symptoms at the same time.
According to the modified Ferriman–Gallwey scale, the majority of women (58.92%) had no manifestations of hirsutism along with obesity, 17.8% had moderate manifestations of hirsutism, 16.07 and 7.14% had mild and moderate hirsutism, respectively.
The patients had no complaints and did not know whether they had PCOS. PCOS were diagnosed in 31 (55.36%) women after ultrasound examination and gynecologist consultation. It was also found that patients with longer obesity and a higher body mass index were more likely to have a diagnosis of PCOS (ρ = 0.77). The largest number of PCOS patients was among women with a body mass index over 40 kg/m2, i.e. with the III degree of obesity.
Conclusions. The algorithm we developed for the diagnosis of PCOS in obese patients allowed us to detect this disease early in 55.36% of cases. We consider it appropriate to recommend screening for PCOS to all obese patients of reproductive age. This tactic will help maintain the fertility of this category of patients.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.20-25
- Evaluation of the complex approach effectiveness of atrophic colpitis
treatment in menopausal aged women from the pathogenetic view
Authors: V.O. Beniuk, V.M. Honcharenko, I.A. Usevych, V.F. Oleshko, A.A. Momot, M.S. Puchko, Y.I. Veretelnyk
Pages: 26 - 31
Abstract: Objectives: to determine the status of connective tissue and ionized magnesium value before and after complex treatment of atrophic colpitis with the CO2 laser in menopausal women.
Materials and methods. 160 women with atrophic colpitis took part in this prospective study and were divided into three groups depending on the therapy. The main group included 55 patients who underwent CO2 laser therapy. The comparison group included 40 women who underwent CO2 laser therapy and local hormonal treatment with suppositories containing estriol and magnesium saturation by magnesium lactate dihydrate. The control group consisted of 65 women who received only suppositories containing estriol. The duration of treatment was 12 months. In addition to general clinical studies, markers of collagen synthesis (Total PINP, Total PІІІNP), collagen resorption marker (Pyriliks-D), as well as the ionized magnesium value in blood serum were determined in all patients.
Results. A significant increase and steady retention at the physiological level of the average value of the Total PINP in the comparison group was revealed. The average level of the Total PIІІNP in patients of this group underwent a significant decrease and remained steadily at the upper limit of the physiological norm. A significant decrease and stable retention at the physiological level of the Pyriliks-D was noted in the comparison group against the background of the proposed therapy. Correction of magnesium status in the comparison group leads to a reliable and stable increase in the Mg+ ions concentration in blood serum.
Conclusions. The inclusion CO2 laser in combination with local hormonal therapy and long-term correction of mineral metabolism in the treatment of the comparison group led to the stable normalization and prolonged retention at the physiological level for 12 months of the procollagen type I N-terminal propeptide, procollagen type III N-terminal propeptide, collagen resorption marker Pyriliks-D and a significant increase in magnesium concentration. This is confirms the effectiveness of the proposed complex.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.26-31
- Role of prenatal microbiota in fetal programming
Authors: S.I. Zhuk, O.D. Shchurevska, V.M. Yefisko
Pages: 32 - 38
Abstract: According to the concept of D. Barker, the intrauterine period is decisive in the programming of postnatal pathology, which can manifest during life. Among the factors of fetal programming, the microbiota plays an important role, but many aspects are still debatable.
Objective: analysis and generalization of literary data devoted to the study of the association between the human body and microorganisms, their characteristics during pregnancy and their role in the health and pathology.
According to the literature analysis, the article provides data on the non-sterility of the intrauterine environment and ways of its formation. The dynamics and features of “healthy” biotopes of intestines, vagina, mouth and placenta during pregnancy are considered. The main ways of fetus colonization by microorganisms are described, in particular, a major role is given to oral microflora. The effects of prenatal microbiota in physiological and complicated pregnancy, namely in preeclampsia, gestational diabetes, and miscarriage are discussed.
Evidence is provided that microbial metabolites are capable of epigenomic modifications that alter fetal metabolism. This is further realized in the diseases of civilization. In addition, there are 360 times more bacterial genes than human genes. Therefore, they are called the “second genome” of a human, which can be changed according to needs. Modern research points to the essential importance of the maternal environment impact on the formation of microflora in fetus and pathology programming, and this process begins in utero. Maternal microbiota in normal and pathological conditions has a direct and indirect effect on the fetus through the immune reactions of the body or microbial metabolites penetrating through the placenta.
Conclusions. The importance of microbiota in the metabolic processes of the fetus and newborn is extremely important. Microbiota also plays a significant role in the main pathophysiological aspects of programmed pathology. The development of correct preventive and therapeutic measures to modify the “healthy” microbiota during periods of its active formation should be a perspective for further research. This will allow it to be corrected taking into account the characteristics of individual biotopes.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.32-38
- The prospects for the use of artificial intelligence in obstetrics in
Ukraine
Authors: N.Y. Zhylka, O.S. Shcherbinska, I.P. Netskar
Pages: 39 - 45
Abstract: In Ukraine, there is a steady trend towards an increase in the incidence of various forms of hypertensive disorders, both mild and severe, among pregnant women. Preeclampsia and eclampsia are severe forms of hypertensive disorders during pregnancy, the rates of which tend to increase, and lead to severe morbidity, disability and mortality in both women and newborns.
The article reveals the question of the artificial intelligence (AI) use in modern midwifery in the national health care system of Ukraine in order to prevent pregnancy complications, in particular eclampsia. Implementation of AI systems in medicine is one of the most important modern trends in global healthcare. AI technologies are fundamentally changing the world health care system, allowing to radically rework the system of medical diagnostics, the development of new medicines, and also to generally improve the quality of health care services while simultaneously reducing costs for medical clinics. AI allows analyzing placenta samples and calculating the risk for a woman’s health in future pregnancies. The system is designed to help obstetrician-gynecologists, who will find it useful to forecast possible complications of future births. The use of AI in clinical practice makes it possible to identify the most serious prognostic signs of damage to blood vessels of the placenta, which is called decidual vasculopathy in preeclampsia and eclampsia. If preeclampsia is detected at an early stage, the patient can be treated before symptoms appear.
AI use must be in compliance with six principles of the WHO in order to limit risks and increase the possibilities of using AI technologies: protection of human autonomy; promotion of human well-being and safety and public interests; ensuring transparency and comprehensibility; promoting responsibility and accountability; ensuring inclusiveness and fairness; promotion of AI in accordance with the principles of adaptability and sustainable development. Adherence to the ethical principles of AI gives the green light for the development of modern health care systems. It can become an effective method of preventing eclampsia in pregnant women, women in labor, and newborns and preserving their health and life.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.39-45
- Optimization of the prevention of perinatal pathology in women with
gestational endotheliopathy
Authors: D.H. Konkov, S.М. Kosianenko, R.S. Ostreniuk, O.L. Lovkina
Pages: 46 - 53
Abstract: Objectives: to evaluate the clinical effectiveness of the Metida for the prevention of perinatal pathology in pregnant women with gestational endotheliopathy and with the risk of preeclampsia.
Materials and methods. 68 pregnant women with verified gestational endotheliopathy and with risk of preeclampsia > 1:150 participated in a prospective clinical comparative study. The patients were divided into subgroups: the first subgroup included 30 women who from 11–13 weeks of pregnancy received acetylsalicylic acid 100 mg/day and vitamin D 2000 IU/day; the II subgroup included 38 pregnant women who from 11–13 weeks of gestation received acetylsalicylic acid 100 mg/day, vitamin D 2000 IU/day and Metida (300 mg of elemental magnesium, 30 mg of vitamin B6). 28 practically healthy pregnant women of the control group received vitamin D 1000 IU/day. The clinical effectiveness of therapy was evaluated by comparing the number of cases of perinatal pathology; cases of intrauterine suffering of the fetus; the dynamics of indicators of laboratory-instrumental research methods (markers of the risk of perinatal pathology) and the pregnancy outcomes.
Results. Metida as an additional preventive therapy made it possible to significantly reduce the number of cases of placental dysfunction (р = 0.01) and intrauterine suffering of the fetus (р = 0.02) compared to standard preventive therapy. There was also a 6-fold reduction in the incidence of preeclampsia and premature birth due to magnesium supplementation, compared to pregnant women who received only acetylsalicylic acid and vitamin D. There was a significant decrease in serum indicators of markers of endothelial dysfunction in women with gestational endotheliopathy as a result of taking magnesium: vascular endothelial growth factor (p < 0.00001), endoglin (p < 0.00001) compared to patients who did not receive magnesium, and there was also normalization of the of 25(OH)D level in blood serum compared to the control group (p = 0.33).
Conclusions. Additional Mg supplementation during pregnancy may reduce the likelihood of perinatal pathology in high-risk patients and help normalize serum markers of endothelial dysfunction in women with high risk of preeclampsia.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.46-53
- Dynamics of markers of lipid metabolism during combined preventive therapy
of pregnant women with obesity and reduced vitamin D status
Authors: O.V. Bulavenko, О.V. Bodnarchuk, O.M. Honcharenko, S.М. Kosianenko, D.H. Konkov
Pages: 54 - 60
Abstract: Objectives: to evaluate the effectiveness of multidose supplementation of vitamin D on the dynamics of serum levels of markers of lipid metabolism in pregnant women with obesity.
Materials and methods. The study included 75 pregnant women with the І degree of obesity and low vitamin D status, who were divided into subgroups depending on the vitamin D dose of and the baseline 25(OH)D level in blood serum: I subgroup – 24 women with 25(OH)D less than 22.0 ng/ml who received Decristol 4000 IU/day; II subgroup – 26 pregnant women with 25(OH)D = 22.1–28.0 ng/ml who received Decristol 2000 IU/day; III subgroup – 25 patients with 25(OH)D over 28.1 ng/ml, who received 1000 IU of vitamin D per day. Pregnant women of all these subgroups also took acetylsalicylic acid at a dose of 100 mg/day. The control group included 26 practically healthy women who received 600 IU of vitamin D per day. Serum adipokinins levels were studied at 11–13, 22–24 and 31–33 weeks of gestation.
Results. Significant differences were found in the increase of leptin (p < 0.0001) and resistin (p < 0.0001) and the decrease of adiponectin (p = 0.006) in pregnant women with impaired vitamin D metabolism against the background of moderate obesity in the І trimester compared to the control group. A more positive effect was found for Decristol 4000 IU (patients with vitamin D deficiency), against the treatment of Decristol 2000 IU (patients with vitamin D deficiency). At 31–33 weeks of gestation, there was a statistically significant decrease in serum level of resistin (p = 0.006) and a similar increase in adiponectin (p = 0.025) in patients receiving vitamin D 4000 IU, compared with the same indicators in clinical subgroups. Resistin and adiponectin may be markers of perinatal pathology in obese pregnant women in the first trimester of gestation, in terms of specificity (91.5 and 78.7%, respectively), sensitivity (100.0 and 91.3%, respectively); positive probability (11.75 and 4.29%, respectively), negative prognostic value (100.0 and 94.9%, respectively) and test accuracy (94.3 and 82.9%, respectively).
Conclusions. The use of markers of lipid metabolism as diagnostic criteria during pregnancy in women with the І degree of obesity and low vitamin D status has predictor and prognostic value for the risk of perinatal pathology and helps to assess the effectiveness of comprehensive prophylactic therapy.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.54-60
- Hormonal and genetic causes of poor response to controlled ovarian
stimulation in women of late reproductive age
Authors: O.H. Boichuk, U.S. Dorofeieva, T.V. Kolomiichenko
Pages: 62 - 67
Abstract: Objectives: to investigate the hormonal and genetic determinants of the poor response to controlled ovarian stimulation (COS) in women of late reproductive age.
Materials and methods. 130 patients from assisted reproductive technology programs were examined. The main group of 80 older reproductive aged patients (35 years and older) was divided into 2 subgroups according to the POSEIDON criteria. Subgroup 1 included 34 women with a predicted poor response to COS, subgroup 2 – 46 patients with a predicted normal response to COS. The comparison group consisted of 50 patients under the age of 35 with a predicted normal response to COS.
The pituitary hormones (luteinizing, follicle-stimulating hormones, prolactin), steroid hormones (testosterone, estradiol, progesterone), cortisol, anti-Mullerian hormone (AMH) and inhibin B values was determined in blood serum by the ELISA. Blood was taken on the third day of the menstrual cycle. A molecular genetic study of FSHR gene polymorphism (Ala307Thr, Ser680Asn) was performed.
Results. AMH decrease, estradiol increase and inhibin B decrease in potentially poor responders to COS may be an additional indication of reduced ovarian reserve. The level of follicle-stimulating hormone increases with age, but does not have high specificity as a marker of ovarian reserve. Elevated levels of cortisol emphasize its role in reproduction and correspond to increased stress value. The effectiveness of IVF if there were 4 or more mature oocytes obtained is associated with higher levels of AMH and inhibin B, and lower estradiol and cortisol values. The multifaceted dependence of the COC effectiveness in women of older reproductive age on the parameters of the hormonal profile, confirmed by correlation analysis, reflects the complexity of the reproductive function implementation with the use of auxiliary reproductive technologies in such patients. The combination of AA/SS genotypes for the Thr307Ala and Asn680Ser polymorphisms of the FSHR gene can be an additional marker of COC inefficiency.
Conclusions. Determination of the hormones levels (inhibin B, estradiol and cortisol), the study of Thr307Ala and Asn680Ser polymorphisms of the FSHR gene can provide additional information for predicting the response to COS in women of older reproductive age.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.62-67
- Algorithms for prescribing menopausal hormone therapy in different periods
of menopause
Authors: T.F. Tatarchuk, N.F. Zakharenko, S.I. Reheda, T.I. Kvasha
Pages: 68 - 70
Abstract: Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause. MHT, initiated in women during the “therapeutic window” to relieve symptoms of estrogens deficiency and prevent or treat osteoporosis, is the only intervention that reduces the risk of cardiovascular diseases and diabetes in healthy middle-aged women. MHT must be individualized and adapted; that is, a differentiated selection of therapy should be carried out, considering the woman’s health status and her comorbidities, as well as the MHT regimen (type, dose, route of administration and possible side effects). The article reflects the algorithms for prescribing MHT in different periods of menopause, which allow applying an individualized approach to patients who need MHT.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.68-70
- Clinical and ultrasound characteristics of the health status of fertile
aged women, who smoke and have metabolic syndrome
Authors: Vol. V. Podolskyi, V.V. Podolskyi, V.V. Buhro
Pages: 72 - 76
Abstract: Objectives: to identify clinical and ultrasound indicators that can determine the need for further examination of fertile aged women who smoke and have metabolic syndrome (MS) regarding the risk of developing somatic pathology or diseases of the reproductive system.
Materials and methods. 2 groups of women of fertile age were examined: the first group consisted of 20 women who smoked with MS, the second group included 20 women who smoked without MS. All women were interviewed using a specially designed general and reproductive health questionnaire. Ultrasound examination of the abdominal cavity and pelvic organs was performed using convex and transvaginal sensors according to existing examination protocols.
Results. Women of the first group had a higher body mass index and other obesity parameters, which is typical for MS. Women of the second group smoked more cigarettes per day. The identified early onset of menstrual function in women with MS may be a manifestation of hormonal homeostasis disorders at the end of puberty with a predominance of estradiol secretion and insufficient progesterone synthesis in the second phase of the menstrual cycle. A significant amount of blood loss during menstruation and painful menstruation in women of the first group may be a manifestation of adenomyosis, which confirms by echo-positive and echo-negative inclusions in the myometrium and thickening of the uterine walls. In most patients with MS ultrasound showed multifollicular ovaries, which may point at polycystic ovary syndrome, given changes in body mass index and ovarian structure as a response on hyperestrogenemia. Prolonged manifestation of MS also negatively affected the abdominal organs, as evidenced by echo-positive inclusions in the liver and pancreas parenchyma, which is a manifestation of inflammatory diseases of these organs.
Conclusions. The combination of prolonged smoking and metabolic syndrome leads to more pronounced changes in the reproductive system and abdominal organs, which in turn expands the range of recommended methods of instrumental examination for such women.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.72-76
- Menopauseal hormonal therapy and the risk of breast cancer in the light of
new data
Authors: O.О. Yefimenko
Pages: 77 - 80
Abstract: Menopause is a natural and inevitable physiological process of the decline of reproductive function due to a decrease in ovarian function, which every woman has to face after about 45–60 years. During this period of hormonal changes the female body needs support more than ever, because the quality of life of a modern woman directly depends on it.
The question of the menopausal hormone therapy (MHT) safety in relation to the risk of breast cancer is a perennial subject of research, studied and debated in the medical literature for more than 20 years. During this time, several different studies on this issue were conducted.
In this review we describe previous insights along with recent research using estradiol and natural micronized progesterone in MHT regimens. The body
of evidence suggests that modifiable lifestyle factors (such as obesity and alcohol consumption) rather than combined MHT are the real breast cancer risks; combined MHT containing estradiol and micronized progesterone was not associated with an increased risk of breast cancer; when prescribing MHT, micronized progesterone may be a safer progestogen.
The clinical significance of the obtained results is also discussed.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.77-80
- Uterine fibroids and the problem of deep vein thrombosis of the lower
extremities. View of a vascular specialist and hematologist
Authors: L.M. Chernukha, O.A. Vlasenko, I.O. Rodionova, Y.P. Markovets, D.A. Vlasenko, H.H. Vlaikov
Pages: 82 - 88
Abstract: The article provides clinical data and an algorithm for the management of patients with symptomatic uterine fibroids complicated by metrorrhagia and venous thrombotic events.
Objective: to improve the treatment of patients with uterine fibroids complicated by abnormal menstrual bleeding, anemia and venous thrombotic events due to the implementation of the developed algorithm for diagnosis and treatment.
Materials and methods. The study included 15 patients aged 32–49 years with a diagnosis of uterine fibroids with menorrhagia and iron deficiency anemia, complicated by deep vein thrombosis of the lower extremities. Thromboembolism of small branches of the pulmonary artery was diagnosed in 5 (30%) of these patients.
The examination algorithm included general clinical tests (general blood and urine analysis, biochemical blood analysis, coagulogram), evaluation of the D-dimer, soluble fibrin monomer complexes, ultrasound of the pelvic organs, ultrasound duplex scanning of the veins of lower extremities, electrocardiography, echocardiography, multispiral computed tomography of chest. All patients underwent endometrial biopsy to exclude oncological pathology.
The proposed treatment included: uterine artery embolization to stop bleeding, correction of hemostatic parameters, and anticoagulant therapy of venous thrombotic events after stopping bleeding.
Results. Bleeding was stopped in all 100% of patients after endovascular uterine artery embolization. The duration of anticoagulant therapy depended on the causes of venous thrombosis and was at least 3–6 months; it was extended for more than 6 months if there were concomitant risk factors.
Conclusions. Uterine artery embolization allows quickly and reliably stopping bleeding and immediately starting adequate anticoagulant therapy for venous thrombotic events.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.82-88
- Efficiency of treatment and diagnostic algorithms in the rehabilitation
program of women after hysterectomy with opportunist salpingectomy due to
uterine myoma
Authors: O.M. Proshchenko, I.B. Ventskivska
Pages: 90 - 97
Abstract: Objectives: to determine the effectiveness of the rehabilitation program in women of reproductive age with uterine fibroids for correction of genitourinary syndrome after hysterectomy with opportunistic salpingectomy.
Materials and methods. 160 women were examined after hysterectomy with fallopian tubes. State of the urogenital tract and urogenital dysfunction researched with the using the POP-Q system,
the Barlow scale, vaginoscopy. Also it was used evaluation of the vaginal pH and mucosal microbiota state, assessment of the vaginal health index according to G. Bochmann, assessment of the impact of vulvovaginal symptoms on the life’s quality with the MOS SF-36 questionnaire in the dynamics of the postoperative period. The treatment algorithm included local preparations of hyaluronic acid, lactobacillus preparations in combination with vitamin D solution, in case of a severe course – topical estrogens, in case of vasomotor symptoms – estradiol 50 μg/day and vitamin D 4000 IU daily or 20,000 IU once a week.
Results. Manifestations of genitourinary syndrome were revealed 1 year after surgery, namely: hypotrophy of the vaginal mucous membrane in 36.3% of women, urinary incontinence in almost a third of patients, prolapse of the vaginal walls of the I–II degree in 8.8% of women, a pathological microscopic picture in 68.1% of female. The proposed algorithms in the rehabilitation program made it possible to eliminate or reduce the severity of genitourinary symptoms 5 years after hysterectomy, in particular, to reduce the frequency of vulvovaginal atrophy by 25%, to normalize the biocenosis and pH of the vaginal contents, to reduce the clinical manifestations of urination disorders (pollakiuria and nocturia by 14% and 12,8%, respectively), feeling of incomplete emptying of the bladder by 12.9%, stress urinary incontinence by 17.9%, vaginal prolapse by 13.3% compared to the group with standard postoperative management.
Conclusions. Hysterectomy with opportunistic salpingectomy for uterine fibroids has a positive effect on the life’s quality of patients by improving the physical comfort due to the reduction of clinical symptoms of uterine fibroids. However, changes in the quality of life after surgical intervention associated with disturbances in the psycho-emotional sphere were recorded in 49.4% of women, including those provoked by the manifestation of genitourinary syndrome in 19.3%. The proposed algorithm in the rehabilitation program made it possible to reduces the severity of genitourinary symptoms.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.90-97
- Diagnosis of complex breast cysts using X-ray pneumocystography and
endoscopic mammocystoscopy
Authors: O.A. Aksonov
Pages: 98 - 103
Abstract: Background. Complex cysts of the breast (CCB), in contrast to simple and complicated cysts, are characterized by a high (up to 31.0%) oncological potential. Mammography and ultrasound (US) as the most common methods of radiological diagnosis do not allow to classify CCB on benign and malignant, and in the case of breast cancer (BC) are not detected the establishment of its molecular genetic subtype.
Objectives: to analyze and popularize own experience of using endoscopic mammocystoscopy (EMCS) and X-ray pneumocystography (RPCG) for the diagnosis of CCB and biopsy navigation.
Materials and methods. The clinical and anamnestic data, the results of radiological, endoscopic and pathomorphological studies in 286 adult women with simple, complicated breast cysts and CCB were analyzed (n = 45, 134 and 142, respectively).
Results. The diagnostic and navigation capabilities of US are limited by frequent (18.1%) false-negative results, which are caused by atypical echosemiotics of CCB. Trepan-biopsy under US control becomes impossible when visualization of the CCB disappears, which often occurs during fine-needle aspiration of the liquid component. Technical difficulties arise when imitating a puncture needle with linear hyperechoic structures induced by Cooper’s ligaments, as well as when positioning the CCB in a bulky, non-fixed gland. In terms of diagnostic specificity and prognostic significance of a negative result, RPCG is slightly (5.6 and 4.7%, respectively) inferior to US and in certain clinical situations it can be used to assess the likelihood of BC, and in case of positive results for navigate a stereotaxic сore needle biopsy. EMCS is a low-traumatic procedure that provides direct visual contact with intracystic neoplasms, allows assessing the probability of BC and conducting a pinch biopsy.
Conclusions. The consistent combined use of well-known and author’s methods with the involvement of US, RPCG and EMCS according to the given algorithm ensures effective management of CCB at the modern level.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.98-103
- Prediction of severe post-castration syndrome in women after surgical
menopause
Authors: L.I. Butina, O.V. Olshevska, L.P. Shelestova, V.S. Olshevskyi
Pages: 104 - 108
Abstract: Objectives: prediction of severe post-castration syndrome (PCS) in women after surgical menopause.
Materials and methods. The study included 67 surgically menopausal women aged 45–55 years who underwent surgical hysterectomy with or without appendages (the main group) and 30 naturally menopausal women (the comparison group). The method of constructing and analyzing multifactorial mathematical models was used to identify risk factors associated with the development of severe PCS in women after surgical menopause and assess its impact on the severity of PCS. 12 clinical and morphological factors were considered in the analysis. The severity of the PCS in women after surgical menopause was evaluated one month after surgery and symptoms of climacteric syndrome in women with natural menopause were assessed according to the modified Kupperman index.
Results. Surgical menopause significantly increases the risk of severe PCS in comparison with natural menopause, when climacteric syndrome develops (p < 0.001). The risk of severe PCS increases with the removal of the uterine appendages, inflammatory changes in the uterine appendages, the ovarian cyst (p < 0.001), and uterine fibroids (p = 0.04). Three factor signs remain after selecting a set of independent signs in a multifactorial model for predicting the risk of severe PCS: removal of the uterine appendages (p < 0.001), inflammatory changes in the uterine appendages (p = 0.006), ovarian cyst (p = 0.082). Based on these factor signs, we can accurately predict the risk of severe PCS (AUC = 0.951, 95% CI 0.89–0.98).
Conclusions. Women with surgical menopause after the uterine appendages removal, with inflammatory changes in the uterine appendages, and ovarian cysts are at risk for the development of severe PCS and therefore it is advisable for them to include in the complex treatment of PCS medicines which reduce inflammatory changes in the uterine appendages and restore immunological reactivity.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.104-108
- Protection of reproductive health: international and national experience
Authors: I.M. Zharovska, M.M. Blikhar, R.M. Matkivska, L.A. Cherkasova
Pages: 109 - 117
Abstract: Objectives: consideration at the scientific level of the problem of the nation’s reproductive health protection in the context of international regulation and individual national experience.
Materials and methods. The statistical method and the author’s survey method were used for the collection and effective processing of public information. 200 women and 100 men aged 21 to 45 were selected as respondents. It was used a direct interview with respondents. The survey was conducted in Kyiv, Lviv, and Volyn regions in 2020–2022. International monitoring reports, global and national statistics, doctrinal developments of scientists of foreign countries (among them Great Britain, China, USA) were also used.
Results. The main causes of impaired human reproductive health are: environmental, socio-economic (unresolved issues of abortion and proper contraception, violence against women and children) and medical problems. In Ukraine, neither specialized legislative acts nor bylaws contain a comprehensive strategy for the protection of reproductive health, which causes gaps in the legal regulation and social security of this area. Gender discrimination is a widespread phenomenon in our country. We must state the discriminatory situations and oppression of both sexes in the reproductive sphere. There are no systematic mechanisms for the prevention of this problem, and the attention of state legal, scientific and public institutions to this problem is insufficient.
Conclusions. Legal policy in the field of reproductive health needs a complementary approach and renewal of strategic understanding at the level of the state legal policy. Only comprehensive consideration of reproductive health problems in Ukraine can ensure their solution. Reproductive counseling should be proactive and encouraged because its implementation is beneficial for the patient’s mental health, quality of life, and adherence to treatment. Providing reproductive health education improves knowledge, attitudes and practices in the field of human reproduction.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.109-117
- Diagnostic value of alpha-fetoprotein in the implementation of non-immune
fetal hydrops due to parvovirus b19 infection during pregnancy
Authors: I.B. Ventskivska, N.P. Bondarenko, Y.M. Vitovskyi, T.V. Tsapenko
Pages: 118 - 120
Abstract: Background. Intrauterine infection remains the main problem of perinatology. Early diagnosis of such infection causes enough difficulties and requires improvement. This study is devoted to the problem of predicting non-immune fetal hydrops if a woman is infected with parvovirus B19 in the II trimester of pregnancy.
Objectives: to improve the diagnosis of non-immune fetal hydrops on the basis of changes in the α-fetoprotein (AFP) value in maternal blood during parvovirus B19 infection .
Materials and methods. Serial AFP determination in blood serum of pregnant women infected with parvovirus B19 (n = 16) at 18–20–22 weeks of pregnancy was carried out. Biochemical analysis of AFP in amniotic fluid was performed after prenatal invasive examination in fetuses with non-immune hydrops. The obtained data were compared with similar indicators of pregnant women from the control group (n = 16) with a normal course of pregnancy in the II trimester. Transabdominal amniocentesis was performed under ultrasound control at 16–20 weeks of gestation for fetuses with non-immune hydrops. Determination of the AFP value in the blood serum of pregnant women in the II trimester was performed with a chemiluminescence immunoassay analyzer.
Results. It was established that the AFP level in maternal blood reaches and exceeds threshold values (2.6 ± 0.05 MoM) on average 2.5 ± 0.5 weeks before the manifestation of severe fetal anemia in infected fetus with non-immune hydrops (r = 0.768, p < 0.001). That is, a sharp AFP increase in the blood of a pregnant woman infected with parvovirus B19 is a predictor of the development of non-immune fetal hydrops due to parvovirus B19 infection.
Conclusions. The described method has proven to be highly effective, it is allows reducing the frequency of ultrasound examinations for infected women, because the fetus is not always infected from an infected mother. This technique can be used as a predictor of intrauterine parvovirus B19 infection in the II trimester, which will allow the development of new approaches to the early diagnosis of non-immune fetal hydrops, as well as contribute to timely intrauterine hemotransfusion.
PubDate: 2022-08-10
DOI: 10.18370/2309-4117.2022.66.118-120
