Rolul oxidului nitric în maturaţia cervixului uman

Articolul prezintă o sinteză a datelor recente din literatura mondială, care analizează cercetări şi studii consacrate rolului Oxidului Nitric în procesul de maturaţie a colului uterin

Conceptul chirurgiei minim invazive - punct de vedere holistic

Lucrarea prezentă familiarizează opinia medicală cu priorităţile intervenţiilor laparoscopice în chirurgia ginecologică vis-à -vis de intervenţiile radicale. Chirurgia minim-invazivă, a cărei parte extrem de importantă, dar nu exclusivă, este chirugia laparoscopică, defineşte o atitudine generală, potrivit căreia chirurgul trebuie să-şi atingă scopul terapeutic folosind cât mai puţine mijloace, gesturi, respectând la maxim integritatea ţesuturilor şi organelor, utilizând cât mai puţin material de sutură şi supunând pacientul unei intervenţii chirurgicale de o durată şi o agresivitate cât mai mică. Ofensiva triumfală a laparascopiei ginecologice, începută de Kurt Sem la sfârşitul anilor ’50, care a luat un avânt ieşit din comun începând cu sfârşitul anilor ’80, nu a făcut decât să completeze şi să întărească această nouă atitudine care s-a încetăţenit, mai ales, în practica noii generaţii de chirurgi ginecologi

Дисфункция эндометрия у пациентов с первичным бесплодием

Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Catedra de obstetrică, ginecologie și reproducere umanăIntroduction. Endometrial dysfunction represent the morpho-functional changes of the endometrium, which can be reversible or irreversible, grounded by molecular mechanisms disruptions, which subsequently lead to infertility, embryo implantation deficiency, placental insufficiency, or even embryo death. The aim of the study. Evaluation of clinical and morphological particularities of endometrial dysfunction in primary infertility patients. Material and methods. A prospective study was conducted, which included 96 patients divided into two groups. The study group (L1) included 48 primary infertility patients and control group (L0) – 48 fertile patients. In both groups, we performed the endometrial biopsy in the proliferative phase with the Pipelle endometrial aspiration curette. The study was approved by the Research Ethics Commission of the State University of Medicine and Pharmacy „Nicolae Testemitanu”, Chisinau, Republic of Moldova (No. 79/62 of 26.04.2017). The patients signed an informed consent to participate in the research. The statistical analysis was performed using SPSS 20 and Microsoft Excel 2016. Results. The mean age of the patients in the study group was 29,0 ± 4,58 and in the control group 29,2 ± 4,29 (p=0,801). În the study group the duration of infertility was mostly: 2 years – 20,8%, 3 years – 22,9% and more than 5 years – 27,1%. The most representative bacteria in the endometrium of the patients with primary infertility was Lactobacillus spp. 75%, c2 = 0,236; p = 0,627; followed by Ureaplasma urealiticum + parvum in 37,5%, c2 = 13,714; p 0,001; Atopobium vaginae – 25%, c2 = 1,640; p = 0,20; Enterobacteriaceae 18,8%, c2 = 9,931; p = 0,002 wich lead to inflammatory changes in the endometrium of primary infertility patients in 79,2%, c2 = 22,238; p <0,001. Conclusion. In our study we have demonstrated that the patients with primary infertility, more often compared with fertile patients suffer from gynecological pathologies, sexually transmitted diseases and also their endometrium is populated by a number of bacteria whose composition and quantity differ in fertile patients and in those that suffer from infertility.Введение. Дисфункция эндометрия – это морфофункциональные изменения эндометрия, которые могут быть обратимыми или необратимыми, основанными на нарушениях молекулярных механизмов, которые впоследствии приводят к бесплодию, нарушению имплантации эмбриона, плацентарной недостаточности, гибели эмбриона. Цель исследования. Оценка клинико-морфологических особенностей дисфункции эндометрия у пациенток с первичным бесплодием. Материал и методы. Было проведено проспективное когортное исследование с участием 96 пациенток, разделенных на 2 группы. В основную группу (L1) вошли 48 пациенток с установленным диагнозом первичного бесплодия, а в контрольную группу (L0) – 48 фертильных пациенток. В обеих группах мы провели биопсию эндометрия в пролиферативной фазе с помощью аспирационной кюретки эндометрия Pipelle. Протокол этого исследования был одобрен Комитетом по этике исследований Государственного университета медицины и фармации им. Николая Тестемицану, Кишинев, Республика Молдова (№ 79/62 от 26.04.2017). Пациенты подписали информированное согласие на участие в исследовании. Статистические данные были обработаны в SPSS 20 и Microsoft Excel 2016. Результаты. Средний возраст пациенток в основной группе составил 29,0 ± 4,58, а в контрольной группе 29,2 ± 4,29 (р = 0,801). В основной группе продолжительность бесплодия была в основном: 2 года – 20,8%, 3 года – 22,9% и более 5 лет – 27,1%. Наиболее представительными бактериями в эндометрии пациенток с первичным бесплодием был Lactobacillus spp. 75%, c2 = 0,236; р = 0,627; с последующим Ureaplasma urealiticum + parvum в 37,5%, c2 = 13,714; р<0,001; Atopobium vaginae – 25%, c2 = 1640; р = 0,20; Enterobacteriaceae 18,8%, c2 = 9,931; p = 0,002, что привело к воспалительным изменениям эндометрия у пациенток с первичным бесплодием в 79,2%, c2 = 22,238; р<0,001. Заключение. В нашем исследовании мы продемонстрировали, что пациенты с первичным бесплодием, чаще по сравнению с фертильными пациентами, страдают гинекологическими патологиями, инфекциями, передающимися половым путем, а также их эндометрий населяется рядом бактерий, состав и количество которых различаются у фертильных пациентов и у тех, которые страдают бесплодием

Коррекция проявлений предменструального синдрома комбинированными контрацептивами, содержащими Дроспиренон

Universitatea de Stat de Medicină şi Farmacie „N.Testemiţanu”, Catedra de Obstetrică şi GinecologieTopicality. PMS is characterized by the cyclic appearance of distressing somatic and behavioural symptoms. Modern pathgenic hypothesis suggests that the essence of the PMS is an inadequate response of CNS, specially, the hypothalamus to the normal fluctuations of steroid hormones during the ovulatory menstrual cycle. COCs containing drospirenone are used in patients with PMS to suppress ovulation, which is expected to facilitate the clinical symptoms. Materials and methods. This study included 69 women of reproductive age with PMS. In order to treat patients was appointed COCs containing drospirenone (Midiana), for 3 cycles, followed by a comparative assessment of premenstrual symptoms and the effectiveness of the assigned drug. Results. The study results showed that COCs containing drospirenone have positive influence for the course of PMS, reduces number of symptoms and their intensity. Assessment of the dynamics ofpremenstrual symptoms by MDQ showed statistically significant improvement of women s well-being after taking COC Midiana by the end of the third cycle, especially the marked improvement of pain scale 8,97 ± 0,9 and 3,94 ±0,86 (p <0,001) before and after treatment, respectively, on water retention scale - 6,24 ± 1,2 and 1,66 ±0,81 (p <0,001) before and after treatment, respectively. COCs containing drospirenone is well tolerated and causes minimal side effects. In general, the frequency and intensity of premenstrual symptoms decreased in 82.1% of patients and 79.7% of patients rated it as an effective treatment. Conclusion. The present study confirmed that COC, containing drospirenone (Midiana) is not only a contraceptive drug, but it is also an effective remedy for the prevention and treatment of premenstrual syndrome, and is considered to be the contraception of choice for women suffering from PMS.Актуальность. ПМС характеризуется циклически повторяюгцейся симптоматикой соматических и психоэмоциональных нарушений. Современная гипотеза этиопатогенеза предполагает что, суть ПМС является неадекватная реакция ЦНС, и прежде всего, гипоталамуса на нормальные колебания уровня стероидных гормонов в течение овуляторного менструального цикла. КОК, содержащий дроспиренон применяется у больных с ПМС с цепью подавления овуляции, в результате чего ожидается облегчение клинической симптоматики. Материал и методы. В данное исследование были включены 69 женщин репродуктивного возраста с ПМС. С цепью лечения пациенткам был назначен КОК, содержащий дроспиренон - Мидиана, в течение 3-х циклов, поспе чего проводилась сравнитепъная оценка предменструальных симптомов и эффективность назначенного препарата. Результаты. Было установлено, что КОК, содержащий дроспиренон положительно влияет на течение ПМС, уменьшая количество симптомов и снижая их интенсивность. Оценка динамики предменструальных симптомов по опроснику MDO выявило статистически значимое улучшение самочуствия женщин на фоне приема Мидианы к ко игру 3-го цикла, особенно отмечено улучшение по шкале болевых ощущений 8,97±0,9 и 3,94±0,86 (р<0,001) до и после лечения, соответственно, по шкале задержка жидкости - б,24±1,2 и 1,66±0,81 (р<0,001) до и после лечения, соответственно. КОК, содержащий дроспиренон хорошо переносится и вызывает минимальные побочные эффекты. В целом, частота и интенсивность предменструальных симптомов уменьшилась у 82,1% пациентов и 79,7% пациентов оценили лечение как эффективное. Выводы. Таким образом, КОК Мидиана (3DRSP/30EE) не только средство для контрацепции, но и эффективный препарат для профилактики и лечения предменструального синдрома, и представляет сооой контрацептив выбора для женщин, страдающих ПМС

Eficacitatea drillingului ovarian laparoscopic în tratamentul infertilităţii, cauzat de sindromul ovarelor polichistice

Elucidarea factorilor care ar putea influenţa prognosticul apariţiei sarcinii la pacientele cu sindromul ovarelor polichistice (SOP) supuse tratamentului drillingului ovarian laparoscopic (DOL) a constituit scopul lucrării prezente. Au fost analizate 138 de cazuri clinice. Pacientele au fost selectate în conformitate cu criteriile Rotterdam pentru SOP în baza secţiei Ginecologie aseptică nr.1 în cadrul Spitalului Municipal nr.1 din mun. Chişinău. Probabilitatea unui răspuns pozitiv este semnificativ mai mare la pacientele cu vârsta sub 35 de ani, (p=0,79, χ²=11,738). Prezenţa obezităţii (IMC>30) reduce semnificativ probabilitatea ovulaţiei (18,0%,

The levels of some hormones in polycystic ovarian syndrome

Introduction. The diagnosis of polycystic ovary syndrome (PCOS) involves not only clinical signs that are characteristic for this pathology but also lots of hormonal tests used in order to identify ovarian pathogenesis. Evaluation can be done by testing follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), prolactin (P), thyroid-stimulating hormone (TSH), 17- hydroxyprogesteron and inhibin B level and in last 5 years – anti-Mullerian hormone (AMH) level. At the moment AMH is proposed as a hormonal test which appreciates female endocrine infertility and is considered a gold standard of diagnosis of PCOS. The blood level of AMH is not affected by menstrual cycle or by oral contraceptives use (OC), making it a useful criterion for diagnosing PCOS. The diagnosis of PCOS involves not only clinical signs that are characteristic for this pathology but also lots of hormonal tests used in order to identify ovarian pathogenesis including testing for FSH, LH, T, P, TSH, 17- hydroxyprogesteron and inhibin B level and in the last 5 years, AMH level. In recent years, AMH has emerged as a gold standard hormonal test for diagnosing PCOS and evaluating female endocrine infertility. The hormonal levels of AMH in the blood samples are very informative in women with PCOS and who are undergoing laparoscopic ovarian drilling (LOD) and also for those who are undergoing (in vitro fertilization (IVF). The blood level of AMH is not affected by the menstrual cycle and is not changing during OC administration, which is a criterion of PCOS diagnosis. The aim of study. To appreciate the correlation between AMH and USG criteria and other hormones implicated in SOP pathogenesis. Material and methods. All 138 patients included in the study met the Rotterdam criteria of SOP diagnose and were treated with LOD, being examined the hormonal levels of FSH, LH, T, estradiol (E2), P, dehydroepiandrosterone sulphate (DHEAS) on the third day of menstrual cycle, not only to confirm the diagnosis of PCOS, but also to appreciate its severity. After LOD all the patients were again hormonally tested in order to establish the impact of surgical treatment on hormonal status, and to assess any, correlation between different hormones. Results. The analysis of the obtained data showed that there is a strong correlation between AMH and the hormones that are defining PCOS. Our research established that AMH correlates statistically with the level of LH, so if the AMH levels are higher the LH levels will be less than 10 UI/L (r=0.6922), which allows us to predict patients that wouldn’t answer to LOD. The research demonstrated that AMH value has an important pre-operative value in PCOS patients, representing a crucial criterion in selecting the best method of endoscopic treatment (LOD or laparoscopic ovarian wedge resection). Furthermore, its value plays an important role in the outcome of the surgical treatment. The study confirms a strong direct correlation between AMH/LH and between AMH and severe biochemical hyperandrogenism (p<0.001). Additionally, a strong indirect correlation was observed between AMH and FSH ((p<0.001). Conclusions. The study established a strong direct correlation between AMH and LH, T, as well as a strong indirect correlation between AMH and FSH, which allows us to appreciate the phenotype of PCOS patients and to select the method of surgical treatment

Suggestions in the early diagnosis of preeclampsy

Summary. Preeclampsia remains a major issue discussed in contemporary obstetrics, and is considered to be responsible for approximately 14% of estimated maternal deaths per year. The diagnosis is based on the monitoring of maternal blood pressure, the presence of proteinuria and one or more characteristics: dysfunctions of the maternal organs, including hepatic, renal, neurological, hematological and/or utero-placental dysfunction, these signs are nonspecific and are generally present when preeclampsia is clinically manifest. In order to reduce the severe complications caused by preeclampsia, a number of biochemical markers for predicting preeclampsia are described in the international literature. Determining the serum level of angiogenic placental factors, in particular ET-1 (endothelin 1) and the PlGF (placental growth factor) / sFlT-1 (soluble FMS-like tyrosine kinase-1) ratio, is very important in predicting preeclampsia as early as possible, in order to avoid multiple complications for both the mother and the newborn.Rezumat. Preeclampsia, o problemă majoră discutată în obstetrica contemporană, este considerată a fi responsabilă pentru aproximativ 14 % dintre decesele materne estimate pe an. Diagnosticul se bazează pe monitorizarea tensiunii arteriale materne, prezența proteinuriei și a uneia sau mai multor caracteristici: disfuncții ale organelor materne, incluzând implicarea hepatică, renală, neurologică, hematologică și/sau disfuncție utero-placentară. Aceste semne sunt însă nespecifice, prezente, în general, atunci când preeclampsia se manifestă clinic. Cu scop de a reduce complicațiile severe cauzate de preeclampsie, în literatura internațională se descrie un șir de markeri biochimici pentru predicția acesteia. Determinarea nivelului seric al factorilor placentari angiogeni, în special a ET-1 (endotelina 1) și a raportului PlGF (factorul de creștere placentar)/sFlT-1 (tirozin kinază-1 solubilă) este deosebit de oportun în diagnosticarea cât mai precoce a preeclampsiei și evitarea multiplelor complicații atât pentru mamă, cât și pentru nou-născut

Conferinţa Zilele Medicale „Vasile Dobrovici”

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra obstetrica-ginecologie şi reproducere uman

Rezultatele implementării tehnologiilor moderne în Centrul perinatologic municipal din or. Chişinău

În studiul dat sunt prezentate rezulatele implementării tehnologiilor moderne în asistenţa spitalicească obstetricală. Rezultatele obţinute în asistenţa perinatală demonstrează că activitatea medicală poate servi ca model pentru activitatea centrelor perinatale din ţară