Программированные роды у женщин с оперированной маткой

The paper deals with the problems of programmed delivery in women with a uterine scar. The study included 144 pregnant women with a uterus operated who started to give birth vaginally (per vias naturales). The conditions for induction, analyze the clinical efficacy of different methods of induction were assessed. 134 women given birth successfully, programmed delivery were conducted in 84 patients. There were 3 ruptures of the uterus.Статья посвящена проблемам программированных родов у женщин с «рубцом на матке». В исследовании участвовали 144 беременных с оперированной маткой, начавших рожать per vias naturales. Проведена оценка условий для родовозбуждения, проанализирована клиническая эффективность различных методов индукции родов. Успешно проведены влагалищные роды у 134 пациенток, у 84 — программированные роды. В группе программированных родов произошел один разрыв матки

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Засл. деятель науки РФ, член-корр. РАН, проф. В.Е. Радзинский о научном прогрессе и современных реалия

Safety and effectiveness of lanolin-based cream to prevent cracked nipples in the early postpartum period

Introduction. According to WHO, 98% of women in the world are capable of full lactation, however, only 35% of infants in the world get exclusive breastfeeding for the first 6 months after birth. Wounds and ulcers of nipples are common causes that lead to 95% of women refusing to breastfeed. Aim of the study. To evaluate the efficacy and safety of the lanolin-based cream to prevent cracked nipples in women in the first 30 days after delivery. Materials and methods. The population consisted of 128 patients in the early postpartum period, randomized into 2 groups depending on the features of breastfeeding and the method of prevention of cracked nipples: Group I – 99 patients who received lanolin-based cream with individual consultation on breastfeeding; Group II – 29 patients who did not receive the cream. Examined substance – nipple cream, composition: 100% lanolin; pharmacotherapeutic group: antiseptic. The cream has kerato-lytic, antiseptic, wound healing effect. Method of application and dosage: externally, after each feeding (or as needed), the cream was applied to the nipple and areola, the cream does not require removal before applying to the child’s chest. Results of the study and discussion. Evaluation of efficacy and safety was carried out on the basis of clinical data, complaints, objective data and the results of cytological studies in a comparative aspect-before the cream was applied and one month after its application. Conclusions. Correction of breastfeeding disorders in combination with a cream based on 100% lanolin has reduced the frequency of clinical manifestations to zero, and most importantly, to preserve exclusive breastfeeding for patients under observation. The studied cream is harmless for the child and effective in preventing cracked nipples. © 2020, Remedium Group Ltd. All rights reserved

Молекулярно-генетические детерминанты бесплодия при генитальном эндометриозе

Background: Genital endometriosis is an urgent problem of modern medicine. It is one of the hard-to-explain diseases and is the cause of reproductive health disorders, a decline in the quality of life and social disadaptation of women of any age. The aim of the study: To evaluate the relationship of genetic markers to the development of infertility in genital endometriosis. Materials and methods: The sample for the study included 428 patients with genital endometriosis: 132 patients with genital endometriosis accompanied by infertility (30.84%) and 296 patients with the onset of pregnancy (69.16%). Genotyping of 32 polymorphic loci of genes-candidates of hyperplastic diseases of the uterus was carried out. An analysis of the role of the polymorphic loci and their combinations in the formation of infertility in genital endometriosis was carried out using the APSampler software. Results: It was found that the risk factors for infertility in genital endometriosis are combinations of genetic variants T rs243865 MMP-2, 6A rs3025058 MMP-3, T rs11568819 MMP-7 and G rs17577 MMP-9 (OR = 2.08, pperm = 0.009), 2G rs1799750 MMP-1, 6A rs3025058 MMP-3 and G rs17577 MMP-9 (OR = 2.03, pperm = 0.013), T rs4073 IL-8, AA rs2107538 RANTES and A rs4512021 I-TAC (OR = 2.23, pperm = 0.009), T rs4073 IL-8, GA rs1801157 SDF1 and AA rs2107538 RANTES (OR = 2.80, pperm = 0.007), and the protective factors of risk of infertility in genital endometriosis combination of molecular genetic factors G rs1042838 PGR, C rs484389 PGR, T rs3798577 ESR1 and C rs2234693 ESR1 (OR = 0.44, pperm = 0.008), T rs699517 TYMS and AA rs1801394 MTRR (OR = 0.30, pperm = 0.022), A rs4073 IL-8 and G rs2107538 RANTES (OR = 0.33, pperm = 0.008). Conclusion: Polymorphism of candidate genes is associated with the development of infertility in genital endometriosis.Актуальность: Генитальный эндометриоз является актуальной проблемой современной медицины. Он входит в число труднообъяснимых заболеваний и является причиной нарушений репродуктивного здоровья, снижения качества жизни и социальной дезадаптации женщин любого возраста. Цель исследования: Оценка связей генетических маркеров с развитием бесплодия при генитальном эндометриозе. Материалы и методы: Выборка для исследования составила 428 пациенток с генитальным эндометриозом: 132 больных с генитальным эндометриозом сопровождающимся бесплодием (30.84%) и 296 больных с наступившей беременностью (69.16%). Проведено генотипирование 32 полиморфных локусов генов-кандидатов гиперпластических заболеваний матки. Анализ роли исследуемых полиморфных локусов и их комбинаций в формировании бесплодия при генитальном эндометриозе проведен с помощью программного обеспечения APSampler. Результаты: Установлено, что факторами риска формирования бесплодия при генитальном эндометриозе являются комбинации генетических вариантов Т rs243865 ММР-2, 6А rs3025058 ММР-3,Т rs 11568819 ММР-7 и G rs17577 ММР-9(OR= 2.08, ppem=0.009), 2G rs1799750 ММР-1, 6А rs3025058 ММР-3 и G rs17577 ММР-9 №= 2.03, pperm=0.013), Т rs4073 IL-8, АА rs2107538 RMIES и А rs4512021 I-ТАС (OR=2.23, pperm=0.009), Т rs4073 IL-8, GА rs1801157 SDF1 и АА rs2107538 RANTES (OR=2.80, pperm=0.007), а протективными факторами риска развития бесплодия при генитальном эндометриозе сочетания молекулярно-генетических факторов G rs1042838 РGR, С rs484389 РGR, Т rs3798577 ESR1 и С rs2234693 ESR1 (OR=0.44, pperm=0.008), Т rs699517 ТYМS и АА rs1801394 МТRR (OR=0.30, pperm=0.022), А rs4073 IL-8 и G rs2107538 RANTES (OR=0.33, pperm=0.008). Заключение: Полиморфизм генов-кандидатов ассоциирован с развитием бесплодия при генитальном эндометриозе

Occult form of premature ovarian insufficiency

Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Despite the description of different genetic, immune and iatrogenic factors of POI, the etiology of most cases of this disease are unexplained, and optimal management strategies are still unclear. Recent data showed that POI may have a long period of oligomenorrhea before the fully developed form (complete ovarian failure stage), with the occurrence of amenorrhea and climacteric symptoms. The main problem in the recognition of early stages of POI is the lack of proper diagnostic criteria. Patients with an undiagnosed occult form of POI may present with menstrual irregularities, unexplained infertility or repeated IVF failures. We evaluated 23 patients with unexplained oligomenorrhea and/or infertility. After a proper evaluation of these patients, a low ovarian reserve was identified, and an occult form of POI was diagnosed. © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Комбинация пробиотика и метабиотика в комплексной терапии дисбиозов

Normal microbial flora includes all microorganisms that can survive, co-exist and develop in a particular physical medium, and do not cause diseases. Complexity and liveliness of species and quantitative composition of microcenosis provide flexible adaptation of microorganisms to environmental changes. Moreover, vaginal colonization resistance maintain stability of normal microcenosis, prevent vaginal colonization by truly pathogenic microorganisms and overgrowth of opportunistic pathogenic microflora. The aim of this study was to assess recovery rate of the normal vaginal flora (Lactobacillus titer) using probiotic Provag in capsules for ingestion and metabiotic Provag Gel for external application for restoration of normobiocenosis (as stage II) after treatment of nonspecific vulvovaginitis (NVV). Combination therapy with probiotic and metabiotic, which may regulate microbial interactions in "bowel-vagina" ecological niche after stage II of treatment increased the Lactobacillus spp. concentration to 5,5x107 He/ml in all 40 patients (relative Lg (N/TBM) was 80-100%). Only 10% had less than -2 Lg (7 ГЭ/мл концентрации Lactobacillus spp. у всех 40 пациенток (относительный Lg (N/ОБМ) составил 80-100%). Только у 10% выявлена доля факультативно-анаэробных микроорганизмов менее -2 Lg (<1%) и у 30% - доля облигатно-анаэробных микроорганизмов менее -2 Lg (<1%). Суммарная частота выделений факультативно-облигатно-анаэробных микроорганизмов от -2 Lg до -1 Lg (1-10%) была минимальной. Патогенные микроорганизмы не определены ни у одной пациентки. Включение пробиотика Проваг в капсулах для приема внутрь и метабиотика Проваг гель для наружного применения в комплекс мероприятий после терапии НВВ способствует увеличению популяции лактофлоры, уменьшению степени колонизации, вплоть до полной элиминации условно-патогенных бактерий, таких как стафилококки, грибы рода Candida, стрептококки, представители рода энтеробактерий, клебсиелл

Iron deficiency Anemia as a risk factor for placental insufficiency and perinatal complications

Objective. To evaluate the efficiency of anti-anemia therapy in the prevention of placental insufficiency (PI) in the second trimester of pregnancy. Subjects and methods. The results of prevention and treatment of perinatal complications were analyzed in 40 pregnant women with anemia. The pathogenetically substantiated package of measures at 17–24 weeks of gestation included drug correction of fetoplacental homeostastic disorders in conjunction with anti-anemia treatment. Results. During treatment, Sideral Forte caused a significant (p < 0.001) increase in the level of hemoglobin from 80.3±1.3 to 114.3±1.8 g/l and red blood cells from 3.2±0.4 1012/l to 4.1±0.3 1012/l. There was a significant rise in serum iron levels (from 12.5±1.5 to 17.4±1.3 μmol/l) and a substantial ferritin increment that is only possible at the least speed of hemoglobin increases. Thus, the assessment of iron depots by serum ferritin concentrations ascertained that the administration of Sideral Forte increased iron stores. The treatment-induced increment in serum ferritin levels tended to exceed from 32.3±1.2 to 34.5±1.5 μg/l. Conclusion. The high frequency of pregnancy complications makes the early diagnosis and prediction of iron deficiency anemia (IDA), its timely and efficient prevention and treatment extremely relevant. The use of Sideral Forte at a dose of one capsule (30 mg of iron) per day for the treatment of IDA in the complex correction of PI allows achievng not only normalization of iron levels and improvement of quality of life in pregnant women, but also a reducton in the incidence of obstetric and perinatal complications. © Bionika Media Ltd

Комбинация пробиотика и метабиотика в комплексной терапии дисбиозов

Normal microbial flora includes all microorganisms that can survive, co-exist and develop in a particular physical medium, and do not cause diseases. Complexity and liveliness of species and quantitative composition of microcenosis provide flexible adaptation of microorganisms to environmental changes. Moreover, vaginal colonization resistance maintain stability of normal microcenosis, prevent vaginal colonization by truly pathogenic microorganisms and overgrowth of opportunistic pathogenic microflora. The aim of this study was to assess recovery rate of the normal vaginal flora (Lactobacillus titer) using probiotic Provag in capsules for ingestion and metabiotic Provag Gel for external application for restoration of normobiocenosis (as stage II) after treatment of nonspecific vulvovaginitis (NVV). Combination therapy with probiotic and metabiotic, which may regulate microbial interactions in "bowel-vagina" ecological niche after stage II of treatment increased the Lactobacillus spp. concentration to 5,5x107 He/ml in all 40 patients (relative Lg (N/TBM) was 80-100%). Only 10% had less than -2 Lg (7 ГЭ/мл концентрации Lactobacillus spp. у всех 40 пациенток (относительный Lg (N/ОБМ) составил 80-100%). Только у 10% выявлена доля факультативно-анаэробных микроорганизмов менее -2 Lg (<1%) и у 30% - доля облигатно-анаэробных микроорганизмов менее -2 Lg (<1%). Суммарная частота выделений факультативно-облигатно-анаэробных микроорганизмов от -2 Lg до -1 Lg (1-10%) была минимальной. Патогенные микроорганизмы не определены ни у одной пациентки. Включение пробиотика Проваг в капсулах для приема внутрь и метабиотика Проваг гель для наружного применения в комплекс мероприятий после терапии НВВ способствует увеличению популяции лактофлоры, уменьшению степени колонизации, вплоть до полной элиминации условно-патогенных бактерий, таких как стафилококки, грибы рода Candida, стрептококки, представители рода энтеробактерий, клебсиелл

The effectiveness of therapy for endometriosis-associated pelvic pain resistant to surgical treatment [Эффективность терапии эндометриоз-ассоциированной тазовой боли, резистентной к хирургическому лечению]

Aim. To assess the efficacy and safety of 24-week therapy with dienogest in patients with endometriosis-associated pelvic pain resistant to surgical treatment. Materials and methods. The study included 126 patients aged 33–40 years with external genital endometriosis (EGE) confirmed by laparoscopy and morphological examination (International classification of diseases, 10th revision [ICD-10] – N80.1, 80.2, 80.3, 80.4) and with pelvic pain that occurred in 3–6 months after surgical treatment of EGE (ICD-10 – N94.8 "Pain and other conditions associated with female genital organs and menstrual cycle"). The participants were stratified into 3 groups by pain syndrome severity according to the Verbal Analog Scale (VAS). The group-1 included patients with 10–40 mm, the group-2 – with 41–70 mm, and the group-3 – with more than 71 mm pain score according to VAS. Patients of all 3 groups were prescribed the denogest (Zafrilla®, Gedeon Richter, 2 mg/day) for 24 weeks (according to the current pack insert). Follow-up and assessment of treatment outcomes were carried out over 6 months. Study design: prospective, observational, comparative study. Results. In 3 and 6 months after the start of therapy, there was a stable statistically significant decrease in pain syndrome severity by all scales (Biberoglu & Behrman Scale, Numeral Rating Scale, VAS) in each of the groups (p<0.01). In all 3 groups, treatment led to an improvement in sexual function, assessed with the Female Sexual Function Index scale, in 3 and 6 months after the start of therapy (p<0.01). According to the quality of life in endometriosis (Endometriosis Health Profile) questionnaire, the analyzed indicators significantly improved in all study participants (p<0.01). Conclusion. Dienogest is an effective and safe method for the treatment of endometriosis-associated pelvic pain resistant to surgical treatment. Treatment with dienogest for 24 weeks effectively relieves pain, improves symptoms, and improves quality of life and sexual functioning. © 2021 Federal Informational-Analytical Center of the Defense Industry. All rights reserved

Treatment of endometriosis-associated pain: An individualized approach

Objective: To conduct a systematic analysis of the data available in the modern literature on the efficacy, safety and pharmacodynamics of combined oral contraceptives (COCs), to evaluate the results of prospective clinical studies in the treatment of endometriosis-associated pain. Main points: Despite the fact that endometriosis continues to be one of the most common gynecological diseases, there are still considerable discussions in the scientific world regarding its diagnosis and treatment. Chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia and infertility are the key symptoms of the disease and seriously affect the quality of life. The combination of surgical and medical methods of treatment before and/or after surgery is one of the most common approaches to the management of endometriosis. Although COCs have been approved by a variety of clinical protocols and they are widely used to relieve pain in endometriosis, clinical studies confirming their effectiveness are few. Conclusion: According to the results of numerous studies, one of the most effective drugs for the treatment of endometriosis is a COC, Siluette. This oral contraceptive contains 30 mcg of ethinyl estradiol and 2 mg of dienogest and affects pathogenetic mechanisms of the disease. Due to dienogest, there is a high antiproliferative activity, activation of apoptosis, subsequent pseudodecidualization and suppression of neoangiogenesis which give the molecule non-contraceptive advantages. Therefore, the pain syndrome is significantly reduced, sexual function is restored and the quality of life is improved. © 2021, Bionika Media Ltd.. All rights reserved