In the case of progression of obstetric haemorrhage (OH) and non-effective preventive and therapeutic measures during childbirth and after delivery, the volume of blood loss can increase and exceed > 1.5% of body weight (25–30% of circulating blood volume – CBV). In such cases that we are talking about massive obstetric haemorrhage (MOH), which leads to an increase in the frequency of maternal morbidity and mortality.The objective: determine the effectiveness of various approaches to the restoration of blood loss in the cases of MOH development, which occurred to various etiological factors, with the introduction of the modern concept of damage control resuscitation (DCR) and innovative methods of surgical hemostasis.Materials and methods. During 2015–2023 years at five clinical bases of the Department of Obstetrics and Gynecology N1 of Shupyk National Healthcare University of Ukraine we analyzed 165 cases of MOH. In all MOH cases, an integrated approach was used to stop haemorrhage using both drug therapy and modern methods of surgical hemostasis in accordance with the regulatory documents of the Ukrainian Ministry of Healthcare.In main group of 59 women in labor with the MOH (2020–2023 years) an integrated approach to stop haemorrhage and restore the blood loss according to DCR concept with the priority of high-quality and rapid CBV restoration with blood products and minimization of infusion therapy was used. The comparison group consisted of 106 women in labor with MOH (2015–2019 years) and similar methods of haemorrhage termination to restore blood loss in accordance with the order N 205 of the Ukrainian Ministry of Healthcare «Obstetric haemorrhage» with the priority of rapid restoration of blood loss by crystalloids (during 2015–2019 years).Results. The mean blood loss, time till haemorrhage is stopped, and the duration of surgery in the main group were significantly lower than in the comparison group (p<0.05). In the postpartum period the number of cases with severe anemia was significantly more often in the comparison group – 47.2% versus 11.9% in the main group (OR 6.6 CI 2.7–15.9; p<0.01), as well as the frequency of hysterectomy – 50.9% versus 28.8% (OR 2.6 CI 1.3–5.1; p<0.01).An early onset and a significantly higher rate of transfusions of fresh frozen plasma and erythrocyte mass were found in the main group – respectively 88.1% versus 38.7% in the comparison group (OR 11.7, CI: 4.8–28.4; p<0.001). This resulted in a significantly lower volume of blood loss, duration of surgical intervention, and average time for haemorrhage stop in the main group compared to the comparison group (p<0.05).Conclusions. The use of modern uterotonic agents (carbetocin), tranexamic acid preparations, innovative surgical technologies and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion and according to the DCR concept for the development of MOH allows to reduce the volume of blood loss, the frequen
{"title":"A comprehensive approach to the prevention and treatment of massive obstetric hemorrhage","authors":"О.V. Golyanovskiy, D.О. Dzyuba, O.V. Tkachenko, A.O. Zhezher, A.O. Ogorodnik, I.А. Hubar, А.V. Коvalenko","doi":"10.30841/2708-8731.6.2023.289994","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289994","url":null,"abstract":"In the case of progression of obstetric haemorrhage (OH) and non-effective preventive and therapeutic measures during childbirth and after delivery, the volume of blood loss can increase and exceed > 1.5% of body weight (25–30% of circulating blood volume – CBV). In such cases that we are talking about massive obstetric haemorrhage (MOH), which leads to an increase in the frequency of maternal morbidity and mortality.The objective: determine the effectiveness of various approaches to the restoration of blood loss in the cases of MOH development, which occurred to various etiological factors, with the introduction of the modern concept of damage control resuscitation (DCR) and innovative methods of surgical hemostasis.Materials and methods. During 2015–2023 years at five clinical bases of the Department of Obstetrics and Gynecology N1 of Shupyk National Healthcare University of Ukraine we analyzed 165 cases of MOH. In all MOH cases, an integrated approach was used to stop haemorrhage using both drug therapy and modern methods of surgical hemostasis in accordance with the regulatory documents of the Ukrainian Ministry of Healthcare.In main group of 59 women in labor with the MOH (2020–2023 years) an integrated approach to stop haemorrhage and restore the blood loss according to DCR concept with the priority of high-quality and rapid CBV restoration with blood products and minimization of infusion therapy was used. The comparison group consisted of 106 women in labor with MOH (2015–2019 years) and similar methods of haemorrhage termination to restore blood loss in accordance with the order N 205 of the Ukrainian Ministry of Healthcare «Obstetric haemorrhage» with the priority of rapid restoration of blood loss by crystalloids (during 2015–2019 years).Results. The mean blood loss, time till haemorrhage is stopped, and the duration of surgery in the main group were significantly lower than in the comparison group (p<0.05). In the postpartum period the number of cases with severe anemia was significantly more often in the comparison group – 47.2% versus 11.9% in the main group (OR 6.6 CI 2.7–15.9; p<0.01), as well as the frequency of hysterectomy – 50.9% versus 28.8% (OR 2.6 CI 1.3–5.1; p<0.01).An early onset and a significantly higher rate of transfusions of fresh frozen plasma and erythrocyte mass were found in the main group – respectively 88.1% versus 38.7% in the comparison group (OR 11.7, CI: 4.8–28.4; p<0.001). This resulted in a significantly lower volume of blood loss, duration of surgical intervention, and average time for haemorrhage stop in the main group compared to the comparison group (p<0.05).Conclusions. The use of modern uterotonic agents (carbetocin), tranexamic acid preparations, innovative surgical technologies and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion and according to the DCR concept for the development of MOH allows to reduce the volume of blood loss, the frequen","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.30841/2708-8731.6.2023.289992
N.Ya. Zhylka, O.S. Shcherbinska
This article is a review of current scientific publications that are devoted to the problem of sexually transmitted infections (STIs) and the importance of probiotics in their treatment. The article also analyzes the data of regulatory documents of the World Health Organization and statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine and the State Statistics Service of Ukraine, which highlight the problem of the prevalence of STIs in the world and in Ukraine.Sexually transmitted infections have a serious negative impact on sexual and reproductive health worldwide. In the absence of treatment, they can have serious outcomes, including neurological and cardiovascular diseases, infertility, ectopic pregnancy, increased risk of infection with the human immunodeficiency virus. One of the serious factors which prevent the reduction of STDs increased rate in the world is the drug resistance for these infections. Infections caused by resistant strains of microorganisms are characterized by a more severe course, more often require hospitalization of the patient, increase the duration of the patient’s stay in the hospital, require the use of combined antibiotic therapy with the administration of reserve drugs.According to the results of scientific studies, Bacillus probiotics are an alternative for solving problems related to STIs and their outcomes. The innovative combination of the components of the drugs that contain the SirionProbioProtection probiotic formula helps to overcome such a problem as the resistance of STI pathogens to etiotropic antibiotic therapy. The use of alternative methods of exposure to STIs and their consequences add to success in providing obstetric and gynecological services.
{"title":"Modern probiotics in the treatment of sexually transmitted infections. From the problem to its solution","authors":"N.Ya. Zhylka, O.S. Shcherbinska","doi":"10.30841/2708-8731.6.2023.289992","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289992","url":null,"abstract":"This article is a review of current scientific publications that are devoted to the problem of sexually transmitted infections (STIs) and the importance of probiotics in their treatment. The article also analyzes the data of regulatory documents of the World Health Organization and statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine and the State Statistics Service of Ukraine, which highlight the problem of the prevalence of STIs in the world and in Ukraine.Sexually transmitted infections have a serious negative impact on sexual and reproductive health worldwide. In the absence of treatment, they can have serious outcomes, including neurological and cardiovascular diseases, infertility, ectopic pregnancy, increased risk of infection with the human immunodeficiency virus. One of the serious factors which prevent the reduction of STDs increased rate in the world is the drug resistance for these infections. Infections caused by resistant strains of microorganisms are characterized by a more severe course, more often require hospitalization of the patient, increase the duration of the patient’s stay in the hospital, require the use of combined antibiotic therapy with the administration of reserve drugs.According to the results of scientific studies, Bacillus probiotics are an alternative for solving problems related to STIs and their outcomes. The innovative combination of the components of the drugs that contain the SirionProbioProtection probiotic formula helps to overcome such a problem as the resistance of STI pathogens to etiotropic antibiotic therapy. The use of alternative methods of exposure to STIs and their consequences add to success in providing obstetric and gynecological services.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic pelvic pain (CPP) for a long time remains one of the important medical and social problems due to the variability of clinical manifestations, negative impact on reproductive health and quality of patient’s life. Epidemiological studies indicate that CPP occurs in 15-20% of women of reproductive age. According to many authors, diagnosis and treatment of CPP is not an easy task due to unclear diagnostic criteria, variety of symptoms, insufficient diagnostic tools, etc.The objective: to analyze the diagnostic and therapeutic measures of women with pelvic pain syndrome in routine clinical practice.Materials and methods. A retrospective study of the medical patient’s cards of 557 women of reproductive age (19–49 years old) who were consulted by a gynecologist for CPP was conducted.Results. A significant prevalence of pelvic pain syndrome in patients under 30 years of age (51.2%) was revealed. In 290 women with complaints only for CPP, in 15.9% of cases, in the absence of gynecological pathology, were diagnosed the following pathologies: interstitial cystitis (19.6%), diverticulitis and dolichosigma (17.4%), irritable bowel syndrome (23.9%), myofascial pain (15.2%), pathology of the lumbosacral spine (10.9%). In the same group of women the following gynecological pathologies were found: malformations of the genitourinary system (3.3%), anomalies of the development of the uterus (9.3%), endometriosis (24.2%), adenomyosis (8.8%), leiomyoma of the uterus (8.4%), combined proliferative benign diseases of the genitals (14.9%), pelvic inflammatory diseases (7.9%), pelvic adhesive process (9.8%), pelvic floor dysfunction (13.5%). The diagnosis of CPP was established in 10.0% of women in the absence of gynecological and non-gynecological pathology.Conclusions. Identifying the CPP reasons in women is a difficult diagnostic process, as it can be caused by the presence of endometriosis, combined proliferative benign diseases of the genital organs, anomalies of genitourinary system, adenomyosis, pelvic inflammatory diseases, pelvic adhesions, pelvic floor dysfunction, venocongestion. CPP in women is often a result of non-gynecological pathology or a combination of such with gynecological diseases, which determines the need for an interdisciplinary approach to both diagnosis and treatment of such patients. In routine clinical practice, not enough attention is paid to determine the intensity and characteristics of the pain syndrome, which is often combined with late referral of patients for examination. In more than half of the analyzed cases (51.5%), the reason for women’s referral for examination is not pelvic pain syndrome as such, but a pathology that could be related to or a consequence of diseases causing CPP (abnormal uterine bleeding, infertility, etc.).
{"title":"Analysis of diagnostic and treatment measures for chronic pelvic pain in women in routine clinical practice","authors":"S.O. Shurpyak, I.V. Kozlovskyi, V.I. Pyrohova, I.I. Okhabska","doi":"10.30841/2708-8731.6.2023.289993","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289993","url":null,"abstract":"Chronic pelvic pain (CPP) for a long time remains one of the important medical and social problems due to the variability of clinical manifestations, negative impact on reproductive health and quality of patient’s life. Epidemiological studies indicate that CPP occurs in 15-20% of women of reproductive age. According to many authors, diagnosis and treatment of CPP is not an easy task due to unclear diagnostic criteria, variety of symptoms, insufficient diagnostic tools, etc.The objective: to analyze the diagnostic and therapeutic measures of women with pelvic pain syndrome in routine clinical practice.Materials and methods. A retrospective study of the medical patient’s cards of 557 women of reproductive age (19–49 years old) who were consulted by a gynecologist for CPP was conducted.Results. A significant prevalence of pelvic pain syndrome in patients under 30 years of age (51.2%) was revealed. In 290 women with complaints only for CPP, in 15.9% of cases, in the absence of gynecological pathology, were diagnosed the following pathologies: interstitial cystitis (19.6%), diverticulitis and dolichosigma (17.4%), irritable bowel syndrome (23.9%), myofascial pain (15.2%), pathology of the lumbosacral spine (10.9%). In the same group of women the following gynecological pathologies were found: malformations of the genitourinary system (3.3%), anomalies of the development of the uterus (9.3%), endometriosis (24.2%), adenomyosis (8.8%), leiomyoma of the uterus (8.4%), combined proliferative benign diseases of the genitals (14.9%), pelvic inflammatory diseases (7.9%), pelvic adhesive process (9.8%), pelvic floor dysfunction (13.5%). The diagnosis of CPP was established in 10.0% of women in the absence of gynecological and non-gynecological pathology.Conclusions. Identifying the CPP reasons in women is a difficult diagnostic process, as it can be caused by the presence of endometriosis, combined proliferative benign diseases of the genital organs, anomalies of genitourinary system, adenomyosis, pelvic inflammatory diseases, pelvic adhesions, pelvic floor dysfunction, venocongestion. CPP in women is often a result of non-gynecological pathology or a combination of such with gynecological diseases, which determines the need for an interdisciplinary approach to both diagnosis and treatment of such patients. In routine clinical practice, not enough attention is paid to determine the intensity and characteristics of the pain syndrome, which is often combined with late referral of patients for examination. In more than half of the analyzed cases (51.5%), the reason for women’s referral for examination is not pelvic pain syndrome as such, but a pathology that could be related to or a consequence of diseases causing CPP (abnormal uterine bleeding, infertility, etc.).","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.30841/2708-8731.6.2023.289996
D.G. Konkov, S.I. Zhuk, V.V. Rud, V.V. Buran
The objective: to evaluate the clinical effectiveness of L-arginine in the prevention of preeclampsia and reduction of other perinatal risks in patients with preclinical gestational endotheliopathy (GE).Materials and methods. A comparative clinical study was performed at the clinical base of the Department of Obstetrics and Gynecology N. 1 of the Vinnytsya National Pirogov Memorial Medical University. 116 pregnant women with preclinical GE (main group), which was diagnosed by laboratory and instrumental research (microalbuminuria and endothelium-dependent vasodilatation), took part in the study. The patients of the main group were divided into clinical subgroups: 31 pregnant women with GE in subgroup A received acetylsalicylic acid (ASA) at a dose of 75 mg per or per day; 33 patients with preclinical GE from subgroup B received L-arginine at a dose of 4-4.2 g per or per day; 52 pregnant women with preclinical GE who refused prophylactic treatment were included in the subgroup C. The control group involved 58 pregnant women with a physiological gestation and without GE.The clinical effectiveness of the therapy was assessed by comparing the number of cases of perinatal pathology in the I, II and III trimesters.Results. The use of L-arginine as an alternative preventive therapy for the development of preeclampsia and other perinatal pathology made possible to reduce the rate of preeclampsia significantly (RR 0.19, 95% CI: 0.05-0.77; p=0.02) and placental hyperplasia/hypoplasia (RR 0.17, 95% CI: 0.04-0.68; p=0.01), compared to patients who did not receive any preventive treatment. In pregnant women with early-onset gestational endotheliopathy who received L-arginine, placental dysfunction was not diagnosed in the II and III trimesters of pregnancy and there were no cases of fetal growth retardation. The use of L-arginine was not associated with side effects and/or adverse reactions in the proposed dose and frequency of administration and can be considered beneficial for the mother and the fetus.Conclusions. Prescribing ASA and L-arginine drugs for pregnant women with a moderate degree of perinatal risk (preclinical GE) made possible not only to prolong pregnancy, but also to prevent the development of severe perinatal pathology. A more pronounced clinical effectiveness of the course prescription of solution of L-arginine per or (daily dose of L-arginine - 4.0-4.2 g) in pregnant women with preclinical form of GE may be associated with the endotheliotropic protective effect of the drug.The appropriateness of using L-arginine during pregnancy is still debated, and further researches are needed to determine the optimal dosage, initial period for using and duration for the best prophylactic or therapeutic effect.
{"title":"The features of the prevention of preeclampsia in pregnant women with gestational endotheliopathy in the first trimester","authors":"D.G. Konkov, S.I. Zhuk, V.V. Rud, V.V. Buran","doi":"10.30841/2708-8731.6.2023.289996","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289996","url":null,"abstract":"The objective: to evaluate the clinical effectiveness of L-arginine in the prevention of preeclampsia and reduction of other perinatal risks in patients with preclinical gestational endotheliopathy (GE).Materials and methods. A comparative clinical study was performed at the clinical base of the Department of Obstetrics and Gynecology N. 1 of the Vinnytsya National Pirogov Memorial Medical University. 116 pregnant women with preclinical GE (main group), which was diagnosed by laboratory and instrumental research (microalbuminuria and endothelium-dependent vasodilatation), took part in the study. The patients of the main group were divided into clinical subgroups: 31 pregnant women with GE in subgroup A received acetylsalicylic acid (ASA) at a dose of 75 mg per or per day; 33 patients with preclinical GE from subgroup B received L-arginine at a dose of 4-4.2 g per or per day; 52 pregnant women with preclinical GE who refused prophylactic treatment were included in the subgroup C. The control group involved 58 pregnant women with a physiological gestation and without GE.The clinical effectiveness of the therapy was assessed by comparing the number of cases of perinatal pathology in the I, II and III trimesters.Results. The use of L-arginine as an alternative preventive therapy for the development of preeclampsia and other perinatal pathology made possible to reduce the rate of preeclampsia significantly (RR 0.19, 95% CI: 0.05-0.77; p=0.02) and placental hyperplasia/hypoplasia (RR 0.17, 95% CI: 0.04-0.68; p=0.01), compared to patients who did not receive any preventive treatment. In pregnant women with early-onset gestational endotheliopathy who received L-arginine, placental dysfunction was not diagnosed in the II and III trimesters of pregnancy and there were no cases of fetal growth retardation. The use of L-arginine was not associated with side effects and/or adverse reactions in the proposed dose and frequency of administration and can be considered beneficial for the mother and the fetus.Conclusions. Prescribing ASA and L-arginine drugs for pregnant women with a moderate degree of perinatal risk (preclinical GE) made possible not only to prolong pregnancy, but also to prevent the development of severe perinatal pathology. A more pronounced clinical effectiveness of the course prescription of solution of L-arginine per or (daily dose of L-arginine - 4.0-4.2 g) in pregnant women with preclinical form of GE may be associated with the endotheliotropic protective effect of the drug.The appropriateness of using L-arginine during pregnancy is still debated, and further researches are needed to determine the optimal dosage, initial period for using and duration for the best prophylactic or therapeutic effect.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.30841/2708-8731.6.2023.290000
S.O. Shurpyak, I.M. Yarmola, V.I. Pyrohova
The widespread introduction of hysteroscopy into clinical practice has significantly expanded the possibilities of diagnosis the causes of infertility. Almost 25% of patients with infertility are diagnosed with intrauterine pathology during hysteroscopy, which is not always identified during ultrasonography and/or hysterosalpingography. The World Health Organization recommends the use of office hysteroscopy in all cases of suspected intrauterine pathology. Among all complications of hysteroscopy, the frequency of which ranges from 0.4 to 6.0%, infectious and inflammatory complications occur most often (0.6-2.5%). Intrauterine interventions disturb the “cervical” protective barrier, which, in the presence of dysbiotic or inflammatory processes of the genital tract, increases the risk of complications. In view of the increase in the frequency of intrauterine pathology, and, accordingly, the frequency of diagnostic and operative intrauterine interventions in women of reproductive age, the development of algorithms for the prevention of infectious and inflammatory complications is relevant.The objective: to investigate the state of the cervical and vaginal microbiota of women of reproductive age with intrauterine pathology and infertility who are preparing for hysteroscopy.Materials and methods. 45 women aged 26 to 45 years (main group) and 30 women of the same age without gynecological pathology (comparison group) were examined before hysteroscopy. A comprehensive study of the state of the cervical and vaginal microbiota, diagnosis of infection with sexually transmitted pathogens, included pH-metry of vaginal contents, bacterioscopic examination of vaginal smears, and polymerase chain reaction (PCR).Results. Indications for hysteroscopy were chronic abnormal uterine bleeding (13.3%), endometrial hyperplasia (8.9%); suspicion of endometrial polyps (8.9%), submucosal myoma (8.9%) or uterine malformations (17.8%); infertility of unclear origin (42.2%). In patients of the main group, inflammatory and dysbiotic processes of the lower part of the genital organs in the anamnesis occurred 5.6 times more often. In 22.2% of the patients of the main group, the normal vaginal pH level was determined (3.8–4.5) versus 60.0% of the women of the comparison group (p<0.05). According to bacterioscopy, normocenosis was found in 28.9% of women in the main group and 43.3% – in the comparison group, while according to PCR normocenosis was determined in 35.6% and 63.3% of cases, respectively. A significant frequency of the intermediate state of the microbiota was estimated (37.8% in the main group and 23.3% – in the comparison group), which correlated with changes in the pH of the vagina (r=0.567). Of the 18 patients in the main group, bacterial vaginosis was diagnosed in 22.2% of cases, vulvovaginal candidiasis – in 4.4%, and chlamydia – in 8.9%.Conclusions. A significant frequency of diseases of the lower part of the genital tract in the anamnesis is typical for patient
{"title":"Study of the cervical and vaginal microbiota in women with intrauterine pathology and infertility","authors":"S.O. Shurpyak, I.M. Yarmola, V.I. Pyrohova","doi":"10.30841/2708-8731.6.2023.290000","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.290000","url":null,"abstract":"The widespread introduction of hysteroscopy into clinical practice has significantly expanded the possibilities of diagnosis the causes of infertility. Almost 25% of patients with infertility are diagnosed with intrauterine pathology during hysteroscopy, which is not always identified during ultrasonography and/or hysterosalpingography. The World Health Organization recommends the use of office hysteroscopy in all cases of suspected intrauterine pathology. Among all complications of hysteroscopy, the frequency of which ranges from 0.4 to 6.0%, infectious and inflammatory complications occur most often (0.6-2.5%). Intrauterine interventions disturb the “cervical” protective barrier, which, in the presence of dysbiotic or inflammatory processes of the genital tract, increases the risk of complications. In view of the increase in the frequency of intrauterine pathology, and, accordingly, the frequency of diagnostic and operative intrauterine interventions in women of reproductive age, the development of algorithms for the prevention of infectious and inflammatory complications is relevant.The objective: to investigate the state of the cervical and vaginal microbiota of women of reproductive age with intrauterine pathology and infertility who are preparing for hysteroscopy.Materials and methods. 45 women aged 26 to 45 years (main group) and 30 women of the same age without gynecological pathology (comparison group) were examined before hysteroscopy. A comprehensive study of the state of the cervical and vaginal microbiota, diagnosis of infection with sexually transmitted pathogens, included pH-metry of vaginal contents, bacterioscopic examination of vaginal smears, and polymerase chain reaction (PCR).Results. Indications for hysteroscopy were chronic abnormal uterine bleeding (13.3%), endometrial hyperplasia (8.9%); suspicion of endometrial polyps (8.9%), submucosal myoma (8.9%) or uterine malformations (17.8%); infertility of unclear origin (42.2%). In patients of the main group, inflammatory and dysbiotic processes of the lower part of the genital organs in the anamnesis occurred 5.6 times more often. In 22.2% of the patients of the main group, the normal vaginal pH level was determined (3.8–4.5) versus 60.0% of the women of the comparison group (p<0.05). According to bacterioscopy, normocenosis was found in 28.9% of women in the main group and 43.3% – in the comparison group, while according to PCR normocenosis was determined in 35.6% and 63.3% of cases, respectively. A significant frequency of the intermediate state of the microbiota was estimated (37.8% in the main group and 23.3% – in the comparison group), which correlated with changes in the pH of the vagina (r=0.567). Of the 18 patients in the main group, bacterial vaginosis was diagnosed in 22.2% of cases, vulvovaginal candidiasis – in 4.4%, and chlamydia – in 8.9%.Conclusions. A significant frequency of diseases of the lower part of the genital tract in the anamnesis is typical for patient","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.30841/2708-8731.6.2023.289998
I.V. Lakhno, O.V. Martynenko, G. Raimondi, V.I. Shulgin
Fetal growth retardation (FGR) is one of the most serious problems in current perinatology. This pathology leads not only to the deterioration of perinatal outcomes but also significantly increases morbidity during adult life. FGR is known to be featured by its delayed “neurological maturation”. This is manifested in a decrease in autonomic nervous regulation according to the fetal heart rate variability (HRV) scores and indices. The objective: to study HRV in fetuses with normal biometric indices compared to similar parameters of growth retarded fetuses. Materials and methods. The 47 pregnant women who had fetuses with normal biometric indices (I group) and 33 patients with fetal growth retardation (II group) were included in the study. The investigation of the fetal HRV was performed by processing the R–R intervals obtained via non-invasive electrocardiogram (ECG) and involved the following indices: STV (short term variations), LTV (long term variations), AC/DC (acceleration capacity/deceleration capacity), TP (total power), SI (stress index), SDNN (standard deviation of normal to normal intervals), EnRE (entropy of the time series), D2 (correlation dimension of the time series), Z (temporary irreversibility) і FL (measure of fuzzy logic, integrated measure of HRV). Results. The obtained data indicated that the indices of fetal HRV were reduced in the patients with FGR. These indices have utility in screening programs for the detection of fetal intrauterine nutrition and growth disturbances. The results of the study allow us to believe that the ability to accelerate heart rate patterns is partly preserved even during FGR. This may indicate a very ancient phylogenetic nature of the reaction of the heart system of the fetus to its motile activity. However, decelerations according to the DC were typical for FGR. A non-invasive fetal ECG could become a useful supplementary method in the current methods’ spectrum used in perinatal medicine. Conclusions. Therefore, the development of algorithms for the diagnosis of FGR requires the inclusion of the following HRV indices: STV, LTV, DC, TP, SI, SDNN, D2, Z, and FL. These biophysical markers of FGR can be used as a screening program in conditions of lack of access to high-quality ultrasound diagnostics or be a valuable addition to existing perinatal strategies.
{"title":"The value of some indices of heart rate variability in the diagnosis of fetal growth retardation","authors":"I.V. Lakhno, O.V. Martynenko, G. Raimondi, V.I. Shulgin","doi":"10.30841/2708-8731.6.2023.289998","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289998","url":null,"abstract":"Fetal growth retardation (FGR) is one of the most serious problems in current perinatology. This pathology leads not only to the deterioration of perinatal outcomes but also significantly increases morbidity during adult life. FGR is known to be featured by its delayed “neurological maturation”. This is manifested in a decrease in autonomic nervous regulation according to the fetal heart rate variability (HRV) scores and indices. The objective: to study HRV in fetuses with normal biometric indices compared to similar parameters of growth retarded fetuses. Materials and methods. The 47 pregnant women who had fetuses with normal biometric indices (I group) and 33 patients with fetal growth retardation (II group) were included in the study. The investigation of the fetal HRV was performed by processing the R–R intervals obtained via non-invasive electrocardiogram (ECG) and involved the following indices: STV (short term variations), LTV (long term variations), AC/DC (acceleration capacity/deceleration capacity), TP (total power), SI (stress index), SDNN (standard deviation of normal to normal intervals), EnRE (entropy of the time series), D2 (correlation dimension of the time series), Z (temporary irreversibility) і FL (measure of fuzzy logic, integrated measure of HRV). Results. The obtained data indicated that the indices of fetal HRV were reduced in the patients with FGR. These indices have utility in screening programs for the detection of fetal intrauterine nutrition and growth disturbances. The results of the study allow us to believe that the ability to accelerate heart rate patterns is partly preserved even during FGR. This may indicate a very ancient phylogenetic nature of the reaction of the heart system of the fetus to its motile activity. However, decelerations according to the DC were typical for FGR. A non-invasive fetal ECG could become a useful supplementary method in the current methods’ spectrum used in perinatal medicine. Conclusions. Therefore, the development of algorithms for the diagnosis of FGR requires the inclusion of the following HRV indices: STV, LTV, DC, TP, SI, SDNN, D2, Z, and FL. These biophysical markers of FGR can be used as a screening program in conditions of lack of access to high-quality ultrasound diagnostics or be a valuable addition to existing perinatal strategies.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.30841/2708-8731.6.2023.289995
V.V. Artyomenko, L.V. Mnikh, N.V. Domakova
The article is devoted to the review of modern scientific publications about the microbiome of a woman and its importance in obstetric and perinatal practice. The composition of the microbiome is changed both in the process of human evolution and personally and in different periods of a person’s life. However, on the other hand, the microbiome is influenced by the specific environment in which a person lives. It consists of a certain collection of genomes of all microorganisms. Complications during pregnancy occur frequently, according to statistics – in every sixth pregnant woman, and pose a danger to the health of the mother and child.During pregnancy, the richness and diversity of the vaginal microbiome decreases, and different species of Lactobacillus play a dominant role. The microbiome stability is hypothesized to be associated with higher levels of estrogen concentration, absence of menstruation, and modification of cervical and vaginal fluids. During an uncomplicated pregnancy, the taxonomic composition of the vaginal microbiota remains stable with the exception of the period before labor, when there is an increase in microbial diversity. This makes the vaginal microbiome similar to that of a non-pregnant woman and is believed to be a trigger for the labor process to begin.The recent studies have determined a relationship between changes in the microbiome during pregnancy and the occurrence of complications in these women. Any change or disturbance in the microbiome balance can be involved in inflammatory processes, which can potentially have adverse effects on the course of pregnancy. A major interaction between the oral microbiome and preeclampsia involves the production of nitrogen derivatives, especially nitric oxide (NO). NO is produced from L-arginine via NO synthases (NOS), and is involved in vascular processes, especially vasodilation and tissue protection. Also, NO is indirectly involved in the processes that occur in the presence of chronic cardiovascular diseases, including hypertension and preeclampsia.In recent years, scientists have begun actively to study a correlation between changes in the gut microbiome and various nosologies regarding gestational diabetes. There is not much of this data at the moment. The gut microbiome is known to modulate insulin resistance and the inflammatory response, and changes in the microbiome may be associated with metabolic diseases. It is hypothesized that changes in the gut microbiome may lead to metabolic diseases through several mechanisms: abnormal intestinal permeability, increased absorption of lipopolysaccharide, abnormal production of short-chain fatty acids, altered conversion of primary bile acids, and enhanced production of bacterial toxins (e.g., trimethylamine-N-oxide).During full-term pregnancy, the “dynamic stability” of the vaginal microbiome is described as a higher concentration of Lactobacillus species starting at 20 weeks of gestation due to increased glycogen availabilit
这篇文章是专门审查现代科学出版物的微生物组的妇女和它的重要性在产科和围产期实践。微生物组的组成在人类进化过程中以及个人和个人生命的不同时期都发生了变化。然而，另一方面，微生物组受到一个人生活的特定环境的影响。它由所有微生物的基因组集合组成。据统计，怀孕期间经常发生并发症，每六名孕妇中就有一名出现并发症，对母亲和儿童的健康构成威胁。在怀孕期间，阴道微生物组的丰富度和多样性下降，不同种类的乳酸菌起主导作用。据推测，微生物组的稳定性与较高水平的雌激素浓度、月经不来以及宫颈和阴道液体的改变有关。在一个不复杂的怀孕期间，阴道微生物群的分类组成保持稳定，除了分娩前的时期，当微生物多样性增加。这使得阴道微生物群与未怀孕妇女的相似，并被认为是分娩过程开始的触发因素。最近的研究已经确定了怀孕期间微生物组的变化与这些妇女并发症的发生之间的关系。微生物群平衡的任何变化或紊乱都可能涉及炎症过程，这可能对妊娠过程产生不利影响。口腔微生物组与子痫前期的主要相互作用涉及氮衍生物的产生，特别是一氧化氮(NO)。一氧化氮是由l -精氨酸通过一氧化氮合成酶(NOS)产生的，参与血管过程，特别是血管舒张和组织保护。此外，一氧化氮还间接参与慢性心血管疾病(包括高血压和子痫前期)发生的过程。近年来，科学家们开始积极研究肠道微生物群变化与妊娠糖尿病各种病种之间的相关性。目前这方面的数据并不多。众所周知，肠道微生物组可以调节胰岛素抵抗和炎症反应，微生物组的变化可能与代谢性疾病有关。据推测，肠道微生物组的变化可能通过以下几种机制导致代谢性疾病:肠道通透性异常、脂多糖吸收增加、短链脂肪酸异常产生、原胆汁酸转化改变、细菌毒素(如三甲胺- n -氧化物)产生增加。在足月妊娠期间，阴道微生物群的“动态稳定性”被描述为从妊娠20周开始，由于糖原可用性增加和微生物群的复杂性和多样性降低，乳酸杆菌种类的浓度更高。这种情况可能是由于怀孕期间缺乏周期性的荷尔蒙变化。乳酸菌和小细菌的多样性被认为是在怀孕结束时开始分娩的关键因素。未来的治疗策略可能应用于调节微生物组的组成，包括使用益生元和益生元以及饮食调整。然而，需要进一步的研究来确定可用于开发个性化预防和治疗的个性化治疗方法的具体工具。
{"title":"Woman’s microbiome and obstetrical and perinatal risks: what do they have in common?","authors":"V.V. Artyomenko, L.V. Mnikh, N.V. Domakova","doi":"10.30841/2708-8731.6.2023.289995","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289995","url":null,"abstract":"The article is devoted to the review of modern scientific publications about the microbiome of a woman and its importance in obstetric and perinatal practice. The composition of the microbiome is changed both in the process of human evolution and personally and in different periods of a person’s life. However, on the other hand, the microbiome is influenced by the specific environment in which a person lives. It consists of a certain collection of genomes of all microorganisms. Complications during pregnancy occur frequently, according to statistics – in every sixth pregnant woman, and pose a danger to the health of the mother and child.During pregnancy, the richness and diversity of the vaginal microbiome decreases, and different species of Lactobacillus play a dominant role. The microbiome stability is hypothesized to be associated with higher levels of estrogen concentration, absence of menstruation, and modification of cervical and vaginal fluids. During an uncomplicated pregnancy, the taxonomic composition of the vaginal microbiota remains stable with the exception of the period before labor, when there is an increase in microbial diversity. This makes the vaginal microbiome similar to that of a non-pregnant woman and is believed to be a trigger for the labor process to begin.The recent studies have determined a relationship between changes in the microbiome during pregnancy and the occurrence of complications in these women. Any change or disturbance in the microbiome balance can be involved in inflammatory processes, which can potentially have adverse effects on the course of pregnancy. A major interaction between the oral microbiome and preeclampsia involves the production of nitrogen derivatives, especially nitric oxide (NO). NO is produced from L-arginine via NO synthases (NOS), and is involved in vascular processes, especially vasodilation and tissue protection. Also, NO is indirectly involved in the processes that occur in the presence of chronic cardiovascular diseases, including hypertension and preeclampsia.In recent years, scientists have begun actively to study a correlation between changes in the gut microbiome and various nosologies regarding gestational diabetes. There is not much of this data at the moment. The gut microbiome is known to modulate insulin resistance and the inflammatory response, and changes in the microbiome may be associated with metabolic diseases. It is hypothesized that changes in the gut microbiome may lead to metabolic diseases through several mechanisms: abnormal intestinal permeability, increased absorption of lipopolysaccharide, abnormal production of short-chain fatty acids, altered conversion of primary bile acids, and enhanced production of bacterial toxins (e.g., trimethylamine-N-oxide).During full-term pregnancy, the “dynamic stability” of the vaginal microbiome is described as a higher concentration of Lactobacillus species starting at 20 weeks of gestation due to increased glycogen availabilit","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.30841/2708-8731.6.2023.289997
O.S. Zahorodnia, V.V. Bila, M.I. Аntoniuk, K.V. Tymoschuk
The article presents the results of a study amniotic glucose concentration as a potential early indicator of the inflammatory process in the fetal membranes. The main focus was on the analysis of the features of pregnancy and labor in women with premature rupture of membranes (PROM) during full-term and preterm labor according to amniotic fluid glucose levels. Currently, the expectant approach in cases of PROM is widely practiced throughout the world. The objective: to estimate the glucose level in the amniotic fluid as a preclinical marker of chorioamnionitis. Materials and methods. Depending on the glucose concentration in the amniotic fluid at the time of rupture of membranes and the term of rupture of membranes, 97 pregnant women were divided into 4 groups. I and II groups consisted of women with PROM between 24 and 36 weeks and 6 days. In the I group there were 34 pregnant women with a glucose concentration in the amniotic fluid of more than 0.5 mmol/l, and in the II group – 15 pregnant women with the indicator of less than 0.5 mmol/l. III and IV groups included pregnant women with PROM at full-term pregnancy (after 37 weeks). In the III group there were 34 patients with an amniotic glucose concentration of more than 0.5 mmol/l, and in the IV – 14 pregnant women with the indicator of less than 0.5 mmol/l. In all groups, the further course of pregnancy, the time period from the rupture of membranes to the beginning of labor, the need for induction of labor, hyperthermia before the beginning of labor, deviations from the normal course of labor were analyzed (hyperthermia, fetal distress in labor, uterine weakness) and the frequency of operative delivery. Results. The study determined that women with an amniotic glucose concentration below 0.5 mmol/l at the time of hospitalization were more likely to have hyperthermia before and during childbirth. Hyperthermia was most often observed during the first 12 hours after membrane rupture. In addition, these women were more prone to serious birth complications, such as fetal distress, weak labor, and a greater likelihood of needing an operative delivery. Conclusions. 1. A decreased amniotic glucose level less than 0.5 mmol/l is associated with more frequent clinical manifestations of amniotic infection (20% in preterm pregnancies and 14.8% – in full-term pregnancies) than in groups with a glucose content of more than 0.5 mmol/l (8.8% in preterm pregnancies and 5.9% – in full-term pregnancies, p≤0.05). 2. Among patients with a glucose content in amniotic fluid less than 0.5 mmol/l, laboratory manifestations of intra-amniotic infection were detected more often (40% in preterm pregnancies and 42.5% in full-term pregnancies) than among pregnant women with a glucose content of more than 0.5 mmol/l (20% in both full-term and preterm pregnancies, p≤0.05). 3. Determination of the glucose level in amniotic fluid can be considered as an available method of preclinical diagnosis of chorioamnionitis for the indiv
{"title":"Glucose level in amniotic fluid as a preclinical marker of chorioamnionitis","authors":"O.S. Zahorodnia, V.V. Bila, M.I. Аntoniuk, K.V. Tymoschuk","doi":"10.30841/2708-8731.6.2023.289997","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289997","url":null,"abstract":"The article presents the results of a study amniotic glucose concentration as a potential early indicator of the inflammatory process in the fetal membranes. The main focus was on the analysis of the features of pregnancy and labor in women with premature rupture of membranes (PROM) during full-term and preterm labor according to amniotic fluid glucose levels. Currently, the expectant approach in cases of PROM is widely practiced throughout the world. The objective: to estimate the glucose level in the amniotic fluid as a preclinical marker of chorioamnionitis. Materials and methods. Depending on the glucose concentration in the amniotic fluid at the time of rupture of membranes and the term of rupture of membranes, 97 pregnant women were divided into 4 groups. I and II groups consisted of women with PROM between 24 and 36 weeks and 6 days. In the I group there were 34 pregnant women with a glucose concentration in the amniotic fluid of more than 0.5 mmol/l, and in the II group – 15 pregnant women with the indicator of less than 0.5 mmol/l. III and IV groups included pregnant women with PROM at full-term pregnancy (after 37 weeks). In the III group there were 34 patients with an amniotic glucose concentration of more than 0.5 mmol/l, and in the IV – 14 pregnant women with the indicator of less than 0.5 mmol/l. In all groups, the further course of pregnancy, the time period from the rupture of membranes to the beginning of labor, the need for induction of labor, hyperthermia before the beginning of labor, deviations from the normal course of labor were analyzed (hyperthermia, fetal distress in labor, uterine weakness) and the frequency of operative delivery. Results. The study determined that women with an amniotic glucose concentration below 0.5 mmol/l at the time of hospitalization were more likely to have hyperthermia before and during childbirth. Hyperthermia was most often observed during the first 12 hours after membrane rupture. In addition, these women were more prone to serious birth complications, such as fetal distress, weak labor, and a greater likelihood of needing an operative delivery. Conclusions. 1. A decreased amniotic glucose level less than 0.5 mmol/l is associated with more frequent clinical manifestations of amniotic infection (20% in preterm pregnancies and 14.8% – in full-term pregnancies) than in groups with a glucose content of more than 0.5 mmol/l (8.8% in preterm pregnancies and 5.9% – in full-term pregnancies, p≤0.05). 2. Among patients with a glucose content in amniotic fluid less than 0.5 mmol/l, laboratory manifestations of intra-amniotic infection were detected more often (40% in preterm pregnancies and 42.5% in full-term pregnancies) than among pregnant women with a glucose content of more than 0.5 mmol/l (20% in both full-term and preterm pregnancies, p≤0.05). 3. Determination of the glucose level in amniotic fluid can be considered as an available method of preclinical diagnosis of chorioamnionitis for the indiv","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article is devoted to the review of scientific publications on gynecological and dermatological aspects of polycystic ovary syndrome (PCOS) in different age periods of women’s life. Analysis of domestic and foreign publications presents that the prevalence of PCOS depends on the age of women and the state of their reproductive function, and is accounted 17% in women 21 to 30 years old and significantly decreased with age. More than half of all cases of endocrine infertility (50-75%) and about 20-22% of the causes of infertile marriage in general are associated with PCOS. The phenotypic heterogeneity of women with PCOS affects the pregnancy outcomes in different ways, which increases the risk of its pathological course, early pregnancy loss, the development of gestational diabetes mellitus, hypertensive disorders, the birth of small and large for gestational age babies, etc.“The golden standard” for hyperandrogenism diagnosis in PCOS patients is the determination of the index of free testosterone and androstenedione. Other indicators are important for differential diagnosis and definition of syndrome phenotypes. Different PCOS phenotypes are characterized by different ratios of the contribution of sources of excess androgen synthesis. Depending on the cause, hyperandrogenism in PCOS patients is accompanied by various metabolic risks. Usually, an excess of androgens in women is clinically manifested by hirsutism, seborrheic dermatitis, acne, acanthosis nigricans, and androgenetic alopecia.The presence of dermatological manifestations of hyperandrogenism has different diagnostic value in puberty, women of reproductive age and in menopause. Acne can be the first sign of pubertal maturation. Additional examinations should be planned in extremely severe cases, which are accompanied by signs of androgen excess, or do not respond to treatment. In women of reproductive age and in perimenopause, the need to assess androgenic status is extremely important. Hair loss according to the female type is associated with manifestations of metabolic syndrome, and it is an independent risk factor for the development of diabetes, atherosclerosis and mortality from cardiovascular diseases.Therefore it is recommended to use the modified Rotterdam criteria for PCOS diagnosis. Such criteria include clinical or biochemical hyperandrogenism, signs of oligoanovulation, polycystosis (morphology of the ovaries according to ultrasound diagnostics), if other causes of relevant disorders are excluded. At the same time, any two of the specified criteria have diagnostic value, which makes possible to establish not only the diagnosis, but also clinical variant (phenotype) of PCOS, the diagnosis of which is the basis for choosing individual treatment for this contingent of women.
{"title":"Gynecological and dermatological aspects of diagnostics of polycystic ovary syndrome from puberty to menopause","authors":"V.G. Siusiuka, M.Y. Sergienko, O.I. Мakarchuk, A.О. Shevchenko, O.V. Deinichenko","doi":"10.30841/2708-8731.6.2023.289991","DOIUrl":"https://doi.org/10.30841/2708-8731.6.2023.289991","url":null,"abstract":"The article is devoted to the review of scientific publications on gynecological and dermatological aspects of polycystic ovary syndrome (PCOS) in different age periods of women’s life. Analysis of domestic and foreign publications presents that the prevalence of PCOS depends on the age of women and the state of their reproductive function, and is accounted 17% in women 21 to 30 years old and significantly decreased with age. More than half of all cases of endocrine infertility (50-75%) and about 20-22% of the causes of infertile marriage in general are associated with PCOS. The phenotypic heterogeneity of women with PCOS affects the pregnancy outcomes in different ways, which increases the risk of its pathological course, early pregnancy loss, the development of gestational diabetes mellitus, hypertensive disorders, the birth of small and large for gestational age babies, etc.“The golden standard” for hyperandrogenism diagnosis in PCOS patients is the determination of the index of free testosterone and androstenedione. Other indicators are important for differential diagnosis and definition of syndrome phenotypes. Different PCOS phenotypes are characterized by different ratios of the contribution of sources of excess androgen synthesis. Depending on the cause, hyperandrogenism in PCOS patients is accompanied by various metabolic risks. Usually, an excess of androgens in women is clinically manifested by hirsutism, seborrheic dermatitis, acne, acanthosis nigricans, and androgenetic alopecia.The presence of dermatological manifestations of hyperandrogenism has different diagnostic value in puberty, women of reproductive age and in menopause. Acne can be the first sign of pubertal maturation. Additional examinations should be planned in extremely severe cases, which are accompanied by signs of androgen excess, or do not respond to treatment. In women of reproductive age and in perimenopause, the need to assess androgenic status is extremely important. Hair loss according to the female type is associated with manifestations of metabolic syndrome, and it is an independent risk factor for the development of diabetes, atherosclerosis and mortality from cardiovascular diseases.Therefore it is recommended to use the modified Rotterdam criteria for PCOS diagnosis. Such criteria include clinical or biochemical hyperandrogenism, signs of oligoanovulation, polycystosis (morphology of the ovaries according to ultrasound diagnostics), if other causes of relevant disorders are excluded. At the same time, any two of the specified criteria have diagnostic value, which makes possible to establish not only the diagnosis, but also clinical variant (phenotype) of PCOS, the diagnosis of which is the basis for choosing individual treatment for this contingent of women.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135343399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.30841/2708-8731.5.2023.286772
O.V. Gorbunova, Kh.V. Zarichanska, O.S. Shcherbinska, I.P. Netskar, I.V. Iarova
In the modern world it is important to understand the interaction of macro- and microorganisms in normal conditions and during illness. It is the biotope of the vagina that plays an extremely important role in a woman’s organism and it reflects the general state of woman’s health. Urogenital endogenous microflora is not static, it is a constantly changing macropopulation. In this population the number of specific types of microorganisms fluctuates within the limits of changes in the conditions of their environment. The microflora of the vagina changes during different periods of a woman’s life, namely during perinatal, late neonatal, prepubertal, pubertal, reproductive and postmenopausal periods, as well as the menstrual cycle, daily and hourly. The ability of commensal microorganisms to protect the region from the invasion of their own microflora from other cavities and the microflora of the sexual partner is unique. Considering the general global trend towards the increase in prevalence, virulence and resistance of microorganisms to traditional methods of antiseptic therapy, as well as the appearance of new types of microorganisms, a steady trend towards an increase in infectious diseases, including sexually transmitted infections, is determined. Dysbiosis is considered qualitative and quantitative violations of the corresponding biotope of the normal flora. According to official statistics, the prevalence of bacterial vaginosis is 10-35% among all patients with pathological vaginal discharge. The variability of the vaginal microbiome is widely studied in the world and depends on many factors, namely the hormonal background of a woman’s organism, her diet, the characteristics of urination and defecation, menstruation, hygienic procedures and infections. One of the key links in the pathogenesis of vaginal infectious diseases is the ability of bacteria to form biofilms, which are microbial associations. Infections caused by film-forming strains of pathogenic and opportunistic microorganisms are characterized by an atypical course, insufficient effectiveness of antibiotic therapy, and often transition to a chronic form or carriage. Therefore, understanding the mechanisms of formation, structure and regulation of vital activities of biofilms helps in solving problems related to human health. The World Health Organization recommends evaluating the vaginal microbiome according to the Hay – Ison criteria. Determining the pH of vaginal secretions also helps to establish the type of vaginal dysbiosis. Clinical therapy includes two main stages of treatment: antiseptic measures and restoration of one’s own vaginal microbiome. Often, these two stages of therapy are carried out simultaneously. Correcting the pH of the vaginal secretion is also important.
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