Pub Date : 2023-07-31DOI: 10.30841/2708-8731.5.2023.286770
S.S. Leush, M.V. Protsyk, M.I. Antoniuk
The use of cord blood gases to predict hypoxic stress during high-risk labor has been known since 1958. This diagnostic test is widely used, especially in specialized clinics, and blood indicators in the umbilical artery accurately reflect the condition of the newborn. However, there is a lack of specific diagnostic criteria for premature births.The objective: to study the ratio of indicators of gas exchange and acid-base status between the newborn and the mother depending on the gestational age at the time of delivery.Materials and methods. The levels of pH, pO2, pCO2, bicarbonate ion concentration (HCO3-) and base excess (BE) were analyzed both in mothers (maternal venous blood, v. cubitalis) and in their newborns (venous blood obtained from the umbilical artery).Study groups: I group – 16 postpartum women with newborns at 24–27 weeks of gestation, II group – 36 postpartum women with newborns at 28–34 weeks, III group (control group) – 24 postpartum women with newborns at term physiological delivery (37–41 weeks).Results. The study found no statistically significant differences in maternal venous and umbilical artery of pH, pO2, pCO2, HCO3- and BE levels between the term pregnancy group and the groups of preterm labor. However, extremely preterm neonates were found to have a marked increase in pH and BE in response to hyperventilation during labor.Conclusions. 1. Preterm infants had higher venous blood pH levels obtained from the umbilical artery, which were more pronounced in those who were born at earlier gestational ages (7.36±0.011 at 24–27 weeks gestation and 7.33±0.022 at a gestation period of 28–34 weeks), compared to full-term children (7.29±0.045; p<0.05).2. The difference in the pH levels of the venous blood of the newborn, obtained from the umbilical artery, and the mother’s blood, obtained from the v. cubitalis, is smaller in premature births (for a gestation period of 24–27 weeks – 7.39±0.018 in maternal blood and 7.36± 0.011 – in newborns; for the period of 28–34 weeks – 7.40±0.021 and 7.33±0.022, respectively) compared to the levels in full-term babies (7.43±0.015 – in maternal blood and 7.29±0.045 – in a newborn); p<0.05. This is primarily due to a decrease in the mother’s venous blood pH.
{"title":"Fetal-maternal gas transport and acid – base balance in preterm labors","authors":"S.S. Leush, M.V. Protsyk, M.I. Antoniuk","doi":"10.30841/2708-8731.5.2023.286770","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286770","url":null,"abstract":"The use of cord blood gases to predict hypoxic stress during high-risk labor has been known since 1958. This diagnostic test is widely used, especially in specialized clinics, and blood indicators in the umbilical artery accurately reflect the condition of the newborn. However, there is a lack of specific diagnostic criteria for premature births.The objective: to study the ratio of indicators of gas exchange and acid-base status between the newborn and the mother depending on the gestational age at the time of delivery.Materials and methods. The levels of pH, pO2, pCO2, bicarbonate ion concentration (HCO3-) and base excess (BE) were analyzed both in mothers (maternal venous blood, v. cubitalis) and in their newborns (venous blood obtained from the umbilical artery).Study groups: I group – 16 postpartum women with newborns at 24–27 weeks of gestation, II group – 36 postpartum women with newborns at 28–34 weeks, III group (control group) – 24 postpartum women with newborns at term physiological delivery (37–41 weeks).Results. The study found no statistically significant differences in maternal venous and umbilical artery of pH, pO2, pCO2, HCO3- and BE levels between the term pregnancy group and the groups of preterm labor. However, extremely preterm neonates were found to have a marked increase in pH and BE in response to hyperventilation during labor.Conclusions. 1. Preterm infants had higher venous blood pH levels obtained from the umbilical artery, which were more pronounced in those who were born at earlier gestational ages (7.36±0.011 at 24–27 weeks gestation and 7.33±0.022 at a gestation period of 28–34 weeks), compared to full-term children (7.29±0.045; p<0.05).2. The difference in the pH levels of the venous blood of the newborn, obtained from the umbilical artery, and the mother’s blood, obtained from the v. cubitalis, is smaller in premature births (for a gestation period of 24–27 weeks – 7.39±0.018 in maternal blood and 7.36± 0.011 – in newborns; for the period of 28–34 weeks – 7.40±0.021 and 7.33±0.022, respectively) compared to the levels in full-term babies (7.43±0.015 – in maternal blood and 7.29±0.045 – in a newborn); p<0.05. This is primarily due to a decrease in the mother’s venous blood pH.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357890","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 presents literature data on the peculiarities of the pregnancy course and changes in the main biotopes in women who suffered from COVID-19 in different periods of gestation. Certain regularities regarding the association of perinatal complications with the severity of the disease, the presence of somatic and gynecological pathology in these pregnant women, in particular, obesity and chronic inflammatory diseases of the genital organs, were observed.According to research conducted on the basis of the department of pathology of pregnancy and childbirth of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. M. Lukyanova of the National Academy of Sciences of Ukraine», the risk group of a severe course of the coronavirus disease includes all the same factors as for any other diseases, not related to pregnancy: age over 35 years; the presence of concomitant pathology (diabetes, obesity, hypertension), work, lifestyle or housing conditions that increase the risk of infection. More frequent manifestations of obstetric pathology were found in older women and primipara women.Complicated obstetric anamnesis, namely, medical abortions and miscarriages, cervical pathology, previous inflammatory diseases, especially of the genital organs, are considered to be risk factors. The course of pregnancy and childbirth are accompanied by such complications as the threat of early miscarriage; anemia; combination of placental dysfunction, polyhydramnios and fetal distress; anomalies uterine activity, which increases the frequency of pathological childbirth in this contingent of women and requires repeated hospitalization during pregnancy.A review of scientific publications in recent years demonstrates the significant impact of COVID-19 on the composition of biotopes of the human organism. There are convincing data on the close relationship between the infection of the mucous membranes of the upper respiratory tract and the infection of the lungs with the SARS-CoV-2 virus. Lung hypoxia, typical for this infection, causes the growth of anaerobes and facultative anaerobes, which are part of the mentioned microbiomes during a person’s life. A significant number of observations have found the correlation of changes in the microbiocenosis of the respiratory tract and intestines in patients with SARS-CoV-2 and convalescents. At the same time, there is also a disorder in the vaginal microbiocenosis after the coronavirus disease, especially during pregnancy. A conclusion was made regarding the correlation between the severity of COVID-19 course and the number of lactobacilli in the vaginal biotope: the more severe course, the worse of the microflora composition. The gestation period is more often complicated by the threat of early pregnancy loss, placental dysfunction, polyhydramnios, fetal distress, and the threat of premature birth in those women who suffered a coronavirus infection in the I trimester. A large rate
本文介绍了不同妊娠期感染COVID-19妇女妊娠过程的特殊性和主要生物群落变化的文献资料。观察到围产期并发症与疾病严重程度、这些孕妇的躯体和妇科病理，特别是肥胖和生殖器官慢性炎性疾病之间存在一定的关联规律。根据国家机构“以乌克兰国家科学院院士O. M. Lukyanova命名的儿科、产科和妇科研究所”妊娠和分娩病理学部门进行的研究，冠状病毒严重病程的风险群体包括与任何其他疾病无关的所有相同因素:年龄超过35岁;存在增加感染风险的伴随病理(糖尿病、肥胖、高血压)、工作、生活方式或住房条件。更常见的产科病理表现见于老年妇女和初产妇。复杂的产科失忆，即药物流产和流产、宫颈病理、以前的炎症性疾病，特别是生殖器官的炎症性疾病，被认为是危险因素。妊娠和分娩过程中伴随着诸如早期流产的威胁等并发症;贫血;胎盘功能障碍、羊水过多合并胎儿窘迫;子宫活动异常，这增加了病理性分娩的频率在这支队伍的妇女和需要在怀孕期间反复住院。对近年来科学出版物的回顾表明，COVID-19对人体生物群落的组成产生了重大影响。有令人信服的数据表明，上呼吸道粘膜感染与SARS-CoV-2病毒感染肺部之间存在密切关系。肺部缺氧是这种感染的典型症状，它会导致厌氧菌和兼性厌氧菌的生长，这是人一生中提到的微生物群的一部分。大量观察发现，SARS-CoV-2患者和恢复期患者呼吸道和肠道微生物群落变化存在相关性。同时，在冠状病毒感染后，阴道微生物病也出现了紊乱，尤其是在怀孕期间。关于COVID-19病程严重程度与阴道菌群乳酸菌数量的相关性得出结论:病程越严重，菌群组成越差。妊娠期往往因早孕流产、胎盘功能障碍、羊水过多、胎儿窘迫以及在妊娠晚期感染冠状病毒的妇女早产的威胁而更加复杂。在大多数情况下，羊水过多率高表明存在宫内感染的风险，因此应仔细监测这些妇女的情况，包括COVID-19的影响，以及在免疫力下降的背景下激活潜伏感染，首先是违反阴道生物群落。与此同时，在这些妇女中发现肥胖的频率很高，这加剧了感染过程和主要生物群落的状况。因此，对这支妇女队伍来说，及时发现和纠正违反生殖道微生物病的问题，作为预防围产期和产科并发症的一个重要问题。为了避免阴道微生物病的变化对妇女及其孩子将来的状况产生负面影响，应在怀孕和哺乳期间使用现代普遍和安全的制剂进行局部治疗和加强再生过程，这些制剂不含抗菌成分，不会引起抗生素耐药性，并且有效，可获得且使用方便。近年来的临床经验允许在妇产科中广泛推荐安全有效的复杂局部制剂，包括氯己定、绿藻脂以及透明质酸和植物提取物制剂。
{"title":"The influence of the coronavirus disease transmitted during pregnancy on the course of gestation and changes in the main biotopes of a woman’s organism","authors":"I.A. Zhabchenko, I.S. Lishchenko, O.M. Bondarenko, T.M. Kovalenko","doi":"10.30841/2708-8731.5.2023.286765","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286765","url":null,"abstract":"The article presents literature data on the peculiarities of the pregnancy course and changes in the main biotopes in women who suffered from COVID-19 in different periods of gestation. Certain regularities regarding the association of perinatal complications with the severity of the disease, the presence of somatic and gynecological pathology in these pregnant women, in particular, obesity and chronic inflammatory diseases of the genital organs, were observed.According to research conducted on the basis of the department of pathology of pregnancy and childbirth of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. M. Lukyanova of the National Academy of Sciences of Ukraine», the risk group of a severe course of the coronavirus disease includes all the same factors as for any other diseases, not related to pregnancy: age over 35 years; the presence of concomitant pathology (diabetes, obesity, hypertension), work, lifestyle or housing conditions that increase the risk of infection. More frequent manifestations of obstetric pathology were found in older women and primipara women.Complicated obstetric anamnesis, namely, medical abortions and miscarriages, cervical pathology, previous inflammatory diseases, especially of the genital organs, are considered to be risk factors. The course of pregnancy and childbirth are accompanied by such complications as the threat of early miscarriage; anemia; combination of placental dysfunction, polyhydramnios and fetal distress; anomalies uterine activity, which increases the frequency of pathological childbirth in this contingent of women and requires repeated hospitalization during pregnancy.A review of scientific publications in recent years demonstrates the significant impact of COVID-19 on the composition of biotopes of the human organism. There are convincing data on the close relationship between the infection of the mucous membranes of the upper respiratory tract and the infection of the lungs with the SARS-CoV-2 virus. Lung hypoxia, typical for this infection, causes the growth of anaerobes and facultative anaerobes, which are part of the mentioned microbiomes during a person’s life. A significant number of observations have found the correlation of changes in the microbiocenosis of the respiratory tract and intestines in patients with SARS-CoV-2 and convalescents. At the same time, there is also a disorder in the vaginal microbiocenosis after the coronavirus disease, especially during pregnancy. A conclusion was made regarding the correlation between the severity of COVID-19 course and the number of lactobacilli in the vaginal biotope: the more severe course, the worse of the microflora composition. The gestation period is more often complicated by the threat of early pregnancy loss, placental dysfunction, polyhydramnios, fetal distress, and the threat of premature birth in those women who suffered a coronavirus infection in the I trimester. A large rate ","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357895","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}
Seborrheic keratosis (SK) remains the leader among benign skin pathologies. In the classical sense, extragenital foci of this dermatosis look like light or dark brown papules with dense hyperkeratotic or verrucous layers. Such a clinical picture is characteristic of the typical form of foci of skin lesions. The etiopathogenetic mechanisms of SK appearance are not sufficiently studied, because a large number of trigger factors are reported. Given the benign profile of these lesions, practitional doctors very often do not pay much attention to these foci. While for patients, their appearance and increase in size can cause the emergence of obsessive or anxiety states both due to the development of cancer-phobic states due to significant aesthetic discomfort.The objective: to determine the peculiarities of the course of seborrheic keratosis in women, taking into account anamnestic data on the effect of insolation on the skin and phenotypic criteria represented by the skin phototype, as well as to analyze the dermatological quality of life indicator in patients with keratosis depending on the location of neoplasms.Materials and methods. Based on the Educational and Scientific Medical Center «University Clinic» of Zaporizhzhia State Medical and Pharmaceutical University, 50 patients with foci of seborrheic keratosis, whose ages ranged from 27 to 80 years old, were examined. To verify the diagnosis, the following parameters were carried out: a clinical examination of neoplasms with an assessment of the phenotypic criterion – skin phototype according to Fitzpatrick, dermatoscopic and pathomorphological examination. The assessment of the impact of keratosis on the quality of life of patients was based on the calculation of the results of the DLQI (Dermatology Life Quality Index) questionnaire.Results. The studied sample is represented by the majority of representatives of the II phototype – 44 persons and a small number of the III phototype – 6 patients, which amounted to 88% and 12%, respectively. The most frequent localization of keratosis was the head – 18 (36%), torso – 11 (22%), extremities – 13 (26%), and neck – 8 (16%). This location on open areas of the body can be an additional confirmation of the effect of ultraviolet radiation on the occurrence of keratosis. According to the results of the questionnaire with the study of anamnestic data, more than half of the examined patients (58%) had skin burns after a long stay in the open sun. In addition, an insufficient level of use of photoprotective agents was determined. All these factors can be as triggers for the appearance of keratosis foci and negatively affect the self-esteem and aesthetic appeal of patients. Indeed, when efflorescences are located in visual areas of the body, the dominant factor is a decrease in the quality of life.Conclusions. Predominance of patients with II skin phototype (88%) and lack of photoprotection skills (48% never use sunscreen, 32% sometimes) are the most influentia
脂溢性角化病(SK)仍然是良性皮肤病理的领导者。在经典意义上，这种皮肤病的生殖器外灶看起来像浅或深棕色的丘疹，有密集的角化过度或疣状层。这种临床图像是典型形式的皮肤病变灶的特征。由于大量的触发因素被报道，SK出现的发病机制尚未得到充分的研究。鉴于这些病变的良性特征，执业医生往往不太注意这些病灶。而对于患者来说，它们的外观和尺寸的增加可能会导致强迫或焦虑状态的出现，这是由于癌症恐惧症的发展，这是由于明显的审美不适。目的:确定女性脂溢性角化病病程的特殊性，考虑到日晒对皮肤影响的记忆数据和以皮肤光型为代表的表型标准，并根据肿瘤的位置分析角化病患者的皮肤生活质量指标。材料和方法。对50例脂溢性角化灶患者(年龄27 ~ 80岁)进行了回顾性分析。为了验证诊断，进行了以下参数:肿瘤的临床检查，并根据Fitzpatrick评估表型标准-皮肤光型，皮肤镜和病理形态学检查。评估角化病对患者生活质量的影响是基于DLQI (Dermatology life quality Index)问卷结果的计算。研究样本以II型代表44人占多数，III型代表6人占少数，分别占88%和12%。角化病最常见的部位是头部18例(36%)、躯干11例(22%)、四肢13例(26%)和颈部8例(16%)。在身体开放区域的这个位置可以进一步证实紫外线辐射对角化病发生的影响。根据对记忆数据研究的问卷调查结果，超过一半(58%)的被检查患者在长时间暴露在阳光下后出现皮肤烧伤。此外，还确定了光防护剂的使用水平不足。这些因素都可能是角化灶出现的诱因，对患者的自尊心和审美情趣产生负面影响。事实上，当红肿出现在身体的视觉区域时，主要因素是生活质量的下降。II型皮肤光型患者的优势(88%)和缺乏光防护技能(48%从不使用防晒霜，32%有时使用)是确定日晒是脂溢性角化瘤形成的主要诱因之一的最重要因素。角化病集中在身体开放部位的局限性更大程度上对女性的生活质量产生负面影响，DLQI指数更高，为7分，而躯干角化的女性为5分。因此，提高患者对阳光照射的认识，使用光防护和定期检查是各级医生的首要任务。
{"title":"Peculiarities of the course of seborrheic keratosis of extragenital localization among the female population","authors":"L.O. Cherneda, V.G. Siusiuka, A.V. Golovkin, M.Y. Sergienko","doi":"10.30841/2708-8731.5.2023.286767","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286767","url":null,"abstract":"Seborrheic keratosis (SK) remains the leader among benign skin pathologies. In the classical sense, extragenital foci of this dermatosis look like light or dark brown papules with dense hyperkeratotic or verrucous layers. Such a clinical picture is characteristic of the typical form of foci of skin lesions. The etiopathogenetic mechanisms of SK appearance are not sufficiently studied, because a large number of trigger factors are reported. Given the benign profile of these lesions, practitional doctors very often do not pay much attention to these foci. While for patients, their appearance and increase in size can cause the emergence of obsessive or anxiety states both due to the development of cancer-phobic states due to significant aesthetic discomfort.The objective: to determine the peculiarities of the course of seborrheic keratosis in women, taking into account anamnestic data on the effect of insolation on the skin and phenotypic criteria represented by the skin phototype, as well as to analyze the dermatological quality of life indicator in patients with keratosis depending on the location of neoplasms.Materials and methods. Based on the Educational and Scientific Medical Center «University Clinic» of Zaporizhzhia State Medical and Pharmaceutical University, 50 patients with foci of seborrheic keratosis, whose ages ranged from 27 to 80 years old, were examined. To verify the diagnosis, the following parameters were carried out: a clinical examination of neoplasms with an assessment of the phenotypic criterion – skin phototype according to Fitzpatrick, dermatoscopic and pathomorphological examination. The assessment of the impact of keratosis on the quality of life of patients was based on the calculation of the results of the DLQI (Dermatology Life Quality Index) questionnaire.Results. The studied sample is represented by the majority of representatives of the II phototype – 44 persons and a small number of the III phototype – 6 patients, which amounted to 88% and 12%, respectively. The most frequent localization of keratosis was the head – 18 (36%), torso – 11 (22%), extremities – 13 (26%), and neck – 8 (16%). This location on open areas of the body can be an additional confirmation of the effect of ultraviolet radiation on the occurrence of keratosis. According to the results of the questionnaire with the study of anamnestic data, more than half of the examined patients (58%) had skin burns after a long stay in the open sun. In addition, an insufficient level of use of photoprotective agents was determined. All these factors can be as triggers for the appearance of keratosis foci and negatively affect the self-esteem and aesthetic appeal of patients. Indeed, when efflorescences are located in visual areas of the body, the dominant factor is a decrease in the quality of life.Conclusions. Predominance of patients with II skin phototype (88%) and lack of photoprotection skills (48% never use sunscreen, 32% sometimes) are the most influentia","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135358110","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: 10.30841/2708-8731.5.2023.286771
O.M. Proshchenko, D.O. Govseev
The article presents data on the association of the rs1800012 polymorphism of the procollagen type I alpha (α) 1 COL1A1 gene and the stigma of non-differentiated connective tissue dysplasia with the development of vaginal prolapse in the Ukrainian population.The objective: to determine the prognostic significance of the rs1800012 polymorphism of the procollagen type I alpha (α) 1 COL1A1 gene and the clinical and anamnestic stigmata of non-differentiated connective tissue dysplasia as factors associated with the development of vaginal prolapse in the Ukrainian population.Materials and methods. In order to achieve the research aim, polymorphism in the rs1800012 locus of the COL1A1 gene was studied by polymerase chain reaction in venous blood samples of 120 women. The main group included 60 patients with vaginal prolapse III, IV, who had indications for surgical correction; to the comparison group – 60 women without pelvic floor dysfunction.The diagnostic algorithm included a physical examination, taking the general and gynecological history, evaluation of the state of the pelvic floor and urogenital dysfunction. The severity of pelvic floor prolapse was assessed based on the Pelvic Organ Prolapse Quantification (POP-Q) classification.Results. During the analysis of clinical and anamnestic data in women of both research groups, concomitant pathology with a possible connection with signs of non-differentiated connective tissue dysplasia was identified as risk factors for the development of pelvic floor dysfunction: 37 people in the main group versus 21 patients in the comparison group (χ2=8.5428; p=.003469).The prevalence of rs1800012 polymorphism of the gene procollagen type I alpha (α) 1 COL1A1 in the homozygous variant (TT) in this study was found in the main group in 8 samples (13.33%) and only in 2 (3.33%) – in the comparison group. The presented polymorphism in the heterozygous variant (GT) in the main group was determined in 19 samples (31.67%) and only in 12 (20.00%) – in the comparison group (χ2=7.3199; p=.025734).Conclusions. The association of the rs1800012 polymorphism in the COL1A1 gene (p=.025734) and clinical and anamnestic stigmata of non-differentiated connective tissue dysplasia (NDST) (p=.003469) with the development of pelvic organ prolapse was established, which is evidence of the importance of genetic changes and connective tissue remodeling in the etiology of genital prolapseThe presence of NDST stigma increases the risk of pelvic organ prolapse by 3 times (OR=3.788; 95% CI: 1.664–8.624), polymorphism rs1800012 in the COL1A1 gene – by 2 times with the heterozygous variant (OR=2.400; 95% CI: 1.230–6.633) and 3 times with the homozygous variant (OR=3.275; 95% CI: 1.300–19.969).
{"title":"Evaluation of COL1A1 gene rs1800012 polymorphism and non-differentiated connective tissue dysplasia as predictors of pelvic organ prolapse","authors":"O.M. Proshchenko, D.O. Govseev","doi":"10.30841/2708-8731.5.2023.286771","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286771","url":null,"abstract":"The article presents data on the association of the rs1800012 polymorphism of the procollagen type I alpha (α) 1 COL1A1 gene and the stigma of non-differentiated connective tissue dysplasia with the development of vaginal prolapse in the Ukrainian population.The objective: to determine the prognostic significance of the rs1800012 polymorphism of the procollagen type I alpha (α) 1 COL1A1 gene and the clinical and anamnestic stigmata of non-differentiated connective tissue dysplasia as factors associated with the development of vaginal prolapse in the Ukrainian population.Materials and methods. In order to achieve the research aim, polymorphism in the rs1800012 locus of the COL1A1 gene was studied by polymerase chain reaction in venous blood samples of 120 women. The main group included 60 patients with vaginal prolapse III, IV, who had indications for surgical correction; to the comparison group – 60 women without pelvic floor dysfunction.The diagnostic algorithm included a physical examination, taking the general and gynecological history, evaluation of the state of the pelvic floor and urogenital dysfunction. The severity of pelvic floor prolapse was assessed based on the Pelvic Organ Prolapse Quantification (POP-Q) classification.Results. During the analysis of clinical and anamnestic data in women of both research groups, concomitant pathology with a possible connection with signs of non-differentiated connective tissue dysplasia was identified as risk factors for the development of pelvic floor dysfunction: 37 people in the main group versus 21 patients in the comparison group (χ2=8.5428; p=.003469).The prevalence of rs1800012 polymorphism of the gene procollagen type I alpha (α) 1 COL1A1 in the homozygous variant (TT) in this study was found in the main group in 8 samples (13.33%) and only in 2 (3.33%) – in the comparison group. The presented polymorphism in the heterozygous variant (GT) in the main group was determined in 19 samples (31.67%) and only in 12 (20.00%) – in the comparison group (χ2=7.3199; p=.025734).Conclusions. The association of the rs1800012 polymorphism in the COL1A1 gene (p=.025734) and clinical and anamnestic stigmata of non-differentiated connective tissue dysplasia (NDST) (p=.003469) with the development of pelvic organ prolapse was established, which is evidence of the importance of genetic changes and connective tissue remodeling in the etiology of genital prolapseThe presence of NDST stigma increases the risk of pelvic organ prolapse by 3 times (OR=3.788; 95% CI: 1.664–8.624), polymorphism rs1800012 in the COL1A1 gene – by 2 times with the heterozygous variant (OR=2.400; 95% CI: 1.230–6.633) and 3 times with the homozygous variant (OR=3.275; 95% CI: 1.300–19.969).","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357892","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}
Although, nausea and vomiting in early pregnancy is very common, affecting approximately 80% of pregnancies, hyperemesis gravidarum (HG) is a severe form that complicates up to 2.2% of pregnancies. HG is one of the most common indications for hospitalization during pregnancy. In addition to the insufficient nutrition both for the mother and fetus, the severity of HG symptoms causes a serious psychosocial stress, which leads to depression, anxiety and even the development of perinatal pathology. The aim of this meta-analysis was to study available randomized controlled trials about therapeutic strategies by HG, their evaluation based on both subjective and objective measures of efficacy, maternal and fetal/neonatal safety, and economic costs.A systematic data search was conducted using the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and publications in professional editions of Ukraine for 2013–2023. The search was conducted using the following keywords: pregnancy, nausea and vomiting of pregnant women, excessive vomiting of pregnancy, hyperemesis, antiemetic therapy during pregnancy, infusion therapy and the safety profile of medications prescribed during pregnancy in various combinations.The main outcome was: the effectiveness of therapeutic strategies (reduction or stopping nausea/vomiting); detailing by safety profile of antiemetic drugs; optimization of infusion therapy; additional clinical strategies that help to improve the quality of care for pregnant women; adverse effects and side effects of drugs for HG for the mother/fetus/newborn.The results presented in this meta-analysis can be used in the creation of a national clinical guideline, protocol, consensus or clinical recommendations regarding the clinical management of hyperemesis gravidarum.
尽管妊娠早期恶心和呕吐很常见，影响了大约80%的妊娠，但妊娠剧吐(HG)是一种严重的形式，高达2.2%的妊娠并发症。HG是妊娠期住院治疗最常见的适应症之一。除了母亲和胎儿的营养不足外，HG症状的严重性还会导致严重的社会心理压力，从而导致抑郁、焦虑甚至围产期病理的发展。本荟萃分析的目的是研究现有的关于HG治疗策略的随机对照试验，以及基于主观和客观疗效、孕产妇和胎儿/新生儿安全性和经济成本的评估。使用MEDLINE、ISI Web of Science、PubMed、Scopus、Google Scholar、Cochrane Database of systematic Reviews和乌克兰2013-2023年专业版出版物等数据库进行系统数据检索。搜索的关键词是:妊娠、孕妇恶心呕吐、妊娠过度呕吐、剧吐、妊娠止吐治疗、输液治疗以及妊娠期间各种联合用药的安全性。主要结果是:治疗策略的有效性(减少或停止恶心/呕吐);止吐药的安全性分析;输液治疗优化;帮助提高孕妇护理质量的其他临床策略;治疗HG的药物对母亲/胎儿/新生儿的不良反应和副作用。本荟萃分析的结果可用于制定关于妊娠剧吐临床管理的国家临床指南、方案、共识或临床建议。
{"title":"The modern aspects of the optimal therapeutic strategy of hyperemesis gravidarum","authors":"V.I. Medved, D.H. Konkov, R.O. Tkachenko, O.A. Muntian","doi":"10.30841/2708-8731.5.2023.286769","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286769","url":null,"abstract":"Although, nausea and vomiting in early pregnancy is very common, affecting approximately 80% of pregnancies, hyperemesis gravidarum (HG) is a severe form that complicates up to 2.2% of pregnancies. HG is one of the most common indications for hospitalization during pregnancy. In addition to the insufficient nutrition both for the mother and fetus, the severity of HG symptoms causes a serious psychosocial stress, which leads to depression, anxiety and even the development of perinatal pathology. The aim of this meta-analysis was to study available randomized controlled trials about therapeutic strategies by HG, their evaluation based on both subjective and objective measures of efficacy, maternal and fetal/neonatal safety, and economic costs.A systematic data search was conducted using the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and publications in professional editions of Ukraine for 2013–2023. The search was conducted using the following keywords: pregnancy, nausea and vomiting of pregnant women, excessive vomiting of pregnancy, hyperemesis, antiemetic therapy during pregnancy, infusion therapy and the safety profile of medications prescribed during pregnancy in various combinations.The main outcome was: the effectiveness of therapeutic strategies (reduction or stopping nausea/vomiting); detailing by safety profile of antiemetic drugs; optimization of infusion therapy; additional clinical strategies that help to improve the quality of care for pregnant women; adverse effects and side effects of drugs for HG for the mother/fetus/newborn.The results presented in this meta-analysis can be used in the creation of a national clinical guideline, protocol, consensus or clinical recommendations regarding the clinical management of hyperemesis gravidarum.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357891","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 objective: to study the state of the immune system in women with pathology of the mammary glands and infertility, and on the background of menstrual cycle disorders.Materials and methods. The research was performed in two stages. The first (1) stage included examination of women with infertility associated with anovulation who had breast pathology. These patients were divided into three groups: 1.1 group – 44 patients with diffuse fibrocystic breast disease (FBD), 1.2 group – 4 patients with fibroadenoma of the mammary glands, 1.3 group (control one) – 37 patients without pathological changes in the mammary glands.During the second (2) stage of the study, 110 women were examined: 2.1 group – 52 patients with regular menstruations and luteal phase insufficiency (LPI) and 2.2 group – 58 patients with anovulatory cycles.During two research stages, the immune status (CD3, CD4, CD8, immunoregulatory index (CD4/CD8), CD72, CD16, circulating immune complexes) and cytokine profile (IL-1, IL-2, IL-6, TNF-α, INF) in venous blood were determined. Differences were considered statistically significant at p<0.05.Results. A significant increase in the CD8 index was found in the group of patients with normal mammary glands (34.7±6.9 pg/ml; p<0.05) and with a diffuse form of FBD (35.13±6.9 pg/ml; p<0.05) versus its normal level in the group of patients with fibroadenoma (26.5±15.9 pg/ml; p>0.05).During the analysis of the CD16 level, it was determined its significantly increased to 18.8±3.1 pg/ml (р<0.05) in patients with LPI and regular menstrual cycle and to 26.3±4.8 pg/ml (р< 0.05) – in patients with anovulation without LPI, the difference between the groups was significant. The level of CD16 was significantly higher in anovulatory menstrual cycle disorder without LPI compared to patients with menstrual cycle disorder and LPI.The concentration of TNF-α in patients with a regular menstrual cycle (998.1±166.3 pg/ml; p<0.05) and with an anovulatory cycle without LPI (1029.3±187.1 pg/ml; p<0.05) was significantly higher compared to normal values (778.5±64.0 pg/ml). The level of IL-2 was significantly lower than normal indices. Thus, in the group of women with LPI, this indicator was 17.13±2.85 pg/ml (р<0.05), and by anovulation without LPI – 16.84±3.07 pg/ml (р<0.05) versus normal parameter 22.29±0.81 pg/ml.Conclusions. In patients with diseases of the mammary glands and infertility associated with anovulation without LPI, a significant decrease in the activity of T2-helpers (IL-2) and an increase in the activity of T1-helpers (TNF-α) were determined in cases of anovulation without LPI compared with cases of luteal phase insufficiency.
{"title":"Immunological disorders in patients with mammary gland pathology in infertility associated with anovulation","authors":"S.Е. Gladenko, I.P. Netskar, O.M. Susidko, O.A. Kovalishin","doi":"10.30841/2708-8731.5.2023.286766","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286766","url":null,"abstract":"The objective: to study the state of the immune system in women with pathology of the mammary glands and infertility, and on the background of menstrual cycle disorders.Materials and methods. The research was performed in two stages. The first (1) stage included examination of women with infertility associated with anovulation who had breast pathology. These patients were divided into three groups: 1.1 group – 44 patients with diffuse fibrocystic breast disease (FBD), 1.2 group – 4 patients with fibroadenoma of the mammary glands, 1.3 group (control one) – 37 patients without pathological changes in the mammary glands.During the second (2) stage of the study, 110 women were examined: 2.1 group – 52 patients with regular menstruations and luteal phase insufficiency (LPI) and 2.2 group – 58 patients with anovulatory cycles.During two research stages, the immune status (CD3, CD4, CD8, immunoregulatory index (CD4/CD8), CD72, CD16, circulating immune complexes) and cytokine profile (IL-1, IL-2, IL-6, TNF-α, INF) in venous blood were determined. Differences were considered statistically significant at p<0.05.Results. A significant increase in the CD8 index was found in the group of patients with normal mammary glands (34.7±6.9 pg/ml; p<0.05) and with a diffuse form of FBD (35.13±6.9 pg/ml; p<0.05) versus its normal level in the group of patients with fibroadenoma (26.5±15.9 pg/ml; p>0.05).During the analysis of the CD16 level, it was determined its significantly increased to 18.8±3.1 pg/ml (р<0.05) in patients with LPI and regular menstrual cycle and to 26.3±4.8 pg/ml (р< 0.05) – in patients with anovulation without LPI, the difference between the groups was significant. The level of CD16 was significantly higher in anovulatory menstrual cycle disorder without LPI compared to patients with menstrual cycle disorder and LPI.The concentration of TNF-α in patients with a regular menstrual cycle (998.1±166.3 pg/ml; p<0.05) and with an anovulatory cycle without LPI (1029.3±187.1 pg/ml; p<0.05) was significantly higher compared to normal values (778.5±64.0 pg/ml). The level of IL-2 was significantly lower than normal indices. Thus, in the group of women with LPI, this indicator was 17.13±2.85 pg/ml (р<0.05), and by anovulation without LPI – 16.84±3.07 pg/ml (р<0.05) versus normal parameter 22.29±0.81 pg/ml.Conclusions. In patients with diseases of the mammary glands and infertility associated with anovulation without LPI, a significant decrease in the activity of T2-helpers (IL-2) and an increase in the activity of T1-helpers (TNF-α) were determined in cases of anovulation without LPI compared with cases of luteal phase insufficiency.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135358096","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}
Today, in the education system, an important opportunity for higher education applicants is the right to form an individual educational trajectory according to the relevant qualification level. Higher education seekers have received not only academic mobility but also the opportunity to study disciplines to consciously choose their specialty and study it more deeply. The skills of ultrasound diagnostics increase the professional level of a doctor of any specialization and open wide diagnostic possibilities.The article reveals the peculiarity of studying one of the subjects of free choice by medical higher education applicants on the basis of Odesa National Medical University – “Ultrasound Diagnostics in Obstetrics and Gynaecology”. The adaptation of the educational process in a mixed format with the possibility of using digital learning technologies and mastering professional skills on ultrasound machines of different classes is described. In the course of studying the discipline, the necessary basic digital skills of using an ultrasound scanner and knowledge of the main visualization modes, adjustment principles, as well as sets of functional capabilities inherent in all modern devices are formed.The method of presentation of theoretical information and the use of case scenarios during the discussion of clinical tasks with mandatory visualization of ultrasound video recordings is described. The applicants’ digital skills are directly related to the course being studied and are necessary to master the proposed professional field. The possibility of learning using the latest medical equipment in combination with the use of digital learning tools and video resources contributes to the acquisition of professional competence and the formation of responsibility and interest of students. In the process of training manual scanning skills, the doctor’s thinking and the ability to analyze and interpret the received ultrasound data are formed. Practical classes help to discuss the most interesting issues for this specific group of higher education applicants in a comfortable and trusting environment. The use of a combined approach in the presentation of the material, the author’s style and the format of the transfer of professional skills by experienced teachers who are engaged in constant practical activities motivate, improve the training process and give a high result.
{"title":"Studying the discipline of free choice «Ultrasound Diagnostics in Obstetrics and Gynaecology»","authors":"I.A. Ancheva, I.Z. Gladchuk, E.M. Mokriienko, N.V. Movlyanova, N.V. Lazor","doi":"10.30841/2708-8731.5.2023.286764","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286764","url":null,"abstract":"Today, in the education system, an important opportunity for higher education applicants is the right to form an individual educational trajectory according to the relevant qualification level. Higher education seekers have received not only academic mobility but also the opportunity to study disciplines to consciously choose their specialty and study it more deeply. The skills of ultrasound diagnostics increase the professional level of a doctor of any specialization and open wide diagnostic possibilities.The article reveals the peculiarity of studying one of the subjects of free choice by medical higher education applicants on the basis of Odesa National Medical University – “Ultrasound Diagnostics in Obstetrics and Gynaecology”. The adaptation of the educational process in a mixed format with the possibility of using digital learning technologies and mastering professional skills on ultrasound machines of different classes is described. In the course of studying the discipline, the necessary basic digital skills of using an ultrasound scanner and knowledge of the main visualization modes, adjustment principles, as well as sets of functional capabilities inherent in all modern devices are formed.The method of presentation of theoretical information and the use of case scenarios during the discussion of clinical tasks with mandatory visualization of ultrasound video recordings is described. The applicants’ digital skills are directly related to the course being studied and are necessary to master the proposed professional field. The possibility of learning using the latest medical equipment in combination with the use of digital learning tools and video resources contributes to the acquisition of professional competence and the formation of responsibility and interest of students. In the process of training manual scanning skills, the doctor’s thinking and the ability to analyze and interpret the received ultrasound data are formed. Practical classes help to discuss the most interesting issues for this specific group of higher education applicants in a comfortable and trusting environment. The use of a combined approach in the presentation of the material, the author’s style and the format of the transfer of professional skills by experienced teachers who are engaged in constant practical activities motivate, improve the training process and give a high result.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357894","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}
Abnormally invasive placenta (AIP), or according to modern terminology PAS (placenta accrete spectrum disorders), is one of the most dangerous obstetric pathologies of pregnancy. It is quite often accompanied by massive blood loss during childbirth. Indicators of placenta accretion are increasing sharply, taking into account the frequency of delivery by cesarean section (CS).The objective: to determine the effectiveness of the blood loss recovery program in the case of delivery of pregnant women with AIP according to modern principles of transfusion therapy of massive blood loss with the use of innovative methods of surgical hemostasis.Materials and methods. At the clinical bases of the Department of Obstetrics and Gynecology N 1 of the Shupyk National Healthcare University of Ukraine during 2018–2023, 49 pregnant women with Placenta рercreta 3a,b were operated by fundal SC.The main group included 19 pregnant women with antenatally diagnosed Placenta percreta, who were delivered by fundal SC followed by hysterectomy with fallopian tubes and restoration of blood loss according to the principles of Damage Control Resuscitation – DCR (during 2021–2023) with priority given to transfusion with blood products with minimization infusion therapy; the comparison group included 30 pregnant women with a similar diagnosis and surgical approach, who had the recovery of massive blood loss in accordance with order No. 205 of the Ministry of Health of Ukraine “Obstetric bleeding” with the priority of rapid infusion therapy with crystalloids (2018-2020).Results. All pregnant women from Pl. percreta were delivered by CS and had hysterectomy at 35–37 weeks of pregnancy with lower median laparotomy and endotracheal anesthesia. The study groups did not differ in terms of the volume of surgery, but differed in the program of transfusion therapy to restore blood loss.In the main group, in which the early start of transfusion therapy using single-group fresh-frozen plasma and erythrocyte mass was applied, a significantly lower frequency of the development of the syndrome of disseminated intravascular blood coagulation, relaparotomy, cases of severe postoperative anemia and a shorter length of stay in the obstetric hospital were determined (p<0.05).Conclusions. The use of innovative surgical technologies, tranexamic acid preparations and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion, according to the Damage Control Resuscitation strategy, in the development of massive intraoperative bleeding in cases of Placenta percreta allows to reduce the volume of blood loss and to prevent severe intra- and postoperative complication.
{"title":"Modern approach to transfusion therapy of massive hemorrhage due to abnormally invasive placenta","authors":"О.V. Golyanovskiy, D.О. Dzyuba, О.V. Morozova, T.V. Gerasimova, O.A. Voloshyn, I.M. Golenia, O.P. Kononets","doi":"10.30841/2708-8731.5.2023.286768","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286768","url":null,"abstract":"Abnormally invasive placenta (AIP), or according to modern terminology PAS (placenta accrete spectrum disorders), is one of the most dangerous obstetric pathologies of pregnancy. It is quite often accompanied by massive blood loss during childbirth. Indicators of placenta accretion are increasing sharply, taking into account the frequency of delivery by cesarean section (CS).The objective: to determine the effectiveness of the blood loss recovery program in the case of delivery of pregnant women with AIP according to modern principles of transfusion therapy of massive blood loss with the use of innovative methods of surgical hemostasis.Materials and methods. At the clinical bases of the Department of Obstetrics and Gynecology N 1 of the Shupyk National Healthcare University of Ukraine during 2018–2023, 49 pregnant women with Placenta рercreta 3a,b were operated by fundal SC.The main group included 19 pregnant women with antenatally diagnosed Placenta percreta, who were delivered by fundal SC followed by hysterectomy with fallopian tubes and restoration of blood loss according to the principles of Damage Control Resuscitation – DCR (during 2021–2023) with priority given to transfusion with blood products with minimization infusion therapy; the comparison group included 30 pregnant women with a similar diagnosis and surgical approach, who had the recovery of massive blood loss in accordance with order No. 205 of the Ministry of Health of Ukraine “Obstetric bleeding” with the priority of rapid infusion therapy with crystalloids (2018-2020).Results. All pregnant women from Pl. percreta were delivered by CS and had hysterectomy at 35–37 weeks of pregnancy with lower median laparotomy and endotracheal anesthesia. The study groups did not differ in terms of the volume of surgery, but differed in the program of transfusion therapy to restore blood loss.In the main group, in which the early start of transfusion therapy using single-group fresh-frozen plasma and erythrocyte mass was applied, a significantly lower frequency of the development of the syndrome of disseminated intravascular blood coagulation, relaparotomy, cases of severe postoperative anemia and a shorter length of stay in the obstetric hospital were determined (p<0.05).Conclusions. The use of innovative surgical technologies, tranexamic acid preparations and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion, according to the Damage Control Resuscitation strategy, in the development of massive intraoperative bleeding in cases of Placenta percreta allows to reduce the volume of blood loss and to prevent severe intra- and postoperative complication.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357898","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 analysis of scientific information on the problem of chronic endometritis (CE) today. CE is a mysterious, multifactorial disease, the etiology, pathogenesis, and optimal treatment of which have not yet been definitively determined.Endometrial inflammation is a complex part of its physiology that is finely regulated by the balance between pro- and anti-inflammatory mechanisms and is involved in all reproductive events.Chronic inflammation stimulates hormone-independent cell proliferation, suppression of apoptosis processes, activation of tumor growth factors, invasion, tumor angiogenesis, and neovasculogenesis. The transformation of the inflammatory process occurs due to chronic leukocyte infiltration. The chronic inflammatory process provokes the development of dystrophic changes in the epithelium, the infiltration of the stroma by leukocytes and the destruction of intercellular contacts, which, in turn, leads to a decrease in the hermetic function of the epithelium and a violation of the differentiation of epithelial cells during the process of metaplasia. This process is accompanied by a disturbance of local humoral immunityMetabolic disorders such as diabetes, dyslipidemia, hypertension, and obesity have also been found to overactivate the immune system, causing leukocyte activation with increased numbers of their proinflammatory phenotypes, which explains the susceptibility to chronic inflammatory diseases.Infectious agents should no longer be considered the sole cause of CE. Any condition that disrupts the balance of the immune system can lead to temporary, recurrent, or persistent CE. The last one can have various dangerous clinical and paraclinical consequences.To date, there are no recommendations that would provide proper analysis or treatment of endometrial inflammation. Therefore, the definition of clinical signs for the assessment of the global risk of development of CE for female patients is relevant. The clinical assessment of the patient’s condition should take into account her age, lifestyle, body mass index, blood pressure, atopy, stress factor, signs of chronic inflammation, as well as history of diseases mediated by inflammation.Further research into this pathological condition and the development of effective ways to prevent it are particularly relevant, which can contribute to the improvement of women’s reproductive health and their fertility.
{"title":"Current global trends in the study of etiology, pathogenesis, diagnosis and treatment of chronic endometritis","authors":"N.V. Kosei, T.F. Tatarchuk, N.V. Vetokh, L.A. Vasylchenko","doi":"10.30841/2708-8731.5.2023.286763","DOIUrl":"https://doi.org/10.30841/2708-8731.5.2023.286763","url":null,"abstract":"The article is devoted to the analysis of scientific information on the problem of chronic endometritis (CE) today. CE is a mysterious, multifactorial disease, the etiology, pathogenesis, and optimal treatment of which have not yet been definitively determined.Endometrial inflammation is a complex part of its physiology that is finely regulated by the balance between pro- and anti-inflammatory mechanisms and is involved in all reproductive events.Chronic inflammation stimulates hormone-independent cell proliferation, suppression of apoptosis processes, activation of tumor growth factors, invasion, tumor angiogenesis, and neovasculogenesis. The transformation of the inflammatory process occurs due to chronic leukocyte infiltration. The chronic inflammatory process provokes the development of dystrophic changes in the epithelium, the infiltration of the stroma by leukocytes and the destruction of intercellular contacts, which, in turn, leads to a decrease in the hermetic function of the epithelium and a violation of the differentiation of epithelial cells during the process of metaplasia. This process is accompanied by a disturbance of local humoral immunityMetabolic disorders such as diabetes, dyslipidemia, hypertension, and obesity have also been found to overactivate the immune system, causing leukocyte activation with increased numbers of their proinflammatory phenotypes, which explains the susceptibility to chronic inflammatory diseases.Infectious agents should no longer be considered the sole cause of CE. Any condition that disrupts the balance of the immune system can lead to temporary, recurrent, or persistent CE. The last one can have various dangerous clinical and paraclinical consequences.To date, there are no recommendations that would provide proper analysis or treatment of endometrial inflammation. Therefore, the definition of clinical signs for the assessment of the global risk of development of CE for female patients is relevant. The clinical assessment of the patient’s condition should take into account her age, lifestyle, body mass index, blood pressure, atopy, stress factor, signs of chronic inflammation, as well as history of diseases mediated by inflammation.Further research into this pathological condition and the development of effective ways to prevent it are particularly relevant, which can contribute to the improvement of women’s reproductive health and their fertility.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135358115","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 : 2023-06-30DOI: 10.30841/2708-8731.4.2023.285767
V. O. Beniuk, V.M. Goncharenko, T.G. Laskava, O. Shcherba, L. Lastovetska, T. R. Nykoniuk, I. Maidannyk, Y.I. Veretelnyk
According to the data of the National Cancer Registry of Ukraine for 2021, the incidence of cervical cancer was 17.9 and the mortality rate was 7.9 per 100,000 female population. Therefore, in modern conditions, timely diagnosis, effective treatment and prevention of precancerous processes, which include cervical intraepithelial neoplasia (CIN) of the cervix, is one of the important tasks of a gynecologist. Women in perimenopause, who are traditionally considered to be at risk, deserve special attention.Today, there is information in the literature that multifactorial diseases account for 90–95% of all diseases, including cervical cancer. Epidemiological factors associated with human papillomavirus (HPV) prevalence are well known. The role of microbial-protozoan-viral associations in contributing to the occurrence of intraepithelial lesions and cervical cancer is being actively investigated.The objective: to assess the state of microbiocenosis and the functional activity of epithelial cells in perimenopausal women with recurrent CIN of the cervix.Materials and methods. 60 women of perimenopausal age with recurrent CIN of the cervix, which occurred after treatment with surgical methods (main group) and 38 healthy women of the appropriate age (control group) were examined. All patients were examined in accordance with the regulatory orders of the Ministry of Health of Ukraine, immunological studies, as well as determination of the electrokinetic activity of epithelial cells of the vagina and cervix according to the method of V. I. Shakhbazov in modification of V. O. Beniuk and co-authors.Results. The data of the anamnesis and clinical examination of the patients were evaluated, which allows to identify a risk group among women of perimenopausal age, according to the development of recurrent CIN of the cervix. During the study of the species composition of the vaginal microbiome in patients of the main group, a decrease in the number or complete absence of lactobacilli, a predominance of opportunistic vaginal flora in the cases with HPV infection was established. Peptostreptococci were found in 46.7 %, corynebacterial – in 61.7%, epidermal staphylococcus – in 66.7%, gardnerella – in 53.3%, Candida spp. – in 46.7% of cases and some specific pathogens versus the control group (7.9%, 23.7%, 10.5%, 15.8%, 5.3%, respectively). Also, in the main group, a significant decrease in the level of interferon-α (IFN) by 1.6 and IFN-γ by 1.9 times in blood serum was found.Studies of the electrokinetic activity of the epithelial cells of the vagina and cervix revealed a decrease of more than 2 times the corresponding indicators in the main group compared to the control group.Conclusions. In perimenopausal women with recurrent CIN of the cervix, profound violations of the vaginal microbiocenosis with the predominance of opportunistic flora, as well as insufficiency of interferonogenesis, decreased functional activity of epithelial cells, were determined.In general,
根据乌克兰国家癌症登记处2021年的数据，宫颈癌的发病率为17.9 / 10万，死亡率为7.9 / 10万。因此，在现代条件下，及时诊断、有效治疗和预防包括宫颈上皮内瘤变(CIN)在内的癌前病变是妇科医生的重要任务之一。传统上认为处于围绝经期的女性有患病风险，因此值得特别关注。今天，文献资料显示，多因素疾病占所有疾病的90-95%，包括宫颈癌。与人乳头瘤病毒(HPV)流行有关的流行病学因素是众所周知的。微生物-原生动物-病毒关联在上皮内病变和宫颈癌发生中的作用正在积极研究中。目的:评估围绝经期宫颈CIN复发妇女的微生物病状态和上皮细胞的功能活性。材料和方法。研究对象为经手术治疗后宫颈CIN复发的围绝经期妇女60例(主要组)和适龄健康妇女38例(对照组)。所有患者都按照乌克兰卫生部的监管命令、免疫学研究以及阴道和宫颈上皮细胞电动力学活性的测定进行了检查，检查方法根据V. I. Shakhbazov在V. O. Beniuk及其合作者修改的方法进行。对患者的记忆和临床检查数据进行评估，根据宫颈CIN复发的发展情况，确定围绝经期妇女的风险组。在研究主要组患者阴道微生物组的物种组成时，乳酸菌数量减少或完全缺乏，HPV感染病例中机会性阴道菌群占主导地位。与对照组相比，胃链球菌(46.7%)、棒状细菌(61.7%)、表皮葡萄球菌(66.7%)、加德纳菌(53.3%)、念珠菌(46.7%)和一些特定病原体(分别为7.9%、23.7%、10.5%、15.8%、5.3%)检出。主组血清中干扰素-α (IFN)水平下降1.6倍，IFN-γ水平下降1.9倍。对阴道和宫颈上皮细胞电动力学活性的研究显示，与对照组相比，主组相应指标下降2倍以上。在宫颈CIN复发的围绝经期妇女中，阴道微生物病严重侵犯，以机会性菌群为主，干扰素生成不足，上皮细胞功能活性下降。总的来说，根据本研究结果和现代科学数据，可以得出结论，在更年期生理变化的情况下，HPV与阴道微生物群的侵犯相关，显著增加了女性宫颈上皮内病变的发生和复发风险。因此，现有的宫颈CIN筛查方法和现代诊断管理对于提供高质量的医疗服务至关重要。
{"title":"Peculiarities of the vagina microbiome and functional activity of epithelial cells in cervical intraepithelial neoplasia of the cervix in women of perimenapausal age","authors":"V. O. Beniuk, V.M. Goncharenko, T.G. Laskava, O. Shcherba, L. Lastovetska, T. R. Nykoniuk, I. Maidannyk, Y.I. Veretelnyk","doi":"10.30841/2708-8731.4.2023.285767","DOIUrl":"https://doi.org/10.30841/2708-8731.4.2023.285767","url":null,"abstract":"According to the data of the National Cancer Registry of Ukraine for 2021, the incidence of cervical cancer was 17.9 and the mortality rate was 7.9 per 100,000 female population. Therefore, in modern conditions, timely diagnosis, effective treatment and prevention of precancerous processes, which include cervical intraepithelial neoplasia (CIN) of the cervix, is one of the important tasks of a gynecologist. Women in perimenopause, who are traditionally considered to be at risk, deserve special attention.Today, there is information in the literature that multifactorial diseases account for 90–95% of all diseases, including cervical cancer. Epidemiological factors associated with human papillomavirus (HPV) prevalence are well known. The role of microbial-protozoan-viral associations in contributing to the occurrence of intraepithelial lesions and cervical cancer is being actively investigated.The objective: to assess the state of microbiocenosis and the functional activity of epithelial cells in perimenopausal women with recurrent CIN of the cervix.Materials and methods. 60 women of perimenopausal age with recurrent CIN of the cervix, which occurred after treatment with surgical methods (main group) and 38 healthy women of the appropriate age (control group) were examined. All patients were examined in accordance with the regulatory orders of the Ministry of Health of Ukraine, immunological studies, as well as determination of the electrokinetic activity of epithelial cells of the vagina and cervix according to the method of V. I. Shakhbazov in modification of V. O. Beniuk and co-authors.Results. The data of the anamnesis and clinical examination of the patients were evaluated, which allows to identify a risk group among women of perimenopausal age, according to the development of recurrent CIN of the cervix. During the study of the species composition of the vaginal microbiome in patients of the main group, a decrease in the number or complete absence of lactobacilli, a predominance of opportunistic vaginal flora in the cases with HPV infection was established. Peptostreptococci were found in 46.7 %, corynebacterial – in 61.7%, epidermal staphylococcus – in 66.7%, gardnerella – in 53.3%, Candida spp. – in 46.7% of cases and some specific pathogens versus the control group (7.9%, 23.7%, 10.5%, 15.8%, 5.3%, respectively). Also, in the main group, a significant decrease in the level of interferon-α (IFN) by 1.6 and IFN-γ by 1.9 times in blood serum was found.Studies of the electrokinetic activity of the epithelial cells of the vagina and cervix revealed a decrease of more than 2 times the corresponding indicators in the main group compared to the control group.Conclusions. In perimenopausal women with recurrent CIN of the cervix, profound violations of the vaginal microbiocenosis with the predominance of opportunistic flora, as well as insufficiency of interferonogenesis, decreased functional activity of epithelial cells, were determined.In general, ","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88664996","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}
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