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Influence of hysterectomy due to leiomyoma on woman’s psychological status 子宫平滑肌瘤切除术对妇女心理状态的影响
Pub Date : 2023-02-28 DOI: 10.30841/2708-8731.1.2023.276247
О. Proshchenko, I. Ventskivska
The objective: to study the clinical-psychopathological features and psycho-emotional symptoms and borderline mental disorders in women of reproductive age after hysterectomy due to leiomyoma.Materials and methods. An assessment of the psychological state of 160 women after hysterectomy for leiomyoma was carried out. 90 patients of them (average age – 45.9±1.3 years old) had transvaginal hysterectomy, both classic and laparoscopically assisted one with opportunistic salpingectomy (I group) and 70 patients (average age – 47.2±1.6 years old) – abdominal hysterectomy with opportunistic salpingectomy (II group). The control group included 50 women 45.7±1.3 years old with asymptomatic leiomyoma. Clinical psychopathological, anamnestic and experimental psychological methods were used. Pathopsychological methods included methods of visual presentation of the personality profile using the Minnesota Multifaceted Personality Questionnaire. The survey was conducted at the pre-operative period, during the adaptation period and during 12 months. Statistical processing of monitoring data was carried out according to the φ-criterion using the statistical analysis software package STATISTICA v. 10 and Microsoft Office Excel application. Results. The results of the questionnaire determined that 44 (48.89 %) patients of the I group and 33 (47.14 %) women of the II group had disorders related to anxiety, and 6 (6.67 %) and 5 (7 .14 %) of the patients of both groups, respectively, were diagnosed depression before surgical treatment. After hysterectomy the number of patients with an anxiety disorder increased to 52 (57.78 %) in the I group and 41 (52.57 %) – II group, with depression – to 10 (11.11 %) and 8 (11.43 %) women, respectively. However, the psychopathological analysis with psychologists in 12 months after hysterectomy determined affective symptoms in 11 (15.7±7.0 %), and latent depression with a somatopsychic correlation, manifested by a feeling palpitation, cardialgias, vegetative disorders was found in 8 (11.4±6.0 %) cases. The type of personality accentuation influenced the development of psychoemotional manifestations. In this structure, the largest rate consisted of psychoasthenic and hysterical character traits. The age of the patient was important when analyzing additional psychological factors. Women under 44 years old associated hysterectomy with loss of femininity with premature aging of the organism. The patients with successful implementation of their role in the family and society had better postoperative psychological adaptation.Conclusions. There is a trend toward an increased number of anxiety and depressive disorders after hysterectomy in women with leiomyoma. After 12 months, affective symptoms were present in 11 (15.7±7.0 %) cases and in 8 (11.4±6.0 %) cases – hidden depression. Postoperative rehabilitation should include a consultation with a psychologist to identify and treat borderline mental disorders, which will lead to the initiatio
目的:探讨子宫平滑肌瘤切除术后育龄妇女的临床精神病理特点、心理情绪症状及边缘性精神障碍。材料和方法。对160例子宫平滑肌瘤切除术后妇女的心理状态进行了评估。其中经阴道子宫切除术90例(平均年龄- 45.9±1.3岁),经经典子宫切除术和腹腔镜辅助下机会性输卵管切除术各1例(I组),经腹部子宫切除术并机会性输卵管切除术70例(平均年龄- 47.2±1.6岁)(II组)。对照组女性50例,年龄45.7±1.3岁,无症状平滑肌瘤。采用临床精神病理学、记忆学和实验心理学方法。病理心理学方法包括使用明尼苏达多面人格问卷对人格轮廓进行视觉呈现的方法。调查分别在术前、适应期和12个月内进行。采用统计分析软件包STATISTICA v. 10和Microsoft Office Excel应用程序,按照φ-准则对监测数据进行统计处理。结果。问卷结果确定,I组44例(48.89%)和II组33例(47.14%)女性存在焦虑相关障碍,两组患者术前分别有6例(6.67%)和5例(7.14%)被诊断为抑郁症。子宫切除术后,I组有焦虑障碍的患者增加到52例(57.78%),II组有抑郁障碍的患者增加到41例(52.57%),分别为10例(11.11%)和8例(11.43%)。然而,在子宫切除术后12个月的心理病理分析中,有11例(15.7±7.0%)出现情感性症状,8例(11.4±6.0%)出现伴有躯体心理相关的潜在抑郁,表现为感觉性心悸、心绞痛、营养障碍。人格强化类型影响心理情绪表现的发展。在这个结构中,最大的比例是精神衰弱和歇斯底里的性格特征。在分析其他心理因素时,患者的年龄很重要。44岁以下的妇女子宫切除术与丧失女性气质和机体过早衰老有关。成功履行家庭和社会角色的患者有较好的术后心理适应能力。子宫平滑肌瘤患者在子宫切除术后出现焦虑和抑郁障碍的趋势有所增加。12个月后,11例(15.7±7.0%)出现情感性症状,8例(11.4±6.0%)出现隐蔽性抑郁。术后康复应包括咨询心理学家,以识别和治疗边缘性精神障碍,这将导致身体的代偿和适应性反应的启动,以及心理情绪状态的正常化。
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引用次数: 0
Planning and use of oncoplastic surgery for breast cancer 乳腺癌肿瘤整形手术的计划和应用
Pub Date : 2023-02-28 DOI: 10.30841/2708-8731.1.2023.276256
A. Samusieva, R. Liubota, V. Zaichuk, O.V. Ponomarova, I. Liubota
Today, breast conserving surgery among women with different stages of breast cancer is increasing. In addition, these operations do not differ in oncological radicality and do not show differences in relation to survival compared to mastectomy, but their cosmetic and psychological benefits are significant. In search of a balance between the risk of local recurrence and cosmetic results in surgical interventions in breast cancer, new surgical variants were introduced – a combination of breast conserving surgery with plastic surgery, so-called oncoplastic surgery. Oncoplastic surgery has been widely developed in the surgical treatment of breast cancer in the last decade. In oncoplastic breast surgery, the tumors of the upper-inner quadrant of the breast are problematic and require more attention of the surgeon. In these cases the size and location of the tumor are two important factors for the post-operative cosmetic outcome. In this article we introduce a modified dermoglandular rotation flap technique, which can be applied for relatively large tumors of inner quadrant of the breast without surgery of the contralateral breast for symmetrical effect. With this technique, a larger breast tumor could be removed without compromising the breast appearance. An important aspect of breast conserving surgery is preoperative evaluation of the clinical and biological features of the tumor as well as the morphological aspects of tumor allow the surgeon to make a decision if a conservative is possible and select the most effective oncoplastic surgical technique. Oncoplastic techniques may improve cosmetic view and patient satisfaction without compromising the oncological outcomes, which is confirms the clinical utility of this approach to the surgical management of patients with breast cancer. The article also presents clinical cases – 46 years old patient with left breast cancer (stage I cT1N0M0 pT1N0M0) and a patient of 42 years old with right breast cancer (stage I cT1NXM0 pT1N0M0) in the treatment of which the described technique was applied.
今天,在不同阶段的乳腺癌妇女中,乳房保留手术正在增加。此外,与乳房切除术相比,这些手术在肿瘤根治性方面没有差异,在生存方面也没有差异,但它们在美容和心理上的好处是显著的。在乳腺癌手术治疗中,为了在局部复发的风险和美容效果之间寻求平衡,新的手术变体被引入——保乳手术与整形手术的结合,即所谓的肿瘤整形手术。在过去的十年中,肿瘤整形手术在乳腺癌的外科治疗中得到了广泛的发展。在乳腺肿瘤整形手术中,乳房上内象限的肿瘤是有问题的,需要外科医生更多的关注。在这些病例中,肿瘤的大小和位置是影响术后美容效果的两个重要因素。本文介绍一种改良的真皮腺体旋转皮瓣技术,可用于乳房内象限较大的肿瘤,而无需对侧乳房进行手术,达到对称效果。使用这种技术,可以在不影响乳房外观的情况下切除较大的乳房肿瘤。保乳手术的一个重要方面是术前对肿瘤的临床和生物学特征以及肿瘤的形态学特征进行评估,以便外科医生决定是否可以进行保守手术,并选择最有效的肿瘤整形手术技术。肿瘤整形技术可以在不影响肿瘤预后的情况下改善美容效果和患者满意度,这证实了该方法在乳腺癌患者手术治疗中的临床应用。本文还介绍了临床病例- 46岁的左乳腺癌患者(I期cT1N0M0 pT1N0M0)和42岁的右乳腺癌患者(I期cT1NXM0 pT1N0M0)在治疗中应用了上述技术。
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引用次数: 0
The role of isthmic-cervical insufficiency in miscarriage 缺血性-宫颈功能不全在流产中的作用
Pub Date : 2023-01-30 DOI: 10.30841/2708-8731.7.2022.272473
О.V. Golyanovsky, O.Z. Morozova, K. Supruniuk, S. V. Frolov
Cervical insufficiency (CI) is one of the main pathological conditions that leads to pregnancy loss, in particular, recurrence miscarriages and premature births, which account for up to 5 % of all obstetric cases. Recurrence pregnancy losses caused by CI lead to serious psychological trauma for both the woman and her family members, as well as significant economic losses for the society. However, many women in some regions of the world still do not know about this pathology, and clinicians do not always diagnose this condition in time.At the same time, etiology of CI remains uncertain, and there are still ambiguous points regarding the diagnosis of this pathology and its treatment. The diagnosis of CI should be established by analyzing the medical history, clinical manifestations and results of ultrasound examination. Treatment of CI mainly includes surgical and conservative methods. Surgical treatment is performed with cervical cerclage, while conservative techniques mainly include the use of vaginal progesterone and insertion of various types cervical pessaries. This article summarizes the potential risk factors associated with cervical insufficiency that are of great attention and may be useful for future researches. Also, the review of the literature considers modern methods of diagnosis and treatment of CI to understand this pathology of the cervix better. From a modern standpoint, a consensus and problematic issues are presented in accordance with the recently updated recommendations, which are of practical importance, and are also important for further deeper research on this topical issue of modern obstetrics.
宫颈功能不全(CI)是导致妊娠丧失的主要病理状况之一,尤其是复发性流产和早产,占所有产科病例的5%。CI引起的复发性流产不仅给妇女及其家庭成员造成严重的心理创伤,也给社会造成重大的经济损失。然而,世界上一些地区的许多妇女仍然不知道这种病理,临床医生并不总是及时诊断这种情况。同时,CI的病因尚不明确,对该病理的诊断和治疗仍有不明确之处。对CI的诊断应结合病史、临床表现及超声检查结果进行分析。CI的治疗主要包括手术和保守两种方法。手术治疗采用宫颈环扎术,保守技术主要包括使用阴道黄体酮和插入各种类型的宫颈托。本文对引起宫颈功能不全的潜在危险因素进行了总结,以期对今后的研究有所帮助。此外,回顾文献考虑CI的现代诊断和治疗方法,以更好地了解宫颈的这种病理。从现代的角度来看,根据最近更新的建议提出了共识和问题,这些建议具有实际意义,对于进一步深入研究现代产科这一主题问题也很重要。
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引用次数: 0
Actualization of differential diagnosis of chronic pelvic pain syndrome in women of reproductive age 育龄妇女慢性盆腔疼痛综合征鉴别诊断的实现
Pub Date : 2023-01-30 DOI: 10.30841/2708-8731.7.2022.272474
O. Solomko, S. Shurpyak
The objective: to study the significance of the levels of tumor necrosis factor α (TNF-α) and brain-derived neurotrophic factor (BDNF) in the blood of patients with chronic pelvic pain syndrome (CPPS).Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) included the patients with CPPS and suspicion of endometriosis and group B (n=76) – patients with CPPS and suspicion for benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).Serum TNF-α and plasma BDNF levels were investigated by enzyme-linked immunosorbent assay. A visual analog scale (VAS) was used to study pain intensity.Results. The mean concentration of TNF-α in blood serum was significantly higher in women of group A (10.76±0.55 pg/ml) and group B (14.65±0.95 pg/ml) than in the control one (5.02±0.31 pg/ml). The mean concentration of BDNF in blood plasma was higher in women in group A (1473.88±53.02 pg/ml; p<0.001) and in group B (1711.65±66.79 pg/ml; p<0.01) compared to the control group (1082.91±56.24 pg/ml). The levels of TNF-α (p<0.001) and BDNF (p<0.01) are significantly higher in the blood of patients with CPPS and suspected combined benign proliferative diseases of the reproductive organs (group B) than in patients with CPPS and suspected endometriosis (group A).Between the intensity of pain according to VAS and the level of TNF-α in the blood a direct correlation of medium strength was found (r=0.56) in patients of group A and group B (r=0.62). A strong direct correlation between the intensity of pain according to VAS and the level of BDNF in the blood was established in women of group A (r=0.74) and group B (r=0.83).Between the disease duration and the level of TNF-α in the blood of patients a direct correlation of medium strength (r=0.65) in group A and a direct strong correlation (r=0.72) in group B were determined. Between the duration of the disease and the level of BDNF in the blood of patients a direct correlation of average strength was also establishe, a strong correlation (r=0.67) was determined in group A and a direct strong correlation (r=0.78) – group B.Conclusions. Women with CPPS and suspicion of benign proliferative diseases of the organs of the reproductive system have significantly higher concentrations of TNF-α and BDNF in the blood compared to healthy women (p<0.001).The existence of a direct correlation between the intensity of pain, the duration of the disease, and the levels of TNF-α and BDNF suggest the possibility of their use as objective markers of the effectiveness of diagnostic and therapeutic measures.
目的:探讨慢性盆腔疼痛综合征(CPPS)患者血中肿瘤坏死因子α (TNF-α)和脑源性神经营养因子(BDNF)水平的变化。材料和方法。研究队列包括150例CPPS患者,根据临床表现分为A组和B组:A组(n=74)为怀疑为子宫内膜异位症的CPPS患者,B组(n=76)为怀疑为生殖器官良性增生性疾病的CPPS患者。对照组为健康女性(n=50)。采用酶联免疫吸附法检测血清TNF-α和血浆BDNF水平。采用视觉模拟评分法(VAS)对疼痛强度进行评估。血清中TNF-α平均浓度A组(10.76±0.55 pg/ml)和B组(14.65±0.95 pg/ml)明显高于对照组(5.02±0.31 pg/ml)。A组女性血浆BDNF平均浓度较高(1473.88±53.02 pg/ml;p<0.001), B组(1711.65±66.79 pg/ml;P <0.01),高于对照组(1082.91±56.24 pg/ml)。CPPS合并疑似生殖器官合并良性增殖性疾病(B组)患者血TNF-α水平(p<0.001)和BDNF水平(p<0.01)明显高于CPPS合并疑似子宫内膜异位症(A组)患者。A组和B组患者VAS疼痛强度与血TNF-α水平呈正相关(r=0.56) (r=0.62)。A组(r=0.74)和B组(r=0.83)的疼痛强度与血液中BDNF的水平有明显的直接关系。病程与患者血液中TNF-α水平之间,a组为中等强度直接相关(r=0.65), B组为直接强相关(r=0.72)。在病程与患者血液中BDNF水平之间也建立了平均强度的直接相关性,a组确定了强相关性(r=0.67), b组确定了直接强相关性(r=0.78)。与健康女性相比,患有CPPS和怀疑生殖系统器官良性增生性疾病的女性血液中TNF-α和BDNF浓度显著升高(p<0.001)。疼痛强度、疾病持续时间与TNF-α和BDNF水平之间存在直接相关性,这表明它们可能被用作诊断和治疗措施有效性的客观标记。
{"title":"Actualization of differential diagnosis of chronic pelvic pain syndrome in women of reproductive age","authors":"O. Solomko, S. Shurpyak","doi":"10.30841/2708-8731.7.2022.272474","DOIUrl":"https://doi.org/10.30841/2708-8731.7.2022.272474","url":null,"abstract":"The objective: to study the significance of the levels of tumor necrosis factor α (TNF-α) and brain-derived neurotrophic factor (BDNF) in the blood of patients with chronic pelvic pain syndrome (CPPS).Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) included the patients with CPPS and suspicion of endometriosis and group B (n=76) – patients with CPPS and suspicion for benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).Serum TNF-α and plasma BDNF levels were investigated by enzyme-linked immunosorbent assay. A visual analog scale (VAS) was used to study pain intensity.Results. The mean concentration of TNF-α in blood serum was significantly higher in women of group A (10.76±0.55 pg/ml) and group B (14.65±0.95 pg/ml) than in the control one (5.02±0.31 pg/ml). The mean concentration of BDNF in blood plasma was higher in women in group A (1473.88±53.02 pg/ml; p<0.001) and in group B (1711.65±66.79 pg/ml; p<0.01) compared to the control group (1082.91±56.24 pg/ml). The levels of TNF-α (p<0.001) and BDNF (p<0.01) are significantly higher in the blood of patients with CPPS and suspected combined benign proliferative diseases of the reproductive organs (group B) than in patients with CPPS and suspected endometriosis (group A).Between the intensity of pain according to VAS and the level of TNF-α in the blood a direct correlation of medium strength was found (r=0.56) in patients of group A and group B (r=0.62). A strong direct correlation between the intensity of pain according to VAS and the level of BDNF in the blood was established in women of group A (r=0.74) and group B (r=0.83).Between the disease duration and the level of TNF-α in the blood of patients a direct correlation of medium strength (r=0.65) in group A and a direct strong correlation (r=0.72) in group B were determined. Between the duration of the disease and the level of BDNF in the blood of patients a direct correlation of average strength was also establishe, a strong correlation (r=0.67) was determined in group A and a direct strong correlation (r=0.78) – group B.Conclusions. Women with CPPS and suspicion of benign proliferative diseases of the organs of the reproductive system have significantly higher concentrations of TNF-α and BDNF in the blood compared to healthy women (p<0.001).The existence of a direct correlation between the intensity of pain, the duration of the disease, and the levels of TNF-α and BDNF suggest the possibility of their use as objective markers of the effectiveness of diagnostic and therapeutic measures.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81066481","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}
引用次数: 0
Obstetric complications in women who underwent conservative myomectomy before pregnancy 妊娠前保守子宫肌瘤切除术妇女的产科并发症
Pub Date : 2022-12-29 DOI: 10.30841/2708-8731.8.2022.272542
V. О. Zabolotnov, O.V. Astrayko, L. Olefir, R.O. Sorokotyaga
The article presents a literature review devoted to the obstetric complications in pregnant women after conservative myomectomy. The attention is paid to such a complication as uterine rupture. The authors consider impractical to evaluate the uterine scar before pregnancy using ultrasound methods and hysteroscopy.Uterine rupture of any type should be documented in the medical history (published), which allows the clinicians and women to better understand factors associated with the risk for rupture and to inform the patient’s decision to deliver by cesarean section or through the vagina.A review and analysis of a case of uterine rupture in a patient after conservative myomectomy is also performed. A 40-weeks pregnant woman was taken to the operating room 12 hours after the start of the acute uterine rupture clinic and decrease of hemodynamic parameters. About 2 liters of blood was found in the abdominal cavity, and a tear up to 7 cm long was determined in the area of the uterine fundus, closer to the left uterine angle. In the female outpatient consultation, during the observation of a pregnant woman who had the laparoscopic intervention – myomectomy, a diagnosis of “scar on the uterus” was not established. Medical documentation providing information on prior surgery was ignored and was not required. During the observation of the pregnant woman, the method of childbirth was not considered by the doctor’s council, and prenatal hospitalization was not performed.By studying the modern scientific sources, there is very little data about factors what increase the risk of uterine rupture, such as penetration into the uterine cavity. Performance of laparoscopic intervention, as a rule, is associated with the implementation of reproductive function in the future. Obstetricians and gynecologists who perform surgical intervention should describe the operation protocol not formally, but taking into account the implementation of the reproductive function. For many women after myomectomy, vaginal delivery can be a safe and feasible option, with patient choice and informed consent regarding the mode of delivery is important. Women should be offered choice and provided with appropriate counseling using all available evidence and monitored during pregnancy and birth in health care institutions that support their choice. This article provides practical recommendations for the management of pregnancy and childbirth in patients who had conservative myomectomy.
本文对保守性子宫肌瘤切除术后孕妇的产科并发症进行了文献回顾。注意子宫破裂等并发症。作者认为在妊娠前用超声和宫腔镜检查子宫瘢痕是不切实际的。任何类型的子宫破裂都应记录在病史中(已发表),这使临床医生和妇女能够更好地了解与破裂风险相关的因素,并告知患者是否决定通过剖宫产或阴道分娩。我们也回顾分析了一例保守子宫肌瘤切除术后子宫破裂的病例。一例妊娠40周的孕妇在急性子宫破裂临床开始12小时后进入手术室,血流动力学参数下降。在腹腔内发现约2升血液,在靠近子宫左角的子宫底区域发现长达7厘米的撕裂。在女性门诊会诊中,在观察一位行腹腔镜干预子宫肌瘤切除术的孕妇时,没有确定“子宫瘢痕”的诊断。提供先前手术信息的医疗文件被忽略,也不需要。在对孕妇进行观察期间,医生委员会没有考虑分娩方法,也没有进行产前住院治疗。通过研究现代科学资料,很少有关于增加子宫破裂风险的因素的数据,例如穿透子宫腔。作为一项规则,腹腔镜干预的表现与未来生殖功能的实现有关。实施手术干预的妇产科医生不应正式描述手术方案,而应考虑到生殖功能的实施。对于许多子宫肌瘤切除术后的妇女来说,阴道分娩是一种安全可行的选择,重要的是患者的选择和对分娩方式的知情同意。应为妇女提供选择,并利用所有现有证据向她们提供适当咨询,并在怀孕和分娩期间在支持她们选择的保健机构进行监测。本文为保守性子宫肌瘤切除术患者的妊娠和分娩管理提供实用建议。
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引用次数: 0
Differential evaluation of the quality of life of women with chronic pelvic pain syndrome depending on concomitant pathologies. 慢性盆腔疼痛综合征妇女生活质量的差异评价取决于伴随的病理。
Pub Date : 2022-12-29 DOI: 10.30841/2708-8731.8.2022.273295
O. Solomko, S. Shurpyak
The World Health Organization defines quality of life as a person’s perception of his position in life in the context of the culture and value systems in which he lives, as well as in relation to his goals, expectations, standards and problems. Today, chronic pelvic pain is considered a condition that can significantly affect the quality of life. At the same time, there are significant prospects for using this method to evaluate the effectiveness of treatment. The objective: to evaluate of changes in the quality of life of patients with chronic pelvic pain syndrome (CPPS) depending on accompanying pathologies. Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) – patients with CPPS and suspicion for endometriosis and group B (n=76) – patients with CPPS and suspicion for combined benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).SF-36 questionnaire which involves the use of eight scales of questions to determine the level of quality of life was used to assess the quality of life.Results. A decrease in quality of life was found in all the scales of the SF-36 questionnaire in patients with CPPS. A statistically significant difference was found in all scales between A and B groups compared to the control group (p<0.001).In addition, a significant difference was found in all scales of the questionnaire between the group with CPPS and combined benign proliferative diseases of the reproductive organs compared to the group with CPPS and endometriosis (p<0.05). At the same time, the most significant changes were found in the scale of physical role functioning and the scale of social role functioning.Conclusions. The decrease in indicators on all scales of the SF-36 questionnaire in patients of the studied cohort confirms that CPPS significantly affects all areas of their quality of life. Significantly lower indicators were observed in the group with CPPS and combined hyperproliferative pathology compared to the group with CPPS and endometriosis (p<0.05).
世界卫生组织将生活质量定义为一个人在其生活的文化和价值体系背景下对其生活地位的认知,以及与其目标、期望、标准和问题的关系。今天,慢性盆腔疼痛被认为是一种严重影响生活质量的疾病。同时,应用该方法评价治疗效果具有重要的前景。目的:评估慢性盆腔疼痛综合征(CPPS)患者生活质量的变化,这取决于伴随的病理。材料和方法。本研究共纳入150例CPPS患者,根据临床表现分为A组和B组:A组(74例)为CPPS合并子宫内膜异位症患者,B组(76例)为CPPS合并生殖器官良性增生性疾病患者。对照组为健康女性(n=50)。采用SF-36问卷对生活质量进行评估,该问卷采用8个等级的问题来确定生活质量水平。在SF-36问卷的所有量表中都发现CPPS患者的生活质量下降。与对照组相比,A组和B组在所有量表上的差异均有统计学意义(p<0.001)。此外,CPPS合并生殖器官良性增生性疾病组与CPPS合并子宫内膜异位症组相比,问卷各量表均有显著差异(p<0.05)。与此同时,生理角色功能量表和社会角色功能量表的变化最为显著。研究队列患者SF-36问卷各量表指标的下降证实了CPPS显著影响其生活质量的所有领域。CPPS合并增生性病变组各项指标均低于CPPS合并子宫内膜异位症组(p<0.05)。
{"title":"Differential evaluation of the quality of life of women with chronic pelvic pain syndrome depending on concomitant pathologies.","authors":"O. Solomko, S. Shurpyak","doi":"10.30841/2708-8731.8.2022.273295","DOIUrl":"https://doi.org/10.30841/2708-8731.8.2022.273295","url":null,"abstract":"The World Health Organization defines quality of life as a person’s perception of his position in life in the context of the culture and value systems in which he lives, as well as in relation to his goals, expectations, standards and problems. Today, chronic pelvic pain is considered a condition that can significantly affect the quality of life. At the same time, there are significant prospects for using this method to evaluate the effectiveness of treatment. The objective: to evaluate of changes in the quality of life of patients with chronic pelvic pain syndrome (CPPS) depending on accompanying pathologies. Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) – patients with CPPS and suspicion for endometriosis and group B (n=76) – patients with CPPS and suspicion for combined benign proliferative diseases of reproductive organs. The control group included healthy women (n=50).SF-36 questionnaire which involves the use of eight scales of questions to determine the level of quality of life was used to assess the quality of life.Results. A decrease in quality of life was found in all the scales of the SF-36 questionnaire in patients with CPPS. A statistically significant difference was found in all scales between A and B groups compared to the control group (p<0.001).In addition, a significant difference was found in all scales of the questionnaire between the group with CPPS and combined benign proliferative diseases of the reproductive organs compared to the group with CPPS and endometriosis (p<0.05). At the same time, the most significant changes were found in the scale of physical role functioning and the scale of social role functioning.Conclusions. The decrease in indicators on all scales of the SF-36 questionnaire in patients of the studied cohort confirms that CPPS significantly affects all areas of their quality of life. Significantly lower indicators were observed in the group with CPPS and combined hyperproliferative pathology compared to the group with CPPS and endometriosis (p<0.05).","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86940604","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}
引用次数: 0
The features of psychological status of pregnant women with an allogeneic fetus 异基因胎儿孕妇的心理状态特点
Pub Date : 2022-12-29 DOI: 10.30841/2708-8731.8.2022.273297
T. Romanenko, N. Yesyp
The objective: to establish the peculiarities of the psychological status of pregnant women with an allogeneic fetus.Materials and methods. The psychological status of 120 pregnant women, who were divided into two groups, was assessed. I group included 80 patients after in vitro fertilization (IVF) programs with the formation of an allogeneic fetus, II group (control one) included 40 pregnant women after IVF with the woman’s own oocytes.The psychological state of pregnant women was assessed using the Spielberger-Hanin questionnaire, the Holmes and Rahe stress event scale, the assessment of well-being, activity and mood, the Edinburgh Postnatal Depression Scale, and the SF-36 quality of life questionnaire.Results. A high level of reactive anxiety was significantly more often determined in pregnant women with an allogeneic fetus compared to the pregnant women in the control group (32.50 % and 12.50 %, respectively), as well as uncertain indicators according to the Edinburgh Postnatal Depression Scale (72.50 % and 52.50 %, respectively).During the evaluation of the quality of life in patients of the I group, significantly lower indicators of role-emotional functioning (41.13±5.29 points), social functioning (72.76±4.88 points), as well as role-physical functioning (35.12±7.22 points) and vitality (38±7.11 points) than in the examined women of the II group (62.43±5.45, 84.4±5.02, 46.89±6.51 and 59.56±9.78 points, respectively) were established. The indicators of well-being and mood were also significantly lower in the I group (3.88±1.40 and 4.21±1.27 points, respectively) compared to the II group (4.83±1.55 and 5.13±1.49 points, respectively).Conclusions. The psychological status of pregnant women with an allogeneic fetus is characterized by the presence of statistically significant deviations not only compared to the control group, but also to the normative indicators provided by standardized survey methods. This indicates the necessity for further study of the relationship between these factors and the frequency of complications during pregnancy, childbirth and the postpartum period, as well as the condition of newborns in these women and possible ways of correcting the psychological status to reduce the frequency of obstetric and perinatal complications.
目的:探讨异基因胎儿孕妇心理状态的特点。材料和方法。研究人员将120名孕妇分为两组,对她们的心理状况进行了评估。I组包括80例体外受精(IVF)后形成异体胎儿的患者,II组(对照组)包括40例使用女性自身卵母细胞体外受精后的孕妇。采用Spielberger-Hanin问卷、Holmes和Rahe压力事件量表、幸福感、活动和情绪量表、爱丁堡产后抑郁量表和SF-36生活质量问卷对孕妇的心理状态进行了评估。与对照组孕妇相比,同种异体胎儿的孕妇明显更常被确定为高水平的反应性焦虑(分别为32.50%和12.50%),以及根据爱丁堡产后抑郁量表(分别为72.50%和52.50%)确定的不确定指标。在生活质量评价中,I组患者的角色-情感功能(41.13±5.29分)、社会功能(72.76±4.88分)、角色-身体功能(35.12±7.22分)、活力(38±7.11分)明显低于II组(分别为62.43±5.45分、84.4±5.02分、46.89±6.51分、59.56±9.78分)。幸福感和情绪指标I组(分别为3.88±1.40和4.21±1.27分)明显低于II组(分别为4.83±1.55和5.13±1.49分)。异体胎儿孕妇的心理状况不仅与对照组相比,而且与标准化调查方法提供的规范性指标相比,均存在统计学上的显著偏差。这表明有必要进一步研究这些因素与妊娠、分娩和产后并发症发生频率的关系,以及这些妇女的新生儿状况,以及纠正心理状态以减少产科和围产期并发症发生频率的可能方法。
{"title":"The features of psychological status of pregnant women with an allogeneic fetus","authors":"T. Romanenko, N. Yesyp","doi":"10.30841/2708-8731.8.2022.273297","DOIUrl":"https://doi.org/10.30841/2708-8731.8.2022.273297","url":null,"abstract":"The objective: to establish the peculiarities of the psychological status of pregnant women with an allogeneic fetus.Materials and methods. The psychological status of 120 pregnant women, who were divided into two groups, was assessed. I group included 80 patients after in vitro fertilization (IVF) programs with the formation of an allogeneic fetus, II group (control one) included 40 pregnant women after IVF with the woman’s own oocytes.The psychological state of pregnant women was assessed using the Spielberger-Hanin questionnaire, the Holmes and Rahe stress event scale, the assessment of well-being, activity and mood, the Edinburgh Postnatal Depression Scale, and the SF-36 quality of life questionnaire.Results. A high level of reactive anxiety was significantly more often determined in pregnant women with an allogeneic fetus compared to the pregnant women in the control group (32.50 % and 12.50 %, respectively), as well as uncertain indicators according to the Edinburgh Postnatal Depression Scale (72.50 % and 52.50 %, respectively).During the evaluation of the quality of life in patients of the I group, significantly lower indicators of role-emotional functioning (41.13±5.29 points), social functioning (72.76±4.88 points), as well as role-physical functioning (35.12±7.22 points) and vitality (38±7.11 points) than in the examined women of the II group (62.43±5.45, 84.4±5.02, 46.89±6.51 and 59.56±9.78 points, respectively) were established. The indicators of well-being and mood were also significantly lower in the I group (3.88±1.40 and 4.21±1.27 points, respectively) compared to the II group (4.83±1.55 and 5.13±1.49 points, respectively).Conclusions. The psychological status of pregnant women with an allogeneic fetus is characterized by the presence of statistically significant deviations not only compared to the control group, but also to the normative indicators provided by standardized survey methods. This indicates the necessity for further study of the relationship between these factors and the frequency of complications during pregnancy, childbirth and the postpartum period, as well as the condition of newborns in these women and possible ways of correcting the psychological status to reduce the frequency of obstetric and perinatal complications.","PeriodicalId":21003,"journal":{"name":"Reproductive health of woman","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87433049","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}
引用次数: 0
Placental factors in the development of preterm birth in pregnant women with comorbidity 有合并症的孕妇发生早产的胎盘因素
Pub Date : 2022-12-29 DOI: 10.30841/2708-8731.8.2022.272543
S. Heryak, N. Petrenko, V. Dobrianska
Premature birth (PB) is a polyetiological problem that depends on many factors, accompanied by violations of the placenta functional competence, changes in its metabolic, hormone-producing and protective functions. The objective: to establish the importance of placental factors in the development of PB in pregnant women with comorbid pathology. Materials and methods. The levels of fetal and placental proteins (placental alfa microglobulin-1, α2-microglobulin of fertility, trophoblastic β1-glycoprotein) and hormones (estriol, placental lactogen, progesterone) were determined in 33 pregnant women with threat of PB at 26–34 weeks of gestation (main group), who had concomitant comorbid pathology in the stage of unstable remission. The control group included 26 healthy pregnant women who were representative for gestational age. Results. In pregnant women with comorbid pathology a decrease of the placenta protein-synthesizing function and the hormone-producing function of the trophoblast was found, which makes it difficult to launch the syntoxic adaptation programs of the mother’s organism, which are responsible for maintaining the pregnancy with the subsequent development of placental dysfunction, the result of which is PB.The markers of these disorders are a 3-fold decrease in the level of trophoblastic β1-glycoprotein (p<0.0001) and a 1.7-fold decrease in the concentration of α2-microglobulin of fertility (p<0.0001) with a simultaneous 4-fold increase of placental alfa microglobulin-1 concentration (p<0.0001) and a decrease in the levels of placental lactogen by 1.6 times (p<0.0001), estradiol by 40 % (p<0.0001) and progesterone by more than 2 times (p<0.0001) compared to healthy pregnant women.Conclusions. In patients with comorbid pathology there are disorders in the secretion of pregnancy proteins due to a decrease in the levels of trophoblastic β1-glycoprotein and α2-microglobulin of fertility and an increase in the level of placental alfa microglobulin-1 and disorders of the hormone-producing function of the trophoblast due to a decrease in the secretion of placental lactogen, progesterone, and estradiol. The disturbance of the secretion of the pregnancy zone proteins and hormones are the early markers for the initiation of premature birth caused by placental dysfunction in pregnant women with comorbid pathology.
早产(PB)是一个多方面的问题,它取决于许多因素,伴随着胎盘功能能力的破坏,其代谢、激素产生和保护功能的改变。目的:确定胎盘因素在合并病理的孕妇发生PB的重要性。材料和方法。测定33例妊娠26 ~ 34周伴有不稳定缓解期病理的PB威胁孕妇(主组)的胎儿及胎盘蛋白(胎盘α -微球蛋白-1、生育α - 2微球蛋白、滋养层β -1糖蛋白)及激素(雌三醇、胎盘乳原、孕酮)水平。对照组包括26名具有胎龄代表性的健康孕妇。结果。在有共病病理的孕妇中,发现胎盘的蛋白质合成功能和滋养细胞的激素产生功能下降,这使得母体机体维持妊娠的合成毒性适应程序难以启动,随后发展为胎盘功能障碍,其结果是PB。这些疾病的标志是与健康孕妇相比,滋养层β1-糖蛋白水平降低3倍(p<0.0001),生育α2-微球蛋白浓度降低1.7倍(p<0.0001),胎盘α -微球蛋白-1浓度同时升高4倍(p<0.0001),胎盘乳原水平降低1.6倍(p<0.0001),雌二醇水平降低40% (p<0.0001),孕酮水平降低2倍以上(p<0.0001)。在有共病病理的患者中,由于生育滋养层β1-糖蛋白和α2-微球蛋白水平降低,胎盘α -微球蛋白-1水平升高,导致妊娠蛋白分泌紊乱;由于胎盘乳原、黄体酮和雌二醇分泌减少,滋养层激素分泌功能紊乱。妊娠区蛋白和激素分泌紊乱是有共病病理的孕妇胎盘功能障碍引发早产的早期标志。
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引用次数: 0
Features of the clinical course of pregnancy, childbirth and the condition of newborns in women with HCV infection 丙型肝炎病毒感染妇女妊娠、分娩及新生儿状况的临床病程特点
Pub Date : 2022-12-29 DOI: 10.30841/2708-8731.8.2022.273289
K. Chaika, Y.M. Zapopadna
The objective: to conduct a retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns in women with HCV infection.Materials and methods. A retrospective clinical and statistical analysis of the pregnancy course, childbirth and the condition of newborns was carried out according to the data of 351 birth histories of women with HCV infection based on the materials of the archive of the communal non-commercial enterprise “Kyiv Municipal Center of Reproductive and Perinatal Medicine” for the period from 2016 to 2021. The control group (CG) included 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 8.0”. Results. In women with HCV infection compared to the group of healthy pregnant women a significantly high frequency (p<0.001) of such pregnancy complications was found: threat of pregnancy interruption – 64 (18.2 %) patients versus 2 (4.0 %) persons, edema of pregnant women – 72 (20.5 %) and 4 (8.0 %), respectively; preeclampsia – 45 (12.8 %) versus 2 (4.0 %), gestational anemia – 131 (37.3 %) versus 6 (12.0 %), as well as placental insufficiency with fetal growth retardation syndrome (FGR) – 69 (19.6 %) versus 3 (6.0 %; p<0.05) and intrahepatic cholestasis of pregnant women – 42 (11.9 %) versus 1 (2.0 %; p<0.05). In 73 (20.8 %) pregnant women with HCV infection the childbirth was complicated by premature rupture of the membranes, of which almost half of the cases (42 (11.9 %) of the patients) finished with premature birth, while in CG only some women had such complications. Fetal distress during childbirth was reliably detected more often in pregnant women with HCV infection than in CG women (χ2=4.76; p=0.024). Caesarean section was performed in 86 (24.5 %) patients with HCV infection versus 2 (4.0 %) persons in CG (p<0.001).The newborns from mothers with HCV infection had lower indicators of physical development and decreased Apgar score assessment, increased frequency of conjugation jaundice.Conclusions. Pregnant women with HCV infection are characterized by a significant increase in the number of pregnancy complications, such as the threat of pregnancy interruption, the threat of premature birth, gestational anemia, placental dysfunction, fetal growth retardation syndrome, and preeclampsia; during childbirth – premature and antepartum rupture of amniotic membranes, premature birth, weakness of uterine activity in labor, increased blood loss. The condition of newborns from women with HCV infection is characterized by a significant increase in the frequency of asphyxia during childbirth, CNS hypoxic-ischemic damage, prematurity and conjugation jaundice.
目的:对HCV感染妇女的妊娠过程、分娩和新生儿状况进行回顾性临床和统计分析。材料和方法。基于公共非商业企业“基辅市生殖与围产期医学中心”档案资料,对351例HCV感染妇女2016 - 2021年的分娩史资料进行妊娠过程、分娩及新生儿情况的回顾性临床和统计分析。对照组(CG)为50例健康孕妇。采用Microsoft Excel 5.0和Statistica 8.0标准程序对研究结果进行统计处理。结果。与健康孕妇组相比,HCV感染妇女出现此类妊娠并发症的频率显著高(p<0.001):妊娠中断威胁64例(18.2%)对2例(4.0%),孕妇水肿分别为72例(20.5%)和4例(8.0%);先兆子痫45例(12.8%)对2例(4.0%),妊娠贫血131例(37.3%)对6例(12.0%),胎盘功能不全合并胎儿生长迟缓综合征(FGR) 69例(19.6%)对3例(6.0%);P <0.05)和肝内胆汁淤积症孕妇:42例(11.9%)vs 1例(2.0%);p < 0.05)。在73例(20.8%)HCV感染孕妇中,分娩并发胎膜早破,其中近一半(42例(11.9%))的患者最终早产,而在CG中只有部分妇女出现此类并发症。HCV感染孕妇分娩时胎儿窘迫的可靠检出率高于CG感染孕妇(χ2=4.76;p = 0.024)。86例(24.5%)HCV感染患者行剖宫产,2例(4.0%)CG感染患者行剖宫产(p<0.001)。感染HCV的母亲所生的新生儿身体发育指标较低,Apgar评分较低,偶联性黄疸发生率较高。HCV感染孕妇的特点是妊娠并发症的数量显著增加,如妊娠中断的威胁、早产的威胁、妊娠贫血、胎盘功能障碍、胎儿生长迟缓综合征和先兆子痫;在分娩时-早产和产前羊膜破裂,早产,分娩时子宫活动减弱,失血增加。丙型肝炎病毒感染妇女所生新生儿的特点是分娩时出现窒息、中枢神经系统缺氧缺血性损伤、早产和结合性黄疸的频率显著增加。
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引用次数: 0
Uterine tube cancer in the practice of an obstetrician-gynecologist 输卵管癌在妇产科医生的实践中
Pub Date : 2022-12-29 DOI: 10.30841/2708-8731.8.2022.273274
О. Korchynska, D. Stryzhak
Fallopian tube cancer (FTC) is an actual problem in oncology. Despite the low frequency of FTC, it is quite easy to confuse it with other malignant diseases of the female genital organs, namely, ovarian and endometrial cancer. It is quite difficult to diagnose FTC in time, since the absence of specific symptoms determines the detection of malignant tumors of fallopian tubes only during surgical interventions for benign gynecological pathology or in case of suspicion of ovarian or endometrial cancer. The final diagnosis and primary origin of the tumor can be established only by postoperative histological study.The article presents a review of the literature of scientometric databases on the etiology, diagnosis, and treatment of FTC. Based on the analysis of data from the scientific literature, the problem of FTC as a rare and deceptive malignant disease with a rather aggressive course is highlighted, which causes the formation of oncological awareness among obstetricians-gynecologists regarding this type of cancer.According to the literature, it is established that FTC is diagnosed very rarely. Among all cases of malignant tumors of the female genital organs, the frequency of FTC is only 0.14–1.8 %. It was also established that it is possible to diagnose FTC in a time only in 0–21 % of cases, according to other data– up to 10 %.Due to the aggressive course of tubal cancer, the five-year survival rate ranges from 22 till 57 %. Intraoperatively, it is possible to detect malignant tumors of the fallopian tubes only in 50 % of cases. The article provides data on the possible causes of development, clinical symptoms that can be manifested by FTC, as well as methods of diagnosis and treatment of this cancer.FTC is a very deceptive oncological pathology, which can be caused by chronic inflammatory changes in the fallopian tubes, infertility, fallopian tube endometriosis, and BRCA1 and BRCA2 mutations. First of all, obstetrician-gynecologists should pay attention on abnormal uterine bleeding in the patient, purulent-bloody discharge, pain in the lower abdomen, the phenomenon of “watery tubal discharge”, since these pathological manifestations are typical for FTC. The tumor marker CA-125 and β-subunit of hCG have important meaning, the levels of which are increased by FTC.Significant similarity of clinical symptoms with ovarian and endometrial cancer leads to significant errors in establishing the correct diagnosis. Since malignant tumors of the fallopian tubes can metastasize to groups of lymphatic lymph nodes that are completely atypical for them, it is also necessary to carry out a differential diagnosis with breast cancer, because FTC can manifest itself in the form of axillary lymphadenopathy, and with stomach cancer, in which an isolated increase of the left supraclavicular lymph node (Virchow’s metastasis) can also be observed, which is also characteristic of fallopian tube carcinomas.
输卵管癌(FTC)是肿瘤学中的一个现实问题。尽管FTC的发病率很低,但很容易与女性生殖器官的其他恶性疾病混淆,即卵巢癌和子宫内膜癌。由于没有特定的症状,决定了只有在妇科良性病理或怀疑卵巢癌或子宫内膜癌的手术干预时才能发现输卵管恶性肿瘤,因此FTC的及时诊断相当困难。只有通过术后组织学检查才能确定肿瘤的最终诊断和原发来源。本文介绍了文献的科学计量数据库的病因,诊断和治疗FTC。通过对科学文献资料的分析,突出了FTC作为一种罕见的、具有欺骗性的恶性疾病,其病程具有相当的侵袭性,这引起了妇产科医生对这类癌症的肿瘤学意识的形成。根据文献,可以确定的是,FTC的诊断非常罕见。在所有女性生殖器官恶性肿瘤中,FTC的发生率仅为0.14 - 1.8%。还确定,在0 - 21%的病例中,有可能在一段时间内诊断出FTC,根据其他数据-高达10%。由于输卵管癌病程的侵袭性,5年生存率从22%到57%不等。术中输卵管恶性肿瘤的检出率仅为50%。本文提供了可能的发展原因、FTC可表现的临床症状以及该癌症的诊断和治疗方法的数据。FTC是一种非常具有欺骗性的肿瘤病理,可能由输卵管慢性炎症改变、不孕症、输卵管子宫内膜异位症以及BRCA1和BRCA2突变引起。首先,妇产科医生应注意患者子宫异常出血、脓血性分泌物、下腹疼痛、“输卵管水状分泌物”现象,因为这些病理表现是FTC的典型。肿瘤标志物CA-125和hCG β-亚基具有重要意义,FTC可使其水平升高。卵巢癌和子宫内膜癌的临床症状明显相似,导致建立正确诊断的重大错误。由于输卵管恶性肿瘤可转移到完全不典型的淋巴淋巴结群,因此与乳腺癌也有必要进行鉴别诊断,因为FTC可表现为腋窝淋巴结病,与胃癌也可观察到左侧锁骨上淋巴结孤立增加(Virchow’s转移),这也是输卵管癌的特征。
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Reproductive health of woman
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