Preview

Obstetrics, Gynecology and Reproduction

Advanced search
Online First

ORIGINAL ARTICLE

34
Abstract
Aim: to evaluate the quality of life parameters dynamics in patients with vulvar cancer I and II stages during early postoperative rehabilitation.
Materials and methods. A prospective comparative randomized study included 47 women with vulvar cancer I–II stages, aged 38 to 70 years, with an average age of 56.3 ± 3.9 years. Patients were randomized into 2 groups: 24 of them underwent a early postoperative rehabilitation and 23 were included in the comparison group. Quality of life and sexual function, as well as psycho-emotional state were assessed using a set of questionnaires: quality of life of the European Organization for Research and Treatment of Cancer EORTC QLQ-C30, functional assessment of cancer therapy (FACT-G) with an extension for vulvar cancer, "Female Sexuality Index (FSFI)" and "SAN" (well-being, activity, mood).
Results. Patient who receiving active rehabilitation even during the first three months, a reliable positive dynamics of all parameters of the index of female sexuality and quality of life, except cognitive function, was noted. At the same time, in the patients not undergoing an active rehabilitation program there was no reliable difference in the results of the questionnaires, except for the female sexuality index, but the severity of changes was significantly less than in the patients of the research group. Dynamics in the EORTC QLQ-C30 parameters in women in active rehabilitation averaged 14.8 points with 7.8 points in the comparison group. In the FACT-G questionnaire, the dynamics were even more pronounced with 19.9 and 6.8 points respectively. There was a reliable positive trend in improving the quality of sexual life and a decrease in the percentage of women suffer from pain and discomfort during sexual intercourse: from 25% (6) to 4.2% (1) in the study group and from 21.7% (5) to 13% (3) in the comparison group. Improvement in sexual desire and satisfaction during the year was noted in 5 (20.8%) women in the study group and only 2 (8.7%) in the comparison group.
Conclusion. The developed program of early postoperative rehabilitation of patients with vulvar cancer, which includes individual and group psychotherapy, "anti-cancer diet therapy", dosed physical activity, dynamic correction of vaginal biocoenosis showed high efficiency already during the first 6 months. All patients with vulvar cancer in the postoperative period should receive early postoperative rehabilitation aimed at correction of psycho-emotional state and sexual function, which will improve the quality of life and improve further prognosis.

ОRIGINAL ARTICLES

29
Abstract

Aim: to develop individual options for the correction of sex steroid deficiency in patients with
uterine leiomyoma in early postmenopausal women.

Materials and methods. 180 postmenopausal patients with uterine leiomyoma were examined. To correct menopausal manifestations, patients of Group 1 (n = 60) were prescribed a low-dose drug estradiol 1 mg/drospirenone 2 mg, patients of Group 2 (n = 60) were assigned an ultra-low-dose drug estradiol 0.5 mg/drospirenone 0.25 mg. Women from Group 3 (n = 60) refused to accept menopausal hormone therapy (MHT). Clinical-anamnestic, laboratory and instrumental examination was carried out with an assessment of vasomotor and genitourinar symptoms. Particular attention was paid to ultrasound examination of the pelvic organs with dopplerometry of the intratumoral vessels.

Results. The vasomotor manifestations of menopausal syndrome in postmenopausal patients with uterine leiomyoma were effectively stopped with a drug containing 17β-estradiol/drospirenone, regardless of the dose of the components (RR = 0.25). The size of the nodes of uterine leiomyoma of type 2–6 according to classification of The International Federation of Obstetricians and Gynecologists (FIGO) and the dopplerometry in the uterine artery in postmenopausal women did not change during 9 months of using 17β- estradiol/drospirenone. In Group 1 an increase in vascularization intensity (RR = 1.4) and a decrease in peripheral vascular resistance in intranodular vessels were revealed in 6 % of patients.

Conclusion. The use of MHT drugs with different dosages of components does not lead to an increase in the size of leiomyoma nodes and does not affect hemodynamic parameters in  the uterine arteries during 6 months of treatment. However, as the duration of MHT increases, vascularization of myoma nodes increases when assessing intranodular blood flow, an increase in vascularization and a decrease in the resistance index against the background of a low-dose MHT drug compared to ultramicrodosed, that should be taken into account when planning the scheme and duration of therapy.

REVIEW ARTICLE

79
Abstract
The results of the evaluation of 7-hydroximatairesinol (7-HMR) properties in comparison with control molecules (17-estradiol, phytoestrogen β-sytostirol, epigallocatechin-3-gallate) are presented. The results of chemoreactomic modeling allowed to formulate the molecular mechanisms of 7-HMR pharmacological effects for anti-inflammatory (inhibition of 5-lipoxygenase, matrix metalloproteinase MMR2, mitogen-activated kinase p38-alpha, leukotriene-b4 receptor, prostacyclin receptor), antitumor (antioxidant effect due to inhibition of hemoxygenase-2, inhibition of cyclin dependent kinases 3 and 4, epidermis growth factor, protein mTOR), vasodilator (inhibition of adrenoreceptors and renin), antibacterial and antiviral (inhibition of viral proteases 3C) properties of 7-HMR molecule.
184
Abstract
The problem of sepsis and septic shock has recently become more and more actual. In obstetrics and gynaecology, the number of cases of sepsis has more than doubled over the past 10 years. The review examines the clinical forms of septic conditions, risk factors, pathogenesis of sepsis and septic shock, the main pathogens of septic conditions. Special attention is paid to neonatal sepsis. The relationship between septic shock and viral infections is considered in the context of the novel coronavirus infection caused by SARS-CoV-2 (COVID-19) pandemic. Hemostasis abnormalities have been demonstrated in patients with septic shock, including disseminated intravascular coagulation (DIC). The importance of determining the level of ADAMTS-13 to refine the forecast is discussed.

CLINICAL CASE

106
Abstract

Aim: to demonstrate the role and importance of prenatal diagnosis of abnormally invasive placenta.
Materials and methods. Retrospective analysis of 3 clinical cases of the delivery in Health Center Medina. All women were diagnosed with the complete placenta praevia and invasion of chorion in the myometrium, the last was confirmed by the results of histological examination. Anamnesis data, extragenital pathology and results of examination during pregnancy were analyzed. In the prenatal period the diagnosis was confirmed by the results of ultrasound examination and MRI in two women.
Results. All women were diagnosed with the different degree of placenta praevia, 2 women had a cesarean section in the past history. All patients had unifetal pregnancy without complications and no extragenital pathology was noted. 2 women were diagnosed with the placenta praevia using ultrasound scan and MRI, were estimated the degree and topography of placental invasion. Both women had planned caesarean section. During operation was performed autohemotransfusion using a Cell Saver system. In one of the cases urgent c-section was performed due to the massive bleeding, presence of placental invasion was diagnosed intraoperatively. Hysterectomy was performed in all 3 cases, total blood loss was 950–1450 ml in patients with the prenatally diagnosed invasive placentation. Iliac artery ligation was performed to the third patient, due to excessive bleeding and development of coagulopathy, 1200 ml of fresh frozen plasma has been transfused for correction of coagulopathy, as well as transfusion of donor erythrocyte mass.
Conclusion. Probably the development of placental invasion abnormalities along with other factors is mostly affected by presence of placenta previa and cesarean section in the patient’s past history. Prenatal assessment of presence and degree of the abnormal placental invasion is important factor for planning of delivery: gestational age, method and the hospital level.



ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)