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Obstetrics, Gynecology and Reproduction

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Vol 14, No 4 (2020)

Original articles

415-425 169
Abstract

Aim: to evaluate the quality of life parameters dynamics in patients with vulvar cancer I and II stages during 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 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-General (FACT-G) with an extension for vulvar cancer, Female Sexuality Index (FSFI) and WAM (well-being, activity, mood).

Results. Patient who receiving postoperative rehabilitation even during the first three months, a reliable positive dynamics of all parameters of FSFI and EORTC, except cognitive function, was noted. At the same time, in the patients not undergoing postoperative rehabilitation program there was no reliable difference in the results of the questionnaires, except for FSFI, but the severity of changes was significantly less than in the patients of the research group. Dynamics in the EORTC parameters in women in postoperative 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 25,0 % (n = 6) to 4,2 % (n = 1) in the study group and from 21,7 % (n = 5) to 13,0 % (n = 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 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 active rehabilitation aimed at correction of psycho-emotional state and sexual function, which will improve the quality of life and improve further prognosis.

426-436 97
Abstract

Introduction. The burden of urinary tract infection (UTI) in pregnancy has been understudied in Cameroon.

Aim: to determine the prevalence and risk factors of UTI in pregnancy in a tertiary hospital in Cameroon.

Materials and methods. A hospital-based matched case-control study of pregnant women with evidence of UTI and those without who underwent antenatal care and gave birth at the Douala General Hospital from January 2014 to December 2018. Demographic, reproductive health/clinical data were collected using a pre-tested questionnaire and analyzed with SPSS.

Results. The prevalence of UTI in pregnancy was 4.41 %. Poor antenatal care uptake (AOR = 5.64; 95 % CI = 2.21–14.33), multiple weekly sexual intercourses (AOR = 4.64; 95 % CI = 0.22–96.94), a history of UTI (AOR = 3.01; 95 % CI = 1.12–8.04) and drying the genitals from back to front (AOR = 5.50; 95 % CI = 1.95–15.44) were associated factors.

Conclusion. The prevalence of UTI in pregnancy is low amid multiple associated factors. Screening for UTI in pregnancy should be made the standard of obstetric care in Cameroon.

437-448 92
Abstract

Aim: to assess the efficacy and safety of non-ablative radiofrequency treatment in the postpartum period in patients with vaginal relaxation syndrome and other initial manifestations of pelvic floor dysfunction (PFD).

Materials and Methods. 44 patients with complaints of the initial manifestations of PFD were enrolled into prospective randomized comparative study: 30 women in the main group and 14 in the control group. Diagnostic methods included medical history collection, objective examination, assessing condition of the perineum by visual inspection; standard clinical and laboratory studies; using the questionnaire for calculating the Female Sexual Function Index (FSFI-19). Staging of pelvic organ prolapse was performed according to the POP-Q classification (Pelvic Organ Prolapse Quantification system). Measurement of the pelvic floor muscle contraction strength was performed by using a perineometer. A course of 3 procedures of radiofrequency non-ablative exposure of the vulvovaginal tissues in patients from the main group was performed 2 months after delivery, with 7-day interval. Assessment of the collagenogenesis and neoangiogenesis was carried out base on measuring expression level of the mRNA specific to proteins of the vaginal connective tissue by using real-time polymerase chain reaction.

Results. Our study allowed to find that anatomical and functional state of the vulvovaginal area and perineum were significantly improved as well as relief of PFD symptoms. The level of expression of decorin mRNA in patients from the main group before and after treatment were 0.1 ± 0.035 and 0.047 ± 0.002, respectively (p = 0.02, Wilcoxon t-test). The median values of mRNA expression of matrix metalloproteinase type 2 before and after treatment were 0.0177 and 0.013, respectively (p = 0.03). The expression of type III collagen mRNA before and after treatment was 0.0675 and 0.0109, respectively (p = 0.03).

Conclusion. The data obtained by us demonstrate positive effects after using monopolar radiofrequency therapy on the tissues in the vulva, vagina and perineum of patients in the postpartum period. However, clinical improvement in patients with PFD represents a cumulative result of morphological and functional changes in the tissues of the perineum as well as vulvovaginal region. We believe it is irrational to associate such positive effects solely with altered magnitude of the metabolism of collagen and other extracellular matrix proteins, due to dynamic balance and genetic determinism of decay and production of connective tissue proteins. The safety and role of radiofrequency therapeutic procedures in prevention and treatment of PFD require further investigation by assessing new markers and research methods, by extending observation period as well as increasing amount and quality of clinical observations.

449-456 63
Abstract

Introduction. The prevalence of congenital malformations (CMFs) in fetal central nervous system (CNS) ranges from 1.5 to 3 % and covers around 29 % among all malformations, whereas percentage in the structure of perinatal and infant mortality reaches 25–26 %.

Aim: to estimate frequency of pathogenic copy number variations (CNVs) in fetuses with congenital malformations of CNS and normal karyotyping cytogenetic analysis.

Materials and Methods. There were enrolled 42 pregnant women underwent invasive prenatal diagnostics in 2013–2019 due to ultrasound detection of congenital CNS defect in fetus. Fetal samples were studied by using chromosome microarray analysis (CMA).

Results. Various pathogenic CNVs were detected in 7 (16.6 %) fetuses with prenatally diagnosed congenital CNS malformations. Non-syndrome pathogenic CNVs were detected in 85.7 %.

Conclusion. Thus, performing chromosome microarray analysis as the first-line assay allows to diagnose not only aneuploidy, but also microdeletion/microduplication, the size of which below resolution threshold for standard cytogenetic karyotyping

457-468 132
Abstract

Aim: to develop individualized options for correcting sex steroid deficiency in early postmenopausal patients with uterine leiomyoma.

Materials and Methods. 180 postmenopausal patients with uterine leiomyoma were examined. To correct menopausal manifestations, patients were prescribed: Group 1 (n = 60) – low-dose drug estradiol 1 mg/drospirenone 2 mg, Group 2 (n = 60) – ultra-low-dose drug estradiol 0.5 mg/drospirenone 0.25 mg, Group 3 (n = 60) – patients refused to take menopausal hormone therapy (MHT). Clinical and anamnestic, laboratory and instrumental examination was carried out by assessing vasomotor and genitourinary symptoms. Special 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 relieved with drug containing 17β-estradiol/drospirenone, regardless of component dosage (RR = 0.25). The size of nodes in uterine leiomyoma type 2–6 according to classification of The International Federation of Obstetricians and Gynecologists (FIGO) as well as Dopplerometry data in the uterine artery in postmenopausal women showed no changes after 9-month use of 17β-estradiol/drospirenone. In Group 1, increased vascularization intensity (RR = 1.4) and decreased peripheral vascular resistance in intranodular vessels were revealed in 6 % patients.

Conclusion. The use of MHT drugs at varying component doses did not enlarge size of leiomyoma nodes nor affected hemodynamic parameters in the uterine arteries during 6-month-treatment. However, while prolonging MHT duration, it increased vascularization of myoma nodes assessed by measuring intranodular blood flow, increased vascularization and decreased resistance index after administering low-dose vs. ultra-low-dose MHT therapy that should be taken into account upon planning therapeutic regimen and its timeframe.

469-478 91
Abstract

Introduction. Preeclampsia (PE) is a specific complication of pregnancy holding a lead place in maternal and perinatal morbidity and mortality worldwide. The development of PE in the maternal body is accompanied by severe hypercoagulation, disturbed anticoagulation and fibrinolytic systems. As a result, vascular microthrombosis in diverse organs with developing endothelial dysfunction, impaired utero-placental blood circulation emerge that leads to adverse perinatal outcomes.

Aim: to study status of coagulation arm in pregnant women with moderate and severe PE, after delivery by cesarean section, to optimize management of the postoperative period.

Materials and Methods. There were enrolled 50 pregnant women with PE: 16 with moderate and 34 with severe PE after surgical delivery. A status of coagulation arm was examined by evaluating major parameters in coagulogram (fibrinogen, activated partial thromboplastin time, prothrombin, international normalized ratio) as well as assay for early diagnostics of blood clotting disorders to reveal bleeding and thrombosis risks.

Results. It was found that prior to surgery patients with severe PE had significantly increased clot growth rate (V) by 1.09-fold (p = 0.001), relative clot density (D) by 1.15-fold (p = 0.001), and time of spontaneous clot appearance (Tsp) was accelerated by 2-fold (p = 0.001) compared to moderate PE. After surgical delivery, patients from both groups had changes evidencing about activated coagulation system: increased V, D, as well as the Tsp. Upon that, all such parameters in patients with severe PE were significantly elevated: the V – by 1.25-fold (p = 0.005); the D – by 1.1-fold (p = 0.02); the Tsp was accelerated by 2-fold (p = 0.03) compared to patients with moderate PE. All parameters in both groups tended to normalize on day 5 after surgical delivery, but patients with severe PE were shown to have significantly increased the V – by 1.5-fold (p = 0.001); the D – by 1.14-fold (p = 0.001); the clot size – by 1.14-fold (p = 0.001); the Tsp – accelerated by 41 % (p = 0.001) compared to patients with moderate PE.

Conclusion. Thus, patients with moderate and severe PE after surgical delivery by cesarean section were featured with markedly activated coagulation hemostasis, which may justify a prolonged use of low-molecular-weight heparins in the postoperative period, especially in patients with PE.

479-489 57
Abstract

Aim: to assess changes in parameters of vascular stiffness, central aortic pressure (CAP) as well as reflected pulse wave in women in different phases of the climacteric period.

Materials and Methods. An open non-randomized single-center comparative study was conducted with 384 menopausal women subdivided into: Group 1 – 168 women at menopausal transition, Group 2 – 216 women at early postmenopause. A 24-hour blood pressure (BP) monitoring was performed with assessing daily dynamics of parameters of arterial stiffness, CAP and reflected pulse wave. The aortic pulse wave velocity and local aortic stiffness were estimated.

Results. It was found that women in early postmenopausal period vs. menopausal transition showed significantly higher values of daily central BP combined with more prominent changes in vascular stiffness. Menopausal women were characterized by lowered difference between nocturnal central and peripheral BP level (less amplified nocturnal vs. diurnal peripheral BP magnitude), which is associated with a greater augmented CAP at this time point. Such pattern was more pronounced in women at postmenopausal period.

Conclusion. Women in climacteric period were found to have increased vascular stiffness combined with elevated CAP, decreased amplification of pulse pressure and increased amplitude of the reflected pulse wave may be associated with increased risk of cardiovascular complications. Much more prominent changes were noted in women in early postmenopausal period.

490-501 67
Abstract

Aim: developing a prognostic model for intrauterine fetal infection risk in extremely preterm and early preterm births induced by rupture of the amniotic membranes.

Materials and Methods. A single-center prospective cohort study was conducted aimed at studying features of pregnancy and childbirth in 160 patients with extremely preterm and early preterm births induced by rupture of the amniotic membranes as well as neonatal period of 160 neonates. Two groups were distinguished: the main group – 37 patients with intrauterine neonatal infection and the comparison group – 123 women without signs of neonatal infection. Along with examination regulated by the order of the Ministry of Health of the Russian Federation No. 572 n, serum level of highly sensitive C-reactive protein, pro-inflammatory cytokines interleukin-6, tumor necrosis factor-α and anti-inflammatory cytokine interleukin-10 were assessed in patients. Risk factors (predictors) of intrauterine infection were assessed by analyzing anamnesis data, echography and laboratory assay data.

Results. Multivariate logistic regression analysis allowed us to identify 10 predictors of intrauterine fetal infection based on which a mathematical model was developed that allowed to predict a risk of intrauterine fetal infection in 95.7 % of cases.

Conclusion. Using a model for predicting intrauterine infection based on a comprehensive predictor assessment, it may allow to accomplish a personalized approach to justify adequate obstetric care and reduce adverse infection-associated perinatal outcomes.

REVIEW ARTICLES

502-514 80
Abstract

Here we review published data from experimental and clinical international studies examining pathogenetic effects of melatonin upon using programs of In Vitro Fertilization (IVF); highlighting various viewpoints on its biological action as a regulator of circadian rhythms: on the one hand, the inhibitory effect of melatonin on pulsating secretion of gonadotropin-releasing hormone was considered, thereby achieving a contraceptive effect; on the other hand, its ability to induce the secretion of human chorionic gonadotropin ensuring ovulation process, was discussed. We also review the data on melatonin acting as a highly active antioxidant. While using melatonin as a metabolic supplement in IVF programs, its positive effect on oocyte morphology and quality of fertilization, embryo division was observed. Moreover, we also highlight the results of studies examining melatonin-related effects on quality of fertilization and embryo division after adding it to culture medium. Such effects demonstrated dose-depended pattern. Taking into account the data of the analyzed publications, adding exogenous melatonin to culture medium may represent a new strategy for personalized approach to improve outcome of IVF programs. Its effectiveness should be further investigated and considered for introduction within the framework of pregravid preparation.

515-522 56
Abstract

The article is devoted to the study and explanation of the meaning, nature, structure, features and ontology of extra-legal regulation in the field of healthcare and medicine (lex biomedica). The authors explain the concept and structure of lex biomedica. The article shows other ontological spaces of the bioethical order associated with the lex biomedica normative space; the content of the subject-object area of lex biomedica regulation is described in detail. The article describes and explains the features of the interactions between the space of legal regulation and the space of extra-legal regulation in the field of healthcare. The authors refer to the concept of "bio-law".

523-533 61
Abstract

Introduction. Adhesive process of the pelvic organs is a pressing issue for operative gynecology that does not allow to consider results of therapeutic and preventive measures as sufficient.

Aim: to analyze published data regarding contemporary aspects of etiopathogenesis of the adhesive process in pelvic organs as well as methods of its prevention.

Materials and Methods. The literature sources retrieved from electronic databases PubMed, Embase, Medline, Ovid HealthSTAR, Cochrane, Google Scholar, eLibrary, CyberLeninka as well as scientific articles published in peer-reviewed open access journals over the last 30 years, including basic research in the field have been analyzed. While searching, the following keywords and their combinations in Russian and English were used: "adhesive process of the pelvic organs", "pathogenesis of the adhesive process", "prevention of the adhesive process", "gynecology", "pelvic adhesions", "pathogenesis of adhesions", "аdhesion prophylaxis", "gynecology".

Results. The current aspects of the etiology and pathogenesis for adhesive process have been summarized. Existing adhesion classifications are presented. The proposed methods for preventing formation of peritoneal adhesions are described exerting most prominent effectiveness as well as describing the properties and characteristics according to the application method, the composition of contained substances and drug form. A phenotype profile of peripheral blood and peritoneal fluid lymphocytes from patients with adhesive process remains debated.

Conclusion. A need to further examine formation of peritoneal adhesions at molecular and cellular levels for developing a comprehensive pathogenetically substantiated method to prevent and treat adhesions of the pelvic organs is in demand.

CLINICAL CASE

534-538 67
Abstract

Thrombophilia might be the essential pathogenetic mechanism of thromboembolism associated with pregnancy. Venous thromboembolism during or after assisted reproductive technologies is predicted to emerge due to increased number of women undergoing this technique. Low molecular weight heparins was effective for preventing recurrent thromboembolism and severe obstetric complications. Women with personal or family history of thromboembolism or with history of obstetric complications should be screened for thrombophilia.

HISTORIC CASES

539-543 63
Abstract

Here, issues related to envisioning mother holding a child in fine arts of XVIII–XXI centuries are discussed. Paintings of Vigee-Le Brun, Bouguereau, Monet, Klimt, Renoir, Dali, Rivera, Picasso are represented as well as works of Russian artists Vasnetsov, Vrubel, Kustodiev, Chagall, and modern painters Hanks and Berggren



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