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Vol 6, No 4 (2019)

Original papers

SQUAMOUS CELL PRECANCEROUS LESIONS OF THE VULVA: CURRENT PROBLEMS OF CLASSIFICATION AND DIAGNOSIS

Chulkova O.V., Novikova E.G., Chulkova E.A.

Abstract

This article systematizes and analyzes objective difficulties in the diagnosis of precancerous and primary vulva cancer, such as: constant changes in classification and long-term coordination, long-term systematization of clinical manifestations. It also reflects the current data and achievements of virology and molecular biology, which again led to a change in the classification and approaches to the diagnosis and management tactics of patients with squamous cell lesions of the vulva. New predictor markers, currently available for use in conventional routine morphological practice, gave new data on the development of pre-tumor and tumor process of the external genitals. Also in this article, the new clinical classification of vulva diseases is analyzed in detail, a comparison of standard and new diagnostic methods is carried out, which in clinical practice helps to correctly diagnose, determine the extent of the lesion and, depending on the molecular factors of the prognosis, choose an individual modern treatment tactics.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):172-177
pages 172-177 views

PRENATAL DIAGNOSTICS IN THE I TRIMESTER OF PREGNANCY: THE CURRENT STATE OF THE PROBLEM

Kuzmina T.E., Timokhina E.V., Ignatko I.V., Lebedev V.A.

Abstract

Prenatal diagnosis is one of the priority areas of modern obstetrics. Improving diagnostic capabilities, the introduction of new methods gradually led to the fact that the first trimester of pregnancy became a full-fledged diagnostic stage in assessing the condition of the fetus, identifying genetic problems and a significant number of malformations. Understanding the value of the proposed methods, the sequence of their use, the accuracy of the results are extremely important for the choice of management for a particular pregnancy.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):178-184
pages 178-184 views

MODERN POSSIBILITIES OF IRON DEFICIENCY ANEMIA TREATMENT IN ONE VISIT

Ozolinya L.A., Shirenina A.A., Kulinicheva E.A.

Abstract

The iron deficiency anemia remains a current problem, despite new methods of treatment. According to the statistics, every fifth woman of reproductive age has manifestations of iron deficiency that worsens quality of her life. The modern way of life causes need for fast and effective treatment. We carried out the analysis of information on treatment of an iron deficiency anemia by oral (ferri sulfas, ferric (III) hydroxide polymaltosate ) and intravenous (ferric (III) hydroxide olygoisomaltosate, ferric (III) carboxymaltosate, ferric (III) sacharose complex) iron preparations and red blood cell transfusion. On the basis of studying of scientific articles, we established that ferric (III) hydroxide olygoisomaltosate has the most effect and fast effect for treatment of iron deficiency medium and heavy gravity.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):185-192
pages 185-192 views

THE ROLE OF ANTI-MULLERIAN HORMONE IN THE PATOGENESIS OF ENDOMETRIOSIS

Paramonova N.B., Semeryuk T.A.

Abstract

Anti-Müllerian hormone is one of the most significant factors regulating woman’s reproductive function, which inhibits endogenous production of estrogens, induces cell cycle arrest, apoptosis and autophagy in human endometrial stromal cells. Disturbance of Anti-Müllerian hormone expression could be an important link to pathogenesis of endometriosis.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):193-197
pages 193-197 views

THE CLINICAL SIGNIFICANCE OF STEM CELLS IN CERVICAL DISEASES

Unanyan A.L., Kogan E.A., Berishvili M.V., Zholobova M.N., Pivazyan L.G., Baburin D.N.

Abstract

Stem cells are cells capable of self-sustaining asymmetric division, resulting in one daughter cell and one progenitor cell from one stem cell. The features of stem cells are the ability to self-renew and differentiate into various cells, ensure hemostasis of tissues, as well as proliferative reserve. The maintenance and functional properties of stem cells are regulated by signals from the stem cell niche, i.e. from their local microenvironment, which contributes to adequate self-renewal and differentiation. Therefore, niches provide regulation of the number of stem cells in the body and protect the body from their excessive proliferation. Structurally, the stem niche is a combination of all factors that ensure the viability and self-reproduction of stem cells and the differentiation of daughter progenitor cells. An example of a stem cell niche can be the transition zone (TZs) - the junction of different types of epithelial tissue. It is believed that carcinogenesis can be associated with these zones: the transition region of the glandular and squamous epithelium in the conjunctiva, the cervical glands of the stomach, in the esophagus, in the lungs (bronchioalveolar transition zone), in the cervix (endo-ectocervical transition). This article discusses modern approaches to the search for significant markers of the state of stem cell niche and tumor stem cells of cervical cancer, which will be of great importance in clinical practice for the timely detection of oncological processes, even before their phenotypic manifestation.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):198-202
pages 198-202 views

THE STATE OF THE HEPATOBILIARY SYSTEM IN PREGNANT WOMEN WHO RECEIVED PROGESTERONE THERAPY

Novruzova D.R., Sosnova E.A., Tumbinskaya L.V., Kirakosyan E.V.

Abstract

Introduction. One of the most common drugs for maintaining pregnancy is exogenous progesterone. With the expansion of the indications for its use during pregnancy, the number of complications associated with it may increase. Material and methods. The article presents the results of a prospective study of medical records of pregnant women, which were observed in the V.F. Snegirev Obstetrics and Gynecology Clinic in 2017 and received exogenous progesterone therapy. Results. The dynamics of changes in the studied biochemical parameters was multidirectional in the main and control groups. According to pregnancy outcomes, statistically significant differences between the groups were not found. Conclusions. Critical abnormalities of the main biochemical parameters in pregnant women of the main group were not detected. Preparations of the gestagen series in appropriate dosages do not significantly affect the main indicators of the hepatobiliary system and pregnancy outcomes, so their use is permissible under the control of laboratory parameters.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):203-208
pages 203-208 views

PREVALENCE AND POSSIBLE RISK FACTORS OF HEMORRHOIDAL THROMBOSIS IN PREGNANCY AND POSTPARTUM PERIOD

Medkova Y.S., Markar’yan D.R., Tulina I.A., Churina Y.A., Aleksandrov L.S., Tsar’kov P.V., Ishchenko A.I.

Abstract

Introduction. Nowadays there are no sufficient evidence based data for a scientifically approach to the treatment of hemorrhoids during pregnancy and after childbirth, as well as current data of the prevalence of hemorrhoidal thrombosis (HT) and possible risk factors. Material and methods. The study included pregnant women and puerperas who were actively diagnosed with chronic hemorrhoids (CH) and HT. The physical examination was performed four times: at the woman’s initial visit to the obstetrician-gynecologist, at 24 weeks of pregnancy, at 36 weeks of pregnancy, in the postpartum period (within 7 days after delivery). Patients suffering from HT were asked to answer a questionnaire to determine possible risk factors. Results. A study was conducted on a population of 668 women. 104 women was diagnosed with CH in the postpartum period, and 81 - during pregnancy. The median VAS score with HT was 7. Second delivery, age over 30 years old, lack of physical activity during pregnancy and vaginal delivery are possible risk factors for the development of HT. Conclusions. In the presence of a high risk of HT during pregnancy and in the postpartum period, preventive examinations by a coloproctologist are an important aspect of patient management.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):209-214
pages 209-214 views

POSSIBILITIES OF ULTRASONIC MONITORING OF ENDOMETRIUM AND OVARIES IN PATIENTS AFTER CANCELLATION OF LONG-TERM RECEPTION OF COMBINED ORAL CONTRACEPTIVES WHEN PLANNING PREGNANCY

Bortsvadze S.N., Svidinskaya E.A., Dzhibladze T.A., Khokhlova I.D., Van Y.

Abstract

The article aims to assess the possibility of ultrasound scanning and dopplerstudy in the assessment of the condition of the ovaries and endometrial in patients after long intake of COC, predicting the restoration of reproductive function after the abolition of hormonal contraception. Material and methods. In 2018-2019, 37 women were examined after the abolition of oral contraceptives, which they took for a long period of time. At the time of the examination, all the patients stopped taking COC at least 2 months ago due to the fact that they were planning a pregnancy. UW the study was conducted on the apparat Voluson E8 Expert (General Electric), improving the quality of diagnostics used Automatic assessment of follicle condition based on ultrasonic echography (Sono AVCTM follicle) and tomographic ultrasound (TUI). Results. According to the study significant changes recorded 17 patients whose menstrual cycle did not recover within the first 6 months after the cancellation of COC. In a group of 20 patients with a regular menstrual cycle, the results of the study were within normal limits, pregnancy within 6 months occurred on their own in 8 of them. Conclusion. The possibilities of 3 dimensional reconstruction and programs for evaluating the follicular apparatus significantly improve the quality of ultrasound diagnostics, give more information about the presence of small follicles, blood flow in the ovarian tissue, the structure of the cortical apparatus substances and stroma, whichis the ability of a clinician to obtain a complete understanding of the condition of the ovaries and endometrial and predicting a good health of patients. The article may be of interest to obstetricians-gynecologists, ultrasound specialists, endocrinologists, reproductive specialists.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):215-220
pages 215-220 views

LEARNING CURVE OF ROBOT-ASSISTED MYOMECTOMY

Tyan A.G., Slukhanchuk E.V.

Abstract

Introduction. Robot-assisted myomectomy is the most modern types of surgical interventions for uterine myoma in patients of reproductive age. It benefit in simplicity of intracorporeal suturing and lack of laparoscopic myomectomy limitations. Of great scientific interest is the speed of mastering the method. We studied the learning curve of a robot-assisted myomectomy based on our own experience. Material and methods. A retrospective analysis of the results of 45 robot-assisted operations for uterine myomas from August 2016 to June 2017 was performed at the City Clinical Hospital named after S.I. Spasokukotskiy. All operations were performed by a single surgeon with extensive experience in laparoscopic surgery. The surgeon had no experience of robotic operations. Results. According to a retrospective analysis, there was stromg correlation between the acquired experience of robotic surgery and such indicators as the average duration of the operation, the time of thermal ischemia and the volume of blood loss. Conclusion. The learning curve of a robot-assisted myomectomy for an experienced laparoscopic surgeon improves to 15 operations. This experience is enough to perform operations with a minimum duration, volume of blood loss and complications.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):221-224
pages 221-224 views

CLINICAL CASE OF A SUCCESSFUL PREGNANCY WITH THE COMPLETE FORM OF GONADAL DYSGENESIS - SWYER SYNDROME

Timokhina E.V., Afanas’yeva N.V., Samoylova Y.A., Silayeva T.M., Belousova V.S., Lomovtseva M.M., Seyfullayeva L.I.

Abstract

Swyer syndrome (46,XY complete gonadal dysgenesis) is a rare chromosomal pathology. This pathology occurs with a frequency of 1 in 80,000. In genetic analysis, mutations are most often found in the following genes: the SRY gene, the NR5A1 gene, the SOX9 gene, the MAP3K1 gene. Patients with this disease develop phenotypically as women, but due to the absence of gonads and eggs, independent pregnancy is impossible. This article describes a clinical case of a successful onset, course of pregnancy and delivery in a woman with Swyer syndrome using assisted reproductive technology.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(4):225-228
pages 225-228 views

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