Vol 9, No 2 (2022)

Currently, uterine fibroids are one of the most common gynecological diseases, with surgical treatments provided in many cases, but hormone therapy is widely used. Gynecologists must consider all aspects of the patient’s condition during treatment, including the blood coagulation system status. Features of hemostasis affect the disease development, features and outcomes of the operation, and the postoperative period course, as well as the possibility of carrying out the necessary drug therapy and its results. This literature review reflects the results of research by domestic and foreign authors regarding the hemostasis system status in patients with uterine fibroids, including the effect of hormonal, antioxidant, and disaggregate therapy. The studies conducted allowed the authors to predict the possibility of bleeding and thromboembolic complications in patients, as well as the growth of uterine fibroids, to timely correct hemostasis and improve the treatment results in patients with this pathology.

The article discusses the effectiveness of the combination of statins and metformin for hyperandrogenism treatment in polycystic ovary syndrome (PCOS).

This study aimed to analyze the current scientific data on the effect of the combination of statins and metformin on the clinical and laboratory indicators of hyperandrogenism, ovarian volume, and menstrual cycle regularity and assess their use in the treatment of women with PCOS.

Results of retrospective and prospective studies, meta-analyses, and systematic reviews at ClinicalTrials.gov, PROSPERO, among the publications of the International Endocrinological Society, as well as in open electronic databases of scientific literature Google Scholar, PubMed, and Cochrane Library were analyzed. Randomized controlled trials (RCTs), meta-analyses, and systematic reviews that involve women with PCOS who received metformin and statins alone or in combination for androgen level reduction and menstrual cycle regularity improvement were selected.

These studies have shown certain effectiveness of statins in reducing the laboratory manifestations of hyperandrogenism. The positive effect of their combination with metformin on insulin resistance and, generally, the high effectiveness of such treatment regimen to reduce laboratory and clinical manifestations of hyperandrogenism in women with PCOS, reduce ovarian volume, and increase menstruation frequency was also demonstrated.

Their isolated use cannot be recommended for patients with PCOS due to the possible negative effect of statins on insulin resistance and an increased risk of developing diabetes. Further, given the demonstrated effectiveness of the combination of statins and metformin, further studies should be conducted to determine the dose of drugs and other features of their use.

BACKGROUND: Obstetric bleeding associated with placental anomalies is a leading cause of massive bleeding and maternal mortality. Their relevance increases due to the increasing abdominal delivery frequency. Numerous proposed approaches and ways to stop such bleeding indicate the complexity and versatility of the problem, as well as its unresolved present stages.

AIM: This study aimed to evaluate the effectiveness of a new method of bleeding control in placenta previa.

MATERIALS AND METHODS: Herein presented the results of a prospective study that included 58 cases of bleeding control for placenta previa in patients who gave birth in 2017–2020 at G.G. Kuvatov Republican Clinical Hospital in Ufa. Two groups were formed depending on the method of bleeding control. The main group included 34 patients who used a new method for bleeding control. The control group included 24 patients who used traditional methods of bleeding control following the clinical protocol.

RESULTS: The proposed method of bleeding control in placenta previa using drainage silicone tubes and a circular suture is used during cesarean section surgery for placenta previa without signs of placenta accreta spectrum. When separating the placenta and bleeding from the placental site in the region of the lower uterine segment and the internal uterine pharynx, drainage tubes were used that are placed in the internal pharynx area, the uterine body, and the vagina in the necessary amount to achieve tamponade of the internal pharynx.

Further, the tubes were fixed by applying a circular suture tied in the lower uterine segment, which pressed the placental area to the tubes in a hard-to-reach place for stitching, located in the region of the lower uterine segment and internal uterine pharynx, with a mechanical vascular compression at the internal pharynx level without disturbing the outflow from the uterine cavity.

CONCLUSION: The comparative study of methods for stopping the lower segment bleeding in patients with placenta previa shows the high effectiveness of the proposed method for reducing the surgical intervention time and the postoperative period course, as well as the ergonomics and simplicity of bleeding control for the surgeon.