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Vol 9, No 2 (2022)

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The stimulation of ovulation and endometrial carcinogenesis: possible relationship and study prospects (literature review)

Klyukina L.A., Sosnova E.A., Ishchenko A.A.


Currently, infertility is still a global problem; therefore, reproductive doctors worldwide are actively studying new and improving existing methods of overcoming female infertility. In recent years, the arsenal of drugs that can stimulate ovarian function has significantly expanded. A prerequisite for the use of drugs in this group is the presence of a follicular apparatus in the ovaries. Ovulation inducers contribute to the maturation of several follicles at once, and their ability to influence the process of steroidogenesis is beyond doubt. However, the long-term risk assessment when using these drugs, namely the risk of developing malignant female reproductive system neoplasm, remains poorly understood despite their long-term use. This problem is multifaceted and quite difficult to study since the etiological causes of infertility are considered a risk factor for developing malignant female reproductive system neoplasms. Oncological diseases are diagnosed several years after infertility treatment, thus proving a causal relationship is difficult, on the one hand, and dictating the need for a long period of observation in the group of women who underwent infertility treatment, considering the characteristics of each specific method, on the other hand. Herein, the authors analyzed the results of published studies on the possible relationship between ovulation induction and the risk of developing cancer in the uterine body.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(2):73-81
pages 73-81 views

Features of the blood coagulation system status in patients with uterine fibroids: a literature review

Ozolinya L.A., Belousova A.O., Useinova S.E.


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.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(2):83-92
pages 83-92 views

Menstrual dysfunction in adolescent girls who are overweight: a literature review

Svidinskaya E.A., Ageev M.B., Paleeva N.V., Mukhaeva V.A., Sosnova E.A.


This study aimed to review the modern literature on the problems of adolescent obesity and the pathogenesis of menstrual dysfunction in overweight adolescents and women of reproductive age. In recent years, a large number of works have been published on the relationship of hyperinsulinemia with ovarian hyperandrogenism. Most authors recognize that insulin resistance and hyperinsulinemia contribute to polycystic ovary syndrome formation. The formation of menstrual disorders in overweight girls is based on the violation of gonadotropin secretion, insulin resistance, and hyperinsulinemia, which over time lead to hyperandrogenism. A decreased level of somatotropic hormone and insulin-like growth factor and an increased level of leptin leads to malfunctions in the correct functioning of the hypothalamic-pituitary system. These changes disturb the ovulatory function and, consequently, adolescent reproductive health. The relationship between obesity and depression is actively discussed by foreign authors, and the obtained results often contradict each other. Most studies suggest that excessive weight gain during adolescence can lead to depression, negative mood, and low self-esteem.

This study analyzes the results of research by domestic and foreign authors on the issues of diagnosis and treatment. Menstrual disorder therapy against the background of overweight adolescent girls is a matter of dispute among clinicians. With weight loss in adolescents, a significant improvement is found in carbohydrate and lipid metabolism, decreased levels of hepatic transaminases, and a decreased severity of obstructive sleep apnea syndrome.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(2):93-102
pages 93-102 views

The use of a combination of metformin and statins in women with polycystic ovary syndrome: a modern view of the problem

Unanyan A.L., Pivazyan L.G., Chugunova A.V., Siordiya A.A., Ishchenko A.I.


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, 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.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(2):103-109
pages 103-109 views

Original articles

Risk factors for pelvic prolapse in women of reproductive age

Danilina O.A., Volkov V.G.


BACKGROUND: Pelvic organ prolapse (POP) is a violation of the position of the uterus or the walls of the vagina, manifested by the displacement of the genitals before entering the vagina or falling out of it. Despite more than a century of history of study, POP remains one of the important problems of modern gynecology.

AIM: This study aimed to identify the most significant risk factors for pelvic organ prolapse and their associations in women of reproductive age.

MATERIALS AND METHODS: The study involved 211 women of reproductive age (18–45 years). Based on the clinical and anamnestic data, all patients were divided into two groups: the main group (n=97), which included patients with pelvic organ prolapse, and the control group (n=114), which included women without prolapse.

RESULTS: The following are the identified significant risk factors: body mass index of >23.03 kg/m2 (odds ratio [OR]: 6.69; 95% confidence interval [CI]: 3.36–13.34), secondary education (OR: 2.41; 95% CI: 1.37–4.21), lifestyle associated with lift (OR: 7.15; 95% CI: 3.41–15.00), history of >3 pregnancies (OR: 4.48; 95% CI: 2.72–8.76), >2 vaginal birth count (OR: 9.12; 95% CI: 4.81–17.28), >1 abortions (OR: 4.34; 95% CI: 2.40–7.85), maximum newborn body weight of >3700 g (OR: 7.67; 95% CI: 4.12–14.28), and perineal obstetric injury (OR: 39.27; 95% CI: 4.79–321.70). Adequate risk factors were childbirth (OR: 8.22; 95% CI: 2.01–33.58), obstetric trauma (OR: 9.16; 95% CI: 1.36–61.68), and weight lifting-associated lifestyle (OR: 37.56, 95% CI: 3.42–412.40).

CONCLUSION: Significant independent risk factors for pelvic organ prolapse in women of reproductive age have been identified as follows: vaginal childbirth, perineal injury in childbirth, and weight lifting-associated lifestyle. The identified risk factors serve as a basis for the development of an early prognosis system for pelvic prolapse development.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(2):111-120
pages 111-120 views

Modern approaches to the therapy of urgent conditions (рlacenta praevia)

Fatkullina Y.N., Yashchuk A.G., Lazareva A.Y.


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.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2022;9(2):121-127
pages 121-127 views

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