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Vol 10, No 1 (2023)

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Etiologic, diagnostic, and management aspects of patients with isthmic-cervical insufficiency

Yashchuk A.G., Yakovleva O.V., Musin I.I., Yanbarisova A.R., Berdigulova E.F., Gromenko D.D.


Isthmic-cervical insufficiency (ICI) is one of the main causes of recurrent miscarriage, leading to an increase in perinatal mortality rates and a deterioration of women’s reproductive health. There are currently several methods for diagnosing ICI during pregnancy. In the non-pregnant state, its diagnosis is mainly made retrospectively based on a history of preterm birth due to shortening of the cervix. The main treatment for ICI during pregnancy is cervical cerclage. Despite the well-established technique, this surgical intervention is not always effective for prolonging pregnancy and is associated certain pregnancy risks, including uterine contractions, bleeding, and infection. Cases of cervical rupture after suturing have also been reported, which can ultimately lead to miscarriage or preterm delivery. There have been repeated cases of pregnancy loss in women even after the timely detection of ICI and surgical treatment, suggesting that these women are at risk of miscarriage in the future. For such patients, it is necessary to develop an examination algorithm to identify the various aspects of their cervical insufficiency and treatment at the pregravid stage.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):5-11
pages 5-11 views

Possibilities and prospects of targeted therapy for persistent human papillomavirus infection

Kaptilnyy V.A., Efimova V.A., Lazarenko A.N.


Although most human papillomavirus (HPV) infections are transient and disappear within a few years of exposure, 10%–20% of infections persist latently, leading to disease progression, and ultimately various forms of invasive cancer. Despite the clinical efficacy of recently developed polyvalent prophylactic HPV vaccines, these preventive measures are not effective against pre-existing infections. In addition, given the difficulties associated with HPV, in areas with limited access to preventive vaccination, the development of effective treatments to control persistent infection remains an imperative need.

This review discusses not only the mechanisms underlying persistent HPV infection but also the prospect of immunomodulatory therapeutic vaccines and small molecule inhibitors that aim to enhance the host’s immune response against viral infection and hinder critical virus-host interactions.

The present review describes various oncogenic mechanisms of HPV infection at the level of the host cell genome. Special attention has been paid to the molecular mechanisms of carcinogenesis associated with persistent HPV infection, which leads to the formation of a risk group for the development of neoplasia among those with asymptomatic virus carriage.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):13-24
pages 13-24 views

Original articles

Phenomenon of hormone-dependent polyneoplasia of the female reproductive system

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


BACKGROUND: Primary multiplicity of malignant tumors of the female reproductive system is the least studied area of clinical oncology. In addition, the steady rise in the number of patients and various localizations of polyneoplasia with lesions of the female reproductive organs necessitate a detailed study of this problem.

AIM: This study aimed to determine the incidence and risk factors and describe the clinical aspects of polyneoplasia of the female reproductive system for 2010–2021 in women seen at the Medical and Rehabilitation Center of the Ministry of Health of Russia, Moscow, and the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University.

MATERIALS AND METHODS: We conducted a retrospective analysis of the case records of 147 patients with a confirmed diagnosis of polyneoplasia of the female reproductive system for 2010–2021, which accounted for 3.6% of all newly diagnosed neoplasms of the female reproductive system in the above medical institutions. Moreover, a continuous sampling method was used.

RESULTS: Breast cancer was the most frequent first tumor, combined with cancer of the contralateral breast in 27 (42.1%) patients, cancer of the uterine body in 4 (6.25%) patients, ovarian cancer in 4 (6.25%) patients, colon cancer in 4 (6.25%) patients, and thyroid cancer in 1 (1.5%) patient. Cancer of the uterine body was combined with breast cancer in 10 (35.7%) patients, ovarian cancer in 2 (7.1%) patients, thyroid cancer in 2 (7.1%) patients, and colon cancer in 3 (11.1%) patients. Endometrioid adenocarcinoma, pathogenic variant I was determined in 20 (71.4%) cases according to the histological structure. Thyroid cancer was detected in 7 (5.6%) cases; in all cases, it developed metachronously, and it was combined as the initial tumor with breast cancer in 1 (14.3%) case, uterine body cancer in 2 (28.5%) cases, and ovarian cancer in 1 (14.3%) case. As the second tumor, it was also combined with uterine body cancer in 2 (28.5%) cases and ovarian cancer in 1 (14.3%) case. The risk factors assessment led to the identification of several factors that are common in patients with hormone-dependent forms of primary multiple cancer, including obesity, diabetes mellitus, irregular menstrual cycle, history of proliferative diseases of the mammary glands, intake of thyroid drugs, uterine hyperplastic processes, and hypothyroidism.

CONCLUSIONS: Understanding the different aspects of the development and course of hormone-dependent polyneoplasia of the female reproductive system will help in developing approaches for follow-up monitoring of women who have been treated for a primary tumor and are at risk of developing a subsequent tumor of hormone-dependent organs, to prevent the recurrence of the disease and predict the subsequent tumor and ensure its timely detection.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):25-37
pages 25-37 views

Results of surgical correction for cervical elongation with vaginal wall prolapse in patients of reproductive and premenopausal age

Ivanova V.V., Ishchenko A.I., Ishchenko A.A., Khokhlova I.D., Dzhibladze T.A., Gorbenko O.Y., Svidinskaya E.A., Gadaeva I.V., Malyuta E.G., Asambaeva A.


BACKGROUND: The problem of cervical elongation is becoming increasingly important due to the rising prevalence of pelvic organ prolapse. In Russia, descent and prolapse of pelvic organs account for 39% of all gynecological pathologies.

AIM: This study aimed to compare the immediate and long-term results of surgical treatment for cervical elongation in combination with vaginal wall prolapse in patients of three clinical groups.

MATERIALS AND METHODS: A total of 105 patients aged 30 to 55 years with a combination of cervical elongation and vaginal wall prolapse of degrees I–II were followed up. The patients were divided into three clinical groups based on the implemented surgical techniques, including group 1 (n=36) with Moscow surgery, group 2 (n=35) with modification of the Manchester surgery using synthetic implants, and group 3 (n=34) with Manchester surgery.

The patients underwent a comprehensive clinical examination, surgical treatment, and follow-up in the early and long-term postoperative periods (1, 6, 12, 24, and 36 months). The efficacy of surgical treatment was assessed using a questionnaire. During dynamic monitoring, a gynecological examination with a Valsalva maneuver, and transperineal, and transvaginal echography were performed.

RESULTS: During the first month after the surgery, patients noted irregular dragging pains in the perineum and/or inguinal region every second. A frequent urge to urinate was reported in 16.7%, 17.1%, and 17.6% of patients in groups 1, 2, and 3, respectively. A further survey revealed that the surgical treatment results were satisfactory, as it had a positive effect on the quality of life and mood and contributed to an increase in social and sexual activity. According to the physical examination, there were no signs of prolapse recurrence and mesh-associated complications. Erosion of the anterior vaginal wall over the polypropylene endoprosthesis was detected 6 months after the surgery in 3 (8.6%) patients of group 2.

Genital prolapse recurrence was diagnosed after 12–36 months in 7 (20.6%) patients of group 3. After 36 months, degree I prolapse of the posterior (n=1) and anterior (n=1) walls of the vagina was revealed in patients of groups 1 and 2, respectively.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):39-48
pages 39-48 views

Assessment of the risk of progression of purulent-inflammatory complications and the possibility of organ-preserving surgeries in puerperas with obstetric peritonitis

Dabuzov A.S.


BACKGROUND: This study aimed to improve the results (justify the possibility) of organ-preserving surgeries in puerperas with peritonitis after cesarean section, through a comprehensive assessment of the clinical and laboratory parameters of operated patients based on mathematical analysis.

MATERIALS AND METHODS: A prospective, comparative cohort study was performed in parallel groups of puerperas whose delivery was performed by cesarean section, and the postoperative period was complicated by suture dehiscence on the uterus with symptoms of peritonitis. A total of 428 patients, distributed into two groups, were examined, and treated. The main group included 194 puerperas who, in accordance with the prognosis, retained the possibility of undergoing organ-preserving surgery; the comparison group included 234 puerperas with a high risk of progression of purulent inflammatory complications, and who underwent hysterectomy. In the main group, after the laparotomy was conducted again, lymphotropic therapy was performed, optimized by laser irradiation of regional lymph nodes. Patients in the comparison group received conventional treatment.

RESULTS: Based on the developed scale for the risk of progression of purulent-inflammatory complications after cesarean section, the conditions for organ-preserving surgery and the technology for intensive care after relaparotomy were determined. The sensitivity of the prognostic model was 93.3%, and the specificity was 87.7%. Only 2 (1.03%) of the 194 patients in the main group showed progression of purulent-inflammatory complications after organ-preserving surgery, which required relaparotomy, and hysterectomy.

CONCLUSIONS: Based on the results of this study, it was concluded that there remains a possibility for performing organ-preserving surgeries in case of peritonitis after cesarean section, provided there is no decompensated stage of the systemic inflammatory response syndrome and multiple organ failure.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):49-54
pages 49-54 views

Cervical cancer incidence and mortality in the Republic of Bashkortostan: The role of human papillomavirus in the development of cervical cancer

Lyalina G.Z., Yashchuk A.G., Zainullina R.M., Izmailov A.A.


BACKGROUND: Malignant neoplasms (MNs) have been the most urgent problem in medicine worldwide for more than a decade. The steady increase in morbidity and mortality from oncological diseases has led to socio-demographic problems and high economic costs.

AIM: This study aimed to assess the incidence and mortality of cervical cancer (CC) in the Republic of Bashkortostan over a 6-year period.

MATERIALS AND METHODS: This study was conducted from 2015 to 2020 according to the reporting form “Information on malignant neoplasms.” The data were evaluated based on the analysis of statistical data on morbidity and mortality from MNs in the Republic of Bashkortostan and the Russian Federation. Cartography was conducted using the R software, ggplot2 package. Statistical analysis was performed using the Statistica 10 program. Standardized indicators were used to analyze morbidity and mortality.

RESULTS: In the Russian Federation, 299,967 newly diagnosed MN cases in women were recorded in 2020. The most significant cause of oncological morbidity in women is MNs of the reproductive system (38.8%), where tumors of the genital organs account for 17.6% of all MNs in women. The standardized incidence rate of cervical cancer in 2020 was 13.67 per 100,000 population in the Russian Federation, and 10.9 per 100,000 population in the Republic of Bashkortostan.

CONCLUSIONS: The process of CC development is quite long, and it should be diagnosed and treated at the dysplastic stage. The necessity of introducing HPV testing into widespread practice for the rapid screening of CC is obvious. Moreover, the primary prevention of CC by vaccination against the human papillomavirus of high carcinogenic risk is also important.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):55-66
pages 55-66 views

Obstetric and perinatal aspects of asymptomatic bacteriuria in underage pregnant women

Sitdikova D.G., Fatkullina I.B., Galiullina L.A.


AIM: This study aimed to investigate the course of pregnancy in underage pregnant women with asymptomatic bacteriuria.

MATERIALS AND METHODS: A retrospective, comparative analysis of the outpatient records of 70 underage pregnant women was performed. The mean age of the patients was 15.3±1.7 years. The main group included 35 patients with asymptomatic bacteriuria (AB), and the control group consisted of 35 patients without asymptomatic bacteriuria. The patients were monitored during the entire period of pregnancy and childbirth. Based on the conducted research, a combination of therapeutic measures was formed.

RESULTS: Escherichia coli was shown to be the main causative agent, revealed during the examination; childhood infections, diseases of the gastrointestinal tract, and sexually transmitted infections were identified as triggering factors for the manifestation of asymptomatic bacteriuria. More complications were observed in underage pregnant women with asymptomatic bacteriuria than in pregnant women without AB.

CONCLUSIONS: The main condition for a successful course of pregnancy in women with AB is the timely diagnosis of the disease and the implementation of therapeutic measures aimed at preventing its associated complications.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):67-71
pages 67-71 views

Prospects for the use of prostaglandin 11-deoxymisoprostol in obstetrics and gynecology: For medical abortion and the induction and initiation of labor (experimental work)

Yashchuk A.G., Musin I.I., Kataeva R.M., Berdigulova E.F., Yanbarisova A.R., Gromenko D.D.


BACKGROUND: According to WHO (2015), abortion complications account for 8% of maternal deaths. These statistics have prompted the search for new ways to safely terminate early pregnancy. In 2010, at the World Congress of Obstetricians and Gynecologists in Lisbon, medical abortion was called a “world revolution.” Due to the introduction of medical abortion, maternal mortality after abortion decreased by 20,000 persons in 2012. Medical abortion using prostaglandin preparations, which can be used to solve this problem, is safer than surgical abortion, since curettage of the uterine cavity can cause inflammation, mechanical trauma, and infertility. In the Russian Federation, a prostaglandin preparation (misoprostol 200 mcg) has been certified for medical termination of pregnancy. However, this drug is expensive, as it is manufactured through complex chemical synthesis. At the Ufa Institute of Chemistry, Russian Academy of Sciences (UIC, RAS), due to a directed search for uterotonics among 11-deoxyprostaglandins of the E- and F-groups, a promising analog of prostaglandin E1 with a higher uterotonic activity than misoprostol was revealed. The agent is 11-deoxymisoprostol (11-DMP), which is several times cheaper and more accessible for synthesis.

AIM: This study aimed to compare the pharmacological properties of misoprostol and 11-deoxymisoprostol.

MATERIALS AND METHODS: The experiments were performed on non-linear white rats weighing 190–210 g. The animals were fed with a standard diet for the entire experimental period. Animals were monitored and assessed on a daily basis. Animals were divided into six experimental groups, using their body weight as the main criterion for randomization (deviation of body weight values within the group was no more than 10%), with 20 animals in each experimental group. The drug was administered intragastrically at a dose of 10 mg/kg.

To assess the immunotoxic properties, we studied the indicators of nonspecific and specific humoral immunity and cellular immunity in rats and assessed its effect on the mass of lymphoid organs and their cellularity. The allergenic properties of 11-DMP were evaluated using the methods of anaphylactic shock, indirect reaction of mast cell degranulation, reaction of immune complexes, and conjunctival test.

RESULTS: After administration of 11-DMP, a decrease in the rate of weight gain, changes in behavior, and death of animals were not observed in any of the studied groups of males or females. The fertility index did not differ significantly in all experimental groups.

The average number of fetuses per female, the sex ratio of rat pups, and the death rate of newborn rat pups did not change in the broods of all experimental groups.

The study of the allergenic effect of the drug revealed that 11-DMP does not have allergenic properties, as shown by the reactions of mast cell degranulation, immune complexes, and the conjunctival test.

CONCLUSIONS: When studying the pharmacological properties, it was revealed that 11-DMP compared with misoprostol has higher uterotonic properties; the therapeutic margin is 2 times greater, the toxicity is 2 times lower, and it is more stable and has a more accessible route of chemical synthesis.

V.F.Snegirev Archives of Obstetrics and Gynecology. 2023;10(1):73-79
pages 73-79 views

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