V.F.Snegirev Archives of Obstetrics and Gynecology

This article analyzed the work of Russian and international authors over the past 10 years on the effect of endometriosis on the development of infertility and evaluated studies on the analysis of in vitro fertilization procedures in patients with this condition. Every third patient who uses assisted reproductive technology (ART) suffers from endometriosis-associated infertility. Endometriosis is a significant cause of this disease, and its clinical forms and the degree of foci spread often limit doctors’ choice of ART programs, which do not always result in pregnancy. Cystic ovarian endometriosis is one of the most common forms of endometriosis. Controversy surrounds the treatment of this form; some authors advocate hormonal therapy (to preserve the ovarian reserve), whereas others believe that more radical surgical treatment helps reduce relapses. In any case, several factors must be considered when choosing the optimal treatment approach for women with ovarian endometriosis and infertility, including the age of the patient, presence of pain, outcomes of previous surgeries, size and number of cysts, preserved ovarian reserve, and access to the follicles. These factors prove the relevance of this condition, which requires a modern approach to its diagnosis and treatment.

This paper presents a review of the current literature on the possible relationship between menopausal hormone therapy and Alzheimer’s disease. Increasing life expectancy in modern society is steadily leading to health problems in older women. Approximately 46.8 million people worldwide currently have cognitive disorders, and 2/3 of them are women. At the age of ≥65 years, every sixth woman and every eleventh man experience a form of higher nervous system pathologies. Older people are most often diagnosed with Alzheimer’s disease. It is a neurodegenerative disease that leads to problems with memory and cognitive functions and is characterized by changes in behavior and social-adaptive position of a person in society.

One theory states that dementia is caused by changes in the endocrine status during menopause, particularly a decrease in estrogen levels. Currently, hormonal drugs are being considered a way to reduce the risk of neurological disorders. The possibility of preventing dementia, particularly Alzheimer’s disease, has long been of interest to leading experts in this field. The prevention of these diseases and prolongation of active longevity are becoming more relevant than ever. The relationship between menopausal hormone therapy and the risk of Alzheimer’s disease is receiving increasing attention.

The uterine factor ranks third among the causes of infertility, accounting for 10–15% and increasing to 50% when combined with other factors. Currently, the introduction of new technologies into medical practice allows the doctor to choose various methods of surgical treatment of intrauterine pathology [endometrial polyp, uterine fibroids with a submucosal location of the G0–G1 node (International Federation of Gynecology and Obstetrics, FIGO), intrauterine adhesions, and congenital malformations of the uterus], including those without anesthetic support. Modern innovations in hysteroscopic surgery have radically changed the way intrauterine pathologies are treated, thanks to the emergence of the “see-and-treat” philosophy and the universal trend toward the miniaturization of office surgical tools and high-resolution optical systems without compromising their functional characteristics. However, many aspects of hysteroresectoscopy in an outpatient setting, namely, its optimal range of applications, advantages and disadvantages in diagnostics and treatment of intrauterine pathologies, and economic components, are not sufficiently covered. This literature review discussed the most current data on the technique and possibilities of using a mini-hysteroresectoscope in outpatient surgical hysteroscopy.

The high prevalence of precancerous pathologies and cervical cancer indicates their relevance. Cervical cancer ranks fourth among the causes of mortality of women with cancer worldwide and second in women aged 15–44 years. According to the World Health Organization, approximately 500 thousand new cases of cervical cancer are diagnosed annually worldwide. In Russia, more than 15 thousand new cases are registered annually, and nearly half of them (47.8%) end in death. The increase in the frequency of advanced stages and the increase in mortality among women of reproductive age are of particular concern. According to statistical data from the oncology database of the Moscow Hertzen Cancer Research Institute, the incidence of cervical cancer over 10 years increased by 2.12% annually.

This article presents the results of the statistical analysis of data for assessing the incidence of precancer pathologies and cervical cancer and discusses trends in the spread and juvenation of this pathology as well as its causes. The results of the analysis of errors in diagnosing intraepithelial lesions and modern possibilities for its optimization are also presented.

Background. Complications following artificial abortion can lead to reproductive dysfunction and gynecological diseases, endocrine disorders, infertility, and miscarriage. One of the most important tasks of practical healthcare is the introduction of safer abortions and an adequate rehabilitation system, including early, as well as ultrasound, diagnostics of emerging complications, into the practice of obstetricians and gynecologists.

Materials and methods. The study included 124 female patients (average age, 34.8+1.7 years) who applied for pregnancy termination in the first trimester. The women were divided into three groups. Group 1 included 52 (42.0%) female patients who received magnetic-infrared-light-laser and ozone therapy to prevent complications following a medical abortion in a complex of therapeutic measures with antibacterial drugs. Group 2 included 24 (19.3%) patients who had dysbiosis, allergic reactions, and drug disease and who used magnetic-infrared-light-laser and ozone therapy without antibiotics to prevent postabortion complications. The control subgroup comprised 48 (38.7%) patients who did not receive treatment for the prevention of complications.

Results. A more rapid change in the size of the uterus toward normalization was noted in women in groups 1 and 2 who received preventive measures. In addition, 1 (2.0%) patient in group 1, 1 (4.1%) in group 2, and 3 (6.2%) in the control group had an exacerbation of bilateral chronic salpingo-oophoritis.

Conclusions. The use of modern technologies (magnetic-infrared-light-laser and medical ozone therapy) with and without antibacterial therapy as preventive measures has a positive effect on uterine contractility and reduces the risk of inflammatory complications in the first months following artificial termination of pregnancy. Ultrasonography of the pelvic organs and laser biophotometer can be used as diagnostic tests and can assess the development of complications following a medical abortion.

Pulmonary embolism is a serious and potentially life-threatening condition, particularly during pregnancy, and is one of the leading causes of maternal mortality.

A 40-year-old female patient at 27–28 weeks of pregnancy was admitted to the hospital with complaints of shortness of breath at rest, dizziness, and loss of consciousness. Three days before admission, she suddenly felt nagging pain in the groin area, which was aggravated by walking. Contrast-enhanced computed tomography (CT) of the chest revealed CT signs of massive thromboembolism of the pulmonary artery. The Qanadli index was 67.5%. Duplex scanning of the veins of the lower extremities revealed thrombosis of the left common femoral vein with a flotation of 6 cm. Following a multidisciplinary consultation, systemic thrombolysis with Alteplase at a dose of 100 mg once was initiated according to vital indications. Improvement was immediately noted in the first hours after thrombolytic therapy. The efficiency of the therapy and satisfactory condition of the mother and fetus extended the pregnancy to 38 weeks. At full term, the patient underwent a successful cesarean section. The postpartum period proceeded without thromboembolic complications during anticoagulant therapy.

This clinical case demonstrates that timely systemic thrombolysis can prolong pregnancy to full term and preserve the life and health of the mother and fetus.