Vol 9, No 4 (2022)

While treating patients with endometrial hyperplasia, the physician may face both bleeding and thrombotic complications, particularly, during hormonal or surgical treatment, which significantly increases the risk of these complications. In addition, thrombotic complications in gynecological patients may result from congenital or acquired thrombophilia, blood flow disorders (blood stasis), and vascular wall damage, that is, the classic Virchow triad.

This study aimed to review the recent scientific literature on the peculiarities of the blood coagulation system in patients with endometrial hyperplasia.

The review reflects the results of studies conducted by Russian and foreign authors on the status of the blood coagulation system in patients with endometrial hyperplasia. The features of vascular, thrombocytic, plasma (procoagulant and anticoagulant), and fibrinolytic elements of hemostasis in these patients are considered. The data from the literature on the state of hemostasis before treatment and following hormone therapy and surgical treatment are presented. Moreover, the data of some studies on the genetic features of the hemostatic system in patients with endometrial hyperplasia are summarized. An analysis of the literature indicates the need for a careful choice of drugs and methods of treatment of these patients to avoid venous thromboembolic complications.

INTRODUCTION: Premature abruption of a normally located placenta is a sudden and challenging problem to manage, and is a leading cause of maternal and perinatal mortality. Here, we reviewed the case of a pregnant woman with multiple organ failure and premature placental abruption involving the successful use of extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory distress syndrome.

AIM: We aimed at assessing the feasibility of using ECMO in the treatment of severe lung damage in a patient with multiple organ failure.

CLINICAL CASE: We reviewed the clinical findings of the course of multiple organ failure and lung damage in a puerpera with severe preeclampsia. Moreover, we analyzed her life history, diseases, and diagnostic and treatment methods were analyzed.

The described clinical case shows the possibility of the successful use of ECMO in patients with severe lung damage and respiratory distress syndrome in multiple organ failure resulting from severe obstetric complications. Currently, this is the first case involving ECMO in the treatment of the consequences of acute total abruption of a normally located placenta with favorable outcomes in the Republic of Bashkortostan.

BACKGROUND: Fetal growth restriction (FGR) is one of the current problems in modern obstetrics and perinatology, which is associated with a large number of adverse perinatal outcomes.

AIM: This study aimed to assess the diagnostic significance of the combination of autoantibodies (AAB) in the early and late FGR manifestation.

MATERIALS AND METHODS: The study involved 117 pregnant women, classified into Group 1 (90 women with FGR) and Group 2 (27 women with a physiological course of pregnancy). Pregnant women with FGR were divided into two subgroups depending on the time of manifestation, i.e. FGR subgroups with early and late manifestation (45 patients each), respectively. Upon hospital admission, all patients of the study groups had blood sampling to determine autoimmune AABs using the ELI-P-test.

RESULTS: An isolated increase in AABs to human chorionic gonadotropin (hCG) antigen, TrM (AAB markers of changes in vascular and hemostasis system), S100 protein, antineutrophil cytoplasm antibodies (ANCA), and KiMS (AABs to the cytoplasmic antigen of glomerular kidney cells) were observed in the early FGR manifestation when comparing the abnormal AAB spectrum in the early and late FGR manifestation, while a statistically significant isolated increase in the level of AABs to DNA and insulin was found in the late FGR manifestation.

CONCLUSIONS: The study revealed the diagnostic significance of AAB combinations, as well as the combinations of increased AAB levels to hCG, S100, ANCA, and KiMS and an increase in AABs to DNA, collagen, and S100 protein in the early and late FGR manifestation, respectively.

BACKGROUND: According to several Russian researchers, the number of cesarean deliveries in different regions of Russia varies from 15.2% to 42%. The incidence of complications — inconsistency of the uterine scar (isthmocele) after surgery is 10%–15%.

AIM: This study aimed to assess the efficiency and safety of robot-assisted surgery in the correction of isthmoceles after cesarean section in patients of reproductive age.

MATERIALS AND METHODS: The study involved seven patients aged 27–34 years with signs of isthmoceles after urgent or elective cesarean section 12 months to 6 years prior to hospitalization. A comprehensive dynamic examination (echography, magnetic resonance imaging, and office hysteroscopy), surgical treatment with the da Vinci Si robotic complex, and outpatient monitoring in the early and long-term period (1, 6, 12, 24, and 36 months) were performed.

RESULTS: The patients were satisfied with the results of surgical treatment during outpatient monitoring due to the improved quality of life resulting from the reduction of pathological symptoms. The control echography (1, 6, and 12 months later) showed normal myometrial thickness (9–11 mm) and adequate blood flow in the metroplasty area in all patients. The “niche” was not visualized during office hysteroscopy 6-months after the metroplasty. Three patients became pregnant 16–20 months after the reconstructive uteroplasty and ended with a timely operative delivery. Two patients were followed up for their pregnancies at 12 and 29 weeks of gestation, while two women continued taking oral contraceptives and planned their next pregnancy at least a year later.

CONCLUSIONS: The use of the da Vinci Si robotic system for surgical correction of isthmoceles provides volumetric three-dimensional visualization of anatomical structures, reduces the duration of surgery and intraoperative blood loss, minimizes the number of intraoperative and postoperative complications, and contributes to accelerated postoperative rehabilitation of patients.

BACKGROUND: The production of many molecular markers at different grades of cervical intraepithelial neoplasia is currently being studied to predict the outcome of the disease and build an individual prognosis. However, no clear criteria for the course of neoplasia are available at this time.

AIM: This study aimed to assess the efficiency of the antiviral immunomodulator Allokin-alpha (Alloferon) in the treatment of cervical intraepithelial neoplasia of moderate severity from the perspective of long-term follow-up.

DESIGN: Prospective study.

MATERIALS AND METHODS: We examined 86 women of reproductive age with grade II cervical intraepithelial neoplasia (CIN II) associated with human papillomavirus (HPV). In the CIN II group, all patients underwent excision of the affected area. According to the study design, 43 women were followed up after excision (Group 1a), while 43 participants were treated surgically and used the study drug (Group 1b). By cytological and colposcopic examination, the efficiency of the chosen therapy was assessed after 3, 12, and 18 months. However, the main criteria for the efficiency of treatment were the absence of HPV or a decrease in the viral load below significant values and the absence of recurrence of the pathological process.

RESULTS: The combination of excision and the use of Allokin-alpha (Alloferon) showed significant advantages over monosurgical treatment.

CONCLUSIONS: The data obtained indicate high HPV elimination and reduced probability of recurrence after excisional treatment in patients with CIN II when using Allokin-alpha (Alloferon).