| Безменко, А. А. Состояние тазового дна во время беременности как предиктор развития тазовых дисфункций и исхода родов / А. А. Безменко, А. С. Староверова // Журнал акушерства и женских болезней. – 2024. – Т. 73, № 4. – С. 85–94. (Pelvic floor condition during pregnancy as a predictor of pelvic dysfunction and labour outcome) |
This review analyses a number of studies investigating the association between pelvic floor health during pregnancy and the development of pelvic organ dysfunction and birth outcomes. These studies have consistently demonstrated that changes in pelvic floor structure and function during pregnancy are associated with an increased risk of pelvic disorders such as urinary incontinence and pelvic organ prolapse. In addition, certain pelvic floor characteristics, such as muscle strength, tone and stretch capacity, have been identified as potential predictors of pelvic organ dysfunction during pregnancy and of prolonged second labour. The data collected suggest that assessment of pelvic floor health during pregnancy may provide valuable prognostic information regarding birth outcomes, and understanding these relationships may lead to improved antenatal care strategies and interventions to optimise pelvic floor function and reduce the incidence of adverse birth outcomes. Further research is needed to identify the specific parameters for assessing pelvic floor changes that are most predictive of pelvic organ dysfunction and adverse birth outcomes, and to evaluate the effectiveness of preventive interventions. |
| Прилепская, В. Н. Контрацепция после родов: современные достижения и перспективы / В. Н. Прилепская, Е. Г. Назаренко // Гинекология. – 2024. – Т. 26, № 1. – С. 5–10. (Contraception after childbirth: current achievements and prospects: A review) |
The article presents modern methods of contraception after childbirth, including their impact on the mother and child, the main advantages and disadvantages. Special attention is paid to barrier methods of contraception, spermicides, and their advantages according to the “Acceptance Criteria” of the World Health Organization (2015) and the “National Acceptance Criteria” (2023), their features and prospects for use. |
| Современный взгляд на тактику ведения пациенток с гиперплазией эндометрия / А. С. Хачатрян [и др.] // Гинекология. – 2024. – Т. 26, № 1. – С. 11–15. (Current view of the management of patients with endometrial hyperplasia: A review) |
Endometrial hyperplasia (EH) is a spectrum of morphological changes in the endometrium characterized by the proliferation of glands and an increase in the gland-stromal ratio. The relevance of this disease is due to its high prevalence (10–55%). The clinical significance of EH is related to the increased risk of endometrioid cancer. One of the leading causes of EH is absolute or relative hyperestrogenism and progesterone deficiency that does not eliminate the proliferative effect of estrogens. The risk group for EH includes women with early menarche, late menopause, infertility, anovulation, polycystic ovary syndrome, obesity, type 2 diabetes mellitus, hypertension, Lynch syndrome, estrogen-producing ovarian tumors, as well as those receiving estrogen monotherapy or tamoxifen. Most leading experts believe that therapy should include surgery followed by drug therapy aimed at eliminating risk factors to reduce the risk of EH recurrence. Despite numerous research findings demonstrating the benefits of a particular treatment modality and the consequent presence of these modalities in clinical guidelines, the potential benefits of alternative therapies are still being discussed. This issue requires further study and the selection of optimal treatment regimens for patients with EH. |
| Гонадотропины в программах вспомогательных репродуктивных технологий (литературный обзор) / С. Я. Острина [и др.] // Гинекология. – 2024. – Т. 26, № 1. – С. 16–21. (Gonadotropins in assisted reproductive technology programs: A review) |
Reproductive medicine is actively developing, and new methods, drugs, and protocols are being developed and introduced for the treatment of infertility. Assisted reproductive technologies (ART) are the most effective methods. In ART protocols, ovarian stimulation (OS) is based on gonadotropin use. The choice of the starting dose of gonadotropin is a critical factor in the successful OS and the effectiveness of ART programs. The article describes the development history of gonadotropins and provides current data on their use in ART programs. The use of biosimilars of follitropin alfa in OS is discussed, and the effectiveness of its Russian biosimilar is also addressed. |
| Особенности репродуктивной функции девочек и женщин с ревматоидным артритом / А. В. Казакова [и др.] // Гинекология. – 2024. – Т. 26, № 1. – С. 22–27. (Features of the reproductive function of girls and women with rheumatoid arthritis: A review) |
Rheumatoid arthritis is one of the most common and severe autoimmune diseases. The prevalence of rheumatoid arthritis among adults in different geographical areas of the world ranges from 0.5 to 2%. The prevalence of juvenile rheumatoid arthritis is approximately 6 per 10 thousand children. The disease occurs 2 times more often in girls than in boys. Some studies have demonstrated a possible effect of high cumulative doses of methotrexate on ovarian function in patients with systemic lupus erythematosus, but further studies are needed to confirm this effect. The analysis of literature data allowed us to identify prognostically significant factors in the development of autoimmune ovarian failure in patients of reproductive age with rheumatic pathology, and to note the fact that there is missing information about the state of the reproductive system in female patients with juvenile arthritis. |
| Прилепская, В. Н. Эстетрол: новое слово в современной гормональной контрацепции / В. Н. Прилепская, М. В. Юрова // Гинекология. – 2024. – Т. 26, № 2. – С. 108–118. (Estetrol: a new word in modern hormonal contraception. A review) |
The concept of the demographic policy of the Russian Federation is to increase the birth rate, preserve citizens’ health, and increase life expectancy. One of the priority areas is the reproductive health of women. The pleiotropic effect of the components of combined hormonal drugs is successfully used in clinical practice by obstetricians-gynecologists not only for contraception but also for conditions requiring prophylaxis and drug therapy. Estrogens have a protective effect on the reproductive and extragenital organs; however, evidence of the effect of estrogen-containing drugs on breast tissue and hemostasis remains debatable. We analyzed the data published in the international databases PubMed, Google Scholar, and MEDLINE (search depth – 5 years). Estetrol (E4) is a native fetal estrogen produced by the fetal liver during pregnancy. The key difference from other estrogens is its highly selective and differentiated effect on various tissues and its unique antiproliferative properties. The review presents the results of studies on estrogenic and antiestrogenic effects of E4 and the combination of E4 with progestogen (Esteretta drug product approved in Russia), with particular attention paid to the oncoprotective effect of E4. Research data suggest that E4 may have different effects on breast epithelial cells and breast cancer cells compared to other estrogens. Clinical data indicate that E4 has a more selective pharmacological profile compared to other estrogens, which is reflected in a low estrogenic effect on the liver, including the production of sex hormone binding globulin, hemostasis parameters, and lipid profile. |
| Истмоцеле: дискуссионные вопросы терминологии, диагностики и лечения / Н. М. Подзолкова [и др.] // Гинекология. – 2024. – Т. 26, № 2. – С. 119–127. (Isthmocele: controversial issues of terminology, diagnosis and treatment. A review) |
The frequency of abdominal delivery in the world is steadily rising. Since the latter is associated with a lot of complications compared with vaginal delivery, the increase in the proportion of deliveries in women with a uterine scar through the natural birth canal is an important strategic goal of the obstetrics and gynecology community. In addition, it is established that every second patient after a cesarean section develops a defect in the scar area, which is often accompanied by various disorders of the menstrual cycle (in 25,5% of cases – abnormal uterine bleeding) and can cause secondary infertility. Both assessment of the risk of scar failure at the stage of preconceptional preparation and timely detection and treatment of isthmocele symptoms are still serious challenges facing obstetricians and gynecologists. Clinical guidelines devoted to the cesarean scar defect problem have not yet been developed. This review presents the quintessence of modern data on possible risk factors, clinical manifestations with a detailed consideration of pathophysiological mechanisms, diagnostic tools and correction methods of symptomatic isthmocele and uterine scar defect with a detailed description of indications and a comparative assessment of their effectiveness in order to standardize approaches to the diagnosis and treatment of these pathological conditions. |
| Белокриницкая, Т. Е. Современные методы оценки кровопотери в родах и диагностики послеродового кровотечения / Т. Е. Белокриницкая, А. Г. Сидоркина, В. А. Мудров // Гинекология. – 2024. – Т. 26, № 2. – С. 129–134. (Modern methods for assessing blood loss in childbirth and diagnosing postpartum hemorrhage: A review) |
Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality in Russia and worldwide. Accurate calculation of circulating blood volume (CBV) and personalized estimation of the extent of blood loss (EBL) play vital roles in the early diagnosis of PPH. Visual assessment of BL in childbirth is an available diagnostic method, but it has a high error rate compared to the gravimetric method. A dynamic assessment of the shock index (SI) as an indicator that reflects hemodynamic disorders early enough can be used as an additional diagnostic method for PPH and a test that allows predicting the need for transfusion of blood products. Aim. To review current literature on the assessment of BL in childbirth and the diagnosis of PPH. Materials and methods. The search for publications by Russian and foreign authors was carried out in the information electronic databases PubMed, PubMed Central, Scopus, MEDLINE, ScienceDirect, Cochrane Library, and eLibrary from 2016 to January 2024 using the keywords “obstetric blood loss,” “PPH,” and “SI.” Results. When assessing the CBV, its correlation with the body mass index was revealed. Subjective methods for the PPH assessment have a large margin of error, which does not depend on the experience and seniority of the healthcare provider. The gravimetric method is more accurate, but it can underestimate the clinical situation when physiological blood loss is exceeded. Dynamic assessment of SI is an early marker of hemodynamic disorders and makes it possible to identify patients with a high risk of adverse outcomes more reliably than other parameters. Conclusion. In order to provide timely and adequate emergency medical care for excessive obstetric blood loss, a personalized approach should be used to calculate the EBL, taking into account the woman’s body mass index, as well as a systematic assessment of the BL, including at least the extent of blood loss and monitoring of the SI. |
| Диагностика и медикаментозная терапия эндометриоза на амбулаторном этапе / А. Е. Солопова [и др.] // Гинекология. – 2024. – Т. 26, № 2. – С. 135–140. (Outpatient diagnosis and drug therapy of endometriosis: A review) |
Endometriosis affects about 10% of women of reproductive age and can negatively impact their quality of life (QoL). Due to the heterogeneity of symptoms or even their absence, early diagnosis is difficult. Therefore, it is necessary to comprehensively assess the patient’s complaints, including a thorough review of medical history, the results of imaging studies, and risk factors for endometriosis. Early diagnosis enables preemptive treatment and avoids surgical intervention. The article presents data on managing patients with endometriosis in outpatient settings, describing methods for non-invasive imaging diagnosis of endometriosis. Current options of pharmacotherapy aimed at controlling the development of the disease and improving the QoL of patients in the long term are addressed. Timely initiated drug treatment improves the QoL of patients, in some cases, leads to a regression of the lesions, and improves the prognosis for the reproductive function. A shift in focus to clinical diagnosis, combined with non-invasive imaging, shortens the time between the first consultation and the final diagnosis. According to the current view of Russian and international professional societies, therapy should be long-term; therefore, selecting treatment with predictable responses and monitoring the course of the disease is necessary. |
| Возможности и перспективы локального применения гиалуроновой кислоты при вульвовагинальной атрофии у женщин репродуктивного возраста / В. Н. Прилепская [и др.] // Гинекология. – 2024. – Т. 26, № 3. – С. 254–259. (Potential and perspectives of local application of hyaluronic acid in vulvovaginal atrophy in women of reproductive age: A review) |
Disruption of the structure and function of the vulvovaginal epithelium in women of reproductive age is accompanied by impaired sexual function and a decrease in the quality of life. This review analyses research on the use of hyaluronic acid (HA) for women of reproductive age with conditions and diseases manifesting as vulvovaginal atrophy. HA is involved in various physiological processes, including tissue regeneration, cell migration and proliferation during inflammation, and helps maintain water balance and tissue integrity. Local therapy with HA is effective in treating the symptoms of vulvovaginal atrophy in women of reproductive age associated with hypoestrogenism, both as a monotherapy and in combination with other treatments. It improves sexual function and quality of life, helping women to improve their sexual lives and living standards. |
| Чернуха, Г. Е. Обильные менструальные кровотечения и анемия: проблема нарастает и требует решения / Г. Е. Чернуха // Гинекология. – 2024. – Т. 26, № 3. – С. 260–269. (Heavy menstrual bleeding and anemia: The problem is growing and requires a solution. A review) |
Anemia is a global health problem, affecting about a quarter of the world’s population, especially women of reproductive age and young children. In 50–75% of cases, anemia is secondary to iron deficiency (ID). Despite the high prevalence of heavy menstrual bleeding (HMB), the associated iron deficiency disorders are underestimated, although they sharply reduce the quality of life and carry significant risks for the mother, fetus and newborn in case of pregnancy. For this purpose, routine screening of girls and women of reproductive age for the presence of ID and anemia is recommended. The new FIGO initiative aims to raise awareness among women and clinicians about the relationship between HMB and ID conditions. Of key importance are: early diagnosis of HMB, elimination of the possible cause, identification of associated iron deficiency disorders, especially preclinical forms. The main task of the gynecologist is to prescribe therapy aimed at quickly stopping high monthly iron losses and replenishing the existing ID. According to Russian clinical guidelines, combined oral contraceptives and an intrauterine system with levonorgestrel are considered first-line therapy to reduce the volume of menstrual blood loss in patients with HMB who require contraception. Qlaira® and Mirena® are the only hormonal drugs registered for contraception and the treatment of HMB not associated with structural disorders of the uterus, since their high effectiveness in reducing menstrual blood loss, restoring hemoglobin and ferritin levels has been confirmed in studies with a high level of evidence. |
| Власов, А. В. Химиопрофилактические свойства 3,3′-дииндолилметана: от экспериментального до клинического применения / А. В. Власов, О. В. Якушевская // Гинекология. – 2024. – Т. 26, № 3. – С. 270–274. (Chemopreventive properties of 3,3′-diindolylmethane: From experimental to clinical studies. A review) |
The basis for the prevention of cancer is the correction of initial epigenetic disorders in the cell, i.e. implementation of pathological genome reversion. Convincing evidence has accumulated to support the potential antitumor activity of compounds derived from cruciferous vegetables of the genus Brassicaceae. Indole-3-carbinol and 3,3′-diindolylmethane (DIM) have been investigated for their use as chemopreventive agents. DIM is formed in the acidic environment of the stomach as a result of dimerization of indole-3-carbinol monomers. Currently, it is impossible to identify a specific vector of influence of DIM at the molecular level. In this review, we summarize the pleiotropic effects of DIM aimed at correcting reversible epigenetic changes in tumor cells. Emphasis will be placed on the major cellular and molecular events that are effectively modulated by DIM. The main profile of DIM competencies concerns the management of intracellular signal transmission and correction of initial molecular genetic changes at the level of key participants in signaling pathways (NF-κB/Wnt/Akt/mTOR) leading to the development of cancer. The ability of DIM to differentially modulate tumor cell apoptosis has been observed in preclinical studies. It has been suggested that using DIM it is possible to increase the effectiveness of chemotherapeutic compounds with different molecular targets, thereby increasing chemosensitization. DIM has entered phase III clinical trials, with preliminary results confirming its promise both as a stand-alone drug and in combination with other components of anticancer therapy. Establishing the range of epigenetic control of DIM molecular and genetic changes in various cancers will allow optimization of therapeutic epigenetics approaches. |
| Современные подходы к профилактике и лечению анемии недоношенных (обзор литературы) / А. М. Козарезова [и др.] // Здравоохранение. – 2024. – № 10. – С. 37–46. (Modern approaches to the prevention and treatment of anaemia of prematurity (literature review)) |
Anaemia of prematurity occurs in the vast majority of newborns who are born extremely immature or have an extremely low birth weight. Of course, the shorter the gestational age of the child, the higher the likelihood of developing this pathological condition. However, due to a number of factors, children with a moderate or mild degree of prematurity are also susceptible to anaemia. Modern data on non-medication prevention of anaemia of prematurity are summarised and systematised, including delayed cord clamping, cord milking, optimisation of blood collection, approaches to enteral and parenteral nutrition of prematurity. Information on drug prophylaxis and the results of recent studies on treatment with haemotransfusion and erythropoietin preparations are presented. |
| Варбанян, В. А. Эндометриоидные кисты и бесплодие: дилемма при выборе тактики (обзор литературы) / В. А. Варбанян, В. Ю. Смольникова, Л. В. Адамян // Проблемы репродукции. – 2024. – Т. 30, № 4. – С. 29–37. (The dilemma of management of patients with endometrioma and infertility) |
The question of management of patients with endometrioma-(OMA-) related infertility is still under debate. Endometriosis can adversely affect fecundity by different mechanisms. Such possible reasons of reduced fertility as disturbed folliculogenesis, impairment embryo development including arrest after fertilization and poor embryo quality are observed in in vitro fertilization cycle (IVF). It is also suspected that surgery in patients with OMA prior to IVF is beneficial and could increase the efficiency of IVF. There are controversial data regarding the useness and safety of OMA surgery and its’ influence on IVF outcomes. |
| Дерябина, Е. Г. Этинилэстрадиол в оральной контрацепции: что мы знаем после 60 лет применения? Обзор литературы / Е. Г. Дерябина // Проблемы репродукции. – 2024. – Т. 30, № 4. – С. 90–100. (Ethinylestradiol and oral contraception: what we know after 60 years of use? (a review)) |
More than 60 years have passed since the appearance of the first combined oral contraceptive (COC). Since then, the use of birth control pills has become widespread throughout the world, providing a simple, safe, effective and reversible regulation of fertility. Appearing in the composition of the first hormonal contraceptive pill as an accidental impurity in the form of its predecessor mestranol, ethinyl estradiol (EE) remained in the composition of COCs for 60 years. The first COCs contained higher concentrations of hormones than today and were associated with side effects. To reduce these effects, significant changes were made to the composition of COCs: the content of EE was reduced by 5 or more times, new highly selective progestogens and endogenous estrogens were developed. Today, COC preparations have become low-dose, safe and diverse, which allows you to choose the most suitable option for each individual woman. But most COCs still include EE as an estrogen component. This literature review 60 years of experience with EE in COCs and provides new data on the subject. |
| Патогенетические аспекты хронической тазовой боли при эндометриозе: перспективы диагностики (обзор литературы) / А. С. Чернецова [и др.] // Проблемы репродукции. – 2024. – Т. 30, № 4. – С. 112–120. (Pathogenetic aspects of chronic pelvic pain in endometriosis: diagnostic perspectives (literature review)) |
Chronic pelvic pain is the most frequent symptom of endometriosis, a pathological process in which the presence of tissue with morphological and functional properties similar to endometrium outside the uterine cavity is determined. Aim of the study. To present literature data on the main aspects of the neuropathic component of pain and important points of management of patients with endometriosis and chronic pelvic pain. Material and methods. At present, limited data on the pathogenesis of chronic pelvic pain associated with endometriosis and early methods of its diagnosis are presented in domestic and foreign literature. Our task was to analyse the sources, to identify the main promising directions of diagnostics and treatment of pain in endometriosis. Results. Promising in terms of diagnosis of endometriosis in chronic pelvic pain is the determination of neurotransmitter levels (dopamine, norepinephrine) and performance of genetic tests. Treatment of chronic pain should be aimed at eliminating the symptoms of central sensitisation using the latest therapies (transcranial magnetic stimulation, virtual reality methods). Conclusion. A multidisciplinary approach to the diagnosis and treatment of patients with endometriosis and chronic pelvic pain will improve the effectiveness of treatment. |
| Неиммунная водянка плода: этиология, патогенез, особенности диагностики и лечения у плода и новорожденного / С. В. Думова [и др.] // Детские инфекции. – 2024. – Т. 23, № 1. – С. 35–43. (Non-immune hydrops fetalis: etiology, pathogenesis, features of diagnosis and treatment in the fetus and newborn) |
Non-immune hydrops fetalis is a polyetiological disease characterized by high perinatal mortality. The development of non-immune fetal hydrops is associated with diseases of the cardiovascular and lymphatic systems, genetic and chromosomal diseases, infectious agents and many other reasons. In this regard, there is no single approach to the treatment of this extremely dangerous pathological condition, which requires the joint work of specialists from different specialties: obstetricians-gynecologists, neonatologists, cardiologists, surgeons, hematologists and geneticists. This article provides a review of current literature data on the etiology, pathogenesis, clinical manifestations, treatment and outcomes of non-immune hydrops fetalis. |
| Современные представления о механизмах развития и факторах риска эндометриоза / Т. А. Пономарева [и др.] // Акушерство и гинекология. – 2024. – № 7. – С. 12–20. (Modern concepts about the mechanisms of development and risk factors of endometriosis) |
One of the gynaecological diseases of high medical, social and economic significance is endometriosis. Along with uterine myoma and pelvic inflammatory diseases, endometriosis is one of the three most common gynaecological diseases in the Russian Federation. The analysis of literature data allows us to conclude that the risk of endometriosis development is associated with the impact of various factors, such as early age of menarche, heavy and long menstruation, short menstrual cycle, low parity, operative delivery in the anamnesis, low body mass index, sexual activity during menstruation, reduced physical activity, chronic inflammatory diseases of the pelvic organs, uterine development anomalies, exposure to environmental factors, smoking, increased consumption of alcohol, coffee, and other factors. Various anatomical, hormonal, immunological, environmental and genetic factors are involved in the pathogenesis of endometriosis. Conclusion: Despite the large number of studies conducted, the ultimate causes of endometriosis remain unknown. There are many theories explaining the mechanisms of endometrioid foci, but endometriosis continues to be a mysterious disease, necessitating the need and relevance of continued research in this area. |
| Молекулярно-биологическая трансформация тазового дна во время беременности и в послеродовом периоде (обзор литературы) / А. В. Варламова [и др.] // Фарматека. – 2024. – Т. 31, № 3. – С. 6–13. (Molecular biological transformation of the pelvic floor during pregnancy and the postpartum period (literature review)) |
An analysis of literature data on epidemiology, morphofunctional changes and molecular mechanisms of remodeling of the connective tissue of the woman’s reproductive system during pregnancy, childbirth and the postpartum period was carried out. The search and analysis of publications in the PUBMED, ScienceDirect, eLIBRARY.RU databases was carried out. The importance of genes that control the processes of synthesis and degradation of connective tissue, in particular the genes for collagen, fibulin and lysyl oxidase-like protein, is described. The place of matrix metalloproteinases and their tissue inhibitors in the proteolytic degradation of the extracellular matrix of connective tissue is discussed. Modern data on methods for assessing the function and strength of the pelvic floor muscles in women during pregnancy are presented, and modern possibilities for conservative treatment of women with pelvic floor dysfunction namely, the use of high-frequency radiotherapy with a detailed description of the mechanisms of effectiveness, are revealed. |
| Борис, Д. А. Альтернативные негормональные методы коррекции климактерических расстройств / Д. А. Борис, И. А. Аполихина, Л. А. Тарнаева // Фарматека. – 2024. – Т. 31, № 3. – С. 14–19. (Alternative non-hormonal methods for correcting menopausal disorders) |
Objective. Systematic analysis of the data available in modern literature on the possibilities of non-hormonal correction of menopausal syndrome. Basic provisions. Menopausal syndrome is characterized by a symptom complex that includes vegetative-vascular, mental and metabolic-endocrine disorders as result of a single pathogenetic process caused by estrogen deficiency and subsequent dysfunction of the hypothalamic-pituitary system. If there are contraindications and concerns about the safety of the use of menopausal hormone therapy, it is possible to use alternative non-hormonal agents to relieve the symptoms of menopausal syndrome. Conclusion. Based on the analysis of literary sources, modern data regarding current methods of non-hormonal correction of menopausal disorders in women during peri- and postmenopause were summarized. |
| Перспективные направления в лечении синдрома поликистозных яичников (обзор литературы) / Ю. С. Абсатарова [и др.] // Проблемы репродукции. – 2024. – Т. 30, № 3. – С. 94–104. (Perspective directions in the treatment of polycystic ovary syndrome (literature review)) |
Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age, manifested by a wide range of hormonal and metabolic disorders. The etiology of PCOS is still unclear, so existing pharmacotherapy is mainly aimed at alleviating symptoms and associated metabolic disorders. With the emergence of new data on the pathogenesis of PCOS, other treatment options are being developed. The present publication is a review of literature data on current and promising therapies for this pathology. It is well known that the symptomatology of this disease is very diverse. None of the available therapeutic agents can cover the entire range of clinical manifestations. Therefore, treatment should be individualised and adapted to the specific needs of each patient. This article reviews data on various drugs used to correct metabolic disorders. Information on new therapeutic options aimed at the mechanisms of neurohormonal regulation is presented. Studies devoted to innovative methods of treatment from the position of complex mechanisms of control of cellular activity, proliferation, apoptosis underlying pathogenesis are analysed.The literature search was conducted in Russian (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. Free access to the full text of the articles was a priority. The period of source selection was from 2017 to 2023; however, there are several publications from earlier years in the reference list. |
| Актуальные клинические проблемы, связанные с атрезией девственной плевы / В. Е. Милюков [и др.] // Российский вестник акушера-гинеколога. – 2023. – Т. 23, № 6, ч. 1. – С. 19–24. (Current clinical problems associated with hymenal atresia) |
The World Health Organization recognises that human reproductive health is an indicator of national security, and human reproduction is the most sensitive indicator of the social and biological health of society. One of the factors leading to the inability to have children is the untimely diagnosis of the congenital anomaly of the development of the female genital organs – hymenal atresia. Patients with hymenal atresia with symptoms of ‘acute abdomen’ are often misdiagnosed (acute appendicitis, appendicular infiltrate, ovarian cyst, ovarian apoplexy, etc.) and undergo unwarranted surgical interventions without noticing the true causes of pain. The inability to remove menstrual blood from the uterine cavity and its retrograde flow can lead to intraobdominal inflammatory processes and the development of uterine tube obstruction, which may be the cause of tubal-peritoneal infertility. In addition, retrograde flow of menstrual blood from the uterus through the fallopian tubes into the abdominal cavity can lead to the formation of pelvic-peritoneal and tubal adhesions, abdominal adhesions and adhesive intestinal obstruction, and infection of haematocolpos, haematometra and haematosalpinx can lead to the development of peritonitis. To prevent such severe complications, timely diagnosis and the choice of the correct tactics of surgical treatment of patients with uterine and vaginal malformations and menstrual blood outflow disorders are necessary. On this basis, we consider it necessary to conduct mandatory preoperative gynaecological examination of pubertal patients with primary amenorrhoea admitted for acute abdominal diseases in surgical hospitals. |
| Мальцева, А. Н. Рефлюкс-нефропатия и беременность / А. Н. Мальцева // Российский вестник акушера-гинеколога. – 2023. – Т. 23, № 6, ч. 1. – С. 12–18. (Reflux nephropathy and pregnancy) |
Reflux nephropathy is one of the most frequent renal diseases occurring in women of childbearing age with a history of vesicoureteral reflux. The results of modern studies provide heterogeneous information on the outcomes of pregnancy and labor in reflux nephropathy. Patients with severe bilateral renal atrophy are most likely to develop proteinuria, arterial hypertension, focal glomerular sclerosis and progressive chronic renal failure. Patients with persistent vesicoureteral reflux have recurrent episodes of pyelonephritis. The disease is often clinically latent and first manifests during pregnancy with urinary tract infection, proteinuria, arterial hypertension, pre-eclampsia or renal failure. However, there is an aggressive course of the disease with rapid progression to terminal renal failure. Pregnancy in patients with reflux nephropathy proceeds favorably with normal renal function or at the initial stage of the pathological process in the absence of arterial hypertension. Urinary tract infection is a frequent cause of morbidity in pregnancy, but rarely results in fetal death. When renal function is significantly impaired, with plasma creatinine concentrations exceeding 0.18—0.20 mmol/l in the first trimester of pregnancy, especially in the presence of arterial hypertension, there is clearly a high risk of severe fetal growth retardation or intrauterine death. The analytical review of published research results showed that reflux nephropathy is a global factor in the formation of high risk of gestational hypertension and pre-eclampsia. Renal scarring is a major risk factor for the disease during pregnancy. Pregnant women with reflux nephropathy require dynamic monitoring, especially in late pregnancy, to avoid severe complications. Planned pregnancy, optimal blood pressure, pregravidal preparation, join obstetric and nephrological monitoring throughout pregnancy, labor and postpartum; they are the key factors for optimal favorable maternal and fetal outcome. |
| Протеомные предикторы преждевременных родов / О. В. Пачулия [и др.] // Журнал акушерства и женских болезней. – 2023. – Т. 72, № 5. – С. 89-104. (Proteomic predictors of preterm birth) |
The aim of the study was to investigate the proteomic spectrum of serum in pregnancies that ended in on-time delivery and pregnancies that ended in preterm labour to identify proteins-markers of threatening preterm labour. Material and Methods. Twenty-seven women were examined, of whom 14 women with preterm labour were in the main group and 13 women whose pregnancy ended in term labour were in the control group. Proteomic profiling of blood serum at 16-17 weeks of gestation was performed by mass spectrometric analysis. Results. Proteins with different regulatory, transport and structural functions specific for the proteomic spectrum of blood serum of women of the main group were revealed and identified, the change of their expression was established already in the II trimester of pregnancy. These proteins are evidently predictors of premature unleashing of labour activity. Conclusion. The identified serum difference proteins can be used as informative markers for predicting preterm labour. The authors inform that there is no conflict of interest. |
| Современные представления об этиологии и патогенезе преждевременного разрыва плодных оболочек / А. Р. Баисова [и др.] // Акушерство и гинекология. – 2023. – № 10. – С. 21–27. (Current understanding of the aetiology and pathogenesis of premature rupture of the fetal membranes) |
Preterm labour is one of the major obstetric syndromes and represents a huge challenge facing obstetrics today. It is the leading cause of infant mortality in the world, accounting for 80% of all neonatal morbidity, resulting in serious financial and emotional losses to families and society. One of the most unfavourable complications leading to preterm birth is premature rupture of the fetal membranes (PROM). This article discusses the etiological and pathogenetic aspects of PROM with inflammation as a key factor. Aseptic inflammation associated with biological aging and maturation of the fetal membranes is discussed as a variant mechanism for the development of PRPM. Factors contributing to the destruction of the extracellular matrix such as collagen remodelling, formation of fetal membrane microcracks and enhanced angiogenesis are considered. So far, the study of fetal membrane rupture has been conducted from the perspective of cell biology and tissue histology as well as inflammation. In the context of this review, different pathogenetic variants of PROM, which may occur independently or in combination, have been considered. Despite the large number of studies conducted, the study of new approaches to the prevention of PROM, search for prognostic markers and risk factors for the development of effective therapeutic tactics is of great interest at present. Conclusion: The introduction of new research methods to reveal or clarify the mechanisms of aseptic and infectious pathogenesis based on mass spectrometry in PRPO will help to identify differential patterns of protein expression associated with oxidative stress and bacterial invasion in amniotic fluid and fetal membranes. The introduction of non-invasive markers into clinical practice will provide an opportunity for timely preventive measures, prescribing therapy and determining the management of pregnant women in order to improve perinatal outcomes. |
| Роль уреаплазм в развитии преждевременных родов: возобновление дискуссии в свете новых данных / Е. В. Шипицына [и др.] // Акушерство и гинекология. – 2023. – № 10. – С. 28–38. (The role of ureaplasmas in the development of preterm birth: renewed discussion in light of new data) |
Intraamniotic infection (IAI) plays a significant role in the development of preterm birth and other pregnancy complications, including premature rupture of membranes, cervical insufficiency, and clinical chorioamnionitis. Ureaplasma is the most common microorganism found in the amniotic cavity of women with IAI. In recent years, there has been a renewed discussion regarding the eradication of ureaplasmas to prevent pregnancy complications associated with IAI, fueled by new data from experimental and clinical studies implicating ureaplasma as an etiological factor. Furthermore, the inclusion of drugs with anti-ureaplasma activity and good placental penetration in treatment regimens for IAI-related pregnancy complications has been shown to improve perinatal outcomes. This review provides an analysis of recent studies on the role of ureaplasmas in triggering preterm birth and other pregnancy complications. This review summarizes findings from meta-analyses of the association between commensal mycoplasmas and adverse perinatal outcomes, and examines data from experimental and clinical studies on the pathogenesis and treatment of ureaplasma-associated IAI. Сonclusion: A substantial body of experimental and clinical evidence supports the involvement of ureaplasmas in the development of IAI. However, it is evident that several factors are necessary for ureaplasmas to exert their pathogenic potential, and identifying these factors is important. Currently, neither species/serotype, high bacterial load, nor specific virulence factors of ureaplasmas can serve as prognostic markers for an unfavorable course or outcome of pregnancy. Developing sensitive and specific biomarkers for IAI, preferably non-invasive biomarkers with high predictive value in the early stages when antibiotic therapy is most effective, would be a significant advancement in the prevention of preterm birth and other pregnancy complications associated with IAI. |
| Трансплантация вагинальной микробиоты / Е. Ф. Кира [и др.] // Акушерство и гинекология. – 2023. – № 10. – С. 39–46. (Vaginal microbiota transplantation) |
This review presents the data of the recent studies on the structure and role of the vaginal microbiota in providing colonization resistance and maintaining female reproductive health. New therapeutic options in the treatment of infectious diseases in gynecology are covered. The review shows the significance of preserving the specific functioning of the vaginal microecosystem, searching for new effective therapeutic opportunities in the treatment of infectious and inflammatory diseases and correction of dysbiotic disorders of the vaginal microbiota, its ability to resist pathogenic microorganisms. The unique local immune status directly correlates with the specific microbial composition of the vagina. Recent studies have shown the high efficiency of intestinal microbiota transplantation in gastroenterology. To date, there is a promising concept of introducing selective microbiota transplantation into clinical practice. According to this concept, it is possible to obtain autoprobiotics that can simultaneously solve the problem of safety during transplantation and provide personalized treatment. It is necessary to carry out further studies on the characteristics of pharmacological properties, on degree of stability and safety, on the ability of microorganisms to multiply in the vagina, and on the determination of dosage and frequency of use. The effectiveness of vaginal microbiota transplantation should be determined and proven in subsequent randomized placebo-controlled clinical trials. Conclusion: Autoprobiotics originating from the vagina can become the basis for the development of personalized medicines using a person’s own microbiota as it is safe and accessible and can help in the treatment of diseases with complex etiology and pathogenesis. Preliminary clinical results in a number of experimental studies have demonstrated a good therapeutic effect and great prospects for vaginal microbiota transplantation in comparison with other methods of treatment. |
| Селективный перенос эмбриона: компромисс или необходимость? / А. Г. Сыркашева [и др.] // Акушерство и гинекология. – 2023. – № 10. – С. 48–59. (Elective single embryo transfer: compromise or necessity?) |
The development of assisted reproductive technologies (ART) as well as the improvement of the methods used for their implementation caused changes in approaches to the management of patients. The main criterion for the effectiveness of ART is the birth of a healthy child, and many factors contribute to the achievement of this result. The question of the number of transferred embryos necessary to achieve the highest possible rate of live birth and the minimum number of complications in women undergoing ART is still relevant. When ART appeared, tactics of transferring several embryos into the uterine cavity were often preferred in order to increase the effectiveness of the programs or due to the lack of the possibility of embryo cryopreservation. Therefore, the use of ART has been associated for a long time with a high incidence of multiple pregnancies which often pose risks for the health of the mother and newborn, as well as the need for performing traumatic embryo reduction procedures. To date, the prevention of multiple pregnancies is a priority for reproductive medicine specialists, and therefore, in many countries, there is a tendency to choose elective single embryo transfer (eSET) as a preventive measure for multiple pregnancies. For this review, the scientific literature was analyzed to compare the effectiveness of eSET tactics and the transfer of two or more embryos in ART programs; the legal framework on this issue was studied as well. Conclusion: Elective single embryo transfer should be recommended to all patients with a “good” prognosis of establishing pregnancy, since the rate of childbirth in this group is comparable to that in patients with the transfer of two embryos. The possibility of introducing eSET in patients with an “unfavorable” prognosis of pregnancy requires further discussion. |
| Риски тромботических осложнений у пациентов с раком яичников и некоторые аспекты безопасности применения антифибринолитических гемостатических средств / В. А. Дерябина [и др.] // Акушерство и гинекология. – 2023. – № 10. – С. 60–69. (Risk of thrombotic complications in patients with ovarian cancer and some safety aspects of using antifibrinolytic hemostatic agents) |
The risk of thrombotic complications is known to increase several times in cancer patients. The malignant process causes changes in the blood coagulation and fibrinolytic systems which negatively affect the prognosis of the patient’s complications. The tumors of the female reproductive system, especially ovarian cancer, are among the most thrombogenic solid tumors. The level of specific markers increases particularly in patients with ovarian cancer. These markers can help to identify patient’s predisposition to the rapid development of venous thromboembolism. There are certain risk factors that increase the likelihood of thrombosis in ovarian cancer: age over 60 years, excess body weight, tumor diameter of more than 100 mm, and the presence of ascites and chronic diseases. Medications used for ovarian cancer are also worth noting. The use of antitumor drugs is known to contribute to thrombotic complications. Conclusion: There is an active discussion about the increased risk of venous thromboembolism in patients who received tranexamic acid and other antifibrinolytic agents to reduce intraoperative blood loss. Although some studies have confirmed the effectiveness of tranexamic acid, there are currently not enough randomized trials to guarantee the absence of a link between the use of antifibrinolytic agents and venous thromboembolism in patients with ovarian cancer. The reasonable use of this group of drugs with obligatory thromboprophylaxis is recommended. |
| Яворовская, К. А. Вопросы эктогенеза и возникновения экстракорпоральной системы развития плода / К. А. Яворовская, А. А. Горячев // Акушерство и гинекология. – 2023. – № 10. – С. 70–76. (Issues of ectogenesis and creation of the extracorporeal system for fetal development) |
The idea of creating a system capable of supporting and ensuring the complete development of the human embryo dates back to the middle of the 20th century. The combination of factors, which are created artificially and are very close to the natural physiological ones, will give a chance to accomplish the development of the fetus without the involvement of the female reproductive organs. The fetus can develop in a separate environment where it is isolated from the possible harmful effects of maternal diseases or toxic substances. This paper presents an overview and summary of the data published on the issue. The creation of an extracorporeal system for fetal development (ESFD) is associated with a number of difficulties. One of the most important challenges is the reproduction of the optimal conditions for the development of the fetus in an artificial environment, where the fetus will have to stay throughout the entire period of its development. In order to avoid ontogenesis disorders and pathologies of organ systems when using ESFD, it is necessary to reproduce all the conditions specific to complete intrauterine development, which include not only the supply of nutrients to the growing embryo, but also the maintenance of parameters such as pH and temperature. Currently, there is a growing interest in creating a device that could allow a fetus to develop ex vivo. Over the past few years, the scientists have published numerous reports on the creation of the necessary components of the system (artificial placenta, amniotic fluid substitute, etc.). Life support systems are improved and supplemented with new elements that contribute to the reproduction of natural conditions which normally exist in the maternal organism. Conclusion: The main aim of the research groups is to create artificial conditions for the development of the fetus simulating all the physiological parameters of the natural environment for the complete formation of the organism. The use of ESFD will make it possible to reproduce vital conditions for the growth and development of the fetus and it will help women who are unable to bear a child on their own. It can also influence the views of society on surrogate motherhood and the restoration of childbearing function using uterine transplantation. There is still no clear understanding of how such a method of gestation can affect the relationship between mother and child, which may compromise the creation and use of such a system from an ethical point of view. |
| Особенности ведения пациенток с тромбофилией при применении вспомогательных репродуктивных технологий / С. Ш. Исенова [и др.] // Акушерство и гинекология. – 2023. – № 11. – С. 5–10. (Management strategies for thrombophilic patients undergoing assisted reproductive technologies) |
Objective: To summarize the current data on optimal thromboprophylaxis in thrombophilic women undergoing in vitro fertilization (IVF) and embryo transfer, primarily with a focus on strategies for preventing venous thromboembolism (VTE); to discuss the possibility of preventing pregnancy complications in pregnant women with thrombophilia. Materials and methods: The databases and services, namely PubMed, Wiley, Scopus and Google scholar, have been searched for articles on thrombophilia and assisted reproductive technology-related pregnancy over the past 10 years. No restrictions were imposed on the design of the study. The search was carried out using MESH keywords. Results: Hereditary thrombophilia is a genetic condition that increases the risk of thromboembolic diseases, especially during pregnancy. However, it is not recommended to have routine screening for hereditary thrombophilia in asymptomatic patients. Pregnant women with a previous history of VTE or with first-line relatives with this disease should be screened for thrombophilia genes. Low molecular weight heparins and acetylsalicylic acid are effective methods of thromboprophylaxis; anticoagulant therapy should start in the first trimester and continue in the postpartum period. The patients with antiphospholipid syndrome may have a high antibody titer, these patients should refrain from IVF until the antibody titer decreases. Immunosuppressive therapy is an effective method of reducing antibodies. Conclusion: The history of repeated IVF failures and habitual miscarriage is not an indication for examination for thrombophilia genes; however, these women should be examined for the presence of antiphospholipid syndrome. |
| Молекулярно-генетические маркеры в патогенезе задержки роста плода / Ш. Р. Гасымова [и др.] // Акушерство и гинекология. – 2023. – № 11. – С. 20–26. (Molecular genetic markers in the pathogenesis of fetal growth retardation) |
The article presents the analysis of the data of modern literature on the actual aspects of fetal growth retardation (FGR) verification in terms of molecular genetic diagnostic methods. The review includes the data of foreign and Russian scientists published in PubMed and eLibrary. The problem of the FGR diagnosis remains relevant, despite the “golden standard” of diagnosis meeting the criteria adopted by the international consensus of Delphi which was introduced into the practice of obstetricians, gynecologists and ultrasound specialists. The article presents the results of the analysis of the literature data on the role of molecular genetic markers in the FGR pathogenesis, various mechanisms of the FGR development in terms of genomics, transcriptomics, as well as the analysis of their combination with the factors of the hemostasis system. Special attention is paid to the mechanisms of the FGR development due to the changes in immune processes, inflammatory reactions, as well as the changes in the processes of angiogenesis in the placenta. This study also examines the possibility of diagnosing a fetus with FGR using the assessment of the level of extracellular fetal DNA, the processes of methylation of genes-regulators of metabolic pathways and a number of immune processes. The literature data on the epigenetic regulation of gene expression in FGR are of particular interest; microRNAs isolated from the placenta and circulating in the blood of pregnant women are studied. The search for specific minimally invasive markers currently continues as they have already allowed the clinicians to improve the existing criteria for diagnosis. Conclusion: Despite the progress in the field of molecular genetics, there is still a need for accurate diagnosis, prevention and rational management of pregnancy complicated by FGR to improve perinatal outcomes. The study of the molecular mechanisms underlying this syndrome may be useful for a better understanding of the signaling pathways involved in the FGR pathogenesis. |
| Чернуха, Г. Е. Современные возможности оптимизации диагностики и терапии эндометриоидных кист яичников / Г. Е. Чернуха, В. А. Пронина, А. Е. Солопова // Акушерство и гинекология. – 2023. – № 11. – С. 28–35. (Modern possibilities for optimizing the diagnosis and therapy of ovarian endometriomas) |
Ovarian endometrioma (OMA) is one of the most common forms of endometriosis and its prevalence is estimated to reach 50%. At the same time, OMA is mostly combined with other forms of endometriosis, namely, deep and peritoneal endometriosis; therefore, despite the high sensitivity of ultrasound diagnosis, it is often necessary to use magnetic resonance imaging (MRI). The review article presents the data from the national and foreign literature illustrating the impact of both OMA and its surgical treatment on the ovarian reserve. The article focuses on modern ideas about the possibility of conservative management of such patients including the oncological risks for them. The importance of MRI is considered not only for determining the prevalence of endometriosis and differential diagnosis of endometriomas with ovarian cancer, but also as a method for evaluating the effectiveness of suppressive hormone therapy. Conclusion: In spite of the negative impact of OMA on the level of anti-muller hormone, the surgical treatment should be reasonably justified, since performing surgery can lead to irreversible decrease in ovarian reserve and significant risk for postoperative relapse if there is no subsequent prescription of suppressive hormone therapy. Currently, there is no clear evidence base for the possibility of long-term hormonal therapy for OMA in women of reproductive age in terms of oncological risks. Therefore, it is recommended to perform MRI in this group of patients not only as a method of verification of endometriomas and differential diagnosis of endometrioid ovarian cancer, but also as a possibility of predicting the effect of suppressive hormone therapy, including the use of a measurable diffusion coefficient. |
| Влияние стресса на репродуктивную систему женщин: патофизиология и нейроэндокринные взаимодействия / Д. А. Бирюкова [и др.] // Акушерство и гинекология. – 2023. – № 11. – С. 36–42. (The effect of stress on the female reproductive system: pathophysiology and neuroendocrine interactions) |
Stress is an important factor that influences the work of many systems, and it can cause an imbalance in the human body. The issue of stress and its consequences is extremely important, since there is a rapid increase in behavior disorders caused by stress and stress-associated diseases all over the world (various forms of neuroses and depressions) which affect from 25 to 35% of the population. The impact of stress on the female reproductive system is of particular interest. Stress can be considered to be one of the most common and underestimated factors which contribute to the female infertility. The main aspect of scientific research is the study of the work and interaction of the nervous, immune and endocrine systems under the influence of external stimuli, namely stress factors. The analysis of the literature data indicates the adverse impact of stress factors on the outcomes of assisted reproductive technology programs, the processes of oogenesis and embryogenesis. Our literature review systematizes the data on the close relationship between the central nervous system, immune and endocrine systems; each of these systems contributes to the female reproductive health at various levels. Conclusion: The optimal functioning of the female reproductive system under stress directly depends on the function of the central nervous system, endocrine and immune systems, as well as their direct interaction. It is necessary to search and develop new personalized approaches to the prevention and treatment of stress-related conditions. Further studies devoted to this problem can be beneficial not only for scientific researchers, but they can also have a high practical significance for clinicians. |
| Ванакова, А. И. Роль микробиоты полости матки в генезе полипов эндометрия / А. И. Ванакова, Н. В. Долгушина, Т. В. Припутневич // Акушерство и гинекология. – 2023. – № 11. – С. 43–47. (The role of the uterine microbiota in the genesis of endometrial polyps) |
Endometrial polyps refer to benign intrauterine pathology. Their etiology is not completely known. One of the possible factors for the development of endometrial polyps is altered microbiota of the uterine cavity. A number of scientific studies have proved that the endometrial microbiota composition is different from the one of the vaginal and cervical microbiota. This concept enabled the scientists to reject the null hypothesis of a “sterile” uterine cavity. There was a suggestion to distinguish the Lactobacillus-dominated endometrial microbiota (≥90%) and the Lactobacillus-deficient microbiota (<90%). According to the literature data, various types of benign intrauterine pathology show differences in the endometrial microbiological composition. The uterine microbiota includes anaerobic and aerobic bacteria in women with endometrial polyps. Previously, endometrial polyps were considered to be a manifestation of chronic endometritis due to reactive proliferation of the endometrium with prolonged mechanical stimulation or exposure to biological factors of inflammation. To date, there are data on the difference in the endometrial microbiota composition in patients with endometrial polyps in combination with chronic endometritis and without it. Conclusion: Further study of the endometrial microbiota may provide new opportunities for further improvement of the diagnosis and treatment strategies of endometrial polyps and chronic endometritis. |
| Лещенко, О. Я. Мастодиния. Современные данные о причинах, течении, диагностике и подходах к коррекции / О. Я. Лещенко // Гинекология. – 2023. – Т. 25, № 3. – С. 282–289. (Mastodynia: Current data on the causes, course, diagnosis, and treatment approaches. A review) |
Mastodynia is a common clinical symptom in general medical and gynecological practice. The objectives of this literature review are to analyze scientific information on the epidemiology of mastodynia/mastalgia, the impact on quality of life, inconsistencies in the etiology determination, to formulate a diagnostic concept, classification, and treatment, and to assess the therapeutic effects of Vitex Agnus-Castus. Scientific publications over the past 30 years were searched in the main research databases, CochraneLibrary, PubMed, Science Direct, Google Scholar, and ELibrary, using the terms “mastalgia,” “mastodynia,” “Vitex Agnus-Castus,” “chest pain,” “chest pain, breast pain.” The pathophysiology of mastodynia is multifaceted, with various etiology factors and independent ways of pain occurrence. Most studies have emphasized the importance of correctly classifying breast pain for accurate diagnosis and effective therapy to reduce the frequency and severity of pain episodes and improve quality of life while minimizing side effects. Vitex Agnus-Castus is safe and effective in the treatment of mastodynia. |
| Данусевич, И. Н. Регулирующие функциональные системы в патогенезе доброкачественной дисплазии молочных желез / И. Н. Данусевич // Вопросы гинекологии, акушерства и перинатологии. – 2023. – Т. 22, № 4. – С. 72–79. (Regulating functional systems in the pathogenesis of benign mammary gland dysplasia) |
An analysis of publications selected as a result of search in information databases: Russian State Library, elibrary, PubMed, Cochrane, Medline, Medscape, devoted to the role of functional systems in the development of benign breast pathology is presented. The results obtained indicate that neuroendocrine, immune and free radical lipid oxidation systems are involved in the development of benign breast pathology. Changes in these systems negatively affect the reproductive health of women, the condition of mammary glands, and increase the risk of breast cancer. |
| Адамян, Л. В. Роль ферроптоза в патогенезе и прогрессировании эндометриоза. История вопроса и новые данные / Л. В. Адамян, Л. Г. Пивазян, К. С. Маилова // Проблемы репродукции. – 2023. – Т. 29, № 5. – С. 92–101. (The role of ferroptosis in the pathogenesis and progression of endometriosis. History of the question and current evidence) |
Endometriosis is a common gynaecological disease that affects about 10% of women of reproductive age — approximately 200 million people worldwide. It is characterised by the presence of endometrium-like tissue outside the uterine cavity. Endometriosis predominantly causes reproductive dysfunction, pelvic pain, dyspareunia, infertility, reduced quality of life and is accompanied by combined hyperplastic processes — uterine myoma, adenomyosis and others. According to our studies, hyperestrogenism plays a significant role in the pathogenesis of endometriosis, which allows us to consider it a hyperproliferative disease. The role of oxidative stress in the pathogenesis of various forms of endometriosis is among the topical and insufficiently studied problems. Cyclic changes in endometriosis foci, their enlargement and inflammation create a microenvironment with high iron content, reactive oxygen species and free radicals that promote adhesion and growth of ectopic endometrial cells. Based on which we developed an experimental model of endometriosis to further investigate the role of iron metabolism in the development and maintenance of endometriosis. It is suggested that the primary defect of endometriosis is an abnormal eutopic endometrium characterised by resistance to ferroptosis, a process of iron-mediated non-apoptotic programmed cell death. Currently, the pathogenesis of endometriosis and the role of oxidative stress and iron metabolism requires further study, which is of high relevance, practical and theoretical importance. |
| Мальцева, Л. И. Длительная контрацепция комбинированными гормональными препаратами до менопаузы. Преимущества и риски / Л. И. Мальцева, Ю. В. Гарифуллова // Проблемы репродукции. – 2023. – Т. 29, № 5. – С. 102–110. (Long-term contraception with combined hormonal drugs until menopause. Benefits and risks) |
Combined oral contraceptives (COCs) are a reliable method of preventing unwanted pregnancies with many important non-contraceptive properties that have been successfully used for the treatment of gynaecological diseases. The safety profile of COCs is of particular importance in long-term use, especially when a woman continues to use hormonal contraception until menopause. The article reviews the literature on the safety of COCs in long-term use up to menopause according to the domestic literature and information in the electronic international databases PubMed, Web of Science, Cochrane Library and Scopus. It is shown that numerous randomised studies, as well as studies of real clinical practice, confirm the possibility of long-term use of COCs from the beginning of the reproductive period up to menopause in compliance with indications and contraindications. The article considers the possibility of long-term use of the combination of estradiol valerate and dienogest as one of the most studied in different aspects of gynaecological practice. It has been demonstrated that long-term use of combined hormonal contraception has a positive balance of benefit and risk when indications and contraindications are met. Women using reliable contraception are not only protected from unwanted pregnancy and subsequent abortion, but can also benefit from numerous research-proven therapeutic and preventive non-contraceptive effects. |
| Цхай, В. Б. Cиндром Бехчета и беременность / В. Б. Цхай, П. А. Шестерня // Клиническая медицина. – 2023. – Т. 101, № 9–10. – С. 449–453. (Behcet’s syndrome and pregnancy) |
Planning and managing pregnancy in the context of an existing rheumatic disease is a serious problem widely discussed in the medical community. Behcet’s syndrome (Behcet’s disease) is one of the least studied diseases in this context. Data on the mutual influence of vasculitis and pregnancy on the course and outcomes are contradictory. There is an obvious need for interdisciplinary support of pregnancy by an obstetrician-gynecologist and a rheumatologist to minimize the risk of losses and complications in this complex clinical situation. This review presents data published over the past two decades on the use of genetically engineered biological drugs in rheumatology. |
| Аномальные маточные кровотечения и COVID-19 (обзор литературы) / Е. В. Сибирская [и др.] // Проблемы репродукции. – 2023. – Т. 29, № 3. – С. 74–80. (Abnormal uterine bleeding and COVID-19 (literature review)) |
This literature review presents current information on abnormal uterine bleeding in women after COVID-19 infection. Unfortunately, abnormal uterine bleeding is the leading indication for hospital admission and there is no tendency for this indicator to decrease. Scientific publications on this topic for 2020-2022 found in eLibrary, PubMed, Cochrane Library, and Google Scholar databases were analysed. The review also reflects the recommendations of the World Health Organisation, the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine (ESHRE/ASRM), the Royal College of Obstetricians and Gynaecologists of Great Britain (RCOG), and clinical recommendations of the Ministry of Health of the Russian Federation. The aim of the review was to assess the relationship between new coronavirus infection and menstrual disorders, the severity of infection and abnormal uterine bleeding caused by it. Given the data presented in the review, it can be concluded that abnormal uterine bleeding remains a major reproductive health problem. In most cases, uterine bleeding tends to be chronic and recurrent, which is an indication for preventive measures. |
| Лебедева, О. П. Антиинфекционная защита влагалища у женщин репродуктивного возраста (мини-обзор) / О. П. Лебедева, В. М. Иванникова // Проблемы репродукции. – 2023. – Т. 29, № 6. – С. 95–101. (Antimicrobial defense of the vagina in reproductive age women (mini-review))/strong> |
Non- culture methods of studying the microbiota of the female reproductive tract, including high-throughput sequencing of 16S rRNA, allow the most complete assessment of the microbiome composition and identification of dominant microorganisms. However, there are few studies on the influence of vaginal microbiome types on local immunoreactivity. We searched eLibrary, Google Academy, EBSCO, ResearchGate and PubMed databases for papers published in the last 20 years. We analysed the relationship between the types of vaginal microbiome and the state of local immunity components. It was found that microbiome types dominated by lactobacillus are able to maintain the integrity of the epithelial barrier, low pH of vaginal mucus, and prevent the induction of an inflammatory response. These properties are most pronounced in microbiome type CST I, dominated by Lactobacillus crispatus, and least pronounced in microbiome type CST III, dominated by Lactobacillus iners. The CST IV microbiome type associated with the predominance of non-lactobacillary flora leads to stimulation of antimicrobial peptide synthesis, activation of macrophages and dendritic cells, increase in the number of natural killer cells, CD4+ T-lymphocytes, TY 7 lymphocytes. These data should be taken into account in the development of preventive measures for obstetric and gynaecological complications. |
| Спектр значимых сывороточных биомолекул и генетических предикторов в антенатальной диагностике патологической инвазии плаценты / А. В. Каюмова [и др.] // Акушерство и гинекология. – 2023. – № 12. – С. 5–15. (Spectrum of significant serum biomolecules and genetic predictors in antenatal diagnosis of placenta accreta spectrum) |
Background: Placenta accreta spectrum (PAS) poses a serious threat to the life of the mother and fetus. Untimely diagnosis of PAS resulting in delayed treatment may be one of the key causes of serious adverse pregnancy outcomes. Recent studies have increasingly focused attention on various biomolecules that have the potential to diagnose PAS in due time. Objective: To compare the effectiveness of various molecular biological markers in the antenatal diagnosis of abnormally invasive placenta. Materials and methods: The analysis of the Russian and foreign research literature databases, namely eLibrary, Medline, PubMed, Embase, Crossref, RSCI, was carried out with the keywords “abnormally invasive placenta”, “placenta accreta spectrum”, “biomarkers”, “antenatal diagnosis”, “epithelial-mesenchymal transition”, “biomolecules”. According to the above goal, 68 literature sources were selected for the analysis. Results: The significant biomarkers of abnormally invasive placenta and their dynamic change at different gestation periods were described and compared in this review. Biomolecules involved in the pathogenesis of abnormally invasive placenta can be conventionally divided into several groups. These are growth factors, interleukins, signaling molecules, oxidative stress products, microRNA, DNA, and circulating cells. Their content in biological fluids and placenta reflects the activity of pathophysiological processes involved in the formation of abnormally invasive placenta. Conclusion: Studying the spectrum and concentration of biomarkers of abnormally invasive placenta can contribute to the antenatal confirmation of the diagnosis and severity of this pathology and it can be crucial for improving maternal and perinatal outcomes. |
| Сидоркина, А. Г. Современные представления о патогенезе развития хронической плацентарной недостаточности / А. Г. Сидоркина, В. А. Мудров // Российский вестник акушера-гинеколога. – 2024. – Т. 24, № 1. – С. 12–18. (Modern ideas about the pathogenesis of chronic placental insufficiency) |
Fetal oxygen deficiency is caused by a variety of factors and may be localised in different parts of the mother-placenta-fetus system. Depending on the cause, oxygen deficiency may develop over a short period of time or gradually increase over a period of weeks. Uteroplacental hypoxia is associated with impaired formation of the placenta in early pregnancy and its angiogenesis in later pregnancy. Local placental disorders are often combined with systemic manifestations: increased systemic vascular resistance, endothelial dysfunction and activation of the blood coagulation system. Reduction in the diameter of uterine arteries reduces placental perfusion. With reduced blood perfusion in the intervillous space may form foci of obliteration of villi with fibrinoid, which, in turn, is the cause of fetal hypotrophy. Chronic placental insufficiency is the leading obstetric pathology, which is the main cause of perinatal morbidity and mortality. The aim of the study was to investigate the current understanding of the pathogenesis of placental insufficiency. In the course of the study, a detailed systematic analysis of modern domestic and foreign literature devoted to the pathogenetic mechanisms of chronic placental insufficiency development was carried out. The study used such information bases as: e-library, PubMed, FIPS from the moment of their creation until December 2022. |
| Путилова, Т. А. Диабетическая фетопатия на фоне материнского ожирения при гестационном сахарном диабете / Т. А. Путилова, И. В. Данькова, Т. Б. Третьякова // Российский вестник акушера-гинеколога. – 2024. – Т. 24, № 1. – С. 19–24. (Maternal obesity as risk factor for diabetic fetopathy in gestational diabetes mellitus) |
This article presents a review of literature data (sources: PabMed, Medline, eLibrary) on maternal obesity in gestational diabetes mellitus as a risk factor for the development of diabetic fetopathy. Obesity in the expectant mother during pregnancy increases fetal glucose and insulin levels, increases cytokine synthesis and secretion by fetal alipoietes, which further increases their concentration, and results in a metabolic response of hypothalamic neurons with subsequent development of fetal macrosomia. Diabetic fetopathy can occur after 12 weeks of gestation when blood glucose levels are elevated in the pregnant woman. Maternal obesity in pregnancy programmes clinically significant disturbances in the energy balance of newborns, who constitute a risk group for the development of metabolic syndrome and obesity in future adult patients, which underlies the ‘fetal origin of adult diseases’. |
| Современные представления о факторах риска развития слабости родовой деятельности / А. М. Зиганшин [и др.] // Российский вестник акушера-гинеколога. – 2024. – Т. 24, № 1. – С. 25–30. (Modern concepts of risk factors for the development of labor weakness) |
Publications of domestic and foreign researchers were used to study the current understanding of risk factors for the development of labour weakness. The study used data from the following databases: e-library, Scopus, PubMed, MEDLINE, ScienceDirect, Cochrane Library for the last 10 years. At present there is no reliable information about the mechanism of development of this pathology of labour activity, but the wide application of modern methods of diagnostics of weakness of labour activity allows to establish criteria for diagnosis. Establishing the boundaries of the clinical situation, the time and onset of the development of labour weakness will make it possible to apply safe and effective diagnostic methods, reduce the frequency of operative delivery, reduce morbidity and improve birth outcomes. |
| Цхай, В. Б. Проблема дифференциальной диагностики лейомиосаркомы у пациенток, планирующих оперативное лечение по поводу миомы матки / В. Б. Цхай, А. И. Пашов, В. В. Рачковская // Акушерство и гинекология. – 2024. – № 1. – С. 42–49. (The problem of differential diagnosis of leiomyosarcoma in patients planning surgical treatment for uterine fibroids) |
Uterine leiomyosarcoma is known to have no clear diagnostic criteria due to its similarity to uterine fibroids. Therefore, clinicians tend to make the wrong diagnosis and/or administer the wrong treatment. This can lead to rapid progression of tumor growth and an increased tendency to metastasis. The article presents the main definitions, classifications, and statistical data on the prevalence of these diseases. A review of literature data on current methods of preoperative diagnosis of tumors was carried out, and special attention was paid to the differential diagnosis of these pathologies. The review covers the general principles of surgical treatment of pathology, as well as the possible extent of surgical intervention. Due to the active introduction and application of uterine artery embolization and intra-abdominal tumor morcellation in gynecological practice, there is a growing interest in preoperative differential diagnosis between leiomyosarcoma and uterine fibroids. These methods of treatment are inadequate if the diagnosis of uterine sarcoma is made in the postoperative period. Conclusion: Preoperative differential diagnosis between uterine fibroids and sarcomas is extremely important in modern gynecological practice. It is associated not only with the progression of the disease, but also with a deterioration in the prognosis of the disease for the patient after surgical organ-preserving treatment. |
| Исторические аспекты развития понятия об эндометриозе (обзор литературы) / З. С. Румянцева [и др.] // Проблемы социальной гигиены, здравоохранения и истории медицины. – 2024. – Т. 32, № 1. – С. 117–122. (The historical aspects of development of concept of endometriosis: publications review) |
The endometriosis is a chronic gynecological disease, etiology and pathogenesis of which are not fully clear to science. Its consequences are hardest burden for health care, society and every female patient and her family. The presented review tries to answer in historical aspect the question of interest to all scientists – why endometriosis, known to science for more than 300 years, still remains “disease of riddles and assumptions”? The search of publications was implemented in such databases as Web of Science, eLibrary, Scopus, PubMed/MEDLINE. The search was based on keywords “history”, “endometriosis”, “review”, “myths”, “authorship”, “infertility”, “reproductive dysfunction”. The study covered full-text sources and publications reviews related to subject under study. The articles having no direct relation to the topic of endometriosis were excluded from the review. The review demonstrated that as before pathogenesis of endometriosis remains enigmatic and complex. The more and more evidences appear that endometriosis is part of syndrome of uterus reproductive dysfunction. Hence necessity in further research and experimental designs in this area. Perhaps in nearest future scientists nevertheless will find the clue to single etiopathogenetic mechanism of development of endometriosis which at a later date will be successfully applied by physicians in diagnostic and treatment of this disease. |
| Ассоциированное с COVID-19 поражение плаценты / Н. Б. Пилькевич [и др.] // Акушерство и гинекология. – 2024. – № 3. – С. 13–19. (COVID-19-associated placental damage) |
Modern society has faced the coronavirus disease (COVID-19), which has become a serious global threat to public health. This infection had a significant impact on the healthcare systems around the world. The article analyzes the literature sources on the pathogenesis of placentitis in COVID-19. During the COVID-19 pandemic, the World Health Organization (WHO) identified pregnant women as a vulnerable group in terms of morbidity, and pregnancy was recognized as a risk factor for the severity of the infection. SARS-CoV-2 placentitis is a severe and rare damage to the placenta, which is due to the infectious and immunological factors. They can cause severe and diffuse placental parenchymal destruction that can affect >75% of the placenta. Viral particles attach to the villous trophoblast and destroy it. There is a complement activation, which contributes to the activation of hemostasis and leads to coagulopathy, as well as microvascular damage. The infected syncytiotrophoblast is damaged through complete or incomplete apoptosis. The persistent high level of the virus in the syncytiotrophoblast can lead to prolonged generation of complement fragments, cytokines of inflammatory origin and other chemotactic factors; it may cause a monocyte-macrophage inflammatory reaction, which further exacer-bates placental dysfunction. Conclusion: COVID-19 infection can lead to the development of placental damage, pregnancy complications, including premature birth, preeclampsia, miscarriages, fetal growth retardation and stillbirth. SARS-CoV-2 placentitis occurs due to direct cytotoxicity after virus replication in the syncytiotrophoblast and manifests in three ways: histiocytic intervillositis, perivillous fibrin deposition and trophoblast necrosis. |
| Аденомиоз и эндометриоз: точки соприкосновения / Р. И. Габидуллина [и др.] // Практическая медицина. – 2023. – Т. 21, № 4. – С. 37–40. (Adenomyosis and endometriosis: common features) |
The purpose — to summarize the results of molecular genetic studies of adenomyosis and endometriosis. Material and methods. Review of publications based on search results in the electronic resources PubMed, Elibrary, EMBASE and Google Scholar. Results. Marked differences between endometriosis and adenomyosis in pathogenesis, lesion localisation and clinical features have led to the recognition of adenomyosis as a separate clinical entity. In the new International Classification of Diseases 11th Revision, adenomyosis was removed from the section «Endometriosis» (GA10) and presented as a separate disease «Adenomyosis». Identical KRAS mutations in epithelial cells in endometriosis, adenomyosis and combined endometriosis suggest that adenomyosis and endometriosis are oligoclonal lesions arising from populations of cells of the basal layer of the endometrium carrying a specific driver mutation. Medication strategies that block ovarian steroidogenesis, as well as local estrogen synthesis, are a long-term treatment option for these chronic diseases. Conclusion. The results of molecular genetic studies indicate that endometriosis and adenomyosis are related conditions with a common molecular etiology. |
| Пути и механизмы влияния COVID-19 у матери на развитие нервной системы плода / Д. Ю. Капралова [и др.] // Вопросы гинекологии, акушерства и перинатологии. – 2024. – Т. 23, № 1. – С. 102–111. (Pathways and mechanisms of effects of maternal COVID-19 infection on fetal nervous system development) |
Immunoneuropsychiatry is a field of science that reflects the influence of the immune system on the nervous system and acts, in addition to genetic and environmental factors, as a component of the etiopathogenesis of neuropsychiatric development. In this aspect, the impact of COVID-19 during pregnancy on the fetus may be expressed both as a direct effect of the infectious agent and as an indirect effect of the components of the maternal immune response to the infectious process on the fetal development. Objective. To review the research literature on the factors of susceptibility of pregnant women to viral infections, mechanisms of the immune defense in pregnant women and COVID-19 infection, neurological outcomes, and their impact on the development of the fetal nervous system and the impact of sexual dimorphism on these processes. Material and methods. Full-text scientific publications were searched in the electronic databases Russian Science Citation Index (RSCI), PubMed, Scopus, and Google Scholar using the following key words: COVID-19; SARS-CoV-2; immune system; immunopathology; pregnancy; neurodevelopmental pathology; neurological diseases; sex of the fetus. The authors independently analyzed relevant studies. In addition to the analysis of the main publications found, the authors analyzed the reference lists of review articles, the selection was made according to the scientific value, with the formation of the final reference list according to the relevance of the analyzed material. Results. Immunopathological reactions in pregnant women during the infectious process, in particular COVID-19, may have a negative impact on the development of the fetal nervous system, which is expressed in the development of neuropsychiatric disorders of varying severity, given the influence of numerous genetic factors, including sexual dimorphism. |
| Гаджиева, П. Х. Сахарный диабет во время беременности: осложнения для плода и новорожденного / П. Х. Гаджиева, Л. В. Дикарева // Журнал акушерства и женских болезней. – 2024. – Т. 73, № 1. – С. 81–90. (Diabetes mellitus during pregnancy — complications for the fetus and newborn) |
Currently, diabetes mellitus is considered one of the most common problems in obstetrics and neonatology, associated with its high incidence and complications it causes — perinatal loss and morbidity of newborns, as well as further negative consequences for the child’s health. The incidence of diabetes mellitus is increasing in the world every year. According to forecasts of the International Diabetes Federation, there is no tendency to decrease the incidence in the near future. The increase in the incidence of diabetes mellitus is also due to a change in the criteria for diagnosis set out in the Gestational Diabetes Mellitus Treatment Guidelines. In addition, patients often do not understand the seriousness of the complications that occur with the disease, thereby not following the doctor’s treatment recommendations. To date, it has been proven that diabetes mellitus is a main cause of perinatal morbidity and mortality. According to the World Health Organization, even slight hyperglycemia in the mother during pregnancy is associated with the development of diabetic fetopathy. This article provides an analytical review of current literature covering the issues of perinatal and neonatal outcomes in the presence of diabetic fetopathy. Its characteristic phenotypic signs include macrosomia (due to increased fat deposition in subcutaneous tissue associated with increased production of somatotropic hormone) or microsomia (due to primary placental insufficiency), general pastiness, skin hyperemia, characteristic сushingoid-type appearance, body disproportion, puffy face in combination with other signs of immaturity, as well as transient hypertrophic cardiomyopathy and hepatosplenomegaly. |
| Зиганшин, А. М. Гипотензивная терапия в акушерской практике / А. М. Зиганшин, А. А. Максютова // Журнал акушерства и женских болезней. – 2024. – Т. 73, № 1. – С. 113–123. (Hypotensive therapy in obstetric practice) |
Arterial hypertension remains a leading cause of maternal morbidity and mortality while leading to significant economic costs in health care. Properly selected treatment tactics allow for prolonging pregnancy and levelling out various complications arising from the disease. However, there are still some questions about the effectiveness and safety of prescribed therapy due to possible side effects of the drugs. The aim of this study was to evaluate the efficacy and complications of hypotensive therapy during pregnancy, childbirth and the postpartum period. We analyzed the literature on eLibrary, Scopus, Cochrane Library, PubMed. |
| Руденко, К. А. Патогенетические особенности преэклампсии при COVID-19: актуальный обзор литературы / К. А. Руденко, В. В. Ишкараева, И. Е. Зазерская // Журнал акушерства и женских болезней. – 2024. – Т. 73, № 1. – С. 137–148. (Pathogenetic traits of preeclampsia in COVID-19. A relevant literature review) |
The aim of this study was to present the latest data on the association of preeclampsia and coronavirus infection and on the preeclampsia-like syndrome, and to analyze the current literature on the pathogenetic relationships between COVID-19 and preeclampsia and on morphological changes in placental tissue in patients with these gestational complications. A significant portion of studies indicate an increased risk of developing preeclampsia in patients with coronavirus infection during pregnancy, regardless of gestational age, especially in severe COVID-19, but other researchers report no association between coronavirus infection and the onset of preeclampsia. The supposed pathogenetic connection between these pathologies consists in the development of systemic endothelial dysfunction and dysregulation of the renin-angiotensin-aldosterone system, while the direct effect of SARS-CoV-2 on the placentation is poorly understood and is a subject of debate. A new concept of the so-called “preeclampsia-like syndrome” has been introduced, which presumably occurs in patients with a severe form of the novel coronavirus infection as its extrapulmonary manifestation. The measurement of the ratio of soluble fms-like tyrosine kinase-1 activity to the level of placental growth factor ratio has been proposed as a differential diagnostic test between preeclampsia and the preeclampsia-like syndrome, but its prognostic value remains ambiguous. The morphological examination of placentas in patients with coronavirus infection and preeclampsia indicates the signs of maternal and fetal vascular malperfusion. The literature on the association between coronavirus infection and preeclampsia remains controversial, however, the better half of the researchers is indicative of a significant increase in the risk of developing this serious complication in pregnant women with COVID-19, especially for its severe form. New information about the preeclampsia-like syndrome, as well as the virtual absence of studies of placental morphology in patients with preeclampsia and coronavirus infection during pregnancy, dictate the need for further study to better understand the association between these two pathologies, determine the possibilities of patient surveillance and prevent complications. |
| Можейко, Л. Ф. Синдром поликистозных яичников / Л. Ф. Можейко // Рецепт. – 2024. – Т. 27, № 2. – С. 205–213. (Polycystic ovary syndrome) |
The urgency of the problem of polycystic ovary syndrome (PCOS) lies not only in the high prevalence of this pathology, but also in its social significance due to the frequent combination of menstrual disorders, metabolic disorders with manifestations of hyperandrogenism (hirsutism, seborrhoea, acne), anovulatory infertility, which often cause disorders of psychological status and quality of life. Despite significant advances in recent decades, there is no unified concept of the etiopathogenesis of PCOS, and the issues of diagnosis and treatment of this pathology continue to be controversial. In adolescence, PCOS is a diagnosis of exclusion, because it can be verified after the exclusion of other diseases with similar clinical symptoms. The article presents the main diagnostic criteria of polycystic ovary syndrome in adolescents, modern approaches to the management and treatment of such patients. |
| Гладкомышечные опухоли с неопределенным злокачественным потенциалом (STUMP): современное состояние проблемы / А. Ю. Захарко [и др.] // Медико-биологические проблемы жизнедеятельности. – 2024. – № 1. – С. 6–15. (Smooth muscle tumors of uncertain malignant potential (STUMP): current state of the problem) |
The most common type of uterine tumors are smooth muscle tumors: benign leiomyomas, smooth muscle tumors of uncertain malignant potential (STUMP), sarcomas. The incidence of STUMP is difficult to estimate. They account for 1,3% of all uterine malignancies. A thorough histopathological examination is necessary to confirm the correct diagnosis of STUMP due to the unreliability of preoperative imaging techniques for differentiating between leiomyoma, STUMP and leiomyosarcoma. Compared with sarcomas, STUMP have a better prognosis, but their biological potential is uncertain because recurrence, malignancy, and metastasis are possible many years later. Considering the rarity of tumors with uncertain malignant potential, the small number of publications on their treatment, there are no clinical recommendations for the management and treatment of patients with this pathology. The article reviews current data on the diagnosis and differential diagnosis of smooth muscle tumors, management tactics, treatment, and prognosis of patients with STUMP. |
| Хабаров, С. В. Инозитол: влияние на репродуктивную систему (обзор литературы) / С. В. Хабаров, Т. В. Андреевская // Вестник новых медицинских технологий. – 2024. – Т. 31, № 1. – С. 44–49. (Nositol: Effects on the reproductive system) |
The purpose of the review is to study the importance for the human body of a sufficient level of inositol, a cyclic hexatomic alcohol existing in 9 stereoisomeric forms. The main ones among them are myo-inositol and D-chiro-inositol. Myo-inositol is an important multifunctional metabolite involved in osmoregulation, chromatin remodeling, cell signaling, regulation of gene expression and plays a key role in reproductive function in both women and men. Inositol has a significant effect on reproductive function, demonstrating high efficacy in the treatment of polycystic ovary syndrome, infertility, anovulatory cycle and other reproductive disorders. Myoinositol and D-chiro-inositol, due to their antiandrogenic and insulin-sensitizing effects, improve the metabolic and reproductive aspects of polycystic ovary syndrome: inositol helps regulate hormones, restore ovulation, improve fertilization rates, improve the quality of oocytes and sperm, reduce the risk of hyperstimulation syndrome during assisted reproductive technologies, thereby increasing the chances of pregnancy. The most studied and effective in clinical practice is the ratio of myo-inositol: D-chiro-inositol 40:1. In some cases, for example, in inositol resistance, a combination of myo-inositol and α-lactalbumin may be effective. In order to study this problem, a search was performed for literary sources in the domestic and international databases Elibrary, Cyberleninka, PubMed, MedLine, Embase, CINAHL for the period 2014-2023. The review includes 28 articles from the peer-reviewed literature. |