Ukrainian Journal «Health of Woman»

Management of patients with abnormal screening results and precancerous conditions of the cervix according to national standards 2024 (clinical case)

2025-02-05T23:57:10+02:00

Аim - to solve the problem of early diagnosis and treatment of pathological conditions of the cervix in accordance with the national standard of medical care (order of the Ministry of Health of Ukraine No. 1057) using the example of a clinical case analysis.

Clinical case. Patient B., born in 1986, complained of periodic pain in the lower abdomen and the inability to get pregnant for 7 years. Additional examination was performed: the conclusion of liquid cytology ASC-US, HPV genotyping revealed 16, 18, 31 HPV genotypes. Full diagnosis as: Primary infertility. ASC-US (atypical squamous epithelial cells of unclear genesis). Immediate risk of CIN 3+ 4.4%. Clinical form of HPV (16, 18, 33 genotypes). Ectopia of the cervix. Transformation zone type 1. Chronic cervicitis. Anti-inflammatory therapy was performed. Diagnosis after treatment: HSIL, AGUS. Immediate risk of CIN 3+ 32%. Clinical form of HPV (16). Ectopia of the cervix. Transformation zone type 1. Chronic cervicitis. Was targeted radio wave excision of the cervix was performed. The results of the pathohistological examination indicated low-grade squamous intraepithelial lesion LSIL, atypical glandular cells were not detected. Diagnosis: LSIL. Immediate risk of CIN 3+ 2.9%. Clinical form of HPV (16). Ectopia of the cervix. Transformation zone type 1. Taking into account the recommendations of the standard, after receiving the appropriate histological conclusion, we can subsequently observe the woman for 1 year.

Conclusions. The analysis of a clinical case indicates that for the timely diagnosis of intraepithelial lesions of the cervix, it is necessary to conduct cervical screening, sorting additional examination and determining the risk of CIN 3+. If cervical screening is already standardized in gynecological practice, sorting additional examination and determining the risk of CIN 3+ are new concepts that are generally not used.

The study was performed in accordance with the principles of the Declaration of Helsinki. The woman's informed consent was obtained for the study.

The author declares that there is no conflict of interest.

The role of angiogenic factors in preeclampsia

2025-02-05T20:54:36+02:00

Preeclampsia is one of the leading causes of maternal and perinatal mortality, and its timely diagnosis is complicated by the multifactorial nature of the disease. The study of angiogenic factors is of key importance for early diagnosis, monitoring, and prevention of complications.

Aim - to analyze the content of angiogenesis factors (PlGF and sVEGF) in the blood serum of pregnant women and determine their impact on preeclampsia.

Materials and methods. 110 pregnant women were examined: 60 women with preeclampsia (main group) and 50 women with physiological pregnancy (control group). 86.7% of women with preeclampsia had hemodynamic disorders of the fetoplacental complex of varying severity. The content of angiogenic factors (PlGF and sVEGF) in the blood serum was assessed in the I (10-12 weeks of pregnancy), II (18-20 weeks) and III (30-34 weeks) trimester of pregnancy. Statistical analysis was performed using Student's t-test, Mann-Whitney U-test and ANOVA analysis.

Results. A decrease in PlGF in the main group was observed from the І trimester (7.89±2.2 pg/ml) and remained below the normative values in the ІІ (83.4±14.3 pg/ml) and ІІІ (62.6±9.1 pg/ml) trimesters. sVEGF in the main group was higher than in the control group in the І (1684±188.1 pg/ml vs. 1232.26±173.9 pg/ml), the ІІ (2289±254.7 pg/ml vs. 1174.35±227.5 pg/ml) and the ІІІ (2675±301.4 pg/ml vs. 1792.19±509 pg/ml) trimesters. The sVEGF/PlGF ratio in the main group was significantly higher than in the control group: 165.6 versus 11.3 in the І trimester; 144.7 versus 18.6 in the ІІ trimester and 112.8 versus 17.3 in the ІІІ trimester. A significant influence of angiogenesis factors on the development of preeclampsia was revealed: PlGF <10 pg/ml - in the І trimester, <80 pg/ml - in the ІІІ trimester; sVEGF ≥1500 pg/ml - in the І trimester, ≥2000 pg/ml - in the ІІ trimester, ≥2500 pg/ml - in the ІІІ trimester of pregnancy.

Conclusions. Decreased PlGF and increased sVEGF in the I trimester predict a high probability of preeclampsia and are markers that allow assessing the risk of complications and ensuring timely treatment.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all patients.

No conflict of interests was declared by the authors.

Clinicopathological features of metastatic breast cancer in patients with metabolic syndrome

2025-02-05T21:05:28+02:00

Breast cancer (BC) is a heterogeneous pathology, characterized by clinicopathological and molecular biological features, as well as the clinical course of the neoplastic process, which has certain metastatic “preferences”. The development of metabolic disorders in menopausal women is not only a risk factor for BC but also has a direct impact on the tumor growth, intensity, and topology of distant metastases.

Aim - to identify the clinicopathological features of primary metastatic BC (pMBCa) associated with distant metastasis, based on the hormonal receptor status of tumors in presence of metabolic syndrome (MetS).

Materials and methods. The retrospective study was conducted using the medical records of 88 pMBCa at stage IV who were treated at the National Cancer Institute during 2016-2023. The total number of metastatic lesions was 182, which were further divided into groups, depending on the presence of MetS signs in patients: MetS+ (78 cases) and MetS- (104 cases). The International Diabetes Federation guidelines (2005) were used to establish the diagnosis of MetS in patients with pMBCa. The study examined the topology of distant metastases, clinical characteristics of patients with pMBCa, taking into account the receptor status of tumors and distribution by morphological structure. The conventional clinical, morphological, immunohistochemical methods, methods of medical and mathematical statistics were used.

Results. In the MetS+ group of patients, metastatic lung involvement was diagnosed the most frequently (43.6% of cases), whereas in the MetS- group of patients, the most common site of distant metastases was the bones (44.2% of cases). In the MetS+ patients, smaller receptor-positive tumors predominantly metastasized to the lungs and liver, while receptor-negative tumors of similar size primarily affected the lungs. It was found, that the presence of MetS signs in patients with pMBCa is associated with a high incidence of metastatic spread to distant organs in the presence of fewer regional lymph nodes. An increase in the number of poorly differentiated tumors was recorded in patients of the MetS+ group with receptor-positive pMBCa cases with distant metastases to the bones and lungs.

Conclusions. The pMBCa in the MetS+ group of patients are associated with the presence of smaller tumors and fewer lymph node involvements, lobular structure, which probably indicates an aggressive course of the malignant process.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. Informed concent of the women was obtained for the research.

The authors declare no conflict of interest.

Clinical features of the state of reproductive health of patients with submucous uterine fibroids after COVID-19

2025-02-05T21:18:22+02:00

The issue of effectively achieving the desired pregnancy still remains debatable due to the increase in infertile patients with comorbid conditions.

Aim - to determine the impact of COVID-19 on the nature of hormonal changes in patients with submucosal uterine fibroids (SUF) before and after hysteroscopic myomectomy.

Materials and methods. 112 women of reproductive age were examined, who were divided into three groups: I - 57 women with SUF who had COVID-19; II - 35 patients with SUF who did not have COVID-19; III - 20 practically healthy women. Hormonal status disorders were studied by determining the serum concentration of gonadotropic and steroid hormones by enzyme-linked immunosorbent assay after surgery in dynamics. To determine the probability of the difference in values, the Student's t-test was used. Differences were considered to be significantly significant at a level of significance of p<0.05.

Results. After the surgical intervention in the scope of hysteroscopic myectomy, according to the results of the hormonal balance studies of women in the groups I and II, it was determined that the differences between the indicators remained, which indicates pathological mechanisms of hormonal imbalance independent of uterine fibroids.

Conclusions. Patients represent a complex contingent from the point of view of the implementation of reproductive function, since hormonal changes detected before surgery, in particular a decrease in steroid hormones, high concentrations of gonadotropic hormones against the background of hyperandrogenism, contribute to the development of desynchronization of the perception of neurohumoral signals by the receptor apparatus of myositis, which leads to the development of fibroids nodes with a submucosal location. Transferred COVID-19 in patients with SUF is the main risk factor for failure to restore fertility after surgery.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee. Informed consent of women was obtained for the study.

No conflict of interests was declared by the authors.

The effect of complex therapy on perinatal outcomes in pregnant women with sleep disorders

2025-02-05T21:34:38+02:00

Aim - according to the results of a prospective study, the effect of complex therapy on the level of melatonin metabolites and placental hormones and their relationship with perinatal outcomes in pregnant women with sleep disorders was determined.

Materials and methods. A randomized controlled trial was conducted in a group of 165 women with diagnosed sleep disorders. Study participants were tested using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and, if sleep disturbances were detected, were randomized according to a table of random numbers into the main group (n=55) and the comparison group (n=60). The control group consisted of 50 pregnant women without sleep disorders. Subsequently, in all groups, melatonin levels were determined based on the level of its metabolite in urine - 6-sulfatoxymelatonin (6-SOM), as well as progesterone and placental lactogen. In the main group, in addition to sleep hygiene psychoeducation, complex therapy was prescribed, which included the use of a vitamin-mineral complex and micronized progesterone, and in the comparison group, only sleep hygiene psychoeducation was prescribed as generally recommended measures. In the groups of pregnant women with sleep disorders, the effect of the proposed complex on the level of 6-SOM in urine, placental lactogen, progesterone and their relationship with perinatal consequences (threat of premature birth, gestational diabetes, hypertensive disorders and preeclampsia, delivery by caesarean section, low fetal weight at birth, postpartum bleeding) compared to the control group.

Results. As a result of the study, a significant increase in the levels of 6-SOM and placental hormones was established in the main group relative to the comparison group, and approaching the indicators of the control group of pregnant women without sleep disorders. An improvement in the quality of sleep and perinatal outcomes was also found in the main group compared to the comparison group, which we associated with the use of complex therapy with the appointment of a vitamin-mineral complex, micronized progesterone and training in sleep hygiene.

Conclusions. The proposed complex therapy in the main group reliably increases the levels of 6-SOM and placental hormones in pregnant women with sleep disorders, which in turn improves the quality of sleep and perinatal outcomes.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Clinical and laboratory peculiarities of pregnancy course complicated with gestational diabetes mellitus and exocrine pancreatic insufficiency

2025-02-05T21:46:32+02:00

The course of pregnancy can be accompanied by a number of adverse conditions, one of which is gestational diabetes mellitus (GDM). Reduced glucose tolerance is an adaptive mechanism during pregnancy, but the development of GDM is based on a certain decompensation of pancreatic functions, which may affect not only endocrine but also exocrine pancreatic activity (EPA).

Aim - to study the anamnestic, clinical and laboratory features of the course of pregnancy with reduced EPA in GDM.

Materials and methods. The study involved 112 patients (87 women from the main group, divided into 2 subgroups according to the presence of dyspeptic symptoms; and 25 pregnant women from the control group). Anamnestic data, the course of this pregnancy were studied and enzyme immunoassays for serum trypsinogen (TPG) and fecal elastase-1 (FE-1) concentrations were performed. Statistical analysis conducted using Microsoft Office Excel and MedStat software. The difference between groups was considered significant at p≤0.05.

Results. In pregnant women with GDM and reduced EPA, the presence of factors in the anamnesis that potentially affect the development of pancreatic diseases was established. Significantly lower TPG and FE-1 levels were found in the main group compared to the control group. A direct relationship was determined between the degree of reduction in EPA in GDM and clinical manifestations of dyspepsia, as well as with the occurrence of early pregnancy complications.

Conclusions. Increasing maternal age, previous gastrointestinal diseases, polycystic ovary syndrome, and obesity are associated with a greater severity of decreased EPA in women with GDM, clinically manifested by the occurrence of dyspeptic manifestations, vomiting of pregnancy, and threatened abortion; laboratory findings were: decreased TPG and FE-1 concentrations, which correlate with the severity of clinical picture.

The study was conducted in accordance with principles of the Declaration of Helsinki. Research protocol was approved by local ethics committee of the participating institution. Informed consent was obtained.

The authors declare no conflict of interest.

Modern approaches to diagnosing the course of the wound process in parturient women with obstetric surgical wound infection

2025-02-05T21:59:16+02:00

Aim - to determine the possibility of using the method of polarization microscopy in diagnosing the course of the wound process in women in labor with infection of the obstetric surgical wound.

Materials and methods. 115 women in labor with purulent wounds were examined and treated. The course of the wound process was determined by the method of polarization microscopy by studying the structure of biological media (blood, wound exudate) and the substrate - biopsy from the wound in the solid phase, which were taken before, during treatment, and after it for 2-3 days. To determine the method of polarization microscopy as a diagnostic criterion for the course of the wound process, the results were obtained and compared with the results of clinical, bacteriological, immunological, histological and cytological research methods. Statistical data processing was carried out using the application program package "Microsoft Excel 5.0" and the standard version of "Statistica 8.0". The difference in indicators was recognized as statistically significant at p<0.05.

Results. Using the method of polarization microscopy, together with clinical, bacteriological, immunological, histological and cytological research methods, pathogenetic changes in the body of women with purulent wounds in parturient women were explained, clinical manifestations of wound infection were characterized, the course of the wound process was assessed, and the restoration of tissue in the wound to its original functional state was shown.

Conclusions. The method of polarization microscopy can be used in clinical practice as an objective criterion of the course of the wound process and the effectiveness of treatment for infected surgical wounds in obstetric practice.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent of the patients was obtained for the research.

The authors declare that there is no conflict of interest.

Comprehensive assessment of the hemostatic system in women with РAI-1 gene polymorphism and first trimester pregnancy loss

2025-02-05T22:20:42+02:00

Aim - to study the associations between hemostatic system parameters, natural anticoagulant levels and serum PAI-1 levels depending on the PAI-1 polymorphism variant in women with early reproductive losses.

Materials and methods. The selected patients (n=115) were divided into 3 groups according to the type of polymorphism: Clinical group I (n=20) - patients with wild-type polymorphism of the РAI-1 gene (675 5G>5G), group II (n=53) - women with heterozygous polymorphism of the РAI-1 gene (675 5G>4G), group III (n=42) - women with homozygous pathological polymorphism of РAI-1 (675 4G>4G). The study was based on bibliosemantic analysis; anamnestic data were evaluated; polymerase chain reaction (PCR) was used to determine thrombophilia gene polymorphisms; enzyme-linked immunosorbent assay (ELISA) to determine the level of РAI-1 in the blood serum; clotting method to determine the levels of natural anticoagulants; coagulometric method to determine the level of fibrinogen and coagulation parameters.

Results. The average age of women in the thematic groups was comparable and amounted to 32.5±0.9, 33.9±0.7 and 33.6±0.7 years, respectively. The analysis of associations in the comprehensive assessment of haemostatic parameters revealed certain associations between these parameters and a complicated obstetric history (spontaneous abortion, fetal growth retardation and pre-eclampsia, pregnancy loss in early (more frequent) and late gestation), and the presence of РAI-1 gene polymorphism. No significant associations were found between the presence of the РAI-1 gene polymorphism and levels of natural anticoagulant activity. The level of РAI-1 depended on the type of polymorphism in this gene and was associated with termination of pregnancy before 12 weeks.

Conclusions. Polymorphisms of the PAI-1 gene should be considered as one of the risk factors for habitual miscarriage. Overexpression of PAI-1 is associated with adverse pregnancy complications, and its level is an extremely promising marker for prognosis and treatment effectiveness.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

The feature of the relationship between vitamin D and anemia in pregnant women

2025-02-05T22:33:28+02:00

Anemia, characterized by low levels of hemoglobin or red blood cells, is a significant global health issue, particularly among pregnant women, due to its severe negative consequences. Recent studies highlight a potential association between anemia and 25-hydroxyvitamin D (25(OH)D) levels; however, the mechanisms underlying this relationship remain poorly understood.

Aim - to establish a causal relationship between 25(OH)D levels and the risk of anemia in the first trimester of pregnancy.

Materials and methods. From January to September 2024, a study was conducted to analyze serum 25(OH)D levels in 135 pregnant women in their first trimester. The study was performed at the Women's Consultation Department of the "Kyiv Perinatal Center" municipal non-commercial enterprise. Based on serum 25(OH)D concentrations, the participants were divided into three groups: the Group I - 77 pregnant women with vitamin D deficiency and anemia; the Group II - 27 pregnant women with vitamin D insufficiency and anemia; the Control group - 30 pregnant women with optimal vitamin D levels and no anemia. A retrospective analysis included data on age, seasonality, anthropometric parameters, somatic and gynecological conditions, reproductive history, and the course and outcomes of both previous and current pregnancies.

Results. The study identified seasonal patterns of vitamin D deficiency and anemia, with the highest risk occurring from mid-winter to spring. The Group I demonstrated significantly increased risks of obstetric complications such as placental abruption, preterm birth, preeclampsia, severe postpartum hemorrhage, and fetal growth restriction. Additionally, thyroid disorders, liver-related digestive issues, and urinary system diseases were more frequently observed in this group.

Conclusions. This study confirms a causal relationship between higher 25(OH)D levels and reduced anemia incidence. The findings emphasize the importance of vitamin D in preventing anemia among pregnant women and highlight the need for further research into the efficacy of vitamin D supplementation as a strategy for reducing anemia risk.

No conflict of interests was declared by the authors.

The role of nitric oxide, endothelin-1, and prostaglandins in the pathogenesis of gestational diabetes

2025-02-05T22:44:58+02:00

Studying the pathophysiological mechanisms of gestational diabetes (GD) will enable more accurate prediction of the development of this condition, its adverse perinatal and long-term metabolic consequences.

Aim - assessment of the role of nitric oxide (NO), endothelin-1 (Et-1), and prostaglandins in the pathogenesis of GD.

Materials and methods. Between 2020 and 2023, a comprehensive examination of 120 pregnant women was conducted. The study group included 90 patients with GD, while 30 women with physiological pregnancies formed the control group. Blood samples from all study participants were analyzed for levels of NO, L-arginine, thromboxane B₂ (TxB₂), Et-1, and prostaglandins E₂ (PGE₂), F₂_α (PGF₂_α), and prostacyclin (PGI₂) using enzyme-linked immunosorbent assays on a "Sunrise" analyzer from Tecan.

Results. The levels of PGE₂ and PGI₂ in pregnant women with GD were significantly lower than those in healthy women, and PGF_2α and ThB₂, on the contrary, were significantly higher. The ratio of prostaglandins PGE_2α/PGE₂ in pregnant women with GD was 0.36, which was more than 4 times higher than that in healthy women. The ratio of ThB₂/PGI₂ in pregnant women with GD was 1.52, which was more than 3 times higher than that in healthy women. Multinomial logistic regression models were constructed to predict the occurrence of GD and determine the most sensitive and specific indicator, which included a comprehensive analysis of body weight, heredity, as well as determining the levels of biomarkers such as Et-1, NO, PGF_2α, PGE₂.

Conclusions. The observed endothelial dysfunction may be a key mechanism underlying the development of preeclampsia and diabetic fetopathy in GD patients, as supported by the multinomial logistic regression models.

No conflict of interests was declared by the authors.

Modern view on the problem of uterine leiomyoma in during pregnancy

2025-02-05T23:14:57+02:00

Aim - analyze the data from current literature from etiopathogenetic officials, diagnosis and treatment of uterine leiomyoma before pregnancy and during the hour of pregnancy with the drive, improving the tactics of managing the postnatal and post-natal period in women with uterine leiomyoma, changing the complexity of bandages with bleeding.

The relevance of the problem of uterine leiomyoma throughout the world is described. Looked at etiopathogenetic officials who are responsible for the disease. The emphasis is placed on the complications and causes of uterine leiomyoma in vaginal patients. Analyzed the effectiveness of methods for diagnosing and treating uterine leiomyomas in women. Examination of the influx of uterine leiomyomas on the treatment of vagusity, uterine ruptures, erectile dysfunction, placental folds, postpartum bleeding and other obstetric problems.

Conclusions. Regardless of the current diagnosis and pharmacological factors, the problem of managing vaginity, pregnancy and the postnatal period in women with uterine leiomyoma is lost, the fragments of hormonal imbalance and the plumpness itself accumulates. disruption of the sensory function of the myometrium, leading to recurrent bleeding. The results highlight the need to optimize tactics for managing the third postnatal period and early postnatal period in women with uterine leiomyoma.

The authors declare no conflict of interest.

Chorioamnionitis as a key cause of extremely preterm births (a review of global data)

2025-02-05T23:28:54+02:00

Preterm labor remains a leading cause of neonatal morbidity and mortality worldwide. Investigating the etiopathogenetic factors contributing to preterm birth and developing preventive interventions are key objectives in obstetric research.

Aim - to examine and integrate existing evidence on the impact of chorioamnionitis, including its subclinical forms, on preterm labor; to analyze potential interventions and evidence-based approaches for modern treatment; and to identify promising strategies in this field.

A review of contemporary evidence-based medical literature was conducted. Primary searches were carried out in four separate databases. Numerous independent studies have documented correlations between infectious factors and preterm birth. The most reliable findings have been provided by pathologists, who described histological evidence of intrauterine infection in 75% of preterm births, with a declining trend as gestational age increase. Epidemiological research using laboratory and clinical data reveals a correlation between preterm birth and the presence of asymptomatic bacteriuria, as well as alterations in the vaginal microbiome. In patients with cervical shortening - a marker of preterm labor - and subclinical intrauterine infection, antibiotic therapy has been shown to resolve the infectious process, reverse symptoms, and prolong pregnancy in 75% of cases.

Conclusions. The analysis confirmed a clear association between chorioamnionitis (both clinical and subclinical, histologically confirmed) and the development of preterm labor. The proportion of chorioamnionitis increases as gestational age decreases. Diagnostic amniocentesis is the method of choice for confirming the diagnosis of chorioamnionitis, particularly in subclinical cases, which can significantly alter treatment approaches and improve pregnancy outcomes.

The authors declare no conflict of interest.

Genital herpes in obstetrics and neonatal herpes (literature review)

2025-02-05T23:46:48+02:00

Genital herpes (GH) is a chronic infection caused by herpes simplex virus (HSV) types 1 and 2, which is mainly sexually transmitted and causes recurrent genital ulcers throughout life. Infection of a woman with HSV during pregnancy poses a risk to the development of the fetus and newborn. Transmission of the virus occurs through contact with HSV type 1 or 2 in the prenatal period, during the intrapartum period, or after delivery.

The aim is to review the clinical forms of HSV infection in pregnant women and newborns, ways of mother-to-child transmission, current approaches to diagnosis and treatment, indications for cesarean section, and ways of prevention in uninfected women during pregnancy and in healthy infants.

The literature search was conducted using PubMed/MEDLINE, Google, the Cochrane Library, international recommendations and guidelines for 2014-2025. The clinical diagnosis of GH is usually made by detecting vesicular, eroded, or ulcerated lesions, but should always be confirmed by laboratory tests. The approach to antiviral therapy in pregnant women with GH takes into account the classification of the infection, the severity of symptoms and the gestational age at the time of infection in relation to the term of delivery. Suppressive antiviral therapy is used to reduce the likelihood of recurrence of GH before delivery. Despite progress in diagnosis, treatment, and prevention, neonatal herpes infection continues to cause significant morbidity and mortality in newborns.

No conflict of interests was declared by the author.