The objective: improving the efficiency of diagnosis and treatment of pathology and implantation ability of the endometrium in women of reproductive age who took part in hostilities and received concussions. Materials and methods. The study of endometrial pinopodia was carried out in 35 women of reproductive age who took part in hostilities and received concussions, who on the 21st day of the MC underwent operative laparoscopy and hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy. Of these women, 22 patients – a comparison group – of reproductive age with a history of trauma without post-concussion syndrome and 13 in the main group, women of reproductive age, have the consequences of contusion in the form of post-concussion syndrome. Served as control 10 samples of endometrium from civilian women of reproductive age. The average age of the surveyed was 27.08±4.23 years. The period of stay in the combat zone was 29.34±9.21 months, the time from the moment of receiving a slight traumatic brain injury (contusion) was 18.8±9.2 months. Results. In combatant-women with contusion in history, there are disturbances in the receptivity of the endometrium, manifested by abnormalities in the development of pinopodia and their microvilli during the implantation window: areas without pinopodia in 47.50% of cases (p<0.006), pinopodia of sizes – in 77.50% (p<0.01) and abundant microvilli – in 37.50% (p<0.02); a decrease in the frequency of the presence of developed pinopodia by 2.12 times (p<0.01), large pinopodia by 2.29 (p<0.01), and a small number of microvilli by 4.00 (p<0.0001), an increase in the occurrence of medium-sized pinopodia by 3.00 (p<0.02) times, and a moderate number of microvilli by 4.00 (p<0.0001). A characteristic feature of endometrial pinopodia in the above patients is the presence of mosaicism of their shape (65.00%) and size (67.50%). Conclusions. Women in the military who have been injured in combat are diagnosed with reproductive health problems caused by both the traumatic brain injury itself and the stressors associated with military service. Keywords: reproductive health, female veterans, post-contusion syndrome, receptive endometrial enlargement, office hysteroscopy.
Objective: optimization of pregravid (pre-pregnancy) preparation in patients with tubal-peritoneal infertility factor and marked delay in endometrial development after unsuccessful assisted reproductive technology (ART) treatment by the use of endometrium injection scratching technology with autoplasma.Material and methods. Study included 40 cases of unsuccessful treatment attempts for tubal-peritoneal factor infertility with severe delay of endometrial development and 10 patients with tubal-peritoneal factor infertility with normal endometrium with one or more unsuccessful ART attempts on history and the existence of cryopreserved embryos of satisfactory quality from previous cycles of assisted reproductive technology. The average age was 39.5 ± 3.1 years. Patients were divided into groups: I – 21 patients who underwent endometrial injection scratching and hormonе replacement therapy (HRT) with a standard (4/6 mg) dose of estradiol; II – 19 patients who were prescribed HRT with a standard (4/6 mg) dose of estradiol; control – 10 patients with normal endometrium who underwent cryo-ET with standard (4/6 mg) dose of estradiol.Clinical results were evaluated and compared in terms of pregnancy rate per embryo transfer and pregnancy loss rate in the first trimester. The correspondence of the morphofunctional structure of the endometrium was evaluated by ultrasound, cytologically, Doppler measurements, histologically, immunohistochemically and via selective electron microscopy. Endometrium was 8.9 ± 1.1 mm during the period of progesterone prescription in the cryoembryo transfer cycle. All participants were transferred day 5 embryos. Results. In the cryo-ET program autoplasma injection scratching in patients with marked delay of endometrial development after the first seven days of monotherapy with a starting dose of estradiol was accompanied by a significant improvement in clinical outcomes in terms of pregnancy rate (25%) and definite decrease of early reproductive losses (25%).Conclusions. After pre-pregnancy preparation according to our method, it is quite sufficient to perform HRT with a standard dose of estradiol (4/6 mg/day) before starting progesterone irrespective of the endometrial development degree. Meanwhile, injection scratching is advisable to be prescribed in cases of marked delay in the endometrium development and it should be combined with physiotherapy methods.
Research aim. to assess the impact of post-traumatic stress on the risk of carbohydrate metabolism disorders in concussed female veterans. Systematization of multidisciplinary analysis and obtained data on the impact of PTSD on the development and course of carbohydrate metabolism disorders. Material and methods. A comprehensive clinical and laboratory examination of women veterans with PTSD and women from the comparison group was carried out. Group I consisted of examination data of women who suffered contusion during combat operations with PTSD, group II – control one, consisted of healthy women. Complaints, obstetric – gynaecological and somatic history were studied in detail, anthropometric data, the state of carbohydrate metabolism, and mental health were assessed. Results and conclusions. The results of the conducted research show that the correction of carbohydrate metabolism disorders and treatment of pre-existing pathology caused by the influence of stress factors in combatants in order to preserve reproductive health is expedient and necessary.
Annotation. Against the background of stress and post-traumatic stress disorder (PTSD) in women, changes in the hormonal background improve – the levels of stress hormones and the morphofunctional endometrium, which in their change negatively affect the reproductive health of women in Ukraine. The purpose of this study was to increase the efficiency of diagnosis and treatment of pathology and implantation capacity of the endometrium in women of reproductive age who took part in hostilities and suffered a concussion. Uterine natural killer cells were studied during the implantation window in 487 women of reproductive age who participated in combat operations and suffered concussions, who underwent hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy on the 21st day of menstruation cycle (MC). Of these women, 246 patients – the comparison group – of reproductive age with a history of trauma without post-concussive syndrome and 211 in the main group, women of reproductive age who have consequences of concussion in the form of post-concussive syndrome. 30 conditionally healthy civilian women of reproductive age served as controls. The average age of the examined was 37.08±4.23 years. The period of stay in the combat zone is 60.26±42.21 months, the time since receiving a traumatic brain injury (concussion) is 18.8±9.2 months. Instrumental examination of women included hysteroscopy. The spectrum of MNC cells (CD16+ and CD56+) in the stroma of the endometrium on the 21st day of MC was determined. Microscopy of the preparations and all morphometric studies were performed on an Olympus AX70 Provis microscope (Olympus, Japan) using the image analysis program Analysis 3.2 Pro (Soft Imaging, Germany) according to the recommendations of the software manufacturer. The obtained results were processed using the Statistica 6.0 and Biostat software packages and methods of analytical statistics. It is established that in women military servicemen, participants in combat operations who suffered a concussion, the content of CD56+ and CD16+ cells in the stroma of the endometrium in women with post-concussion syndrome is greater than that in patients without post-concussion syndrome: in the endometrium, which corresponds to the proliferation phase, it is 1.45 (p<0.0001) and 1.64 times (p<0.0001), in the endometrium, which corresponds to the early secretion phase, 1.93 (p<0.0001) and 2.22 (p<0,0001), in the endometrium, which corresponds to the middle phase of secretion, – in 1.61 (p<0.0001) and in 3.42 (p<0.0001), in chronic endometritis – in 1.92 (p<0 .0001) and 1.94 (p<0.0001), with SAHE – in 1.79 (p<0.0001) and 1.51 (p<0.0001), with endometrial polyps – in 1, 60 (p<0.0001) and at 1.56 (p<0.0001). This study proves the need to improve the efficiency of diagnosis and treatment of endometrial pathology in women of reproductive age who participated in hostilities and suffered concussions.
№1 (21) / березень 2015 www.reproduct-endo.com.ua ISSn 2309-4117 Е.Н. БОРИС д. мед. н., профессор кафедры акушерства, гинекологии и репродуктологии НМАПО им. П.Л. Шупика, заведующая клиникой репродуктивных технологий Украинского государственного института репродуктологии НМАПО им. П.Л. Шупика Л.В. СУСЛИКОВА д. мед. н., доцент кафедры акушерства, гинекологии и репродуктологии НМАПО им. П.Л. Шупика, директор Украинского государственного института репродуктологии НМАПО им. П.Л. Шупика В.В. КАМИНСКИЙ член-корр. НАМН Украины, д. мед. н., профессор, заведующий кафедрой акушерства, гинекологии и репродуктологии НМАПО им. П.Л. Шупика, главный акушер-гинеколог МЗ Украины, директор Киевского городского центра репродуктивной и перинатальной медицины Л.Н. ОНИЩИК Украинский государственный институт репродуктологии НМАПО им. П.Л. Шупика, Киевский городской центр репродуктивной и перинатальной медицины А.В. СЕРБЕНЮК кафедра акушерства, гинекологии и репродуктологии НМАПО им. П.Л. Шупика, Украинский государственный институт репродуктологии НМАПО им. П.Л. Шупика Контакты: Борис Елена Николаевна Национальная медицинская академия последипломного образования им. П.Л. Шупика, кафедра акушерства, гинекологии и репродуктологии 04112, Киев, Дорогожицкая, 9 тел.:
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