Національна медична академія післядипломної освіти імені П.Л. Шупика, м. Київ Вагітність-період в організмі жінки, коли відбуваються зміни в усіх органах і системах. Максимальна перебудова відбувається у статевих органах, у тому числі й на шийці матки (ШМ), яка під час вагітності є важливою анатомічною і функціональною структурою, створеною для утримання плода в порожнині матки до його народження. Структурно-функціональні властивості ШМ багато в чому визначають перспективи повноцінного запліднення, успішного виношування вагітності і своєчасних пологів. Сьогодні у світі високою залишається частота фонової і передракової патології ШМ, поширеність раку ШМ у вагітних зростає, а етіопатогенетичні особливості перебігу захворювань, що передаються статевим шляхом, зумовлюють загрозу та спричинюють розвиток акушерських і перинатальних ускладнень. Тому проблема ефективного лікування патології ШМ є однією з актуальних у сучасній гінекології. Стан ШМ відіграє важливу роль у забезпеченні нормального перебігу вагітності та пологів. Останніми роками запропоновано багато методів лікування її захворювань-як консервативних, так і оперативних. Аналіз численних наукових досліджень свідчить, що загальна кількість своєчасних пологів становить від 80,0% до 98,8% випадків. Серед ускладнень пологів у жінок з оперованою ШМ переважали первинна слабкість пологової діяльності, розриви ШМ, розриви промежини. У статті наведено переваги і недоліки використання фізіохірургічних компонентів, спрямованих на деструкцію або вилучення вогнища фонового і передракового характеру. Аналіз перебігу вагітності і пологів у жінок з оперованою ШМ залежно від методу хірургічного лікування (діатермокоагуляція, кріодеструкція, лазерна вапоризація, радіохвильова коагуляція) свідчить, що при різноманітних патологічних процесах на ШМ слід диференційовано використовувати різні методи деструктивного впливу, які необхідно враховувати при плануванні вагітності.
After destructive methods of treatment of the cervix, women are at high risk for the development of gestational complications as one of the causes of reproductive losses, which determines the social significance of the problem.The objective: to carry out a comparative analysis of the reproductive function in women who have undergone various surgical interventions on the cervix, to study the effect of destructive methods of treating cervical pathology on the course of pregnancy to improve the principles of antenatal care.Materials and methods. All examined women (n=201) who underwent organ-sparing operations (electroconization, cryodestruction, laser vaporization or radiowave excision) on the cervix for dysplasia of I-III degree, were divided into 3 groups: 1 group (retrospective, n=114) – patients in whom the features of menstrual and reproductive function were studied anamnestically; group 2 (prospective, n=57) – women who were included in the study immediately after surgery; group 3 (control, n=30) – almost healthy women. Patients in the comparative groups were comparable in age (mean age 25,7±4,4 years) and the course of the pathological process in the cervix.Results. In a 5-year study, menstrual and generative functions in patients after surgery were studied. Menstrual function is preserved in all patients, but most women complain of algodysmenorrhea and bleeding before and after menstruation: the highest percentage – in women after electroconization, the lowest – after cryodestruction, after laser vaporization and radiowave excision changes were not observed.In the analysis of pregnancy complications, the most significant were significant differences between the percentage of pregnant women at risk of abortion in the first two groups (47,9% and 26,0%, respectively) and the control group (14,8%), which can be explained by the development of isthmic-cervical insufficiency. Patients who underwent surgery on the cervix, as well as the presence of placental dysfunction, confirmed by violations of doppler indices.Conclusion. Modern destructive methods of treatment of cervical pathology, the least traumatic of which are laser vaporization and radiowave excision, can cure the underlying disease and preserve both menstrual and generative functions. Taking into account the clinical picture of the disease and the established diagnosis, it is necessary to develop individual management tactics for each patient, to conduct active monitoring during the year after surgery and observation during the year after pregnancy, regardless of its outcome.
One of the most important problems of modern urogynecology is the improvement of the treatment-diagnostic algorithm and prevention of overactive bladder syndrome (OAB). The purpose of the work is to construct and analyze discriminant models of the possibility of OAB occurrence in pregnant women of different age groups depending on the characteristics of anthropo-somatotypological indicators or hormonal background. 75 pregnant women with clinical signs of OAB syndrome and 60 healthy pregnant women had hormonal screening in the 1st and 3rd trimester of pregnancy and at 16 weeks postpartum using radioimmunoassay and immune enzyme methods (estradiol, progesterone, thyroid stimulating hormone and testosterone levels were determined). The anthropometry was carried out according to the method of V. V. Bunak, the components of the somatotype were determined according to the method of J. Carter and B. Heath, as well as the components of the body composition according to the method of J. Matiegka and the American Institute of Nutrition (AIN). By age, all pregnant women were divided into 3 subgroups: І - from 17 to 25 years, ІІ - from 26 to 35 years, ІІІ - from 36 to 41 years. A discriminant analysis of the possibility of OAB occurrence, depending on the anthropo-somatotypological or hormonal indices in women of different age groups, was conducted using the licensing program “Statistica 5.5”. When taken into account anthropo-somatotypological indices in women aged from 17 to 25 years, the model is correct in 86.7% of cases; in women aged from 26 to 35 years - in 90.9% of cases; in women between the ages of 36 and 41 years - in 89.3% of cases. Between healthy and OAB patients, women aged from 17 to 25 years discriminating variables are the width of the distal epiphysis of the shoulder (which has the greatest contribution to discrimination), conjugata externa, the muscle component of the body weight by AIN and the forearm's girth in the upper third; women from 26 to 35 years - dist. Іntеrtrochantericа, the width of the distal epiphyses of the forearm (the greatest contribution to discrimination), hip circumference, conjugata externa, mesomorphic component of the somatotype according to by Heath-Carter, fat mass component of the body by Matiegka, the forearm's girth in the upper third and the shoulder girth; women of age from 36 to 41 years - the width of the distal epiphysis of the leg (which has the greatest contribution to discrimination) and the length of the body. In general, the aggregate of all variables has a low level of discrimination between healthy and sick with OAB women between the ages of 17 and 25 (Wilkes Lambda statistics = 0.531; F = 5.521; p <0.01) and 36-41 years (Wilkes Lambda statistics = 0.445; F = 15.62; p <0.001), while among women between the ages of 26 and 35 - the average level of discrimination (Wilkes Lambda statistics = 0.386; F = 13.52; p <0.001). When taken into account characteristics of the hormonal background in women of all ages, the model is correct in 100% of cases. Between healthy and OAB patients, of 17-25 years age, discriminant variables are estradiol levels at 16 weeks of postpartum (with the largest contribution to discrimination) and prolactin levels in the first trimester of pregnancy; women aged from 26 to 35 years - estradiol levels at 16 weeks of postpartum (the most contributing to discrimination), testosterone in the third trimester of pregnancy, estradiol in the third trimester of pregnancy, prolactin in the third trimester of pregnancy, estradiol in the first trimester of pregnancy, and testosterone levels in the first trimester of pregnancy; women aged from 36 to 41 years - estradiol in the third trimester of pregnancy (has the largest contribution to discrimination) and estradiol in the 16 weeks of postpartum period. In general, the totality of all variables has a low level of discrimination between healthy and sick at OAB women between the ages of 17 and 25 (Wilkes Lambda statistics = 0.619; F = 131.4; p <0.001) and ages 26-35 (Wilks Lambda statistics = 0.493; F = 224.9; p <0.001), while among women between the ages of 36 and 41 - the average level of discrimination (Wilkes Lambda statistics = 0.371; F = 207.4; p <0.001). Thus, with the aid of discriminant analysis, reliable models of the possibility of OAB occurrence, based on anthropo-somatotypological or hormonal indices in women of different age groups, are constructed. In all age groups, the greatest contribution to discrimination between healthy and sick with OAB pregnant women, in most cases, make parameters of the width of distal epiphyses of long limb bones or the level of estradiol.
The objective: is proceeding in a genesial function for women after the different methods ofoperative treatment of pathology of cervix on the basis of study for them clinical—and-functionaland morphological features, and also improvement and introduction of algorithm of surgical andtreatment-and-prophylactic measures with the use of auxiliary genesial technologies. Materials and methods. An inspection and treatment was conducted 96 patients of genesial agewith infertility on a background passionately dystrophic and hyperplastic processes of endocervix.Basic group from 70 patients were made by women, which treatment of pathology of cervix whichwas studied was executed, by the methods of cryolysis or radio wave surgery (in particular by themethod of cryolysis – 30 patients, by the method of radio wave surgery – 40 patients); to the groupcomparisons entered 26 women which surgical operations – curettage and bougienage concerningpathology of cervix were executed. Results. Pathology of cervix is one of principal reasons of femaly infertility, thus in 45,8% – primaryand in 54,2% – secondary. Concomitant violations of menstrual function for these patients meet in89,6%, and chronic inflammatory processes of uterus and appendages – in 33,4% respectively. Forwomen with the secondary infertility after the different methods of operative treatment of pathologyof cervix the burdened genesial anamnesis takes place due to high-purity of artificial (73,7%)and involuntary abortions (44,7%), thus a level of inflammatory complications after differentendometrial interferences is 86,4%. The clinical results of auxiliary genesial technologies dependon the presence of concomitant dishormonal violations for women after the different methods ofoperative treatment of pathology of cervix: frequency of implantation – higher at 1,7 time, offensiveof pregnancy – in 2,0 times and births by a living fetus – at 2,1 time. Conclusions. The got results testify to efficiency of the offered algorithm of the differentiated goingnear the introduction of auxiliary genesial technologies for women with pathology of cervix takinginto account the presence of concomitant dishormonal violations. The presented information allowto recommend the improved algorithm for the wide use in cabinets and clinics of reprooduction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.