The aim: To determine the association between the Glu298Asp (G894T) polymorphisms of the eNOS gene with metabolic disorders in excessive gestational weight gain (GWG) pregnancy. Materials and methods: 97 pregnant women in 9-12, and 37-39 weeks of gestation were examined. The recommended GWG was diagnosed in 33 (34.0 %), insufficient in 19 (19.6 %), and excessive in 45 (46.4 %) patients. Genetic variants of eNOS were analyzed by real-time polymerase chain reaction, lipid profile, and carbohydrate status were performed. The results were statistically analyzed using Statistica 6.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. Results: GWG in the group of patients with gene eNOS TT polymorphism was significantly higher (1.5-fold) compared to pregnant with GG – genotype (р<0.05). Pregnant, inherited the TT allele of the eNOS gene, associated with higher levels of hypertriglyceridemia, hypercholesterolemia, of lipoprotein low density, glycemia, hyperinsulinemia, and higher HOMA–IR compared to carriers of GG and GT alleles (р<0.05) in the third trimester, which is especially manifested in excessive GWG. Conclusions: Decreased activity of the eNOS gene in the presence of pathological alleles is the initiator of impaired lipid and carbohydrate metabolisms and, as a consequence, excessive GWG. A high risk of excessive GWG was found in pregnant women with TT polymorphism Glu298Asp (G894T) (OR=4.52; 95%CI: 1.18-17.32; р<0.05) (frequency distribution of 73.7 %). Endothelial dysfunction is a pathogenetic link of excessive body weigh in pregnancy.
According to the WHO, every second woman has a problem with excess weight, while about 23% of women indicate a pathological body mass index, and excess weight (the so-called “pre-obesity”) is noted in 25% of women. The aim of the research was to evaluate the structural and functional parameters of the endometrium and ovarian tissue and to optimize the diagnostic algorithm and monitoring of the endometrium in women with obesity and impaired reproductive function. Materials and methods. 110 patients of reproductive age with impaired reproductive health underwent a comprehensive clinical and laboratory examination within the framework of this research. The main group included 64 patients with overweight and class 1 obesity, and the comparison group consisted of 46 women with a normal body mass index. The proposed diagnostic algorithm included a sonographic study of the structural parameters of the endometrium and ovaries, as well as an assessment of the features of the blood supply to the pelvic organs and statistical processing of the results. Research results and their discussion. The presented results allow us to note a significant percentage of comorbidity of somatic and gynecological pathology in overweight and obese patients. Pregnancy is accompanied by a higher percentage of early reproductive losses (14.0%), preterm birth (10.9%), preeclampsia (42.2%), placental dysfunction (46.4%) and low birth weight (17.2%). The main clinical forms of endometrial pathology in the main group were polyposis (32.8%), endometrial hyperplasia (23.4%) and dyschronosis of morphological changes of the endometrium (28.1%). The combination of endometrial hyperplasia with/or uterine leiomyoma, adenomyosis, benign ovarian tumors and retention formations was noted in 53.6% of observations in both groups; in 46.4% of women the isolated form was noted. The morphological characteristics of endometrial polyposis allowed us to note the dominance of glandular-fibrous polyps (45.2%) and in the case of a combination with myoma or ovarian retention cysts - glandular forms (32.3%). The most frequent sonographic marker of dysfunction of the endometrial potential (inconsistency of the ultrasound image of the endometrium with the phase of the menstrual cycle) was revealed in more than half of the cases (62.5%). Sonographic evaluation of the structural parameters of the endometrium and ovarian tissue showed an increase in the anterior-posterior size of the uterus and the thickness of the endometrium by 2.8 times, the volume of the ovary – by 2.0 times. It should be noted that the patients of the main group had a greater proportion of cysts and endometriomas. According to dopplerometry data, significantly lower parameters of the vascular resistance index were confirmed in the ovarian arteries and in the arteries of the stroma; in almost half of the observations, varicose veins of the parametrium were noted. Conclusions. Changes in steroidogenesis against the background of lipid metabolism disorders are accompanied by an increase in the volume of the endometrium and ovarian tissue, growing proportion of cystic formations in the appendages, an increase in the hemodynamic imbalance of blood flow in pelvic organs, which requires optimization of the monitoring program at the stage of preconception preparation and elimination of risk factors for placental dysfunction.
The problem of optimizing the management of women with chronic pelvic pain syndrome (CPP) is actual due to the high frequency of this pathology, unclear many aspects of the pathogenesis, negative impact on quality of life, as well as difficulties in diagnosing the leading factor and effective treatment. Aim. Optimization of the diagnostic algorithm of managing women with chronic pelvic pain (CPP) and pelvic congestion syndrome (PCS). Materials and methods. A prospective study was carried out at Ivano-Frankivsk City Clinical Perinatal Center, Ukraine. 112 patients with CPP and 53 women without pain and symptoms of gynecological pathology as a control group have been included. Exclusion criteria are as follows: pelvic tumors, genital endometriosis, acute inflammatory diseases of the pelvic organs and specific inflammatory diseases of the pelvic organs. Clinical and laboratory examination, ultrasound and Doppler ultrasound of the main pelvic veins: uterine, ovarian, internal iliac and arcuate veins, Valsalva᾽s test have been performed, which helps to detect venous diameter and reflux, for all patients. Short Pain Assessment Scale, the McGill Pain Questionnaire (SF-MPQ), and the Visual Analog Scale (VAS) were used for pain assessment. The tests were conducted in the form of interviews and questionnaires. The results were statistically analyzed using Statistica 7.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. The differences between the selections were considered statistically reliable at p<0.05 (Tukey’s test). Results. Pain duration, examination and treatment of chronic pelvic inflammatory disease were in average 3.8±2.4 years at the time of the first visit. The study has proved that the risk factors for CPP and PCS are high parity (3 or more deliveries), prolonged work in prolong standing or sitting position, interrupted intercourse. 69.6 % of women noted a deterioration in general activity, 43.8 % impaired gait, 79.5 % had difficulties in performing daily work and professional activities, 71.4 % of patients had increased pain in the second phase of the menstrual cycle, and in 83.9 % after prolonged standing. Half of women have sleep disorders, 80.4 % – emotional lability, a third group have periods of depression, and 71.4 % – a negative impact on sexual life according to the results of a Short Pain Assessment Scale. Based on SF-MPQ, it was found that the sensory characteristics of pain were different. 69 (61.6 %) women had convulsive, aching and moderate pain, 16.1 % – severe and burning pain, 8.9% of patients suffered on prickly pain. Evaluation of the emotional scale showed that PCS caused exhaustion in more than half of women, nausea in a third of cases, while 5 (4.5 %) patients reported severe pain that led to despair. Pain intensity due to VAS was 4.44±1.15. Ultrasound revealed an increased diameters of the main pelvic venous collectors, decreased peak systolic bleeding rate in women with CPP and PCS compared with the results of women of the control group (p<0,05). Valsalva᾽s test showed that the presence of reno-ovarian reflux was found in 15.2 % patients of the main group, including bilateral in 23.53 %, isolated left – in 64.7 %. Conclusions. Women with CPP, especially in the presence of risk factors and the specific clinical picture of pelvic congestion should undergo ultrasound and Doppler ultrasound examination of the uterine, ovarian, internal iliac and arcuate veins. Pain assessment scales have the prognostic value of routine pain assessment to analyze the treatment results.
The objective: to evaluate the psycho-emotional state, lifestyle changes, clinical symptoms and treatment measures in women with genital endometriosis after COVID-19 disease. Materials and methods. The study involved 120 women with genital endometriosis. The main group included 62 women with genital endometriosis after COVID-19 disease, the control group consisted of 58 patients with genital endometriosis, no symptoms of COVID-19 and negative PCR test at the time of examination. Impact of Covid-19 on lifestyle changes, symptoms and treatment of endometriosis was measured with a questionnaire. Pain assessment was performed by a visually analog scale (VAS). The psychoemotional state of women was analyzed by a Peritraumatic Distress Inventory. Statistical analyses based on Microsoft Excel statistical analysis package and “Statistica 7.0”(StatSoft Inc., USA). Results. The scientific work demonstrated high level of peritraumatic stress, lifestyle changes (decreased physical activity, increased sleepiness), worsening of clinical manifestations (increased fatigue, severe menstrual bleeding, dysmenorrhea, increased pelvic pain) and changes in treatment measures (increased analgesics and non-steroidal anti-inflammatory drugs using, discontinuation of hormonal therapy) in women with genital endometriosis after COVID-19 disease compared with group of women with genital endometriosis and without symptoms of coronavirus infection. Conclusions. The obtained results are necessary to optimize the management of patients with genital endometriosis and COVID-19.
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