The objective: to assess the hormonal homeostasis and ovarian reserve in women of reproductive age after urgent gynecological operations due to the symptom complex of “acute abdomen”.Materials and methods. The studied cohort included 90 women 19–40 years old. The main group included 60 women after emergency surgery for ectopic pregnancy (23 patients), ovarian apoplexy (18 patients), complicated ovarian tumor (19 patients), and at the rehabilitation stage they refused to receive the proposed hormonal therapy; control group – 30 women of reproductive age without somatic and gynecological pathology. A complex study of the reproductive system was carried out: ultrasound (transvaginal) examination of the pelvic organs with the calculation of the number of antral follicles, determination of the levels of estradiol, follicle-stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone, free testosterone index, anti-Müllerian hormone (AMH), and 25(OH)D level in blood serum. The examinations were carried out 3 and 6 months after surgery. Statistical processing of the results was performed using the Microsoft Excel 7.0 and “Statistica 6.0” standard programs.Results. The average age of the patients was 26.4±3.5 years. Before the current surgical intervention, 21 % of patients in the main group were diagnosed premenstrual syndrome, dysmenorrhea, abnormal uterine bleeding, pelvic inflammatory disease, and ovarian tumors. In the postoperative period, the most often menstrual cycle (MC) disorder was an increase in its duration (56.7 % of patients). 63.3 % of patients after urgent gynecological operations had normogonadotropic dysfunction of the ovaries, which is characterized by anovulation, insufficiency of the luteal phase and the ovarian blood flow disorders. The restoration of normal two phases of MC after 6 months was found in 34.2 % of the patients who did not have the hormonal correction. In 18.3 % of patients with ovulatory MC, the insufficiency of the luteal phase is characterized by a decrease of progesterone concentration in the blood serum on the 18–20th day of MC and a disperancy in the endometrium structure. Transient hyperprolactinemia was found in 15.0 % of patients. The surgical injury of the ovary in some patients leads to a decrease in the ovarian reserve. AMH indicators in 61.1 % of patients with the effect of surgical energies on the affected ovary were significantly reduced (0.67±0.4 ng/ml) compared to controls (2.1±0.3 ng/ml; p<0.01) until the 6th month after the operation. Similar dynamics were absent in patients operated on for a ruptured tubal pregnancy. The recovery of the two phases of MC during a six-month observation was established in only 47.4 % of patients with torsion of an ovarian tumor.As a result of the lack of complex rehabilitation therapy, the repeated operations due to the ruptured tubal pregnancy happened in 13.5 % of patients, recurrence of apoplexy and/or ovarian tumors – in 25.8 % of women.Conclusions. Acute gynecological pathology, which requires immediate surgery, occurs in 21 % of patients with the disorders of the reproductive system. In 63.3 % of women after urgent gynecological operations, normogonadotropic dysfunction of the ovaries was observed, which was characterized by anovulation, insufficiency of the luteal phase and ovarian blood flow disorders. The absence of rehabilitation complex therapy causes recurrence of acute gynecological pathology in 13.5–25.8 % of operated women.
The objective: to analyze the long-term reproductive effects in women who after emergency gynecological surgery. Materials and methods. A retrospective analysis of the reproductive outcomes after urgent surgical operations (after 2 years) was performed in 300 gynecological patients aged 19 to 42 years. Results. A retrospective analysis showed that 69,3% of women who underwent emergency gynecological surgery had a history of gynecological diseases, but 30,7% of patients were not observed by a gynecologist. Before surgery, menstrual disorders were diagnosed in 42,0 % of patients, pathology of the lower genital tract – 19,7%, inflammatory diseases of the pelvic organs – 7,7 %. 8,2 % of women had gynecological operations before, 13,9 % – reproductive losses, and 11,1 % persons were examined and treated for infertility. The predominant method of surgical intervention in this cohort of patients was open laparotomy (59,7 %), laparoscopic intervention was performed in 40,3 % of cases. The most common indications for surgery were damage tubal pregnancy, ovarian apoplexy, complicated ovarian formation. Morphological verification of intraoperative findings showed that most often indications for operations were serous ovarian tumors (38,7 %), follicular tumors (22,4 %), complicated endometrioid and dermoid cysts (22,4 %), corpus luteum cysts with hemorrhage (9,2 %), paraovarian cysts (7,1 %). Rehabilitation postoperative therapy was performed for a limited number of patients (31,7 %), which could not but affect the state of reproductive health of women – an increase in the incidence of pain (42,0 %; p<0,05) and chronic pelvic pain (42,3%) in the absence of such before surgery, as well as infertility (from 11,1 % to 22,5 %; p<0,05). Conclusions. The lack of pathogenetically intra- and postoperative measures after urgent surgical interventions leads to increase the frequency of reproductive dysfunction, which requires the development and improvement of differentiated rehabilitation therapy and secondary prevention according to the nosology that caused urgent surgical operatrion.
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