Оbjectives: to assess the clinical and pathomorphological features of ovarian endometriosis and adenomyosis in women of reproductive age in order to determine possible causes of fertility disorders and ways to correct them.Materials and methods. 87 patients were examined and divided into 2 groups. The first group included 45 (51.7%) patients with adenomyosis with or without concomitant pathology. The second group included 42 (48.3%) women with ovarian endometriomas. The control group consisted of 30 healthy women of childbearing age who were screened for male infertility.Results. Clinical examination of the patients revealed a high frequency of gynecological (uterine fibroids, endometrial hyperplasia, infertility) and extragenital pathology. Obstetric and gynecological history was burdened by reproductive losses (involuntary and medical abortions, ectopic pregnancy), premature birth, preeclampsia, abnormal uterine and obstetric bleeding, and pelvic surgery. All patients underwent endoscopic treatment (laparoscopy, hysteroscopy). Morphological examination revealed features of the structure of endometrioid cysts, which explains the decrease in ovarian reserve, active adenomyosis, reactive hyperplasia and chronic endometritis, distortion of the uterine cavity by fibroids. This may play an important role in implantation and placentation.Conclusions. Features of morphogenesis of ovarian endometrioma, found by us cystic and glandular-cystic forms may form the basis of endometrial microperforation pathogenesis, development of adhesions of the pelvic organs (in every third woman), ectopic pregnancy, fibrotic adjacent endometrioid tissue and reduction of ovarian reserve. The peculiarities of the uterus histostructure in adenomyosis, frequent combination with uterine fibroids, endometrial hyperplasia, chronic endometritis, ovarian endometriosis, deep infiltrative endometriosis, old age, aggravated obstetric anamnesis and the history of obstetric disorders may be related.
Research objective: to assess the morpho-functional status of the fetoplacental complex and hemostasis system in pregnant women with congenital malformations in the fetus to prevent antenatal fetal death and determine further tactics of management and delivery.Materials and methods. The state of fetoplacental circulation was studied in 120 pregnant women with fetal congenital malformations in the third trimester by Doppler assessment of blood flow in the umbilical artery (UA) and middle cerebral artery (MCA) in the fetus, with resistance index, pulse index and maximum systolic and terminal diastolic velocities ratio. The functional activity of the hemostasis system was assessed by low-frequency piezoelectric thromboelastography. Morphological examination of the placenta was performed. The control group included 25 pregnant women without fetal congenital malformations.Results. In case of Doppler flow disturbances in UA and combination of these disturbances with hypercoagulability, the probability of antenatal fetal death if there were congenital malformations ranged from 2–3 to 7–14 days (r = 0.51 and r = 0.55, respectively). A high risk of antenatal fetal death occurred with blood flow disorders in the UA and MCA (r = 0.70), as well as with blood flow disorders in the UA in combination with hypercoagulation and inhibition of fibrinolysis (r = 0.78). The highest risk of antenatal death occurred in case of impaired blood flow in the MCA with hypercoagulation and inhibition of fibrinolysis (r = +0.99).An urgent delivery within a day is indicated when there are blood flow disorders in the UA or MCA, combined with hypercoagulation and inhibition of fibrinolysis. The respiratory distress syndrome is treated by administering a surfactant at gestational ages up to 34 weeks. Delivery within 2–3 days is indicated in case of impaired blood flow in the UA and hypercoagulation, this allows preventing of respiratory distress syndrome with corticosteroids if the gestational age is less than 34 weeks. Conclusions. In pregnant women with fetal congenital malformations, significant disturbances in blood flow in the UA (increased resistance index and maximum systolic and final diastolic velocities ratio) and decreased pulse index in the MCA were revealed, which indicates intrauterine hypoxia and centralization of blood flow. The functional activity of the hemostasis system was characterized by an increase in the blood coagulation potential in the vascular-platelet, a coagulation unit, which was accompanied by morphological and functional changes in the placenta in response to hypoxia.Implementation of the proposed algorithm for perinatal support of pregnant women with fetal congenital malformations and placental dysfunction helps to optimize pregnancy management and delivery, reduce perinatal morbidity and mortality.
Deep infiltrating endometriosis (DIE) in one of the most common reason for surgical treatment due to chronic pelvic pain and/or infertility. The goal of surgery is excision of all visible heterotopias and minimize risk of recurrence of disease and repeated surgeries or improve fertility outcomes. However there are no standardized technique of surgical procedure in DIE. During last 5 year (2010)(2011)(2012)(2013)(2014) we performed 195 laparoscopic operations in patients with DIE with complains of resistant to medical treatment chronic pelvic pain and/or infertility. Our standardized procedure in laparoscopic surgical treatment of DIE include several steps: (1) laparoscopic revision of pelvic and abdominal cavity; (2) adhesiolysis and "second-look" laparoscopic revision, verification of DIE, its localization and stage, ureteres vizualization; (3) surgical treatment of endometriomas (using technique of enucleation and partially ablation); (4) ovarian fixation; (5) lateral peritoneal resection (total or partial); (6) central peritoneal dissection (Duglas dissection with or without vaginal opening and resection of vaginal fornix wall); ( 7) shaving or resection of endometriosis nodules in rectum, bladder, sigmoid colon, ureter, appendectomy if needed; (8) evacuation of macropreparation, inspection of validity of pelvic organs (bladder, rectum, colon); (9) haemostasis and (10) drainage. In our clinic we observed all favorable results of the operations. Rectal shaving was performed in 35 cases, bowel resection in 17, bladder resectionin 10, ureterolysis -in 6, appendectomy -in 11 cases, posterior vaginal fornix resection -in 40 cases. Recurrence of DIE symptoms we detected in 15 patients who did not received or withdrawn postoperative treatment or did not conceive at 12-18 months of observation.Conclusion: standardization of laparoscopic surgical procedure in deep infiltrating endometriosis improves short and long-term results of treatment.
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.