REPRODUCTIVE ENDOCRINOLOGY

Reproductive health and violations of the human right to body integrity

M.M. Blikhar — 2024-12-31

Background. The article analyses the current practice of violating the right to bodily integrity, focuses on the international and European regulation of the problem, the policies of the WHO and other international institutions, and indicates the policy of discrimination on the basis of age and gender inequality in the reproductive sphere.
Objective of the review: to study the medical and non-medical practice of implementing and protecting the human right to bodily integrity through the study of the problem of legal protection against female genital mutilation and male circumcision.
Materials and methods. The authors have chosen an intercomplementary methodological approach, which allows a social phenomenon of a medical nature to be considered through the prism of a somatic problem, medical harm, doctor’s orders, as well as from other social points of view in combination with legal, social, cultural and moral factors. To systematize legal regulation, the grouping method is distinguished, and the method of axiological idealism is used to understand the humanistic direction of legal policy in the field of reproductive and sexual human rights, to determine the value determinants of legal reality in modern society and to search for optimal possibilities of the legal system in this field.
Analysis of literary data. The article examines the legal ideology in the field of protection of the right to physicality in the reproductive sphere, conducts a comprehensive analysis of the practice of female genital mutilation and presents a representative analysis of male circumcision as a controversial method of medical intervention.
Conclusions. Based on the analysis of regulatory legal acts of the international and European level, individual national practices, and positions of medical associations, we note that at the current stage of development of legal ideology in the field of medical law, the WHO approach does not meet modern legal requirements for combating torture, the legal interpretation of the human right to autonomy in the field of treatment, the value of childhood and non-discrimination on the basis of age.

The evaluation of the clinical efficacy of Prodexyn vaginal suppositories in the treatment of recurrent bacterial vaginosis

D.G. Konkov — 2024-12-31

Background. Bacterial vaginosis (BV) is the most common vaginal infection among women of reproductive age and is associated with an increased risk of sexually transmitted infections and pregnancy complications. First-line antimicrobial treatments are often accompanied by recurrences due to bacterial resistance, biofilm formation, and other factors.
Objective of the study: to evaluate the clinical efficacy, impact on vaginal microbiota, and safety profile of a combination product containing octenidine dihydrochloride and dexpanthenol
(Prodexyn) in the treatment of recurrent BV.
Materials and methods. A prospective study conducted in 2024 and included 192 patients aged 18–36 years with recurrent BV. The participants were divided into two groups: group I – 74 women treated with suppositories based on octenidine dihydrochloride and dexpanthenol, group II – 118 women treated with alternative vaginal antimicrobial drugs (subgroups receiving ternidazole, metronidazole, tinidazole). Efficacy was assessed by symptom resolution, analysis of vaginal microbiota using Hay-Ison criteria, and quality of life using the SF-36 questionnaire.
Results. Group I, treated with octenidine dihydrochloride and dexpanthenol (Prodexyn), demonstrated a higher symptom resolution rate (91.2%) compared to group II (76.3%, p < 0.05). Follow-up PCR analyses confirmed the restoration of normal vaginal biocenosis in 87.5% of patients in group I compared to women in group II: in the ternidazole subgroup, the hazard ratio (HR) was 1.37, 95% confidence interval (CI) was 1.05–1.78 (p = 0.019), in the metronidazole subgroup HR = 1.63, 95% CI = 1.14–2.33 (p = 0.007), in the tinidazole subgroup HR = 1.62, 95% CI = 1.12–2.35 (p = 0.009). The safety profile was favorable, with minimal adverse effects reported.
Conclusions. The combination product containing octenidine dihydrochloride and dexpanthenol (Prodexyn) demonstrates high clinical efficacy, promotes the restoration of normal vaginal microbiota, and has a favorable safety profile. These findings support its use as an effective approach in the treatment of recurrent bacterial vaginosis.

Persistence of antiphospholipid antibodies, features of pregnancy management

L.V. Kalugina — 2024-12-31

Since antiphospholipid syndrome (APS) is a rare condition, it is often overlooked by clinicians. At the same time, APS is one of the causes of serious obstetric complications, including early pregnancy loss and preterm birth.
This clinical case describes the course of pregnancy by trimesters, labor, and postpartum period in a woman with systemic lupus erythematosus associated with APS, highlighting the management of pregnancy, labor, and postpartum care.
A 31-year-old woman was hospitalized at 4 weeks of pregnancy with a threatened miscarriage. This was her third pregnancy. The first and second pregnancies ended in early miscarriage. She has a family history of thrombosis: her father died from pulmonary artery thrombembolism at 49 years old, paternal relatives had thrombosis, and her maternal grandfather died from a stroke. The patient’s personal medical history is not complicated by thrombosis.
After excluding inherited thrombophilia, clinical and laboratory tests revealed the antiphospholipid antibodies (anti-β2-glycoprotein 1, anticardiolipin, lupus anticoagulant) and an elevated titer of antinuclear antibodies (ENA screening, anti-double-stranded DNA antibodies).
The patient was given combined antithrombotic therapy with aspirin and enoxaparin, combined with hydroxychloroquine. At 37 weeks, woman delivered a baby per vias naturalis without any complications during labor or the postpartum period.
Conclusions. Considering that APS is a common cause of pregnancy loss, this pathology requires proper attention from clinicians. The diagnosis and management of this thrombophilia are further complicated by the lack of an accepted standard for the care of such patients in Ukraine. Additionally, the existing APS criteria do not cover all patients who face difficulties in carrying a pregnancy due to the presence of antiphospholipid antibodies. This creates difficulties in recognizing these women, leaving them without appropriate treatment.

Incidence of vaginal birth after cesarean section in Al-Zahraa Maternity and Pediatrics Teaching Hospital

S.R.M. Hussein — 2024-12-31

Background. As we approach the centennial of the maxim «Once a cesarean, always a cesarean,» the debate over the safety and viability of vaginal birth after cesarean (VBAC) continues. With cesarean section (CS) rates climbing globally, there is a revitalized interest in VBAC as a means to reduce maternal and neonatal morbidities associated with repeated cesarean operations. Objective of the study: to evaluate the incidence of VBAC at Al-Zahraa Maternity and Pediatrics Teaching Hospital (Iraq) and identify risk factors those influence the success or failure in trials of labor after cesarean section (TOLAC).
Materials and methods. This observational study conducted at Al-Zahraa Maternity and Pediatrics Teaching Hospital from October 2023 to April 2024 involved women who had undergone one previous CS. During this time, comprehensive demographic and medical data were collected from participants to assess the outcomes of TOLAC in this population. Obtained data were analyzed using various statistical tools to identify trends and outcomes associated with TOLAC attempts.
Results. Among 418 study participants, 268 (64.1%) attempted TOLAC, with a VBAC success rate of 39.20% (from the total study sample representing 61.2% of TOLAC cases). Statistical analysis revealed that older women, those with a longer interval since their last CS, and those with a history of previous vaginal delivery or previous VBAC demonstrated higher success rates. Common impediments to successful VBAC included labor progression issues and fetal distress.
Conclusions. VBAC is viable and reduces risks linked to repeated CS, with a 39.20% success rate among those attempting TOLAC. Success factors include longer intervals since the last CS and no major comorbidities. Common barriers to successful VBAC include labor progression issues and fetal distress.

Examining the level of awareness and attitudes towards gender-neutral HPV vaccination of the parents of children aged 9-18 years and adults: a qualitative research

T.F. Tatarchuk — 2024-12-31

Objective of the study: to assess the awareness of human papilloma virus (HPV) infection and HPV-related diseases among the parents of children aged 9-18 years and adults, to determine the level of readiness to be vaccinated and to vaccinate their children against HPV; to identify existing barriers to this, and to explore how war affects perceptions of vaccination.
Materials and methods. A qualitative exploratory research was conducted. The data were collected through focus group discussions. Parents of children aged 9-18 and adults (men aged 18-26, women aged 18-45) took part in the research.
Results. Most respondents were aware of HPV infection and HPV-related diseases, adult women and parents of children aged 9-18 years were more aware than adult men. However, the level of knowledge was limited and generally insufficient.
The majority of respondents recognize HPV as a serious problem that leads to cancer, but the opinion that HPV is not a big problem was quite often expressed among adults and parents. Only a part of the interviewed women was informed about HPV by gynecologists, while men did not receive any data on this issue from health workers at all. The research revealed an extremely low level of awareness among adults and parents of children about the availability of HPV vaccination and its features. Adults and parents explained their ignorance in this matter by the fact that doctors mostly do not tell patients about this vaccine and do not recommend vaccination against HPV.
The vast majority of parents did not want to vaccinate their children against HPV due to the lack of information about its effectiveness and safety. But they were more likely to reconsider their decision after receiving more information about the vaccine. Less often, parents reported a potential willingness to vaccinate their child against HPV. Common barriers to vaccination are primarily related to doubts about vaccine safety, mistrust of the medical system and vaccine manufacturers, and lack of knowledge about how vaccines work, what they are made of, and how they affect the body. However, parents and adults overwhelmingly believe that their attitudes toward HPV vaccination will improve if free vaccination is introduced.
In the regions closest to hostilities (East, South) the situation with vaccination during the war worsened to a greater extent than in other regions. Most adults did not change their attitudes about vaccination during the war, and for a minority of them vaccination became less important. A third of parents reported that the relevance and importance of vaccination for them decreased, for a third it remained unchanged, and for another third it increased.
Conclusions. Widespread and insufficient awareness of HPV infection and HPV-related diseases among parents of children aged 9-18 years and adults. Adults and parents base their assumptions that HPV is not a serious problem on the lack of objective information from doctors, as well as in the mass media or social networks.
Most adults and parents of children aged 9-18 are not currently ready to vaccinate themselves or their children against HPV.
The war affected both access to vaccination and the perception of the relevance of vaccination, depending on the distance of the region of residence from the front line. Vaccination access decreased in regions near active hostilities, in small cities and rural areas.
Efforts are needed to increase awareness of HPV vaccination, including the importance of informing parents and adults about the HPV vaccine, timely vaccination, and regular screenings.

Premature ovarian insufficiency (POI): guideline of European society of human reproduction and embryology – 2024

Editor Editor — 2024-12-31

This updated guideline offers best practice recommendations for the care of women with both primary and secondary premature ovarian insufficiency (POI). POI is a clinical condition defined by the loss of ovarian function indicated by irregular menstrual cycles together with biochemical confirmation of ovarian insufficiency before the age of 40.
Women with POI have unique needs. They may not only suffer from symptoms associated with estrogen deficiency, but can also experience other issues, with a significant impact on their quality of life and later health outcomes. POI can have significant effects on fertility, bone health, cardiovascular health, sexual function, psychological health and neurological function.
The impact of POI on these different domains and the treatment options for each along with monitoring needs where relevant are all discussed in the guideline.
In addition to hormone therapy the guideline also covers non-hormonal and complementary treatments, lifestyle interventions and puberty induction.
This guideline is an updated version and replaces the ESHRE Guideline on the management of women with POI (2016).

Modern possibilities of organ-sparing treatment of uterine fibroid

N.V. Kosei — 2024-12-31

Uterine fibroid is a benign tumor originating from myometrial cells, which due to the various exogenous and endogenous factors has the potential for rapid multi-localized growth, progression of clinical symptoms, and impact on the physical and mental health of women, leading to deterioration in their quality of life. It often impedes reproductive function, causing infertility and pregnancy loss.
Despite the availability and variety of conservative treatment methods, hysterectomy remains the treatment of choice for large uterine fibroids, which permanently deprives women of the possibility of childbearing.
This article presents a clinical case of successful organ-preserving treatment of a woman with a giant uterine fibroid.
A combined three-stage treatment was applied. Stage I – inducing medical menopause by administering a gonadotropin-releasing hormone agonist (goserelin 10.8 mg subcutaneously); stage II – uterine artery embolization during medical menopause; stage III – laparotomic conservative myomectomy with simultaneous abdominoplasty. One month after administering goserelin 10.8 mg, during medical menopause, the uterine volume reduced from 3257 to 2798 cm³ (a 14% decrease), and the fibroid volume from 1362 to 1065 cm³ (a 21.8% decrease). After uterine artery embolization, the uterine and fibroid volumes continued to decrease to 2424 cm³ (a 25% reduction) and 876 cm³ (a 35% reduction), respectively.
One month after uterine artery embolization, laparotomic myomectomy with abdominoplasty was performed. Following the surgery, the uterine volume decreased to 782 cm³ (a 76% reduction from the initial volume), and two months post-surgery, the uterus decreased to 58 cm³, reflecting a 98.2% reduction from the initial volume. During the postoperative rehabilitation period, to prevent abnormal uterine bleeding, recurrence of uterine fibroids, and to ensure effective contraception, the levonorgestrel-releasing intrauterine system was placed.
Conclusions. Organ-preserving conservative methods offer a safe and accessible treatment option for women with uterine fibroids who have not yet fulfilled their reproductive plans. The described combination of methods makes it possible to preserve the uterus and realize the reproductive function.