Comorbid pathology of the mammary glands and endometriosis: risk factors and prognosis.

OBJECTIVE: Aim: based on a retrospective analysis, the relationship between external genital endometriosis and comorbid breast pathology was established and risk factors were identified, their comparison and the formation of a prognostic risk criterion were determined. PATIENTS AND METHODS: Materials and Methods: to address the objectives of the study, a retrospective analysis of 470 cases of patients treated for external genital endometriosis after surgical treatment and comorbid breast pathology was conducted. The control group included 30 healthy non-pregnant women. Statistical processing was performed on a personal computer using the statistical software package Statistica 10. RESULTS: Results: As a result of the analysis, the age of the patients ranged from 23 to 40 years. The average age of patients in the study group was (32.2}1.18) years, and in the control group (31.1}1.35) (p>0.05). The groups were homogeneous in terms of age (p>0.05), marital status (p>0.05) and level of education (p>0.05). Close relatives in 208 (44.25}2.18) % (OR=8.86; 95 % CI: (0.68-10.53); p<0.002) cases suffered from benign (hormone-dependent) tumours and tumour-like diseases of the uterus and appendages in isolation or in various combinations (fibroids, adenomyosis, endometrial hyperplasia). It was also found that 102 (21.70}1.67) % of patients had endometriosis, which may indicate a genetic predisposition to this disease. In the closest relatives of EM patients: in 118 (25.10}2.01) % of the examined parents, breast problems were noted, in 66 (14.04}1.12) % - diabetes mellitus, and in 98 (20.85}1.22) % thyroid diseases were detected, which in total amounted to (60.00}2.23) % (OR=9.12; 95 % CI: (0.58-11.54); p<0.002). Early menarche almost tripled the risk of EM (OR=2.72; 95% CI: (1.02-5.11); p<0.002), and menstrual irregularities doubled it (OR=2.04; 95% CI: (1.09-3.14); p<0.05), higher education, urban residents - 2.2 times higher (OR= 2.27; 95 % CI: (1.11-3.63); p<0.05), diseases of the gastrointestinal tract and hepatobiliary complex - 5.2 times higher (OR=5.27; 95 % CI: (1.89-12.03); p<0.05), frequently recurrent inflammatory diseases of the appendages - 3 times higher (OR=3.14; 95 % CI: (0.91-5.14); p<0.05), dysmetabolic manifestations (thyroid dysfunction) - 5 times higher (OR=5.11; 95 % CI: (1.61-9.503); p<0.002). CONCLUSION: Conclusions: Thus, in endometriosis and dyshormonal diseases of the mammary glands, menstrual and generative function disorders, along with clinical symptoms of pelvic pain, dysmenorrhoea, autonomic nervous system disorders and sexual dysfunction, are significant components of this problem, initiating comorbidity processes in target organs in the setting of hormonal maladaptation. Therefore, these comorbidities become a trigger for the activation of systemic hormonal imbalance and become an urgent interdisciplinary problem that requires further study.

FETAL INFECTIONS OPTIMIZATION OF PREGNANCY AND DELIVERY INTRODUCTION.

OBJECTIVE: The aim: Improving perinatal outcomes in pregnant women at high risk of intrauterine infection by developing diagnostic criteria and algorithms for managing pregnancy and childbirth. PATIENTS AND METHODS: Materials and methods: The study of pregnancy and childbirth was conducted in 72 patients at high risk of IUI, which formed the main group. The control group consisted of 64 patients with a low infectious risk of IUI. Culture, bacterioscopic and biochemical methods were used to identify microorganisms. Peculiarities of infection in the examined women were investigated by determining the concentration of Ig M and IgG in the blood serum and performed polymerase chain reaction for measles virus, cytomegalovirus, parvovirus B19. Serum for the presence of specific immune globulins to these pathogens was examined by ELISA. Comprehensive ultrasound examination in B-mode was performed to determine the feto metry of the fetus and assess its development with the determination of the estimated mass, location, size and structure of the placenta, the amount of amniotic fluid. To determine the condition of the fetus, a Doppler study of blood flow in the uterine arteries, umbilical artery, middle cerebral artery of the fetus and venous duct. RESULTS: Results: Analyzing the course of this pregnancy in women of the studied groups threatened miscarriage and the threat of premature birth occurred in 24 (33.3%) cases, with signs of isthmic-cervical insufficiency were diagnosed in 13 (18.1%) patients. In the control group of patients, the threat of abortion was diagnosed in 15 (23.4%) patients. According to ultrasound examination, patients in the main group in 12 (16.7%) cases were diagnosed with fetal growth retardation, in 25 (34.7%) patients at high risk of IUI there were changes in the placenta, namely, hyper echogenic inclusions in the placenta occurred in 7 (9.7%) cases, dilation of the intervillous space in 8 (11.1%) cases, placental hyperplasia in 7 (9.7%) cases, polyhydramnios was diagnosed in only 5 (6), 9%) cases, with 1 (1.4%) acute polyhydramnios in patients with signs of acute respiratory viral infection during pregnancy. CONCLUSION: Conclusions: Women at high risk for IUI require close monitoring of the fetus due to the increased frequency of hemodynamic changes in uteroplacental-fetal circulation, including fetal-placental - 22.2% and the occurrence of intrauterine growth retardation. Women with suspected cytomegalovirus infection require determination of seroconversion; in case of immunologically confirmed infection, it is desirable to recognize PCR for cytomegalovirus in the amniotic fluid in order to determine further management and monitoring of this pregnancy.