Background. Plausible predictions of future mortality and disability are useful aids in making decisions about priorities for medical research. Recent advances in medicine have led to the fact that some countries, such as Japan, have the highest life expectancy in the world. Osteoporotic fractures make a significant contribution to the development of morbidity and mortality in the aging population. Despite an active study of the mechanisms of the development of pelvic organ prolapse and disorders of bone mineral density separately, the general background of these diseases has previously been little studied. Aim. To study bone density according to densitometry data in peri- and postmenopausal women. Materials and methods. To carry out this study, 2 groups of women were formed. The first (experimental) group included 76 women admitted for routine surgical treatment of genital prolapse, the second group (control) 68 women without clinical manifestations of pelvic floor descent, who underwent a medical examination by a gynecologist on an outpatient basis. Results. Analysis of extragenital diseases in women included in the study showed a high prevalence in the experimental group of hypertension (p=0.028), osteochondrosis (p=0.001), scoliosis (p=0.028), hemorrhoids (p=0.013). Also, women in this group more often noted stretch marks on the skin (p=0.002) and were more often operated on for other diseases (p=0.043), which indicates the association of genital prolapse with undifferentiated connective tissue dysplasia and hypertension. The diagnosed severe osteoporosis (according to 1 or more densitometry indicators, where the T-score is less than -2.5) had a direct correlation with the duration of menopause. For a detailed analysis of the factors influencing severe osteoporosis in peri- and postmenopausal women, logistic regression analysis and ROC analysis were performed. The independent variable was the presence of severe osteoporosis, and the dependent variables were: stage according to POP-Q, the presence of hypertension, the presence of diabetes mellitus in history. Conclusion. This study confirms the presence of a comorbidity decrease in bone density according to densitometry and the presence of hypertension (p=0.028) and genital prolapse. According to the ROC analysis, an increase in the stage of genital prolapse according to the POP-Q classification increases the risk of developing severe osteoporosis.

Aim. To assessment of risk factors for erosion of the vaginal mucosa after the use of mesh prostheses to correct genital prolapse. Materials and methods. The authors of this article evaluated modifiable and unmodifiable risk factors for erosion of the vaginal mucosa after the use of a mesh implant to correct pelvic prolapse. The analysis of the relationship between the indicators of obstetric-gynecological, somatic anamnesis in women with an implant-associated complication (erosion of the vaginal mucosa, n=25) and in women with successful surgical treatment of genital prolapse using a mesh prosthesis (n=58) was carried out. The STATISTICA 10.0 and EViews 12.0 software packages were used for statistical processing of the obtained results. Results. Statistical analysis revealed the relationship of vaginal erosion after the use of a mesh prosthesis in the surgical correction of genital prolapse with the presence of factors such as: premenopausal age at the time of surgery (p=0.002; odds ratio OR 4.7, relative risk RR 2.79), vaginal delivery over the age of 35 years (p=0.003; OR 6.35, RR 2.78), episiotomy in the anamnesis (p0.0001; OR 11.2, RR 6.19), perineal ruptures III degrees in anamnesis (p0.0001; OR 19.7, RR 6.57), hypertension (p=0.049; OR 2.79, RR 2.19), type 2 diabetes mellitus (p=0.007; OR 4.99, RR 1.82). Conclusion. The formation of a high-risk group for erosion of the vaginal mucosa will allow us to develop a set of preventive measures and improve the outcomes of surgical treatment of genital prolapse.

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РезюмеКлиницистам часто приходится сталкиваться с привычным невынашиванием беременности вследствие истмикоцервикальной недостаточности. Несмотря на широкое применение акушерского пессария и наложения хирургического шва на шейку матки с целью коррекции цервикальной недостаточности во время беременности, наблюдается рост данной патологии, что свидетельствует о необходимости диагностики несостоятельности шейки матки и ее коррекции вне беременности. В доступной литературе отсутствуют сведения о «скрытых» дефектах шейки матки, приводящих к невынашиванию беременности в I-III триместрах. Представляем случай исходов беременности у пациентки с цервикальной недостаточностью из нашей клинической практики до и после хирургической коррекции шейки матки по методу Lash вне беременности. Представленный случай позволяет оценить роль хирургической коррекции истмико-цервикальной недостаточности вне беременности. Ключевые словаБеременность, истмико-цервикальная недостаточность, невынашивание беременности, преждевременные роды, дефекты шейки матки, операция Lash. Статья поступила: 24.05.2017 г.; в доработанном виде: 27.10.2017 г.; принята к печати: 30.11.2017 г. Конфликт интересовАвторы заявляют об отсутствии необходимости раскрытия финансовой поддержки или конфликта интересов в отношении данной публикации.Все авторы сделали эквивалентный вклад в подготовку публикации. Для цитированияЯщук А.Г., Нафтулович Р.А., Зайнуллина Р.М., Попова Е.М., Яковлева О.В. Роль хирургической коррекции истмико-цервикальной недостаточности вне беременности на примере случая из клинической практики. Акушерство, гинекология и репродукция. 2017; 11 (4): 72-75. SummaryClinicians often see a recurrent miscarriage caused by isthmic cervical incompetence. Today, obstetric pessaries and surgical sutures are widely used to correct cervical incompetence during pregnancy. The occurrence rate of this abnormality continues to rise, which emphasizes the need to diagnose and correct cervical incompetence prior to the upcoming pregnancy. In the available literature there is little information about the «hidden» defects of the cervix that can lead to miscarriage in the I-III trimesters of pregnancy. Here we present a case of two different pregnancy outcomes in a single patient with cervical incompetence before and after surgical correction of the cervix by the LASH procedure. The present case supports the importance of surgical correction of cervical incompetence in non-pregnant women. For citation Yashuk A.G., Naftulovich R.A., Zainullina R.M., Popova E.M., Yakovleva O.V. Surgical correction of isthmic cervical insufficiency in non-pregnant women: a clinical case. Obstetrics, gynecology and reproduction [Akusherstvo, ginekologiya i reproduktsiya]. 2017; 11 (4): 72-75 (in Russian).

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