4 курс / Акушерство и гинекология / ОПТИМИЗАЦИЯ_ХИРУРГИЧЕСКОГО_МЕТОДА_ЛЕЧЕНИЯ_МИОМЫ_МАТКИ_В_ПРЕДГРАВИДАРНОМ

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%

Figure 2.8 – Incidence of different grades of preeclampsia in the study vs. control group

Gestational diabetes mellitus (GDM) incidence assessment (Table 2.6) showed that in the study group the frequency of GDM was 41.6%, and in the control group – 26.6%. Statistical analysis showed a significant difference between these groups (p<0.05). Attention is drawn to the high frequency of GDM in women of both groups compared with the general population (7-10%) [19], which makes us pay attention to the role of uterine fibroids in the development of GDM.

Table 2.6 – GDM incidence rate in the study vs, control group

In order to determine the incidence of chronic placental insufficiency (CPI), this indicator was studied in both groups of patients. The results of the analysis are presented in Table 2.7. As can be seen from the table data, significant differences between the groups are not detected.

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compensatory-adaptive reactions were noted in both groups. In rare cases, inflammatory changes in placentas were noted in women in the comparison group. This indicates that there is no effect of fibroids on the morpho-functional characteristics of the placenta of both groups.

Specific results reported in Chapter 2 are published in the following paper: Shapovalova A.I. Myomectomy or conservative management of uterine myoma: impact on reproductive potential / A.I. Shapovalova, E.N. Popov, E.V. Mozgovaya // Journal of Obstetrics and Women Diseases. – 2021. – Vol.70, N 5. – P. 95-104 [70].

2.3 Scope of indications for C-section surgery

In the study group of women examined, indications for CS were analyzed. The structure of indications for operative delivery is presented in Table 2.9.

Table 2.9 – CS indications

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of women who have undergone laparoscopic myomectomy and women without treatment of uterine fibroids is sufficient for conception, gestation and birth of a child with timely and qualified assistance from obstetricians and gynecologists.

2.5 Mathematical model for predicting the viability during pregnancy

and childbirth of a scar on the uterus after laparoscopic myomectomy

The role of anamnestic data as predictors of the viability/insolvency of a uterine scar after laparoscopic myomectomy during pregnancy and childbirth was evaluated.

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CHAPTER 3 AGE-RELATED DYNAMICS OF SIGNALLING MOLECULES EXPRESSION IN THE UTERINE POST-SURGERY SCAR AREA

3.1 p53 apoptosis and cellular aging factor expression

in post-surgery uterine scar area in women of different ages

Figure 3.1 shows the expression of the cellular aging marker p53 in the area

of the postoperative scar in both age groups after conservative myomectomy when studied by confocal laser microscopy. The conducted studies allowed us to establish that the process of apaptosis and cellular aging is more pronounced in group 2 than in group 1.

А B Figure 3.1 – Expression of the p53 marker in age group.

A – Group 1, B – Group 2. Cell nuclei were stained with DAPI – blue fluorescence, p53 expression – red fluorescence (Alexa 647), ×200

The results of statistical processing of the studied marker in terms of the area of expression in samples from the zone of postoperative scar on the uterus after conservative myomectomy revealed a significant 1.6-fold increase in this indicator in group 2 when compared with group 1 (Figure 3.2). The results obtained indicate that with age, the processes of cellular aging and apoptosis in uterine tissue,

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A.I. Shapovalova, A.A. Tsypurdeeva, M.I. Kakhiani, E.N. Popov, V.O. Polyakova // Molekulyarnaya meditsina. – 2019. – Vol.17, N 9. – P. 60–63 [14].

Shapovalova, A.I. Age-related changes in expression levels of markers of close contacts in women after myomectomy / A.I. Shapovalova, V.O. Polyakova, T.S. Kleimenova // Siberian Journal of Life Sciences and Agriculture. – 2021. – Vol.13, N 2. – P. 32-46 [67].

Shapovalova, A.I. Age-specific p53 expression in intact myometrial biopsies sampled at the time of myomectomy / A.I. Shapovalova, Yu.V. Shilenkova, R.E. Popov // Journal of obstetrics and women's diseases. – 2017. – Vol.66, N S.1. – P. 167-168 [68].

Shapovalova, A.I. Expression of signaling molecules (p53, type II collagen, VEGF and VEGFR) in biopsies of intact myometrium in women of different ages / A.I. Shapovalova, V.O. Polyakova, T.S. Kleimenova // Doctor. – 2021. – Vol.32, N 9. – P. 76-79 [71].

3.2 Expression of apoptosis and cellular aging factor p21

in the post-surgery uterine scar area in women of different ages

It was previously shown that transcription and apoptosis factor p21 is expressed during cellular aging, characterized by telomere shortening, in the uterus and placenta of C57BL/6 mice [85]. In addition, it was found that an age-related decrease in estrogen synthesis in mice correlates with an increase in the expression of markers of cellular

aging p21 and p53 in the uterus [125]. However, we were unable to find data in

the literature on the expression of pro-apoptotic protein p21 in the area of postoperative uterine scar in women.

In our study, it was found that the area of p21 expression in the area

of the postoperative uterine scar in women aged 36-46 years was 2.1 times higher compared to this indicator in younger women, 29-35 years, the difference is statistically

significant (Figure 3.4). The average brightness of p21 protein expression in

the postoperative scar area in women tended to increase with age, but there was no significant change in this indicator (Figure 3.5). The data obtained by us indicate