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Long-term chronic inflammation in combination with persistent human papillomavirus infection is one of the potential causes of cervical dysplasia and cancer. Surgical treatment of severe dysplasia, transient insufficiency of the epithelial layer, inflammation that occurs as a result of postoperative trauma can cause long-term consequences for the vaginal biotope. The correct choice of the drug during the rehabilitation period after surgical treatment will prevent the development of complications and recurrences of vaginal flora disorders. The objective: to reduce the frequency of complications after excisional treatment in women with severe cervical intraepithelial neoplasia and to evaluate the clinical effectiveness and safety of using vaginal forms of antimicrobial and antiseptic drugs during postoperative rehabilitation. Materials and methods. 79 women of reproductive age with verified severe cervical intraepithelial neoplasia participated in the study and were divided into three groups. All patients had excisional treatment – radio wave conization of the cervix. In the postoperative period women of the 1st group (n=27) were prescribed a preparation for intravaginal use based on chlorophyllipt thick extract, the 2nd group (n=26) – a preparation that includes chlorophyllipt thick extract and chlorhexidine bigluconate, the 3rd group group (n=26) – suppositorium with chlorhexidine. The postoperative period was divided into 2 visits: on the 30-35th and 60-65th day. Complaints, the degree of subjective feeling of comfort during treatment, the duration and degree of epithelization of the cervix, violation of the biocenosis of the vagina and complications in the form of acute inflammatory diseases of the pelvic organs, strictures of the cervical canal, bleeding in the postoperative period were studied. Results. According to the results of the study, the drug which was prescribed to women of the 2nd group, demonstrated the highest clinical effectiveness both on the 30-35th and on the 60-65th day of the postoperative period, in contrast to the women of the 1st and 3rd groups. The high degree of subjective feeling of comfort after the treatment with the drug, which contains chlorophyllipt extract thick and chlorhexidine bigluconate (women of the 2nd group), on the 30-35th day was 88.46%, which is 14.38% more than in women of the 1st group – 74.08% and by 23.08% more than in patients of the 3rd group – 65.38%. Complete epithelization of the cervix in women of the 2nd group was finished in 76.92%, which is 21.36% more than in the women of the 1st group (55.56%), and 7.69% more than in the patients of the 3rd group (69.23%). Biocenosis of the vagina was evaluated according to the Hay-Ison criteria: in the women of the 2nd group the 1st degree of purity was found in 76.92%, in contrast to the patients of the 1st group – 55, 56%, which is 21.36% more, and 11.54% more than that of women of the 3rd group – 65.38%. After 60–65 days of the postoperative period according to the research data, all women of the 2nd group had complete epithelization of the cervix, normocenosis – in 88.46% of women, in contrast to single-component antiseptic preparations; all patients noted a high degree of subjective feeling of comfort. None of the women from the three studied groups had complications such as acute pelvic inflammatory disease, bleeding and strictures of the cervical canal during the entire observation period. Conclusions. The use of vaginal forms of antiseptics in a combination of chlorhexidine bigluconate and chlorophyllipt extract in women with severe cervical intraepithelial neoplasia demonstrated the highest effectiveness in rehabilitation in the postoperative period compared to single-component antiseptic preparations containing chlorophyllipt or chlorhexidine. [ABSTRACT FROM AUTHOR]

Cervical cancer (СС) remains a major global health problem, causing significant morbidity and mortality among women worldwide. Despite significant research efforts and advances in screening and prevention strategies, CС remains an unsolved public health challenge, particularly in low- and middle-income countries. Every year in the world, more than half a million women are diagnosed with СС. The article is devoted to the review of modern scientific publications on the prevention, diagnosis and treatment of cervical lesions on the background of human papilloma virus (HPV) infection. Chronic infection with highly oncogenic strains of HPV in 99.7% is a cause of CC development. A comprehensive understanding of the cofactors of the persistence and realization of the oncogenic potential of HPV is crucial for optimizing strategies for early detection, treatment and prevention of recurrences of dysplastic lesions of the cervical epithelium and cervical cancer. A vaginal gel that contains ingredients of natural origin (hyaluronic acid niosomes, glucan niosomes, Centella asiatica phytosomes, Coriolus versicolor extract, Neem extract, prebiotic, Aloe extract vera, etc.) is scientifically based, available for practical use and clinically effective in patients with HPV infection, it makes a protective and therapeutic barrier in the transformation zone of the cervix. The gel blocks the integration of HPV and in such way it prevents the formation of new lesions, acts as an support medication for re-epithelialization of already existing ones, and stimulates the regeneration of the vaginal microbiota. The effectiveness and safety of vaginal use of this gel which include the natural components in women of reproductive age with HPV-associated lesions of the cervical epithelium has been proven (the results of the multicenter open controlled randomized clinical trial PALOMA, 2021). The expediency and effectiveness of its use in women with HPV-associated lesions of the cervical epithelium of late reproductive and perimenopausal age have been established. Improvement and implementation in practice of the prevention system of cervical pathology and making it closer to European standards is a real step towards overcoming the cervical cancer rate. The mentioned vaginal gel is an innovative and safe medicine which contains only natural ingredients, and its therapeutic effect is aimed at increasing the clearance of HPV, repairing intraepithelial lesions of the cervical epithelium and maintaining the normal bacterial microflora of the vagina [ABSTRACT FROM AUTHOR]

The objective: to evaluate the therapeutic effect of a vaginal gel containing hyaluronic acid and decamethoxine for the prevention of obstetric injuries reduction of the birth canal during childbirth, as well as to improve the course of the postpartum period. Materials and methods. An analysis of the course of vaginal births in the fetal head presentation of 500 births that took place in the communal non-commercial enterprise «Kyiv City Maternity Hospital No. 2» during 2021–2022 was carried out. The main group included 250 pregnant women who were given a vaginal gel containing decamethoxine, sodium hyaluronate and lactic acid during childbirth and in the postpartum period. The comparison group consisted of 250 pregnant women who did not use the specified gel during childbirth and in the postpartum period. Results. The average age of patients in the main and the comparison group was 28.92±1.32 and 27.17±1.56 years, respectively. In both groups, primiparous women prevailed – 157 (62.80%) persons in the main group, 158 (63.20%) – in the comparison group, 93 (37.20%) and 92 (36.80%) women had the second labor respectively. There was a tendency to decrease the time of the second period of labor in women of the main group compared to the comparison group. The frequency of episiotomy was 1.63 times lower in the main group than in the comparison group (p<0.05), the rate of soft tissue injuries in childbirth – 1.32 times lower (109 (43.60%) and 144 (57.60%) women respectively; p=0.002). During the week of the postpartum period, the number of patients with discomfort in the vagina and perineum was 2.49 times less in the main group (59 (23.60%) persons) than in the comparison group (147 (58.80%) women; p<0.001), with pain – 1.85 times (88 (35.20%) and 163 (65.20%) individuals respectively; p<0.001). 132 (52.80%) women of the comparison group complained on the limitations in their daily activities due to the mentioned symptoms, which was 2.16 times more than in the main group (61 (24.40%) persons; p<0.001). Conclusions. The use of vaginal gel, which contains hyaluronic acid and decamethoxine, during childbirth and in the postpartum period for prevention of obstetric injuries and improvement the course of the postpartum period is effective, which led to a 1.32- fold decrease of women with vaginal and perineal tears (p<0.05) and 1.63 times – the frequency of episiotomy (р<0.05) and improvement of the course of the postpartum period. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is one of the most common groups of viruses. Almost all sexually active people can be included in the risk group of HPV infection. Numerous studies indicate a significant prevalence of HPV with a high oncogenic risk, especially among women under 30 years of age. The course of HPV depends on the state of the immune system and can be transient, latent or persistent. A significant role belongs to the state of local immunity and vaginal microbiota. Long-term persistence of HPV in the tissues of the lower part of the genital tract organs provokes the development of precancer and cancer processes. The objective: to evaluate the effectiveness of a vaginal gel based on Coriolus versicolor in the treatment of low-grade cervical lesions caused by HPV. Materials and methods. This study involved 91 HPV-positive women with low-grade pap smear lesions who had regular colposcopy. Women were randomized (in a 1:1:1 ratio) to three treatment groups: A treatment, B treatment, and a control group (expectant approach). Results. Since the state of the immune system largely determines the course of HPV infection, the modern approach to the treatment of HPV-associated diseases involves the use of local intravaginal antiviral and immunomodulatory therapy, which promotes the elimination of pathogens and ensures full epithelization of the cervix, reducing the frequency of recurrence, which preserves women’s reproductive health. The percentage of patients with a normal Pap smear and serial colposcopy in 6 months was significantly higher in the treatment group than in the control group (84.9% vs. 64.5%, respectively; p=0.031; this difference was even more prominent in the high-risk subgroup of HPV-infected women (87.8% vs. 56.0% for the treatment and control groups, respectively; p=0.003). Significant differences were also observed at 3 months in the overall sample of patients (78.0% vs. 54.8% for the treatment and control groups, respectively; p=0.023) and the subgroup of high-risk HPV-infected women (79.5% vs. 52 .0%, respectively; p=0.017). Conclusions. Treatment with a Coriolus versicolor vaginal gel has demonstrated greater clinical benefit than a standard expectant approach in clinical practice for patients with total and high risk of HPV infection for the treatment efficacy of HPVrelated cervical lesions and removal of all HPV strains from the organism after one six-month period. [ABSTRACT FROM AUTHOR]

Dysbiotic changes in microbial ecosystem of the female lower genital tract are risk factors for spontaneous abortions, spontaneous preterm births, intra-amniotic infection, postpartum endometritis, and adverse perinatal outcomes. However, the opinions about the expediency of antimicrobial therapy in women with bacterial vaginosis and a history of preterm birth are controversial, and discussions and the search for an effective method of treatment are still continuing. Treatment of dysbiosis of the vaginal microbiota requires a complex approach for not only the pathogen elimination, but also for the restoring of the normal vaginal biotope. The objective: to evaluate the effectiveness of correction of dysbiotic disorders of the vaginal microbiota in women with risk factors for premature birth using the prebiotic topical therapy. Materials and methods. The studied cohort included 105 women with risk factors for premature birth. I group included 38 women at the stage of pregnancy planning, II group - 39 pregnant women, III group - 28 pregnant women from the moment of their first visit to the female consultation for pregnancy monitor. The control group included 20 conditionally healthy pregnant women at the same gestational age. The patients of the I and II groups after diagnosis of bacterial vaginosis (BV), vulvovaginal candidiasis, or aerobic vaginitis received etiotropic topical therapy in accordance with the recommendations of the Centers for Disease Control and Prevention and International Union against sexually transmitted infections. Bacterial vaginosis was treated by clindamycin cream (2 %) once a day for 7 days; aerobic vaginitis - vaginal tablets which contain 10 mg of dequalinium chloride for 6 days; candida vaginitis - fenticonazole 600 mg in one vaginal capsule once followed by topical application of a prebiotic complex (oligosaccharide, sodium hyaluronate, xylitol, vitamins, lactose) for 10 days. Then pH balance and normocenosis of the vagina were supported by the use of one vaginal capsule of the prebiotic complex per week till the 22nd week of gestation. The pregnant women in the III group with similar pathologies received only classical antimicrobial therapy with antibiotics and/or antifungal drugs. The assessment of the vaginal microbiota was carried out at the time of the patients inclusion in the study and at the 17-19 weeks of gestation by determination of the vaginal pH and using molecular biological and bacterioscopic methods. Results. The effectiveness of BV and mixed vaginitis therapy in all groups was high, the frequency of BV detection after treatment decreased from 28.9 % to 2.6 % in the I group and from 32.1 % to 3.6 % - in the III group. In the I and II groups, in which the patients received complex treatment with the prebiotic complex, the quantity of women with normocenosis of the vagina increased significantly (from 39.5 % to 89.5 % in the I group; from 35.9 % to 89.7 % in the II group), the frequency of the intermediate state of the vaginal microbiota decreased twice (from 13.2 % to 7.9 % in the I group and from 15.4 % to 7.7 % in the II group). In patients of the III group, the incidence of normocenosis increased slightly (from 32.1 % to 39.3 %), but the rate of pregnant women with an intermediate state of vaginal microbiota increased significantly (from 14.3 % to 46.4 %), which is a threat to the recurrence of dysbiotic processes. Conclusions. The topical use of the prebiotic complex, which contains oligosaccharide, sodium hyaluronate, xylitol, vitamins and lactose, is effective in the management of symptoms and pathogenic load in uncomplicated vaginal infection, which is manifested by a decrease in the prevalence of intermediate states of the microbiota and a steady increase in normocenosis. The complex therapy with antibiotics/antifungal agents with a vaginal prebiotic complex provides an effective restoration of the vaginal flora to the state of normocenosis compared to treatment with antibiotics/antifungal agents only. [ABSTRACT FROM AUTHOR]