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EFFICIENCY OF STAGED RESTORATIVE TREATMENT OF PATIENTS WITH
CHRONIC ENDOMETRITIS AND REPRODUCTIVE DISORDERS
Kurbaniyazova Aziza Zafarjonovna
Bukhara State Medical University Department of Obstetrics and Gynecology N 2
https://doi.org/10.5281/zenodo.13913874
Materials and methods.
We reviewed the available publications that reflect the state-of-
the-art in the diagnosis and treatment of patients with CE.
Results
. At present, a point of view has been formed about the advisability of carrying out
a complex two-stage therapy for CE. According to some experts, the empiric prescription of
antibacterial agents is justified, but a number of authors believe that when prescribing them, it is
necessary to take into account the types and quantitative composition of microorganisms detected
in endometrial biopsy.
Summary
. Most of the modern studies that show various methods of treating CE,
analyzing the effectiveness of CE therapy, are aimed at alleviating the clinical symptoms of the
disease and normalizing the ultrasound image of the endometrium. At the same time, to adequately
assess the therapy, it is necessary to study the morphological picture of the endometrium before
and after treatment. The effectiveness of etiotropic therapy for CE is mainly determined by the
accuracy of identifying the pathogen in biopsy samples of the uterine mucosa. Despite the diversity
of recommended treatment methods for CE, the treatment of this disease is associated with
significant methodological and practical difficulties. Given the connections in the pathogenesis of
CE and the new diagnostic possibilities, it is necessary to further search for innovative integrated
approaches in the treatment of CE.
chronic endometriosis antibacterial drug treatment
A major event of the last decade is the implementation of the Human Microbiome Project
at the US National Institutes of Health (NIH) in 2010 [1]. Research has shown that more than
10,000 microorganisms of viral-bacterial nature, represented by 8 million unique genes encoding
proteins necessary for maintaining metabolic processes in the host organism, live in the human
div. The results obtained from this project showed that the maximum number of microbial
species lives in the gums and colon, and the minimum in the vagina, which is explained by the
ability of the vaginal and cervical epithelium to produce antimicrobial peptides [1].
Mucous membranes of various biotopes, which perform a barrier function together with
mechanisms of immunological reactivity, are involved in ensuring the resistance of the
macroorganism to colonization [2] - a physiological phenomenon that maintains microecological
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homeostasis through the interaction of the host organism and the local population. permanent)
microflora. The stability of the local vaginal microflora is under the control of hormonal and
immune mechanisms that ensure the dominance of lactobacilli. A characteristic feature of the
vaginal microflora is its variability under the influence of exogenous and endogenous factors.
Violation of homeostasis, use of antibacterial (AB) drugs, hormone therapy, surgical interventions,
as well as the development of intestinal dysbiosis have a great impact [3]. This leads to the
destruction of the local vaginal microflora and an increase in the population density of the
temporary microflora, which is accompanied by a decrease in resistance to colonization, a violation
of the vaginal microcenosis, and the secondary development of inflammatory diseases [3-5].
Chronic endometritis (CS) is considered as a clinical and morphological inflammatory
syndrome, characterized by a complex of morphofunctional changes in the endometrium, which
leads to a violation of its cyclic transformation and receptivity [6-10]. The prevalence of CE has
not been fully studied and ranges from 0.8 to 66%, with an average of 15% [6, 7, 11-13]. According
to a 2015 leading ACOG expert opinion [14], CE is a polymicrobial disease characterized by
abnormal uterine bleeding, recurrent miscarriage, and infertility.
The diagnosis of CE is based on the identification of its morphological signs: the presence
of lymphoid infiltrates in the endometrium, which are often located around glands and blood
vessels, the presence of plasma cells and focal fibrosis in the stroma, together with sclerotic
changes in the walls. of spiral arteries [6, 15-18]. Foreign morphologists describe the "golden"
standard for the diagnosis of CE and mean: in one view of the endometrial sample (magnification
× 400) in the stroma 5 or more neutrophils and 1 or more plasma cells (x120) [18, 19] or only The
presence of 5 or more neutrophils (×400) [5]. A number of researchers [5] interpret this
morphological picture as an increase in the chronic inflammatory process in the endometrium. The
presence of only 1 or more plasma cells (×100) and the absence of neutrophils in one field of view
is considered by them as chronic or plasmatic endometritis. According to the morphological
criteria proposed by A. Takebayashi et al. [20], detection of 1 or more plasma cells in 10 non-
overlapping fields of view (×400) is sufficient for diagnosis.
The leading role in the origin of the disease belongs to opportunistic pathogens (OPM),
their detection rate reaches 58-77.5% [21, 22]. The most common facultative anaerobes include
enterobacteria, staphylococci, enterococci, and streptococci, obligate anaerobes, and among
microaerophiles, peptostreptococci [21-23]. According to the expert opinion of leading ACOG
experts in 2015 [14], ureaplasma was added to them. A unique causative agent of CE is the herpes
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simplex virus, as well as microorganisms associated with sexually transmitted infections and
tuberculosis [16, 23, 24].
Adequate treatment of CE in modern conditions causes certain difficulties due to the
transition of clinical signs to muted and atypical forms of the disease, increased resistance to AB
drugs in UPM released from the genital tract.
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