Hydrosalpinx in adults: causes, diagnosis, treatment

District gynecologist, Gynecologist-surgeon (SOD)

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Tatyana Leonidovna

Obstetrician-gynecologist of the highest category

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Obstruction of the fallopian tubes can be caused by various reasons. One of them is the accumulation of liquid in the lumen of the pipe. In medical language, this pathological condition is called hydrosalpinx, a type of sactosalpinx, when multiple adhesions impede patency and contribute to the accumulation of exudate in the cavity. The accumulation of fluid in a closed space can cause suppuration and a sharp deterioration in the patient’s condition, posing a serious threat to her reproductive function.

Etiology of the disease

Hydrosalpinx of the tubes can develop in one or both tubes. It is possible that liquid accumulates in one chamber or the cavity is fragmented into several cells separated by partitions. An intense increase in the volume of exudate leads to swelling of the tube and the onset of the inflammatory process. The walls of the pipe become thinner, and pronounced swelling occurs. A stable inflammatory process, which is not treated with timely and competent treatment, can cause infertility or miscarriage, preventing the implantation of the embryo to the uterine wall or its full development. It is possible to influence the pathology conservatively or surgically. In the most difficult cases, the patient is indicated for tubectomy.

Classification of disease types

Depending on the distribution and nature of the disease, the following types of hydrosalpinx are distinguished:

• right- or left-sided, affecting the right or left pipe, respectively;
• bilateral, threatening a woman with complete infertility due to obstruction of the fallopian tubes;
• simple, in which only the pipe cavity is involved in the pathological process;
• follicular, in which multiple cavities are formed as adhesions grow;
• venticular, in which the contents of the fallopian tube burst into the uterine cavity and out.

Determination of the volume of fluid behind the uterus by ultrasound

It is extremely difficult to determine the exact volume of such a formation using ultrasound, since the fluid spreads between the organs. To clarify the amount of liquid, the length of the vertical level of formation is analyzed. Thus, today the following criteria have been developed for assessing the amount of fluid in the retrouterine space:

• at a height of up to 10 mm, the formation size is insignificant;
• at a height of 10 to 50 mm - moderate;
• at a height of more than 50 mm – significant.

The data obtained must be compared with the patient’s menstrual cycle. Additional tests may be needed if your doctor has concerns about the cause of fluid behind the uterus.

Causes of hydrosalpinx development

The main cause of unilateral or bilateral hydrosalpinx during pregnancy or menopause, according to most medical specialists, is the consequences of prolonged inflammatory processes and numerous adhesions. The enlarged walls of the uterus prevent the full outflow of secretions produced by the mucous membrane. Also, an increase in the volume of fluid becomes possible due to its “leakage” from the cells of neighboring tissues. The adhesions formed during inflammation are located inside the oviduct or in the abdominal cavity. Their formation occurs gradually, and until the lumen is completely overgrown, the accumulated liquid may partially flow out of the cavity.

In addition to inflammatory processes, hydrosalpinx on the left or right can cause appendicitis, peritonitis, complications after surgery, endometriosis, diseases of the female genital area and STDs. There is also a possibility of developing pathology due to abortions and curettage. The inflammatory process is usually localized in the ovaries, uterine cavity or appendages. In some cases, the outflow of fluid is prevented by a benign or malignant neoplasm. The likelihood of such a development of events forces differential diagnosis to exclude oncological disease.

Causes of ovarian cysts

Factors contributing to the formation of ovarian cysts are:

• hormonal imbalances resulting both from diseases of the endocrine system (in particular, hypothyroidism) and from taking medications (for example, to stimulate ovulation);
• inflammatory diseases of the pelvic organs (endometritis, salpingoophoritis);
• adhesions in the pelvis;
• endometriosis;
• surgeries on the pelvic organs (removal of the uterus, unilateral removal of the ovary, resection of the ovary);
• abortions;
• obesity;
• smoking;
• menstrual irregularities (irregular menstruation);
• early onset of menstruation (at age eleven and earlier);
• stress, both psychological and physical, climate change, unfavorable environmental situation;
• age-related hormonal changes during premenopause.

Symptoms of hydrosalpinx

The list of main signs of hydrosalpinx includes:

• a feeling of heaviness, nagging pain in the area of ​​the inflammatory process during physical activity;
• copious discharge with clear or cloudy contents.

If the tube ruptures and the contents leak into the abdominal cavity, a patient with hydrosalpinx experiences sharp pain, cold sweat and increased heart rate. A possible complication is peritonitis, when bleeding occurs into the abdominal cavity followed by suppuration. The leakage of fluid from the fallopian tube does not mean the elimination of the problem: new adhesions form at the site of the rupture, and a relapse of the disease occurs.

When to see a doctor

Discomfort, nagging pain and questionable discharge that appears outside the menstrual period should be an immediate reason for a woman to consult a specialist.

Are you experiencing symptoms of hydrosalpinx?

Only a doctor can accurately diagnose the disease. Don't delay your consultation - call

What to do after confirming the pathology by ultrasound

The doctor’s actions after diagnosis depend on the identified cause. If a woman is found to have tumors, a biopsy and fluid puncture are performed. If the problem is limited to inflammation, then anti-inflammatory therapy is carried out, but sometimes surgery is also performed. In the case of polycystic diseases, hormonal therapy may be used.

The fluid itself, which has accumulated in a woman’s lower abdomen, must be removed. For this purpose, drug or surgical treatment is used.

Medication

If about 2 ml of fluid is detected in the area of ​​the posterior fornix of the uterus, medications are not prescribed, since this is water from the follicle that ruptured during the period of ovulation.

Up to 15% of cases of ascites are eliminated with a diet limiting salt and drinking.

They switch to drug treatment only if the diet does not help.

The medications used are diuretics: spironolactone, and if this does not help, then furasemide. When they are taken, the volume of blood plasma decreases, and fluid passes from the space between organs into the blood. At the same time, a woman loses 2–3 kg per week, and loses 0.5 liters in urine every day. more liquid than was drunk.

Surgical

If surgical intervention is necessary, use:

• laparocentesis to remove water in severe ascites or to determine the composition of the fluid;
• culdocentesis (uterine puncture) to determine the composition of fluid when it accumulates in women in the pelvic area.

These are extreme measures that are used for severe forms of ascites.

It is important to follow dietary recommendations because the need for surgery depends on how the ascites responds to diuretics. If you consume too much salt, diuretics will not work.

Traditional methods

Ascites often indicates a serious illness. Traditional methods are unpredictable in their effect; individual consultation with the attending physician is necessary so that they do not negatively affect the underlying disease, its treatment and the woman’s health.

You can find out more about various home treatment methods here

Diagnosis of hydrosalpinx

In the early stages, only high-precision instrumental research methods can diagnose the disease. Later, when the pathology becomes more pronounced, it is possible to see the inflammation of the tube during a routine gynecological examination. The form of the disease can be determined by:

• smear examination of discharge;
• Ultrasound diagnosis of hydrosalpinx using the vaginal or abdominal method;
• diagnostic laparoscopy;
• hysterosalpingography, which studies the condition and patency of the fallopian tubes, as well as clarifying the possible development of a neoplasm in the uterine area.

The advantages of the laparoscopic method are the combination of diagnosis and treatment of the disease. During examination, it is possible to dissect adhesions and apply a stoma for effective drainage of fluid. Conservative treatment can eliminate the consequences of pathology.

Endometritis

Acute endometritis Most often occurs after abortion, childbirth or diagnostic curettage of the uterus. Clinical signs of acute endometritis usually appear 3-4 days after infection. The temperature rises, the pulse quickens, there is chilling, there are all signs of an inflammatory process in the body and according to a clinical examination. The discharge is serous-purulent, often sanguineous for a long time, which is associated with a delay in the regeneration of the mucous membrane. The acute stage lasts 8-10 days. With proper antibacterial treatment, the process ends and less often becomes subacute or chronic.

Chronic endometritis The frequency of chronic endometritis averages 14%. In recent years, there has been a tendency towards its increase, which is associated with the widespread use of intrauterine devices and the increase in the number of abortions.

As a rule, chronic endometritis occurs as a result of untreated acute postpartum or post-abortion endometritis; its development is often facilitated by repeated intrauterine interventions due to uterine bleeding.

The diagnosis can be indirectly made by ultrasound signs, but it can be 100% confirmed only by hysteroscopy and histological examination of the endometrium!!

Quite often, chronic endometritis is a uterine factor of infertility, and requires long-term and serious treatment after confirmation of the diagnosis.

When the infection spreads upward from the uterine cavity into the fallopian tubes, salpingoophoritis develops, i.e. inflammation of the uterine appendages.

Treatment of hydrosalpinx

At the initial stage of treatment, a patient with hydrosalpinx is sent for surgery to remove inflammation, restore patency of the tubes and their normal functioning. The laparoscopic method is considered optimal for most patients. Its low morbidity is explained by the use of endoscopic equipment, which does not require deep incisions and eliminates tissue damage. A few hours after recovering from anesthesia, the patient can get up and move around with the help of loved ones. The effect of the treatment can be supplemented by:

• a conservative course, which involves taking antibiotics, anti-inflammatory drugs and drugs for resolving adhesions;
• methods of physiotherapy: electrophoresis, magnetic therapy, mud therapy, balneotherapy, electrical stimulation of pipes, etc.

Complete restoration of tube patency is considered impossible, since hydrosalpinx is recurrent. This increases the risk of ectopic pregnancy, which is dangerous for the mother and the fetus. If the patient does not plan to conceive and give birth to a child, a tubectomy is indicated so that the inflamed tissue does not become a source of infection for the entire body.

Treatment of inflammatory diseases of the pelvic organs in women

Pelvic inflammatory diseases (PID) are characterized by various manifestations depending on the level of damage and the strength of the inflammatory response. The disease develops when a pathogen (enterococci, bacteroides, chlamydia, mycoplasma, ureaplasma, trichomonas) penetrates into the genital tract and in the presence of favorable conditions for its development and reproduction. These conditions occur during the postpartum or post-abortion period, during menstruation, during various intrauterine manipulations (insertion of an IUD, hysteroscopy, hysterosalpingography, diagnostic curettage) [1, 5].

Existing natural protective mechanisms, such as anatomical features, local immunity, the acidic environment of the vaginal contents, the absence of endocrine disorders or serious extragenital diseases, can in the vast majority of cases prevent the development of genital infection. In response to the invasion of a particular microorganism, an inflammatory response occurs, which, based on the latest concepts of the development of the septic process, is usually called a “systemic inflammatory response” [16, 17, 18].

Acute endometritis always requires antibacterial therapy. The basal layer of the endometrium is affected by the inflammatory process due to the invasion of specific or nonspecific pathogens. Endometrial protective mechanisms, congenital or acquired, such as T-lymphocyte aggregates and other elements of cellular immunity, are directly related to the action of sex hormones, especially estradiol, act in conjunction with the macrophage population and protect the body from damaging factors. With the onset of menstruation, this barrier on a large surface of the mucous membrane disappears, which makes it possible to become infected. Another source of protection in the uterus is the infiltration of the underlying tissues with polymorphonuclear leukocytes and the rich blood supply of the uterus, which promotes adequate perfusion of the organ with blood and nonspecific humoral protective elements contained in its serum: transferrin, lysozyme, opsonins [16].

The inflammatory process can spread to the muscle layer: then metroendometritis and metrothrombophlebitis occur with a severe clinical course. The inflammatory reaction is characterized by a disorder of microcirculation in the affected tissues, expressed by exudation; with the addition of anaerobic flora, necrotic destruction of the myometrium can occur [12].

Clinical manifestations of acute endometritis are characterized already on the 3rd–4th day after infection by an increase in body temperature, tachycardia, leukocytosis and an increase in ESR. Moderate enlargement of the uterus is accompanied by pain, especially along its ribs (along the blood and lymphatic vessels). Purulent-bloody discharge appears. The acute stage of endometritis lasts 8–10 days and requires quite serious treatment. With proper treatment, the process is completed, less often it turns into subacute and chronic forms, and even less often, with independent and indiscriminate antibiotic therapy, endometritis can take a milder abortive course [5, 12].

Treatment of acute endometritis, regardless of the severity of its manifestations, begins with antibacterial infusion, desensitizing and restorative therapy.

Antibiotics are best prescribed taking into account the sensitivity of the pathogen to them. The dosage and duration of antibiotic use are determined by the severity of the disease. Due to the frequency of anaerobic infections, additional use of metronidazole is recommended. Considering the very rapid course of endometritis, cephalosporins with aminoglycosides and metronidazole are preferable among antibiotics. For example, cefamandole (or cefuroxime, cefotaxime) 1.0–2.0 g 3–4 times a day IM or IV drip + gentamicin 80 mg 3 times a day IM + Metrogyl 100 ml IV /in drip.

Instead of cephalosporins, you can use semi-synthetic penicillins (for abortive cases), for example, ampicillin 1.0 g 6 times a day. The duration of such combination antibacterial therapy depends on the clinic and laboratory response, but should not be less than 7–10 days. To prevent dysbacteriosis from the first days of antibiotic treatment, use nystatin 250,000 units 4 times a day or Diflucan 50 mg/day for 1–2 weeks orally or intravenously [5].

Detoxification infusion therapy may include a number of infusion agents, for example, Ringer-Locke solution - 500 ml, polyionic solution - 400 ml, hemodez (or polydesis) - 400 ml, 5% glucose solution - 500 ml, 1% calcium chloride solution - 200 ml, Unithiol with a 5% solution of ascorbic acid, 5 ml 3 times a day. In the presence of hypoproteinemia, it is advisable to carry out infusions of protein solutions (albumin, protein), blood replacement solutions, plasma, red blood cells or whole blood, and amino acid preparations [12].

Physiotherapeutic treatment occupies one of the leading places in the treatment of acute endometritis. It not only reduces the inflammatory process in the endometrium, but also stimulates ovarian function. When normalizing the temperature reaction, it is advisable to prescribe low-intensity ultrasound, inductothermy with an HF or UHF electromagnetic field, magnetic therapy, and laser therapy.

Every fifth woman who has suffered salpingo-oophoritis is at risk of infertility. Adnexitis can cause a high risk of ectopic pregnancy and pathological course of pregnancy and childbirth. The fallopian tubes are the first to be affected, and the inflammatory process can involve all layers of the mucous membrane of one or both tubes, but more often only the mucous membrane of the tube is affected, and catarrhal inflammation of the mucous membrane of the tube occurs - endosalpingitis. Inflammatory exudate, accumulating in the tube, often flows through the ampullary opening into the abdominal cavity, adhesions form around the tube and the abdominal opening of the tube closes. A saccular tumor develops in the form of a hydrosalpinx with transparent serous contents or in the form of a pyosalpinx with purulent contents. Subsequently, the serous exudate of the hydrosalpinx resolves as a result of treatment, and the purulent pyosalpinx can perforate into the abdominal cavity. The purulent process can capture and melt increasingly large areas of the pelvis, spreading to all internal genitalia and nearby organs [9, 10, 13].

Inflammation of the ovaries (oophoritis) as a primary disease is rare; infection occurs in the area of ​​the ruptured follicle, since the rest of the ovarian tissue is well protected by the covering germinal epithelium. In the acute stage, swelling and small cell infiltration are observed. Sometimes, in the cavity of the follicle of the corpus luteum or small follicular cysts, ulcers and microabscesses form, which, merging, form an ovarian abscess or pyovarium. In practice, it is impossible to diagnose an isolated inflammatory process in the ovary, and this is not necessary. Currently, only 25–30% of patients with acute adnexitis have a pronounced picture of inflammation; the remaining patients experience a transition to a chronic form, when therapy is stopped after a rapid subsidence of the clinic.

Acute salpingoophoritis is also treated with antibiotics (preferably third generation fluoroquinolones - Ciprofloxacin, Tarivid, Abaktal), since it is often accompanied by pelvioperitonitis - inflammation of the pelvic peritoneum.

Inflammation of the pelvic peritoneum most often occurs secondary to the penetration of infection into the abdominal cavity from an infected uterus (with endometritis, infected abortion, ascending gonorrhea), from the fallopian tubes, ovaries, from the intestines, with appendicitis, especially with its pelvic location. In this case, an inflammatory reaction of the peritoneum is observed with the formation of serous, serous-purulent or purulent effusion. The condition of patients with pelvioperitonitis remains either satisfactory or moderate. The temperature rises, the pulse quickens, but the function of the cardiovascular system is slightly impaired. With pelvioperitonitis, or local peritonitis, the intestine remains unbloated, palpation of the upper half of the abdominal organs is painless, and symptoms of peritoneal irritation are determined only above the pubis and in the iliac regions. However, patients note severe pain in the lower abdomen, there may be retention of stool and gas, and sometimes vomiting. The level of leukocytes is increased, the formula shifts to the left, the ESR is accelerated. Gradually increasing intoxication worsens the condition of patients [14, 15].

Treatment of salpingoophoritis with or without pelvioperitonitis begins with a mandatory examination of the patient for flora and sensitivity to antibiotics. The most important thing is to determine the etiology of inflammation. Today, benzylpenicillin is widely used for the treatment of specific gonorrheal process, although drugs such as Rocephin, Cephobid, Fortum are preferable.

The “gold standard” in the treatment of salpingoophoritis from antibacterial therapy is the prescription of Claforan (cefotaxime) at a dose of 1.0–2.0 g 2–4 times a day intramuscularly or one dose of 2.0 g intravenous in combination with gentamicin 80 mg 3 times/day (gentamicin can be administered once at a dose of 160 mg IM). It is imperative to combine these drugs with the administration of Metrogyl IV 100 ml 1-3 times a day. A course of antibiotic treatment should be carried out for at least 5–7 days, prescribing cephalosporins of the second and third generations (Mandol, Zinacef, Rocephin, Cephobid, Fortum and others at a dose of 2–4 g/day) [14].

In case of acute inflammation of the uterine appendages, complicated by pelvioperitonitis, oral administration of antibiotics is possible only after the main course, and only if the need arises. As a rule, there is no such need, and the persistence of previous clinical symptoms may indicate the progression of inflammation and a possible suppurative process.

Detoxification therapy is mainly carried out with crystalloid and detoxification solutions in an amount of 2–2.5 liters with the inclusion of solutions of hemodez, Reopoliglyukin, Ringer-Locke, polyionic solutions - acessol, etc. Antioxidant therapy is carried out with a solution of Unithiol 5.0 ml with a 5% solution of ascorbic acid 3 times/day i.v. [14].

In order to normalize the rheological and coagulation properties of blood and improve microcirculation, acetylsalicylic acid (Aspirin) 0.25 g/day is used for 7–10 days, as well as intravenous administration of Reopoliglucin 200 ml (2–3 times per course). Subsequently, a whole complex of resorption therapy and physiotherapeutic treatment is used (calcium gluconate, autohemotherapy, sodium thiosulfate, Humisol, Plazmol, Aloe, FiBS) [3, 15]. Among the physiotherapeutic procedures for acute processes, ultrasound is appropriate, providing analgesic, desensitizing, fibrolytic effects, enhancing metabolic processes and tissue trophism, inductothermy, UHF therapy, magnetic therapy, laser therapy, and later - sanatorium-resort treatment.

Among 20–25% of inpatients with inflammatory diseases of the uterine appendages, 5–9% develop purulent complications requiring surgical interventions [9, 13].

The following provisions regarding the formation of purulent tubo-ovarian abscesses can be highlighted:

• chronic salpingitis in patients with tubo-ovarian abscesses is observed in 100% of cases and precedes them;
• the spread of infection occurs predominantly through the intracanalicular route from endometritis (with IUD, abortion, intrauterine interventions) to purulent salpingitis and oophoritis;
• frequent combination of cystic transformations in the ovaries with chronic salpingitis;
• there is a mandatory combination of ovarian abscesses with exacerbation of purulent salpingitis;
• Ovarian abscesses (pyovarium) are formed mainly from cystic formations, often microabscesses merge with each other.

Morphological forms of purulent tubo-ovarian formations:

• pyosalpinx - predominant lesion of the fallopian tube;
• pyovarium - predominant damage to the ovary;
• tubo-ovarian tumor.

All other combinations are complications of these processes and can occur:

• without perforation;
• with perforation of ulcers;
• with pelvioperitonitis;
• with peritonitis (limited, diffuse, serous, purulent);
• with pelvic abscess;
• with parametritis (posterior, anterior, lateral);
• with secondary lesions of adjacent organs (sigmoiditis, secondary appendicitis, omentitis, interintestinal abscesses with the formation of fistulas).

Clinically differentiating each of these localizations is almost impossible and impractical, since the treatment is fundamentally the same; antibacterial therapy takes a leading place both in the use of the most active antibiotics and in the duration of their use. The basis of purulent processes is the irreversible nature of the inflammatory process. Irreversibility is due to morphological changes, their depth and severity, often accompanying severe renal dysfunction [3, 9].

Conservative treatment of irreversible changes in the uterine appendages is unpromising, since if it is carried out, it creates the preconditions for the occurrence of new relapses and aggravation of impaired metabolic processes in patients, increases the risk of upcoming surgery in terms of damage to adjacent organs and the inability to perform the required volume of surgery [9].

Purulent tubo-ovarian formations represent a difficult diagnostic and clinical process. Nevertheless, a number of characteristic syndromes can be identified:

• intoxication;
• painful;
• infectious;
• early renal;
• hemodynamic disorders;
• inflammation of adjacent organs;
• metabolic disorders.

Clinically, intoxication syndrome manifests itself in intoxication encephalopathy, headaches, heaviness in the head and severity of the general condition. Dyspeptic disorders (dry mouth, nausea, vomiting), tachycardia, and sometimes hypertension (or hypotension in the onset of septic shock, which is one of its early symptoms along with cyanosis and facial hyperemia against the background of severe pallor) are noted [4].

Pain syndrome is present in almost all patients and is of an increasing nature, accompanied by a deterioration in general condition and well-being, there is pain during a special examination, displacement behind the cervix and symptoms of irritation of the peritoneum around the palpable formation. Pulsating increasing pain, persistent fever with a body temperature above 38°C, tenesmus, loose stools, lack of clear contours of the tumor, lack of effect from treatment - all this indicates the threat of perforation or its presence, which is an absolute indication for urgent surgical treatment. The infectious syndrome is present in all patients, manifested in the majority by high body temperature (38°C and above), tachycardia corresponds to fever, as well as an increase in leukocytosis, ESR and leukocyte index of intoxication increase, the number of lymphocytes decreases, the shift of white blood to the left and the number of molecules of average mass, reflecting increasing intoxication. Often there is a change in kidney function due to impaired urine passage. Metabolic disorders manifest themselves in dysproteinemia, acidosis, electrolyte imbalance, etc.

The treatment strategy for this group of patients is based on organ-preserving principles of surgery, but with radical removal of the main source of infection. Therefore, for each specific patient, the volume of the operation and the time of its implementation should be optimal. Clarifying the diagnosis sometimes takes several days - especially in cases where there is a borderline variant between suppuration and an acute inflammatory process or in differential diagnosis from an oncological process. Antibacterial therapy is required at each stage of treatment [1, 2].

Preoperative therapy and preparation for surgery include:

• antibiotics (use Cefobid 2.0 g/day, Fortum 2.0–4.0 g/day, Reflin 2.0 g/day, Augmentin 1.2 g IV drip 1 time/day, Clindamycin 2.0– 4.0 g/day, etc.). They must be combined with gentamicin 80 mg IM 3 times a day and Metrogyl infusion 100 ml IV 3 times;
• detoxification therapy with infusion correction of volemic and metabolic disorders;
• mandatory assessment of the effectiveness of treatment based on the dynamics of body temperature, peritoneal symptoms, general condition and blood counts.

The surgical stage also includes ongoing antibacterial therapy. It is especially valuable to administer one daily dose of antibiotics on the operating table immediately after the end of the operation. This concentration is necessary as a barrier to further spread of infection, since penetration into the area of ​​inflammation is no longer prevented by dense purulent capsules of tubo-ovarian abscesses. Betalactam antibiotics (Cephobid, Rocephin, Fortum, Claforan, Tienam, Augmentin) pass these barriers well.

Postoperative therapy includes the continuation of antibacterial therapy with the same antibiotics in combination with antiprotozoal, antimycotic drugs and uroseptics in the future (according to sensitivity). The course of treatment is based on the clinical picture and laboratory data, but should not be less than 7–10 days. Antibiotics are discontinued based on their toxic properties, so gentamicin is often discontinued first, after 5–7 days, or replaced with amikacin.

Infusion therapy should be aimed at combating hypovolemia, intoxication and metabolic disorders. Normalization of gastrointestinal motility is very important (intestinal stimulation, HBOT, hemosorption or plasmapheresis, enzymes, epidural blockade, gastric lavage, etc.). Hepatotropic, restorative, antianemic therapy is combined with immunostimulating therapy (UVR, laser blood irradiation, immunocorrectors) [2, 9, 11].

All patients who have undergone surgery for purulent tubo-ovarian abscesses require post-hospital rehabilitation in order to prevent relapses and restore specific body functions.

Literature

1. Abramchenko V.V., Kostyuchek D.F., Perfileva G.N. Purulent-septic infection in obstetric and gynecological practice. St. Petersburg, 1994. 137 p.
2. Bashmakova M. A., Korkhov V. V. Antibiotics in obstetrics and perinatology. M., 1996. No. 9. P. 6.
3. Bondarev N. E. Optimization of diagnosis and treatment of mixed sexually transmitted diseases in gynecological practice: abstract. dis. ...cand. honey. Sci. St. Petersburg, 1997. 20 p.
4. Ventsela R.P. Nosocomial infections // M., 1990. 656 p.
5. Gurtovoy B. L., Serov V. N., Makatsaria A. D. Purulent-septic diseases in obstetrics. M., 1981. 256 p.
6. Keith L. G., Berger G. S., Edelman D. A. Reproductive health: Vol. 2 // Rare infections. M., 1988. 416 p.
7. Krasnopolsky V.I., Kulakov V.I. Surgical treatment of inflammatory diseases of the uterine appendages. M., 1984. 234 p.
8. Korkhov V.V., Safronova M.M. Modern approaches to the treatment of inflammatory diseases of the vulva and vagina. M., 1995. No. 12. P. 7–8.
9. Kumerle X. P., Brendel K. Clinical pharmacology during pregnancy / ed. X. P. Kumerle, K. Brendel: trans. from English T. 2. M., 1987. 352 p.
10. Serov V.N., Strizhakov A.N., Markin S.A. Practical obstetrics: a guide for doctors. M., 1989. 512 p.
11. Serov V.N., Zharov E.V., Makatsaria A.D. Obstetric peritonitis: diagnosis, clinic, treatment. M., 1997. 250 p.
12. Strizhakov A. N., Podzolkova N. M. Purulent inflammatory diseases of the uterine appendages. M., 1996. 245 p.
13. Khadzhieva E. D. Peritonitis after cesarean section: a textbook. St. Petersburg, 1997. 28 p.
14. Sahm DE The role of automation and molecular technology in antimicrobial susceptibility testing // Clin. Microb. And Inf. 1997; 3: 2(37–56).
15. Snuth CB, Noble V., Bensch R. et al. Bacterial flora of the vagina during the mensternal cycle // Ann. Intern. Med. 1982; p. 948–951.
16. Tenover FC Norel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens // Am. J. Med. 1991; 91, p. 76–81.

V. N. Kuzmin, Doctor of Medical Sciences, Professor MGMSU, Moscow

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Endometriosis and infertility

The main complication of this pathology is infertility. There are several mechanisms of reproductive dysfunction:

1. Formation of adhesions in the pelvic cavity between the ovaries, fallopian tubes, intestines, abdominal wall and pelvic walls. This causes the fallopian tubes to bend and makes it difficult for the egg to travel to the uterus.
2. The formation of endometrioid cysts in the ovaries, which makes ovulation and pregnancy difficult.
3. Immune disorders lead to the production of antibodies to all endometrial cells, including normal uterine tissue. As a result, the implantation of the egg to the uterine wall is disrupted, or the pregnancy is terminated in the early stages.
4. Hormonal imbalance when estrogen levels exceed progesterone levels, resulting in failure to ovulate.

Infertility treatment tactics for endometriosis most often include the use of assisted reproductive technologies, such as IVF and embryo transfer.

Diseases that develop against the background of blood stagnation

As a result of prolonged stagnation, diseases develop that have to be treated with medication and, in some cases, surgery.

The following pathologies are observed in women:

• Adnexitis, inflammation of the appendages;
• Menstrual irregularities;
• Miscarriage;
• Infertility.

In men, the diseases are as follows:

• Prostatitis;
• Varicocele;
• Impotence.

One of the most common ailments is hemorrhoids, and almost everyone notices a deterioration in their emotional state.