Characteristics of hysteroscopy findings in women veterans who have suffered injuries with unrealified reproductive function

Abstract

DOI: 10.52705/2788-6190-2023-02-10

Today, more than 50,000 women serve in the Armed Forces of Ukraine. According to statistical data, the number of people with post-traumatic stress disorder is 27.7% among military personnelwho took part in active combat operations. Post-traumatic syndrome is a frequent predictor ofvarious conditions with changes in the hormonal background, morpho-functional changes of theendometrium, which in turn has a negative impact on women’s reproductive health.In our study, the diagnostic value of hysteroscopic examination of the uterine cavity in women whohave suffered a contusion was studied and evaluated. This study proves the need to increasethe effectiveness of hysteroscopic diagnosis and treatment of the uterine cavity in women ofreproductive age who participated in combat operations and suffered contusions.

Research aim: todetermine the diagnostic value of hysteroscopic examination of the uterine cavity to assess the stateof the endometrium in women with unfulfilled reproductive function who have suffered a contusion.The objective: to determine the diagnostic value of the data obtained during hysteroscopicexamination of the uterine cavity to assess the state of the endometrium in women who havesuffered a concussion, and to develop an algorithm for the management of this category women.

Materials and methods. A prospective study was conducted in concussed women with unrealizedreproductive function. The study of the features of the hysteroscopic picture was carried out in 457 women of reproductive age who participated in combat operations and suffered a concussion,who underwent a comprehensive examination on the 21st day of the menstrual cycle (MC). Ofthese women, 246 patients (the comparison group) of reproductive age with a history of traumawithout post-concussive syndrome and 211 in the main group, women of reproductive age whohave consequences of concussion in the form of post-concussive syndrome (F7.02 за МКХ-10).30 conditionally healthy civilian women of reproductive age served as controls.The average age of the examined was 37.08±42.31 years. The period of stay in the combat zone is60.26±42.21 months, the time since receiving a traumatic brain injury (concussion) is 18.81±9.211months. Symptoms of the consequences of a concussion at the time of examination weredetermined according to the Cicero questionnaire. Patients self-assessed their own symptomswith regard to the present. The PCL questionnaire (military version) was used to screen for PTSD.The study of the state of autonomic regulation was carried out by filling out a questionnaire for thesubjective assessment of dystonia according to A. M. Wayne’s questionnaire.

Results. Hysteroscopy was performed in 457 patients of reproductive age who took part in combatoperations and suffered a concussion. Of the examined 457 patients who suffered a contusion inonly 48 (16.11%) cases, the endometrium did not have any pathology. Intrauterine pathology wasdetected in 409 (83.89%) patients. According to the frequency of chronic endometritis and polyps,the examined groups with post-concussion syndrome and women with a history of concussionwithout post-concussion syndrome did not statistically differ. In patients with a mismatch inthe secretion phase, the endometrium was of uneven thickness, the vascular pattern was notvisualized, only in some areas the folds of the uterine mucosa were determined.

Conclusions. Based on the results of the study, it can be stated that in patients with postconcussionsyndrome, compared to patients without post-concussion syndrome, there is1.72 times more frequent mismatch of the endometrium with the MC phase, 3.11 times moreintrauterine synechiae, 2.01 times more SNGE. The conducted research showed the highdiagnostic significance of hysteroscopy in women of reproductive age who participated in combatoperations and suffered contusions, which allows recommending the inclusion of this technique inthe management algorithm of women of the above-mentioned category.