Diagnostics OF Diseases OF the Cervic in Modern Gynecology

As a result of complex clinical and endoscopic studies, 78 (32.2%) women turned out to be practically healthy. In 164 (67.8%) women, certain diseases were detected, including: a nd exocervicitis in 44 (27%), endometriosis of the cervix in 9 (5.5%), pseudo-erosion and erosion of the cervix 35 (21.3%) , cervical polyp in 6 (3.7%), simple and partially overlapped ectopia in 20 (12.2%), old ruptures and scars of the cervix in 8 (4.9%), narrowing and infection of the cervix in 5 ( 3%), cervical papilloma in 4 (2.4%), cervicitis caused by herpetic and fungal infection in 29 (17.7%), leukoplakia in 4 (2.4%) women. Given the clinical and echographic prognosis, women who had significant discrepancies in the diagnosis were assigned to the group of active observation by an oncogynecologist.

colposcopy, human papillomavirus infection. The invariably urgent problem of practical gynecology is still the task of effective treatment and rehabilitation of patients with pathology of the cervix in order to restore the normal morphofunctional relationships of the tissues of the cervix, its barrier function, prevent ascending infection of the genitals, the occurrence of cancer of this localization, and also due to the severity of the caused concomitant pathology of reproductive health disorders in women. In recent years, Uzbekistan has seen a steady increase in infectious and inflammatory diseases of the vagina and cervix, of which 23.2% are endocervicitis, in 30% of cases, cervicitis manifestations are observed against the background of ectopia. In inflammatory diseases, the processes of maturation and desquamation of the epithelium are disrupted, which creates conditions predisposing to the development of cervical dysplasia. According to I.S. Sidirova and S.A. Levakov, in every seventh woman, cervical cancer (CC) occurs against the background of chronic inflammation, trauma, and a sharp deformation of the cervix. In recent years, the diagnosis and treatment of diseases associated with the human papillomavirus (HPV) has attracted special attention due to the sharp increase in the incidence, significant contagiousness and high oncogenic potential of this pathogen. It is known that the primary factor in the development of cervical cancer is human papillomavirus (HPV). After each change of partner, the risk of infection with genital types of HPV is 10-15%. HPV types 16, 18, 31 and 45, highly oncogenic viruses, are associated with more than 80% of all cases of invasive cervical cancer that occurs against the background of a previRXVG\VSODVWLFSURFHVV&XUUHQWO\LWLVNQRZQWKDW+39LQIHFWLRQSUHYDLOVDPRQJ³\RXQJ´ women from 15 to 25 years old and decreases with age. Along with this, the elimination of HPV and the regression of HPV-associated pathology in young women is faster than in women of the older age group. However, according to data, there has been an increase in the incidence of cervical cancer among young women, in particular, the incidence in women under the age of 20 was 7% per year. Cervical leukoplakia (CLC) is a benign disease but may be a predisposing factor for the 52 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us development of precancer and cervical cancer. Until now, the issue of its pathogenesis, whether it is benign or malignant, remains controversial. In recent years, an assumption has been made about the viral nature of LSM. Although this pathology is not common, malignant transformation of stratified squamous epithelium, according to V.N. Prilepskaya, observed in 31.6% of patients with LSM. In this regard, timely diagnosis of leukoplakia is necessary for the prevention and reduction of the incidence of precancer and cervical cancer. According to a number of authors, important factors contributing to the occurrence of LSM are a long-term inflammatory process supported by a violation of the anatomical structure of the cervix, as well as a history of various destructive methods of influencing the cervix: diathermocoagulation, cryodestruction, CO2 laser vaporization. The presented data once again confirm that the ctological research method currently remains the leading one in the diagnosis of diseases of the cervix. Unfortunately, there is still an erroneous opinion among gynecologists about the dangers of an in-depth cytological examination of the cervix in pregnant women due to possible pregnancy complications. The relevance of the problem of treating benign diseases of the cervix is due to the widespread pathology of the cervix, which occurs, according to V.N. Prilepskaya, in 10-15% of women of reproductive age. In addition, it is known that benign processes may precede malignant neoplasms of the cervix, the incidence of which is currently, according to the studies of V.I. Krasnopolsky has no downward trend. Inflammatory diseases of the cervix, accompanying most background processes, were considered by many researchers as etiological factors of possible malignancy. In the works of E.N. Kaukhova, A.Yu. Lugueva, et al. examined 2119 patients with various non-tumor diseases of the cervix (ectopia, simple leukoplakia, hypertrophy, cervical deformity, nabothian cysts, endometriosis). The significance for the diagnosis and choice of the method of treatment of ultrasound of the pelvic organs, the use of PCR, cytological, bacterioscopic, bacteriological

has been proved. In the studies of I.S. Sidorova, M.N. Zholobova et al. found that 48% of women of reproductive age with combined benign diseases of the uterus (uterine fibroids, adenomyosis and endometrial hyperplasia) were diagnosed with cervical pathology. Research

S.A. Levakova, A.G. Kedrova et al. made it possible to draw the following conclusions: Modern colposcopic diagnosis at the primary gynecological appointment is a highly informative screening method for moderate and severe cervical dysplasia, reduces the time from diagnosis to treatment by 2-4 weeks, and also reduces the number of visits by 1-2 to the doctor, with an average increase in the time for the initial examination up to 7 minutes. The sensitivity of the colposcopic method was 73.2%, the specificity was 64.1%, and its accuracy was 69%. In the presence of signs of invasion identified during colposcopy, the diagnosis coincided with the data of a cytological study in 80% of cases. Author Vaganova S.E. The advantage of using epigen intim spray for cryodestruction of genital warts has been proven. The effectiveness of galenophyllipt in burn erosion of the cervix was studied by the staff of the Institute of Toxicology under the supervision of Doctor of Medical Sciences V.K. Sukhankin. On the model of cervical erosion, a comparative evaluation of the effectiveness of galenophyllipt and the registered drug Solkovagin, manufactured by Solco Basel AG, was carried out. Ectopia of the cervix - displacement of the boundaries of the cylindrical epithelium on the vaginal part of the cervix - is detected in 38.8% of the female population and in 49% of gynecological patients. The hormonal factor in the genesis of precancerous diseases of the cervix is widely discussed. Experimental data show that the induction of cancer under the influence of the human papillomavirus is potentiated by the action of estrogens when the number of actively proliferating cells increases sharply. The frequency of traumatic injuries of the cervix ranges from 5.6 to 30%. A number of researchers believe that the infectious processes of the genitals caused by the herpes simplex virus type 2 play a role in the development of precancerous and cancerous diseases of the cervix. The continuing frequency of pathological conditions of the 53 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us cervix, the tendency to a long, recurrent course, the possibility of transformation make it very important to search for both new effective and safe methods of influencing the pathological focus, and additional factors in order to increase the effectiveness of treatment. The main purpose of the cytological study is to identify the morphological features of cells that characterize the pathological process. The method makes it possible to assess the structure and cellular level of damage to tissues that have fallen into the smear-print, and allows you to identify precancerous changes 3-5 years before the development of cervical cancer. It is known that pregnancy is a risk factor for the development of human papillomavirus infection (PVI) and contributes to the active replication and persistence of HPV. At the same time, the latent form of PVI can turn into subclinical and clinical forms; the clinical features of PVI depend on the type of virus (low and high oncogenic). In patients with highly oncogenic types (16th, 18th), the manifestations of PVI are localized mainly on the cervix in the form of a flat condyloma or the development of cervical intraepithelial neoplasia. With low-oncogenic types (6th, 11th), changes in the cervix are less common, and are determined in the vulva and vagina in the form of genital warts. During pregnancy, visible warts often recur, grow progressively and can reach gigantic proportions. The number of cases of transmission of HPV from mother to fetus, according to different researchers, ranges from 4 to 87%, depending on the sensitivity of the diagnostic methods used. HPV has been described as capable of infecting trophoblast cells, leading to spontaneous abortions. The term "dysplasia" is a morphological and at the same time a clinical concept and includes the process of proliferation of cells with the appearance of atypia in them, especially nuclear, with a subsequent change in the entire structure of the epithelium, the loss of a normal layered structure. Depending on the intensity of cell proliferation, the severity of structural and cellular atypia in the epithelial layer, 3 degrees of dysplasia are distinguished: mild, moderate and severe, characterized by the appearance of atypical cells, first in the lower third, then in the lower two thirds and, finally, in the entire third, then in the lower two-thirds and, finally, the entire thickness of the stratified squamous epithelium, including more superficial sections. The condition in which the expansion of atypical cells continues beyond the basement membrane is called invasive cancer. The problem of diagnosis and treatment of benign diseases of the cervix is due to their steady growth and significant share in the structure of gynecological morbidity. According to T.A. Oboscalova, I.N. Kononova and other diseases of the cervix account for 61.2% in the structure of gynecological diseases. In 83% of cases, the pathology of the cervix is accompanied by a violation of vaginal dysbiosis and immune dysfunctions, which is consistent with the data of other researchers. Colposcopy is one of the leading methods for examining patients with cervical pathology. Currently, the International Classification of Colposcopic Terms, approved at the 14th World Congress of the International Federation of Colposcopy and Cervical Pathology (IFCPC), held in July 2011 in Rio de Janeiro, is used to interpret colposcopic pictures. This colposcopic study also has a predictive value of 64.6% with a sensitivity of 88.4% and a specificity of 43.2%. The most specific features are acetowhite epithelium (prognostic value - 91.7%), iodine-positive mosaic and punctuation (77.8%), atypical transformation zone (77.4%). Diagnosis of precancerous processes in the cervix is carried out in several stages. At the first stage, an initial examination of women is carried out, which includes a thorough history taking, physical examination, examination with gynecological mirrors, bimanual gynecological examination, colposcopy, cytology of smears, analysis of vaginal smears to determine the flora. Colposcopy (CS) is a highly informative, widely available and inexpensive method for diagnosing diseases of the cervix (CC), vagina, and vulva, which significantly increases the efficiency of examining women with gynecological pathology. Along with other modern

of examination, the CS allows you to choose the best ways to manage patients and monitor the state of the epithelium of the cervix, vagina and vulva in various physiological 54 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us periods of a woman's life, and can be used repeatedly. The main task of the CS is to identify precancerous conditions of the cervical epithelium, which include dysplasia of the stratified squamous epithelium (SSE) and endocervical glandular epithelium, which is initiated by the human papillomavirus (HPV). Extended CS - the most effective and common technique - examination of the epithelium using various epithelial and vascular tests, which assess the response of tissues in response to treatment with drug formulations. The technological chain of the CS includes examination of tissues under different magnifications, using a filter, after treatment with acetic acid and Lugol solutions. Each stage allows you to clarify colposcopic data, since the method is to a certain extent subjective and requires sufficient training and qualifications. The colposcope is an optical system mounted on a tripod (binocular loupe) with a directional lighting system. It is recommended to use a binocular colposcope, since monocular devices and digital devices without eyepieces have low research efficiency due to the inability to obtain a three-dimensional three-dimensional picture. With a pathological colposcopic picture (acetowhite epithelium, puncture, mosaic, dyskeratosis, iodine-negative zone, the presence of atypical vessels), if invasive carcinoma is suspected during colposcopy, as well as when cytological smears of types III, IV and V are obtained, a targeted biopsy is performed followed by a histological examination of the biopsy . Many clinicians involved in the problem of diagnosis and treatment of benign diseases of the cervix note that against their background, deep naboth cysts are often detected in the thickness of the cervix. According to V.N. Prilepskaya et al. Inadequate choice of treatment method in the presence of a large number of treatment methods in the presence of a large number of cysts or their deep location affects the effectiveness of treatment. Until now, there is no consensus among clinicians regarding the tactics of managing patients with another pathology of the cervix - cervical canal polyps. Most authors consider it necessary to perform hysteroscopy, polypectomy in the endometrium, as well as the possible location of the pedicle of the cervical canal polyp in the uterine cavity. In recent years, a number of works have appeared on the use of ultrasound to detect cysts of the cervix and polyps of the cervical canal. However, ultrasound does not fully evaluate from the point of view of choosing a method of treatment for these types of pathology of the cervix. In women with a healthy cervix, the material is obtained from three sites: from the exocervix, from the site on the border of the stratified squamous epithelium and the cylindrical epithelium of the cervical canal from the lower third of the endocervix. To do this, use special brushes (cervix bronch), spatulas, grooved probes, Volkmann spoons. It is fundamentally important that colposcopic and cytological studies do not allow assessing the morphological changes in the epithelium in its deep layers, its deep layers, therefore, the histological method plays a decisive role in assessing morphological changes. If the histological

shows mild, moderate or pronounced dysplasia (CIN I, II, III), in these cases it is recommended to perform a separate diagnostic curettage of the mucous membrane of the cervical canal and the body of the uterus with a histological examination of the scrapings. Thus, diseases of the cervix continue to be an urgent problem of gynecology and the most common pathology of the female genital area. As studies by gynecologists, hygienists and other specialists have shown, a woman's body reacts to adverse environmental factors with the emergence of a number of adaptive reactions, which can later turn into a pathomorphological state. Conclusions. Thus, colposcopy is recommended for widespread implementation in the practice of obstetricians and gynecologists in order to carry out comprehensive diagnostic measures. Due to the use of digital video systems with software in modern colposcopes, the effectiveness of this diagnostic 55 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us

is significantly increased, which allows for adequate timely treatment. Comprehensive diagnostic measures with the inclusion of colposcopy in polyclinics, gynecological hospitals, more in-depth studies carried out in specialized oncological institutions are promising and expedient, as they improve the accuracy of diagnosing diseases of the cervix, provide adequate timely treatment and provide secondary prevention of cervical cancer. Literature 1. Rakhmatullaeva MM, Navruzova NO The role of colp in the early diagnosis of the cervix// Almanac of Young Science. 2018 No. 4. S. 21-23. 2. Ashurova, NG, & Navruzova, NO (2017). Preclinical diagnosis of cervical diseases. News of dermatovenerology and reproductive health. 3. Ikhtiyarova GA, Navruzova NO, Karimova GK Modern diagnostic methods for early detection of cervical diseases // Doctor akhborotnomasi. 2019. N. 4. P. 78-80. 4. Navruzova, NO, & Karimova, GK (2019). Modern diagnostic methods for early detection of cervical diseases. Doctor akhborotnomasi, (4), 78-80. SCIENTIFIC PROGRESS VOLUME Ä,668(Ä,661-1601 Uzbekistan www.scientificprogress.uz Page 207 5. Ikhtiyarova, GA, Navruzova, NO, & Karimova, GK (2019). Modern diagnostic methods for early detection of cervical diseases. Doctor akhborotnomasi, (4), 78-80. SCIENTIFIC 352*5(66 92/80(  Ä ,668(  Ä  ,661  -1601 Uzbekistan www.scientificprogress.uz Page 207