Journal of obstetrics and women's diseases

Peer-review bimonthly medical journal

Editor-in-Chief

Eduard K. Ailamazyan, MD, PhD, Academician of the Russian Academy of Sciences

Publisher

About

The Journal has been issued since 1887. It is the first scientific journal in Russia for obstetricians and gynecologists. For over a century, the Journal regularly covers the latest achievements of Russian science.

Journal of Obstetrics and Women's Diseases, a Gold Open Access journal, publishes six volumes per year. Additionally, the Journal will publish occasional special issues featuring selected papers from major conferences.

Journal Topics

Journal of Obstetrics and Women's Diseases is a scientific and practical peer-reviewed medical journal, which discusses the most pressing health issues:

  • reproductive health;
  • results of clinical and sociological research;
  • current problems in perinatal obstetrics;
  • issues of gynecological endocrinology, pregravid preparation, and family planning;
  • actual problems in operative gynecology;
  • diagnostics and therapy of reproductive tract infections;
  • advances in clinical genetics and prenatal diagnosis of hereditary and congenital diseases, immunology, and pathology;
  • new and important information and recommendations for the practical physicians (introduction of modern diagnostic and therapeutic technologies, the use of effective drugs, etc.);
  • impact of harmful environmental and production factors on the female reproductive system.

Journal Mission

The main mission of the Journal is to provide new scientific and technical information, to promote scientific knowledge, to help obstetricians and gynecologists to choose the best methods of diagnosis and treatment, and to help improve their skills.

The publications of the Journal are of interest to a wide range of scholars in the field of obstetrics, gynecology, reproduction, genetics, pathology, and immunology of reproduction, as well as for medicine and biology tutors and students.

Abstracting and Indexing


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Management of pregnant, parturient, and postpartum women with novel coronavirus infection (COVID-19)

Posted: 11.01.2021

New publication: Brief clinical guidelines. Management of pregnant, parturient, and postpartum women with novel coronavirus infection (COVID-19). ICD-10: U07.2, U07.1 (Version 2.0 of 11/01/2021). Download


 

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Vol 73, No 1 (2024)

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Original Research

Serotonin receptor and serotonin transporter expressions in the placental villous tree in gestational diabetes mellitus
Bettikher O.A., Belyaeva O.A., Dukovich A.I., Vorobeva O.M., Tral T.G., Tolibova G.K., Bart V.A., Kogan I.Y., Zazerskaya I.E.
Abstract

BACKGROUND: The serotonergic system during pregnancy plays an important role not only in carbohydrate metabolism, but also in the laying and regulation of the fetoplacental complex, growth and development of the fetus. The study of the expression of placental serotonin 5-HT2A receptor and serotonin transporter (SERT) in gestational diabetes mellitus is foremost for scrutinizing the pathogenesis of perinatal complications, as it may allow for finding new opportunities for their prevention and correction.

AIM: The aim of this study was to compare the expression patterns of the serotonin 5-HT2A receptor and SERT in placental tissue in gestational diabetes mellitus and in normal pregnancy.

MATERIALS AND METHODS: This comparative cohort study included pregnant women with gestational diabetes mellitus (n = 6) and patients with normal pregnancy (n = 10). The expression of serotonin 5-HT2A receptor (Abcam, USA) and SERT (Bioss Antibodies, USA) was studied in placenta samples from the both study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia).

RESULTS: The relative area of SERT expression in the placenta in gestational diabetes mellitus was higher compared to normal pregnancy (p < 0.001). The relative areas of expression of the serotonin 5-HT2A receptor in the placenta did not differ between the study groups (p = 0.5).

CONCLUSIONS: Higher SERT expression in the placentas of patients with gestational diabetes mellitus compared to those from women with normal pregnancies may reflect the level of tension of compensatory mechanisms in gestational diabetes mellitus and the effect of insulin therapy on these mechanisms.

Journal of obstetrics and women's diseases. 2024;73(1):5-16
pages 5-16 views
Assessment of the impact of COVID-19 experienced at different stages of gestation on perinatal outcomes and structural changes in the placenta
Borovaya S.Y., Yakimova A.V., Ageeva T.A., Mudrov V.A.
Abstract

BACKGROUND: At the beginning of the pandemic COVID-19, the attention of obstetricians and gynecologists was focused on studying the impact of SARS-CoV-2 on obstetric and perinatal outcomes. Currently, the dynamics of mutations in genes encoding SARS-CoV-2 proteins determines the emergence of a large number of new strains of the virus that are highly virulent. Given this fact, the problem of assessing the impact of COVID-19 on pregnancy outcomes also remains relevant.

AIM: The aim of this study was to assess the impact of the novel coronavirus infection (COVID-19) transmitted at different stages of gestation on perinatal outcomes and structural changes in the placenta.

MATERIALS AND METHODS: In 2022–2023, a prospective analysis of 113 cases of childbirth in women who had the novel coronavirus infection during pregnancy was carried out in obstetric institutions in Novosibirsk. The total sample of subjects was divided into three study groups using cluster analysis. Group 1 included 25 women who had SARS-CoV-2 at a gestation period of up to 16 weeks; Group 2 consisted of 61 patients who underwent COVID-19 at gestation period of 17 to 34 weeks; and Group 3 comprised 27 pregnant women in whom COVID-19 was detected after 34 weeks of pregnancy. The control group included 65 pregnant women who had a negative smear test result for SARS-CoV-2. Pathological examination of the placenta included macro- and microscopic studies. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 program.

RESULTS: The most common fetal distress was observed in patients of Groups 1 and 2 (p = 0.002). We found an inverse correlation between the gestational age at which a woman suffered coronavirus infection and the volumetric density of capillaries and intervillous fibrinoid, as well as the percentage of formation of the syncytial-capillary membrane and villi with symplastic buds. On the contrary, a direct correlation between the gestational age and the volumetric density of connective tissue was found. Intervillusitis was more often observed in the placentas of women of Groups 1 and 2. Histitocytic infiltration was characteristic of the placentas of patients of Group 2.

CONCLUSIONS: The frequency of adverse perinatal outcomes and the intensity of structural changes in the placenta depend on the gestation period in which the patient suffered the novel coronavirus infection. The most significant structural changes in the placenta were detected in patients of Group 2.

Journal of obstetrics and women's diseases. 2024;73(1):17-28
pages 17-28 views
Personalized approach to outpatient management of patients taking tamoxifen by gynecologists
Golubenko E.O., Savelyeva M.I., Korennaya V.V., Podzolkova N.M.
Abstract

BACKGROUND: 30% of women with luminal breast cancer receiving adjuvant tamoxifen experience disease recurrence within 15 years. This demonstrates the wide variability in clinical response to tamoxifen. Both nongenetic (age, gender, body mass index, duration of drug use) and genetic factors have been described to influence the high variability of response to tamoxifen. Differences in the genes encoding the enzymes CYP2D6, CYP2C, and CYP3A (CYP2D6*4, CYP3A5*3, CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*3) and the ABCB1 gene (C3435T) may also be the main factors of susceptibility to the occurrence of undesirable effects when taking tamoxifen, which in turn may lead to decreased patient adherence to therapy.

AIM: The aim of this study was to create a concept and an algorithm for a personalized approach to outpatient management of patients taking tamoxifen by a gynecologist in connection with the carriage of polymorphisms of cytochrome P450 and drug transporter genes.

MATERIALS AND METHODS: In 2017–2018, the outpatient records of 230 patients with breast cancer were analyzed retrospectively. A single-stage pharmacogenetic study of 120 women with stage I–III luminal breast cancer taking tamoxifen was conducted prospectively for the presence of cytochrome P450 gene polymorphisms using the polymerase chain reaction method and assessing associations with adverse drug reactions, and 54 patients were interviewed after five-year follow-up to assess adherence and satisfaction with medical supervision.

RESULTS: The likelihood of developing endometrial hyperplasia has been shown to increase while taking tamoxifen with increasing average age, body mass index, duration of tamoxifen use, and postmenopause. Significant associations have been identified between the carriage of the CYP2D6, CYP2C9, CYP2C19, CYP3A5, and ABCB1 gene polymorphisms and the development of adverse drug reactions. Predictive models have been developed to determine the risk of adverse drug reactions. All studied adverse drug reactions associated with various genetic polymorphisms predominated in the group of patients who stopped taking tamoxifen due to poor intolerance. Gynecologists regularly observed 57.4% of patients. Moreover, the higher the adherence to therapy was, the higher was the regularity of observation by a gynecologist.

CONCLUSIONS: A plan for outpatient management of patients receiving adjuvant endocrine therapy with tamoxifen by a gynecologist has been developed.

Journal of obstetrics and women's diseases. 2024;73(1):29-39
pages 29-39 views
Evaluation of serotonin levels in full-term newborns of diabetic mothers
Zvereva N.A., Milyutina Y.P., Arutjunyan A.V., Evsyukova I.I.
Abstract

BACKGROUND: The growth of neurological and mental diseases in the offspring of patients with pre- and gestational diabetes mellitus determines the need to study the regulatory function of the serotoninergic system of the brain in newborns. This plays a key role in its morphofunctional development in early ontogenesis, which is necessary for timely diagnosis of disorders and prevention of long-term consequences.

AIM: The aim of this study was to evaluate serotonin levels in full-term newborns with diabetic fetopathy from mothers with pre- and gestational diabetes mellitus.

MATERIALS AND METHODS: The main group consisted of 45 newborns with diabetic fetopathy, of whom 30 individuals were from mothers with type 1 diabetes mellitus and 15 ones from mothers with gestational diabetes mellitus. The control group comprised 20 healthy full-term newborns from healthy mothers without pregnancy complications. Serotonin concentrations were determined in platelet-rich plasma of blood from the umbilical cord vein, and in a platelet suspension prepared from venous blood taken on the first day of life, using high-performance liquid chromatography with electrochemical detection.

RESULTS: Platelet-rich plasma serotonin level in umbilical cord blood taken from newborns of the main group was more than two times lower compared to children of healthy mothers. This parameter in venous blood taken from mothers with type 1 diabetes (0.744 ± 0.117 µmol/l) corresponded to that in healthy patients, while in mothers with gestational diabetes mellitus, it was significantly lower and amounted to 0.331 ± 0.071 µmol/l (p < 0.05). Moreover, platelet-rich plasma serotonin level in all newborns correlated with that in their mothers (R = 0.505; p < 0.05). Serotonin levels in venous blood platelets of newborns of the main group was almost 2.5 times lower than in healthy ones.

CONCLUSIONS: The data obtained indicate the need to use platelet serotonin values as a biochemical marker of disorders of functional brain development in children with diabetic fetopathy.

Journal of obstetrics and women's diseases. 2024;73(1):41-50
pages 41-50 views
Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction
Rusina E.I., Zhevlakova M.M., Shelayeva E.V., Yarmolinskaya M.I.
Abstract

BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life.

AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age.

MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure.

RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p < 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p < 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires.

CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the effect of therapy is associated with biodegradation of the drug. This method of treating mild forms of stress urinary incontinence is effective for women of reproductive and perimenopausal age who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.

Journal of obstetrics and women's diseases. 2024;73(1):51-66
pages 51-66 views

Reviews

Evaluation of renal function in patients with type 1 diabetes mellitus implementing reproductive function in assisted reproductive technology protocols
Veretekhina T.V., Yarmolinskaya M.I.
Abstract

The prevalence of type 1 diabetes mellitus has increased significantly among women of reproductive age over the past two decades. Despite improved glycemic control and intensified insulin therapy, patients with diabetes still suffer from many reproductive problems, which often makes this group of patients potential participants in assisted reproductive technology programs under certain conditions. Diabetic nephropathy is one of the most serious complications of type 1 diabetes mellitus. It ranks first in the structure of chronic kidney disease and is a common cause of end-stage renal failure, disability, and mortality. Early diagnosis and identification of specific markers of diabetic nephropathy will allow for timely initiation of nephroprotective therapy to slow the progression of diabetic kidney damage.

This review article is based on the results of the PubMed, Frontiers, and ResearchGate search queries from 2016 to 2023. We analyzed worldwide and domestic data on the impact of type 1 diabetes mellitus on kidney function, the influence of sex hormones on diabetic nephropathy, and the importance of the personalized approach to this group of patients at the pre-pregnancy stage, especially those planning treatment within assisted reproductive technology programs.

Journal of obstetrics and women's diseases. 2024;73(1):67-79
pages 67-79 views
Diabetes mellitus during pregnancy — complications for the fetus and newborn
Gadzhieva P.K., Dikareva L.V.
Abstract

Currently, diabetes mellitus is considered one of the most common problems in obstetrics and neonatology, associated with its high incidence and complications it causes — perinatal loss and morbidity of newborns, as well as further negative consequences for the child’s health. The incidence of diabetes mellitus is increasing in the world every year. According to forecasts of the International Diabetes Federation, there is no tendency to decrease the incidence in the near future. The increase in the incidence of diabetes mellitus is also due to a change in the criteria for diagnosis set out in the Gestational Diabetes Mellitus Treatment Guidelines. In addition, patients often do not understand the seriousness of the complications that occur with the disease, thereby not following the doctor’s treatment recommendations. To date, it has been proven that diabetes mellitus is a main cause of perinatal morbidity and mortality. According to the World Health Organization, even slight hyperglycemia in the mother during pregnancy is associated with the development of diabetic fetopathy.

This article provides an analytical review of current literature covering the issues of perinatal and neonatal outcomes in the presence of diabetic fetopathy. Its characteristic phenotypic signs include macrosomia (due to increased fat deposition in subcutaneous tissue associated with increased production of somatotropic hormone) or microsomia (due to primary placental insufficiency), general pastiness, skin hyperemia, characteristic сushingoid-type appearance, body disproportion, puffy face in combination with other signs of immaturity, as well as transient hypertrophic cardiomyopathy and hepatosplenomegaly.

Journal of obstetrics and women's diseases. 2024;73(1):81-90
pages 81-90 views
Postoperative adhesions in urgent gynecological practice — the analysis of etiological and pathophysiological factors
Gudz O.V., Sulima A.N.
Abstract

The adhesive process in the abdomen in the postoperative period is still a stumbling block for modern medicine. This is due to the fact that surgical activity is increasing, but there is no common solution for precaution. Complications associated with adhesions after urgent gynecological interventions are some of the causes of infertility, which becomes a problem for not only healthcare and society, the patient and their future, but also the government, as it leads to population decline.

This review is focused on the study of the adhesive process etiology in surgical gynecology and the pathogenesis traits. We analyzed the literature on the Web of Science, eLibrary, Scopus, and PubMed/Medline using the following keywords: “adhesions,” “adhesive process,” “review,” “operations,” “pathogenesis of formation of adhesions,” and “reproductive dysfunction”. The research included full-text sources and literature reviews on the studied subject. Articles not related directly to the topic of the adhesive process in the postoperative period were excluded from the review.

This literature review has demonstrated that despite the ongoing research of scientists all over the world into postoperative adhesion, its etiology and pathogenesis remain not fully understood and disclosed. This dictates the need to continue studying the adhesive process and searching for new solutions in prevention. As far as the attention of surgeons and reproductive specialists is focused on the issues of preventing the adhesive process, we are confident that in the near future, scientists will find a unified solution to this complex problem and practical healthcare specialists will successfully implement it.

Journal of obstetrics and women's diseases. 2024;73(1):91-100
pages 91-100 views
Gestational diabetes mellitus as a risk factor for neuropsychiatric pathology in offspring
Evsyukova I.I.
Abstract

This review article summarizes current ideas about gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity in offspring. Herein, we describe the genetic programming patterns of morphofunctional brain development during intrauterine life, which provide the basis for short- and long-term functions of the central nervous system. The results of experimental and clinical studies are presented that explain the pathophysiological mechanisms of the harmful effects on the fetal brain of hyperglycemia, hyperinsulinemia, hyperlepthyremia, oxidative stress, and systemic inflammation in the mother with pregnancy complicated by diabetes mellitus. We also discuss structural brain abnormalities and neuropsychiatric consequences. The article substantiates the need for the prevention of neuropsychiatric diseases in the offspring of women with obesity and other concomitant pathology at the stage of family planning, and at the onset of pregnancy, the expediency of early screening, treatment of gestational diabetes mellitus and neuroprotection in the perinatal period of the child’s life.

Journal of obstetrics and women's diseases. 2024;73(1):101-111
pages 101-111 views
Hypotensive therapy in obstetric practice
Ziganshin A.M., Maksyutova A.A.
Abstract

Arterial hypertension remains a leading cause of maternal morbidity and mortality while leading to significant economic costs in health care. Properly selected treatment tactics allow for prolonging pregnancy and levelling out various complications arising from the disease. However, there are still some questions about the effectiveness and safety of prescribed therapy due to possible side effects of the drugs. The aim of this study was to evaluate the efficacy and complications of hypotensive therapy during pregnancy, childbirth and the postpartum period. We analyzed the literature on eLibrary, Scopus, Cochrane Library, PubMed.

Journal of obstetrics and women's diseases. 2024;73(1):113-123
pages 113-123 views
Mechanisms of injury in the nervous system in fetuses with growth restriction
Nikolayenkov I.P., Shakalis D.V., Sudakov D.S.
Abstract

This review article analyzes current literature on the mechanisms of damage to the nervous system in fetal growth restriction, which is a leading cause of perinatal morbidity and mortality in the economically developed countries. In some cases, this condition is associated with damage to the fetal nervous system, the symptoms of which can persist throughout life. Foundation of the effective pathogenetic therapy for intrauterine growth restriction during pregnancy would significantly reduce child mortality, morbidity and disability, and ease the financial burden on the healthcare system and social institutions.

Journal of obstetrics and women's diseases. 2024;73(1):125-136
pages 125-136 views
Pathogenetic traits of preeclampsia in COVID-19. A relevant literature review
Rudenko K.A., Ishkaraeva V.V., Zazerskaya I.E.
Abstract

The aim of this study was to present the latest data on the association of preeclampsia and coronavirus infection and on the preeclampsia-like syndrome, and to analyze the current literature on the pathogenetic relationships between COVID-19 and preeclampsia and on morphological changes in placental tissue in patients with these gestational complications.

A significant portion of studies indicate an increased risk of developing preeclampsia in patients with coronavirus infection during pregnancy, regardless of gestational age, especially in severe COVID-19, but other researchers report no association between coronavirus infection and the onset of preeclampsia. The supposed pathogenetic connection between these pathologies consists in the development of systemic endothelial dysfunction and dysregulation of the renin-angiotensin-aldosterone system, while the direct effect of SARS-CoV-2 on the placentation is poorly understood and is a subject of debate. A new concept of the so-called “preeclampsia-like syndrome” has been introduced, which presumably occurs in patients with a severe form of the novel coronavirus infection as its extrapulmonary manifestation. The measurement of the ratio of soluble fms-like tyrosine kinase-1 activity to the level of placental growth factor ratio has been proposed as a differential diagnostic test between preeclampsia and the preeclampsia-like syndrome, but its prognostic value remains ambiguous. The morphological examination of placentas in patients with coronavirus infection and preeclampsia indicates the signs of maternal and fetal vascular malperfusion.

The literature on the association between coronavirus infection and preeclampsia remains controversial, however, the better half of the researchers is indicative of a significant increase in the risk of developing this serious complication in pregnant women with COVID-19, especially for its severe form. New information about the preeclampsia-like syndrome, as well as the virtual absence of studies of placental morphology in patients with preeclampsia and coronavirus infection during pregnancy, dictate the need for further study to better understand the association between these two pathologies, determine the possibilities of patient surveillance and prevent complications.

Journal of obstetrics and women's diseases. 2024;73(1):137-148
pages 137-148 views
Modern view of preconception carrier screening
Talantova O.E., Postnikova T.B., Mikhailova A.A., Bespalova O.N.
Abstract

The article provides an overview current literature covering the issues of preconception carrier screening.

Hereditary diseases make a large contribution to disability, deterioration in quality of life and reduction in life expectancy, primarily among the child population. Treatment and rehabilitation of patients with hereditary diseases is accompanied by serious economic costs, as well as psychological and social problems. In many countries, preference for preventive measures over treatment measures is enshrined in law. Awareness of preconception carrier screening among non-genetic doctors and the general population is currently very low.

The development and introduction into practical healthcare of effective approaches to the prevention of hereditary diseases is of paramount importance in reproductive medicine. Conducting expanded carrier screening before pregnancy will allow for identifying in future parents the latent carriage of hereditary diseases responsible for infertility, miscarriage, infant or child mortality, and fetal development abnormalities, as well as formulating optimal tactics to prepare and introduce pregnancy, including the use of diagnostic and preventive measures.

Journal of obstetrics and women's diseases. 2024;73(1):149-156
pages 149-156 views

Theory and Practice

New International Federation of Gynecology and Obstetrics ovulatory disorders classification system 2022. Diagnostic assessment of ovulatory dysfunction
Kovalyova Y.V.
Abstract

Until recently, researchers and clinicians have used the World Health Organization classification of ovulatory disorders (1973), which was based on the levels of gonadotropins and estrogens in the blood serum (mainly follicle-stimulating hormone) and classified ovulatory disorders depending on the hypothalamic-pituitary-ovarian axis dysfunction levels.

This review article presents a new classification system for ovulation disorders developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2022. The first level of this classification system is based on an anatomical approach (hypothalamus, pituitary gland, ovaries), which is complemented by a separate category for polycystic ovary syndrome. At the second level, each anatomical category is classified according to the putative etiopathogenetic mechanisms underlying ovulation disorders. The third level suggests the presence of specific nosologies, which represent the direct cause of ovulation disorders. This new classification should be used after a preliminary examination that reveals the presence of an ovulation disorder. This review discusses various ovulation disorders and provides tools for their diagnosis in accordance with international guidelines and domestic recommendations.

Journal of obstetrics and women's diseases. 2024;73(1):157-170
pages 157-170 views


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