Obstetrics and Gynecology

Uterine myoma is the most common benign tumor in gynecological practice and the leading cause of hysterectomy. This pathology has clinical manifestations in every three female patients, decreases quality of life and level of fertility in reproductive-aged women, and also substantially affects the human potential of any country. Uterine fibroids can be now treated with various medical, surgical, interventional, and ablative methods that differ in the nature of their impact, in the criteria for selecting female patients, in the required level of technical equipment, and in economic characteristics. In connection with to the active introduction of modern minimally traumatic local treatments into wide practice, high-intensity focused ultrasound therapy, a non-invasive thermal ablation technique for solid neoplasms at various sites, is of particular interest to patients with uterine myoma. The literature review presents the possibilities of using high-intensity focused ultrasound therapy in patients with uterine myoma; highlights the advantages and disadvantages of this type of local thermal effect in the treatment of a benign uterine tumor; determines indications for and contraindications to highintensity focused ultrasound therapy; describes the main complications of ultrasound ablation and ways for their prevention; identifies criteria for the efficiency of treatment, as viewed from both the general somatic characteristics of a woman and the biological characteristics of a myomatous node and the parameters of the procedure; and demonstrates the clinical results of local treatment (the time course of changes in tumor sizes, pain syndrome level, menorrhagia volume) and its impact on female reproductive abilities. Conclusion: The present study has shown that high-intensity focused ultrasound therapy can be considered as an affordable, effective, relatively safe method to treat patients with uterine myoma.

Objective: To summarize the data available in the literature on the currently used criteria for evaluating the vaginal microbiota in reproductive-aged women, the principles of its classification, and the exogenous and endogenous factors influencing the microbial structure. The review includes data from the publications presented in the MedLine and Russian Science Citation databases. The review describes the key distinguishing features of the species Lactobacillus iners from other vaginal lactobacillus species, including cultivation features, tinctorial properties, and pathogenicity power. It presents data on the frequency of this species in the microbiota of reproductive-aged women and elucidates the need for its isolation and identification in the microbiological laboratories of any level in order to make a correct diagnosis. There are data on the characteristics of the vaginal microbiota in bacterial vaginosis, which are due to a variety of the microflora, including the species diversity of Gardnerella spp. The review highlights the role of a polymicrobial biofilm in the pathogenesis of bacterial vaginosis. It touches upon the relevance of a further study of the interaction of Gardnerella spp. and L. iners species, as well as the effectiveness of an integrated approach to evaluating the vaginal microbiota, by using the results of classical and molecular biological methods. Conclusion: L. iners is one of the most common lactobacilli in the microbiota of reproductive-aged women. The role of this species in the functional stability of the vaginal microbiota has not yet been def ined to date. Further investigation of the species is required to establish strain diversity. There is a need for routine practice introduction of research methods allowing the isolation of L. iners in the microbiological laboratories of all levels.

This review analyzes an update on the clinical presentations of female genitourinary malformations (OHVIRA or Herlyn-Werner-Wunderlich syndrome) and new approaches to their diagnosis and treatment. The review includes data from foreign and Russian articles found in PubMed on the topic under consideration and published in recent years. The state-of-the-art in the area under study is analyzed. The data on the diagnosis and management of patients with the rare associative state are systematized; further areas that require in-depth study are identified. Conclusion: The presented studies indicate that there is a need to revise the name of the Herlyn-Werner- Wunderlich syndrome and the acronym OHVIRA in favor of uterovaginal septum and ipsilateral renal anomaly. The important role of and need for the widespread introduction of visual diagnostic methods and minimally invasive surgical treatment technologies in the management of these patients in order to improve the efficiency of medical care are emphasized.

Background: Selective fetal growth restriction (sFGR) affects 10-25% of all monochorionic twin pregnancies. If not detected and treated, sFGR is associated with high perinatal mortality and a wide range of neonatal complications. However, currently, due to the introduction of the dynamic fetal monitoring and intrauterine treatments, including fetoscopic laser coagulation of placental vascular anastomoses and the determination of optimal delivery time, it is possible to achieve high survival rates for both fetuses. The main etiological factor of sFGR is placental dysfunction, including morphological and functional changes associated with reduced placental volume, impaired development of arterio-arterial anastomoses, and vascular and angiogenic factors during the formation of an early monochorionic pregnancy. Objective: To investigate the role of vascular endothelial factors in the development of sFGR in monochorionic twin pregnancy. Materials and methods: The study included 51 patients with monochorionic diamniotic twins. Group 1 comprised patients with sFGR (n=31) and Group 2 consisted of patients with uncomplicated monochorionic twin pregnancies (n=20). The study retrospectively analyzed the role of maternal vascular and angiogenic factors at 18-26 weeks’ gestation in the development of sFGR. The analysis also included the evaluation of perinatal outcomes, the course of the early neonatal period, stay in the intensive care unit, and length of hospital stay at the second stage of nursing. Results: The mean age of participants was 31.6 (5.13) years. There were no statistically significant differences in concentrations of vascular and angiogenic factors, pregnancy and early neonatal outcomes. However, high concentrations of maternal VEGF-R1, VEGFC, and HIF-1a were associated with neonatal mortality, and a high concentration of HIF-1a was associated with stillbirth. These findings may be used in clinical practice to predict antenatal and early neonatal loss. Pregnant women with sVEGF-R1 greater than 0.787ng/mL and Ang-2greater than 8255.91 ng/mL were found to have an increased risk of low-birthweight babies. Conclusion: Comparative assessment of vascular and angiogenic factors in sFGR pregnancies offers the opportunity to prevent the progression of this condition by timely fetoscopic intervention, improve perinatal outcomes, and minimize the risks of severe antenatal and neonatal complications.

According to current concepts, immunological mechanisms play a fundamental role in the initiation of labor. The current literature lacks information related to the plasma cytokine content of pregnant women prior to spontaneous and induced labor. Studying the cytokine profile may contribute to the identification of its imbalance and determine prognostic criteria for failed labor preinduction. Objective: To investigate cell subpopulation composition and cytokine content in peripheral blood before spontaneous and induced labor. Materials and methods: A prospective pilot study included 30 healthy primiparous women who were divided into 3 groups. Control group (n=8) included women with early signs of labor; patients in group 1 (n=14) required one stage of labor preparation to develop labor activity; patients in group 2 (n=8) required two stages of preparation. Results: Women who required longer labor preparation had significantly higher TNF-a levels [2.9 (2.0;3.1) vs 2.9 (2.0;3.7) vs 5.4 (4.3;6.1) pg/ml in the control group, group 1 and group 2, respectively, p=0.025]. Conclusion: The highest level of TNF-a in women who required the second stage of labor preparation probably reflects slower cervical ripening.

About half of women planning pregnancy have too much adipose tissue, insulin resistance, hypothalamic-pituitary-ovarian axis disorders, and consequently anovulation and infertility. Objective: To assess the results of using the biologically active dietary supplement Dikirogen (myo-inositol and D-chiroinositol in a ratio of 5:1) in conjunction with combination therapy for anovulation in overweight and obese women. Materials and methods: During 2021-2022, a descriptive study assessing the results of lifestyle changes (in diet and exercises) and nutritional support (a combination of myo-inositol 1000 mg and D-chiroinositol 200 mg, folic acid 200 ig, and manganese 5 mg (Dikirogen) was conducted in the clinics of Moscow, Nizhny Novgorod, Novosibirsk, Krasnodar, Yekaterinburg, and Voronezh in 197 reproductive-aged women who had overweight or obesity and anovulation for 2-4 months. Results: The use of the biologically active dietary supplement Dikirogen in conjunction with combination therapy (diet + exercises) caused decreases in body weight by 2.5 kg, body mass index (BMI) by 0.5 kg/m2, and waist circumference by 1.75 cm. The normal menstrual cycle was 1.41 times more often observed at Visit 2. There were reductions in LH levels from 8.45 (3.91) to 6.4 (4.9; 8.8) mU/ml and in the LH/FSH ratio from 1.4 (0.9; 2.0) to 1.2 (0.8; 1.6) (p<0.0001). There were also significant decreases in fasting glucose levels from 5.0 (4.5; 5.5) to 4.8 (4.2; 5.0) mmol/l (p<0.0001) and on the number of women with fasting glucose levels above 5.1 mmol/ml by 3.07 times. During 80-90follow-up days, pregnancy occurred in 30 (15.2%) patients; at Visit 2, the ovulation test was positive in 96 (48.73%) women. Conclusion: The results of the study can recommend Dikirogen containing myo-inositol and D-chiroinositol in a ratio of 5:1, folic acid, and manganese in conjunction with combination therapy (diet, exercises) to obese and overweight women with complaints of anovulation and failure to achieve pregnancy,

Polycystic ovary syndrome (PCOS) occurs in every 5 reproductive-aged women. Women with PCOS are frequently found to have carbohydrate metabolism disorders, overweight, and obesity. The pathogenesis of PCOS is associated with both insulin resistance and a proinflammatory state, oxidative stress, which support the development of metabolic disorders. The role of micronutrients in both the correction of inflammation and oxidative stress and the processes of steroidogenesis, epigenetic regulation, lipid metabolism, and glucose and insulin transport is known. Widespread deficiencies of vitamin D and omega-3 polyunsaturated fatty acids (PUFAs) are the most common conditions associated with the insufficient intake of these micronutrients in the population. Correction of deficiency conditions with the use of vitamins and dietary supplements in women with PCOS is reflected in numerous new studies investigating the benefits of these treatments. This review summarizes the latest data of randomized controlled trials, meta-analyses, and systematic reviews that analyze the efficacy of vitamin D and omega-3 PUFAs in the treatment of PCOS. Conclusion: Using the drugs that affect steroidogenesis, insulin resistance, and lipid metabolism and correcting inflammation and oxidative stress in combination with basic treatment and therapeutic lifestyle changes can prevent adverse reproductive and metabolic outcomes in women with PCOS. The data of the presented studies suggest that the use of vitamin D and omega-3 PUFAs may be a useful adjunctive treatment for PCOS.

Background: Mirror syndrome is a rare pregnancy complication that occurs with obvious placental hydrops in the presence of immune or non-immune hydrops fetalis. The clinical symptoms of the mirror syndrome bear similarities to those of preeclampsia, but unlike the latter, they are reversible as placental hydrops and hydrops fetalis resolve. Therefore, the differential diagnosis of the mirror syndrome and preeclampsia is very important and determines the tactics of managing a patient and the prognosis of this pregnancy. Case report: Our paper describes an observation of pregnant patients with monochorionic twins, whose pregnancy was complicated by anemia polycythemia sequence accompanied by evident placental hydrops and by the development of the mirror syndrome with clinical presentations of pulmonary edema. The described cases show the time course of changes in laboratory parameters, including angiogenic (PlGF) and antianginal (sFLt-1) factors. A decreased sFLt-1/PLGF ratio was noted as placental hydrops reversed, which made it possible to regard these changes as an additional laboratory tool for the differential diagnosis of the mirror syndrome with preeclampsia. The correctly diagnosed mirror syndrome determined the tactics of managing these patients and allowed a long-awaited pregnancy to be maintained in both cases. Conclusion: The mirror syndrome and preeclampsia are needed to make a careful differential diagnosis. Determining the changes in the sFLt-1/PLGFratio can be used as an additional laboratory differential diagnostic test.