Scientific peer-reviewed medical journal. Publish 12issues per year since 1922 Editor-in-Chief: Gennadiy T. Sukhikh, M.D.; Ph.D.; Academician of the Russian Academy of Sciences; Director of National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation. ORCID: 0000-0002-7712-1260 Indexation: Russian Science Citation Index, Google Scholar, Ulrich's Periodicals Directory, WorldCat, Scopus, EBSCO, Emerging Sources Citation Index WoS, Russian Citation Science Index WoS, Abstract of Bulgarian Scientific Medical Literature, Experta Medica ISSN 0300-9092 (Print), 2412-5679 (Online)
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The role of vitamin D in the prevention of pregnancy complications
Vitamin D deficiency is a serious problem affecting a significant part of the female population of reproductive age. Vitamin D acting through vitamin D receptors in the organs of the hypothalamic-ovarian-uteroplacental axis participates in the regulation of implantation, placentation, and organogenesis processes. The analysis of recent research data presented in the PubMed, Embase, eLibrary, and RSCI databases indicates a close relationship between vitamin D deficiency and an increased risk of gestational diabetes, preeclampsia, spontaneous miscarriages, preterm birth, and operative delivery. Optimization of the vitamin D level helps to normalize metabolic and immune processes, improve fertility and reduce the frequency of obstetric complications. A significant preventive effect is achieved by ensuring an adequate level of vitamin D at the preconception stage and in early pregnancy. Despite the proven efficacy and safety of vitamin D supplementation, there are still questions about the optimal dosage, the duration of treatment, and the need for regular screening. It is necessary to clarify the algorithms for the correction and prevention of vitamin D deficiency in women of reproductive age. Conclusion: Vitamin D is an essential nutrient for the normal course of pregnancy and fetal development. Maintaining its adequate level should be considered as one of the key components of preconception care and management of pregnancy, aimed at reducing the risk of obstetric and perinatal complications.
Pain syndrome after laparoscopic myomectomy: pathogenesis and evolution of methods for combating pain
Laparoscopic myomectomy is the main surgical option in the treatment of uterine fibroids and it currently has become the gold standard in the uterus-sparing approach. Despite its minimally invasive nature and proven clinical efficacy, postoperative pain remains a significant concern. According to published data, up to 80% of patients report moderate to severe pain during the first 24 hours after surgery. This can affect the early postoperative period, delay mobilization, prolong hospitalization, and increase the need for systemic analgesics, including opioids. Persistent pain may also reduce patient’s satisfaction with the treatment and limit the implementation of Enhanced Recovery After Surgery (ERAS) protocols aimed at improving perioperative outcomes. This review provides a comprehensive analysis of the pathophysiological mechanisms underlying postoperative pain after laparoscopic myomectomy. It discusses the activation of somatic and visceral nociceptors, the development of peripheral and central sensitization, and the role of intracellular signaling and inflammatory mediators. Particular attention is given to the anatomical and physiological characteristics of uterine innervation, including the zones of overlapping somatic and visceral nociceptive input, and the superior hypogastric plexus in pain transmission. The characteristics of visceral pain, a challenging and less manageable aspect of postoperative pain, are discussed. The analysis of published materials provides up-to-date information on modern approaches to pain management in patients after laparoscopic myomectomy. Special focus is placed on multimodal and preemptive analgesia techniques aimed at reducing both pain intensity and opioid consumption. Local interventions such as anterior abdominal wall infiltration and superior hypogastric plexus block are discussed as part of a pathophysiology-based approach to postoperative pain control. Data on the effect of pain severity on recovery parameters, patient satisfaction, and overall quality of medical care are presented. Conclusion: The findings support the need for personalized analgesic strategies that account for neurophysiological pain mechanisms and surgical specifics. The use of pathogenetically-based and preemptive analgesic strategies can not only reduce the severity of pain, but can also improve the overall course of the postoperative period, increase patient compliance and the effectiveness of ERAS protocols.
Hyaluronic acid in the correction of genitourinary syndrome of menopause in women after anticancer treatment
Objective: To study the effectiveness of hyaluronic acid in the correction of genitourinary syndrome of menopause in cancer patients after antitumor treatment. Materials and methods: The literature search was conducted in the electronic databases, namely PubMed, Scopus, Web of Science, Cochrane Library, ScienceDirect, Embase, PsycINFO using the keywords in Russian and English. The articles were published between 1987 and 2024. Results: The symptoms of genitourinary syndrome of menopause have a long-term negative impact on the quality of life of women who underwent antitumor treatment for malignant neoplasms. In cases of hormone-dependent forms of the disease, and when patients refuse to receive menopausal hormone therapy, alternative treatment methods become necessary. Currently, there is no single standard for non-hormonal correction of genitourinary syndrome of menopause in this population. The use of hyaluronic acid in both non-injectable and injectable forms for cancer patients is an effective method for addressing problems associated with vulvovaginal atrophy. The safety of volume-forming substances based on hyaluronic acid has also been demonstrated in the absence of disease progression. Conclusion: The analysis of the literature showed the potential for further research into the efficacy and safety of using hyaluronic acid including long-term follow-up to correct vulvovaginal changes in cancer patients after antitumor treatment. This research could help determine whether it should be included in the standard restorative treatment for these patients. Such an approach could improve the quality of life for this patient group and address a number of psychological and socio-economic issues.
Organ-preserving treatment of borderline ovarian tumors: modern surgical strategies and reproductive outcomes
Borderline ovarian tumors (BOT) are a unique type of epithelial neoplasms that mainly affect women of reproductive age. Due to their favorable course and high detection rate in the early stages, organ-preserving treatment is becoming a top priority, especially for patients planning a pregnancy. Objective: To summarize and systematize current data on oncological safety, surgical approaches, reproductive outcomes, and the role of assisted reproductive technologies (ART) in patients with BOT who had a previous history of fertility-sparing treatment. Materials and methods: The literature was searched using PubMed, Scopus, Web of Science, and CNKI databases. The review article included original studies with more than 20 patients. The studies provided the data on the types of surgery, disease recurrence and reproductive outcomes. The total sample included 4,586 patients. Results: The lowest recurrence rate after fertility sparing surgery (FSS) was observed in ultrasound guided ovarian wedge resection (UGOWR) (0–3%); intermediate rate was observed in unilateral salpingo-oopherectomy (USO) (10–15%); maximum rate was noted in cystectomy (25–31%); micropapillary serous variant is associated with a recurrence risk of up to 45%. In the total sample of 4,586 patients, the pregnancy rate after FSS was 39–52%, the proportion of live births was up to 30%, miscarriages were ~11%, and premature births were 9%; ART was effective after thorough selection (8.6–20% recurrences, more often after cystectomy); full staging procedure reduces recurrence rate to 8–12% versus 30–40% without staging. Conclusion: Organ-preserving interventions in BOT are oncologically justified if there is an individualized approach combined with complete surgical staging; UGOWR demonstrates the best profile of oncological safety and fertility preservation, and the use of ART is acceptable in specialized centers with controlled stimulation.
Complications in surgical treatment of colorectal endometriosis
In colorectal endometriosis, surgery may involve techniques such as shaving, disc excision or segmental resection with anastomosis (either using hardware or manual methods). A two-stage intestinal resection with stoma removal followed by restoration of intestinal integrity is performed in case of multifocal infiltrative forms. However, it is the order and extent of surgical treatment that is debatable for some patient groups. The article discusses various approaches to the surgical treatment of colorectal endometriosis. Colorectal endometriosis is the most severe type of deep endometriosis, among all other types. Complications, such as intestinal obstruction, bleeding, and perforation may occur in 4–13% of cases. Surgical intervention is the only effective treatment method. There can be the following types of surgery: segmental bowel resection (35.8%), shaving (31.9%), disc excision (23.1%). Combined treatment is used in 2.9% of cases. According to the Clavien–Dindo classification, perioperative complications range from 10 to 14% (anastomotic failure with the development of pelvic abscesses – 6.6%, rectovaginal fistulas – 3.8%, intestinal paresis in the postoperative period – 12.7%, severe dysuric disorders – 1.5%, hydronephrosis – 4.5%). The frequency of complications depends on several factors, including the surgical access, the size of the infiltrate, the depth of the lesion, and intraoperative approaches. Conclusion: Colorectal surgery for endometriosis is a high-tech surgical procedure that requires a personalized approach at all stages of treatment. This includes preoperative imaging to create a detailed map of the affected area, which can help to develop an individual treatment plan.
Premature ovarian failure: modern and promising approaches to improving ovarian function and overcoming infertility
Premature ovarian failure (POF) affects approximately 3.5% of female population. This condition is associated with decreased ovarian reserve, infertility and systemic complications. Objective: To analyze methods of early diagnosis, modern and promising strategies for the treatment of POF with a focus on restoring ovarian function and overcoming infertility. Materials and methods: The analysis included systematic reviews, meta-analyses, and randomized controlled trials. A total of 62 studies were analyzed. Results: FSH (less than 25 IU/ml), AMH, and antral follicle count are used for early diagnosis; however, their prognostic value remains controversial. Inhibin B, insulin-like factor 3 (INSL3), and chronic inflammation markers have been noted as predictors. No biomarkers for POF have been identified. Currently, there are no criteria available for predicting the development and timing of POF. Preventive measures and fertility support methods for women with risk factors for POF include lifestyle modifications (adequate physical activity, smoking cessation, sleep restoration, and a balanced diet), nutritional supplements, antioxidants, and mitochondrial function restoration agents (CoQ10, resveratrol, melatonin). Women at risk for POF, as well as those with the latent form of the disease, are recommended to have their reproductive potential assessed before the onset of the disease and to use ART to obtain and vitrify their own eggs/oocytes or ovarian tissue. Hormone replacement therapy for the prevention of complications and the use of ART to overcome infertility (donor oocytes) are of primary importance in the treatment of the clinical form of POF. Promising approaches to fertility restoration include in vitro follicle activation, the use of stem cells, exosomes, platelet-rich plasma, ovarian tissue transplantation, and bioengineered (artificial) ovaries (their study is currently in the experimental stage). Conclusion: Prediction of the risk for ovarian function loss and early detection of POF make it possible to take measures for preserving or restoring fertility. Preventive interventions help preserve ovarian reserve and increase the likelihood of restoring ovulation. Fertility preservation is achieved by assisted reproduction (cryopreservation of the woman’s own eggs/oocytes or ovarian tissue), while donor oocytes are used in cases of complete POF. Future research should focus on a more in-depth understanding of the pathogenesis of POF, a clear definition of predictors and their significance, as well as the development of personalized methods for prevention and treatment.
Anthropometric predictors of cephalopelvic disproportion
Background: The discrepancy between the sizes of the maternal pelvis and fetus is associated with high operative delivery rates, as well as obstetric and neonatal morbidity and mortality. The use of classical pelvimetry to predict cephalopelvic disproportion is currently considered insufficient. Evidence suggests that in the formation of a clinically narrow pelvis, the ratio of the head circumference to the maternal height plays a major role rather than the body weight of the fetus. Therefore, studying the anthropometric data of both the mother and fetus during full-term pregnancies in Russia is essential for identifying the risk groups for clinically narrow pelvises. Objective: To investigate the prognostic significance of anthropometric data of women and fetuses at full term concerning the risk of a clinically narrow pelvis. Materials and methods: This retrospective cohort study analyzed 12,034 delivery case records, which were divided into two groups. The study group (n=183) comprised women who underwent cesarean delivery due to a narrow pelvis, while the control group (n=915) included women who underwent vaginal delivery. Results: The highest frequency of a clinically narrow pelvis and operative abdominal delivery was observed with a head circumference >342.15 mm and fetal body weight >3670 g. The median ratio of fetal head circumference measured by ultrasound to maternal height in the vaginal delivery group was lower, at 2.0 (1.94; 2.05), compared to 2.08 (2.02; 2.13) in the clinically narrow pelvis group (p<0.001). Conclusion: The ratio of fetal head circumference to maternal height was lower in vaginal deliveries, measuring 2.0 versus 2.08 for the clinically narrow pelvis group. A fetal body weight of 3670 g and head circumference above 342.15 mm, as measured by ultrasound one week before the onset of labor, likely represent the threshold beyond which the probability of cephalopelvic disproportion significantly increases.
Clinical and morphological variants of insufficient uterine scar after cesarean section
Objective: To explore the morphological features and clinical manifestations of insufficient uterine scar after cesarean section. Materials and methods: The study included 109 patients with uterine scar after cesarean section. They were divided into four groups depending on the clinical and morphological features of insufficient uterine scar: group I – “vascular”type (n=23), group II – “connective tissue” type (n=39); III – “inflammatory” type (n=27), and Group IV – the comparison group (n=20). Histological and histomorphological evaluation of excised scar tissue, clinical assessment of anamnestic indicators, and statistical data analysis were performed. Results: Three main morphological variants of insufficient uterine scar were identified – "inflammatory," "vascular," and "connective tissue." The clinical and morphological parallels of insufficient uterine scar were assessed taking into account the histological variant. The patients with the "vascular" type of insufficient uterine scar had a history of irregular menstrual cycles (r=0.71; 95% CI 0.81;0.89 p<0.001). The main indication for delivery was the risk of uterine rupture along the scar (r=0.67; 95% CI 0.78;0.95 p<0.001). The patients with the "connective tissue" type of insufficient uterine scar underwent the first cesarean section due to abnormal labor (r=0.81; 95% CI 0.65;0.74 p<0.001). Uterine scar insufficiency – thinning of the uterine scar (< 2 mm) was detected by ultrasound. At the same time, the clinical picture showed no risk of uterine rupture along the scar (r=0.88; 95% CI 0.76;0.85 p<0.001). The "inflammatory type" of insufficient uterine scar correlated with recurrent miscarriage in history (r=0.65; 95% CI 0.58;0.83 p<0.001) and fetal distress in current pregnancy (r=0.63; 95% CI 0.61;0.81 p<0.001). Conclusion: The obtained data indicate that there is a need for an in-depth study of the pathogenetic mechanisms of uterine scar formation and the development of a prediction model.
The role of ascending amniotic infection in the genesis of premature separation of the normally implanted placenta
Objective: To explore the influence of premature separation of the normally implanted placenta in combination with ascending amniotic infection on obstetric outcomes and conditions in newborns. Materials and methods: The retrospective analysis of medical documentation of 108 patients was performed. Group 1 included 40 puerperant women with premature separation of the normally implanted placenta associated with infectious lesions of the placenta. Group II (the control group) included 60 patients with only premature separation of the normally implanted placenta. Results: Comparison between the groups I and II showed that the women in group I gave birth at 35 (31;38) weeks versus 37 (35;39) weeks in Group II; 25/40 (62.5%) women gave birth prematurely versus 27/69 (39.1%). Preterm births before 33 weeks of pregnancy occurred in 3/40 (32.5%) versus 10/69 (14.5%.) women. Time interval between membrane rupture and delivery was longer – 12 hours and 30 minutes versus 3 hours and 45 minutes. In 7/17 (41.2%) versus 3/28 (10.7%)women, this time interval was > 24 hours. Preterm babies were born with asphyxia, required respiratory support and antibiotic therapy. Postnatal death occurred exclusively among preterm babies. Conclusion: Premature separation of the normally implanted placenta of infectious genesis occurs as a result of ascending amniotic infection, often against the background of preexisting impairment of uteroplacental blood flow. Inflammatory conditions of the placenta are one of the causes of premature separation of the normally implanted placenta and are associated with preterm babies with birth asphyxia.
In vitro maturation as a fertility preservation strategy in cancer patients
Objective: To describe a case series on the use of in vitro maturation (IVM) technology in patients with cancer. Materials and methods: This study included 34 patients aged 23–43 years who presented to the IVF Department of the Medsi on Solyanka Clinical and Diagnostic Center for fertility preservation programs. Transvaginal puncture of the antral follicles was performed, followed by aspiration of the follicular fluid. The resulting oocyte-cumulus complexes (OCCs) were matured for 24–48 h in an embryology laboratory. Results: IVM were performed in 34 patients. In one case, no oocytes were retrieved, and in five cases, mature oocytes were not obtained after the culture. A total of 185 OCCs were retrieved, averaging 5.4 OCCs per patient. Additionally, 95 mature oocytes at the MII stage were retrieved, averaging 2.9 per patient, resulting in an average maturation rate of 51.8%. Oocyte cryopreservation was conducted in 13 patients, resulting in a total of 47 oocytes, or an average of 3.6 oocytes per patient. Fertilization was performed using oocytes obtained after IVM in 15 patients. In 10 cases, embryos were not produced (due to lack of cleavage or embryos being unsuitable for transfer according to the PGT-A results). In five cases, embryos suitable for transfer to the uterine cavity were obtained (either euploid according to PGT-A or PGT-A was not performed). Embryo storage continued in two cases, while one patient discontinued embryo storage. Two thawed embryos were transferred: one into the patient's uterine cavity, which did not result in pregnancy, and the other into a surrogate mother's uterus, resulting in pregnancy and delivery. Conclusion: IVM is a promising approach for fertility preservation in patients with cancer in whom ovarian stimulation is not feasible. The effectiveness of this technique is influenced by the patient's baseline parameters, primarily age and ovarian reserve. However, further research is required to standardize the approaches and enhance the efficacy of this technology.
Plasma miRNA expression levels in women with preeclampsia and chronic arterial hypertension in the first trimester of pregnancy
Objective: This study aimed to investigate the expression of several miRNAs in the plasma of patients with chronic arterial hypertension (CAH) without preeclampsia and pregnant women with CAH-associated preeclampsia (CAP) during the first trimester of pregnancy. Materials and methods: The study included 100 patients: Group 1 (n=58) comprised pregnant women with CAH without preeclampsia, and Group 2 (n=42) included women with CAP. The plasma expression levels of 11 miRNAs were assessed in these patients at 12–14 weeks of gestation using quantitative real-time polymerase chain reaction. Statistical analysis was conducted using the IBM SPSS Statistics software (version 26.0, USA). Results: Women with CAP exhibited contrasting changes in the expression of five out of 11 plasma miRNAs compared to the group without CAP. The expression levels of miRNA-20a (p<0.001) and miRNA-181a (p<0.001) were significantly decreased in the CAP group. Conversely, the expression levels of miRNA-221 (p<0.001), miRNA-146a (p=0.02), and miRNA-210 (p=0.041) were higher in this group than in women who did not develop preeclampsia. Conclusion: Statistically significant changes in the expression levels of several miRNAs associated with cardiovascular pathology and placental dysfunction were identified in the first trimester of pregnancy in patients with CAH and CAP.
Lipidome profile of follicular fluid in patients with ovarian endometrioma and its role in predicting IVF outcomes
Relevance: Lipidome profile of follicular fluid (FF) in patients with ovarian endometrioma (OMA) offers valuable information about oocyte competence, embryo viability, and IVF outcomes. Objective: To create a model for predicting the probability of clinical pregnancy in patients with OMA undergoing IVF based on the lipidome profile of follicular fluid. Materials and methods: Patients baseline characteristics were collected, lipidome profile of FF and IVF outcomes in patients with OMA were analyzed (n=41). The lipidome signature of follicular fluid was analyzed using high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS). Orthogonal projections to latent structures discriminant analysis (OPLS-DA) were used to create a differential model. Results: Comparative analysis of FF samples from women who achieved pregnancy versus those with negative result revealed differences in lipidome signature within each group that correlated with IVF outcomes. Based on these findings, a predictive OPLS model was developed. The model allows to differentiate pregnant and non-pregnant women based on the levels of lipids belonging to the following classes: cholesteryl esters, phosphatidylcholines, sphingomyelins and triglycerides. Conclusion: Lipidome profiling of follicular fluid using HPLC-MS allows for fairly accurate differentiation between women who achieve pregnancy and those who do not. These results are consistent with international data and confirm the potential for using this method to predict IVF outcomes in patients with ovarian endometriomas.
Evaluation of the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age
Adenomyosis is a medical and social problem associated not only with a deterioration in the quality of life of reproductive and perimenopausal women, but is also one of the causes of infertility and miscarriage in young patients. Objective: To evaluate the course of clinical symptoms and reproductive outcomes after laser drilling of the uterus with a holmium laser in patients of reproductive age. Materials and methods: The study included 470 patients with uterine factor infertility due to diffuse and/or nodular adenomyosis Grade 2 and Grade 2–3 (MUSA 2022), treated during the period of 2000–2024. The patients underwent laser drilling of the uterus with a holmium laser using a laparoscopic approach. Results: During the follow-up period after organ-preserving surgery, clinical symptoms and reproductive outcomes were assessed. Ultrasound and MRI were used to objectify the data. Six months after surgery most patients demonstrated a significant reduction in the severity of dysmenorrhea (from 8.10 to 2.0 according to the NRS scale). Menstrual blood loss also markedly decreased from 153.1 (80) ml to 67.0 ml. Pregnancy occurred in 127/337 patients under the follow-up. No intra- or postoperative complications were noted. Conclusion: The obtained data demonstrate a significant improvement in clinical symptoms (decrease in the severity of dysmenorrhea, menstrual blood loss, and uterine size) in patients with adenomyosis. Reproductive outcomes also improved, which did not show statistical significance after Bonferroni correction, therefore requiring further confirmation with control groups.
Omics data analysis using deep learning-based framework in differential diagnosis of ovarian cancer
Relevance: The course of malignant epithelial ovarian tumors is considered to be highly aggressive. Limitations of diagnostic methods are associated with the late detection of tumors at stages III–IV, which is the cause with high mortality. Objective: To compare the effectiveness of machine learning (ML) methods for minimally invasive diagnosis of early-stage ovarian cancer (OC) using scalable, objective lipid biomarker profile data. Materials and methods: A single-center observational retrospective cohort clinical study included 239 patients with early-stage high-grade ovarian cancer (HGOC, n=10); with other tumor/proliferative processes (n=203, of which: including 30 cystadenomas, 59 endometrioid cysts, 21 teratomas, 28 borderline tumors; 16 – low-grade ovarian cancer (LSOC), HGOC of III-IV stages and control group women (n=26). Lipid extraction, analysis by high-performance liquid chromatography coupled with electrospray ionization mass spectrometry, and data preprocessing were performed. The SHAP method was used to interpret the predictions generated by building complex models. For multi-class classification, 7 ML methods were tested, including Naive Bayes classification, PLS discriminant analysis, Random Forest, External Gradient Boosting classification, Multilayer Percepton, and Convolutional Network. For binary classification, the following were additionally tested: support vector machine and extreme gradient boosting (Xgboos) classifications. Results: In Stages I–II HGOC, a decrease in PC O-18:1/18:0, PE P-18:0/18:2, LPC O-16:0, PC 18:0_18:2, OxTG 16:0_18:1_16:1(CHO), OxPC 18:2_16:1(COOH), OxPC 20:4_14:0(COOH) and an increase in PC 16:0_18:0, PC P-18:1/20:4, PC 18:1_18:2, PC 16:0_18:0, PC 18:2_18:2 (compared to the control group) occurred, as well as a decrease in Cer-NS d18:1/22:0, PC P-16:0/18:1, PC P-18:1/20:4, PC P-18:0/18:1, oxidized lipids, carboxy- and carbohydroxy-derivatized and an increase in PC P-18:0/18:2, PC P-20:0/20:4 (compared to patients with OC). The best differentiation ability between the control group and the OC group was demonstrated by OPLS models, as well as random forest, and support vector machine with a radial kernel (90%). Conclusion: The use of advanced ML methods strengthens the diagnostic potential of omics data and can be applied in gynecological oncology.
The characteristics of pregnancy course and delivery outcomes in patients after abortion: the results of a phase II study
Objective: To study the characteristics of pregnancy course and delivery outcomes in patients after abortion. Materials and methods: The study included 129 pregnant women who were divided into two groups and some subgroups. Group 1 included 60 pregnant women after medical abortion: subgroup 1A (n=41) consisted of patients who took the Superlymph suppositories in a dose of 25 units, and subgroup 1B (n=19) consisted of women who did not receive treatment with Superlymph. Group 2 (n=69) included pregnant women after surgical abortion: subgroup 2A (n=45) consisted of women who took Superlymph, subgroup 2B (n=24) included patients who did not take the medication. Results: The patients after surgical abortion who did not receive Superlymph demonstrated a higher frequency of threatened miscarriage in the first trimester by 2.7 times (p=0.02). There were no significant differences in the frequency of threatened miscarriage in the second trimester in patients after medical abortion regardless of administration of the Superlymph medication (p=0.150). After artificial abortion followed by Superlymph therapy (subgroup 2A), the frequency of threatened miscarriage at a later gestation was twice lower than one in the subgroup of women without therapy (2B) (p<0.001). The frequency of threatened miscarriage was significantly higher in women who underwent surgical abortion without subsequent treatment (p=0.04). The course of the third trimester of pregnancy and delivery outcomes had no significant differences between the groups. Conclusion: The frequency of miscarriage is higher among patients after surgical abortion. Conducting a course of cytokine therapy after both medical and surgical abortion can improve endometrial receptivity and the course of subsequent pregnancy.
The impact on cervical epithelialization in destructive treatment in patients with cervical intraepithelial neoplasia, recurrent bacterial vaginosis and papillomavirus infection
Objective: To evaluate the combined approach in the treatment of patients with mild cervical intraepithelial neoplasia (CIN I) accompanied by concomitant papillomavirus infection and recurrent bacterial vaginosis (BV) during destructive treatment of cervical pathology. Materials and methods: The study included 100 patients aged 22 to 45 years with CIN I combined with papillomavirus infection and recurrent BV. The patients of group I (n=50) were prescribed suppositories Superlymph 25 IU intravaginally as perioperative therapy, the patients of group II (n=50) were administered traditional antiviral therapy and vaginal suppositories with dexpanthenol and chlorhexidine. Visual assessment of the cervix, colposcopy, cytological examination, human papillomavirus (HPV) testing, biopsy and determination of cytokine concentration in cervical mucus by enzyme immunoassay were performed. The statistical analysis was conducted using Microsoft Excel and Statistica 7.0 software. Results: The complete elimination of HPV was noted 3 months after treatment in group I and negative test was observed after 6 months in 96% of patients; this parameter exceeded the indicator of group II by 1.6 times (p<0.001). The risk of recurrence of BV symptoms in group I was reduced by 2-5 times in the period from 1 to 6 months (p<0.05). The levels of TNFa, IFN-γ, and IL-6 were significantly lower in group I than those in group II after 1 and 3 months (p<0.001). The complete healing of the damaged area of the cervix was more frequently observed in group I. After 10 days, it was seen 1.4 times more often (p=0.04) and after 15 days, it was 1.3 times more common (p=0.04). Conclusion: The use of Superlymph as a perioperative therapy for patients with mild CIN can increase the effectiveness of destructive treatment methods. This is achieved by completely eliminating HPV after three months and maintaining a negative HPV test after six months in 96% of cases. Additionally, Superlymph helps reduce levels of local pro-inflammatory cytokines and decrease the risk of bacterial vaginosis recurrence that in turn improves cervical epithelialization processes after surgery.
Features of medical history of women with uterine fibroids
Objective: To study the features of the family, obstetric and gynecological as well as somatic anamnesis of women with uterine fibroids. Materials and methods: A retrospective study of 212 case reports (2022–2025) was conducted at the multidisciplinary hospital "RZhD-Medicine" (Yekaterinburg). The study group included 117 patients with uterine fibroids, while the control group included 95 patients without uterine fibroids. Exclusion criteria included pregnancy, postmenopause, and cancer. Results: The group with a history of uterine fibroids more often included the following pathologies: adenomyosis, endometrial hyperplasia, hydrosalpinx, endometrial polyps, cervical cysts, grade 1 obesity and a positive family history of breast cancer. Age at menarche, number of pregnancies, miscarriages, abortions, and previous deliveries, including vaginal deliveries and cesarean sections, did not show statistically significant differences between the study and the control groups. Body mass index also did not differ significantly between the compared groups. Conclusion: The identified clinical criteria confirm the similarity of individual elements in the pathogenesis of uterine myoma, emphasizing the importance of taking into account anamnestic data when examining patients, and also allow us to identify risk groups for the development of uterine leiomyomas.
The effectiveness of complex therapy with activated glycyrrhizic acid in patients with bacterial vaginosis associated with papillomavirus infection
The detection rate of human papillomavirus (HPV) in women with bacterial vaginosis (BV) is significantly higher than in the general population. The disease may be a trigger factor that increases the risk of HPV reactivation. Objective: To evaluate the effectiveness of complex therapy with activated glycyrrhizic acid (Epigen Intim, 0.1% spray) in patients with BV associated with papillomavirus infection (PVI). Materials and methods: The study included 60 patients with BV: group 1 (n=20) consisted of patients with latent/subclinical forms of PVI, group 2 (n=40) included women with anogenital warts. Microscopic, molecular biological, and cytological techniques were the research methods used in the study. The patients were treated with clindamycin and intravaginal spray Epigen Intim, the latter was prescribed during 180 days follow-up period if triggering factors were present. Results: Two weeks after therapy, all patients showed a decrease in the detection rate of abnormal vaginal discharge (by 94.7% in group 1 and 94.9% in group 2), pH of vaginal discharge >4.5 and positive amino test (by 94.1% and 97.4%), the presence of the key cells (by 94.1% and 97.1%) (p<0.001). During the 6-month follow-up period, BV recurrence was noted in 1/20 (5.0%) patients of group 1 and 4/40 (10.0%) patients of group 2 (p<0.001); recurrence of anogenital warts was observed in 4/40 (10.0%) patients (p=0.002). HPV elimination after six months was detected in 16/20 (80.0%) patients of group 1 and 30/40 (75.0%) of group 2 (p<0.001). Normal cytological findings were revealed after six months in 19/20 (95%) (p=0.031) and 38/40 (95%) (p=0.029) patients, respectively. Conclusion: Epigen Intim, 0.1% spray has demonstrated a high level of efficacy in the complex therapy of BV associated with genital PVI. It can be recommended as an additional component of treatment and for the prevention of disease recurrence in case of the presence of triggering factors.
Modern aspects of preconception care and management of pregnant women with obesity and diabetes mellitus
Endocrine disorders are one of the most significant public health issues affecting millions of people worldwide. In particular, conditions such as obesity and diabetes mellitus, among other factors, have a profound effect not only on the quality of life of patients but also significantly increase health risks, especially during pregnancy. It should be noted that pregnancy in the presence of these diseases is accompanied by an increased risk of complications for both mother and child. This article provides a detailed examination of the mechanisms underlying the development of obesity and diabetes, their impact on the course of pregnancy and childbirth. In addition, attention is given to modern approaches to the diagnosis and treatment of these diseases; the aim of these approaches is to optimize the health of both mothers and newborns. This comprehensive view provides a better understanding of how risks can be minimized and safety can be improved during this significant period in a woman’s life. Conclusion: Obesity and diabetes are multifactorial diseases. The success of pregnancy, the health of the child, the absence of progression of diabetes complications and the reproductive potential of the mother in the future directly depend on well-planned preconception care, effective metabolic control and proper pregnancy management with an interdisciplinary team approach.
A new perspective on uterine embryogenesis
Background: The embryonic development of the uterus and vagina has been studied through a systematic review of scientific literature, from the earliest published papers to the most recent studies. According to the theory proposed by Muller in 1830, the fallopian tubes, uterus, and vagina develop from fused paramesonephric ducts, while the mesonephric ducts are reduced in the female fetus. Results: A comparative analysis of clinical variations of uterine abnormalities was conducted based on the results of the observations between 1996 and 2025. Some complex issues have been identified, namely, how to draw a distinction line between the uterus, which has a thick layer of myometrium and endometrial cavity, and the fallopian tubes and vagina during the fusion of symmetrical genital ducts. The origin of the normal endometrium is still unknown. The results of the review demonstrated the chronological stages of embryonic morphogenesis; relevant references to primary sources were provided. Conclusion: A new theory of uterine embryogenesis has been formulated: the fallopian tubes and vagina develop from the mesonephric ducts, and the uterus is formed by the fusion of the mesonephric ducts with the gonadal ridges. The proposed new theory may be the key to understanding abnormalities in the development of the uterus, as well as major gynecological diseases such as myoma and endometriosis from embryonic polypotent cells.
The potential of spiramycin in modern gynecological practice
Background: Empirical antibiotic therapy can be a necessary solution when rapid treatment is needed before the results of microbiological tests are available. One of these medications is spiramycin, an antibiotic of the macrolide group, which has a wide range of activity and proven effectiveness in combating a number of infectious diseases. Objective: To analyze the efficacy and safety of spiramycin in gynecological practice. Results: Modern antibacterial therapy presents several challenges, including the risk of increased antibiotic resistance, the likelihood of adverse reactions, and high economic costs. Spiramycin plays an important role in the treatment of gynecological infections due to its effectiveness against a variety of pathogens, including intracellular pathogens such as Chlamydia trachomatis and Toxoplasma gondii. Its ability to penetrate the placental barrier and create high tissue concentrations, as well as its relative safety for pregnant women, make this drug a preferred choice in a number of clinical situations. An important advantage of spiramycin is its low incidence of resistance, which sets it apart from other macrolides. Additionally, it has minimal effects on the microbiome and rarely causes side effects, which enhances patient compliance with treatment. Conclusion: Spiramycin is characterized by high efficacy against a wide range of pathogens, safety and low incidence of antibiotic resistance. Nevertheless, the administration of spiramycin requires an individual approach and consideration of all risk factors and contraindications. Following the doctor’s recommendations and completing the prescribed course of treatment are essential for successfully getting rid of infectious diseases and preventing recurrences.
Preservation of reproductive health as a basis for increasing birth rates. A joint position of experts in reproductive medicine, obstetrics and gynecology, endocrinology, and clinical pharmacology
Russian eligibility criteria for menopausal hormone therapy in patients with cardiovascular and metabolic diseases. Consensus document of the Russian Society of Cardiology, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Russian Phlebological Association, Russian Scientific Medical Society of Therapists, Russian Association of Gerontologists and Geriatricians, Russian Society of Gynecological Endocrinology and Menopause Specialists