Obstetrics and Gynecology

Postpartum hemorrhage remains one of the leading causes of maternal mortality. Annually worldwide, postpartum hemorrhage occurs in 14 million women, resulting in 45,000 deaths (0.32%). In the Russian Federation in 2024, blood loss of over 1000 ml was recorded in 28% of cases of critical obstetric conditions, demonstrating a mortality rate of 0.34%.

The World Health Organization (WHO) consolidated 2025 guidelines represent a comprehensive revision of the approaches to managing this complication based on the analysis of complications in more than 300,000 women who have just given birth from 23 countries. A conceptual shift has been made in the diagnostic criteria for postpartum hemorrhage. Instead of an arbitrary threshold of 500 mL, new criteria have been proposed: blood loss ≥300 mL in combination with signs of hemodynamic instability, or ≥500 mL regardless of hemodynamic parameters. This reduces the time before diagnosis from 30 to 15 minutes and prevents underestimation of blood loss.

A clear hierarchy of uterotonics has been established. Oxytocin remains the first-line agent. In cases of inadequate storage conditions, thermostable carbetocin or misoprostol is recommended. Ergotamine is excluded from prophylaxis protocols due to the high risk of arterial hypertension and myocardial ischemia. Correction of anemia prior to delivery reduces its frequency in the postpartum period by 39% and reduces the need for blood transfusion by 30%.

In the treatment of bleeding that has already taken place, a comprehensive E-MOTIVE mnemonic approach is recommended: E – Escalation, M – Massage of the uterus, O – Oxytocin, T – Tranexamic acid, I – intravenous Infusion of crystalloids, V – Vaginal and genital tract examination, E – Escalation of care. It is important to apply all components within 15 minutes of identifying the complication. Tranexamic acid must be administered no later than 3 hours after delivery; its prophylactic use is not recommended. The systemic aspects of implementing the guidelines include the requirement for objective measurement of blood loss volume, availability of medications, clear protocols, and staff training.

Conclusion: The 2025 recommendations demonstrate a transition from fragmented approaches to evidence-based systematic management of postpartum hemorrhage.

Preeclampsia is a dangerous complication of the perinatal period, a period of neurocorticogenesis, the formation of the neocortex – the principal human brain structure – as well as the correlates of consciousness and sensorimotor signaling, and the structures and functions of higher nervous activity.

This literature review addresses a topical issue: the impact of preeclampsia on fetal neurodevelopment and the search for potential biomarkers of fetal brain damage.

This was a comprehensive analysis of the complex pathophysiological chain of effects that preeclampsia has on the pregnant woman and fetus: ranging from placental dysfunction and impaired integrity and permeability of the blood-brain barrier (BBB), changes in the expression of neuron-specific proteins (NSPs) and the formation of NSP-mediated maternal autoantibodies, to changes in the cytoarchitectonics of the cerebral cortex, neurocorticogenesis and synaptogenesis, and, consequently, the development of a wide spectrum of neurodevelopmental disorders (aautism spectrum disorders, cerebral palsy, attention deficit hyperactivity disorder, cognitive impairment, mental and other disorders).

Conclusion: The presented data offer a new perspective on the phenomenon of preeclampsia as a key process determining fetal brain development and neurodevelopment in general, taking into account factors such as BBB permeability and the role of NSPs as effective diagnostic markers capable of predicting both short-term and long-term outcomes of fetal neurodevelopment.

Episiotomy has been a widely used invasive procedure in obstetrics, reflecting the evolution of attitudes over the centuries. Currently, seven episiotomy techniques have been described, the most common of which are mediolateral, lateral and midline episiotomy. To date, there has been a scientific consensus on the limited use of episiotomy, with mediolateral episiotomy as a priority technique due to its significantly lower risk of complications after childbirth. In addition, a new episiotomy technique without incision of the posterior part of the perineum and distal part of the posterior vaginal wall may be promising in reducing the risk of both immediate and long-term complications.

The restoration of the damaged perineum by using continuous intradermal suturing is a more appropriate technique, as it provides faster and more efficient wound healing, as well as better aesthetic outcomes.

Conclusion: Appropriate episiotomy followed by episiorraphy performed in the correct technique prevents the occurrence of immediate and long-term complications, thereby preserving the quality of life and health of women.

The treatment of women for cervical precancerous condition, namely cervical intraepithelial neoplasia (CIN2/3), is accompanied by the risk of its recurrence during excision treatment and the development of vaginal intraepithelial neoplasia (VaIN) after total hysterectomy. The recurrence of CIN2+ after excision treatment occurs in 5.2–17.6% of cases, and the risk of cervical cancer is increased by 3 times. Human papillomavirus (HPV) persistence is one of the leading predictors of CIN2+ recurrence along with the presence of a positive resection margin.

The article presents the analysis of the current data on the risk of VaIN after hysterectomy for CIN. The incidence of VaIN following hysterectomy for CIN2+ is between 2.6% and 9.6%. Among women who undergo hysterectomy for CIN3, the risk of developing high-grade VaIN is 8 times higher than for those undergoing hysterectomy for other benign conditions. It has been shown that patients who have a previous history of CIN are more likely to develop VaIN and vaginal carcinoma after hysterectomy compared to patients without a history of CIN. The study presents the results of HPV genotyping in VaIN and correlation with CIN. The most common genotype in VaIN is HPV type 16, which is found in 2/3 of cases (36.4–51.8%). There are several different HPV genotypes present in 1/3 of cases. The combination of VaIN and CIN reaches 44.2%. The combination of vaginal and high-grade cervical squamous intraepithelial lesions (SIL), and the similarity of viral composition indicate a potential link between cervical and vaginal squamous cell abnormalities. The article presents recommendations of the international consensus on VaIN management.

Conclusion: Surgical treatment of cervical precancerous lesions carries risks for developing cancer in the cervix and vagina. High-risk HPV persistence is associated with an increased risk of CIN2+ recurrence following excision treatment and VaIN2+ following total hysterectomy for CIN3. This explains the need for subsequent cervical and/or vaginal cytology screening, regardless of the extent of treatment, as well as a high-risk HPV test in order to detect these conditions promptly.

Objective: To investigate the impact of women’s awareness of their health status on cardiovascular health parameters and long-term cardiovascular outcomes.

Materials and methods: The study was conducted in two stages. The first stage was an observational, cross-sectional study analyzing baseline data from 325 women. The second stage was a prospective cohort study with a median follow-up of 13 years, designed to assess long-term cardiovascular outcomes and adherence to medical follow-up. To assess awareness levels, an original composite Awareness Index (AI) was calculated, incorporating measures of knowledge, behavior, and medical activity. The index comprised five components: (1) knowledge of cardiovascular risk factors and their contribution to cardiovascular disease; (2) implementation of healthy lifestyle practices; (3) self-assessment of quality of life; (4) awareness of reproductive risk factors and their contribution to cardiovascular pathology; and (5) awareness of personal health status and disease-related symptoms.

Results: The study cohort consisted of employed women, predominantly of older working age, with low baseline cardiovascular risk and relatively favorable cardiometabolic profiles. Exploratory factor analysis revealed a two-factor structure reflecting health awareness and cardiometabolic status, which were largely independent. Over the 13-year follow-up period, cardiovascular events were documented in 16.1% of the participants. Awareness indicators were not associated with a statistically significant reduction in cardiovascular event risk, suggesting that awareness alone has limited prognostic value without corresponding behavioral and clinical changes.

Conclusion: These findings suggest that health awareness is an independent but insufficient factor for preventing cardiovascular events among working women. This highlights the need for comprehensive interventions across all stages of the cardio-reproductive pathway that target knowledge acquisition, behavioral modification, and improved access to medical care.

Objective: To explore the features of delivery in pregnant women with placenta accreta spectrum (PAS) based on clinical and anamnestic data and the course of gestation.

Materials and methods: The study included 107 patients with singleton pregnancies. Among them, 57 women with PAS comprised the main group, and 50 women without placental abnormalities were included in the comparison group. We analyzed the age of patients, somatic, obstetric and gynecological history, the course of current pregnancy, timing and types of delivery, as well as the volume of blood loss using different uterine devascularization techniques.

Results: Analysis of the obstetric and gynecological history showed that patients with PAS were significantly more likely to have two or more uterine scars after cesarean section. Pregnancy-related complications were significantly more often associated with the risk of preterm birth. In patients with PAS, no cases of preeclampsia, placental insufficiency, or fetal growth restriction were observed. Vaginal bleeding in patients with PAS occurred at 22–36.6 weeks of pregnancy. Blood volume loss was higher during emergency delivery in patients with PAS versus planned delivery, regardless of the method used for uterine devascularization. However, the differences were not statistically significant.

Conclusion: Given the absence of statistically significant differences in the volume of blood loss, as well as similar risks of bleeding at different stages of the second half of gestation, delivery of patients with PAS in the absence of episodes of vaginal bleeding should be considered optimal near to full-term pregnancy, in the context of preventing perinatal complications associated with prematurity.

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is the most modern approach to this procedure, involving a transvaginal hysterectomy performed using an endoscope.

Objective: To evaluate the effectiveness of vNOTES hysterectomy compared with the traditional laparoscopic approach based on intraoperative and postoperative parameters.

Materials and methods: This study included 200 patients aged 45–75 years who had undergone hysterectomy. In the VEH group, a hysterectomy was performed using the vNOTES approach, whereas in the LH group, a laparoscopic hysterectomy was performed. The study cohort was analyzed for anthropometric and anamnestic characteristics, obstetric and gynecological history, total operative time, time to hysterectomy, total blood loss, surgical table angle, extension of the surgical procedure, intraoperative and postoperative complications, and number of days until hospital discharge.

Results: The groups were comparable in terms of anthropometric parameters, age, number of pregnancies, parity, total operative time, blood loss, hospital stay, and absolute number of complications. The VEH group showed statistically significant advantages in terms of shorter time to hysterectomy -17.0 (95% CI 0.54–1.12; р-value< 0.001; d_Cohen=0.83); lower maximum CO₂ pressure 2,0 (95% CI 1.06–1.68; р-value< 0.001; d_Cohen=1.37); a smaller operating table inclination -10.0 (95% CI 2,81–3,65; р-value< 0,001; d_Cohen=3,2, shorter time of vaginal stump suturing -8.0 (95% CI, 2.52–3.32; p-value< 0.001; dCohen= 2.92) and reduction of postoperative pain at 6 and 24 hours after surgery -1.0 (95% CI 0.24–0.8; p-value< 0.001; d_Cohen=0.52) and -1.0 (95% CI 0.26–0.82; p-value< 0.001; d_Cohen=0.54), respectively. The VEH group also had the advantage of not requiring an incision on the anterior abdominal wall, which had a beneficial effect in the postoperative period.

Conclusion: The results demonstrate the advantages of the vNOTES approach over the traditional laparoscopic approach to hysterectomy.

Objective: To develop and evaluate a diagnostic model for stratifying patients with ovarian tumor-like lesions to optimize treatment strategies and reduce the risk of overtreatment.

Materials and methods: This study included 288 patients who underwent laparoscopic surgery for ovarian tumor-like lesions. According to histological findings, 44 (15.3%) patients had functional cysts, while 244 (84.7%) had non-functional benign lesions. The model incorporated the following predictors: HE4, CA125, neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), lesion size on ultrasound, and the number of years since menopause. A Decision Tree Classifier algorithm was used to construct the model. Seventy percent of the dataset (202 patients) was allocated for training, and the remaining 30% (86 patients) served as an independent test set.

Results: In the training set, the model achieved an AUC of 0.852. In the test set, the AUC was 0.835, with a sensitivity and specificity of 81.1% and 84.6%, respectively. The application of the model improves the accuracy of stratifying patients by the likelihood of a functional lesion and reduces the risk of unnecessary surgical intervention.

Conclusion: The developed diagnostic model may serve as an effective clinical decision-support tool for managing patients with ovarian tumor-like lesions. External validation of this model is required.

Objective: To demonstrate the effectiveness of implementing modern medical and organizational technologies for providing medical care to pregnant women and newborns who experienced specific conditions during the perinatal period (neonatal near misses).

Materials and methods: The effectiveness of organizational technologies for providing medical care to newborns who experienced specific conditions during the perinatal period (neonatal near misses) was evaluated during 2014–2024 at the third level of perinatal care in the Minsk region.

Results: The article presents the analysis of the effectiveness of organizational technologies implemented in the period from 2014 to 2025 at the third level of perinatal care for pregnant women at risk of premature birth, newborns who experienced specific conditions during the perinatal period and newborns from the neonatal near miss group, in the Minsk region. These implemented technologies included the development of clear algorithms for providing medical care to pregnant women and newborns during the perinatal period, especially in emergency situations, maximum concentration of newborns who experienced specific conditions during the perinatal period at the third level of perinatal care, the introduction of high-tech diagnostic and treatment methods, team-based organization of medical personnel, etc.

Conclusion: The study demonstrated the effectiveness of implementing new organizational technologies in providing medical care to newborns classified as neonatal near misses at the third level of perinatal care in the Minsk region.

Bacterial vaginosis (BV) is one of the most common conditions associated with an imbalance in the vaginal microbiota in women of reproductive age. BV is a risk factor for miscarriage, preterm birth, postpartum endometritis, intrauterine infection of the fetus, and many other obstetric complications. Treatment of BV in pregnant women, particularly during the first trimester, presents certain challenges. The search for new ways to correct the vaginal microbiota is a priority area.

Objective: To conduct a comparative analysis of the clinical and laboratory efficacy and safety of treatment for primary BV in pregnant women, comparing 100 mg lactic acid vaginal suppositories with conventional therapy using antiseptics or metronidazole.

Materials and methods: An open-label, controlled, prospective cohort study was conducted to assess the efficacy, safety and tolerability of 100 mg lactic acid in the treatment of primary BV in pregnant women during the first, second and third trimesters. The study included 120 women divided into two representative groups. Group 1 comprised 70 patients who were treated for BV with 100 mg of lactic acid. Group 2 consisted of 50 pregnant women who were prescribed standard courses of antiseptics or a single-dose course of metronidazole.

Results: Thirty days after the end of treatment, normal vaginal acidity persisted in 98.7% of pregnant women in group 1, whereas in group 2 it persisted in only 44% (p< 0.0001). One month after treatment, key cells were not detected in any of the patients in group 1. In the control group, they were detected in 56% of cases (p< 0.0001). Similar positive dynamics was observed with regard to the aminotest: the absence of a sign was noted in group 1 and the presence of a sign was observed in 52% of patients in group 2. It has been established that treatment with lactic acid is more effective for BV than with antiseptics or antibiotics. The dynamics of changes in the vaginal microbiota in group 1 showed a significant increase in the number of lactobacilli across the trimesters of pregnancy: in the first trimester – from 10^5.21±2.02 to 10^6.58±0.72 (p=0.0051); in the second trimester – from 10^4.75±2.43 to 10^6.50±0.79 (p=0.0051) and in the third trimester – from 10^4.89±2.32 to 10^6.67±0.69. The increase was 26.4%, 36.84% and 36.36% in the first, second and third trimesters, respectively (p=0.0051). The analysis of the course of pregnancy, labor and the postpartum period showed better results in group 1.

Conclusion: Lactic acid (100 mg) in the form of vaginal suppositories is an effective and safe treatment for BV during pregnancy, including for pregnant women in the first trimester.

Background: Vulvovaginal infections (VVI) are among the most common conditions in gynecological practice and are accompanied by severe symptoms, including itching, burning, dryness and irritation of the vulvovaginal area. Despite the effectiveness of standard etiotropic therapy, some patients continue to experience signs of a compromised skin-mucosal barrier and discomfort; thus, it is necessary to introduce additional pathogenetically based approaches.

Objective: To assess the efficacy and safety of an external emollient and intimate hygiene products as part of a comprehensive treatment regimen for VVI.

Materials and methods: A multicenter prospective comparative study was conducted involving 59 female patients aged 19–46 with VVI. The main group (n=39) received standard etiotropic therapy in combination with an emollient cream and gel for intimate hygiene (twice daily for 14 days); the control group (n=20) received standard therapy in combination with regular hygiene (using neutral soap or water alone). The study assessed pH changes in three anatomical areas (the labial cleft, the vaginal vestibule and the posterior vaginal fornix), as well as the severity of itching, dryness and irritation, quality of life and treatment tolerability.

Results: By day 15, the main group showed a more pronounced decrease in pH in the labial sulcus (MD=-0.36; p=0.009) and the vestibule of the vagina (MD=-0.91; p< 0.001). The intensity of itching decreased in both groups; however, it was statistically significantly lower in the main group on day 4 (p=0.037) and on day 15 (p=0.002). The proportion of patients who had no itching on day 15 was 91.2% in the main group versus 46.2% in the control group (p< 0.001). The absence of dryness at the follow-up visit was recorded in 100% of patients in the main group and in 50% of those in the control group (p< 0.001). The therapy was well tolerated, and no clinically significant adverse events were observed.

Conclusion: The addition of emollient and intimate hygiene products to standard VVI treatment improves the resolution of subjective symptoms and indicators of the local environment; it helps to relieve itching and dryness more quickly, whilst maintaining a favorable safety profile.

Uterine fibroids are a common benign disease of the female reproductive system. The issue of choosing the best treatment for uterine fibroids is important for young women who plan to have children. Plastic and reconstructive minimally invasive organ-preserving uterine surgery, namely laparoscopic robot-assisted myomectomy, is currently the gold standard in the treatment of reproductive-aged patients. Despite the great interest in this topic, there are still a number of significant challenges that even experienced highly qualified gynecological surgeons may face. These issues include excessive intraoperative blood loss, the need for blood transfusion, prolonged postoperative rehabilitation, the risk of diagnosing extremely malignant and aggressive uterine tumors (sarcomas), and long-term complications associated with abdominal morcellomas. This article analyzes current literature data on minimizing blood loss and potential risks of minimally invasive extraction of drugs from the abdominal cavity (morcellation) during removal of myomatous nodes using laparoscopic robot-assisted techniques.

Conclusion: A review of the available literature suggests that, despite the numerous publications, there are still areas in minimally invasive gynecologic surgery that require further study. Strategies aimed at reducing intraoperative blood loss during myomectomies and ablastic morcellation can improve the quality of surgical care for young reproductive-aged patients with uterine fibroids.

Premenstrual syndrome is a condition characterized by mental and/or physical discomfort that occurs during the last five days of the luteal phase of the menstrual cycle and resolves within the first four days of the next menstrual period. The main mechanism underlying the condition is thought to be an inappropriate response of the central nervous system to fluctuations in sex hormones during the menstrual cycle. It is well known that the first step in alleviating the clinical manifestations of premenstrual syndrome is non-pharmacological treatment, the main components of which are lifestyle changes, a balanced diet, treatment for obesity and the use of calcium supplements. In severe cases, or if the non-pharmacological methods described above prove ineffective, it is recommended to consider pharmacological treatment options, namely, selective serotonin reuptake inhibitors or combined oral contraceptives (COCs). It has been established that COCs containing drospirenone and ethinyl estradiol (Vidora micro) have a positive effect on alleviating the main symptoms of premenstrual syndrome, such as swelling, mood swings, and social withdrawal. Ethinyl estradiol improves the pharmacokinetics of drospirenone by interacting with CYP enzymes. Compared with other progestogens, drospirenone-containing preparations offer certain advantages due to their antimineralocorticoid activity (which not only prevents fluid retention and the development of edema-related symptoms, but also allows this progression to be used in patients with fluctuating blood pressure) and antiandrogenic activity (which has a positive effect on alleviating irritability and aggressiveness, as well as on prevention of weight gain). The analysis of the scientific literature revealed that the use of drospirenone-containing COCs demonstrated efficacy compared with the placebo group. It has been shown that long-term continuous use of this medicine is more effective than its periodic use. In addition, combined treatment is recommended, alongside with lifestyle changes, moderate physical activity and a healthy, balanced diet. The possibility of combining drospirenone-containing COCs and selective serotonin reuptake inhibitors shows promise.

Conclusion: There is a need for further large-scale studies involving a large sample of patients and control groups in order to obtain new data and establish an evidence base for using this type of therapy in clinical practice.

Background: Neonatal hemochromatosis refers to gestational alloimmune liver diseases (GALD), leads to neonatal death and has a high risk of recurrence in offspring. The disease is rare and there is limited clinical experience with the use of human immunoglobulins to prevent neonatal hemochromatosis.

Case report: The article presents a clinical observation of the successful use of human normal immunoglobulin during pregnancy in a woman with neonatal hemochromatosis, pathologically established in a previously deceased newborn. The dose of human normal immunoglobulin (1 g per 1 kg of body weight) for intravenous administration was calculated based on the patient’s body weight at 14–18 weeks gestation (50 g), and did not change with further weight gain. Taking into account the half-life of the drug, infusions were given every 14–21 days, which in total amounted to 7 administrations. The treatment continued until 35 weeks gestation and resulted in the birth of a healthy girl weighing 3150 g.

Conclusion: Timely initiation of intravenous immunoglobulin therapy at 14–18 weeks gestation, regular monitoring of immunological parameters and evaluation of the fetal liver using MRI made it possible to prolong pregnancy to full term and minimize the risk of fetal damage. The joint work of obstetricians, gynecologists, immunologists, hematologists, and international experts, as well as development of personalized treatment plans adapted to the patient’s needs and the administrative restrictions of the region, were the key factors in achieving a positive outcome.