No 6 (2025)

Background: Early detection of central nervous system (CNS) anomalies is of great importance due to the substantial impact of such anomalies on the development of the CNS, often resulting in the onset of neuropsychiatric disability and cognitive impairment. Congenital pathology of CNS development is one of the main causes of perinatal and early infant mortality. Echographic evaluation of the CNS in the first trimester of pregnancy is extremely challenging due to the active development of brain structures during this period. However, scientific and technological progress in the last decade has expanded the diagnostic possibilities for obtaining new information about the characteristics and nature of pathological changes.

Objective: To analyze scientific publications reporting early detection of fetal CNS anomalies using volumetric ultrasound imaging.

Materials and methods: The literature search was performed in Scopus, Medline (PubMed), and eLibrary databases. The relevant sources were analyzed. Forty-seven scientific papers were used.

Results: The data on modern possibilities of ultrasonic diagnostics in the first trimester of pregnancy for early detection of fetal CNS anomalies were obtained.

Conclusion: The scientific literature highlights the clinical value and relevance of the development and implementation of expert multiparametric fetal neurosonography in the first trimester, according to the methodology recommended for specialised examination in the second trimester of pregnancy. The effectiveness of combining three-dimensional echography with genetic research methods and the application of machine analysis of echograms was confirmed.

Endometrial hyperplasia is a common gynecological disease in women of reproductive age characterized by significant changes in the endometrium, with an increase in gland to stroma ratio. Endometrial hyperplasia tends to develop into endometrial cancer. Therefore, early detection and treatment of this condition is of great importance for improving the quality of life and prognosis. This pathology continues to be the subject of attention for Russian and foreign scientists, as there are currently more questions about the causes and mechanisms of endometrial hyperplasia than answers. Imbalance in the estrogen-progesterone system, inflammatory processes and other factors play an important role in the development of endometrial hyperplasia. Significant risk factors of endometrial hyperplasia include obesity, insulin resistance, chronic anovulation, polycystic ovary syndrome, characteristics of the uterine microbiota, early menarche, late menopause, lack of pregnancy in the history, genetic factors, etc. The review offers a fresh perspective on the ‘old’ issue.

Conclusion: The literature suggests that endometrial hyperplasia is a complex and multifactorial condition. At the same time, there is no universally accepted concept of the etiology and pathogenesis of endometrial hyperplasia, which means that further research in this area is required.

The review contains publications from the PubMed/MEDLINE and eLibrary.ru databases over the past 5 years on the use of preimplantation genetic testing and aneuploidy diagnosis (PGT-A) in the practice of assisted reproductive technologies (ART). PGT-A is used worldwide with a frequency ranging from 2 to 33% depending on national guidelines and patients’ age, however, PGT-A is not used in ART practice in some countries. PGT-A supporters present arguments about the association of aneuploidy with advanced reproductive age, its effect on pregnancy rates and live births. PGT-A opponents raise concerns about the epigenetic effects of mechanical damage to the embryo during biopsy, as well as its prolonged stay in an artificial environment until the blastocyst stage; they also suggest that aneuploidy may be self-corrected during embryo development. The frequency of PGT-A use is directly related to the funding source and the beneficiary. Most researchers find evidence in favor of the rational use of PGT-A. In case of miscarriages, 58% of embryos are aneuploid and embryo selection in the ART protocol reduces the miscarriage rate; in case of ongoing pregnancy, it does not significantly affect the live birth rate. The difficult interpretation of PGT-A results is due to objective reasons. Firstly, the trophectoderm may contain cells with different sets of chromosomes simultaneously; secondly, there is no complete coincidence of the ploidy of the cells of the trophectoderm with the inner cell mass of the blastocyst; thirdly, there is a different degree of mosaicism depending on the proportion of abnormal cells, the type of damaged chromosome, the number of abnormal chromosomes, and the type of chromosomal abnormality. The most commonly used method for performing PGT is next-generation sequencing (NGS). The use of microarrays for the study of single nucleotide polymorphisms (SNP-microarray) is a promising direction in this field.

Conclusion: PGT has strong scientific potential in improving laboratory technologies, development and application of SNP-array, and research into the nature of chromosomal abnormalities. The use of PGT in reproductive medicine remains in demand due to the large proportion of infertile couples of advanced reproductive age, the need for improved outcomes of ART and higher rates of healthy births.

Urinary tract endometriosis refers to deep infiltrating endometriosis. Its incidence ranges from 0.3 to 12% of all cases of endometriosis. The article presents the main theories that provide evidence-based explanations of the etiology and pathogenesis of endometriosis. Endometriosis is primarily associated with the diseases of the reproductive system. However, the clinical picture of urinary tract endometriosis has its own characteristics; it depends on the extent and localization of endometrioid lesion and may be atypical. The symptoms may be completely absent or manifest as severe dysuric disorders. But their specific characteristics are due to the cyclic nature and association with a woman’s menstrual cycle.

The diagnosis of urinary tract endometriosis has a number of difficulties and requires a comprehensive approach. It includes clinical, laboratory and instrumental examinations: ultrasound, MRI, CT, cystoscopy, excretory urography. The complex of studies provides a complete picture of the localization of endometrioid nodules, the depth of the lesion and the extent of dysfunction in the organs of the genitourinary system. Special attention should be given to immunohistochemical studies of endometrioid nodules, which provide insight into the expression of stem cell marker Musashi-1 in endometrioid heterotopias and autologous endometrium. This explains the morphological characteristics of the disease. The results of the study are important in predicting the recurrence of the disease.

Treatment involves medication therapy and surgery. Each stage has its advantages and limitations. The aim of treatment is to relieve pain, restore the impaired functions of the genitourinary system, reduce the risk of recurrence of the disease, improve the quality of a woman’s life and preserve her reproductive function.

Conclusion: Urinary tract endometriosis is a complex and multifactorial condition that requires a thorough diagnostic approach, as well as the collaboration of various specialists, namely, gynecologists, urologists, and internists.

According to statistical forecasts, 30% of the global population will reach the age of 65 or more by the year 2050. An increase in life expectancy is often accompanied by an increase in the number of years people live with chronic and age-related conditions. Postmenopausal women with estrogen deficiency are more likely to develop obesity, insulin resistance, type 2 diabetes, and cardiovascular complications. Until recently, the role of androgens in the development of age-related diseases has remained uncertain. The recent studies suggest that endogenous androgens may have protective effects on the cardiovascular system, cognitive functions, musculoskeletal system, and libido in postmenopausal women. Therefore, it is important to select menopausal hormone therapy carefully, considering the maintenance of physiological levels of endogenous hormones, including androgens.

Conclusion: A personalized approach that accounts for a patient’s unique characteristics is essential in the management of postmenopausal women. Menopausal hormone therapy, which does not suppress the production of endogenous androgens, in combination with lifestyle correction is the key to healthy longevity and improving the quality of life of postmenopausal women.

Objective: To evaluate the obstetric and neonatal outcomes associated with the use of dinoprostone vaginal insert for cervical ripening and labor induction in routine obstetrical clinical practice.

Materials and methods: Multicenter clinical trial utilizing «real-world evidence» was conducted across 18 hospitals. The study included 503 primiparous and multiparous women with singleton pregnancies in cephalic presentation, gestational ages between 37 and 41⁺⁶ weeks, and a cervical Bishop score of 5 or less, who met all inclusion criteria, none with the exclusion criteria, and signed an informed consent form. Vaginal insert containing prostaglandin E2 (dinoprostone) was used for cervical ripening. After 24 h the insert was removed and the patients were re-evaluated. Based on the Bishop score, patients underwent either additional cervical ripening or labor induction.

Results: Labor began in 64.61% of patients before the end of the 24-hour interval while the dinoprostone vaginal insert was still in place. Failed cervical ripening and failed labor induction occurred in 2.78% and 2.78% of patients, respectively. The mean increase in the Bishop score was 2. A vaginal delivery was achieved for 77.14% of patients, while a cesarean was performed on 22.86% of patients. No infectious complications or significant side effects were reported.

Conclusion: The findings from our multicenter real-world evidence study indicate that the dinoprostone vaginal insert is an effective and safe method for cervical ripening and labor induction.

Objective: To evaluate the impact of cytokine therapy on utero-endometrial blood flow in different morphological types of chronic endometritis.

Materials and methods: We analyzed data from 298 women of reproductive age with a confirmed diagnosis of chronic endometritis (CE). The study group comprised 140 patients in whom standard anti-inflammatory therapy was supplemented with Superlymph. The control group included 158 patients treated with a similar regimen but without cytokine therapy. Doppler parameters of uterine artery blood flow were assessed, including arterial perfusion index (API) and volumetric blood flow indices (VI, FI, and VFI).

Results: Following therapy, a significant decrease in vascularization was observed in women with mixed and hyperplastic CE morphotypes, which was attributed to the normalization of venous outflow in the uterine mucosa. However, this pronounced effect was not observed in women with a hypoplastic morphotype. During the first six months after completing complex treatment with exogenous cytokines, clinical pregnancy rates were 38.8% in the study group compared to 27.5% in those receiving only anti-inflammatory therapy (RR=1.412; 95% CI 1.008–1.997). In the study group, pregnancy occurred 1.9 times more frequently in women with hyperplastic macrotype than in those with hypoplastic macrotype CE.

Conclusion: The administration of exogenous cytokines, in conjunction with anti-inflammatory therapy, restores venous outflow in the endometrium for mixed and hyperplastic macrotypes of CE, while enhancing the effectiveness of pathogenetic treatment in the hypoplastic macrotype. This approach increases pregnancy rates by 1.5 times in cases of thin endometrium, by 1.8 times in cases of mixed macrotype, and by 1.3 times in cases of hyperplasia.

Objective: To evaluate the anatomical and functional characteristics of the pelvic floor in women of different age groups.

Materials and methods: This study was conducted at the Military Medical Academy and included 1,546 women who were divided into three age groups. Anatomical characteristics were assessed using the POP-Q system and transperineal ultrasound examinations. Functional characteristics were analyzed with the PERFECT system, and the PFDI-20 and SF-36 questionnaires were utilized. In addition, the Female Sexual Function Index was evaluated.

Results: The study revealed that women in the second group experienced age-related shifts in the locations of points Aa and Ba, along with a statistically significant increase in the angle of urethral inclination and bladder neck displacement (p=0.01). Women in group 3 showed a significant decrease in strength, endurance, and muscle contractions (p=0.001). The PFDI-20 questionnaire results indicated an increase in the severity of pelvic dysfunction symptoms, rising from 9.4 points in group 1 to 144.8 points in group 3 (p=0.001). The increase in prolapse symptoms and severity of pelvic dysfunction correlated with a decrease in both the physical (ρ=-0.56, p=0.001) and psychological components of health (ρ=-0.60, p=0.001).

Conclusion: This study demonstrated that anatomical and functional changes in most women begin long before menopause onset. The data obtained can be used to develop individualized prevention and treatment measures.

Objective: To study the structure and frequency of hormone-dependent diseases in women over 35 years of age who underwent treatment in Gynecology Department of Osh Interregional Clinical Hospital in the period 2011–2015.

Materials and methods: This was a retrospective analysis of 199 case histories of patients over 35 years of age who were treated in Gynecology Department of Osh Interregional Clinical Hospital in 2011–2015. The methods of clinical examination, ultrasound and histological examinations were used. Digital data processing was carried out in MS Excel version 16.94 using arithmetic mean calculations.

Results: The most common gynecological diseases were uterine fibroids (26.5%) and endometrial hyperplasia (25%). Ovarian torsion (17.5%), endometriosis (6.5%) and endometrial polyps (10.5%) were also diagnosed. Abnormal uterine bleeding (25%) and dysfunctional bleeding (8.5%) were more frequent among the complications. Anemia (59.5%), genital tract infections (49.5%), cystitis (35.5%) and obesity (35%) were the most common among concomitant diseases. The most frequent surgical procedures were vacuum aspiration (20%), hysterectomy (18.5%) and cystectomy (17.5%). Significant differences in the prevalence of certain diseases between urban and rural women have been identified.

Conclusion: A retrospective study of the case histories of 199 women over 35 years of age who were treated in Gynecology Department of Osh Interregional Clinical Hospital in the period 2011-2015 showed that hormone-dependent gynecological diseases, uterine bleeding and concomitant general somatic diseases are common, and surgical treatment remains relevant.

Menopausal hormone therapy (MHT) has been the most effective method for relieving menopausal symptoms and menopausal disorders for many years. Despite the fact that modern research confirms the safety of this therapy, there are absolute and relative contraindications for its use. In addition, a significant number of patients continue to refuse to take MHT. In this regard, the search for non-hormonal alternative treatment methods is a relevant issue.

Objective: To evaluate the effect of taking a combination of myoinositol and D-chiroinositol in the ratio of 5:1, folic acid (Dikirogen) and manganese on the course of menopausal syndrome of mild to moderate severity in patients in early postmenopausal period.

Materials and methods: A prospective study included 84 women in early postmenopausal period with mild to moderate menopausal syndrome. They were divided into three groups: group 1 consisted of patients with metabolic syndrome and BMI of more than 25 kg/m² (stage 1–2 overweight or obesity); group 2 (n=28) included lean patients without metabolic disorders with BMI of less than 25 kg/m². In these two groups, the patients took a combined medication containing myoinositol and D-chiroinositol in the ratio of 5:1, manganese and folic acid (in a dosage of 1,000 mg+200 mg+5 mg+20 mcg), one sachet twice a day for six months. Group 3 (control group) consisted of 30 patients who did not receive therapy and they were divided into two subgroups: subgroup 3A (n=14) included women with metabolic syndrome and BMI of more than 25 kg/m2 (stage 1–2 overweight or obesity), subgroup 3B (n=16) included lean patients without metabolic disorders with BMI of less than 25 kg/m². Before starting therapy and after 6 months of taking the medication, patients’ complaints and parameters of lipid and carbohydrate metabolism were evaluated.

Results: Therapy with the combined medication containing myoinositol and D-chiroinositol in the ratio of 5:1, manganese and folic acid contributed to a statistically significant decrease in the severity of menopausal disorders (the average value on the Greene Climacteric Scale lowered from 35 to 11 scores), a decrease in total cholesterol by 19.5%, triglycerides by 42.5%, fasting glucose by 19%, BMI by 10.9%, and waist circumference by 4.6% in group 1 that included patients with metabolic disorders. There were no statistically significant results after therapy (p>0.05) and there was no improvement in menopausal symptoms in group 2 which consisted of women with normal BMI.

Conclusion: Taking Dikirogen has been shown to reduce the severity of menopausal disorders in patients in the early postmenopausal period who have metabolic syndrome and obesity. In patients with normal body weight, no clinical effect was observed on menopausal and metabolic disorders.

The use of indole carbinol in the treatment of benign breast diseases has shown potential benefits for preventing the development of neoplasia. The metabolism of indole carbinol begins in the stomach, where a number of biologically active compounds are formed as a result of acid-catalyzed reactions. These compounds include 3,3'-diindolylmethane (DIM) and 5,11-dihydroindolo-[3,2-b]-carbazole (ICZ), which are oligomers. Indole carbinol and DIM, through their own aryl hydrocarbon receptors, regulate the expression of enzymes involved in liver metabolism and the excretion of various biologically active substances, including steroid hormones, medications, carcinogens, and toxins. Preclinical studies have shown that indole carbinol and DIM have indirect anti-estrogenic activity, which may help reduce the risk of hormone-dependent cancer. Indole carbinol and DIM can alter the profile of estradiol metabolites in the urine of women, reducing the number of proliferation-stimulating molecules. Experimental studies have demonstrated that indole carbinol is able to affect several signaling pathways that are inhibited in tumor cells, namely, those that control cell proliferation, apoptosis, migration, invasion and angiogenesis. Thus, indole carbinol can selectively affect altered cells. DIM has lower bioavailability than indole carbinol. Indole carbinol, which is part of the Indinol Forto medication, is included in clinical guidelines for the treatment of benign breast disease.

Conclusion: The mechanisms of action of indole carbinol characterize Indinol Forto as a medication with a potential oncoprotective effect. This result is especially important in terms of preventing breast cancer in patients with cyclic mastalgia.

Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition that affects the spine and sacroiliac joints. It often occurs in women of reproductive age. The impact of AS on pregnancy has been the subject of much debate: a number of studies have indicated a correlation between AS and an elevated risk of preeclampsia, preterm labor and other complications, while other studies do not support this association.

Case report: A pregnant woman with AS who discontinued taking certolizumab at 20 weeks’ gestation was diagnosed with preeclampsia, fetal growth retardation, and nephrotic syndrome with marked proteinuria and hypoalbuminemia at 24–25 weeks’ gestation. However, the patient did not undergo renal replacement therapy and renal biopsy due to preserved renal nitrogen excretion function. The absence of effect of the multicomponent therapy resulted in the decision on the necessity of delivery at 28–29 weeks. After delivery, the patient resumed therapy with certolizumab and laboratory findings became normal.

Conclusion: Pregnancy in women with AS can be complicated by amyloidosis which has symptoms similar to preeclampsia. Pregnancy in patients without preeclampsia can last longer, but preeclampsia requires an early delivery. The sudden cessation of AS therapy had a negative impact on the course of the disease and the development of preeclampsia. It is important to continue therapy during pregnancy to reduce the risk of complications. The management of these patients requires a multidisciplinary approach.

Background: Abdominal pregnancy is an extremely rare type of ectopic pregnancy. However, it requires attention due to the risk of severe maternal complications and adverse perinatal outcomes during delivery.

Case report: This is a clinical observation of an abdominal pregnancy at 31 weeks’ gestation in a multiparous woman who had an emergency operative delivery with a favorable outcome. A 47-year-old patient was transported to the Regional Perinatal Centre by an ambulance from an outpatient department. On admission, blood pressure was 180/100 mmHg, and the pregnant woman was hospitalized to the intensive care unit (ICU). She was not registered at the antenatal clinic. She learned about the pregnancy 10 days ago for the first time at the appointment with a gastroenterologist. She presented to the doctor with abdominal pain syndrome that lasted for a month, spastic abdominal pain, belching, heartburn, abdominal bloating, weight loss of up to 8 kg. In ICU, she was examined, ultrasound and Dopplerometry were performed. The examination revealed anhydramnios, fetal growth retardation, uterine myoma with isthmic localization of nodes, hemodynamic disorders in uterine arteries, in umbilical arteries with centralization in the middle cerebral artery. A multidisciplinary council was held due to the severe condition of the pregnant woman and the questionable CTG type; the diagnosis of severe preeclampsia was made. According to the decision of the council, the patient was delivered by emergency caesarean section. During the operation, the fetus was found to be loose and positioned high up in the abdomen in a transverse position. The amniotic fluid was heavily stained with meconium. A live premature girl was delivered by the legs; the newborn’s condition was moderately severe, no asphyxia, with an Apgar score of 7/7. The parameters of the physical development of the newborn corresponded to the gestational age, with body weight measuring 1620 g and length measuring 41 cm. The placenta was located in the area of the left appendages; it was limited by the leaves of the broad ligament, in the mesosalpinx, with a network of dilated vessels connecting it to the left ovary, fallopian tube and vessels of the broad ligament. Intraoperative blood loss was 1500 ml, 33% of the blood volume.

Conclusion: The successful delivery in abdominal pregnancy was ensured by the work of a qualified surgical team. During the operation, it was possible to avoid fetal damage, profuse blood loss, and maternal mortality. The delivery was considered to be successful as the perinatal outcome was favorable, the newborn was in a satisfactory condition at birth, there were no skeletal deformities and congenital malformations, the baby was successfully treated in the neonatal pathology department and discharged in a satisfactory condition.