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No 1 (2023)


The role of high-intensity focused ultrasound treatment in patients with uterine myoma

Moskvicheva L.I.


Uterine myoma is the most common benign tumor in gynecological practice and the leading cause of hysterectomy. This pathology has clinical manifestations in every three female patients, decreases quality of life and level of fertility in reproductive-aged women, and also substantially affects the human potential of any country. Uterine fibroids can be now treated with various medical, surgical, interventional, and ablative methods that differ in the nature of their impact, in the criteria for selecting female patients, in the required level of technical equipment, and in economic characteristics. In connection with to the active introduction of modern minimally traumatic local treatments into wide practice, high-intensity focused ultrasound therapy, a non-invasive thermal ablation technique for solid neoplasms at various sites, is of particular interest to patients with uterine myoma. The literature review presents the possibilities of using high-intensity focused ultrasound therapy in patients with uterine myoma; highlights the advantages and disadvantages of this type of local thermal effect in the treatment of a benign uterine tumor; determines indications for and contraindications to highintensity focused ultrasound therapy; describes the main complications of ultrasound ablation and ways for their prevention; identifies criteria for the efficiency of treatment, as viewed from both the general somatic characteristics of a woman and the biological characteristics of a myomatous node and the parameters of the procedure; and demonstrates the clinical results of local treatment (the time course of changes in tumor sizes, pain syndrome level, menorrhagia volume) and its impact on female reproductive abilities. Conclusion: The present study has shown that high-intensity focused ultrasound therapy can be considered as an affordable, effective, relatively safe method to treat patients with uterine myoma.
Obstetrics and Gynecology. 2023;(1):5-12
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Uterine sarcoma and pregnancy: modern view on the problem

Tskhay V.B., Pashov A.I., Ashrafyan L.A., Rachkovskaya V.V.


The scientific review considers a gynecological disease, such as uterine sarcoma. The paper presents the main definitions of the gynecological disease, provides statistical data on the prevalence of this disease, describes its current classifications, and touches upon the etiological and pathogenetic aspects of uterine sarcoma. It reviews the current foreign and Russian sources of literature data on the incidence of uterine sarcoma during pregnancy and analyzes the outcomes of pregnancies. The authors also discuss the general principles of surgical treatment for this type of cancer, give an account of the possible volumes of surgical intervention, and highlight the expediency and principles of radiation therapy and adjuvant chemotherapy. They detail clinical outcomes and survival rates in women after surgical intervention of varying complexity and volume. Much attention is paid to the incidence of uterine sarcoma in women of childbearing age who are interested in maintaining their reproductive function in the future. The paper describes treatment options for uterine sarcoma (presents clinical cases), by preserving further female reproductive function, namely organ-sparing operations. Conclusion: Organ-sparing operations in women of childbearing age with detected uterine sarcoma are an experimental procedure. However, the data on survival rates are more encouraging in patients with lowand moderate-grade endometrial stromal sarcoma (LMGESS) after organ-sparing surgery. From this it is inferred that organ-sparing surgery can be proposed and performed in women who are interested in maintaining their reproductive function.
Obstetrics and Gynecology. 2023;(1):13-19
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The role of Lactobacillus iners and bacterial vaginosis-associated microorganisms in making up the vaginal microbiota

Mikhanoshina N.V., Priputnevich T.V., Bairamova G.R.


Objective: To summarize the data available in the literature on the currently used criteria for evaluating the vaginal microbiota in reproductive-aged women, the principles of its classification, and the exogenous and endogenous factors influencing the microbial structure. The review includes data from the publications presented in the MedLine and Russian Science Citation databases. The review describes the key distinguishing features of the species Lactobacillus iners from other vaginal lactobacillus species, including cultivation features, tinctorial properties, and pathogenicity power. It presents data on the frequency of this species in the microbiota of reproductive-aged women and elucidates the need for its isolation and identification in the microbiological laboratories of any level in order to make a correct diagnosis. There are data on the characteristics of the vaginal microbiota in bacterial vaginosis, which are due to a variety of the microflora, including the species diversity of Gardnerella spp. The review highlights the role of a polymicrobial biofilm in the pathogenesis of bacterial vaginosis. It touches upon the relevance of a further study of the interaction of Gardnerella spp. and L. iners species, as well as the effectiveness of an integrated approach to evaluating the vaginal microbiota, by using the results of classical and molecular biological methods. Conclusion: L. iners is one of the most common lactobacilli in the microbiota of reproductive-aged women. The role of this species in the functional stability of the vaginal microbiota has not yet been def ined to date. Further investigation of the species is required to establish strain diversity. There is a need for routine practice introduction of research methods allowing the isolation of L. iners in the microbiological laboratories of all levels.
Obstetrics and Gynecology. 2023;(1):20-26
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Endometriosis comorbidity and its clinical significance

Chernukha G.E., Pronina V.A.


Comorbidity is one of the urgent interdisciplinary problems of modern medicine, including gynecology. From the standpoint of diagnosing endometriosis, the assessment of the comorbidity is one of the most effective and affordable methods of primary screening for this group of female patients. However, patient complaints, clinical presentations, and gynecological diseases are mainly evaluated in real clinical practice, while a somatic history is not fully assessed and sometimes completely ignored. Nevertheless, the relationship of endometriosis to a non-gynecological disease may be of great clinical significance. The modern Russian and foreign literature sources rather widely discuss the comorbidity of endometriosis with thyroid, cardiovascular, and fibrocystic diseases, and cancers. However, a wide range of concomitant non-gynecological diseases, which is, nevertheless, quite common and is of prognostic signif icance for the diagnosis of endometriosis, rema ins unaddressed. The review presents the data demonstrating the common etiology and pathogenesis of endometriosis with low body mass index (BMI), acne, migraine, and irritable bowel syndrome (IBS). The comorbidity of endometriosis with low BMI and acne has been insufficiently studied due to lack of a strong evidence base for this relationship. Nevertheless, these comorbidities are not only easy to diagnose at a primary outpatient visit, but they also have a sufficient degree of specificity to identify women at risk for the disease along with well-known disorders, such as migraine and IBS. Conclusion: Information about the comorbidity of endometriosis with both gynecological diseases and non-gynecological ones can serve as the basis for appropriate patient counseling at the initial examination stage. This will assist in reducing the time to diagnosis and in minimizing the use of invasive research methods.
Obstetrics and Gynecology. 2023;(1):27-34
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Obstructed hemivagina (OHVIRA syndrome) or uterovaginal septum and ipsilateral renal anomaly?

Batyrova Z.K., Uvarova E.V., Chuprynin V.D., Asaturova A.V., Kumykova Z.K., Kruglyak D.A., Gautier M.S.


This review analyzes an update on the clinical presentations of female genitourinary malformations (OHVIRA or Herlyn-Werner-Wunderlich syndrome) and new approaches to their diagnosis and treatment. The review includes data from foreign and Russian articles found in PubMed on the topic under consideration and published in recent years. The state-of-the-art in the area under study is analyzed. The data on the diagnosis and management of patients with the rare associative state are systematized; further areas that require in-depth study are identified. Conclusion: The presented studies indicate that there is a need to revise the name of the Herlyn-Werner- Wunderlich syndrome and the acronym OHVIRA in favor of uterovaginal septum and ipsilateral renal anomaly. The important role of and need for the widespread introduction of visual diagnostic methods and minimally invasive surgical treatment technologies in the management of these patients in order to improve the efficiency of medical care are emphasized.
Obstetrics and Gynecology. 2023;(1):35-40
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Comparison of the course and outcomes of pregnancies complicated by hypertensive disorders

Shelekhin A.P., Baev O.R., Krasnyi A.M.


Objective: To compare the course of pregnancy, childbirth, and pregnancy outcomes in patients with hypertensive disorders. Materials and methods: A retrospective study enrolled 335 pregnant women, who were divided into 6 groups. Group 1 included uncomplicated pregnancies (control group, n=60), Group 2 included patients with gestational arterial hypertension (GAH, n=55), Group 3 included patients with chronic arterial hypertension (CAH, n=60), Group 4 included patients with moderate preeclampsia (MPE, n=60), Group 5 included patients with severe preeclampsia (SPE, n=50), Group 6 included patients with preeclampsia superimposed on chronic arterial hypertension (PE/CAH, n=50). Results: Pregnant women with hypertensive disorders were older and had a higher body weight than women in the control group. Women with SPE and PE/CAH were more likely to have a history of PE. The highest rate of edema was observed in the MPE group. Compared to the GAH and CAH groups, uterine-placental and fetal-placental blood flow disorders were significantly more often diagnosed in patients with PE. Pregnancies with SPE were more often complicated by fetal growth restriction and HELLP syndrome. The highest preterm birth was observed in the SPE (52%) and PE/CAH (44%) groups. Most low-birthweight deliveries and neonatal complications occurred in the SPE and PE/CAH groups. Conclusion: The most adverse maternal and perinatal outcomes were observed in the early-onset hypertensive disorders, especially in patients with SPE and PE/CAH. Particular attention should be paid to women with CAH, who constitute the basis of the PE/CAH group and have a high rate of operative delivery.
Obstetrics and Gynecology. 2023;(1):41-47
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The role of vascular and angiogenic factors in the development of selective fetal growth restriction in monochorionic multiple pregnancy

Gladkova K.A., Sakalo V.A., Vtorushina V.V., Piskulina A.A., Frolova E.R., Kostyukov K.V., Khodzhaeva Z.S.


Background: Selective fetal growth restriction (sFGR) affects 10-25% of all monochorionic twin pregnancies. If not detected and treated, sFGR is associated with high perinatal mortality and a wide range of neonatal complications. However, currently, due to the introduction of the dynamic fetal monitoring and intrauterine treatments, including fetoscopic laser coagulation of placental vascular anastomoses and the determination of optimal delivery time, it is possible to achieve high survival rates for both fetuses. The main etiological factor of sFGR is placental dysfunction, including morphological and functional changes associated with reduced placental volume, impaired development of arterio-arterial anastomoses, and vascular and angiogenic factors during the formation of an early monochorionic pregnancy. Objective: To investigate the role of vascular endothelial factors in the development of sFGR in monochorionic twin pregnancy. Materials and methods: The study included 51 patients with monochorionic diamniotic twins. Group 1 comprised patients with sFGR (n=31) and Group 2 consisted of patients with uncomplicated monochorionic twin pregnancies (n=20). The study retrospectively analyzed the role of maternal vascular and angiogenic factors at 18-26 weeks’ gestation in the development of sFGR. The analysis also included the evaluation of perinatal outcomes, the course of the early neonatal period, stay in the intensive care unit, and length of hospital stay at the second stage of nursing. Results: The mean age of participants was 31.6 (5.13) years. There were no statistically significant differences in concentrations of vascular and angiogenic factors, pregnancy and early neonatal outcomes. However, high concentrations of maternal VEGF-R1, VEGFC, and HIF-1a were associated with neonatal mortality, and a high concentration of HIF-1a was associated with stillbirth. These findings may be used in clinical practice to predict antenatal and early neonatal loss. Pregnant women with sVEGF-R1 greater than 0.787ng/mL and Ang-2greater than 8255.91 ng/mL were found to have an increased risk of low-birthweight babies. Conclusion: Comparative assessment of vascular and angiogenic factors in sFGR pregnancies offers the opportunity to prevent the progression of this condition by timely fetoscopic intervention, improve perinatal outcomes, and minimize the risks of severe antenatal and neonatal complications.
Obstetrics and Gynecology. 2023;(1):48-54
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Comparative analysis of the effect of two antihypertensive therapy regimens on maternal hemodynamic parameters in earlyand late-onset preeclampsia

Muminova K.T., Khodzhaeva Z.S., Gorina K.A., Shmakov R.G., Ziganshina M.M.


Objective: To investigate the effect of antihypertensive therapy on maternal hemodynamic profile and the relationship between hemodynamic parameters and endothelial glycocalyx (eGCX) status in patients with preeclampsia. Materials and methods: The study comprised 82 patients, including women with uncomplicated pregnancy (n=30, comparison group) and patients with preeclampsia (n=52, study group) receiving monoor combined antihypertensive therapy. Monotherapy consisted ofDopegit (mean dose 1500mg/day) and two-component therapy included Dopegit (mean dosage 2000 mg/day) and Cordaflex (mean dosage 40 mg/day). All hypertensive patients underwent 24-hour ambulatory blood pressure monitoring (24h-ABPM) using a BPLab device (Peter Telegin, Nizhny Novgorod, Russia). Blood components of eGCX were measured by an enzyme immunoassay. Results: Early-onset preeclampsia was associated with worse perinatal outcomes, such as earlier gestational age at delivery, lower birth weight, and a lower Apgar score. Patients with early-onset preeclampsia receiving two-component therapy had higher systolic and diastolic BP. In patients with early-onset preeclampsia, (dP/dt)max values were significantly elevated, most markedly in patients on two-component antihypertensive therapy. This subgroup also had a higher augmentation index (AIx) and a higher RWTTindex. Patients with late-onset preeclampsia on monotherapy showed a significant increase in (dP/dt)max and ED; they also had a borderline signif icant increase in AIx. All patients receiving Dopegit monotherapy had a signif icant increase in syndecan-1 blood levels. Patients with early-onset preeclampsia on two-component therapy showed a significant decrease in hyaluronan levels and a borderline significant increase in syndecan-1 levels compared to women with healthy pregnancy. No signif icant differences in eGCX status were detected in patients with late-onset preeclampsia. Conclusion: The findings suggest a pathogenetic link between molecular and functional vascular changes, which is partially compensated by antihypertensive therapy. In early-onset preeclampsia, antihypertensive therapy is less effective because hemodynamic changes are not corrected by Dopegit and Cordaflex. At the same time, in late-onset preeclampsia the effectiveness of combined antihypertensive therapy is confirmed by compensation of hemodynamic parameters of the maternal cardiovascular system.
Obstetrics and Gynecology. 2023;(1):55-66
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Cell subpopulation composition and cytokine content in peripheral blood before spontaneous and induced labor

Tysyachnyi O.V., Inviyaeva E.V., Vtorushina V.V., Krechetova L.V., Baev O.R.


According to current concepts, immunological mechanisms play a fundamental role in the initiation of labor. The current literature lacks information related to the plasma cytokine content of pregnant women prior to spontaneous and induced labor. Studying the cytokine profile may contribute to the identification of its imbalance and determine prognostic criteria for failed labor preinduction. Objective: To investigate cell subpopulation composition and cytokine content in peripheral blood before spontaneous and induced labor. Materials and methods: A prospective pilot study included 30 healthy primiparous women who were divided into 3 groups. Control group (n=8) included women with early signs of labor; patients in group 1 (n=14) required one stage of labor preparation to develop labor activity; patients in group 2 (n=8) required two stages of preparation. Results: Women who required longer labor preparation had significantly higher TNF-a levels [2.9 (2.0;3.1) vs 2.9 (2.0;3.7) vs 5.4 (4.3;6.1) pg/ml in the control group, group 1 and group 2, respectively, p=0.025]. Conclusion: The highest level of TNF-a in women who required the second stage of labor preparation probably reflects slower cervical ripening.
Obstetrics and Gynecology. 2023;(1):67-74
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Feasibility of preimplantation genetic testing for aneuploidy in patients undergoing in vitro fertilization after conservative treatment of atypical hyperplasia and early endometrial cancer

Krasnopolskaya K.V., Novikova O.V., Isakova K.M., Shostenko L.V., Rau D.I., Shishkina A.V.


Relevance: Atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) are frequently detected in female patients before the realization of their reproductive potential. Patients of older reproductive age with AEH and early EC have an increased risk of chromosomal pathology in offspring. Objective: To investigate the feasibility of preimplantation genetic testing for aneuploidy (PGT-A) of embryos in patients with a history of AEH and early EC undergoing IVF. Materials and methods: Fifty patients aged 25- 43years (median 35 years) who underwent IVF after conservative hormonal treatment for AEH and early EC constituted the study group. The control group included 40 patients with tubal-peritoneal and mild male factor infertility. We studied the pregnancy rate (PR) in patients of different age groups and the association between pregnancy rate and PGT-A during IVF. Results: Euploid blastocysts were obtained from 32% (32/100) of patients in the study group, of whom 74% (17/23) were aged <35 and 19% (15/77) >35 years. The rate of euploid embryos in the control group was comparable. The PR among all the patients in the study group was 32% (19/60); among them it was 38% (12/32) and 25% (7/28) in women <35 and >35 years, respectively. In the control group, PR was 41% (22/54) among all patients, including 46% (13/28) in patients of young reproductive age and 35% (9/26) in women >35 years. There was a correlation between PGT-A and PR. Among all patients in the study group who did and did not undergo PGT-A, PR was 47% (7/15) and 27% (12/45), respectively. In the control group, PR was 47% (9/19) among all patients who underwent PGT-A and 34% (12/35) among patients who refused PGT-A. Conclusion: The PGT-A of embryos during IVF can exclude chromosomal abnormalities in the retrieved embryos and increase PR by transferring an euploid embryo into the uterine cavity.
Obstetrics and Gynecology. 2023;(1):76-82
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A possibility for health improvement in overweight and obese women at the stage of pregravid preparation

Radzinsky V.E., Solovyeva A.V., Kuleshov V.M., Katkova N.Y., Mingaleva N.V., Korotkikh I.N., Oboskalova T.A., Vorontsova A.V.


About half of women planning pregnancy have too much adipose tissue, insulin resistance, hypothalamic-pituitary-ovarian axis disorders, and consequently anovulation and infertility. Objective: To assess the results of using the biologically active dietary supplement Dikirogen (myo-inositol and D-chiroinositol in a ratio of 5:1) in conjunction with combination therapy for anovulation in overweight and obese women. Materials and methods: During 2021-2022, a descriptive study assessing the results of lifestyle changes (in diet and exercises) and nutritional support (a combination of myo-inositol 1000 mg and D-chiroinositol 200 mg, folic acid 200 ig, and manganese 5 mg (Dikirogen) was conducted in the clinics of Moscow, Nizhny Novgorod, Novosibirsk, Krasnodar, Yekaterinburg, and Voronezh in 197 reproductive-aged women who had overweight or obesity and anovulation for 2-4 months. Results: The use of the biologically active dietary supplement Dikirogen in conjunction with combination therapy (diet + exercises) caused decreases in body weight by 2.5 kg, body mass index (BMI) by 0.5 kg/m2, and waist circumference by 1.75 cm. The normal menstrual cycle was 1.41 times more often observed at Visit 2. There were reductions in LH levels from 8.45 (3.91) to 6.4 (4.9; 8.8) mU/ml and in the LH/FSH ratio from 1.4 (0.9; 2.0) to 1.2 (0.8; 1.6) (p<0.0001). There were also significant decreases in fasting glucose levels from 5.0 (4.5; 5.5) to 4.8 (4.2; 5.0) mmol/l (p<0.0001) and on the number of women with fasting glucose levels above 5.1 mmol/ml by 3.07 times. During 80-90follow-up days, pregnancy occurred in 30 (15.2%) patients; at Visit 2, the ovulation test was positive in 96 (48.73%) women. Conclusion: The results of the study can recommend Dikirogen containing myo-inositol and D-chiroinositol in a ratio of 5:1, folic acid, and manganese in conjunction with combination therapy (diet, exercises) to obese and overweight women with complaints of anovulation and failure to achieve pregnancy,
Obstetrics and Gynecology. 2023;(1):83-90
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Correction of iron deficiency states in reproductive-aged patients with chronic abnormal uterine bleeding

Savelyeva I.V., Nosova N.V., Bukharova E.A., Prodanchuk E.G., Galyanskaya E.G.


Objective: To evaluate the effectiveness of correcting iron deficiency states (IDS) in chronic abnormal uterine bleeding (AUB) in reproductive-aged patients. Materials and methods: The investigation enrolled 155patients with chronic AUB. Group 1 included 53patients with latent iron deficiency (LID); Group 2 consisted of 58 women with mild iron deficiency anemia (IDA); Group 3 comprised 44 patients with moderate IDA. The investigation methods included the determination of the level of serum iron (SI), total serum iron-binding capacity (TSIC), ferritin, and complete blood cell count parameters (hemoglobin, red blood cell count, mean corpuscular volume (MCV), cellular hemoglobin content (CHC) in serum). IDS was treated with a combination agent containing ferrous fumarate and folic acid (Ferretab comp.) for 12 and 24 weeks. Therapy outcome assessments were based on determination of hemoglobin and ferritin levels and on clinical evaluation of complaints potentially associated with iron deficiency. Results: It was established that effective correction of IDS in chronic AUB in reproductive-aged patients could be achieved by routine administration of the drug containing ferrous fumarate and folic acid (Ferretab comp.), by taking into account its efficacy and good tolerability, which determined adherence to therapy. After 12 weeks of taking this drug, there was a rise in hemoglobin and ferritin levels in Groups 1 and 2 and a statistically significant increase in hemoglobin levels in Group 3 (p=0.01). In addition, the common symptoms of anemia were recorded to be relieved in all the women included in the investigation. Conclusion: The combination drug Ferretab comp. is effective in restoring hemoglobin levels and iron stores in patients with IDS in chronic AUB. This combination drug has prescription benefits for IDS, since folic acid is an iron synergist for erythropoiesis and also due to the need to maintain optimal serum folate levels in reproductive-aged patients.
Obstetrics and Gynecology. 2023;(1):93-99
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The role of vitamin D and omega-3 polyunsaturated fatty acid deficiencies in the pathogenesis of polycystic ovary syndrome

Abashova E.I., Yarmolinskaya M.I.


Polycystic ovary syndrome (PCOS) occurs in every 5 reproductive-aged women. Women with PCOS are frequently found to have carbohydrate metabolism disorders, overweight, and obesity. The pathogenesis of PCOS is associated with both insulin resistance and a proinflammatory state, oxidative stress, which support the development of metabolic disorders. The role of micronutrients in both the correction of inflammation and oxidative stress and the processes of steroidogenesis, epigenetic regulation, lipid metabolism, and glucose and insulin transport is known. Widespread deficiencies of vitamin D and omega-3 polyunsaturated fatty acids (PUFAs) are the most common conditions associated with the insufficient intake of these micronutrients in the population. Correction of deficiency conditions with the use of vitamins and dietary supplements in women with PCOS is reflected in numerous new studies investigating the benefits of these treatments. This review summarizes the latest data of randomized controlled trials, meta-analyses, and systematic reviews that analyze the efficacy of vitamin D and omega-3 PUFAs in the treatment of PCOS. Conclusion: Using the drugs that affect steroidogenesis, insulin resistance, and lipid metabolism and correcting inflammation and oxidative stress in combination with basic treatment and therapeutic lifestyle changes can prevent adverse reproductive and metabolic outcomes in women with PCOS. The data of the presented studies suggest that the use of vitamin D and omega-3 PUFAs may be a useful adjunctive treatment for PCOS.
Obstetrics and Gynecology. 2023;(1):101-108
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Results of bioequivalence studies on dienogest, progesterone, and levonorgestrel+estradiol in healthy volunteers after single dose intake during fasting

Apolikhina I.A., Tarnaeva L.A., Kondratyeva N.E.


The paper presents the results of three bioequivalence studies on DlyaZhens metri (dienogest), DlyaZhens pro (progesterone), DlyaZhens klimo (levonorgestrel + estradiol) manufactured by the “Farmasintez-Tyumen” LLC, Russia, and their corresponding original (reference) drugs Visanne (Bayer Pharma AG, Germany), Utrogestan (Besen Healthcare SA, Belgium), and Klimonorm (Jenapharm GmbH & Co. KG, Germany). The bioequivalence studies determined the pharmacokinetic parameters of dienogest, progesterone, and levonorgestrel + estradiol in the plasma of healthy volunteers after single oral dose intake of the compared drugs during fasting according to a 2-stage open-label randomized crossover regimen for dienogest and levonorgestrel + estradiol and according to 4-stage one for progesterone. The plasma concentration of the active ingredients of the drugs was analyzed by a highly sensitive and selective bioanalytical method using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The following pharmacological parameters (AUC0-t, AUC0-∞, AUC0-72, AUCresid, AUCresid%, Cmax, TСmax, T½, kel, f’, Cmax/AUC, MRT) were calculated for the drugs analyzed. The 90% confidence intervals for the ratios of the geometric mean values of AUC0-t and Cmax were in the range from 80.00 to 125.00% in the bioequivalence studies of dienogest, progesterone, and levonorgestrel + estradiol. Conclusion: The findings have led to the conclusions about the bioequivalence of the test and reference drugs, such as dienogest, progesterone, and levonorgestrel + estradiol. The safety profiles of the compared drugs were comparable.
Obstetrics and Gynecology. 2023;(1):110-121
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Mirror syndrome in complicated monochorionic twin pregnancy

Kurtser M.A., Shamanova M.B., Malmberg O.L., Normantovich T.O., Nikolaeva E.V., Sukhanova D.I.


Background: Mirror syndrome is a rare pregnancy complication that occurs with obvious placental hydrops in the presence of immune or non-immune hydrops fetalis. The clinical symptoms of the mirror syndrome bear similarities to those of preeclampsia, but unlike the latter, they are reversible as placental hydrops and hydrops fetalis resolve. Therefore, the differential diagnosis of the mirror syndrome and preeclampsia is very important and determines the tactics of managing a patient and the prognosis of this pregnancy. Case report: Our paper describes an observation of pregnant patients with monochorionic twins, whose pregnancy was complicated by anemia polycythemia sequence accompanied by evident placental hydrops and by the development of the mirror syndrome with clinical presentations of pulmonary edema. The described cases show the time course of changes in laboratory parameters, including angiogenic (PlGF) and antianginal (sFLt-1) factors. A decreased sFLt-1/PLGF ratio was noted as placental hydrops reversed, which made it possible to regard these changes as an additional laboratory tool for the differential diagnosis of the mirror syndrome with preeclampsia. The correctly diagnosed mirror syndrome determined the tactics of managing these patients and allowed a long-awaited pregnancy to be maintained in both cases. Conclusion: The mirror syndrome and preeclampsia are needed to make a careful differential diagnosis. Determining the changes in the sFLt-1/PLGFratio can be used as an additional laboratory differential diagnostic test.
Obstetrics and Gynecology. 2023;(1):123-128
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Retroperitoneal pelvic mass in a 15-year-old female patient

Salnikova I.A., Khabas G.N., Uvarova E.V., Mamedova F.S., Sheshko P.L., Khashchenko E.P., Asaturova A.V.


Background: Differential diagnosis and treatment of retroperitoneal non-organ tumors are a difficult task in clinical practice. Neoplasms of the retroperitoneal space have diverse morphological characteristics, clinical presentations, and a process course. Retroperitoneal non-organ tumors occur in less than 1% of all human neoplasms. These tumors can be located in the retroperitoneal space from the diaphragm to the pelvis, which causes a pronounced variety of clinical manifestations of the disease. Surgery is the main and only radical treatment of retroperitoneal non-organ tumors. Case report: The paper presents a clinical case of a 15-year-old girl. The atypical localization of the mass has determined the complexity of diagnosis and choice of treatment. The authors describe the ultrasound characteristics of the mass, MRI data, the features of differential diagnosis and surgical treatment in the female patient. Conclusion: The clinical case discussed reflects the complexity of differential diagnosis of retroperitoneal pelvic masses in teenage girls.
Obstetrics and Gynecology. 2023;(1):130-136
pages 130-136 views

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