No 9 (2025)

The increasing frequency of induced labor in recent years has led to the need for scientific and clinical research into the outcomes of this procedure for both mother and fetus. Labor induction is an active medical intervention intended to stimulate uterine contractions before natural labor begins. Labor may be induced for a variety of indications. However, there are still significant challenges in choosing the best methods, timing of the procedure, and clear indications for induction, especially when dealing with a combination of extragenital pathology and gestational complications, as well as varying degrees of cervical ripening and gestational age.

Methods of labor induction include both pharmacologic and non-pharmacologic approaches. The most widely used methods involve prostaglandin preparations, antiprogestins, oxytocin, and mechanical techniques. Each method has its own indications, contraindications, and risk profile, which require an individual approach to choosing patient management tactics. The combined use of methods can increase the effectiveness of the procedure, but it may also increase the risk of complications such as uterine hyperstimulation or fetal distress.

Conclusion: The results of recent studies have been contradictory, and there is still no definitive conclusion on the effect of labor induction on maternal and perinatal outcomes compared to a wait-and-see approach. It is necessary to use more personalized induction protocols, systematic risk profiling of pregnant women, standardization of approaches to assess cervical ripening with the help of the Bishop score and ultrasound techniques. Additionally, objective criteria for evaluating the effectiveness and safety of labor induction procedures should be developed.

Objective: To analyze the current data on chromosomal mosaicism in human embryos and the mechanisms of its formation, as well as its clinical significance in the context of assisted reproductive technologies.

Materials and methods: This is a systematic review of the literature that includes the analysis of the results of preimplantation genetic testing for aneuploidy (PGT-A), data on sequencing of individual embryo cells, and outcomes of cryocycles with mosaic embryo transfer.

Results: Modern diagnostic methods reveal a wide spectrum of chromosomal mosaicisms, depending on the technology used and the interpretation criteria. Sequencing of individual cells demonstrates a high prevalence of mosaicism in human embryos with an average proportion of aneuploid cells of 25%. Self-correction mechanisms include selective apoptosis of aneuploid cells controlled by bone morphogenetic protein (BMP4), preferential division of euploid cells, and slowing proliferation of aneuploid blastomeres. Meta-analysis of 1,106 cryocycles showed no significant differences in reproductive outcomes with mosaicism levels below 50%. Segmental chromosomal abnormalities are associated with more favorable outcomes compared to numerical anomalies. Prenatal diagnosis confirms normal fetal karyotype in 86% of cases following mosaic embryo transfer.

Conclusion: Research findings indicate insufficient diagnostic significance of single trophectoderm biopsy for assessing chromosomal status of the entire embryo. The high frequency of mosaicism and the ability of an embryo to self-correct make it possible to consider a certain level of chromosomal mosaicism as a normal variant of embryonic development. This justifies a revision of the criteria for selecting embryos for transfer, with a greater tolerance for low-level mosaicism.

Allergic reactions in the female genital tract are a clinically relevant but understudied issue in obstetrics and gynecology. Frequently they present as infectious and hormonal disorders resulting in the chronic course of vulvovaginitis and reduced quality of life. This article provides a structured review of current concepts about the possible triggers of allergic reactions in the female genital tract. The main contact triggers are sperm, latex, metals, especially nickel, infectious allergens, including Candida, cosmetics and hygiene products, a number of drugs for local use. Food, aeroallergens and systemic drugs are considered as systemic allergens. The article analyzes in detail the various methods of modern allergy diagnosis, both in vivo and in vitro, including skin and provocative testing, assessment of specific IgE levels, and the basophil activation test. It emphasizes that an allergology examination should be conducted comprehensively using a variety of methods depending on the specific clinical symptoms. As a preventive measure, it is recommended to eliminate confirmed allergens and to use rational care procedures for the perineal area.

Conclusion: Knowledge of the triggers of allergic reactions in the female genital tract and the algorithm for their detection will allow the physician to significantly improve the diagnosis of the disease. The management of women with a previous allergic history should be carried out by a group of doctors including an obstetrician-gynecologist and an allergologist-immunologist as it may effectively help patients with combined pathology.

Relevance: The prevalence of fetal macrosomia is steadily increasing worldwide and reaches up to 20%. Fetal macrosomia complicates the course of pregnancy and birth, leading to the increase in the number of emergency caesarean sections and perinatal losses by 1.5–3 times. Current prediction strategies are inaccurate, and most patients with fetal macrosomia are sent to labor with the “unknown status”. Current prognostic strategies are inaccurate, and the majority of patients with fetal macrosomia go into labor with the "unknown status".

Objective: To assess the clinical and laboratory risk factors for fetal macrosomia with subsequent development of prognostic mathematical models.

Materials and methods: The case-control study included 110 female patients. Group I (the main group) consisted of 30 patients with gestational diabetes mellitus (GDM). Group II (the control group) consisted of 80 women without GDM. The patients were stratified into four subgroups: Ia and 1b, IIa and IIb) depending on the presence of absence of fetal macrosomia and GDM. The clinical and laboratory risk factors were determined using univariate and multivariate logistic regression.

Results: Risk factors for the development of macrosomia included parity, body mass index before and during pregnancy, macrosomia in history, body weight of the pregnant woman and her partner (baby’s father) at birth, triglyceride and glucose levels at 24–28 weeks of pregnancy, estimated fetal weight during the 3rd ultrasound screening, and baby’s gender. Based on the obtained clinical and laboratory data, mathematical prediction models of macrosomia were constructed. The sensitivity was 100–78%, and specificity was 85–50%, the AUC was 0.76–0.77.

Conclusion: The developed mathematical models can be used to predict the development of fetal macrosomia at or after 24 weeks of pregnancy, both independently of the presence of GDM (also in the group with unknown GDM status) and can be used separately in the group of women with carbohydrate metabolism disorders.

Objective: To develop optimal approach to assessment of the clinical features of the gestational process and the role of associations of the members of the subgingival microbiome in the development of pregnancy complications associated with inflammatory changes in periodontium.

Materials and methods: The total number of patients in the study was 146 pregnant women, who were divided into 4 groups depending on the presence or absence of the concomitant inflammation of periodontal tissues (gingivitis) and/or local inflammation of the lower reproductive tract. The study design included obstetric and gynecological anamneses collection, assessment of the current pregnancy complications, determination of the composition of the subgingival microbiome and the vaginal microbiome using PCR. Statistical data processing included cluster analysis.

Results: The study found relationship between systemic manifestations of periodontal diseases and preterm birth, low birth weight. There was statistically significant relationship between these complications and gingivitis. Cluster analysis was used to identify 4 different associations of the microorganisms exhibiting periodontopathogenic properties, 3 of them were found in more than half of cases in the groups with concomitant gingivitis.

Conclusion: The cluster approach to assessment of the subgingival microbiome in pregnant women helped to identify associations of the microorganisms exhibiting periodontopathogenic properties. High frequency of their occurrence was accompanied by the presence of clinical signs of gingivitis and the development of systemic effects of pregnancy complications.

Chromosomal mosaicism is a common finding in human embryos.

Objective: To determine the possibility of mosaic embryos transfer in the absence of euploid embryos and the importance of medical genetic counseling.

Materials and methods: 15 women with no prospects for obtaining euploid embryos were examined in the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia during the period of 2022–2024. Preimplantation genetic testing (PGT) of all embryos was performed by high-performance next-generation sequencing on the Illumina platform (AneuPGT). Confirmatory prenatal diagnostics in 5 (33.3%) cases was performed in amniotic fluid by chromosomal microarray analysis and in one case a FISH method was additionally used.

Results: The following chromosomes were involved in mosaicism: 2, 5, 7, 8, 9, 10, 11, 14, 15, 16, 19, 20, 22, Y. Among the 16 (two mosaic embryos were transferred in one case) analyzed embryos, 10 (62.5%) had numerical mosaicism and in 6 (37.5%) embryos segmental mosaicism was found. Successful implantation occurred in 10 cases (with 5 cases of segmental mosaicism and 5 cases of numerical mosaicism), in one case a 9-week non-developing pregnancy took place, in 4 cases pregnancy did not occur. Afterwards 10 clinically healthy children were born.

Conclusion: Selection and transfer of mosaic embryos is possible and indicated for spouses with a burdened medical history and reduced reproductive potential according to medical genetic counseling, which allows the couple to give birth to a healthy child in the absence of euploid embryos.

Embryo aneuploidy is a leading cause of implantation failure and miscarriage during early pregnancy. Preimplantation genetic testing for aneuploidies (PGT-A) enables the assessment of embryo ploidy before transfer; however, it has several limitations. The integration of automated analysis algorithms into embryologists' workflows can significantly enhance embryo selection and mitigate human errors.

Objective: To evaluate the effectiveness of automated analysis algorithms in determining embryo ploidy across different age groups.

Materials and methods: This retrospective study was conducted from January to May 2022 at the Family Medical Center and included embryos from 51 patients who underwent in vitro fertilization (IVF) with PGT-A. The effectiveness of determining euploidy based on blastocyst images was compared with the results obtained through PGT-A. The study utilized the Embryo Ranking Intelligent Classification Algorithm (ERICA 1.0) software.

Results: A total of 117 blastocysts were obtained, of which 101 were subjected to PGT-A and automated analysis: 31 blastocysts from women under 35 years of age (mean age 30.7 years), 39 blastocysts from women aged 35–39 years (mean age 37.4 years), and 31 blastocysts from women over 40 years of age (mean age 42 years). According to the PGT-A results for 101 embryos, the euploidy rate was 51.5%. The accuracy, positive predictive value, negative predictive value, sensitivity, specificity, and area under the ROC curve were 0.74, 0.76, 0.73, 0.73, 0.76, and 0.78, respectively. The most significant results were observed in patients aged < 35 years.

Conclusion: Automated image analysis shows promise as an auxiliary tool for decision-making in embryo selection, particularly in patients over 35 years of age.

Objective: A comprehensive assessment of the microbiota composition in the cervical canal and endometrium in women with various forms of endometrial hyperplastic processes (EHP) – polyp/endometrial hyperplasia in combination with uterine myoma or adenomyosis – compared to patients without endometrial pathology, followed by the analysis of its potential pathogenetic role in hyperplastic changes in the endometrium.

Materials and methods: The study included 100 women of reproductive age, divided into 4 groups depending on the presence and nature of endometrial hyperplastic processes. Microbiological examination included polymerase chain reaction test (PCR test) of samples obtained from the cervical canal, as well as culture-based analysis of aspirates from the uterine cavity. To characterize microbial communities, an assessment of microbial saturation and biological diversity was carried out using alpha diversity indices (Shannon-Wiener diversity, Simpson diversity, Margalef's richness) and subsequent data statistical processing.

Results: We found that microbial richness and taxonomic diversity were significantly higher in the cervical canal compared to the endometrium in all study groups. The maximum frequency of endometrial sterility was observed in the control group (52%). However, this indicator was lower and amounted to 24% (p=0.042) in a combination of hyperplastic changes with adenomyosis. The leading representatives of normobiota were Lactobacillus jensenii, L. crispatus and L. gasseri. Opportunistic microorganisms, including Gardnerella vaginalis, Escherichia coli and Enterococcus faecalis, were more often detected in the endometrium of patients with EHP, which may indicate the presence of disorder in microbial homeostasis and the potential pathogenetic significance of these microorganisms.

Conclusion: The microbiological analysis revealed a decline in species diversity and an increase in the proportion of opportunistic microorganisms in the endometrium of patients with EHP. Such changes may indicate microbial transformation of the intrauterine environment and the supposed participation of microbiota in the pathogenesis of this pathology. The obtained results confirm the relevance of further research aimed at a detailed study of the interaction mechanisms between microbiota and endometrial tissue structures, as well as an assessment of its impact on the prevention and treatment of EHP.

Background: Menopause is characterized by a gradual decline and eventual "turn-off" of ovarian function. Physiological changes in a woman's body are accompanied by the development of neuropsychiatric, vegetovascular, and neuroendocrine symptoms. Menopause is an important period associated with intense hormonal changes that can cause cognitive decline, anxiety and depression, sexual dysfunction, and sleep disturbances.

Objective: To conduct a comparative analysis of the use of various pharmacological drugs for the correction of menopausal symptoms.

Materials and methods: The study was conducted at the Pirogov City Hospital No. 1 during the period of September 2024–June 2025. The study included 62 postmenopausal women that were divided into 3 groups: Group 1 (n=21) – patients who received tibolone (Leatrisa) for 6 months; Group 2 (n=17) – patients who received a drug containing estradiol 1 mg and dydrogesterone 5 mg (E2/DYD); Group 3 (n=24) – postmenopausal women who did not receive menopausal hormontherapy (MHT). In addition to standard research methods, a questionnaire was administered (Greene Menopause Index, Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), Female Sexual Distress Scale (FSDS), sleep quality questionnaire).

Results: Tibolone's effect was found to be comparable to that of E2/DYD, a drug recommended for use 12 months after menopause, in terms of relieving menopausal symptoms and alleviating their severity. Tibolone is effective in treating sexual dysfunction in postmenopausal women due to its androgenic metabolite. The results of the study showcase that tibolone has no proliferative effect on the endometrium.

Conclusion: Tibolone significantly improves sexual function, reduces anxiety and depression, alleviates menopausal symptoms, and promotes weight stabilization, without causing endometrial proliferative effects. We believe tibolone can be considered an effective therapy for many postmenopausal women.

Inflammatory diseases of the lower female genital tract, including cervicitis and vaginitis, are among the most common causes for seeking medical attention from a gynecologist. These conditions can lead to severe complications, such as pelvic inflammatory diseases, infertility, miscarriage, and cervical neoplasia. These diseases are multifactorial in their origin: the causative agents are aerobic and anaerobic bacteria, as well as intracellular pathogens such as Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma spp. In recent years, there has been a significant increase in antibiotic resistance, especially in intracellular microorganisms. This resistance complicates therapy and leads to the need for alternative antibacterial strategies.

Josamycin is one of the few macrolides that have high activity against M. genitalium, Ureaplasma spp. and M. hominis. It also has a favorable safety profile and can be used by pregnant women. The medication has been proven effective in treating chlamydia, mycoplasma, and mixed infections of the vagina and cervix, making it a popular choice for use in daily outpatient care. In 2025, the Russian generic of josamycin, Josafen, was registered and entered the pharmaceutical market. It is identical in all respects to the original medication and it is available in the form of a dispersible tablet. This form increases treatment adherence, provides predictable therapeutic effects, and reduces the risk of adverse reactions.

Conclusion: Josamycin (Josafen) plays an important role in modern gynecological practice as an effective and safe treatment for nonspecific cervicitis and vaginitis in reproductive-aged women and pregnant women as well. Its use makes it possible to increase the effectiveness of therapy, reduce the risk of relapses and improve reproductive outcomes.

Gonadotropin-releasing hormone (GnRH) agonists, which significantly suppress steroidogenesis, lead to anovulation and temporary secondary amenorrhea. This contributes to the regression of endometriotic lesions and a decrease in the clinical symptoms of endometriosis. These medications have been successfully used for many years as a treatment for endometriosis. GnRH agonists (Buserelin depot) are highly effective in treating endometriosis but can lead to side effects associated with hypoestrogenemia. For many years, researchers have been searching for ways to reduce the severity of the condition without compromising the effectiveness of the treatment. Attempts to use a dose-dependent effect and short courses of treatment have not led to positive clinical results, and a widespread add-back therapy has not reduced the cost of treatment. However, this approach is still used due to a lack of alternative treatment regimens. At the same time, extending the inter-injection interval may be a promising option to improve the acceptance of long-term treatment with GnRH agonists. The theoretical basis for this is the ability to block the pituitary receptors for luteinizing and follicle-stimulating hormones for more than 45–50 days. A number of studies conducted by the foreign and Russian scientists confirm the comparable effectiveness of the 4- and 6-week inter-injection interval in the treatment of pain syndrome in endometriosis and in the use of Buserelin depot.

Conclusion: Endometriosis is not only a disease that is resistant to progesterone, but above all, it is an estrogen-dependent condition. There is currently no data in the literature on the response of endometriosis to therapy that creates a hypoestrogenic environment, therefore, GnRH agonists are likely to remain the medications of choice for treating severe forms of endometriosis for a long time. A dosing regimen of GnRH agonists with an extended interval (6 weeks) will reduce treatment costs and the incidence of side effects, as well as reduce the number of cases of forced discontinuation of treatment.