Obstetrics and Gynecology

There is an increasing prevalence of infertile women, and one of the main causes is endometriosis, which is detected in half of infertile patients. Endometriosis is a chronic disease characterized by severe pain during menstruation, intercourse, defecation and urination, as well as chronic pelvic pain that interferes with a normal life and prevents pregnancy. The growth of endometrioid tissue outside the uterine cavity occurs in 10% of reproductive-aged women. The exact causes of endometriosis remain unknown; however, relationships with genetics, hormonal status, inflammatory processes and environmental factors have been identified. Both invasive and non-invasive methods such as ultrasound and MRI can be used to diagnose this pathology. Among surgical techniques, laparoscopy together with histological verification is the gold standard. The treatment of endometriosis-associated infertility is the reduction or removal of endometrioid tissue outside the uterine cavity in order to restore the anatomical structure of the pelvic organs using medications and surgery. In case of ineffectiveness of the previous therapies, methods of assisted reproductive technologies (ART) are used; the most successful of them is IVF.

Conclusion: The treatment of endometriosis depends to a large extent on the severity of the pathology, therefore, both medical and surgical methods can be used while treating this disease. When standard therapies are ineffective, assisted reproduction is used to treat endometriosis-associated infertility.

Endometriosis is the most common condition in young women. This review presents the analysis of the recent studies on the etiology, pathogenesis of the disease, and risk factors for its development. The search for non-invasive markers for the early diagnosis of endometriosis led to the involvement of artificial intelligence and the development of specialised software. In order to meet the needs of the practitioner, the classification of endometriosis has been modernized. The search for drugs aimed at pathogenetic treatment of the disease as well as its prevention with high safety and efficacy continues. Every year there are improvements in surgical techniques using artificial intelligence and robotics.

Conclusion: There is a high need for basic research on the endometriosis pathophysiology in the fields of genomics, proteomics, transcriptomics, metabolomics, combined with the study of the characteristics of immunological surveillance and endocrine dysregulation. This type of research would help clarify the specific mechanisms of endometriosis pathogenesis and identify new diagnostic and therapeutic targets.

The increase in life expectancy means that women will live a significant portion of their lives in postmenopausal period. This period of the woman’s life is characterized by an increase in the number of comorbidities; many postmenopausal patients have cardiovascular and endocrine diseases, cerebrovascular disorders, etc. Therefore, it is important to identify risk factors and prevent them, diagnose diseases in their early stages in peri- and early postmenopausal women, and treat them appropriately using a multidisciplinary medical approach. Current guidelines suggest that menopausal hormone therapy (MHT) is the most effective treatment for menopausal symptoms. It may have preventive effects for a number of cardiometabolic diseases although this is not among the approved indications, and it may improve women’s long-term quality of life. The use of the combination of estradiol and drospirenone provides additional benefits for health and quality of life in postmenopausal women. These benefits include correction of symptoms associated with estrogen deficiency and a protective effect of drospirenone on the endometrium due to its marked progestogenic effect. It also prevents fluid retention and preserves/improves body composition due to antimineralocorticoid effect. Moreover, it normalizes androgen status by correcting relative hyperandrogenism in early postmenopausal period, which helps prevent the development of metabolic and cardiovascular disorders.

Conclusion: The prescription of MHT with drospirenone in early postmenopausal period and continuous ultralow-dose therapy in late postmenopausal period may be the foundation for preserving women’s long-term health and quality of life, which is fully consistent with the principles of the 5 P’s of modern medicine. Such an approach to the management of postmenopausal women will also contribute to the implementation of the national strategy aimed at preserving active and healthy longevity.

Objective: To evaluate neurogenesis dysfunction during early-onset fetal growth restriction by obtaining fetal neuronal exosomes (FNE) from maternal plasma, assessing the expression of neurotrophin proteins involved in neurogenesis and the regulation of fetal nervous system plasticity, and establishing relationships with clinical and functional data.

Materials and methods: This study included 45 pregnant women. The study group consisted of 20 women with early-onset fetal growth restriction, whereas the control group comprised 25 women with normal pregnancies. The gestational age of the newborns in both groups did not exceed 34 weeks. Extracellular vesicles were isolated from maternal plasma using a commercial kit, followed by immunoprecipitation to obtain FNE. The expression of neurotrophin proteins—nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF)—was assessed using Western blotting.

Results: A decrease in the expression of BDNF (pro-BDNF) and NGF (pro-NGF) precursors was observed in the FNE of the study group. Mature forms of neurotrophin proteins were not detected in FNE. Changes in pro-BDNF levels were noted only in cases of intraventricular hemorrhage (IVH), while pro-NGF levels varied in IVH, cerebral ischemia, and asphyxia in newborns during the neonatal period.

Conclusion: The results demonstrate, for the first time, the potential to detect brain neurodysfunction in fetuses with growth restriction by assessing the expression of neuronal proteins in FNE isolated from maternal blood via immunoprecipitation. Changes in these protein levels may reflect the degree of brain dysfunction and serve as potential prognostic and diagnostic markers of pathological conditions.

Objective: To assess the severity of respiratory and cardiovascular disorders in preterm infants based on the degree and anatomical and topographic type of placenta accreta spectrum disorders as well as the diameter of the placental hernia in their mothers.

Materials and methods: A retrospective cohort study was conducted involving 288 preterm infants with a gestational age (GA) of 33⁰–36⁶ weeks born to mothers with placenta accreta spectrum disorders. The clinical data were analyzed in three stages. In Stage I, patients were divided into three groups based on the type of placenta accreta spectrum (accreta, increta, and percreta). In Stage II, infants were classified into five groups according to the anatomical and topographic types of the placenta accreta spectrum, following H. Palacius's classification. In Stage III, the infants were divided into two groups based on the placental hernia diameter. In the study groups, GA, anthropometric parameters, sex, Apgar scores at 1 and 5 min after birth, and the correspondence of body weight and length to GA were compared. The severity and duration of respiratory disorders were assessed using indirect criteria: frequency and duration of respiratory therapy, including mechanical ventilation (MV) and high-frequency oscillatory ventilation (HFOV), maximum required mean airway pressure (MAP), frequency and duration of additional oxygen supplementation, and frequency of surfactant replacement therapy. The severity of acute cardiovascular disorders was evaluated based on the frequency of cardiotonic and vasopressor therapies, including the use of dopamine and dobutamine, and the maximum vasoactive inotropic index (VII). Integral indicators of the severity of preterm infants' conditions after birth included the length of stay in the NICU and total duration of hospitalization in days.

Results: The analysis revealed no significant differences in the severity of respiratory and cardiovascular disorders among newborns based on the degree of placental invasion or type of accreta. However, a significant increase in hospitalization duration was observed in newborns of mothers with placenta percreta compared to those born to mothers with placenta accreta, likely due to the lower GA of infants born to mothers with placenta percreta. Additionally, an increase in the duration of HFOV and the need for higher HFOV parameters, particularly MAP, were noted in preterm infants born to mothers with a placental hernia diameter exceeding 7 cm.

Conclusion: The severity of respiratory and cardiovascular disorders in preterm infants was not influenced by the degree of abnormal placental invasion or the anatomical and topographic type of placental implantation. However, a correlation was found between the severity of respiratory disorders and the placental hernia diameter.

Relevance: With increasing life expectancy in developed countries, the incidence of age-related musculoskeletal disorders (MSDs) has increased in postmenoupausal women. There is a growing need for exploring new methods for early diagnosis of these conditions.

Objective: To explore the severity of the climacteric syndrome (CS) and mobility impairments in women aged 55–60 years with MSDs and with natural and surgical menopause.

Materials and methods: The study included 104 female patients aged 55–60 years with CS. They were divided into 2 groups; group 1 included 54 women with natural menopause, and group 2 included 50 women with surgical menopause. Assessment of the severity of CS and locomotive syndrome (LS), the state of bone tissue measured by using fragility score, bioimpedance analysis to evaluate muscle tissue status, hand grip dynamometry, and the sit-and-rise test (5 times with no hands) was conducted.

Results: It was found that the group of women with surgical menopause developed severe CS manifestations. The median score of the Greene climacteric scale in this group was 12 (6;19), that was significantly higher than in the group of women with natural menopause – 8.5 (6;17) (p=0.0177). The fragility score of the lumbar spine was lower in group 1 – 26.1 (24.7; 30.8) in comparison with group 2 – 31.1 (26.1; 33.2) (p=0.023). According to the "Locomo 25" questionnaire, the median in group 2 was significantly higher – 12.0 (8; 18) versus 9.6 (3.5; 12) in group 1 (p=0.017). It was found that LS stage 1 was more common in women with natural menopause, while LS stage 2 was associated with surgical menopause.

Conclusion: The obtained results indicate a high prevalence of mobility impairments and musculoskeletal diseases in 55–60 year old women with climacteric syndrome. Therefore, further large-scale multicenter studies are needed.

Relevance: A uterine myoma is a hormone-dependent tumor composed of muscle and connective tissue elements. It occupies a special place in the spectrum of tumors affecting the female reproductive system, accounting for 10–20% of all gynecological pathologies, and is diagnosed in 10–30% of women of reproductive age. One important aspect of the pathogenesis of uterine fibroids is the imbalance between progesterone and estrogen levels, which creates conditions conducive to the rapid growth of fibroid nodules. Polymorphisms in the genes of estrogen and progesterone receptors may influence their expression and, therefore, be significant in the pathophysiology of large uterine myomas.

Objective: To investigate the associations between combined polymorphic variants of estrogen and progesterone receptor genes and the development of large uterine myomas.

Materials and methods: A total of patients (n=380) diagnosed with uterine fibroids were divided into three groups based on the size of the largest nodule. Five polymorphic loci of estrogen and progesterone receptors were selected for the study: rs2234693 ESR1 c453-397T>C, rs3798577 ESR1 c.1029T>C, rs9340799 ESR1 c.453-351A>G, rs484389 PGR c.38T>C, and rs1042838 PGR c.1415-11113G>T. The analysis was performed by polymerase chain reaction (PCR) on a CFX-96 Real-Time System thermal cycler. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to determine associations. The APSampler program (https://sourceforge.net/projects/apsampler/) was used to evaluate the associations of allele and genotype combinations of the analyzed genes with the occurrence of large myomas. The online programs HaploReg and Gtex Portal were used to assess the functional effects of SNPs associated with the formation of large myomas.

Results: This study demonstrated a significant role of ESR1 rs3798577, ESR1 rs9340799, PGR rs484389, and PGR rs1042838 in the characteristics of uterine fibroids. A combination of polymorphic variants C rs3798577 ESR1 and AA rs9340799 ESR1 should be considered a risk factor for the development of large uterine fibroids (OR = 2.30-2.42), while a combination of markers GG rs1042838 PGR, C rs484389 PGR, and G rs9340799 ESR1 should be regarded as a protective factor against the formation of large nodules (OR=0.27–0.28).

Conclusion: The polymorphic loci ESR1 rs3798577, ESR1 rs9340799, PGR rs484389, and PGR rs1042838 were associated with the development of large uterine fibroids. The combinations of allelic variants of estrogen and progesterone receptor genes identified for the first time, which are associated with an increased risk of developing large uterine fibroids, underscores the importance of the interaction of polymorphic gene variants in the formation of this pathology. These findings may have practical applications in identifying risk groups for preventive measures.

Objective: To evaluate lifestyle features and significant clinical and anamnestic factors associated with apical prolapse in parous women.

Materials and methods: A clinical retrospective case-control study analyzed medical records data of 230 patients with pelvic organ prolapse who underwent examination and treatment in the period from 2017 to 2024 at the University Clinic "I am healthy!" The main group was composed of 130 patients with apical prolapse, and the control group was composed of 100 patients without apical prolapse (with prolapse of the anterior and/or posterior vaginal wall).

Results: The analysis identified lifestyle features and clinical factors, which have statistically significant relationship with occurrence of apical prolapse: hard physical job, advanced age for a first birth, apical prolapse in first-degree relatives, prolonged labor for a first birth, weight gain during pregnancy and duration of postmenopause. Analysis determined threshold values of the indicators which increase the probability of occurrence of apical prolapse. Thus, the value of the weight gain of 13 kg during pregnancy was determined as a threshold value; the value exceeding this threshold was associated with increased probability of occurrence of apical prolapse by 4.15 times (odds ratio (OR)=4.15, 95% confidence interval (CI) 2.38–7.21, p<0.001). Duration of postmenopause for more than 7 years was determined as a threshold value; the value exceeding the threshold was associated with increased probability of occurrence of apical prolapse by 2.79 times (OR=2.79, 95% CI 1.63–4.77, p<0.001). Duration of labor in first-time mothers for more than 15.5 hours was determined as the threshold value; the value exceeding the threshold was associated with increased probability of occurrence of apical prolapse by 3.48 times (OR=3.48, 95% CI 2.02–6.00, p<0.001). The age for the first birth over 22 years was determined as a threshold value, the value exceeding the threshold was associated with increased probability of occurrence of apical prolapse by 9.57 times (OR=9.57, 95% CI 5.23–17.51, p<0.001).

Conclusion: This study made it possible to identify for the first time a number of clinical factors and the features of lifestyle, pregnancy, labor and duration of postmenopause associated with apical prolapse. The calculated threshold values and odds ratios for these factors may help understand and manage risk occurrence of apical prolapse in parous women.

Objective: To evaluate the predictors of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) success in females receiving oral dydrogesterone for luteal phase support with subsequent evaluation of the relationship between influencing factors and pregnancy rates, and the creation for the first time of a prognostic table for clinical pregnancy in IVF and ICSI cycles, identifying the most influential predictors.

Materials and methods: Multicenter open-label observational program for assessing the probability of pregnancy in IVF cycles enrolled females who were prescribed dydrogesterone 30 mg a day for luteal phase support while undergoing assisted reproductive technology in routine setting of Russia and Kazakhstan according to the national guidelines. The primary objective of the study was to evaluate the predictors of pregnancy rate in IVF and ICSI, followed by the creation of a prognostic table of clinical pregnancy in IVF and ICSI cycles considering 4–5 most significant predictors. Secondary objectives assessed included biochemical and clinical pregnancy rates, convenience and overall satisfaction with therapy, live birth, and maternal and fetal safety were also assessed.

Results: 1150 patients were enrolled from 42 study sites in the Russian Federation and 2 study sites in the Republic of Kazakhstan.

1146/1150 (99.7%) patients were exposed to Duphaston and constituted the safety set, out of them 534 patients were from the IVF subgroup, and 612 patients were from the ICSI subgroup. 1143/1150 (99.4%) patients constituted the full analysis set (994 from Russia and 149 from Kazakhstan) with a median age of 34 years. Clinical pregnancy rate was 36.7% and the live birth rate was 30.1%. The collected data has been used to build a clinical pregnancy rate prediction model. According to the prediction model, the best pregnancy probability while taking dydrogesterone would be for females under 37 years of age with antral follicle count of ≤12 and top-quality embryos, for whom IVF would be used. The study confirmed a high level of satisfaction with dydrogesterone therapy. In the study population dydrogesterone showed a favorable safety profile for fetus/newborn and mothers.

Conclusion: Results of the study provide the practical a robust predictive model for IVF/ICSI success while demonstrating favorable oral dydrogesterone efficacy and safety profiles in routine practice.

The article presents a review of literature sources on maternal and child health care related to the prevention and treatment of non-communicable diseases (NCDs) with a particular focus on the countries of the WHO European Region: Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. A range of publications presented in electronic medical databases, including Cochrane Library, Google Scholar, PubMed, PsycINFO, Scopus, Web of Science, CyberLeninka, eLibrary.ru

and regional databases were considered. The period covered was 2000 to 2024.

The state of integration of NCD care systems with maternal and child health care was analyzed. The analysis demonstrated that the relationship between NCDs and pregnancy, obstetric and perinatal outcomes requires a strategic approach to optimize the integration of the two systems, focusing on reducing maternal and child morbidity and mortality.

Conclusion: The interactions and opportunities for integrating programs dealing with NCDs and maternal and child health are diverse. They include screening of at-risk pregnant women, early detection of NCDs, optimizing the management of existing NCDs and addressing risk factors for future development of NCDs in both the woman and the child. It is recommended that large, country-wide studies are conducted to identify the most significant gaps, as well as to assess the contribution of barriers to integration that are known to exist from the experience of other countries.

Genitourinary syndrome of menopause is a chronic condition that occurs during the perimenopausal and menopausal periods. It is characterized by a wide range of symptoms and signs such as vaginal dryness, itching, burning, dyspareunia, bloody vaginal discharge, urinary disorders. These symptoms are caused by estrogen deficiency and tend to progress over time. Vulvovaginal atrophy and postmenopausal atrophic vaginitis are the most common manifestations.

Objective: To evaluate clinical, laboratory and instrumental parameters in postmenopausal women with atrophic vaginitis before and after topical application of estriol (50 µg/g).

Materials and methods: The study included 75 menopausal women with a verified diagnosis of postmenopausal atrophic vaginitis. The diagnosis was confirmed on the basis of the data obtained after clinical, laboratory and instrumental investigations. The monitoring of the patients included several visits where adequate topical therapy was administered and a number of follow-up examinations.

Results: The findings from the present study showed an improvement in clinical, laboratory and instrumental data of postmenopausal women with atrophic vaginitis during and after the treatment with ultra-low-dose estriol intravaginally (50 µg/g). There was a decrease in symptoms and clinical signs of vulvovaginal atrophy as well as normalization of vaginal microbiota in these women. The results of pelvic ultrasound obtained before, during and after the topical treatment with estriol showed neither an increase in M-echo of more than 5 mm, nor ovarian neoplasms or growth of myomatous nodes.

Conclusion: Intravaginal administration of ultra-low-dose estriol is considered to be a viable treatment option for women suffering from atrophic vaginitis.

Objective: To evaluate the effect of prednisolone in vitro administered in the form of prednisolone sodium phosphate in the Elzhina combined preparation on biofilm-forming microorganisms of the vaginal biotope.

Materials and methods: The study included clinical isolates forming the films of the following bacteria: Klebsiella pneumoniae (3), Escherichia coli (2), Enterococcus faecalis (3), Streptococcus agalactiae (1), Gardnerella vaginalis (8), Staphylococcus epidermidis (1), Candida albicans (5), Candida dubliniensis (1), Candida glabrata (1), Candida parapsilosis (1). There were 26 isolates. Dense and liquid selective nutrient media were used for cultivation, storage and further research. Microorganisms were identified using MALDI-TOF mass spectrometry (Bruker Microflex). The ability to form biofilms was assessed using a modified protocol of Christensen et al. (1985). The Elzhina preparation (solution of 1 tablet in 10 ml of physiological solution) and solutions of the main active ingredients of the preparation, i.e. neomycin, ornidazole, econazole, prednisolone (in the form of sodium phosphate), in concentrations corresponding to their content in the preparation were used to assess the effect on bacterial films.

Results: The Elzhina preparation showed a destructive effect on most biofilms that were formed by isolates of microorganisms included in the study (the coefficient of change of optical density after exposure to the Elzhina preparation was more than 1.0 in 96% of the isolates studied). The inclusion of prednisolone in the composition of the drug enhances the effect of the drug components in destroying biofilms formed by bacteria and yeast-like fungi. When determining the sensitivity of one isolate of K. pneumoniae to neomycin sulphate and four isolates of C. albicans to econazole in the presence of prednisolone, there was an increase in the zone of growth retardation around the inoculum with antibiotic towards the site of application of prednisolone sodium phosphate.

Conclusion: Prednisolone sodium phosphate, which has no direct antimicrobial and antifungal effect, has been shown to increase the antibacterial and antifungal effect of neomycin, ornidazole, econazole, contained in the Elzhina vaginal tablets, on bacteria and yeast-like fungi, as well as to increase the destructive effect of the preparation on bacterial films.

Proliferative diseases present an important issue in contemporary gynecology. Among gynecological diseases, combinations of benign proliferative diseases represent up to 85% of cases. This pathology is most frequently detected in patients aged 40-45 years. Comorbid proliferative diseases are among the most common indications for radical hysterectomy, a procedure that is complicated by the development of post-hysterectomy syndrome. This condition significantly reduces the quality of life and performance of relatively young women.

The gold standard of therapy for comorbid proliferative disorders is the use of gonadotropin-releasing hormone agonists, which block sex hormone synthesis and have marked antiproliferative, antiangiogenic and anti-inflammatory effects.

This article presents a review of the scientific literature data on the use of the drug Buserelin-depo in the treatment of comorbid proliferative diseases.

Conclusion: According to the literature, the use of Buserelin-depo in the complex therapy for comorbid diseases can lead to a reduction in the size of the enlarged uterus, relatively rapid relief of pain syndrome and abnormal uterine bleeding, reduction in the risk of postoperative complications and recurrences. This significantly improves the quality of life of this group of patients, reduces the number of radical treatments and improves the outcomes of organ-preserving surgeries.

Background: The selection of high-quality embryos prior to transfer into the uterine cavity can increase live birth rates in in vitro fertilization (IVF) programs. In addition to routine morphological evaluation, the genetic status of the embryo is associated with the success of the infertility treatment using assisted reproductive technologies (ART). Preimplantation genetic testing (PGT) with the next-generation sequencing (NGS) helps to improve the procedure of selecting a high-quality embryo, and thus to increase the efficiency of IVF. In the presence of reciprocal translocation in one of the potential parents, the primary goal of preimplantation genetic testing for structural rearrangements (PGT-SR) is to avoid the birth of a child with a chromosomally unbalanced translocation product and to reduce the risk of miscarriage to the level that can be found in couples with a normal karyotype.

Case report: TThis article demonstrates a clinical example of a healthy child born to a patient with reciprocal translocation and type 1 von Willebrand disease. The rational tactics for treating a couple with this pathology included the preconception care and administration of myo-inositol 600 mg + alpha-lactalbumin + folic acid 200 mcg, one capsule twice a day, orally (Inofert Forte, Italfarmaco, Italy) to improve the quality of oocytes and embryos. Providing the IVF treatment with PGT-SR embryos and selective transfer of a healthy embryo made it possible to achieve the desired result and obtain an uncomplicated pregnancy and a healthy premature baby.

Conclusion: PGT technology can help people who are at high risk of having children with genetic diseases. PGT-SR of embryos can achieve high live birth rates in couples where one person is a carrier of a chromosomal rearrangement that increases the risk of pregnancy loss.