Journal of obstetrics and women's diseases

BACKGROUND: The established differences in the incidence of uterine fibroids between ethnic groups require a study of their endocrine causes. A comparative analysis of the hormonal profile in women of European and Mongoloid ethnic groups will reveal specific patterns that may account for the observed epidemiological heterogeneity and identify individual pathogenetic mechanisms of the disease.

AIM: The aim of this study was to determine ethno-specific features of hormonal regulation in reproductive-aged women with uterine fibroids based on a comparative analysis of pituitary and steroid hormone levels between European and Mongoloid ethnic groups.

METHODS: This study is based on data derived from a multicenter cross-sectional epidemiological study. The study sample included 1,041 women (aged 18–44 years) of European (n = 725) and Mongoloid (n = 316) ethnic groups. The hormonal profile was analyzed using liquid chromatography with tandem mass spectrometry (testosterone), enzyme-linked immunosorbent assay (follicle-stimulating and luteinizing hormones, thyroid-stimulating hormone, prolactin, progesterone, 17-hydroprogesterone, estradiol, estrone, estrone metabolites, sex hormone-binding globulin), and chemiluminescent immunoassay (dehydroepiandrosterone sulfate). The free androgen index was calculated. Statistical analysis was performed using R.

RESULTS: Uterine fibroids were more prevalent in the Mongoloid ethnic group (18.35%) compared to the European ethnic group (12.28%; p = 0.01). Comparative analysis of the hormonal profile, without stratification by ethnicity, revealed differences between patients with uterine fibroids and the comparison group only for the levels of prolactin (p = 0.01), testosterone (p = 0.006), and dehydroepiandrosterone sulfate (p = 0.002) in the luteal phase, although the median values remained within the reference range. In the European ethnic group, patients with uterine fibroids showed elevations in luteal phase prolactin (p = 0.014) and testosterone levels (p = 0.024). In the Mongoloid ethnic group, patients with uterine fibroids demonstrated a decrease in dehydroepiandrosterone sulfate levels (p = 0.002) during the luteal phase. Among patients of the Mongoloid ethnic group, prolactin levels were higher compared to those of the European ethnic group. This finding was consistent in both the uterine fibroids group (p = 0.003) and the comparison group (p < 0.001).

CONCLUSION: In women of the Mongoloid ethnic group with uterine fibroids, a trend toward a combined alteration in prolactin and dehydroepiandrosterone sulfate levels in the luteal phase is observed, which is less pronounced in the European ethnic group. The identified ethnic variability in prolactin and androgen levels in uterine fibroids highlights the importance of an in-depth study of the ethnic aspects of disease pathogenesis.

BACKGROUND: Placental abruption of a normally located placenta remains one of the most severe obstetric complications of pregnancy, associated with a high risk of maternal and perinatal morbidity and mortality. Current studies indicate the polyetiological nature of placental abruption, emphasizing the key role of uteroplacental vascular disorders associated with chronic arterial hypertension, preeclampsia, and other forms of endothelial dysfunction. Investigation of placental morphological changes in placental abruption is essential for understanding the causes and pathogenesis of this condition, identifying risk factors, optimizing pregnancy management, and preventing recurrence.

AIM: The aim of this study was to evaluate the relationship between clinical manifestations and placental morphofunctional characteristics in placental abruption of a normally located placenta.

METHODS: This retrospective case–control study included 14 patients delivered at the Almazov National Medical Research Centre, St. Petersburg, Russia in 2023–2024. Two study groups were formed: Group I (the main group) consisted of pregnant women with isolated placental abruption (n = 7); Group II (the control group) consisted of pregnant women with placental abruption complicated by preeclampsia (n = 7). Placental specimens were examined histologically in the Laboratory of Morphology at the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia using standard hematoxylin and eosin staining. Statistical data analysis was performed using the Python 3 programming language, the VisualStudioCode code editor, and the Pandas and SciPy application libraries.

RESULTS: The study groups were comparable in baseline clinical characteristics, with differences identified in the severity and structure of gestational complications. In the group with placental abruption complicated by preeclampsia (Group II), severe preeclampsia was diagnosed in 43% of cases; in one patient (14% of cases), it developed in the presence of chronic arterial hypertension, while moderate preeclampsia associated with chronic arterial hypertension was observed in two patients (29% of cases). Despite a more complicated clinical course in the combined pathology group, emergency delivery allowed for achievement of comparable perinatal outcomes. Histological examination revealed distinct differences in placental morphology between the study groups. Placental abruption complicated by preeclampsia was characterized by chronic placental insufficiency, impaired villous maturation (hypoplasia and immaturity), and pronounced circulatory disorders. In isolated placental abruption, acute hemodynamic disturbances and focal placental ischemia predominated. These differences account for variations in the clinical course and potential perinatal outcomes in placental abruption depending on the presence of preeclampsia.

CONCLUSION: The findings of this study are consistent with global trends. Placental abruption complicated by preeclampsia is associated with chronic maternal vascular malperfusion and impaired placental perfusion, whereas isolated placental abruption is characterized by an acute pattern of placental injury.

BACKGROUND: Asymptomatic adenomyosis, which occurs in approximately one-third of patients, is a clinical and scientific enigma, thus being a subject of debate. Practicing physicians face unresolved questions: should they take no action or should they actively monitor and prescribe preventive therapy, especially in the context of preconception care?

AIM: The aim of this study was to assess the psychoemotional status, hormonal profile (including oxytocin levels), ultrasound characteristics, and endometrial morphofunctional status in patients with symptomatic or asymptomatic adenomyosis.

METHODS: This prospective, observational, single-center cohort study was conducted at Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. A total of 641 patients were examined, including 574 women with adenomyosis in the main group and 67 women without gynecological diseases in the comparison group. The diagnosis of adenomyosis was established based on magnetic resonance imaging or ultrasound using a patented method. The patients underwent an assessment of their psychoemotional status using the Quality of Life Questionnaire (SF-36), determination of serum follicle-stimulating hormone, luteinizing hormone, and estradiol levels, as well as plasma oxytocin levels on days 2–6 of the menstrual cycle, and serum progesterone levels on days 19–23 of the menstrual cycle. Histological evaluation of endometrial samples was performed using standard methods on days 7–13 or 16–23 of the menstrual cycle.

RESULTS: Of the 574 patients with adenomyosis in the main group, 530 women presented complaints (abnormal uterine bleeding, pain syndrome), 44 (7.6%) women being asymptomatic. The comparison group comprised 67 women without gynecological diseases. The age of the examined patients ranged from 20 to 48 years, with an average of 36 (7) years. In patients with adenomyosis, an increase in the transitional zone thickness was found in both subgroups, regardless of complaints. In patients with asymptomatic adenomyosis, the average transitional zone thickness was 2.84 (0.79) mm (95% CI 2.4–3.4), in patients with complaints 3.12 (1.21) mm (95% CI 3.0–3.3), and in the comparison group 1.50 (0.49) mm. In the group of patients with asymptomatic adenomyosis, we revealed a decrease in the psychoemotional state parameters, such as general physical well-being 56 (54, 57) points vs. 82 (79, 84) in the comparison group; general mental well-being 51 (45, 53) vs. 86 (86, 87) in the comparison group; mental health 70 (65, 72) vs. 91 (89, 92) in the comparison group; and vital activity 69 (13) vs. 81 (4), respectively. In patients with asymptomatic adenomyosis, the serum progesterone level was 10.77 nmol/L vs. 33.94 nmol/L in the comparison group. The plasma oxytocin level in asymptomatic patients was 134 (21) pg/mL, not differing from that in symptomatic patients 128 (31) pg/mL. In the comparison group, the plasma oxytocin level was lower 100 (33) pg/mL. According to the morphological assessment of the endometrium, only 63% of asymptomatic patients had endometrial histology consistent with the cycle phase. The incidence of endometrial hyperplasia without atypia in the asymptomatic group was 13%.

CONCLUSION: Patients with asymptomatic adenomyosis demonstrate the absence of obvious symptoms of the disease (dysmenorrhea, pelvic pain syndrome, abnormal uterine bleeding). Frequent detection of endometrial hyperplasia in this group of patients and a decrease in the quality of life compared to women without gynecological diseases dictates the need for a thorough examination of such patients, more frequent follow-up, and joint patient management with related specialists.

Despite growing clinical interest in the administration of autologous platelet-rich plasma (PRP) in primary ovarian insufficiency and diminished ovarian reserve, data on its efficacy remain extremely limited and methodologically heterogeneous. There are no standardized protocols, and the effect of therapy on key clinical outcomes has not been sufficiently studied. It is necessary to systematize the available data in order to assess the current level of evidence and identify areas for further research. The aim of the study was to evaluate the effectiveness of PRP therapy in women with poor ovarian response and primary ovarian insufficiency. This systematic review included English-language publications evaluating the effectiveness of PRP therapy in women with diminished ovarian reserve and primary ovarian insufficiency for the period 1985–2025. The review is based on the PRISMA checklist. Randomized and non-randomized original clinical trials (prospective, retrospective, quasi-experimental, etc.) were used for the analysis. After searching for and excluding duplicates, 415 articles were screened, of which 4 studies were selected for qualitative synthesis. The included studies demonstrate that intraovarian PRP administration can help improve biomarkers of ovarian reserve (anti-Müllerian hormone, follicle-stimulating hormone, and antral follicle count), particularly in patients with poor ovarian response syndrome and after surgery. A positive trend in pregnancy and live birth rates was noted, with no increase in the rates observed. PRP therapy demonstrates potential effectiveness in improving ovarian reserve parameters. However, due to the small number of studies, their heterogeneity and varying risk of systematic error, the impact on final reproductive outcomes requires further research. Large, randomized, controlled trials are needed to standardize PRP preparation and administration protocols and define clear indications for therapy.

Vulvar lichen sclerosus is a chronic immune-mediated disease associated with inflammation, atrophy, fibrosis, and genital scarring. Although topical glucocorticosteroids remain the first-line therapy and are effective in controlling inflammatory symptoms, some patients develop persistent anatomical and functional impairment, including synechiae, vaginal stenosis, dyspareunia, and reduced quality of life. This supports the need for additional treatment approaches. This review article presents a series of three clinical cases involving patients aged 48, 55, and 62 years with verified vulvar lichen sclerosus with clinically significant scarring and atrophic changes. Treatment included lipofilling of the external genitalia using microfragmented autologous lipoaspirate obtained by closed double microfiltration; in two patients, the procedure was combined with laser dissection of synechiae. Treatment outcomes were assessed by clinical examination, symptom dynamics, photographic documentation, and restoration of vulvar anatomy and functional status. The follow-up period ranged from 1.5 to 6 months. In the short-term follow-up period, all patients showed a reduction in symptoms, including pain, itching, burning, and discomfort, as well as improved vulvar tissue elasticity. In patients with baseline synechiae, combined treatment resulted in restoration of the anatomical patency of the vaginal introitus, with no recurrence of synechiae during follow-up visits. Patients with baseline sexual dysfunction reported resumption of sexual activity. No adverse events, infectious complications, or signs of disease worsening were observed during the follow-up period. The presented clinical observations suggest that lipofilling, including its combination with laser dissection of synechiae, may be considered a potentially promising component of comprehensive treatment for patients with scarring and atrophic manifestations of vulvar lichen sclerosus. These findings are preliminary and require confirmation in prospective controlled studies with larger patient cohorts, using validated symptom and quality-of-life assessment scales and long-term follow-up.