Journal of obstetrics and women's diseases

BACKGROUND: Neonates with excessive body fat deposition are at increased risk of adverse short- and long-term outcomes. The potential of fractional fetal thigh (TVol) and arm (AVol) volume assessment to predict fetal body composition at birth, including but not limited to neonates of mothers with diabetes mellitus, is to be investigated.

AIM: The aim of this study was to investigate the association between the extended fetal biometry measurements, based on the calculation of fetal fractional limb volumes, the neonatal body composition, and the development of neonatal hypoglycemia.

METHODS: This single-center cohort study included patients with singleton pregnancies divided into the study groups: pregestational diabetes mellitus, gestational diabetes mellitus, and no carbohydrate metabolism disorders. Routine fetal biometry and TVol and AVol assessment were performed within 7 days before delivery. Body fat mass at birth was calculated using the Catalano et al. (1995) equation.

RESULTS: The study included 46 patients with diabetes mellitus (pregestational, n = 32; gestational, n = 14) and 18 healthy control individuals, as well as their children. In newborns with diabetic fetopathy, the percentage of body fat was the highest — 25.0 [22.1; 26.1]% (p < 0.001). Neonates in the pregestational diabetes mellitus group had a higher weight-for-length Z-score (INTERGROWTH-21st) — 1.253 [0.663; 2.058] (p = 0.001), in the gestational diabetes mellitus group — 0.247 [0.014; 0.411] (p = 0.001), and in the control group — 0.485 [0.059; 0.887] (p = 0.004). The percentage of body fat mass was strongly associated (p < 0.001) with neonatal weight (r = 0.706) and its Z-score (r = 0.840), the weight-for-length ratio and its Z-score (r = 0.843), TVol (r = 0.639), and AVol (r = 0.532). The percentage of body fat mass did not correlate with the estimated fetal weight (r = 0.135, p = 0.288). A linear regression model including TVol and gestational age at birth had r² = 0.64 (p < 0.001) for body fat mass prediction. Generalized linear models identified pregestational diabetes mellitus as independent risk factor (p < 0.001) for higher body fat mass percentage with comparable TVol. For neonatal hypoglycemia prediction, the birth weight Z-score (sensitivity 66.7%, specificity 70.0%) and the weight-for-length Z-score (sensitivity 66.7%, specificity 75.0%) were unreliable estimates, whereas the percentage of body fat mass had better performance (sensitivity 70.8%, specificity 80.0% at a percentage of greater than or equal to 20.2%).

CONCLUSION: The accuracy of fetal adiposity detection and assessing the risk of neonatal hypoglycemia can be improved by using fetal fractional limb volume measurements. TVol is a sonographic predictor for excessive fat deposition, which can be used for body fat mass calculation, while parameters measured during routine fetometry poorly reflect the distribution of fat tissue in the fetus.

BACKGROUND: The relevance of studying the pathological mechanisms that lead to reduction of ovarian reserve is due to the growing problem of female infertility. This is largely related to the disruption of ovarian function. Chronic salpingo-oophoritis is a significant factor in this disorder. Oxidative stress and impaired vascular endothelial function, coupled with chronic inflammation, lead to deterioration of microcirculation in ovarian tissue and contribute to a decrease in folliculogenesis. The development of new approaches to the prevention and treatment of ovarian dysfunction can significantly improve the reproductive capacity of women with chronic salpingo-oophoritis.

AIM: The aim of this study was to evaluate the function of the vascular endothelium and blood flow parameters in the ovaries in women with chronic salpingo-oophoritis and diminished ovarian reserve during complex treatment using preformed factors.

METHODS: This non-randomized, controlled clinical trial was conducted to evaluate ovarian reserve, ovarian artery blood flow, and vascular endothelial function markers in women with diminished ovarian reserve and chronic salpingo-oophoritis during their prime reproductive years. These patients were divided into two study groups (a main group and a comparison group). Both groups received dydrogesterone 20 mg/day orally during the second phase of the menstrual cycle. In the main group, vaginal laser and magnetic therapy was additionally performed during the first phase of the menstrual cycle. The parameters studied were evaluated before and after treatment and were compared with those in a control group of otherwise healthy women.

RESULTS: Patients with chronic salpingo-oophoritis and diminished ovarian reserve (n = 70) in the main group (n = 42) and comparison group (n = 28) showed hemodynamic changes in the ovarian arteries, as well as deterioration of ovarian hormonal function and folliculogenesis, which was accompanied by changes in the condition and function of the vascular endothelium. The control group included 22 women. The application of preformed factors in the treatment improved ovarian blood flow, restored vascular endothelial function, and, consequently, enhanced follicle recruitment and increased ovarian reserve in the selected contingent of patients.

CONCLUSION: The use of preformed factors opens up new treatment options for women with chronic salpingo-oophoritis and diminished ovarian reserve. This allows for improving the prognosis for reproductive restoration and increasing the chances of successful conception.

BACKGROUND: Endometriosis affects 5–10% of women of reproductive age worldwide. Despite the high prevalence of the disease, its diagnosis is usually delayed for several years and misdiagnosis is common, leading to delay in effective pathogen-based treatment. Early diagnosis and timely treatment of endometriosis are particularly important in patients with type 1 diabetes mellitus, as the longer the disease lasts, the greater the risk of vascular complications and the lower ovarian reserve, thus decreasing the reproductive capacity.

AIM: The aim of this study was to analyze the clinical features of endometriosis in patients with type 1 diabetes mellitus allowing for a timely and accurate diagnosis.

METHODS: This clinical study included women with endometriosis, type 1 diabetes mellitus, and a combination of the two. The control group consisted of healthy women of reproductive age. The diagnosis of endometriosis was confirmed by laparoscopic surgery and verified by histological examination. Serum anti-Müllerian hormone levels were determined using the immunochemiluminescence method from days 2 to 5 of the menstrual cycle. Glycated hemoglobin levels were measured in patients with type 1 diabetes mellitus.

RESULTS: The study included 51 patients with endometriosis, 209 patients with type 1 diabetes mellitus, 79 patients with a combination of these diseases, and 31 conditionally healthy women. In patients with endometriosis combined with type 1 diabetes mellitus, the frequency of abnormal uterine bleeding was 31%, which is higher than in patients with only type 1 diabetes mellitus (11%), but lower than in those with only endometriosis (71%). Dysmenorrhea according to the McGill visual analogue pain scale in patients with endometriosis combined with type 1 diabetes mellitus was 3.9 ± 1.48 points, with endometriosis 7.06 ± 1.27 points, and with type 1 diabetes mellitus 1.2 ± 0.7 points. In patients with endometriosis combined with type 1 diabetes mellitus, there was a decrease in the number of antral follicles (8 ± 3) and anti-Müllerian hormone level (3.12 ± 1.78 ng/ml) compared to patients with type 1 diabetes mellitus (12 ± 4, 3.52 ± 2.0 ng/ml, respectively). The most pronounced decrease in the number of antral follicles (4 ± 2) and anti-Müllerian hormone level (0.94 ± 0.4 ng/ml) was found in patients with endometriosis. The incidence of deep infiltrative endometriosis was higher in patients without diabetes mellitus, occurring in 71% of cases. In patients with endometriosis combined with type 1 diabetes mellitus, it only occurred in 42% of cases. Endometrioid cysts were found in 42% of patients without type 1 diabetes mellitus and in 22% of those with the disease. Repeat surgical interventions were performed in 25% of patients with endometriosis without type 1 diabetes mellitus, compared to only 10% of women with endometriosis combined with type 1 diabetes mellitus.

CONCLUSION: Late diagnosis and delayed treatment of endometriosis, which is often asymptomatic when combined with type 1 diabetes mellitus, can lead to a decrease in ovarian reserve and infertility. In patients with type 1 diabetes mellitus, endometriosis should be suspected in the presence of mild pain, abnormal uterine bleeding, decreased anti-Müllerian hormone levels and antral follicle count, and infertility to ensure timely diagnosis and selection of treatment strategies. Diabetic patients require a long period of pre-pregnancy planning in order to compensate for their disease.

BACKGROUND: Hereditary monogenic diseases are a significant medical and social problem that burdens the healthcare system and affects thousands of families worldwide. Preconception screening is a key element in the primary prevention of these pathologies. Despite its proven clinical significance, public awareness about the benefits of pre-pregnancy training, including preconception screening, remains unsatisfactory. According to the World Health Organization data (2023), only 30–40% of couples planning a pregnancy undergo a comprehensive examination before conception.

AIM: The aim of this study was to assess patients’ knowledge about preconception screening options.

METHODS: This cross-sectional comprehensive study was conducted in the field of sociology of medicine, in which patients from St. Petersburg, Russia participated on a voluntary and anonymous basis. We developed a 24-question survey questionnaire that was administered online using a Google Form.

RESULTS: The study involved 209 respondents of different age groups. The questionnaire was asked to be filled out by both individual female patients at the reception and couples who attended the appointment together. The main factors contributing to the low appeal of women of reproductive age regarding preconception screening are a lack of awareness of the benefits of this type of pre-pregnancy training, the perception of preconception screening as an unnecessarily expensive diagnostic procedure, and organizational barriers, including the lack of specialized programs at the primary healthcare level.

CONCLUSION: To expand preconception screening coverage, it is advisable to raise patient awareness, train specialists in this field, and develop clinical guidelines, examination protocols, and algorithms for managing identified risk factors. The implementation of these measures will reduce the incidence of pregnancy complications, improve newborn health outcomes, and optimize healthcare costs. Further research should be aimed at evaluating the effectiveness of various preconception counseling models, depending on regional characteristics and sociodemographic groups.

BACKGROUND: VOCAL (Virtual Organ Computer-aided AnaLysis) software enables quantitative assessment of vascularization in anatomical structures based on three-dimensional reconstruction combined with power Doppler imaging. Available scientific databases, including PubMed and Google Scholar, lack systematized studies focused on the dynamic analysis of regional cervical vascularization throughout gestation using VOCAL technology.

AIM: The aim of this study was to evaluate cervical vascularization using three-dimensional power Doppler angiography using VOCAL at different gestational stages.

METHODS: This single-center cohort study included women with singleton pregnancies at 7⁺⁰–41⁺⁰ weeks of gestation. The VOCAL analytical subsample included cases with a complete data set. The protocol comprised transvaginal cervicometry, elastography (using E-Cervix parameters such as hardness ratio, elasticity contrast index, internal os strain, external os strain, and cervical length), and three-dimensional power Doppler angiography of the cervix with automatic calculation of the vascularization index, flow index, and vascularization flow index.

RESULTS: We performed 516 ultrasound examinations in 337 pregnant women. The VOCAL analytical subsample included cases with a complete data set (n = 223). Cluster analysis identified three distinct cervical phenotypes: immature, ripening, and mature. The vascular indices (vascularization index, flow index, vascularization flow index) increased progressively from the immature phenotype to the mature phenotype. The association of vascular indices with gestational age was moderately positive (Spearman’s rank correlation coefficient ρ ranged from 0.324 to 0.359; p < 0.001), whereas that with cervical length was weakly negative (ρ ranged from −0.161 to −0.224). In the full-term pregnancy subgroup, the vascularization index showed the highest diagnostic performance for identifying a mature cervix (phenotype 3) with an AUC of 0.729.

CONCLUSION: Three-dimensional power Doppler angiography using VOCAL is a method for assessing cervical vascularization during pregnancy. Increased cervical vascularization is associated with elastographic signs of cervical maturation and increased gestational age, but is weakly related to cervical shortening, which limits the prognostic value of isolated cervicometry. A comprehensive ultrasound assessment using elastography and vascular indices may serve as a useful tool for identifying physiological and premature cervical remodeling.

Preeclampsia is one of the most common complications of the second half of pregnancy, which poses a threat to the life and health of both the mother and the fetus. The problem remains relevant to this day, due to the lack of a clear understanding of the pathogenesis of the disease, because of which there is no unified classification, early diagnostic methods, or effective treatment. According to the World Health Organization, conditions associated with hypertension are among the leaders in the structure of maternal mortality worldwide. According to Rosstat, this pregnancy complication ranks fourth. Preeclampsia not only affects the health of the woman, but also leads to disorders in the fetus such as an increased risk of perinatal mortality, growth retardation, and chronic hypoxia. Children from mothers with hypertensive disorders are susceptible to delayed development of nervous, cardiovascular, and endocrine diseases.

According to the clinical guidelines from the Russian Society of Obstetricians and Gynecologists and the American Society of Obstetricians and Gynecologists, this complication is a hypertensive disorder combined with proteinuria and signs of other failing organs or systems and developing from 20 weeks of pregnancy. Currently, preeclampsia is classified depending on the gestational age at diagnosis or at delivery: early (up to 34 weeks) and late (after 34 weeks). This distinction is based on different pathogenesis, severity of symptoms, and different perinatal outcomes.

To effectively reduce the incidence of preeclampsia and associated complications, it is necessary to base the work algorithm on early detection and risk stratification, taking into account the presence of aspirin resistance in a certain proportion of pregnant women.

Preserving the fertility of patients with multiple primary gynecological malignancies is a pressing issue in reproductive medicine. Organ-preserving treatment, combined with assisted reproductive technology, enables these patients to achieve their reproductive plans.

From August 2022 to May 2025, assisted reproductive technology programs were conducted to preserve fertility in a cancer patient with synchronous malignant neoplasm of the endometrium stage TIA1 and ovary stage T1a without signs of stromal invasion in a borderline endometrial tumor.

The patient underwent successful primary organ-preserving treatment in 2018 and repeat treatment in 2020 for recurrent endometrial cancer. Given the absence of disease progression over two years, the patient entered a program of assisted reproductive technology to preserve fertility. From August 2022 to May 2025, she underwent 14 transvaginal follicle punctures in a natural cycle, followed by vitrification of 13 stage MII oocytes using a levonorgestrel-releasing intrauterine system. In 3 cases, oocytes were retrieved from the right ovary, in 10 cases from the left ovary, and in 1 case, no oocyte was retrieved from the left ovary.

The patient was observed and examined every 3 months, while using a levonorgestrel-releasing intrauterine system. No signs of recurrence of ovarian cancer or endometrial cancer were detected.