ISSN (print): 0300-9092, ISSN (online): 2412-5679 Founders: Federal State Institution "Research Center for Obstetrics, Gynecology and Perinatology" Ministry of Healthcare of Russian Federation; All-Russian public organization "Russian Society of Obstetricians and Gynecologists" Editor-in-Chief: Sukhikh G.T., Doctor of Sc., Full Professor Frequency / Assess: 12 issues per year / Subscription Included in: White List (3rd level), Higher Attestation Commission List, RISC, Scopus
Urinary incontinence during pregnancy: prevalence, pathogenesis, risk factors, treatment and prevention
Urinary incontinence in women is a significant public health issue, as it affects 25–45% of the adult female population. This condition has a negative impact on various aspects of a woman’s life, including social, professional, and sexual well-being. Different types of urinary incontinence are based on various pathogenetic mechanisms, but the correlation between urinary incontinence and obstetric factors is well known. Anatomical and metabolic changes that occur in a pregnant woman increase the risk of urinary incontinence, both during pregnancy and in the postpartum period. Urinary disorders during pregnancy and after childbirth are predictors of urinary incontinence in subsequent periods of a woman’s life. This review presents new scientific data on the prevalence of urinary incontinence among pregnant women and its impact on the quality of life during pregnancy. The article discusses the pathogenetic mechanisms leading to urinary incontinence during pregnancy (increased pressure of the growing uterus and fetus on the pelvic floor muscles, increased mobility of the neck of the bladder and urethra, urethral sphincter insufficiency, increased progesterone levels, decreased levels of relaxin and collagen). The article presents the results of studies aimed at identifying risk factors for urinary incontinence during pregnancy and after childbirth. Clinical studies have been analyzed and their results show that pelvic floor muscle training is essential for the prevention and treatment of urinary incontinence in pregnant women. Conclusion: It is necessary to conduct further research into the mechanisms of development and risk factors for urinary incontinence in pregnant women, as this will contribute to improving and developing both existing and new preventive and treatment strategies for this medical condition.
Autoimmune hepatitis during pregnancy: epidemiology, clinical manifestations, diagnosis, therapy, maternal and perinatal outcomes
Autoimmune hepatitis (AIH) is an evolving liver disease characterized by aminotransferase and IgG level increase in blood serum, presence of autoantibodies and histological features of hepatitis in the absence of known etiology. AIH is associated with an increased risk of preterm birth, hypertensive disorders, and gestational diabetes. This condition is also the cause of an increased cesarean section rate. In addition to adverse maternal outcomes cirrhosis negatively impacts the fetus, reducing live birth rates among patients with AIH. Data on the course of pregnancy with AIH are limited with few studies presented. Clinical guidelines for the management of AIH during pregnancy have not been developed, and there is an insufficient number of studies demonstrating pregnancy outcomes among patients with AIH. Apart from this, the incidence of AIH during pregnancy is increasing due to advanced diagnosis methods, pathogenetically based treatment, and prenatal and postnatal monitoring. This study is aimed at the analysis of current data on the epidemiology, classification, diagnosis, treatment, and delivery methods in patients with AIH during pregnancy. We also present data on maternal and perinatal outcomes in pregnant women. Moreover, here we discuss modern approaches to pregnancy and postpartum care for AIH. Conclusion: Timely diagnosis, adequate treatment and careful management of pregnancy in patients with AIH significantly reduce the risk of complications and improve both maternal and perinatal outcomes. Further study of the course of pregnancy in AIH, maternal and perinatal outcomes, as well as the influence of pregnancy on the course of the disease is paramount, since the data obtained may contribute to the development of preventive, diagnostic and therapeutic strategies.
The role of epigenetic modification in pathogenesis of diminished ovarian reserve
Diminished ovarian reserve (DOR) is characterized by a decrease in the number and quality of oocytes. The pathogenesis of DOR remains unclear, which makes this condition one of the most challenging problems in the field of infertility treatment and assisted reproductive technologies. The development of the oocyte is directly dependent on its “molecular dialog” with granulosa cells; therefore, studies of the epigenetic mechanisms underlying DOR are primarily focused on detailing, clarifying, and identifying epigenetic changes induced by hormones and other extracellular molecules not only in oocytes but also in ovarian granulosa cells. This review provides a detailed analysis of various factors that play a role in the pathogenesis of DOR, including epigenetic modifications such as DNA methylation, N6-methyladenosine (m6A) modifications and changes in the expression levels of long non-coding RNAs and microRNAs in granulosa cells and oocytes in DOR. These epigenetic changes affect the biological functions of cells by controlling the expression of protein-coding genes and thus all intracellular signaling pathways responsible for oocyte development. This review examines the role of epigenetic alterations in DOR, providing new insights into its pathogenesis and clinical diagnosis. In addition, the article discusses the possibility of potential application of targeting epigenetic modifications for the therapeutic correction of DOR. Conclusion: The data presented in the review make it possible to clarify the characteristics of DOR pathogenesis and the impact of epigenetic modifications on the processes of folliculogenesis and oogenesis. The study of epigenetic regulation has been gaining the attention of more and more scientists around the world. This suggests that future research will identify new epigenetic factors related to DOR. Epigenetic modifications may become new diagnostic markers for assessing ovarian function, and their analogues or inhibitors may be used as targeted therapies in the future.
Epigenetic regulation of reproductive potential: from folliculogenesis to implantation
Epigenetic regulation plays an important role in the ovarian function. It determines the ovarian response to hormonal stimulation and the embryo implantation potential in assisted reproduction. Epigenetic modifications such as DNA methylation, (de)methylation and (de)acetylation of histone proteins, and changes in expression levels of non-coding RNAs are identified as key factors regulating ovarian function and reproductive outcomes. Changes in the expression levels of microRNAs in follicular fluid and granulosa cells are related to the process of oocyte development, the level of ovarian reserve and the implantation potential of the embryo. miR-27a-3p and miR-15a-5p have been shown to be associated with impaired granulosa cell function and poor ovarian response to ovarian stimulation, while global DNA hypomethylation is associated with ovarian aging. Epigenetic changes affect ovarian function through pathways that control hormone signaling, follicular development and success of implantation. It is necessary to conduct further research to identify ways of practical application of epigenetic modifications as markers for predicting the effectiveness of ART programs and optimizing patient management and treatment. Conclusion: The results of the review that included recent studies highlight the critical importance of epigenetic factors in predicting the success of assisted reproduction. The studies suggest that epigenetic biomarkers and personalized targeted therapy based on these biomarkers are a promising direction. This approach aims to individualize treatment methods by modifying criteria for embryo culture, ovarian stimulation protocols, and implantation potential parameters.
The spectrum of genetic causes of female infertility: modern molecular mechanisms and clinical significance
Objective: To summarize the current data on the role of genetic factors in female infertility, including disorders of oocyte maturation, fertilization, embryonic developmental arrest, and to consider the possibilities of molecular genetic diagnosis. Materials and methods: The article presents a review of recent Russian and foreign publications on the molecular and chromosomal etiology of female infertility with focus on phenotypes associated with pathogenic gene variants, as well as modern methods of molecular analysis (WES, WGS, GWAS). Results: Female infertility affects 10-15% of reproductive-aged couples, while up to 30% of cases remain idiopathic. Genetic factors play a leading role in the pathogenesis of infertility, especially with repeated ART failures. Chromosomal and monogenic mechanisms have been identified in both syndromic and non-syndromic forms. More than 90 genes associated with premature ovarian insufficiency have been found; TUBB8, PATL2, TRIP13, TBPL2, ZP1-3, WEE2, CDC20, BTG4, PADI6, and other genes determine the phenotypes of disorders of oogenesis, fertilization and early embryogenesis. Key molecular complexes have been identified, including the subcortical maternal complex (SCMC), which is critically important for early embryo development. The use of NGS technologies made it possible to better understand the genetic basis of infertility and to identify new clinical variants. Conclusion: The genetic etiology of female infertility is more complex than previously believed; therefore, it is necessary to integrate molecular genetic methods into the practice of obstetricians, gynecologists and reproductive medicine specialists. Precision diagnosis and genetic counseling can increase the effectiveness of ART programs and help personalize the choice of treatment options.
Oncological aspects of endometrial polyps in peri- and postmenopausal women
Benign endometrial proliferative changes are the primary factor contributing to the risk of cancer, especially in peri- and postmenopausal women, as the incidence of uterine cancer rises. The aim of the review is to focus on the risks of developing uterine cancer among menopausal patients with endometrial polyps (EPs) and on patient management tactics. The paper presents the current data on the incidence of EPs, the frequency of precancerous lesions and endometrial cancer, depending on the course of the disease. The frequency of EPs in women with abnormal uterine bleeding (AUB) averages 38%. EPs are characterized by an asymptomatic course in peri- and postmenopausal women, as well as in women with AUB (33.4–58.9%). In recent years, there has been a trend towards an increase in atypical and malignant EPs, with a higher prevalence in postmenopausal women (4.93%) compared to those in the menopausal transition phase (1.12%). In postmenopausal women, endometrial cancer develops both in the polyp itself and in the surrounding endometrium; in late postmenopausal women, the incidence of endometrial cancer in patients over 65 years of age is 9%. The risk of malignancy exists in both symptomatic and asymptomatic EPs. There is an analysis of risk factors for EP malignancy, which include menopausal status, AUB, diabetes mellitus, hypertension, obesity, tamoxifen intake, as well as multiple growth patterns and a history of nulliparity. The clinical and diagnostic characteristics in the detection of precancerous endometrium and endometrial cancer in patients with EP are considered. Conclusion: EP in peri- and postmenopausal women is one of the main causes of AUB, postmenopausal bleeding, and the risk of malignancy, which is increased in postmenopausal women. Risk factors for EP malignancy have been identified with the maximum significance of menopausal status and AUB. Due to the variety of approaches to managing patients with EP in the world, symptomatic EP needs urgent removal. In case of asymptomatic course of EP in postmenopausal women, there is a persistence of cancer risk, which limits the use of wait-and-see tactics.
Functional hypothalamic amenorrhea: etiology and pathogenesis, the role of genetic factors
Functional hypothalamic amenorrhea is a disease of reproductive-aged women, which is due to impaired activity of the hypothalamic-pituitary-ovarian axis. The main etiological factors leading to the manifestation of functional hypothalamic amenorrhea have been widely described but their elimination does not always result in the restoration of the menstrual cycle rhythmicity. Therefore, it is necessary to search for additional mechanisms that determine the duration of the disease and explain the lack of effectiveness of standard therapeutic strategies. Increasing amounts of data suggest a significant role of genetic factors in the development and course of functional hypothalamic amenorrhea. It is believed that polymorphisms of genes involved in the regulation of energy metabolism, stress response, and hormonal homeostasis can influence the sensitivity of hypothalamic neurons to external stressors and modify individual responses to them. During the preparation of this review, the studies on this subject available in the PubMed and eLibrary databases were analyzed. A search was conducted for articles published between 2014 and 2025 using the following keywords: functional hypothalamic amenorrhea, hypogonadotropic hypogonadism, stress, disordered eating, excessive exercise. Conclusion: A detailed study of the genetic mechanisms underlying functional hypothalamic amenorrhea could help better understand its pathogenesis, confirm the multifactorial nature of the condition and open up opportunities for the development of personalized treatment strategies. This could also aid in predicting the course of the condition and facilitate early identification of high-risk individuals.
Pathogenetic mechanisms and modern approaches to the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women
Relevance: Sexual dysfunction associated with vulvovaginal atrophy (VVA) in postmenopausal women is a significant medical and social problem. Estrogen and androgen deficiency leads to structural and functional changes in the urogenital tissues, represented by dryness, dyspareunia and an increased risk of urinary tract infections. The intracrinologic approach using dehydroepiandrosterone (DHEA)/prasterone provides local tissue repair through intracellular synthesis of estradiol and testosterone without systemic hormonal effects, making it a promising alternative to traditional therapy. Materials and methods: The analysis of domestic and foreign literature was conducted using keywords to study and summarize modern research on methods of treating genitourinary syndrome of menopause (GSM, VVA, dyspareunia) with the assessment of the role of intravaginal DHEA/prasterone. Results: A review of scientific data demonstrates that intravaginal prasterone promotes vaginal epithelial restoration, normalizes pH, improves sexual function, and reduces dyspareunia. We also notice a lack of systemic hormonal effects, including a neutral effect on the endometrium and mammary glands, and its effectiveness in preventing urinary tract infections. Conclusion: Intravaginal DHEA/prasterone represents a physiologically reasonable alternative to traditional estrogens in the treatment of vulvovaginal atrophy. Its intracrine mechanism of action provides a local therapeutic effect without systemic stimulation of hormone-dependent organs. Further research should be aimed at the assessment of long-term effects and improvement of dosing regimens as part of a personalized approach to correcting vulvovaginal atrophy.
Antiphosphatidylserine/prothrombin complex antibodies in patients with healthy pregnancies
Antiphosphatidylserine/prothrombin complex (aPS/PT) antibodies are an additional set of biomarkers that can be used to detect thromboembolic and obstetric complications, in addition to the traditional panel of phospholipid antibodies. Objective: To determine aPS/PT levels in patients with healthy pregnancies. Materials and methods: A study of serum aPS/PT IgG and IgM levels was conducted in 50 pregnant women with normal pregnancies during the first, second, and third trimesters of gestation. Results: The median level of aPS/PT IgG in pregnant women during the first trimester was 3.77 (2.67; 5.72) U/ml; in the second trimester, it was 3.48 (2.93; 5.39) U/ml; and in the third trimester, it was 3.72 (3.02; 4.79) U/ml. The median level of aPS/PT IgM in these patients was 3.6 (2.61; 5.09) U/ml in the first trimester; 4.1 (2.65; 5.4) U/ml in the second trimester; and 5.0 (3.41; 6.38) U/ml in the third trimester. Statistically significant changes were observed only in the third trimester (p=0.018). Conclusion: The scientific community recognizes aPS/PT among non-criterial phospholipid antibodies as a promising diagnostic marker that may enhance the effectiveness of antiphospholipid syndrome diagnosis. Further studies involving patients with complicated pregnancies are needed to determine the significance of aPS/PT and confirm their potential use in the clinical practice of obstetricians and gynecologists.
Relationship between spontaneous abortion history and treatment outcomes in patients with threatened abortion: a prospective cohort study
Objective: Identification of relationship between the history of spontaneous abortion (SA) and miscarriage in patients with singleton pregnancy associated with threatened miscarriage (TM) in singleton pregnancy. Materials and methods: A prospective cohort study was carried out among the patients who were admitted to hospital and underwent treatment due to TM in 2021. The patients were divided into two groups. The exposed group included 97 women with spontaneous abortion history, and the unexposed group comprised 145 women without SA history. Both groups were divided into the subgroups based on the obstetric outcomes – prolongation of pregnancy or SA. The relationship between SA history and miscarriage in cases of threatened abortion, as well as the differences between the clinical and laboratory parameters on the first day of hospitalization due to TM in patients with and without SA history were identified based on the results of comprehensive physical exam. Results: The women with TM and singleton pregnancy, who had SA history, relative risk of adverse pregnancy outcome, particularly termination of pregnancy was 3.3 (95% CI 1.2–9.2), р=0.018, that contributed to the increased number of cases of habitual abortion (HA). The incidence rate of SA in the cohort was 6.6%. All patients with TM (in the exposed and unexposed groups) had latent iron deficiency characterized by the median ferritin level below 30 μg/L. Double increase in the frequency of hypothyroidism detection in patients with previous SA (OR 2.0; 95% CI 0.9–4.3; p=0.073) did not reach statistical significance of the obtained results. Conclusion: Given that in pregnant women with the diagnosis of threatened miscarriage, who previously experienced SA, relative risk of recurrent miscarriage is 3.3-fold higher, that can lead to habitual abortion, it is necessary that the patients with the burdened anamnesis should be carefully monitored. Particularly, it is necessary to develop and closely monitor management strategy for these women during the pregravid preparation, that is highly important for reducing the risk.
Effectiveness of vaginal metroplasty for treating cesarean scar defect: a comparative analysis of techniques
Objective: To evaluate the effectiveness of metroplasty via vaginal access in patients with uterine scar after cesarean section (CS). Materials and methods: This comparative prospective study included 100 patients with a confirmed diagnosis of cesarean scar defect who were planning to become pregnant. The first group of patients (n=50) underwent metroplasty using vaginal access, 10 patients underwent laparotomy (group 2), and the third group (n=40) underwent metroplasty using traditional laparoscopic access. All patients in the study groups were evaluated based on the following criteria: complaints; condition of the uterine scar six months after surgery, as determined by ultrasound data; duration of surgery; amount of blood loss; characteristics of the pain syndrome experienced in the first six hours after surgery; and presence of complications. A comparative analysis of the results of the three surgical treatment methods was conducted. Results: The following characteristics were identified in the study groups: after CS, the main complaints included menstrual cycle disorders, such as prolonged spotting after menstruation, heavy and frequent menstruation with a regular cycle (menorrhagia, polymenorrhea), painful menstruation, and secondary infertility. Following metroplasty in the study groups, clinical manifestations regressed in all patients after six months. The mean minimum thickness of the myometrium in the scar area increased significantly: in group 1, it ranged from 3.8 to 5.35 mm with a mean value of 5.3 (0.8) mm; in group 2, it ranged from 4.5 to 5.2 mm with a mean value of 4.9 (0.3) mm; and in group 3, it ranged from 3.8 to 5.3 mm with a mean value of 4.7 (0.5) mm. The “scar thickness, mm” indicator dynamics were significantly different before and after metroplasty in all the study groups (p<0.0001). The use of the vaginal method of uterine scar correction showed comparable results, with the following features noted: the duration of the operation in group 1 ranged from 20 to 55 min, with a median time of 35 (30; 40) min; in group 2, the duration of the operation ranged from 75 to 120 min, with a median time of 95 (90; 120) min; and in group 3, the duration of the operation ranged from 70 to 135 min, with a median time of 95 (90; 110) min. This is associated with a more technically simplified surgical correction technique that does not require a laparoscopic stand. Group 1 differed significantly from groups 2 and 3 (p1,2=0.0003 and p1,3<0.0001, respectively). The following features were identified when assessing the severity of pain syndrome using VAS: in group 1, the VAS score ranged from 1 to 5 points, with a median of 2 (2; 3); in group 2, it ranged from 6 to 7 points, with a median of 6 (6; 7); and in group 3, it ranged from 4 to 6 points, with a median of 5 (4; 5). Group 1 significantly differed from groups 2 and 3 (p1,2= 0.00002 and p1,3= 0.00030, respectively), whereas groups 2 and 3 did not differ significantly in terms of VAS scores (p2,3= 0.79). Histological examination of the uterine scar in the study material revealed moderate to severe expression of markers of chronic endometritis (CD 138, CD 56, and CD 20), indicating a chronic inflammatory process, concurrent infertility, miscarriage, and failed in vitro fertilization attempts. In several cases, endometrioid lesions were observed in the study material. Conclusion: The study demonstrated that vaginal access metroplasty is highly effective and has certain advantages over traditional laparoscopic techniques. Therefore, it can be considered the preferred surgical treatment option in areas with limited resources and appropriately qualified specialists.
Remodeling of the endometrial cavity in patients experiencing infertility and pregnancy loss
Relevance: Uterine abnormalities occur in 35% of infertile patients and in approximately 63% of cases of pregnancy loss. Early detection of congenital uterine abnormalities and timely surgical correction are crucial. Objective: To evaluate the effectiveness of surgical remodeling of the endometrial cavity in patients with reproductive dysfunction and various types of intrauterine septa. Materials and methods: Between 2024 and 2025, 325 patients with various types of intrauterine septa underwent surgery at the Department of Operative Gynecology at V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia. All patients underwent pelvic examination using three-dimensional ultrasound scanning. The extent of surgical treatment was determined by the anatomical form of the intrauterine septum and the presence of concomitant gynecological pathologies. Reproductive outcomes were studied in 135 patients over two years following the recovery phase. Results: The mean age of the patients was 33.6±3.5 years. Based on the anatomical characteristics of the uterus, we classified the intrauterine septa into three categories: complete intrauterine septum (n=22), incomplete intrauterine septum (n=183), and T-shaped narrowing of the uterine cavity (n=120). Hysteroresectoscopy was performed in 245 cases, whereas laparoscopy was combined with hysteroresectoscopy in 80 cases. Three-dimensional surgical remodeling of the endometrial cavity was performed by making a transverse incision in the subendometrial layer of the myometrium using a monopolar hysteroscopic loop at the fundus of the uterine cavity between the openings of the fallopian tubes. Areas of fibrous myometrium at the fundus were excised to a depth of 4–6 mm and a length of 25–30 mm in the transverse direction. Subsequently, a longitudinal excision of the subendometrial layer of the fibrous myometrium was performed along the lateral walls of the uterus from the openings of the fallopian tubes to the internal os, measuring 30–35 mm in length, 4–5 mm deep, and 6–8 mm wide. Pregnancy occurred in 34.8% of patients: 27 achieved pregnancy in a natural cycle, and 20 through IVF and embryo transfer. Thirty-six (26.7%) patients participated in the oocyte donation and pre-pregnancy preparation programs. Conclusion: Three-dimensional surgical remodeling of the endometrial cavity is recommended for patients with congenital (intrauterine septum) or acquired narrowing (synechiae) of the uterine cavity. It also aims to enhance reproductive outcomes in cases of ineffective embryo transfer attempts during IVF and in older reproductive age groups as part of preimplantation preparation.
A prospective randomized controlled study on the effectiveness of neodymium laser therapy for vulvovaginal atrophy in postmenopausal women
Objective: To evaluate the effectiveness and safety of non-ablative neodymium laser for the treatment of vulvovaginal atrophy (VVA) symptoms in postmenopausal women. Materials and methods: The study included 120 patients aged 50 to 85 years with symptoms of postmenopausal VVA. According to the standard regimen, all patients underwent treatment with topical estriol (n=40), or three sessions of non-ablative neodymium laser therapy with an interval of 4–6 weeks between sessions (n=40), or a combination of laser treatment and topical estriol (n=40) between 2021 and 2023. The effectiveness of the therapy was assessed using the vaginal health index (VHI) and validated questionnaires: the Female Sexual Function Index (FSFI), the Vulvovaginal Symptom Questionnaire (VSQ), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the visual analogue scale (VAS). The observation period accounted for 9 months from the onset of treatment. Results: Statistically significant differences were observed between pre-treatment and follow-up visits, and between groups at follow-up visits. It was shown that in the laser and combination therapy groups, compared with the hormonal treatment group, after 3 and 9 months from the start of therapy, the average score on the PISQ-12 questionnaire significantly increased, and the severity of VVA symptoms on the VAS scale decreased (up to complete elimination). According to the VHI data, a statistically significant difference was noted after 3 and 9 months from the start of therapy in the laser and combination treatment groups compared to the hormonal treatment group. Analysis of the changes in the VSQ questionnaire scores revealed a significantly more pronounced symptoms reduction in the laser and combination therapy groups in comparison with the hormonal treatment. However, no statistically significant differences were found in the effectiveness of laser monotherapy and combination therapy. When assessing the FSFI questionnaire scores 3 and 9 months after the start of therapy, a statistically significant increase in scores was observed in all groups. A statistically significant difference was noted after 3 and 9 months from the start of therapy in the laser and combination treatment groups compared to the hormonal treatment group, while the highest changes in subjectively assessed indicators of the quality of sexual life were detected in the laser treatment group without the use of hormonal therapy. Conclusion: Localized neodymium laser therapy is an effective treatment for VVA symptoms and has a positive effect on the quality of women's sexual life.
Study the modifying effect of obesity on uterine fibroid’s clinical characteristics in syrian women
Objective: To evaluate the modifying effect of obesity on clinical manifestations of uterine fibroids (UF) in Syrian women. Materials and methods: 1,000 Syrian women, ages 22–83, from different cities participated in the study, which ran from June 2023 to August 2024. They were divided based on obesity and disease into two groups: with obesity BMI ≥30 kg/m2 (160 patients and 146 controls), and without obesity BMI <30 kg/m2 (340 patients and 354 controls). The study employed a questionnaire consisting of 65 items that provided information on the clinical features and risk factors for the development of UF. Version 30 of SPSS was used to analyze data. Results: Revealed the features of the clinical characteristics of the non-obese group that were statistically significant in patients compared to controls: an older age, a shorter menstrual cycle length and a lower rate of endometrial ablation, and didn't reveal specific features in the obese group. In both studied groups, obese and non-obese, in patients compared to controls, the age of menopause was earlier, and by the time elapsed since the last birth, the percentage was lower in the categories: ≤5 years and 11–15 years, while within the categories: 6–10 years, 16–19 years, and ≥20 years, it was higher. Conclusion: This study demonstrated the modifying effect of obesity on clinical manifestations of UF in Syrian women. That will provide additional clarification of the impact of obesity on the risk/prevalence of UF, which will be beneficial for both its prevention and diagnosis.
Use of complex of natural antimicrobial peptides and cytokines for the treatment of patients with abnormal cervical screening results “atypical squamous cells of uncertain significance”
Objective: To evaluate the frequency of cervical lesions with atypical squamous cells of uncertain significance (ASCUS) in patients with chronic endometritis (CE) and the effectiveness of treatment using a complex of natural antimicrobial peptides and cytokines. Materials and methods: A prospective open-label randomized controlled trial included 1,126 patients with CE. Group I (n=563) received a natural antimicrobial peptide and cytokine complex (Superlymph) at a dose of 25 U/day per vaginam for 20 days. Group II (n=563) did not receive the peptide-cytokine complex. Both groups underwent antimicrobial therapy. Examination methods included real-time polymerase chain reaction and Pap test. Results: The patients' age ranged from 18 to 45 years: 36.0 (3.1) years in Group I and 35.9 (4.4) years in Group II (p=0.22). ASCUS was detected in 45.5% (256/563) and 42.6% (240/563) of patients (p=0.37), and human papillomavirus (HPV) was identified in 71.6% (403/563) and 71.8% (404/563), respectively (p=1.0). In patients who suffered from ASCUS before treatment, the condition improved in 85.6% (219/256) and 45.8% (110/240) in groups I and II, respectively. The potential for recovery was 2 times higher when using Superlymph (ОР=1,87, 95% ДИ 1,61; 2,16). HPV-negative status after treatment was observed in 85.4% (481/563) of patients in Group I versus 29.7% (167/563) in Group II (OR=0.21, 95% CI 0.17; 0.26, p<0.001). Conclusion: Among patients with CE, the prevalence of ASCUS is 44.1%, and the prevalence of HPV-positive status is observed in 71.7% of women. Combination therapy with Superlymph promotes the resolution of ASCUS in 85.6% of patients (a 2-fold risk reduction compared to antibacterial/antimycotic therapy alone) with a negative HPV test rate in 85.4% of CE patients after treatment.
Experience of using tight uterus bandage in complex therapy of hypotonic bleeding in the postpartum period
Objective: To identify the potential of using the method of tight bandaging of the uterus in the complex treatment for hypotonic bleeding. Materials and methods: This was a comparative study that included 12 patients with hypotonic bleeding who were divided into 2 groups of 6 people each. The patients of the main group had tight uterine bandaging that was used as a part of complex therapy along with traditional methods of hemostasis. The patients of the comparison group underwent treatment with standard methods without bandaging. The volume of blood loss, the need for invasive interventions, and outcomes were compared. Results: The total blood loss was 1200–2500 ml in the main group, and it was 2600–3500 ml in the comparison group. Tight bandaging provided a temporary or permanent cessation of bleeding, and in some cases it prevented embolization of the uterine arteries and repeated surgical interventions. All patients of the main group had their uterus preserved; there were no complications related to the bandaging technique. The method proved to be effective and available in the absence of advanced technologies. Conclusion: Tight bandaging of the uterus as a part of complex treatment for hypotonic bleeding helps to reduce blood loss, decrease the number of invasive procedures and preserve reproductive potential; therefore, this method can be recommended in providing obstetric care in hospitals at various levels.
Characteristics of the pregnancy course and childbirth in women of early reproductive age
Objective: To study the characteristics of the pregnancy course, childbirth, and the condition of newborns in women of early reproductive age who gave birth in Vladivostok Clinical Maternity Hospital No. 3 in 2021 and 2022. Materials and methods: The study presents the analysis of the medical history, pregnancy course, childbirth and perinatal outcomes in 78 women under the age of 18. Methods for calculating averages, standard deviations, frequency distribution, as well as Student’s t-test and Fisher’s exact test were used for statistical processing. Results: The average age of the patients was 16.7 years in 2021 and 16.4 years in 2022 (p>0.05). In 2021, 45% of patients were from single-parent families, and in 2022, this number decreased to 35% (p>0.05). The age of sexual debut was 15.3 years in 2021 and 15.1 years in 2022 (p>0.05). The share of women whose marriage was registered decreased from 36.7% to 31.3%, respectively (p>0.05). There was an increase in the incidence of chronic extragenital diseases, especially grade II anemia and ENT diseases (p>0.05), and the number of cases of grade I anemia and diseases of the urinary system decreased (p>0.05). The age of menarche remained the same. The rate of menstrual disorders increased from 16.6% to 18.7% (p>0.05), and the number of repeat pregnancies increased from 8.3% to 18.7% (p>0.05). In 2021, there were 75% of full-term births, and there were 68.75% in 2022 (p>0.05). In 2021, the share of preterm births was 16.7%, while in 2022 this number increased to 18.75% (p>0.05). Postterm births were noted in 8.3% of cases in 2021, and in 12.5% of cases in 2022. The rate of vaginal delivery was 83.3% in 2021 and 81.25% in 2022 (p>0.05). The rate of premature rupture of membranes increased to 25.3% in 2022 (p>0.05). The average length of newborns was 52.7 cm in 2021 and 51.1 cm in 2022 (p<0.05), the average body weight decreased from 3570.2 g to 3429.4 g (p<0.05). The condition of newborns was satisfactory in 100% of cases based on the Apgar score, no serious complications were observed. Conclusion: The determinants of teenage pregnancy are early sexual debut, low level of education and upbringing in single-parent families. It is necessary to adopt an individual approach to pregnancy management in adolescents at risk of complications.
The use of tibolone for menopausal hormone therapy
Relevance: Currently, women are living longer, which means a need for long-term use of menopausal hormone therapy (MHT). Improving quality of life is one of the main criteria for prescribing MHT. However, the benefits of MHT do not always outweigh the risks in certain medical conditions. Therefore, the use of MHT should be strictly justified and individualized. Objective: To study clinical, laboratory and instrumental parameters in women in early postmenopause under tibolone intake. Materials and methods: 41 postmenopausal women were enrolled in an observational study conducted at Pirogov City Hospital No. 1 during the period of September 2024-September 2025. Participants took the hormone replacement therapy (MHT) tibolone (Leatrisa) for 6 months. The study included an analysis of complaints and monitoring of changes in the key instrumental and laboratory indicators after 2 and 6 months of tibolone intake. Results: The results of the study revealed no growth of the endometrium during the tibolone intake (3.16 mm at the beginning of the study, 2.95 mm after 6 months of taking tibolone). Abnormal uterine bleeding was observed for a short period in 7.3% of patients, which did not require surgical intervention. When analyzing the major indicators (lipid profile, atherogenic index, coagulation profile, D-dimer), no statistically significant changes were detected during the observation period, which indicates the absence of a negative effect of the studied hormonal drug on the lipid profile and hemostasis. In addition, no deterioration in extragenital pathology was demonstrated; for example, in patients with hypertension, there was no increase in blood pressure, which did not require correction of antihypertensive therapy. Conclusion: Our study showed that tibolone has no proliferative activity on the endometrium or mammary glands, does not affect the growth of myomatous nodes in the short term, and has no negative impact on lipid profiles or hemostasis. Women using tibolone reported a significant reduction in the severity of menopausal symptoms.
Wernicke’s encephalopathy as a complication of hyperemesis gravidarum
Background: Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder, best known as a complication of chronic alcoholism, but it can also occur in pregnant women with excessive vomiting due to thiamine deficiency. This condition requires urgent intervention to prevent irreversible neurological damage and fatal outcomes. WE is characterized by the classic triad of symptoms: oculomotor disturbances, cerebellar dysfunction, and altered mental status. Despite the good understanding of WE due to alcoholism, this condition is often undiagnosed in pregnant women since it has nonspecific clinical presentation and it may be similar to other pregnancy complications. The article provides a review of the pathogenesis, diagnosis, and treatment of WE in pregnant women, as well as a clinical observation of a patient with WE in the first trimester. Case report: A pregnant woman in her first trimester presented with complaints of persistent vomiting, confusion, and ataxia. Severe hyperemesis gravidarum, metabolic disorders, and neurological pathology were considered during the differential diagnosis. Laboratory tests revealed thiamine deficiency, and MRI scans confirmed the diagnosis of Wernicke’s encephalopathy. The patient was immediately treated with high doses of intravenous thiamine, which led to her recovery. This observation demonstrates the difficulties in diagnosing WE during pregnancy, especially in differentiating it from other causes of neurological symptoms. Timely recognition and thiamine replacement therapy played a significant role in preventing irreversible consequences. Conclusion: Although rare, Wernicke’s encephalopathy is a life-threatening complication of hyperemesis gravidarum that requires immediate thiamine administration. Clinicians should remain highly alert to this condition in pregnant women who experience prolonged vomiting and neurological symptoms, as delayed diagnosis can lead to irreversible cognitive and motor impairments. The presented case emphasizes the significance of early administration of thiamine for patients at risk, and the need to increase awareness of this condition among obstetricians, gynecologists, and neurologists. It is necessary to carry out further research to develop standardized protocols for the diagnosis and treatment of WE during pregnancy.
New insights into TECAR therapy in gynecological practice
Modern aesthetic gynecology aims to implement gentle and effective techniques that can correct age-related and postpartum changes, improve the quality of life for patients, and raise their comfort level. In this context, TECAR therapy is of particular interest, since it is a physiotherapy technique based on radiofrequency energy that contributes to active tissue regeneration, improves microcirculation, and restores the functional state of the intimate area. The article discusses the mechanisms of TECAR therapy, its indications and contraindications, as well as the results of clinical studies. The physiological effect of this type of therapy is caused by the electromagnetic field with a frequency of approximately 0.5 MHz. The effects of this technique include increased deep and superficial blood flow, vasodilation, increased temperature, removal of excess fluid, and increased cell proliferation. The ability to induce a thermotherapy effect in deep target tissues (deep muscle layers, joints, and tendons) without excessive increase in surface (skin) temperature makes TECAR therapy well tolerated by patients and suitable for the treatment of various diseases in urogynecology. Therefore, the use of TECAR therapy may be an option for treatment, especially in disorders where blood flow dysfunction plays an important role in the onset and persistence of pain and dysfunction (e.g., chronic pelvic pain syndrome, vulvodynia, and myofascial pain syndrome). Conclusion. The results of the analysis demonstrate the high potential of TECAR therapy in gynecology. However, in order to develop protocols for the use of this technique, it is necessary to conduct further research focusing on long-term effects of therapy and the optimal parameters for its effect.
Spontaneous rupture of a splenic artery aneurysm as a cause of a critical obstetric condition in a woman whose pregnancy was complicated by acute coronavirus infection (COVID-19)
Background: Ruptured splenic artery aneurysm in pregnant women is one of the causes of near miss events, maternal death and antenatal fetal death. The diagnosis of ruptured splenic artery aneurysm in pregnancy can be challenging, therefore it is important to analyze each case to prevent adverse outcomes. Case report: The article presents a description and analysis of a clinical case of ruptured splenic artery aneurysm with massive blood loss in a pregnant woman at 36–37 weeks’ gestation. It is the case of dichorionic diamniotic twin pregnancy complicated by moderate COVID-19. The medical team consisting of experts in obstetrics and gynecology, surgery, anesthesiology, intensive care, and transfusion medicine, promptly provided emergency medical assistance, resulting in a successful outcome. Conclusion: It is necessary to remember about the spontaneous rupture of a splenic artery aneurysm as one of the likely causes of intra-abdominal bleeding in women during pregnancy, childbirth and the postpartum period.
Female infertility associated with the FMR1 gene premutation
Background: The FMR1 gene premutation (the number of CGG repeats ranging from 55 to 200) is considered to be an important genetic factor associated with the development of premature ovarian failure (POF), decreased ovarian reserve and impaired reproductive function in women. Despite the extremely low levels of anti-Müllerian hormone (AMH) and the presence of severe symptoms of hypoestrogenism, there is a possibility of spontaneous pregnancy in some cases. This requires an individual approach and timely genetic counseling. Case report: This was an observation of a 27-year-old patient with the FMR1 premutation (34-94 CGG repeats), AMH level of 0.01 ng/ml and severe ovarian hypoplasia revealed by ultrasound scanning of the pelvic organs. After undergoing hormone replacement therapy (HRT) and ovulation stimulation, the patient became pregnant and her pregnancy resulted in timely delivery of a girl. Conclusion: This clinical observation emphasizes the importance of a personalized approach to the management of patients with FMR1 gene mutation. The aim of this approach is not only to control hypoestrogenism, but also to achieve conception using modern opportunities of assisted reproduction and fertility preservation programs.
Bilateral lung lesion caused by benign metastasizing uterine myoma
Background: Benign metastasizing leiomyoma is a rare condition characterized by the development of multiple slow-growing tumors composed of smooth muscle cells that form in atypical locations, primarily in lung tissue. These tumors are usually discovered after a considerable period of time following a myomectomy. This pathology is characterized by a mostly asymptomatic course, which makes it difficult to detect and often leads to accidental detection during examinations for other reasons. Despite the benign histological picture, the tumor can have a clinically aggressive course and can result in serious complications as well as increase in mortality. Case report: The article presents a clinical case of bilateral lung lesion caused by benign metastasizing leiomyoma in a 50-year-old woman after myomectomy performed 11 years before. The disease was characterized by the latent course; the pulmonary metastases were accidentally detected during a routine examination. The therapeutic strategy included consistent surgical resections of the lesions in combination with surgical hormonal deprivation. Conclusion: Due to the lack of approved clinical protocols for managing patients with benign metastasizing leiomyoma, it is very important to have a systematic description of such cases, since it may give an insight into the pathophysiological mechanisms and characteristics of this disease. Each clinical observation has a significant scientific value and makes it possible to obtain the information for developing the optimal treatment approaches and evaluating prognostic criteria.